Assessment of the role of gut health in childhood stunting in a multisite, longitudinal study in India, Indonesia and Senegal: a UKRI GCRF Action Against Stunting Hub protocol.

INTRODUCTION: Childhood stunting has a complex aetiology, with poor gut health being an important contributor. This study will assess inter-relationships between maternal and infant gut health indices and infant linear growth. Inter-relationships between gut health indices, systemic inflammation and growth hormones in early childhood will also be assessed. METHODS AND ANALYSIS: A longitudinal observational study of cohorts of 600 newborns and their mothers in India, Indonesia and Senegal will be conducted. Women will be recruited during pregnancy and their children followed up to age 24 months. Stool, urine and blood samples will be collected from the women and children for assessments of helminthic and protozoal parasites, bacterial pathogens, faecal microbiota taxa, biomarkers of environmental enteric dysfunction, systemic inflammation and growth hormones. Child anthropometric measurements will be collected at birth and at ages 3, 6, 9, 12, 18 and 24 months. The gut health indices will be integrated with cohort data from other Action Against Stunting Hub (AASH) workstreams for interdisciplinary analyses of childhood stunting and the development of a new typology of stunting. DISCUSSION: This study will advance scientific understanding of the role of gut health in childhood stunting and will contribute to a broader knowledge of the complex aetiology of this condition as part of the interdisciplinary AASH research to reduce the global burden of childhood stunting. ETHICS AND DISSEMINATION: This study has been approved by the relevant Ethics Committees in Senegal, India, and Indonesia and LSHTM. The results will be submitted for publication in peer-reviewed journals.

Problem Nutrients and Food-Based Recommendations for Pregnant Women and Under-Five Children in High-Stunting Districts in Indonesia.

Background: Stunting and anemia in pregnant women and under-five children remain a challenge in developing countries, including Indonesia. One of the significant contributors to these problems is inadequate nutrient intake. Objectives: The aim of the study was to identify, using a linear programming (LP) approach, problem nutrients and optimized food-based recommendations for under-five children and pregnant women in 10 stunting-prioritized districts in Indonesia. Methods: LP analysis was done using the Optifood tool on dietary data collected using single 24-h dietary recall in the National Monitoring of Nutrient Consumption (Pemantauan Konsumsi Gizi), conducted by the Ministry of Health from 10 stunting-prioritized districts in Indonesia. Problem nutrients and nutrient-dense foods were identified, and all alternative food-based recommendations or complementary feeding recommendations were compared to identify which recommendation will best contribute to fulfill dietary adequacy. Results: The number of problem nutrients in each district ranged from 0 to 7 nutrients for under-five children and 1 to 6 nutrients for pregnant women. The top 3 problem nutrients were: iron, zinc, and folate (for children aged 6-11 mo); zinc, folate, and calcium (for 12-23-mo-olds and 24-35-mo-olds); folate, zinc, and vitamin C/riboflavin (for 36-59-mo-olds); and iron, folate, and calcium (for pregnant women). The findings showed that problem nutrients identified using LP were in line with nutritional problems in under-five children (stunting and anemia) and pregnant women (anemia). Food-based recommendations (FBRs)/complementary feeding recommendations were developed that best meet dietary adequacy for the nutrients. Conclusions: Despite the similarity in stunting prevalence across the districts, there was variation in number and types of problem nutrients. The developed FBRs that promoted nutrient-dense foods suited to the problem nutrients in each area need to be promoted to improve nutrient intakes of under-five children and pregnant women in these areas with high stunting prevalence.

Goat Milk Yoghurt by Using Lacto-B Culture Modulates the Production of Tumor Necrosis Factor-Alpha and Interleukin-10 in Malnourished Rats.

Total spleen lymphocytes, lymphocyte proliferation, tumor necrosis factor-α (TNF-α), and interleukin-10 (IL-10) in spleen lymphocyte culture were studied in malnourished Wistar rats fed with goat milk yoghurt. Malnourished rats were created by using standard feed restriction as much as 50% of normal rats for 21 d. Goat milk yoghurt containing three types of microorganism e.g., Lactobacillus acidophilus, Sterptococcus thermophilus and Bifidobacterium longum derived from Lacto-B culture in powder form. After 21 d, the rats continued to receive restricted feeding and supplemented with goat milk yoghurt for 7 d. Total splenocytes were counted by hemocytometer. Splenocytes proliferation was expressed as stimulation index, whereas the TNF-α and IL-10 of spleen lymphocyte culture were measured by ELISA technique. The total number of splenocytes and stimulation index of splenocytes in moderate malnourished and normal rats supplemented with goat milk yoghurt was not significantly different. The level of TNF-α in the rat supplemented with goat milk yoghurt was lower (p<0.05) than the control group, whereas the level of IL-10 in the rat supplemented with goat milk yoghurt was higher (p<0.05) than the control group. In conclusion, goat milk yoghurt supplementation in malnourished rats could decrease TNF-α as a representation of the proinflammatory cytokine, while it increases IL-10 as a representation of the anti-inflammatory cytokine.