The Efficacy of Amino Acid Supplementation in Treating Environmental Enteric Dysfunction Among Children at Risk of Malnutrition

Environmental Enteric Dysfunction (EED) is caused by subclinical infection due to enteric pathogens that thrive in conditions of poor sanitation and hygiene. It is characterized by villous atrophy, crypt hyperplasia, increased intestinal permeability, inflammatory cell infiltrate, and possibly nutrient malabsorption. The increased gut permeability, often measured by oral lactulose and mannitol test, is related to gut barrier dysfunction, with translocation of pathogenic organisms and endotoxins. EED is known to be an important component of the causal origin of undernutrition and stunting in infants in low-and-middle-income countries (LMICs) as it reduces the efficacy of nutritional interventions with food supplements to restore normal growth and allow catch-up growth. In order to improve these conditions that contribute to poor child growth it is required to minimise EED and improve nutrition by combining improvements in water quality, sanitation and nutritional intervention. Protein supply is a major contributor to support normal growth and catch-up growth, but very few data are available on the impact of EED on protein and amino acid requirement, protein digestion and amino acid absorption and metabolic availability to support growth. Targeted nutrient therapies (such as supplementation with specific amino acids) may be one such approach. The objective of this CRP is to use a combination of nuclear techniques to assess the response of EED to a short course of targeted amino acid supplementation. Specifically, the CRP will aim to 1) develop a combined minimally invasive protocol for the application of the dual stable isotope tracer method for protein digestion (DSIT) and the 13-C Sucrose Breath Test (13-C SBT) to assess nutrient absorption in the context of EED; 2) test the applicability of combined DSIT and 13-C SBT to understand the interaction between EED and protein metabolism and; 3) asses the efficacy of amino acid supplementation on the treatment of EED in children. The CRP will provide the evidence base to enable Member States to formulate policies to improve optimal child growth and development. Further, the CRP results would contribute to the revision of the global clinical management and feeding regimens for stunted children complicated with or without EED, for the promotion of linear growth and the reduction in morbidity and mortality of vulnerable children in LMICs.
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