Environmental Enteric Dysfunction and the Fecal Microbiota in Malawian Children

M. Isabel Ordiz Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.

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Kevin Stephenson Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.

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Sophia Agapova Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.

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Kristine M. Wylie Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
The McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri.

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Ken Maleta Department of Community Health, College of Medicine, University of Malawi, Malawi, Africa.

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John Martin The McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri.

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Indi Trehan Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
College of Medicine, University of Malawi, Malawi, Africa.

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Phillip I. Tarr Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.

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Mark J. Manary Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
School of Public Health and Family Medicine, University of Malawi, Blantyre, Malawi.
United States Department of Agriculture/Agricultural Research Service Childrens Nutrition Research Center, Houston, Texas.

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Environmental enteric dysfunction (EED) is often measured with a dual sugar absorption test and implicated as a causative factor in childhood stunting. Disturbances in the gut microbiota are hypothesized to be a mechanism by which EED is exacerbated, although this supposition lacks support. We performed 16S ribosomal RNA gene sequencing of fecal samples from 81 rural Malawian children with varying degrees of EED to determine which bacterial taxa were associated with EED. At the phyla level, Proteobacteria abundance is reduced with severe EED. Among bacterial genera, Megasphaera, Mitsuokella, and Sutterella were higher in EED and Succinivibrio, Klebsiella, and Clostridium_XI were lower in EED. Bacterial diversity did not vary with the extent of EED. Though EED is a condition that is typically believed to affect the proximal small bowel, and our focus was on stool, our data do suggest that there are intraluminal microbial differences that reflect, or plausibly lead to, EED.

Author Notes

* Address correspondence to Mark J. Manary, St. Louis Children's Hospital, One Children's Place, 660S Euclid Avenue, Campus Box 8116, St. Louis, MO 63110. E-mail: manary@kids.wustl.edu

Financial support: This study was supported by the Feed the Future Program, USAID, and the Children's Discovery Institute of Washington University and St. Louis Children's Hospital.

Conflict of interest: Phillip I. Tarr is on the Scientific Advisory Board of MediBeacon, and is the coinventor of a novel technology to measure gut permeability.

Authors' addresses: M. Isabel Ordiz, Kevin Stephenson, Sophia Agapova, Kristine M. Wylie, Indi Trehan, Phillip I. Tarr, and Mark J. Manary, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, E-mails: ordiz_i@wustl.edu, kbstephe@gmail.com, shtepaz@gmail.com, kwylie@wustl.edu, itrehan@wustl.edu, tarr@wustl.edu, and manary@wustl.edu. John Martin, The McDonnell Genome Institute, St. Louis, MO, E-mail: jmartin@wustl.edu. Ken Maleta, Department of Community Health, College of Medicine, University of Malawi, Malawi, Africa, E-mail: ken.maleta@gmail.com.

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