Invited Review
Starved Guts
Morphologic and Functional Intestinal Changes in Malnutrition
Suzanna Attia,
Marjon Feenstra,
Nathan Swain,
Melina Cuesta,
Robert H.J. Bandsma,
Suzanna Attia
Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children
Search for more papers by this authorMarjon Feenstra
Translational Medicine Program, Hospital for Sick Children
Search for more papers by this authorNathan Swain
Translational Medicine Program, Hospital for Sick Children
Department of Nutritional Sciences, University of Toronto
Search for more papers by this authorMelina Cuesta
Translational Medicine Program, Hospital for Sick Children
Search for more papers by this authorCorresponding Author
Robert H.J. Bandsma
Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children
Translational Medicine Program, Hospital for Sick Children
Department of Nutritional Sciences, University of Toronto
Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
Address correspondence and reprint requests to Robert H.J. Bandsma, MD, PhD, Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada (e-mail: [email protected]).Search for more papers by this authorSuzanna Attia,
Marjon Feenstra,
Nathan Swain,
Melina Cuesta,
Robert H.J. Bandsma,
Suzanna Attia
Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children
Search for more papers by this authorMarjon Feenstra
Translational Medicine Program, Hospital for Sick Children
Search for more papers by this authorNathan Swain
Translational Medicine Program, Hospital for Sick Children
Department of Nutritional Sciences, University of Toronto
Search for more papers by this authorMelina Cuesta
Translational Medicine Program, Hospital for Sick Children
Search for more papers by this authorCorresponding Author
Robert H.J. Bandsma
Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children
Translational Medicine Program, Hospital for Sick Children
Department of Nutritional Sciences, University of Toronto
Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
Address correspondence and reprint requests to Robert H.J. Bandsma, MD, PhD, Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada (e-mail: [email protected]).Search for more papers by this authorThe authors report no conflicts of interest.
ABSTRACT
Malnutrition contributes significantly to death and illness worldwide and especially to the deaths of children younger than 5 years. The relation between intestinal changes in malnutrition and morbidity and mortality has not been well characterized; however, recent research indicates that the functional and morphologic changes of the intestine secondary to malnutrition itself contribute significantly to these negative clinical outcomes and may be potent targets of intervention. The aim of this review was to summarize current knowledge of experimental and clinically observed changes in the intestine from malnutrition preclinical models and human studies. Limited clinical studies have shown villous blunting, intestinal inflammation, and changes in the intestinal microbiome of malnourished children. In addition to these findings, experimental data using various animal models of malnutrition have found evidence of increased intestinal permeability, upregulated intestinal inflammation, and loss of goblet cells. More mechanistic studies are urgently needed to improve our understanding of malnutrition-related intestinal dysfunction and to identify potential novel targets for intervention.
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