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.
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.
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.
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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Data analyzed for this study are available from the corresponding author on reasonable request.
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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.
The authors declare no competing interests.
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