Child malnutrition is not only due to a deficit or excess in dietary intake. The intestinal microbiota may also be involved.
Various forms of malnutrition
Child malnutrition includes several nutritional disorders, including undernutrition, overweight/obesity, and deficiencies of certain nutrients or vitamins--with a significant impact on the risk of developing other diseases and the likelihood of survival1 . According to a 2011 WHO study, 115 million children under the age of 5 were underweight. Furthermore, throughout the world, 30% of children are affected by overweight and obesity in countries with emerging economies2. Malnutrition in children may be the cause of 3.1 million deaths each year, thus representing 45% of childhood mortality in 20111.
Intestinal microbiota at fault
Cases of severe acute malnutrition are associated with an inadequate protein intake, oxidative stress, and disruptions in the intestinal microbiota3-5 . Studies have shown intestinal dysbioses in children suffering from acute undernutrition. Furthermore, fecal transplants from these young patients into germ-free mice led to significant weight loss5,6 . These dysbioses concern bacteria, notably the genera Escherichia, Streptococcus, Shigella, Enterobacter and Veillonella, involved in the use of nutrients by the intestine, in the extraction of calories from undigested food, and in the start of infectious processes, particularly enteropathies6,7.
Furthermore, in obese children, a study showed that changes in the intestinal microbiota precede the onset of overweight and obesity8. Dysbiosis can lead to de novo hepatic synthesis of triglycerides and glucose9.
Probiotics as an option
Treatment for undernutrition focuses on the use of ready-to-use therapeutic foods in developing countries10 .The WHO also recommends simultaneous use of broad-spectrum antibiotics, again reinforcing the importance of acting on the flora in these patients. for obesity is based on hygiene/dietary measures.
In the future, identifying the bacteria that promote the proper use of nutrients and adequate weight gain in mothers as well as young children will reduce the risk of malnutrition and the associated morbi-mortality7 . Studies have already shown that the use of certain probiotics can lead to weight gain in children presenting with acute undernutrition11,12, and promote the absorption of micronutrients7,13.
1- Black RE et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013 ; 382 : 427-51.
2- OMS http://www.who.int/mediacentre/factsheets/malnutrition/fr/
3- Ghosh TS et al. Gut microbiomes of Indian children of varying nutritional status. PLoS One 2014 ; 9 : e95547. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0095547
4- Monira S et al. Gut microbiota of healthy and malnourished children in bangladesh. Front Microbiol 2011 ; 2 : 228.
5- Smith MI et al. Gut microbiomes of Malawian twin pairs discordant for kwashiorkor. Science 2013 ; 339 : 548-54 https://www.ncbi.nlm.nih.gov/pubmed/23363771
6- Blanton L et al. Gut bacteria that rescue growth impairments transmitted by immature microbiota from undernourished children. Science. 2016 February 19; 351(6275)
7- Hermann E et al. Healthy gut microbiota can resolve undernutrition. Hepatobiliary Surgery and Nutrition 2017;6:141-143.
8- Kalliomaki M et al. Early differences in fecal microbiota composition in children may predict overweight. Am J Clin Nutr 2008 ; 87 : 534-8. https://www.ncbi.nlm.nih.gov/pubmed/18326589
9- Payne AN et al. The metabolic activity of gut microbiota in obese children is increased compared with normal-weight children and exhibits more exhaustive substrate utilization. Nutr Diabetes 2011 ; 1 : e12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3302137/
10- Collins S et al. Management of severe acute malnutrition in children. Lancet 2006 ; 368 : 1992-2000. https://www.ncbi.nlm.nih.gov/pubmed/17141707
11- Kerac M et al. Probiotics and prebiotics for severe acute malnutrition (PRONUT study): a double-blind efficacy randomised controlled trial in Malawi. Lancet 2009; 374 : 136-44. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60884-9/abstract
12- Angelakis E, Merhej V, Raoult D. Related actions of probiotics and antibiotics on gut microbiota and weight modification. Lancet Infect Dis 2013 ; 13 : 889-99.
13- Sheridan PO et al. Can prebiotics and probiotics improve therapeutic outcomes for undernourished individuals? Gut Microbes 2014 ; 5 : 74-82. https://www.ncbi.nlm.nih.gov/pubmed/24637591