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Nutrition during the early life cycle

Free living total energy expenditure in young South Indian children at risk of environmental enteric dysfunction and its relation to faltered linear growth

European Journal of Clinical Nutrition (2023)Cite this article

Subjects

Abstract

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.

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Fig. 1: The association of length-for-age z-score and total energy expenditure (as kcal/kg BW/day) by EED categories.

Data availability

Data analyzed for this study are available from the corresponding author on reasonable request.

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Acknowledgements

We acknowledge Jean Wei-Chen Hsu for her contribution to the lactulose and rhamnose analyses. This research was supported by a grant (award number: OPP1133329) from the Bill and Melinda Gates Foundation to FJ and AVK. The funders were not part of the design, implementation, analysis and interpretation of the data.

Author information

Authors and Affiliations

  1. Division of Nutrition, St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore, India

    Nirupama Shivakumar & Sarita Devi

  2. Department of Biostatistics, St. John’s Medical College, St. John’s National Academy of Health Sciences, Bangalore, India

    Tinku Thomas

  3. USDA/Agricultural Research Service, Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA

    Farook Jahoor

  4. Department of Physiology, St. John’s Medical College, St. John’s National Academy of Health Sciences, Bangalore, India

    Anura V. Kurpad

Authors
  1. Nirupama Shivakumar
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Contributions

The authors’ responsibilities were as follows: NS and TT performed the secondary analyses. All the authors critically read and approved the final manuscript. AVK had primary responsibility for final content. The authors declare no competing financial interests.

Corresponding author

Correspondence to Anura V. Kurpad.

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Competing interests

The authors declare no competing interests.

Ethics approval

The study protocol was approved by the Institutional Ethical Review Board of St. John’s Medical College and Hospital and by the Institutional Review Board for Human Subject Research of Baylor College of Medicine & Affiliated Hospitals. A written informed consent was obtained from the primary caregivers of the participating children. The study was registered at the Clinical Trials Registry of India (http://ctri.nic.in/Clinicaltrials/login.php); registration number: CTRI/2017/02/007921.

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Shivakumar, N., Thomas, T., Devi, S. et al. Free living total energy expenditure in young South Indian children at risk of environmental enteric dysfunction and its relation to faltered linear growth. Eur J Clin Nutr (2023). https://doi.org/10.1038/s41430-023-01268-w

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