Dr. Michael Gottlieb on Malnutrition & Enteric Diseases

November 12, 2010 - (From the left) Mary Braun, Katrina Epperson, Dr. Gottleib, Karla Garcia-Huerta, and Annette Ruth. Ms. Katrina Epperson is the program coordinator for the CRND and BIOS 40450. Mss. Braun, Garcia-Huerta and Ruth are students in the class who joined Dr. Gottlieb for an informal Q&A luncheon before his presentation. (Photo: Will Wall, 2010).

Dr. Michael Gottlieb is the Associate Director for Science at the Foundation for the National Institutes of Health (FNIH) and the Deputy Director for Grand Challenges in Global Health at the Bill & Melinda Gates Foundation. He is also the Co-Principal Investigator for the Malnutrition and Enteric Diseases Project (Mal-Ed), which is funded by the Fogarty International Center (FIC) at the NIH and the Bill & Melinda Gates Foundation. On November 12, 2010, Dr. Gottlieb visited with CRND faculty and students (BIOS40450), delivering a seminar for the CRND Clinical-Translational Series entitled: “The MAL-ED Project: Towards a better understanding of the relationship between malnutrition and enteric diseases”

Dr. Gottlieb discussed the Mal-Ed Project's work in establishing sites in the developing world for researchers to identify the risk factors for malnutrition, intestinal diseases and health consequences in children. One in every five children in the developing world is malnourished and half of all child deaths worldwide result from poor nutrition. Mal-Ed develops models to estimate the distribution and burden of malnutrition and intestinal infections and identify beneficial interventions.

Referencing UNICEF's report in 2008 that 31% of children under 5 years old are stunted, Dr. Gottlieb outlined factors contributing to the "vicious cycle" of malnutrition leading to poor immunity and subsequently increased disease and stunted growth: 1) Diarrheal disease and malnutrition are synergistic and have long term effects on physical growth and cognition; 2) Resource poor communities lack adequate access to clean water and good sanitation; 3) Early and frequent exposure to pathogens; 4) High disease incidence; 5) Tropical (environmental) enteropathy develops which may effect digestion, nutrient absorption, and immune response to vaccines; 6) Inadequate food supply – amount and nutritional content; 6) Developing malnutrition leads to stunting, wasting. Citing Checkley et al.(Int. J. Epid., 2008; 1-15), Dr. Gottlieb quantified the connection between diarrhea and developmental damage: "Each diarrheal episode increases the likelihood of stunting by 5%." Additional measures related to diarrhea and malnutrition include increased mortality because of poor immunity, as well as cognitive and fitness impairments affecting school and work performance. Dr. Gottlieb also noted the paradoxical association of stunting and obesity as malnutrition, bad water and bad food put populations at increased risk of developing obesity.

In describing the multi-national context in which Mal-Ed teams operate, Dr. Gottlieb noted the complications of large scale studies and data gathering, ranging from from establishing standardized terminology and sampling procedures to conducting socioeconomic surveys for group comparisons to understanding local regulations on shipping biologicals. Dr. Gottlieb works closely with a Bioethics panel and care agencies to implement referrals as people are identified by the Mal-Ed Project for assistance and intervention. Mal-Ed field sites include: Iquitos, Peru; Kathmandu, Nepal; Fortaleza. Brazil; Dhaka, Bangladesh; Haydom, Tanzania; Karachi, Pakistan; Limpopo, S. Africa; and Vellore, India.

In preparation for Dr. Gottlieb's visit, students in BIOS40450 read the following papers on his recommendation: 1) Schaible UE, Kaufmann SHE (2007). Malnutrition and infection: Complex mechanisms and global impacts. PLoS Med 4(5): e115. doi:10.1371/ journal.pmed.0040115; 2) Ahmed T., Haque R, Ahmed AMS, Petri WA, and Cravioto A. (2009). Use of metagenomics to understand the genetic basis of malnutrition. Nutrition Reviews Vol. 67(Suppl. 2):S201–S206.



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