Gut Microbiome-Targeted Nutrition Interventions and Growth among Children in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis
Hammond Yaw Addae, Charles Apprey, Alexander Kwarteng
Abstract
BackgroundChildhood malnutrition is a public health challenge of much interest and concern globally. Yet, a perturbed gut microbiome may limit some nutrition interventions' effects among healthy and children with undernutrition.ObjectivesThis review aimed to evaluate the effects of gut microbiome-targeted nutrition interventions on growth outcomes among children (0 to 59 months) using published studies in low- and middle-income countries (LMICs).MethodsThe methods were guided by the Cochrane methodology. The literature search was conducted to include articles published from inception to July 2023 in PubMed, Google Scholar and Cochrane Databases. We identified and included 35 studies among 11,047 children. The analysis was conducted considering various growth parameters in the qualitative synthesis and weight gain (kg) in the meta-analysis.ResultsIn the qualitative synthesis, 55.6% of prebiotics, 66.7% of probiotics, 71.4% of synbiotics and 28.6% of “microbiome complementary feed” studies had significant effects on growth outcome. Also, prebiotics had more studies with significant effects among healthy children while probiotics, synbiotics and ‘microbiome complementary feeds’ had more studies with significant effects among children with undernutrition. Nineteen studies were included in the meta-analyses, of which 7 (36.8%) measured gut microbiome outcomes. The meta-analysis showed that prebiotics exhibited heterogeneity but had significant effects on weight in the intervention as compared to the control [MD: 0.14kg, (95% CI: 0.02; 0.25); I2 = 63%, p = 0.02; 4 studies, n = 932]. Probiotics had significant effects on weight in the intervention [MD: 0.15kg, (95% CI: 0.06; 0.25); I2 = 42%, p = 0.05; 8 studies, n = 2437] as compared to the control. However, synbiotics [MD: 0.26kg, (95% CI: -0.04; 0.56); I2 = 41%, p = 0.17; 4 studies, n = 1896] and “microbiome complementary feed” [MD: -0.03kg, (95% CI: -0.18; 0.11); I2 = 0%, p = 0.60; 3 studies, n = 733] had no significant effects on weight in the intervention as compared to control.ConclusionsAlthough probiotics and synbiotics may be effective at enhancing growth among children, the selection of interventions should be contingent upon health status.Review RegistryThis review was registered with PROSPERO and available at www.crd.york.ac.uk/prospero/as CRD42023434109.