Peer-reviewed article
Bile acid dysmetabolism in Bangladeshi infants associated with poor linear growth, enteric inflammation, and small intestine bacterial overgrowth.
Farah Hasan, Phillip B Hylemon, Rashidul Haque, William A Petri, Abu Syed Golam Faruque et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined bile acid metabolism in 100 Bangladeshi infants aged 6-9 months and found abnormal patterns compared to American children, characterized by higher unconjugated bile acids and lower conjugated bile acids. These bile acid imbalances were associated with poor linear growth (shorter height), low weight, and small intestine bacterial overgrowth. The findings suggest that environmental enteric dysfunction—a condition caused by poor sanitation and fecal contamination—disrupts how children's bodies process bile acids, which interferes with nutrient absorption and growth.
Key points
- Bangladeshi infants showed 65.23% unconjugated primary bile acids versus 44.25% in American infants (P=0.003)
- Stool unconjugated primary bile acids were inversely associated with height-for-age and weight-for-age Z scores
- Bile acid dysmetabolism was linked to small intestine bacterial overgrowth
- The pattern suggests an age-dependent defect in bile acid conjugation in Bangladeshi children
- Fecal markers of intestinal inflammation (myeloperoxidase) correlated with abnormal bile acid profiles
Limitations
This is a cross-sectional study without intervention, so causality cannot be established. The American control group was very small (n=6) and may not be representative, limiting the validity of the comparison.
Abstract
BACKGROUND: Environmental enteric dysfunction (EED) is a subclinical condition caused by fecal-oral contamination leading to enteric inflammation and dysbiosis. Bile acids serve to facilitate lipid digestion and absorption, regulate metabolic pathways associated with childhood growth and inflammation, and may be affected by EED. AIM: To investigate bile acid metabolism in Bangladeshi children with EED and its association with growth impairment. METHODS: We conducted a cross-sectional study of 100 Bangladeshi infants (aged 6-9 months) and quantified serum and fecal bile acids using LC-MS/MS. We compared profiles to a control group of 6 American children (6-12 months) and 80 older Bangladeshi children (aged 2 years). RESULTS: Bangladeshi infants had higher levels of plasma unconjugated primary (65.23% vs 44.25%, P = 0.003) and sulfated primary bile acids (12.98% vs < 0.001%, P = 0.01), with lower primary conjugated bile acids (0.69% vs 2.74%, P ≤ 0.001) compared to American children. Stool unconjugated primary bile acids were inversely associated with weight-for-age [regression coefficient (β) = -0.01, P = 0.01] and height-for-age Z scores (β = -0.01, P = 0.03). Conjugated secondary bile acids were inversely associated with small intestine bacterial overgrowth (β = -1096.68, P = 0.05). Fecal myeloperoxidase was associated with sulfated secondary bile acids (β = -0.40, P = 0.04). Compared to 2-year-old children, the Bangladeshi infant's serum had higher levels of unconjugated primary bile acids (65.23% vs 9.20%, P ≤ 0.001) and lower levels of primary conjugated bile acids (0.69% vs 80.38%, P ≤ 0.001). CONCLUSION: Our data suggests an age-dependent defect in conjugation of primary bile acids in Bangladeshi children with compensatory hydrophilic shunting. Additionally, bile acid profiles are associated with intestinal overgrowth.