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Foods that increase intestinal microbes could be a new way to help malnourished children

In the densely populated slums of Dhaka, Bangladesh, children survive on baked rice with powdered curry and biscuits and chips, packaged in attractive colorful wrappers. These low-protein foods provide scarce nutrients for growing bodies. It adds poor sanitation of several generations of a family that often lives in a single room with no access to health care, and these difficulties are etched in the malnourished bodies of these children.

“Such is life in these places,” says Tahmeed Ahmed, who heads the International Research Center on Diarrheal Diseases, Bangladesh.

Dhaka is far from unique. According to UNICEF, more than 1 in 5 children under the age of 5 or 149.2 million face malnutrition, a form of malnutrition most common in low- and middle-income countries (SN: 1/8/20). Malnutrition leaves children atrophied or short for their age and underutilized, with little weight due to their height. And it can be deadly: globally, 5.2 million children under the age of 5 died in 2019; 45 percent of these deaths are related to nutrition-related problems, according to the World Health Organization.

The COVID-19 pandemic was expected to make matters worse, disrupting nutrition programs and the ability of families to find and afford food, researchers reported in May 2020 in the Lancet Global Health.

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It is still early to know the toll the pandemic has had on child malnutrition. But “we’re not out of the woods yet in many countries,” says Denish Moorthy, senior technical advisor on global nutrition initiatives for John Snow Inc., a Boston-based public health management research and consulting organization.

However, in Dhaka there is a glimmer of hope. Children fed a new type of dietary supplement, intended not only to nourish them but to restore useful bacteria in their gut, gained more weight on average than children fed traditional high-calorie supplements, Ahmed and colleagues reported in a study preliminary conducted April 7 in the New England Journal of Medicine. In six months, researchers hope to have results that determine whether those gains persist.

The approach is based on more than a decade of work, led by Jeffrey Gordon, a microbiologist at the University of Washington School of Medicine in St. Louis, on whether disruptions in our gut microbiota can cause malnutrition (SN: 6/4/14). The team found that malnourished babies lack beneficial intestinal microbes and the problem persists even after babies are fed foods designed to increase their weight. These intestinal microbes are important for metabolism, immunity, digestion, and overall development, so the lack of them hinders efforts to help these boys catch up (SN: 03/03/11).

In Bangladesh, Gordon’s team set out to create a microbiome-based food supplement by testing foods common to the local diet and seeing which foods boosted healthy bacteria. The team also tested a way to measure the impact of food by characterizing intestinal bacteria in healthy, malnourished children and developing a pattern of markers in the blood. This pattern allowed the team to understand how malnutrition changes the body and also tracks changes in intestinal microbiomes.

Investigators tested his food in the Dhaka slum in Mirpur. There, 118 malnourished children aged 12 to 18 months received microbial-friendly food or a more traditional food ready to use twice a day for three months.

Microbial-compatible foods contained fewer calories than commonly used complementary foods: 204 calories per 50-gram daily dose compared to 247 calories. However, the researchers used a specialized score to show that children with microbial-friendly foods gained weight to length 0.011 points faster than those who received the ready-to-use supplement. If this growth rate were projected up to a year, it would be good enough to move these children to the normal range, Gordon says. They improved blood markers linked to bone growth, nervous system development, and overall health. And a comparison of feces showed that the microbiomes of these children resembled those of healthy children in Bangladesh. The results suggest that microbial-compatible foods could help children’s bodies back away from the effects of malnutrition.

Malnutrition has been around for decades and efforts to combat it have not made much of a dent, says Moorthy, who was not involved in the research. “Malnutrition is not just about providing food, no matter how big the food is or about amazing results in trials,” he says. "This is the first step to a better understanding of biology and that's key."

Gordon’s team is now working with nutrition scientists in India and the WHO to expand the trial to other parts of the world. Back in Dhaka, Ahmed is excited by the results. After 35 years treating children with malnutrition, he says he could see the difference in children taking the right supplement for microbes. You can also see it, he says, in the "gratitude and happiness of mothers."

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