To save starving children, aid workers have long used one clear remedy: food. But a new study suggests feeding their gut bacteria may be just as important – or even more important – than feeding their stomach. In a head-to-head comparison with leading treatments for malnutrition, a new supplement designed to promote gut bacteria that helps cause signs of increased growth and weight gain, despite having 20% fewer calories. The study also highlights how important gut bacteria – the so-called microbiome – is to human health.
“This is an exciting study that holds promise for the millions of children who are acutely malnourished,” said Honorine Ward, a medical scientist at Tufts University School of Medicine who was not involved in the study.
About 30 million children worldwide are so hungry that their bodies are getting smaller. Their growth slows down, their immune systems don’t work properly, and their nervous systems fail to develop properly. To combat malnutrition, health clinics often provide packaged ready-to-use food additives (RUSF), which are easy to store and turn sticky after kneading. But improving the health of malnourished children is rarely permanent, and many never fully recover, even after they have eaten enough. “This is a problem that previously had no available solutions,” said Ruslan Medzhitov, an immunologist at Yale University who was not involved in the study.
For more than 10 years, Jeffrey Gordon, a microbiologist at the University of Washington School of Medicine in Sts. Louis, has studied the role of the microbiome in the recovery of malnutrition. He and his colleagues found that 15 key bacteria were required for normal growth in mice, pigs, and to some extent humans, and that children whose microbiome failed to “mature” to include these species did not recover from malnutrition as well as children whose gut bacteria become an adult. “Current therapies do not improve this disrupted microbiome,” explains Gordon.
So he and Tahmeed Ahmed, the expert malnutrition scientist who heads the International Center for Diarrheal Disease Research in Dhaka, Bangladesh, tried with colleagues to figure out which of the half a dozen food combinations were easily available. promote the growth of these healthy bacteria the most. In the new study, they tested the best-performing candidates: a complex mixture of chickpeas, bananas, soybeans, and peanut flour and an oil they called microbiota No. 2, or MDCF-2.
About 120 malnourished toddlers from the slum area of Dhaka received MDCF-2 or the standard RUSF supplement twice daily for 3 months. Every 2 weeks during treatment, and again 1 month after treatment ended, the researchers weighed and measured the children, took their blood samples, and analyzed the bacteria in their faeces.
MDCF-2 not only increases blood components associated with growth – such as proteins required for proper bone, nervous, and immune system development – but also produces growth rate twice as high, as measured by changes in weight-to-length scores, as in those who received RUSF, the researchers reported today on The New England Journal of Medicine. What’s more, 21 types of beneficial bacteria increased in abundance. The increased growth in children continues even after treatment ends. “Small amounts of these dietary supplements can actually cure malnutrition in children,” Ahmed concluded.
But becoming standard treatment could take years, said Ahmed. First, the team needs to come up with a simpler formulation that can be stored for months – nowadays supplements are made fresh – and easy for mothers to obtain and use. Additionally, larger trials need to be conducted in other countries, with children followed for up to 5 years to see if the beneficial effects persist, Ward said.
Meanwhile, this study offers tantalizing clues to how gut bacteria can alter growth. “Different bacteria benefit or harm at different stages of development,” says Medzhitov. For example, bacteria associated with the beneficial effects of breastfeeding, Bifidobacterium longum, was associated with a slight increase in the children in the study. The findings paved the way for the development of disease-specific interventions to shape the microbiome, Ward added.
Until that happens, Gordon and Ahmed continue to refine their formulations, and they are eyeing other countries – and communities – for their studies. “I think the challenge that remains is largely logistical,” said Medzhitov. Gordon agrees, adding that their findings still boil down to a simple message: “Healthy children depend … on a healthy microbiome.”
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