Supplement targets gut microbes to boost growth in malnourished children

A mother feeds her child one of the therapeutic foods as part of the clinical trial in Bangladesh. International Centre for Diarrhoeal Disease Research

More than 45 million children around the world live with moderate to severe acute malnutrition. Inadequate nutrition can make children more susceptible to disease and death.

The impacts of malnutrition can last a lifetime. Children who don’t get adequate nutrition can end up stunted—much smaller than they would have been if they’d received enough food. They may also have problems with their immune system, metabolism, and nervous system that affect their adult lives.

Calorie-dense supplemental foods have been developed to prevent death and encourage normal growth in malnourished children. However, these products have showed a limited ability to prevent long-term damage to the body.

Previous research has found that the bacteria, viruses, and fungi normally found in the digestive system—called the gut microbiome—are also harmed by malnutrition. Some studies have suggested that the resulting state of microbiome disrepair contributes to ongoing malnutrition. Ongoing studies have been testing whether therapeutic foods designed to repair the gut microbiome could better improve children’s health.

In a new trial of this concept, researchers led by Dr. Jeffrey Gordon of Washington University School of Medicine in St. Louis and Dr. Tahmeed Ahmed of the International Centre for Diarrhoeal Disease Research in Bangladesh tested a microbiome-boosting supplement in malnourished children.

The team enrolled 123 Bangladeshi children between the ages of 12 and 18 months with moderate acute malnutrition, called wasting. Half received a standard nutritional supplement for 3 months. The other half received a supplement made from locally sourced foods shown to repair defects in the developing microbiome. The ingredients included chickpeas, soy, bananas, and peanuts.

The research team then followed the children for an additional month to track growth and changes in their microbiomes. A total of 118 children finished the trial. The work was funded in part by NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Results were published on April 7, 2021, in NEJM.

Growth deficits were similar between the two groups at the start of the study. By the end of the trial, children who received the microbiome-targeted supplement had greater improvements in weight gain than those who received the standard supplement. This advantage was seen even though the microbiome-targeted supplement contained 20% fewer calories.

Blood samples taken before, during, and at the end of supplementation also showed changes. Children who received the microbiome-targeted supplement had greater increases in proteins associated with healthy bone, cartilage, and brain growth. They also had lower levels of proteins associated with harmful inflammation. These changes correlated with the positive improvements seen in weight.

The team found that almost two dozen types of gut bacteria were associated with weight gain during the study. Notably, levels of 21 beneficial bacteria increased more in the children fed the microbiome-targeted supplement.

“Our findings reveal that the effects of the developing microbiome extend well beyond the walls of the gut and that a healthy microbiome is linked to healthy growth,” Gordon says.

Longer term studies in diverse groups of children are needed to see if the changes seen during this study translate to lasting improvements in physical and cognitive health.

—by Sharon Reynolds