Geophagy is Associated with Environmental Enteropathy and Stunting in Children in Rural Bangladesh. Am Jnl Trop Med Hyg, April 2015.
Authors: Christine M. George, Lauren Oldja, et al.
There is a growing body of literature indicating an association between stunting and environmental enteropathy (EE), a disorder thought to be caused by repeated exposures to enteric pathogens. To investigate the relationship between exposure to enteric pathogen through geophagy, consumption of soil, EE, and stunting, we conducted a prospective cohort study of 216 children under 5 years of age in Bangladesh. Geophagy was assessed at baseline using direct observation and caregiver reports. Stool was analyzed at baseline for fecal markers of intestinal inflammation: alpha-1-antitrypsin, myeloperoxidase, neopterin (all three combined to form an EE disease activity score), and calprotectin.
Eighteen percent of children had observed geophagy events and 28% had caregiver reported events in the past week. Nearly all households had Escherichia coli (97%) in soil, and 14% had diarrheagenic E. coli. Children with caregiver-reported geophagy had significantly higher EE scores (0.72 point difference, 95% confidence interval [CI]: 0.01, 1.42). Furthermore, at the 9-month follow-up the odds of being stunted (height-for-age z-score < −2) was double for children with caregiver-reported geophagy (odds ratio [OR]: 2.27, 95% CI: 1.14, 4.51). These findings suggest that geophagy may be an important unrecognized risk factor for EE and stunting.
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