The Medical School’s Foundation for the National Institutes of Health recently received a $30 million grant from the Bill and Melinda Gates Foundation to participate in a five-year study about the causes of malnutrition in developing countries and its effects on children.
Mortality rates in developing countries have subsided in recent years, but the problem of malnutrition still has not been resolved, said Richard Guerrant, director of the University’s Center for Global Health and the study’s lead researcher.
“Good water and sanitation is actually worth twice as much as we had ever calculated before,” Guerrant said.
Guerrant said though oral rehydration work has reduced the number of deaths from diarrhea in developing countries, many children still are experiencing repeated episodes of diarrhea. As a result, these children tend to have both stunted growth and cognitive development. Unfortunately, it is difficult to find a treatment.
To find a treatment, scientists first must find the causes of malnutrition in some children and not others. To answer this question, the study funded by the new grant will test three hypotheses, said William Petri, chief of the Division of Infectious Diseases and International Health at the Medical School.
The first hypothesis — which Guerrant proposed — is that children with more instances of diarrhea are likely to be stunted because diarrhea blocks absorption of food, Petri said.
The second hypothesis is that bacteria in the gut differ between the malnourished and well-nourished, Petri said. If true, this would mean that the bacteria in well-nourished children are more effective at digesting meals than the bacteria in malnourished children.
The third hypothesis is that malnourished children are genetically different from well-nourished children, Petri said.
He explained that these hypotheses will be tested through work in eight field sites around the world. Sites in Bangladesh, Brazil, Tanzania and South Africa will be run by University researchers, Petri said, while researchers from institutions like Johns Hopkins University and Washington University will run sites in India, Nepal, Peru and Pakistan.
Guerrant said the studies will benefit from new tools and technology.
“Diarrheal diseases will be detected by technology we did not have even a year ago,” Petri said. Recent technological innovations will also be used in the intestinal microbe study and the genome scans, Petri said.
The new technologies provide the researchers with an excellent opportunity to figure out solutions for malnutrition, Petri said.
“The expectation is that if you understand those [genetic] pathways ... you can make drugs to modify [their effects],” Petri said. He also said he thinks that differences between the intestinal flora of malnourished and well-nourished children could be treated with probiotic cultures. By ingesting these cultures, malnourished children could develop an intestinal flora more similar to that of well-nourished children, Petri said.
“Forty percent of children in the developing world are malnourished, and probably at least half of all deaths of children under 5 can be attributed to malnutrition,” Petri said, adding that most deaths from diseases like malaria disproportionately affect malnourished children.
“It’s proven very difficult to treat malnutrition in Bangladesh and other countries ... because giving additional food is not sufficient to prevent stunting,” Petri said. Studies have found that some children will suffer from malnutrition and others will not, regardless of similar childhoods.
“When you think about that, it’s completely counterintuitive,” Petri said. “What is different about that child who became stunted versus the one who was in the same environment and became healthy?”
Finding the reasons behind this situation may uncover previously unknown factors that may have a large influence on nutrition and childhood development, Guerrant and Petri said.
“That is what [is exciting],” Guerrant said, “... because if repeated intestinal infections are causing these long-term developmental consequences for children, then that becomes far more important than we realized.”
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