To tackle childhood malnutrition, researchers turn to the microbiome

Nearly half of all deaths worldwide in children under the age of 5 is from malnutrition. And those who manage to survive suffer long-term consequences, such as stunted growth and delays in neurodevelopment.

From nutrition bars to energy supplements, the current standards for addressing the nutrition gap focus on providing the recommended amount of calories as well as individual nutrients.

But getting these supplies to those in need can often be a challenge. These therapeutic food options can also be expensive. Even still, these foods are often very different — in form, texture, and taste — than what people are culturally used to and getting people to consume them regularly can be a problem.

In the quest for better options, researchers decided to turn to the microbiome. In a study published Thursday in Science, they describe how a diet that promoted certain microbial species in the gut seemed to help malnourished children in Bangladesh more than standard therapy.

To understand what malnourished children were missing, researchers first turned to healthy children in a slum in Bangladesh. They collected fecal samples once a month over the course of the first few years of their lives and then analyzed the microbial makeup of the childrens’ guts.

The healthy microbiomes were then compared to the microbiomes of malnourished children. Using machine learning algorithms, the scientists were able to identify a small group of organisms that were present in the healthy children’s guts but missing or in different proportions in the guts of malnourished children.

After a thorough search, researchers found that a combination of chickpeas, bananas, soy flour, peanuts, and a few other foods would promote the growth of these healthy gut microbes. In a clinical trial of 63 malnourished children ages 12-18 months, about a quarter were given a diet based on these foods, and, after a month of treatment, they fared better than the other groups of children in the study.

STAT spoke with Dr. Jeffrey Gordon, a microbiome researcher at the Washington University in St. Louis and senior author of the new study, to learn more. This interview has been condensed and lightly edited.

How did you find the foods included in the diet you tested?

Any solution has to be culturally acceptable and affordable. We turned to the foods that are normally consumed by children in this area. People in the lab then screened these complementary food ingredients in different combinations and found combinations that boosted the growth of the [microbial] community.

Why was it not enough to just focus on height and weight as measures of health?

A key commitment on our part was to get a more comprehensive molecular description of the biology of these healthy children. With new technologies, we can measure literally over a 1,000 different proteins that regulate the growth of bones, proteins that regulate metabolism, proteins that are associated with brain development, associated with immune function, and that gave us a much more comprehensive signature of healthy. We were armed with a much larger toolbox to measure the effects of these new microbiome directives.

What was surprising or unexpected about what you found?

The degree to which repair of the gut community was associated with effects on so many different aspects and mediators of growth. So, the idea that this [microbial] community’s effects reach far beyond the wall of the gut to influence so many different systems.

And what’s the takeaway here?

[It shows] how important healthy development of the gut community might be for healthy growth. The capacity to be good stewards of the healthy development of an infant’s or child’s microbial community could have very long-term effects on their biology, their health status, and even disease risk. So, we have this critical window of opportunity in the first couple of years after birth to monitor the development of a microbial community and to do everything that we might be able to do in a very informed, scientifically driven sense to help shepherd the development of a healthy [microbial] community.

What’s next?

We have to determine how generalizable the effects are, and how durable the effects are. [Nutrition] is a key component of human development, and if we’re trying to affect catch-up growth, we want to make sure long-term effects are beneficial. We’re also working on identifying the representation of ingredients in the different foods to know what the chemical signatures at play are.