South Africa faces a paradox in terms of food supply. The supermarkets in South Africa are bursting at the seams. It continues to experience high rates of stunted development.
It seems that this is a worldwide problem.
In the past two decades, the world produced more food and wealth. A staggering 150 million under-fives are stunted.
Early-life issues like illness, poor nutrition and unhealthful environments are often the cause of stunted growth and cognitive problems. It has been proven that these impediments in a child’s ability to learn and grow can have long-term effects on their health and economic future.
It is more concerning that it seems that simply putting calories in the mouth isn’t enough to stop stunting. Science points out that our intestinal microbiome, the trillions and trillions of tiny organisms including bacteria, virus and fungi living in us and on us, is responsible for the inability to properly digest food.
A microbiologist, along with a health economics expert published an article in which they outline the emerging evidence that poverty has a profound impact on children’s bodies and not just their ability to access resources. To address childhood stunting, we must move beyond simple interventions like providing food. It is necessary to use integrated strategies that address sanitation, disease control, nutrition and stimulation of early childhood.
The findings of our study support growing evidence from science that both physiologic and environmental factors need to be considered together in order to end the cycle of intergenerational poverty and developmental disabilities. The story isn’t just about nutrition. Gut microbiome is a key player in the digestion of complex carbohydrates, which our bodies are unable to digest.
It converts them into forms we can absorb and use for growth and developmental purposes.
The microbiome unlocks the nutritional potential of the diet, which contributes to the growth and development. It is clear that the microbiome can perform these functions because of the surrounding environment.
Microbes that cause poverty, stunting and disease
The growth of children is affected by their diet, as well as how efficiently they can absorb and process nutrients.
In informal settlements where sanitation standards are generally low, children living there may be exposed to bacteria through toxic dust, dirt and sewage.
The exposure to microorganisms can lead to environmental enteric dysfunction. Inflammation of the intestine can affect absorption, which includes vitamins, fats and proteins.
Stunting is the result. It may go undiagnosed, but it can have a negative impact on health for a lifetime.
It is still unclear whether environmental enteric dysregulation occurs in South Africa. The lack of easily accessible diagnostic tests is one reason. Another reason is that there are no large-scale coordinated studies at national level.
Studies in Asia support the idea that the microbiome may be a major contributor to stunting. The studies indicate that the gut microbiome of healthy infants tends to adhere to predictable milestones in their first two years. If these milestones are not met, the ability of the microbiome to efficiently process food may be compromised. This could have important consequences for growth and development.
Children with severe acute malnutrition, on the other hand, often have an undeveloped gut microbiota that is not responsive to interventions that focus solely on water, hygiene, and sanitation services.
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South African policies don’t connect child nutrition with sanitation
Scientists in Malawi transplanted the gut bacteria of malnourished kids into animals, and found that they developed growth deficiencies. Microbes taken from children who are healthy can restore their growth.
The studies suggest that an unhealthy microbiome may not only be the result of poor growth, but also its cause.
The concept of “a healthy” microbiome is a subject that has received much debate. However, it is becoming increasingly clear that healthy microbiomes have high levels of diversity and are not dominated by one organism. They also show resilience, a capacity to stay stable and can maintain vital functions when the community composition is disturbed or changes.
In studies that examined the small intestine, it was found that bacteria in children with stunted growth were growing on the wrong side of the gut. The bacteria in the gut may affect the way the body digests fat. This could lead to poor growth.
According to other studies, it is not the species present that matters but what microbes can do.
Simply put, the microbiome helps determine whether food consumed by a child is being used to build body tissue or wasted.
Knowledge Gaps
Stunting has been a problem for many years.
First, the traditional interventions were focused on providing food and sanitation but did not understand how biological damage was affecting the absorption of nutrients.
Second, studies in high-income countries where the main constraint may be nutrition are used as evidence. Multiple pathways are involved in the biology of stunting that occurs in low- and middle-income countries.
Geographical research is a part of the solution. Early groundbreaking research came from Asia, South Asia, and a few locations in East Africa and Malawi. The MAL-ED Project and other studies conducted in Bangladesh and large multi-country cohorts have produced strong evidence on enteric pathogens.
Sub-Saharan Africa is underrepresented in long-term microbiome research despite a heavy burden of stunting.
This gap can have real-world consequences. The gut microbiome is known to vary considerably, and can be influenced by a number of factors such as diet and geography.
Different children in different locations have a different diet, different exposures, and different baseline bacteria. In some regions, interventions that are successful may not be effective in other areas.
Answers to your questions
It is important to conduct research led by Africans, which includes sampling children from across the continent.
It is necessary to change the way we approach policy and research.
First, the policymakers must stop considering food availability synonymous with nutrition success. It is important to ensure food security, but this alone will not suffice.
Second, it is important to monitor growth at the primary level of healthcare so that stunting in areas where small stature appears normal can be detected.
Not only should studies measure weight and height, but also gut function. It will reveal who does not benefit from food.
Water, sanitation, and hygiene are all interconnected.
Lastly, fund African research and build African capacities for this.
What science can lead to
The research on the microbiome could change strategies, from focusing solely on treating hunger towards restoring long-term health.
It may, for example be possible to find new microbes which block the absorption of fat or degrade vitamins essential. It may be possible to begin mapping how disruptions early in the life of gut function affect metabolism, and lead to an increased risk for non-communicable disease later on.
It is possible to learn how to use blood or stool markers in order to detect children that, even though they are eating enough, do not gain weight without gut-directed treatment.
