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When children are severely malnourished, they are not just losing weight.
This disease is wreaking havoc in the body's biological systems, including the microbiome, healthy bacteria, and other microbes that live in our digestive tract. These bacteria count billions of people in each person and include hundreds of different species. They are essential for metabolism, bone growth, brain function, the immune system, and other bodily functions.
In a study published Thursday in the peer-reviewed journal Science, scientists in a renowned microbiology laboratory at the Washington University School of Medicine in St. Louis, report the development of a specialized food designed to rehabilitate intestinal microbes in severely malnourished children, a treatment that should facilitate their immediate recovery and in the long run.
Food – a spoon-fed paste made from chickpeas, soy, peanuts, bananas and a blend of oils and micronutrients – has dramatically improved the health of microbiomes.
Researchers are still working to understand the exact biochemistry that gives some foods a greater impact on microbiome restoration than others. But Lawrence David, one of the leading specialists in intestinal microbes at Duke University School of Medicine and who did not participate in the study, says this research represents unprecedented progress in understanding how what should a healthy intestinal microbiome look like, and how does a disease such as malnutrition affect it. and what interventions could work to repair the damage.
"Their systematic and thoughtful design of the design of this intervention far exceeds the field of skills on the ground," he said. "It's quite remarkable what they did."
According to the World Health Organization, child malnutrition is a critical global health problem that affects more than 150 million children worldwide and accounts for nearly half of the deaths among children under five years.
Treatment is usually based on a diet rich in energy and nutrients. Although some specialized malnutrition recovery foods, such as Plumpy & # 39; nut, have been largely successful in saving lives by promoting rapid weight gain, malnourished children often continue to experience long-term effects. health, says Justin Sonnenburg, microbiologist at Stanford University, who was not badociated with it in the study.
According to Dr. Sonnenburg, more and more medical researchers are saying that many of the effects of malnutrition are disrupted by the number and diversity of species of intestinal microbes. They also increase the risk of long-term diseases, including inflammatory bowel disease, obesity, psoriasis and type 2. Diabetes.
The study, he says, offers the most promising avenue to date for finding clinical treatments specifically designed to treat diseases by strengthening the microbiome.
"What they show well in this study," he says, "is that the modulation of the microbiome is a key element in finding the path to health."
Several years ago, the Washington University microbiologist's lab, Jeffrey Gordon, began collaborating with the International Center for Diarrheal Disease Research in Dhaka, Bangladesh to study the bacterium found in stool samples of healthy children.
Their goal was to paint a picture of a healthy microbiome as it changes – in terms of total amount of bacteria and mixture of different species – during the first two years of the life. Using powerful computer algorithms that have sorted the vast menagerie of microbes from each sample, they have developed a catalog of microbial "signatures", characteristic combinations of microbes that are usually found in children in good condition. health of certain ages.
With this information in hand, they began collecting stool samples from more than 60 children aged 12 to 18 months hospitalized for severe malnutrition (the samples, collected in Dhaka, were frozen and transported to St. Louis). They found that the microbial "signature" in malnourished children was deformed and underdeveloped, lacking the number and diversity of microbes expected for a child of this age.
"It looked like that of a young child," Gordon says.
The researchers wanted to develop specialized foods capable of bringing the microbiome back to its "characteristic" state. To test different possibilities, they transplanted microbes from malnourished children into sterilized laboratory mice, then fed them with a variety of diets to determine which ones promoted healthy microbial growth. They quickly realized that the rice-based foods and lentils commonly used in Dacca to treat malnourished children had little effect on the microbiome.
But they still wanted to use ingredients that would be locally available, cheap and culturally acceptable. As a result, they began systematically testing combinations of different foods commonly used to feed Bangladeshi children, including tilapia, chickpeas, milk powder, potatoes, spinach and pumpkin.
Researchers have developed a prototype combination of chickpeas, peanuts, soy and banana, known as the appetizing appellation of microbiome-2-directed dietary supplement (MDCF-2), which appeared to be very popular. effective to restore the microbiome of the mouse. Subsequent tests in piglets and later in children reproduced the results.
The researchers also took blood samples from malnourished children before and after the test to track the evolution of more than 1,000 essential proteins in order to measure even more accurately the impact of these foods. One group of children received MDCF-2, while other groups received different experimental foods. MDCF-2 was the clear winner.
"MDCF-2 has had a dramatic effect on multiple proteins badociated with bone growth and progression of the metabolic system to a health state," Gordon said.
Regarding his culinary skills, MDCF-2 will probably not win Michelin stars or become a new staple of street food in Dhaka. Gordon says that it was designed to be tolerable by children; it has a consistency similar to chalky peanut butter, he says, and although it is "relatively bland, it is not at all offensive."
According to Gordon, the next challenge is to delve deeper into how the chemical components of different foods interact with the bacteria in the gut microbiome, to understand exactly how the beneficial changes are occurring, and why specific ingredients of MDCF-2 have been found so effective.
A second article published simultaneously by the same group describes a mathematical model that could solve this mystery by helping researchers badyze the astronomical number of chemical reactions that occur when individual microbes interact with other molecules in the body.
According to Gordon, long-term monitoring is also needed to determine if the beneficial impact of the food persists after the children have stopped eating it. He warned that even the best microbiome-based treatment may not be enough to help the most severely malnourished children, who may also need feeding tubes or intravenous nutrient injections. And he says the ingredients may need to be rehabilitated to different local tastes if they are tested elsewhere than in Bangladesh. It may take some time before MDCF-2, or similar foods, become widely available in clinics.
Sonnenburg says the study "raises the bar for what we should try to achieve in studies on the gut microbiome". He opens the door, he says, to further research on the possibility of giving in advance to infants at risk of malnutrition therapeutic foods to strengthen their intestinal microbes, to prevent damage such as problems bone development, brain function, and the immune system.
Tim McDonnell is a journalist specializing in environment, conflict and related issues in sub-Saharan Africa. Follow on Twitter and Instagram.
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