# The impact of environmental enteric dysfunction on the growth and energy expenditure of school-age children: analysis of unique longitudinal data and finger-prick dried blood spot biomarkers

> **NIH NIH R15** · BAYLOR UNIVERSITY · 2022 · $418,933

## Abstract

PROJECT SUMMARY
Environmental enteric dysfunction (EED), an acquired subclinical condition of the small intestine, is now
viewed as a leading cause of childhood linear growth faltering and its associated lifetime disparities in health
and human capital. A complex condition, EED is characterized primarily by poor intestinal absorptive capacity,
increased permeability to microbes, and resulting mucosal and systemic inflammation. Once acquired under
unsanitary conditions and pathogen exposure during infancy, EED typically persists into adulthood, and the
number of cases globally is thought to be hundreds of millions. Despite presumed lifetime effects, the impact of
EED on growth has never been systematically investigated beyond the age of 5 years. Moreover, the impact of
EED on energy expenditure – thought to be central to the etiology of childhood growth faltering – has never
been studied, at any age. These gaps in knowledge relate, in part, to the burden of traditional invasive
sampling methods for assessing EED. The proposed study has three specific aims: First, to optimize
preliminarily validated assays for measuring key EED biomarkers in minimally invasive finger-prick dried blood
spot samples. Second, to determine the impact of EED on longitudinal growth among school-age children.
Third, to define relationships between childhood EED and measured energy expenditure. We are well-
positioned to undertake this work because we can capitalize on a unique existing data and biospecimen set
from 320 school-age children (age 4-12 years) among the Indigenous Shuar people of Amazonian Ecuador.
Predominant energetic models in human nutrition are additive, implying that calories habitually spent on any
single metabolic task (e.g., immune activity) correspondingly increase total energy expenditure (TEE) and
overall daily energy requirements. In the case of EED, this model suggests that chronic inflammation should
increase TEE, resulting in growth faltering due to subsequent energy deficit. Challenging this model, we have
shown that inflammation and other forms of immune activity have no impact on TEE among Shuar children
and, in fact, that children living in rural and urban contexts spend the same total number of calories each day.
These findings suggest that, rather than additive, children’s habitual TEE is relatively stable (i.e., “constrained”)
across diverse environments. Constrained TEE in contexts of EED can explain growth faltering as the result of
energy allocation trade-offs with chronic inflammation, irrespective of energy availability, a prediction that is
supported by data from nutrition supplementation studies showing negligible improvements in growth. Here, we
would advance our work among the Shuar to include key measures of EED. Results are expected to further
challenge the additive model of children’s energy expenditure, improving understanding of the etiology of
growth faltering, energy balance, and lifetime health and human capital disparit...

## Key facts

- **NIH application ID:** 10437220
- **Project number:** 1R15HD106177-01A1
- **Recipient organization:** BAYLOR UNIVERSITY
- **Principal Investigator:** Samuel S Urlacher
- **Activity code:** R15 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $418,933
- **Award type:** 1
- **Project period:** 2022-06-03 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10437220

## Citation

> US National Institutes of Health, RePORTER application 10437220, The impact of environmental enteric dysfunction on the growth and energy expenditure of school-age children: analysis of unique longitudinal data and finger-prick dried blood spot biomarkers (1R15HD106177-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10437220. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*