Fecal Markers of Environmental Enteric Dysfunction and their Relation to Faltering Growth in a Sample of Egyptian Children

Gut–brain Axis: Impact of Intestinal Inflammation and Micronutrient Deficiency on Psychomotor Development and Cognitive Functions in Egyptian Children with UndernutritionGut–brain Axis: Impact of Intestinal Inflammation and Micronutrient Deficiency on Psychomotor Development and Cognitive Functions in Egyptian Children with Undernutrition

Cognitive impairment, growth faltering and stunting are pervasive in many countries. mostly causes are unknown. Role of intestinal inflammation in such cases should be minded especially in low- and middle-income countries. We assessed serum markers of inflammation, fecal markers of intestinal inflammation and serum micronutrients in cases with aged 1 to 10 years who suffer from moderate or severe malnutrition “weight-for-age z-score and height-for-age z- Score (WAZ or HAZ) less than -2 SD”. Cognitive abilities were assessed using Wechsler intelligence scale for preschool and school children, Bayley scale III. 55.6% of preschool cases were below average or had mild or moderate intelligence retardation while 24.5% of school cases and 5% of children below 2 years were below average regarding cognitive functions. Cases showed statistically significant reduction of vitamin D, zinc and iron as compared to control. Serum markers of inflammation (alpha 1- glycoprotein (a1-AGP), endotoxin core protein (EndoCAB)) and fecal markers of intestinal inflammation (alpha 1 antitrypsin (AAT) and neopterin (NEOP)) were significant higher in cases than controls. School children showed negative correlation between processing functions and( a1-AGP), positive correlation between perceptual reasoning and serum vitamin A. Children below 2 years, showed negative correlations between motor function and (AAT), (a1-AGP), tumor necrosis factor- alpha (TNF-a) and (EndoCAB), positive correlation between language and serum zinc. In conclusion, our study showed impaired neurocognitive and psychomotor functions in malnourished stunted children. Also, vitamins and minerals deficiency and increased markers of intestinal inflammation were observed in cases compared to healthy control.

Assessment of Gut leakage Induced Systemic Inflammation in Children on Chronic Hemodialysis

BACKGROUND: Children with chronic kidney disease (CKD) are at high risk to develop GIT complications such as intestinal wall edema and increased permeability which contributes to chronic systemic inflammation that increases morbidity and mortality burden. AIM: This study aim was to show the relationship between inflammation and increased intestinal permeability in children on hemodialysis (HD). METHODS: The study included 50 children with CKD on regular HD of variable duration; their age range was (5−16) years and 40 controls. They were followed up at Nephrology clinic- Eldemerdash hospital. Complete history taking, physical examination were done. Laboratory measurement in the form of zonulin, tumor necrosis factor-alpha (TNF-alpha), high sensitive C-reactive protein (hs-CRP), and alpha1-antitrypsin (AAT) were quantified in serum by ELISA method. RESULTS: There was a highly significant decrease in anthropometric measures (weight, height and BMI) and their corresponding z score in cases compared to controls with p ≤ 0.001. Furthermore, there was significant increase of levels of zonulin, TNF-alpha, AAT, and hs-CRP in cases compared to controls with p value of 0.009, 0.001, 0.002, and 0.003, respectively. There was significant positive correlation between zonulin and (TNF-alpha, AAT, hs-CRP, and creatinine) with P values (0.003, 0.001, 0.001, and 0.001), respectively. Zonulin is negatively correlated with weight for age Z score (WAZ) and height with p value (0.01 and 0.018), respectively. TNF-alpha and hs-CRP were negatively correlated with WAZ with P-values of 0.02 and 0.01, respectively. CONCLUSION: Children with CKD on chronic hemodialysis had elevated levels of zonulin, TNF-alpha, hs-CRP, and AAT which reflects gut permeability induced systemic inflammatory state.

Serum Biomarkers of Environmental Enteric Dysfunction and Growth Perspective in Egyptian Children

BACKGROUND: Environmental enteric dysfunction (EED) is a chronic subclinical condition, contributed to limited sources and poor countries. EED pathology is concerned with small intestine structure and function, which affect the macronutrients and micronutrients absorption with consequent growth faltering. AIM: This study aimed to evaluate some serum biomarkers involved in EED and determine their association with stunting and faltering growth in children; zonulin, endotoxin core antibody (EndoCAb), high-sensitive C-reactive protein (hsCRP), alpha-1-acid glycoprotein (AGP), and tumor necrosis factor (TNF), serum iron, and Vitamins A and D. PATIENTS AND METHODS: This case–control study enrolled 105 children aged from 1 to 10 years old, having weight-for-age z-scores and height-for-age z-scores (WAZ or HAZ) ranging from −1.5 to −2. They were compared with control group consisted of 100 children having WAZ or HAZ > −1 of matched age and sex. Assessment of serum markers levels of enteric dysfunction (zonulin and EndoCAb), markers of systemic inflammation (Hs CRP and AGP), along with serum micronutrients (vitamin A, vitamin D and iron) in children with malnutrition in comparison to controls. RESULTS: There was a highly significant decrease as regarding the anthropometric measurements; weight, height, BMI, and arm circumference. Moreover, significant increase in serum zonulin, EndoCAb, HsCRP, and AGP and highly significant decrease of serum Vitamin D and iron in cases group as compared to control group. Height Z score showed negative correlation with zonulin, HsCRP, and AGP and positive correlation with Vitamin D. Weight Z score showed negative correlation with zonulin, HsCRP, and AGP and positive correlation with Vitamin D and Vitamin A. Regression analysis noted increase of zonulin and α1AGP as high associative markers with height Z score affection, however, increase of zonulin was high associative markers with weight Z score affection. CONCLUSION: Faltering growth is associated with elevated serum systemic markers of intestinal inflammation (HsCRP and α1AGP). EED may be a cause of faltering growth.

Serum Biomarkers of Environmental Enteric Dysfunction and Growth Perspective in Egyptian Children

BACKGROUND: Environmental enteric dysfunction (EED) is a chronic subclinical condition, contributed to limited sources and poor countries. EED pathology is concerned with small intestine structure and function, which affect the macronutrients and micronutrients absorption with consequent growth faltering. AIM: This study aimed to evaluate some serum biomarkers involved in EED and determine their association with stunting and faltering growth in children; zonulin, endotoxin core antibody (EndoCAb), high-sensitive C-reactive protein (hsCRP), alpha-1-acid glycoprotein (AGP), and tumor necrosis factor (TNF), serum iron, and Vitamins A and D. PATIENTS AND METHODS: This case–control study enrolled 105 children aged from 1 to 10 years old, having weight-for-age z-scores and height-for-age z-scores (WAZ or HAZ) ranging from −1.5 to −2. They were compared with control group consisted of 100 children having WAZ or HAZ > −1 of matched age and sex. Assessment of serum markers levels of enteric dysfunction (zonulin and EndoCAb), markers of systemic inflammation (Hs CRP and AGP), along with serum micronutrients (vitamin A, vitamin D and iron) in children with malnutrition in comparison to controls. RESULTS: There was a highly significant decrease as regarding the anthropometric measurements; weight, height, BMI, and arm circumference. Moreover, significant increase in serum zonulin, EndoCAb, HsCRP, and AGP and highly significant decrease of serum Vitamin D and iron in cases group as compared to control group. Height Z score showed negative correlation with zonulin, HsCRP, and AGP and positive correlation with Vitamin D. Weight Z score showed negative correlation with zonulin, HsCRP, and AGP and positive correlation with Vitamin D and Vitamin A. Regression analysis noted increase of zonulin and α1AGP as high associative markers with height Z score affection, however, increase of zonulin was high associative markers with weight Z score affection. CONCLUSION: Faltering growth is associated with elevated serum systemic markers of intestinal inflammation (HsCRP and α1AGP). EED may be a cause of faltering growth.