In the densely populated slums of Dhaka, Bangladesh, children survive on rice cooked with curry powder and cheap cookies and chips, packaged in appealing, colorful wrappers. These protein-poor foods provide scarce nutrients for growing bodies. Add in poor sanitation from multiple generations of a family often living in a single room and no access to health care, and these hardships are etched in these children’s malnourished bodies.
“This is what life is like in these places,” says Tahmeed Ahmed, who heads the International Centre for Diarrheal Disease Research, Bangladesh.
Dhaka is far from unique. According to UNICEF, more than 1 in 5 children under age 5, or 149.2 million, are coping with undernutrition — a form of malnutrition most common in low- and middle-income countries (SN: 1/8/20). Undernutrition leaves children stunted, or short for their age, and wasted, underweight for their height. And it can be deadly: Globally, 5.2 million children under age 5 died in 2019; 45 percent of those deaths are linked to nutrition-related issues, according to the World Health Organization.
The COVID-19 pandemic was expected to make things worse, disrupting nutrition programs and families’ ability to find and afford food, researchers reported in May 2020 in the Lancet Global Health.
It’s still too early to know the toll the pandemic has had on child malnutrition. But “we are not yet out of the woods in many countries,” says Denish Moorthy, a senior technical advisor on global nutrition initiatives for John Snow Inc., a Boston-based public health management consulting and research organization.
Yet in Dhaka, there is a glimmer of hope. Children fed a new kind of food supplement, aimed at not only nourishing them but restoring helpful bacteria in their guts, gained more weight on average than children fed traditional high-caloric supplements, Ahmed and his colleagues reported in a preliminary study April 7 in the New England Journal of Medicine. In six months, the researchers hope to have results that determine whether those gains persist.
The approach is based on more than a decade of work, led by Jeffrey Gordon, a microbiologist at Washington University School of Medicine in St. Louis, on whether disruptions in our gut microbiota could cause malnutrition (SN: 6/4/14). The team has found that malnourished babies lack beneficial gut microbes, and the problem lingers even after the babies are fed foods designed to boost their weight. Those gut microbes are important for metabolism, immunity, digestion and overall development, so the lack of them stymies efforts to help these kids catch up (SN: 6/3/11).
In Bangladesh, Gordon’s team set out to create a microbiome-based food supplement by testing foods common to the local diet and seeing which foods boosted healthy bacteria. The team also tested a way to measure the food’s impact by characterizing the gut bacteria in healthy and malnourished children and developing a pattern of markers in the blood. This pattern let the team understand how undernutrition changes the body, and also track gut microbiome changes.
The researchers then put their food to the test in the Dhaka slum of Mirpur. There, 118 undernourished children ages 12 to 18 months received either the gut microbe–friendly food or a more traditional ready-to-use supplementary food twice a day for three months.
The microbe-friendly food contained fewer calories than the commonly used supplementary food — 204 calories per 50-gram daily dose compared with 247 calories. Even so, researchers used a specialized score to show that children on the microbe-friendly food increased weight-for-length by 0.011 points faster than those given the ready-to-use supplement. If this growth rate was projected out to a year, it would be good enough to move these children into the normal range, says Gordon. Blood markers linked to bone growth, nervous system development and overall health improved. And a stool comparison showed that these children’s microbiomes looked like those of healthy Bangladeshi children. The results suggest the microbe-friendly food could help children’s bodies turn back the clock on the ill effects of undernutrition, the researchers say.
Malnutrition has been around for decades and efforts to combat it haven’t made much of a dent, says Moorthy, who was not involved in the research. “Malnutrition is not just about providing food, no matter how great the food is or about amazing results in trials,” he says. “This is the first step toward understanding some of the biology better and that is key.”
Gordon’s team is now working with nutrition scientists in India and with the WHO to expand the trial to other parts of the world. Back in Dhaka, Ahmed is encouraged by the results. After 35 years of treating children with malnutrition, he says he could see the difference in children taking the microbe-friendly supplement. You can also see it, he says, in the “gratitude and happiness on the face of the mothers.”