Geophagy is associated with environmental enteropathy and stunting in children in rural Bangladesh

Christine Marie George, Lauren Oldja, Shwapon Biswas, Jamie Perin, Gwenyth O. Lee, Margaret Kosek, R. Bradley Sack, Shahnawaz Ahmed, Rashidul Haque, Tahmina Parvin, Ishrat J. Azmi, Sazzadul Islam Bhuyian, Kaisar A. Talukder, Shahnaij Mohammad, Abu G. Faruque

Research output: Contribution to journalArticlepeer-review

82 Scopus citations


There is a growing body of literature indicating an association between stunting and environmental enteropathy (EE), a disorder thought to be caused by repeated exposures to enteric pathogens. To investigate the relationship between exposure to enteric pathogens through geophagy, consumption of soil, EE, and stunting, we conducted a prospective cohort study of 216 children under 5 years of age in rural Bangladesh. Geophagy was assessed at baseline using 5 hour structured observation and caregiver reports. Stool was analyzed for fecal markers of intestinal inflammation: alpha-1-antitrypsin, myeloperoxidase, neopterin (all three combined to form an EE disease activity score), and calprotectin. Eighteen percent of children had observed geophagy events by structured observation and 28% had caregiver reported events in the past week. Nearly all households had Escherichia coli (97%) in soil, and 14% had diarrheagenic E. coli. Children with caregiver-reported geophagy had significantly higher EE scores (0.72 point difference, 95% confidence interval [CI]: 0.01, 1.42) and calprotectin concentrations (237.38 mg/g, 95% CI: 12.77, 462.00). Furthermore, at the 9-month follow-up the odds of being stunted (height-for-age z-score < -2) was double for children with caregiver-reported geophagy (odds ratio [OR]: 2.27, 95% CI: 1.14, 4.51). These findings suggest that geophagy in young children may be an important unrecognized risk factor for EE and stunting.

Original languageEnglish (US)
Pages (from-to)1117-1124
Number of pages8
JournalAmerican Journal of Tropical Medicine and Hygiene
Issue number6
StatePublished - Jun 1 2015

ASJC Scopus subject areas

  • Parasitology
  • Virology
  • Infectious Diseases


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