January 21, 2016

Dr. Paul C. Turner, assistant professor in the Maryland Institute for Applied Environmental Health, is a co-author of a Clinical Infectious Diseases article highlighting the emerging concerns about the role of dietary fungal toxins, also known as mycotoxins, on child growth. Mycotoxin contamination of food is common, but certain high risk regions exist due to climate, poor storage, and limited nutritional diversity. This can lead to lifelong chronic exposure at high levels. The article is one of a series on The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial published in the December 2015 issue of Clinical Infectious Diseases.

“Globally, stunting affects approximately one-quarter of children under the age of five and is responsible for about one-fifth of their deaths,” Dr. Turner said.  “Stunting, which is particularly prevalent in Africa and Asia, limits success in childhood and leads to reduced economic productivity in adulthood.”

Several decades of research indicate that while infection and poor diet cause stunting, they fail to fully explain early life growth faltering. The SHINE trial is a major research initiative on the role of “environmental enteric dysfunction” (EED) in stunting and anemia in children. EED is a subclinical disorder of the small intestine, which SHINE researchers’ posit is primarily caused by infants’ ingesting fecal microbes related to water quality, sanitation, and hygiene (WASH) issues.

The ongoing SHINE trial in rural Zimbabwe is recruiting 4,800 pregnant women for longitudinal assessment of births and child health through infancy; with participants divided equally amongst the trial’s four hygiene intervention arms, related to components of WASH, in order to highlight behaviors and practices that are causative in stunting and anemia.

In addition to fecal contamination, an emerging concern as a cause for stunting are mycotoxins, toxic secondary metabolites of fungi that contaminate dietary staples such as peanuts and maize. Dr. Turner previously published seminal papers demonstrating strong associations between mycotoxin exposure and growth faltering in West African infants, though studies lacked the scale and depth of the SHINE trial.

In this publication on mycotoxins, the research team describes the rationale for linking three mycotoxins — aflatoxins, fumonisins, and deoxynivalenol — with poor child health and development. This ongoing SHINE sub-study will examine the relationship between agricultural practices and mycotoxin exposure; associations between mycotoxin exposure and child stunting, and investigate EED as a possible pathway linking mycotoxin exposure to child stunting.

“This study of mycotoxins is intended to help us develop better hygiene initiatives that improve the health of children in some of the most vulnerable global populations,” Dr. Turner said.

The SHINE trial is funded by the Bill & Melinda Gates Foundation; UK Department for International Development; Wellcome Trust, United Kingdom; Swiss Agency for Development and Cooperation; US National Institutes of Health; and the European Union.

Related Links

Clinical Infectious Diseases: The Potential Role of Mycotoxins as a Contributor to Stunting in the SHINE Trial

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Paul Turner