Environmental enteric dysfunction and growth

J Pediatr (Rio J). 2019 Mar-Apr:95 Suppl 1:85-94. doi: 10.1016/j.jped.2018.11.004. Epub 2019 Jan 7.


Objective: To describe the current indicators of environmental enteric dysfunction and its association with linear growth deficit and the height-for-age anthropometric indicator.

Data sources: Narrative review with articles identified in PubMed and Scopus databases using combinations of the following words: environmental, enteric, dysfunction, enteropathy, and growth, as well as the authors' personal records.

Data synthesis: In the last 15 years, new non-invasive markers have been investigated to characterize environmental enteric dysfunction; however, the best tests to be used have not yet been identified. There is evidence that, in environmental enteric dysfunction, a systemic inflammatory process may also occur as a consequence of increased intestinal permeability, in addition to intestinal mucosa abnormalities. Bacterial overgrowth in the small intestine and changes in fecal microbiota profile have also been identified. There is evidence indicating that environmental enteric dysfunction can impair not only full growth but also the neuropsychomotor development and response to orally administered vaccines. It is important to emphasize that the environmental enteric dysfunction is not a justification for not carrying out vaccination, which must follow the regular schedule. Another aspect to emphasize is the greater risk for those children who had height impairment in early childhood, possibly associated with environmental enteric dysfunction, to present overweight and obesity in adulthood when exposed to a high calorie diet, which has been called "triple burden."

Conclusions: According to the analyzed evidence, the control of environmental enteric dysfunction is very important for the full expression of growth, development, and vaccine response in the pediatric age group.

Keywords: Ambiental; Desnutrição, crescimento; Disfunção; Dysfunction; Enteric; Enteropathy; Enteropatia; Entérica; Environmental; Malnutrition, growth.

Publication types

  • Review

MeSH terms

  • Biomarkers
  • Child
  • Feces / chemistry
  • Growth Disorders / etiology
  • Growth Disorders / physiopathology*
  • Humans
  • Intestinal Diseases / complications
  • Intestinal Diseases / physiopathology*
  • Intestinal Mucosa / metabolism*
  • Intestinal Mucosa / physiopathology
  • Malnutrition / physiopathology*


  • Biomarkers