The MAL-ED study: A multinational and multidisciplinary approach to understand the relationship between enteric pathogens, malnutrition, gut physiology, physical growth, cognitive development, and immune responses in infants and children up to 2 years of age in resource-poor environments

The MAL-ED Network Investigatorsa

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157 Citations (Scopus)

Abstract

Highly prevalent conditions with multiple and complex underlying etiologies are a challenge to public health. Undernutrition, for example, affects 20% of children in the developing world. The cause and consequence of poor nutrition are multifaceted. Undernutrition has been associated with half of all deaths worldwide in children aged <5 years; in addition, its pernicious long-term effects in early childhood have been associated with cognitive and physical growth deficits across multiple generations and have been thought to suppress immunity to further infections and to reduce the efficacy of childhood vaccines. The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health (MAL-ED) Study, led by the Fogarty International Center of the National Institutes of Health and the Foundation for the National Institutes of Health, has been established at sites in 8 countries with historically high incidence of diarrheal disease and undernutrition. Central to the study is the hypothesis that enteropathogen infection contributes to undernutrition by causing intestinal inflammation and/or by altering intestinal barrier and absorptive function. It is further postulated that this leads to growth faltering and deficits in cognitive development. The effects of repeated enteric infection and undernutrition on the immune response to childhood vaccines is also being examined in the study. MAL-ED uses a prospective longitudinal design that offers a unique opportunity to directly address a complex system of exposures and health outcomes in the community-rather than the relatively rarer circumstances that lead to hospitalization-during the critical period of development of the first 2 years of life. Among the factors being evaluated are enteric infections (with or without diarrhea) and other illness indicators, micronutrient levels, diet, socioeconomic status, gut function, and the environment. MAL-ED aims to describe these factors, their interrelationships, and their overall impact on health outcomes in unprecedented detail, and to make individual, site-specific, and generalized recommendations regarding the nature and timing of possible interventions aimed at improving child health and development in these resource-poor settings.

Original languageEnglish (US)
Pages (from-to)S193-S206
JournalClinical Infectious Diseases
Volume59
DOIs
StatePublished - Nov 1 2014

Fingerprint

Growth and Development
Malnutrition
Infection
National Institutes of Health (U.S.)
Vaccines
Micronutrients
Health
Growth
Child Development
Social Class
Diarrhea
Immunity
Hospitalization
Public Health
Diet
Inflammation
Incidence

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{9a9c6446b3294e28b289692ad486fbe8,
title = "The MAL-ED study: A multinational and multidisciplinary approach to understand the relationship between enteric pathogens, malnutrition, gut physiology, physical growth, cognitive development, and immune responses in infants and children up to 2 years of age in resource-poor environments",
abstract = "Highly prevalent conditions with multiple and complex underlying etiologies are a challenge to public health. Undernutrition, for example, affects 20{\%} of children in the developing world. The cause and consequence of poor nutrition are multifaceted. Undernutrition has been associated with half of all deaths worldwide in children aged <5 years; in addition, its pernicious long-term effects in early childhood have been associated with cognitive and physical growth deficits across multiple generations and have been thought to suppress immunity to further infections and to reduce the efficacy of childhood vaccines. The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health (MAL-ED) Study, led by the Fogarty International Center of the National Institutes of Health and the Foundation for the National Institutes of Health, has been established at sites in 8 countries with historically high incidence of diarrheal disease and undernutrition. Central to the study is the hypothesis that enteropathogen infection contributes to undernutrition by causing intestinal inflammation and/or by altering intestinal barrier and absorptive function. It is further postulated that this leads to growth faltering and deficits in cognitive development. The effects of repeated enteric infection and undernutrition on the immune response to childhood vaccines is also being examined in the study. MAL-ED uses a prospective longitudinal design that offers a unique opportunity to directly address a complex system of exposures and health outcomes in the community-rather than the relatively rarer circumstances that lead to hospitalization-during the critical period of development of the first 2 years of life. Among the factors being evaluated are enteric infections (with or without diarrhea) and other illness indicators, micronutrient levels, diet, socioeconomic status, gut function, and the environment. MAL-ED aims to describe these factors, their interrelationships, and their overall impact on health outcomes in unprecedented detail, and to make individual, site-specific, and generalized recommendations regarding the nature and timing of possible interventions aimed at improving child health and development in these resource-poor settings.",
author = "{The MAL-ED Network Investigatorsa} and Mark Miller and Acosta, {Angel Mendez} and Chavez, {Cesar Banda} and Flores, {Julian Torres} and Olotegui, {Maribel Paredes} and Pinedo, {Silvia Rengifo} and Trigoso, {Dixner Rengifo} and Vasquez, {Angel Orbe} and Imran Ahmed and Didar Alam and Asad Ali and Bhutta, {Zulfiqar A.} and Shahida Qureshi and Sadia Shakoor’ and Sajid Soofi and Ali Turab and Yousafzai, {Aisha K.} and Zaidi, {Anita K.M.} and Ladaporn Bodhidatta and Mason, {Carl J.} and Sudhir Babji and Anuradha Bose and Sushil John and Gagandeep Kang and Beena Kurien and Jayaprakash Muliyil and Raghava, {Mohan Venkata} and Anup Ramachandran and Anuradha Rose and William Pan and Ramya Ambikapathi and Danny Carreon and Vivek Charu and Leyfou Dabo and Viyada Doan and Jhanelle Graham and Christel Hoest and Stacey Knobler and Dennis Lang and Benjamin McCormick and Monica McGrath and Mark Miller and Archana Mohale and Gaurvika Nayyar and Stephanie Psaki and Zeba Rasmussen and Stephanie Richard and Jessica Seidman and Vivian Wang and Rebecca Blank",
year = "2014",
month = "11",
day = "1",
doi = "10.1093/cid/ciu653",
language = "English (US)",
volume = "59",
pages = "S193--S206",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",

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TY - JOUR

T1 - The MAL-ED study

T2 - A multinational and multidisciplinary approach to understand the relationship between enteric pathogens, malnutrition, gut physiology, physical growth, cognitive development, and immune responses in infants and children up to 2 years of age in resource-poor environments

AU - The MAL-ED Network Investigatorsa

AU - Miller, Mark

AU - Acosta, Angel Mendez

AU - Chavez, Cesar Banda

AU - Flores, Julian Torres

AU - Olotegui, Maribel Paredes

AU - Pinedo, Silvia Rengifo

AU - Trigoso, Dixner Rengifo

AU - Vasquez, Angel Orbe

AU - Ahmed, Imran

AU - Alam, Didar

AU - Ali, Asad

AU - Bhutta, Zulfiqar A.

AU - Qureshi, Shahida

AU - Shakoor’, Sadia

AU - Soofi, Sajid

AU - Turab, Ali

AU - Yousafzai, Aisha K.

AU - Zaidi, Anita K.M.

AU - Bodhidatta, Ladaporn

AU - Mason, Carl J.

AU - Babji, Sudhir

AU - Bose, Anuradha

AU - John, Sushil

AU - Kang, Gagandeep

AU - Kurien, Beena

AU - Muliyil, Jayaprakash

AU - Raghava, Mohan Venkata

AU - Ramachandran, Anup

AU - Rose, Anuradha

AU - Pan, William

AU - Ambikapathi, Ramya

AU - Carreon, Danny

AU - Charu, Vivek

AU - Dabo, Leyfou

AU - Doan, Viyada

AU - Graham, Jhanelle

AU - Hoest, Christel

AU - Knobler, Stacey

AU - Lang, Dennis

AU - McCormick, Benjamin

AU - McGrath, Monica

AU - Miller, Mark

AU - Mohale, Archana

AU - Nayyar, Gaurvika

AU - Psaki, Stephanie

AU - Rasmussen, Zeba

AU - Richard, Stephanie

AU - Seidman, Jessica

AU - Wang, Vivian

AU - Blank, Rebecca

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Highly prevalent conditions with multiple and complex underlying etiologies are a challenge to public health. Undernutrition, for example, affects 20% of children in the developing world. The cause and consequence of poor nutrition are multifaceted. Undernutrition has been associated with half of all deaths worldwide in children aged <5 years; in addition, its pernicious long-term effects in early childhood have been associated with cognitive and physical growth deficits across multiple generations and have been thought to suppress immunity to further infections and to reduce the efficacy of childhood vaccines. The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health (MAL-ED) Study, led by the Fogarty International Center of the National Institutes of Health and the Foundation for the National Institutes of Health, has been established at sites in 8 countries with historically high incidence of diarrheal disease and undernutrition. Central to the study is the hypothesis that enteropathogen infection contributes to undernutrition by causing intestinal inflammation and/or by altering intestinal barrier and absorptive function. It is further postulated that this leads to growth faltering and deficits in cognitive development. The effects of repeated enteric infection and undernutrition on the immune response to childhood vaccines is also being examined in the study. MAL-ED uses a prospective longitudinal design that offers a unique opportunity to directly address a complex system of exposures and health outcomes in the community-rather than the relatively rarer circumstances that lead to hospitalization-during the critical period of development of the first 2 years of life. Among the factors being evaluated are enteric infections (with or without diarrhea) and other illness indicators, micronutrient levels, diet, socioeconomic status, gut function, and the environment. MAL-ED aims to describe these factors, their interrelationships, and their overall impact on health outcomes in unprecedented detail, and to make individual, site-specific, and generalized recommendations regarding the nature and timing of possible interventions aimed at improving child health and development in these resource-poor settings.

AB - Highly prevalent conditions with multiple and complex underlying etiologies are a challenge to public health. Undernutrition, for example, affects 20% of children in the developing world. The cause and consequence of poor nutrition are multifaceted. Undernutrition has been associated with half of all deaths worldwide in children aged <5 years; in addition, its pernicious long-term effects in early childhood have been associated with cognitive and physical growth deficits across multiple generations and have been thought to suppress immunity to further infections and to reduce the efficacy of childhood vaccines. The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health (MAL-ED) Study, led by the Fogarty International Center of the National Institutes of Health and the Foundation for the National Institutes of Health, has been established at sites in 8 countries with historically high incidence of diarrheal disease and undernutrition. Central to the study is the hypothesis that enteropathogen infection contributes to undernutrition by causing intestinal inflammation and/or by altering intestinal barrier and absorptive function. It is further postulated that this leads to growth faltering and deficits in cognitive development. The effects of repeated enteric infection and undernutrition on the immune response to childhood vaccines is also being examined in the study. MAL-ED uses a prospective longitudinal design that offers a unique opportunity to directly address a complex system of exposures and health outcomes in the community-rather than the relatively rarer circumstances that lead to hospitalization-during the critical period of development of the first 2 years of life. Among the factors being evaluated are enteric infections (with or without diarrhea) and other illness indicators, micronutrient levels, diet, socioeconomic status, gut function, and the environment. MAL-ED aims to describe these factors, their interrelationships, and their overall impact on health outcomes in unprecedented detail, and to make individual, site-specific, and generalized recommendations regarding the nature and timing of possible interventions aimed at improving child health and development in these resource-poor settings.

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DO - 10.1093/cid/ciu653

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