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Gut damage identified as cause of vaccine failure malnutrition

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Malnutrition in children is a global issue “ in children it defined as children becoming stunted or abnormally short for their age. As per an estimate, even if every nutritional measure known to be helpful were applied to every child in the world, global malnutrition would be decreased by only a third. A new research from the University Of Virginia School Of Medicine, the University of Vermont and the International Centre for Diarrheal Disease Research in Bangladesh explains why it is so. It says infection in the gut causes severe damages and hence, food alone cannot sort the issue of malnutrition. In order to be effective, nutritional therapy must include measures to prevent or treat the damage to the gut of infants.  The findings of the study have been published online in the journal EBiomedicine.

As a part of the research, the researchers enrolled children at birth and their parents from an urban slum in Dhaka, Bangladesh for the last four years. These children were visited in their homes twice a week; they received free medical care and were observed for the development of malnutrition. Despite vaccination, free medical care and nutritional counseling and care, stunting increased from 9.5 percent at enrollment to 27.6 percent at 1 year of age. This confirms a long known fact – malnutrition is extraordinarily difficult to prevent or treat.

Caitlin Naylor, PhD, who conducted this research as part of her PhD dissertation research remarked that the fact that the infants became malnourished despite the best efforts showed what a difficult problem this is to solve. One can size the challenge by the fact that nearly one in four children in the study developed malnutrition by their first birthday. That made the researchers suspect that food was not being properly digested by the children who were becoming stunted. Bill Petri, MD, PhD, chief of the Division of Infectious Diseases and International Health at UVA said that they knew that the children’s intestines were being repeatedly infected, on a near daily basis, which was not the case in infants in Charlottesville as they are rarely infected and do not suffer from malnutrition. Hence, it was decided that the next step would be to see if damage to their gut from infection was causing malnutrition. The team in Bangladesh did the same tests on the children there that are done in children in the U.S. suffering from inflammatory bowel disease. Nearly every child had abnormal results, indicating their guts were damaged.

Rashidul Haque, MD, PhD, director of the field study in Bangladesh opined that children living in poverty have problems not only with nutrition but with vaccination. Oral vaccines to eradicate polio and life-saving rotavirus vaccines are substantially less effective in these children. Since these two vaccines immunize the intestine, it was decided to test if children with the worst gut damage also suffered from vaccine failure. That exactly was found to the case which demonstrates that a damaged gut caused both malnutrition and oral vaccine failure.

The study shows a new way to treat and combat malnutrition. Prevention of intestinal infections is one such approach, and this could be accomplished by improving sanitation, or targeted vaccination or treatment of infections that are most likely to cause damage.

Petri said that the next thing to work on now is to find out if some infections are much more dangerous for the health of the child’s gut, and to understand how these infections are transmitted in order to prevent them. Naylor added that the health of the mother predicts whether a 1-year-old child is malnourished. Maternal nutritional supplementation and prenatal care provides another opportunity for intervention. It was found that the longer that the child suffered from inflammation, the worse was their nutrition, which suggests that the body’s immune response is at the heart of malnutrition and a target for prevention.