Publications

BACKGROUND/OBJECTIVES: Chronic immune activation in Environmental Enteric Dysfunction (EED) could lead to increased fed-state metabolic rate (MR) or total  energy expenditure (TEE) and limit the energy available for optimal linear  growth. In a secondary analysis, MR and TEE were compared in young Indian  children from urban slums, with and without stunting or EED. SUBJECTS/METHODS:  Children (18-24 months, n = 69) were classified into non-stunted (LAZ ≥ -2) and  stunted (LAZ < -2), and no-EED (lactulose rhamnose ratio, LRR < 0.068) and EED  (LRR ≥ 0.068) groups. Associations between MR and TEE (kcal per kg bodyweight  [BW] or fat free mass [FFM]) with stunting and EED were examined using logistic  regression. RESULTS: Median TEE was significantly higher in the stunted compared  to non-stunted group (76.8 versus 92.0 kcal/kg BW/day, p = <0.01). The adjusted  (for sex, FFM, EED) odds ratio (AOR) for stunting with TEE (kcal/day) was 1.01  (95% CI: 1.00, 1.01), but importantly, there was no interaction between EED and  TEE. The median TEE was also significantly higher in the EED compared to the  no-EED group (89.1 vs 76.8 kcal/kg BW/day, p = 0.02), and the AOR (adjusted for  sex and TEE) for stunting with EED was 3.56 (95% CI:1.09, 11.63). MR (per kg BW  or FFM) was not associated with stunting or EED. CONCLUSION: Higher TEE and  presence of EED were independently and positively associated with stunting.  Children with EED also had higher TEE but not MR. Energetically, the higher TEE  in stunted children may not specifically be linked to the presence of EED,  although the latter independently had higher odds of stunting.