Lack of Associations between Environmental Exposures and Environmental Enteric Dysfunction among 18-Month-Old Children in Rural Malawi

Zhifei Liu, Yue Mei Fan, Per Ashorn, Chilungamo Chingwanda, Kenneth Maleta, Lotta Hallamaa, Heikki Hyöty, David Chaima, Ulla Ashorn

Research output: Contribution to journalArticleScientificpeer-review

1 Citation (Scopus)
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Environmental enteric dysfunction (EED) is common and contributes to linear growth faltering (stunting) and mortality among children in low-resource settings. A few studies on the environmental causes of EED have been conducted but the exact exposures that cause or predispose children to EED are context-specific and not clear. This study aimed to assess associations between selected environmental exposures and EED markers among 620 18-month-old children. This was a secondary analysis of data from Malawian children who participated in a randomized controlled trial (iLiNS-DYAD, registered at as NCT01239693) from birth to 18 months of age. Data on environmental exposures, including drinking water source, sanitation, exposure to animals, housing materials, season, residential area, and food insecurity were collected at enrolment. Biomarkers of EED included concentrations of calprotectin, regenerating 1B protein (REG1B), and alpha-1-antitrypsin from stool samples to assess intestinal inflammation, repair, and permeability, respectively. We performed bivariate and multivariable analyses to assess associations between environmental exposures and EED biomarkers. Adjusting for possible confounders, we did not find associations between the selected environmental exposures and the three biomarkers. These results do not provide support for our hypothesis that the studied adverse environmental exposures are associated with increased concentrations of children’s EED markers in rural Malawi.

Original languageEnglish
Article number10891
JournalInternational Journal of Environmental Research and Public Health
Issue number17
Publication statusPublished - 1 Sept 2022
Publication typeA1 Journal article-refereed


  • alpha-1-antitrypsin
  • calprotectin
  • environmental exposure
  • Malawi
  • REG1B

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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