Restitution of gut microbiota in Ugandan children treated for severe acute malnutrition: a randomized controlled study with the probiotics Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis BB-12. Restitution of gut microbiota in Ugandan children treated for severe acute malnutrition: a randomized controlled study with the probiotics Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis BB-12

Background:The elemental causes of malnutrition seem not to be treated sufficiently with current rehabilitation procedures. Recent research indicates that dysbiosis of gut microbiota (GM) may be involved in prevalence of acute malnutrition. Here, we followed the GM evolution during rehabilitation from severe acute malnutrition (SAM) and the impact of probiotics supplementation (Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis BB-12) on GM during inpatient/outpatient treatment.Results: The GM of children showed distinct composition signatures over admission (e.g. Klebsiella spp., and Enterobacteriaceae spp.), discharge (e.g. Clostridiaceae spp., Veilonella dispar), and follow-up (e.g. Lactobacillus ruminis, Blautia spp., Faecalibacterium prausnitzii), reaching similar β- and α-diversity as healthy controls. Diarrhoeic children were characterized by a reduced abundance in Bacteroidaceae, Lachnospiraceae, an increased in Enterobacteriaceae and Moraxellaceae, and lower α-diversity as compared to non-diarrhoeic. Simultaneously, oedematous toddlers had diminished Prevotellaceae, Lachnospiraceae, Ruminoccaceae and a higher α-diversity when compared to non-oedematous. Supplementation of probiotics did not influence β-diversity during discharge or follow-up. However, it increased (p 4.5] during admission/discharge and reduced (p < 0.001) the incidence of days with diarrhoea over the follow-up period, even between “high-responders” and “low-responders”.Conclusions:This study demonstrates that GM composition significantly changes over the rehabilitation period toward a similar apparent composition of healthy controls. Our data shows that non-oedematous and oedematous SAM differ in GM composition, which might have implications for future GM targeted treatments. Furthermore, supplementation of probiotics to the standard treatment protocol SAM reduces the numbers of days with diarrhoea after discharge, indicating a potential direction for future research and management of SAM.