The association of zonulin with LBP, IgG anti-LPS and anti-FliC, low tryptophan and malnutrition (lower SS WAZ for all children and, if greater than 12 months old, also SS HAZ) is consistent with the involvement of this tight junction modulator early in development of EE [62], while the reduced zonulin with increased A1AT or neopterin may reflect compensatory zonulin pathway down-regulation secondary to epithelial disruption. This evidence concerns the gene SERPINA1 and nutritional deficiency disease.