Draft:Microbiota Directed Therapeutic Food

Microbiota directed therapeutic foods are dietary formulations designed to modulate the gut microbiota of malnourished children. Gut microbiota is closely linked to growth and development of young children. Dysbiosis of gut microbiota or immature gut microbial profile is a common phenomenon in children with undernutrition.. . Microbiota directed therapeutic foods are found to be beneficial in improving the components of small intestinal microbiota.

Background
Post-natal human development involves development of microbial communities in different parts of the body including the gut. Diets play a crucial role in the development of intestinal microbiota during early years of life. The interactions between gut microbiome and molecules obtained from dietary ingredients are critical for optimal health. Recent evidence showed that childhood undernutrition characterized by impaired linear and ponderal growth is linked to defects in the development of gut microbiota. Therefore, the treatment of malnutrition needs attention to develop approaches that will help to repair perturbed gut microbiota in undernourished children. The conventional therapeutic foods used to treat children with undernutrition were not developed taking into consideration the developmental biology of the gut microbiota. The microbiota directed therapeutic foods are developed to promote growth in malnourished children through durable repair of the gut microbiome profile.

Microbiota Directed Therapeutic Foods
The microbiota directed therapeutic foods are food formulations that are developed by locally available, culturally acceptable, and affordable dietary ingredients. The ingredients were selected based on commonly consumed complementary foods by children during their transition from breastfeeding to a fully weaned stage.

Composition
The commonly used food ingredients to prepare microbiota directed therapeutic foods are chickpea flour, green banana (plantain), soybean flour, oat flour, millet flour, sweet potato, peanut, sugar, and soybean oil. There is no universally accepted formulation for microbiota directed therapeutic foods. The compositions of microbiota-directed complementary food (MDCF) and microbiota-directed ready to use supplementary food (MD-RUSF) formulations are highlighted in the table.

Delivery method
The microbiota directed therapeutic foods are developed for children with acute malnutrition. Doses depend on age, calorie requirements, and status of malnutrition. Children with moderate acute malnutrition aged between 12 and 18 months received 50 gm daily in a trial conducted in Bangladesh. The formulation was administered orally in two daily servings for 3 months

Effect on growth outcomes
The intervention with microbiota directed therapeutic foods showed promise in improving the growth outcomes in malnourished children. The positive changes in weight-for-length and weight-for-age z scores were observed in children who received the formulation. The receipt of microbiota directed therapeutic foods was also associated with the increase in plasma proteins known as mediators of bone growth and neurodevelopment. The bacterial taxa linked to consumption with microbiota directed therapeutic foods were found to be positively correlated with weight-for-length z score in malnourished children

Examples

 * Microbiota-directed complementary food (MDCF) developed by Tahmeed Ahmed and his team from International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) and scientists from Jeffrey I. Gordon Lab at Washington University in St. Louis, USA.
 * Microbiota-directed ready to use supplementary food (MD-RUSF) developed by scientists from China and Nigeria.