Assessment of environmental enteropathy in the MAL-ED cohort study: Theoretical and analytic framework

Margaret Kosek, Richard L. Guerrant, Gagandeep Kang, Zulfiqar Bhutta, Pablo Penãtaro Yori, Jean Gratz, Michael Gottlieb, Dennis Lang, Gwenyth Lee, Rashidul Haque, Carl J. Mason, Tahmeed Ahmed, Aldo Lima, William A. Petri, Eric Houpt, Maribel Paredes Olortegui, Jessica C. Seidman, Estomih Mduma, Amidou Samie, Sudhir Babji

Research output: Contribution to journalArticlepeer-review

119 Citations (Scopus)


Individuals in the developing world live in conditions of intense exposure to enteric pathogens due to suboptimal water and sanitation. These environmental conditions lead to alterations in intestinal structure, function, and local and systemic immune activation that are collectively referred to as environmental enteropathy (EE). This condition, although poorly defined, is likely to be exacerbated by undernutrition as well as being responsible for permanent growth deficits acquired in early childhood, vaccine failure, and loss of human potential. This article addresses the underlying theoretical and analytical frameworks informing the methodology proposed by the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study to define and quantify the burden of disease caused by EE within a multisite cohort. Additionally, we will discuss efforts to improve, standardize, and harmonize laboratory practices within the MAL-ED Network. These efforts will address current limitations in the understanding of EE and its burden on children in the developing world.

Original languageEnglish
Pages (from-to)S239-S247
JournalClinical Infectious Diseases
Publication statusPublished - 1 Nov 2014


  • environmental enteropathy
  • infant growth failure
  • intestinal infections
  • lactulose mannitol test
  • tropical enteropathy


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