Summary

The purpose of this grant proposal is to delineate improved non-invasive or minimally invasive biomarkers to characterize the disease activity of environmental enteropathy in a birth cohort of closely followed children living in an area with high diarrheal illness rates and stunting in rural Peru. A balanced approach to measuring the physiologic alterations of malabsorption, altered intestinal mucosal permeability, intestinal inflammation, systemic immune activation, and metabolic changes related to bone growth are proposed. These determinations are to be associated with environmental enteropathy utilizing data and specimens that include extensive personal illness histories, nutritional indicators, and growth trajectories in a group of 200 children.