Gut Health Digest

BACKGROUND: Environmental enteric dysfunction (EED) and linear growth stunting affect many rural agrarian children in the developing world and contribute to the persistently high rates of stunting that are observed worldwide. Effective interventions to consistently ameliorate EED are lacking. OBJECTIVE: We tested whether a bundle of safe and affordable interventions would decrease EED and stunting over 12-24 wk in a cohort of rural Malawian children 12-35 mo old. METHODS: This was a randomized, double-blind, placebo-controlled clinical trial in which the intervention group received a single dose of albendazole and 14 d of zinc at enrollment and after 20 wk. The intervention group also received a daily multiple micronutrient powder throughout the 24 wk of study. The primary outcomes were improvements in EED, as measured by the urinary lactulose-tomannitol ratio (L:M ratio) from dual-sugar absorption testing, and linear growth. Urinary L:M ratios and anthropometric measurements were evaluated after 12 and 24 wk of intervention and compared with a placebo group that did not receive any of these interventions. RESULTS: A total of 254 children were enrolled at a mean age of 24 mo; 55% were female. Their mean weight-for-age z score was -1.5, and their mean length-for-age z score was -0.9. After 12 and 24 wk of study, increases in the L:M ratio did not differ between the intervention group (0.071 and 0.088 units, respectively) and the placebo group (0.073 and 0.080 units, respectively) (P = 0.87 and 0.19, respectively). Relative changes in length and weight also did not differ significantly between groups at any time point. CONCLUSION: The combined usage of albendazole, zinc, and a daily multiple micronutrient powder did not decrease EED or stunting in this population of agrarian children 12-35 mo old in rural Malawi. Alternative interventions to improve these diseases should be investigated. This trial was registered at clinicaltrials.gov as NCT02253095. WEB: 10.3945/jn.116.237735 IMPACT FACTOR: 3.74 CITED HALF-LIFE: >10.0 UW EDITORIAL COMMENT: This was a follow up study to previous work by the authors that found a modest amelioration of EED in rural Malawi children upon administration of zinc, albendazole, and multiple micronutrient separately. In this follow up study, the authors hypothesized that combining these three interventions would be even more efficacious against EED and stunting in a similar population of children. However as can be seen in Table 3, the authors did not find any statistically significant difference in the L:M ratio or linear growth measures between children in the intervention and control arms. Potential limitations of the study include the short length of follow up (about 24 weeks) and the high baseline intake of zinc, iron, and other nutrients in the study population. These limitations may have affected the ability of the study to detect a positive effect of the combined interventions.