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The aim of this study was to characterize serum non-esterified fatty acids (NEFA), in association with childhood undernutrition and EED, as potential biomarkers to predict growth outcomes. The study comprised a cohort of undernourished rural Pakistani infants (n = 365) and age-matched controls followed prospectively up to 24 months of age. Serum NEFA were quantified at ages 3\u20136 and 9 months and correlated with growth outcomes, serum bile acids and EED histopathological biomarkers. Serum NEFA correlated with linear growth-faltering and systemic and gut biomarkers of EED. Undernourished children exhibited essential fatty acid deficiency (EFAD), with low levels of linoleic acid and total n-6 polyunsaturated fatty acids, compensated by increased levels of oleic acid and increased elongase and desaturase activities. EFAD correlated with reduced anthropometric Z scores at 3\u20136 and 9 months of age. Serum NEFA also correlated with elevated BA and liver dysfunction. Essential fatty acid depletion and altered NEFA metabolism were highly prevalent and associated with acute and chronic growth-faltering in EED. The finding suggests that targeting early interventions to correct EFAD and promote FA absorption in children with EED may facilitate childhood growth in high-risk settings.<\/jats:p>","DOI":"10.3390\/metabo13040489","type":"journal-article","created":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T03:32:25Z","timestamp":1680060745000},"page":"489","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Essential Fatty Acid Deficiency Associates with Growth Faltering and Environmental Enteric Dysfunction in Children"],"prefix":"10.3390","volume":"13","author":[{"given":"Monica","family":"Narvaez-Rivas","sequence":"first","affiliation":[{"name":"Division of Pathology & Laboratory Medicine, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH 45229, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth D. R.","family":"Setchell","sequence":"additional","affiliation":[{"name":"Division of Pathology & Laboratory Medicine, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH 45229, USA"},{"name":"Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie L.","family":"Galandi","sequence":"additional","affiliation":[{"name":"Division of Pathology & Laboratory Medicine, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH 45229, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4156-3294","authenticated-orcid":false,"given":"Xueheng","family":"Zhao","sequence":"additional","affiliation":[{"name":"Division of Pathology & Laboratory Medicine, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH 45229, USA"},{"name":"Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Najeeha Talat","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Child Health, Biological and Biomedical Sciences, Aga Khan University, Karachi 74800, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2336-3165","authenticated-orcid":false,"given":"Sheraz","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junaid","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Child Health, Biological and Biomedical Sciences, Aga Khan University, Karachi 74800, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sana","family":"Syed","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan"},{"name":"Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Virginia, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syed Asad","family":"Ali","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean R.","family":"Moore","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Virginia, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Salameh, E., Morel, F.B., Zeilani, M., Dechelotte, P., and Marion-Letellier, R. 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