Environmental enteric dysfunction (EED) is an asymptomatic gut disorder that can lead to children’s slow growth such as stunting affecting more than 160 million children under the age of five globally. In this context, understanding EED causal pathways is crucial for preventing or treating EED, thereby reducing its adverse effects on children’s health.
In her doctoral dissertation, Zhifei Liu used non-invasive biomarkers to assess EED with a longitudinal sample of 790 children in Malawi.
“We collected stools from children and extracted EED biomarkers from those stools. This process is acceptable and safe for children,” Liu says.
In this study, a 12-month nutrition intervention with small-quantity lipid-based nutrient supplements (SQ-LNS) was implemented for children in Malawi. Liu compared EED biomarkers between the intervention and control groups at 18 months and 30 months. One of important results is that this intervention had no impact on EED in children. The findings suggest that this nutrition intervention alone may be insufficient to improve intestinal health.
“It is important to note that the findings pave the way for a better understanding of the complexity of EED, but they are not evidence against the use of SQ-LNS,” Liu says.
Since more than 50% of households in Malawi lack access to improved sanitary facilities, such environmental condition typically puts children at risk for EED which is environmentally caused. Ten environmental exposures were examined in her research. The results show that EED biomarkers were unaffected by those environmental exposures. Therefore, individual exposure is not likely able to be identified here. It is likely that the control group may have been exposed to other environmental contaminants. This may pose a challenge for identifying individual exposures in Malawi.
Regarding EED biomarkers used in this study, the findings suggest that regenerating 1B protein (REG1B) may not be a predictor of children’s stunting in Malawi, differing from findings from Peru and Bangladesh. The findings also highlight variations in the EED biomarker REG1B across different settings.
Overall, Liu’s dissertation enhances the understanding of children’s intestinal health and offers valuable knowledge on the applications of EED biomarkers in Malawi. The findings are important for identifying specifical causal pathways of EED and for designing future studies on EED prevention and treatment.
Public defence on Friday 4 April
The doctoral dissertation of Master of Public Health Zhifei Liu in the field of international health titled Growth Faltering, Nutrient Supplements, and Environmental Exposures Among Children at Risk for Environmental Enteric Dysfunction in Malawi will be publicly examined at the Faculty of Medicine and Health Technology at Tampere University at 13 o’clock on Friday 4 April 2025 in the Yellow Hall of the Arvo building (Arvo Ylpön katu 34, Tampere). The Opponent will be Professor Vinod Diwan from Karolinska Institute. The Custos will be Docent Ulla Ashorn from Tampere University.