Dietary supplements that alter intestinal bacteria could ‘cure’ malnutrition Science

In Bangladesh, a health worker measures a child’s arm to monitor progress in a study on malnutrition supplementation.

MUNIR UZ ZAMAN / AFP via Getty Images

Written by Elizabeth Pennisi

To save a starving child, helpers have long used one obvious treatment: food. But new research suggests that feeding their gut bacteria is just as important – or even more important – than feeding their stomachs. Compared to the leading malnutrition treatment, the new supplement designed to promote beneficial intestinal bacteria has led to signs of improved growth and greater weight gain, even though it has 20% fewer calories. The study also highlights how important intestinal bacteria – the so-called microbiome – can be for human health.

“This is exciting research that promises to bring hope to millions of severely malnourished children,” says Honorine Ward, a scientist-physician at Tufts University School of Medicine who was not involved in the business.

About 30 million children worldwide are so hungry that their bodies consume. Their growth slows down, the immune system does not work well, and the nervous system does not develop properly. To combat malnutrition, health clinics often provide pre-packaged, ready-to-eat supplements (RUSF), which are easily stored and turned into anger after kneading. But malnourished children with malnourished health are rarely permanent, and many never fully recover, even after eating enough. “It’s a problem that didn’t have a solution available before,” says Ruslan Medzhitov, an immunologist at Yale University who was not involved in the deal.

For more than 10 years, Jeffrey Gordon, a microbiologist at the University of Washington School of Medicine in St. Louis. Louis, studied the role that the microbiome plays in recovering from malnutrition. He and his colleagues found that 15 key bacteria are needed for normal growth in mice, pigs and, to some extent, humans, and that children whose microbiomes fail to “mature” to include these species do not recover from malnutrition, as do children whose gut bacteria mature. . “Current therapies do not fix this disturbed microbiome,” Gordon explains.

So he and Tahmeed Ahmed, a malnutrition expert who heads the International Center for Diarrhea Research in Dhaka, Bangladesh, tried to find out with colleagues which of the half-dozen combinations of readily available foods most boosted the growth of this healthy food. bacteria. In the new study, they tested their best candidate: a complex mixture of chickpea flour and oil, banana, soy and peanuts, which they call complementary food no. 2 or microbiota-targeted MDCF-2.

About 120 malnourished toddlers from the poor Dake neighborhood received either MDCF-2 or standard RUSF supplement twice daily for 3 months. Every 2 weeks during treatment and again one month after the end of treatment, the researchers weighed and measured the children, took blood samples from them and analyzed the bacteria in their feces.

MDCF-2 not only enhanced growth-related blood components – such as proteins needed for proper bone development, the nervous and immune systems – but also resulted in twice the growth rate, as measured by changes in weight and length, as in those receiving RUSF. researchers today report in New England Journal of Medicine. Moreover, 21 species of beneficial bacteria have increased in abundance. The increased growth of the children continued even after the end of the treatment. “A small amount of this food supplement can actually cure child malnutrition,” concludes Ahmed.

But becoming a standard treatment could take years, Ahmed says. First, the team must come up with a simpler formulation that can be stored for months – the supplement is currently fresh – and easy for mothers to obtain and use. Moreover, larger trials should be conducted in other countries, with children followed up to 5 years of age to determine if the beneficial effects will last, Ward says.

Meanwhile, the paper offers enticing hints as to how intestinal bacteria can change growth. “Different bacteria are useful or harmful at different stages of development,” says Medzhitov. For example, bacteria associated with the beneficial effects of breastfeeding, Bifidobacterium longum, was associated with minor improvement in children in the study. That discovery paves the way for the development of disease-specific interventions to shape the microbiome, Ward adds.

Until that happens, Gordon and Ahmed continue to refine their formulation and observe other countries – and communities – for their studies. “I think the remaining challenges are mostly logistical,” Medzhitov said. Gordon agrees, adding that their findings still boil down to a simple message: “Healthy children depend … on a healthy microbiome.”