Key Initiatives

MAL-ED: A Global Network for the Study of Malnutrition and Enteric Diseases

Poor nutrition is linked to more than half of child deaths worldwide and to acute and chronic morbidity in children living in the developing world. The MAL-ED, (pronounced mal a dee), http://mal-ed.fnih.org/, program studies the relationship between malnutrition and intestinal infections and the consequences of these conditions on various aspects of child development. It is a five-year, multi-site project administered by the Foundation for the NIH and the Fogarty International Center and is supported by a grant from the Bill & Melinda Gates Foundation of approximately $30 million.

Malnutrition and diarrheal diseases are linked in a complex, vicious cycle: under-nutrition contributes to the severity of disease caused by intestinal infections, and infection, in turn, affects the gut’s capacity to absorb nutrients, thus contributing to further malnutrition. By developing a clearer picture of this relationship, investigators in the Network hope to facilitate the design of better intervention strategies.

The study is conducted across eight sites, all using the same or harmonized protocols, in an effort to address the following hypotheses:

  • Infection with specific intestinal pathogens leads to malnutrition by causing intestinal inflammation and/or by altering the barrier and absorptive functions of the gut;
  • The combination of intestinal infections and malnutrition results in growth and cognitive impairments in young children and may lead to impaired immunity as measured by responses to childhood vaccines.

The multi-site nature of the study will help determine if observations and results from one poverty stricken community can be extrapolated to other underserved populations based on common environmental and biological determinants.

The MAL-ED Project conducts epidemiological, microbiological, physiological, immunological and psychological tests, integrates the data and develops models and tools for other researchers to use. The MAL-ED Network collaborates with other projects to determine the contributions of human genetic factors and that of normal gut flora to the susceptibility to malnutrition, diarrheal diseases and child developmental deficits.

“The interactions between diarrheal diseases and malnutrition produce a vicious cycle that has devastating developmental consequences for the world’s poorest children. We have much to learn about this relationship and expect that the robust and expanding network that we are establishing will provide us with a wealth of useful information.”

                                -Roger I. Glass, M.D., Ph.D.
Director, Fogarty International Center
Associate Director for International Research, National Institutes of Health