Assessing the Accessibility, Affordability and Cultural Acceptability of Ingredients for Novel Microbiota Directed Complementary Food Development in Bangladesh

Administration of existing therapeutic foods to acutely undernourished children has led to a reduction in mortality but has failed to adequately address the long-term consequences of undernutrition, including stunting, impaired immune function, and reduced cognitive performance. Recent research has identified a causal relationship between healthy development of the gut microbiota over the first 2-3 years of postnatal life and healthy growth; moreover, undernourished children in low-income countries such as Bangladesh exhibit impaired development of their gut community, such that it is considered 'immature' compared to that of age-matched healthy children from the same locale. Using gnotobiotic animals to screen a range of affordable, culturally-acceptable complimentary food ingredients commonly consumed by Bangladeshi children during the weaning period, researchers at Washington University identified several complementary ingredients that were able to promote the expressed beneficial functions of growth-promoting members of the gut microbiota that are underrepresented in children with undernutrition. When locally-produced formulations of these 'microbiota-directed complementary foods' (MDCFs) were tested in a 4-week controlled feeding study in Bangladeshi children with moderate acute malnutrition (MAM), a formulation was identified that repaired microbiota immaturity and produced changes in the levels of growth-associated plasma biomarkers towards those observed in age-matched healthy children. While additional, more extensive, and longer clinical trials are currently ongoing, there are many factors that need to be taken into consideration for an MDCF formulation to be affordable, accessible, and culturally-acceptable to populations with high burdens of undernutrition. Due to the lack of precedence for this scientific approach and the unique considerations that must, therefore, be addressed, this thesis is written as a case study that highlights a framework for how MDCF therapy could be implemented in Bangladesh. The ultimate goal is for this body of work to serve as a framework for adoption by other countries looking to implement MDCFs in the future.