Gut Instincts: Why Breastfeeding Is Critical to Preventing Childhood Malnutrition
What is SAM?
Severe acute malnutrition (SAM) is a critical health issue affecting millions of children worldwide, particularly in low and middle-income countries. According to the World Health Organization (WHO), SAM is characterized by a weight-for-length z-score more than three standard deviations below the median or the presence of nutritional edema. While inadequate food intake and infections are contributors, emerging research highlights the significant role of gut development, especially influenced by breastfeeding, in the onset and progression of SAM.
Malnourished children have gut microbiota that don’t mature properly. Unlike their healthy peers, these children’s microbiomes remain stuck in an immature state. Even when their diets are supplemented with therapeutic foods — which increase calories and nutrients — their gut health doesn’t fully recover. These foods help reduce deaths from starvation, but they don’t fix the deeper issue: an underdeveloped gut ecosystem.
Because gut immaturity in early life has long-term consequences. It doesn’t just slow physical growth. According to research:
“Perhaps more insidious than slowing growth is malnutrition’s effect on less visible aspects of health, including impaired brain development and dysfunctional immunity, which follow these children throughout their lives.”
The Role of Breastfeeding in Gut Development
Breastfeeding is fundamental for the optimal development of an infant’s gut microbiota. Human breast milk contains a complex array of nutrients and bioactive components, including human milk oligosaccharides (HMOs), which promote the growth of beneficial bacteria like Bifidobacterium longum subsp. infantis (B. infantis). These bacteria are crucial for establishing a healthy gut environment, enhancing nutrient absorption, and strengthening the immune system.
In contrast, infants who are not breastfed or are weaned early often exhibit delayed or disrupted gut microbiota development. Studies have shown that such infants have reduced levels of beneficial bacteria and increased colonization by potentially harmful pathogens. This imbalance can impair nutrient absorption and compromise immune defenses, increasing the risk of malnutrition.
Gut Microbiota and Severe Acute Malnutrition
The gut microbiota plays a pivotal role in a child’s nutritional status. In children with SAM, research has identified a significant alteration in gut microbial composition, characterized by decreased diversity and a reduction in beneficial anaerobic bacteria. This dysbiosis leads to impaired digestion and nutrient absorption, exacerbating malnutrition.
Moreover, the absence or low abundance of B. infantis in malnourished infants has been linked to poor growth outcomes. This bacterium is instrumental in metabolizing HMOs and producing short-chain fatty acids, which are vital for gut health and energy provision. Its deficiency underscores the importance of breastfeeding in establishing a beneficial gut microbiota
WHO Guidelines and Interventions
Recognizing the critical role of breastfeeding in preventing and managing SAM, the WHO recommends exclusive breastfeeding for the first six months of life, followed by continued breastfeeding alongside appropriate complementary foods up to two years or beyond. For infants under six months with SAM, the WHO advises inpatient care with a focus on re-establishing breastfeeding. Support for relactation or wet nursing is encouraged when direct breastfeeding is not immediately possible. In cases where breastfeeding cannot be reinitiated, appropriate replacement feeding with close monitoring is recommended. Additionally, interventions targeting the gut microbiota are being explored. Probiotic supplementation, particularly with strains like B. infantis, has shown promise in improving growth outcomes in malnourished children. These approaches aim to restore a healthy gut environment, enhancing nutrient absorption and immune function.
Conclusion
The development of a healthy gut microbiota is essential for a child’s growth and overall health. Breastfeeding plays a crucial role in this process by providing the necessary nutrients and beneficial bacteria to establish a balanced gut environment. Lack of breastfeeding can disrupt gut development, leading to increased susceptibility to infections and malnutrition, including severe acute malnutrition. Therefore, promoting and supporting breastfeeding practices are vital strategies in preventing and managing SAM, as emphasized by WHO guidelines. Continued research into microbiota-targeted interventions offers hope for enhancing treatment outcomes for malnourished children. Integrating these approaches with established nutritional and breastfeeding support can provide a comprehensive strategy to combat SAM and improve child health globally.
In 2005, only 10% of children in the US were breastfed. Only 40% of the world’s children were breastfed in 2005.
Infant Formula Statistics
all infections begin with immune deficiency
For ANY infectious or parasitic disease to start, it is ALWAYS a requisite that the host suffer immunodeficiency. At the same time, infectious and parasitic diseases themselves cause additional immune suppression and more malnutrition. This immune suppression is secondary to the accumulation of free radicals, especially oxidizing species, that occurs during and after infectious and parasitic diseases.
Clinical Aspects of Immunology and Biochem J.
Gut bacterium supports growth in infants with severe acute malnutrition
Severe acute malnutrition (SAM) affects about 18 million children under age 5 worldwide and causes over 3 million deaths each year. While current treatments like high-calorie food and antibiotics can save lives, they don’t fully fix long-term problems like stunted growth, weak immune systems, and poor brain development.
A new 2021 study led by Washington University in St. Louis and researchers in Bangladesh tested a probiotic called Bifidobacterium infantis (B. infantis) in infants with SAM. This healthy gut bacteria usually grows well in breastfed babies but was nearly absent in severely malnourished infants. Adding this probiotic to standard treatment helped infants gain more weight and reduced gut inflammation.
However, the probiotic strain from the U.S. didn’t grow very well in the Bangladeshi infants’ guts. Researchers then found a stronger local strain of B. infantis that digests local foods better. In lab tests on mice, this Bangladeshi strain showed better colonization and improved growth.
The study shows that selecting the right strain of gut bacteria—especially ones adapted to local diets—could help improve treatments for malnourished children and support better long-term recovery.
Source:
Gut bacterium supports growth in infants with severe acute malnutrition
Source:
A microbiome-directed therapeutic food for children recovering from severe acute malnutrition
Building better barriers: how nutrition and undernutrition impact pediatric intestinal health
Gut microbiome development and childhood undernutrition
Malnutrition and Gut Microbiota in Children
Gut bacterium supports growth in infants with severe acute malnutrition
WHO
- Breastfeeding,
- food (security)
- and water security (sanitation)
are major protective factors against malnutrition and critical factors in the maturation of healthy gut microbiota, characterized by a transient bifidobacterial bloom before a global rise in anaerobes. Early depletion in gut Bifidobacterium longum, a typical maternal probiotic, known to inhibit pathogens, represents the first step in gut microbiota alteration associated with severe acute malnutrition (SAM). Later, the absence of the Healthy Mature Anaerobic Gut Microbiota (HMAGM) leads to deficient energy harvest, vitamin biosynthesis and immune protection, and is associated with diarrhea, malabsorption and systemic invasion by microbial pathogens. A therapeutic diet and infection treatment may be unable to restore bifidobacteria and HMAGM.
Gut microbiota and malnutrition
A sparse covarying unit that describes healthy and impaired human gut microbiota development
Immune For Life
M. Ferrari
After decades of chronic health conditions and serious gut issues like IBS and SIBO, immune deficiencies and an autoimmune condition discover how I recovered my health thanks to natural oral immune therapeutics (maf and gcmaf). Due to a premature birth and being formula fed, I was a SAM child in real life. My book is a step by step journey you won't want to miss that illustrates how to regain or maintain health for all ages.