Background
Malnourished children have increased risk of dying, with most deaths caused by infectious diseases. One mechanism behind this may be impaired immune function. However, this immune deficiency of malnutrition has not previously been systematically reviewed.

/pdf/the-immune-system-in-children-with-malnutrition-a-systematic-36n3si2c7h.pdf

The immune system in children with malnutrition--a systematic review.

Environmental enteropathy: critical implications of a poorly understood condition

The ability to assimilate lactose, a primary constituent of milk, is dependent upon the presence of lactase, a genetically controlled enzyme in the small intestine. In most mammals, levels of lactase are high during infancy, but fall rapidly following weaning; adults are lactase-deficient. In man, some populations, including Orientals, Australian Aborigines, and Negroes, are deficient as adults, while others, including Nilotic Negroes and Europeans, maintain consistently high levels of lactase throughout life regardless of individual lactose intake. Ingestion of even small amounts of lactose by lactase-deficient individuals usually gives rise to a variety of symptoms, including cramps, bloating, and diarrhea. It is hypothesized that prior to the domestication of animals and the development of dairying, the normal condition for all men was adult lactase deficiency, but that with the introduction of lactose into the adult diet in certain cultures, new selective pressures were created that favored the genoty...

Lactase Deficiency: An Example of Dietary Evolution

https://www.gastrojournal.org/article/0016-5085(78)90458-4/pdf

Familial enteropathy: A syndrome of protracted diarrhea from birth, failure to thrive, and hypoplastic villus atrophy

In 2011, one in every four (26%) children under 5 years of age worldwide was stunted. The realization that most stunting cannot be explained by poor diet or by diarrhoea, nor completely reversed by optimized diet and reduced diarrhoea has led to the hypothesis that a primary underlying cause of stunting is subclinical gut disease. Essentially, ingested microbes set in motion two overlapping and interacting pathways that result in linear growth impairment. Firstly, partial villous atrophy results in a reduced absorptive surface area and loss of digestive enzymes. This in turn results in maldigestion and malabsorption of much needed nutrients. Secondly, microbes and their products make the gut leaky, allowing luminal contents to translocate into systemic circulation. This creates a condition of chronic immune activation, which (i) diverts nutrient resources towards the metabolically expensive business of infection fighting rather than growth; (ii) suppresses the growth hormone-IGF axis and inhibits bone growth, leading to growth impairment; and (iii) causes further damage to the intestinal mucosa thereby exacerbating the problem. As such, the unhygienic environments in which infants and young children live and grow must contribute to, if not be the overriding cause of, this environmental enteric dysfunction. We suggest that a package of baby-WASH interventions (sanitation and water improvement, handwashing with soap, ensuring a clean play and infant feeding environment and food hygiene) that interrupt specific pathways through which feco-oral transmission occurs in the first two years of a child's life may be central to global stunting reduction efforts.

/pdf/preventing-environmental-enteric-dysfunction-through-325o629m1q.pdf

Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction in developing countries.

J.P. Stanfield

Papers

Intestinal biopsy in kwashiorkor.

Crisis in Uganda

Bitter Canaan