Markers of Environmental Enteric Dysfunction (EED) are Associated with Neurodevelopment in Tanzanian Children

Background: Children with environmental enteric dysfunction (EED) are at increased risk for impaired growth and neurodevelopment. We conducted a study to evaluate novel biomarkers of gastrointestinal epithelial and barrier function associated with EED as predictors of neurodevelopment. Methods: Blood samples were obtained from 107 Tanzanian infants at 6 weeks and 6 months for assay of serum citrulline (CIT) and antibodies to LPS and flagellin. Neurodevelopmental testing (Bayley Scales of Infant Development-III) was conducted at 15 months of age. Results: The log odds of having a below-median raw expressive language score (< 20) was increased by 1.66 (p=0.03) for every 1 unit increase (1-UI) in LPS IgA at 6 weeks and by 0.19 (p=0.04) per 1-UI in CIT at 12 months; log odds were decreased by 1.54 (p=0.02) per 1-UI in flagellin IgG and by 0.16 (p=0.02) per 1-UI in CIT at 6 months. Conclusion: Higher levels of LPS-IgA at 6 weeks and CIT at 12 months, and lower levels of flagellin-IgG and CIT at 6 months were a...