In children exposed to poor hygiene and sanitation, invasion of the gut by pathogenic microbes can result in a subclinical enteropathy termed "environmental enteric dysfunction" (EED) that contributes to undernutrition, growth faltering, and impaired organ development. EED may already be present by age 6-12 weeks; therefore, interventions that can be started early in life, and used alongside breastfeeding, are needed to prevent or ameliorate EED. A healthy gut microbiota is critical for intestinal development and repair, nutrient digestion and absorption, and resisting colonization or overgrowth by pathogens. However, its development can be impaired by several environmental factors. Dietary supplementation with pro-, pre-, or synbiotics may be a pragmatic and safe means of building the resilience of the developing gut microbiota against adverse environmental factors, thereby preventing EED.
Bibliographical noteFunding. This paper was conceived by the research teams engaged in the Gut Health workstream of the Action Against Stunting Hub (https://actionagainststunting.org/) funded by the United Kingdom Research and Innovation Global Challenges Research Fund (grant number: MR/S01313X/1) and the PRObiotics and SYNbiotics supplementation in infants in Kenya (PROSYNK) study (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9798) funded by the Children’s Investment Fund Foundation (grant number: R-1806–02780). A.W.W. also receives core funding support from the Scottish Government’s Rural and Environment Science and Analytical Services Division (RESAS; no grant number).
Data Availability StatementThe following Supporting Information is available through the online version of this article at the publisher’s website: Table S1 Interventions that have been trialed previously to prevent or ameliorate environmental enteric dysfunction.
- environmental enteric dysfunction
- gut microbiota
- gut pathogens