Immature Microbes in the Guts of Malnourished Children

Malnutrition (severe or moderate acute malnutrition) affects 23 percent of children in developing countries.1 The World Health Organization estimates that malnutrition is the cause of one-third of all child deaths.2 Malnutrition, or inadequate nutrition, manifests most noticeably as delayed growth, but also includes deficiencies in vitamins, minerals, essential fatty acids, and protein.

A recently developed intervention for severe acute malnutrition, known as Ready-to-use Therapeutic Food, is currently being distributed to hundreds of thousands of children in the developing world. Other food interventions, such as a lentil and rice dish called khichuri-halwa, are being utilized. A recent study published in the journal Nature sought to understand whether the development of gut bacteria during infancy was associated with improvements in malnutrition after such interventions in Bangladeshi children.3

The researchers first tested the stool of healthy Bangladeshi children on a monthly basis during the first two years of life to determine the healthy development of gut bacteria. That is, they used these findings as a benchmark of a normally maturing gut bacterial community. After all, the first two to three years of life see some of the biggest changes in gut bacterial composition, and by this age, the gut microbes resemble that of an adult.

Next, they tested the gut bacteria of children with severe and moderate acute malnutrition before, during, and after receiving either the Therapeutic Food or the lentil and rice dish. Before the interventions, gut bacteria was found to be immature—that is, the gut microbes were found were not fully developed as they were in healthy children. After the food interventions, the children’s gut microbiota immaturity was only partially improved—and temporarily, at that. By four months after the interventions had ceased, their gut microbes reverted back to their original, immature state.

The researchers suggest that either a longer food intervention or a different food that more resembles the children’s native diet is needed. They also recommend “next-generation probiotics using gut-derived taxa [groups],” which I believe will have the best impact. What if they isolated the gut microbes from the healthy children and gave them to the malnourished children? Those microbes would take up residence in the children’s guts, especially if the children were also given a food that those bacteria naturally thrive on.

Aside from lack of food, gastrointestinal (GI) infection is another cause of malnutrition. During a GI infection, the immune system is taxed in such a way that a broad range of nutrients are required to fight the pathogenic organism. Let’s not forget that a healthy gut microbiota can help ward off such infections in the first place—and can help improve the body’s nutrient capacity. You see, gut microbes play an important role in the harvest of nutrients from food. They help to break down food so that the body can efficiently absorb the nutrients it needs. When the community of gut microbes is not a healthy one, the ability to absorb nutrients adequately is compromised. When this occurs during infancy along with a lack of food or an infection, malnutrition can be worsened.

I cannot overemphasize the importance of developing a healthy gut balance during infancy. Avoiding medically unnecessary Cesarean sections and antibiotics during pregnancy (and during infancy for baby), breastfeeding for at least one year (more is better), and taking probiotics during and after pregnancy along with eating fermented foods is the best way to set infants up with a healthy balance of gut microbes, both in developing countries and here at home.

References

1. Lazzerini M, Rubert L, and Pani P, “Specially formulated foods for treating children with moderate acute malnutrition in low- and middle-income countries.” Cochrane Database Syst Rev. 2013 Jun 21;6:CD009584.
2. http://www.who.int/maternal_child_adolescent/topics/child/malnutrition/en/ Accessed 6/19/2014.
3. Subramanian A, Huq S, Yatsunenko T, et al., “Persistent gut microbiota immaturity in malnourished Bangladeshi children.” Nature. 2014 Jun 4.

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