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International Health

The Mal-ED Network
New Global Project on Nutrition, Infection, and Child Development

Professor Laura Caulfield will lead the Hopkins arm of a new and innovative, large-scale project funded by the Foundation for the National Institutes of Health to investigate the connections between infection, malnutrition and child development. The project will operate through a global network—the Malnutrition and Enteric Diseases Network (Mal-Ed). Its mandate will allow researchers to delve further into the connections between specific infections and malnutrition and their effects. Department Chair Robert Black, Assistant Professor Laura Murray-Kolb, and Assistant Scientist Margaret Kosek will also participate in the network.

Several aspects of this project stand out in light of the 40th anniversary of the groundbreaking WHO monograph, Interactions of Nutrition and Infection. That publication first conceptualized of the vicious cycle of malnutrition and infection that was little understood or accepted at the time. While many studies over the last four decades have documented this relationship, few have examined the link between specific micro-organisms and malnutrition. Furthermore, few attempts have been made to quantify the global burden and long-term effects of chronic enteric infections. This project addresses these research gaps and will continue to advance the state-of-the-art in human nutrition.

First, it will develop systems to assess the overall burden of morbidity and mortality due to chronic and recurrent enteric infections and malnutrition. And second, it will be the first of its kind to prospectively measure the impact of repeated enteric infections on gut function and child development, while controlling for other influences, including maternal IQ, the fostering home environment, nutrition (iron, zinc, iodine) and the environment (lead).

Specifically, Mal-ED will try to clarify:

  1.  Which micro-organisms or mixed infections are most relevant to growth faltering and poor development
  2.  At what age in early life do specific infections cause the most disruption to growth and development

Dr. Margaret Kosek will lead the Hopkins lab in Peru where Department researchers have studied enteric disease over the last twenty years. Other countries in the study include Brazil, India, Nepal, Bangladesh, Pakistan, South Africa, and Tanzania. Specimens will be collected from participants to assess the following:

•             gut functional capacity

•             enteric infection assessment

•             growth and development

•             vaccine response

•             respiratory illnesses 

Malnutrition and Development

Mal-ED is truly a global research collaboration. Research sites will be established in South America, Asia and Africa. Moreover, universities and research centers from across the globe will coordinate their efforts and share their findings with one another, including the University of Virginia, the Unidade de Pesquisas Clinicas & Instituto de Biomedicina/ Center for Global Health in Brazil, the University of Venda in South Africa, and  the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B).

The results of this global effort are intended to shed new light on the causes, and therefore potential treatments, of childhood malnutrition. Considering that malnutrition is thought to be an underlying cause of 35% of child mortality, this is arguably the most important health problem the world faces. The ramification of such advances has the potential to not only save millions of lives, but to improve the quality of those lives in the long term.

----Brandon Howard, May 2009