FIG 1.

Interplay of malnutrition with environmental enteric dysfunction and systemic inflammation. Exposure to intestinal pathogens and intestinal dysbiosis, as a consequence of poor sanitation and possibly specific nutrient deficiencies (e.g., zinc, vitamin A, and protein), lead to intestinal inflammation and disruption of intestinal barrier function. Impaired barrier function allows the translocation of bacteria and bacterial products from the intestine, which activate innate immune cells in the mesenteric lymph nodes, liver, and systemic circulation to generate proinflammatory cytokines. The increased systemic inflammation carries a metabolic cost and leads to impaired host defense. Collectively, these vicious cycles lead to growth faltering and increased mortality.