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To investigate the contribution of undernutrition to enteropathy we conducted a case\u2013control study of adult patients with starvation due to benign esophageal strictures, compared with non\u2010malnourished community controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Fasting blood samples and duodenal biopsies were collected from 34 cases and 66 controls. Duodenal biopsies were evaluated by morphometry while circulating C\u2010reactive protein and hormones were measured by ELISA or Luminex. Multivariable models were adjusted for stricture, body mass index, HIV, and C\u2010reactive protein.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Epithelial surface area was reduced in cases (median 323\u2009\u03bcm (IQR 271, 392) per 100\u2009\u03bcm muscularis mucosae) compared to controls (448\u2009\u03bcm (IQR 384, 516);\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0001), even after adjustment in a linear regression model that included BMI, CRP, and HIV status. Hormonal analysis showed lower median concentrations of C\u2010peptide (0.36\u2009ng\/mL vs. 0.7\u2009ng\/mL;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), insulin (639\u2009pg\/mL vs. 2037\u2009pg\/mL;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0001), and GLP\u20102 (0\u2009ng\/mL vs. 2.3\u2009ng\/mL;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0063) in cases compared to controls. Cases also had higher glucagon (52.4\u2009pg\/mL vs. 36.6\u2009pg\/mL;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0012) and secretin concentrations (24.4\u2009pg\/mL vs. 11.7\u2009pg\/mL;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Starvation and malnutrition consequent upon esophageal stricturing drives a further reduction in epithelial surface area, superimposed on environmental enteropathy. There was some evidence of abnormalities in secretion of pancreatic hormones and GLP\u20102.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.72772","type":"journal-article","created":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T10:10:02Z","timestamp":1783764602000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Structural and Hormonal Changes Associated With Starvation in Zambian Adult Patients With Esophageal Strictures: A Cross\u2010Sectional Study"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5606-9435","authenticated-orcid":false,"given":"Ellen","family":"Besa","sequence":"first","affiliation":[{"name":"Tropical Gastroenterology &amp; Nutrition Group University of Zambia School of Medicine  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Violet","family":"Kayamba","sequence":"additional","affiliation":[{"name":"Tropical Gastroenterology &amp; Nutrition Group University of Zambia School of Medicine  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Mudenda","sequence":"additional","affiliation":[{"name":"Tropical Gastroenterology &amp; Nutrition Group University of Zambia School of Medicine  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chola","family":"Mulenga","sequence":"additional","affiliation":[{"name":"Tropical Gastroenterology &amp; Nutrition Group University of Zambia School of Medicine  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enala","family":"Musheba","sequence":"additional","affiliation":[{"name":"Tropical Gastroenterology &amp; Nutrition Group University of Zambia School of Medicine  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malambo","family":"Mubbunu","sequence":"additional","affiliation":[{"name":"Tropical Gastroenterology &amp; Nutrition Group University of Zambia School of Medicine  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Frost","sequence":"additional","affiliation":[{"name":"Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0844-6448","authenticated-orcid":false,"given":"Paul","family":"Kelly","sequence":"additional","affiliation":[{"name":"Tropical Gastroenterology &amp; Nutrition Group University of Zambia School of Medicine  Lusaka Zambia"},{"name":"Blizard Institute, Barts and The London School of Medicine Queen Mary University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1054\/clnu.2000.0157"},{"key":"e_1_2_9_3_1","volume-title":"The Evolutionary Biology of Human Body Fatness","author":"Wells J. 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