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- 1. The Roles Of Probiotics Supplementation Improving Gut Microbiota in Stunting Children Dr. Tonny C. Maigoda, SKM. MA Nutrition Department, Poltekkes Kemenkes Bengkulu November 15th 2022
- 2. O u t l i n e 01 02 03 04 05 BACKGROUND GUT MICROBIOTA IN EARLY LIFE THE ROLES OF PROBIOTIC , PREBIOTIC, AND SYNBIOTIC SCIENTIFIC FINDING RECOMMENDATION
- 3. BRIEF CURRICULUM VITAE NAMA : Dr. TONNY CORTIS MAIGODA, SKM.MA Email : tonnycmaigoda@yahoo.com tony@poltekkesbengkulu.ac.id Mobile Phone (HP): 085267167398 EDUCATIONAL BACKGROUND 1.NUTRITION ACADEMY, DEP.KES RI PADANG (SUMATERA BARAT), 1987 2.BACHELOR OF PUBLIC HEALTH , UNIVERSITAS INDONESIA (Jakarta), 1996 SUBJECT : COMMUNITY NUTRITION (S1) 3.MASTER DEGREE : INTERPROFESSIONAL HEALTH AND COMMUNITY CARE, BOURNEMOUTH UNIVERSITY, UK-ENGLAND, 2003(S 2/MASTER) 4.P.hD DEGREE : HUMAN NUTRITION , HUMAN ECOLOGY FACULTY, 2016 BOGOR AGRICULTURAL UNIVERSITY 5.Vocational Profession (Registered Dietitian) CURRENT POSITION: A Lecturer in Nutrition Academy, Poltekkes Kemenkes Bengkulu
- 6. The Food and Nutrition Technical Assistance III Project (FA NTA) [2012-2018]
- 7. The Prevalence of Stunted Children in Indonesia (SSGI, 2021)
- 10. Outline 2 Gut Microbiota in Early Life
- 11. Gut Microbiota Scientists define microbiota as โthe assemblage of microorganisms (all the bacteria, archaea, eukaryotes, and viruses) present in a defined environment.โ The term microbiota is thus preceded by the name of the environment in which it is located. For example, โgut microbiotaโ refers to the microbiota in the intestinal tract. The largest microbiota of the human body is found in the gastrointestinal tract (GIT) with about 10.13 โ10.14 microorganisms (Viaola Sent et al, 2020)
- 12. The gut microbiota is the system of microorganisms in a personโs gastrointestinal system. This includes many bacteria, fungi, viruses, and other organisms. The gut microbiota assists in a range of bodily functions : Markus MacGill โ Updated on July 11, 2022 Harvesting energy from digested food Protecting against pathogen Regulating immune function Strengthening biochemical barries of the gut and intestine
- 13. The gut microbiota (GM) is a complex ecological community that influences host physiology and susceptibility to disease through its metabolic activities and interactions with many systems and functions of the host. Alterations of the GM, caused either by environmental or host-related factors, can impair its ability to maintain good health and lead to dysbiosis Dysbiosis, defined as an โimbalanceโ between GM and host, is characterized by a reduction in microbial diversity and/or an increase in proinflammatory species, and has been associated with a plethora of gastro-intestinal-extra-intestinal disorders, such as inflammatory bowel diseases (IBDs), obesity, cancer, malnutrition, and neurological disorders
- 14. The gut microbiota has been shown to play a role in energy metabolism of the host. Dysbiosis of the gut microbiota may predispose to obesity on the one hand, and stunting on the other
- 15. Bifidobacterium spp Ruminococcus spp Faecalibacterium prausnitzii Lactobacillus spp Eubacterium spp Lactobacillus mucosae Bacteroidetes spp Bilophila wadsworthia Clostridioides innocuum Enterobacter spp Streptococcus spp Escherichia spp Malnutrition Wasting / Stunting / Underweight โ Inflammation Status Diet โ Fibre, โ Energi, โ Micronutrients โ SCFA production โ SCFA production Gut Microbiota Shift Source : Iddrisu, 2021. โ Micronutrients extraction
- 16. Factors influencing the gut microbiota in early life. Source: Laursen, 2021
- 17. Maturation of the gut microbiota.
- 18. Mode of feeding influences early infancy microbiota Laursen, 2021
- 19. Sources : Masny, 2022. Selected mechanisms through which gut microbes affect the process of growth in children
- 20. Early colonization of the gastro-intestinal tract in newborns. Source : (M. Tidjani Alou et al, 2016
- 21. Windows of opportunity to enhance growth may also exist beyond the first 1000 days The assembly and maturation of the gut microbiota has largely occurred by the age of 2 or 3years, hence strategies to target the gut microbiota after this period may have less impact. However, the periconceptional period in adolescent females, beginning 14 weeks prior to conception, may represent an additional window of opportunity in which to optimize nutrition and the gut microbiota , which may have significant benefits for health and nutrition behaviors, suggesting potential for microbiota-targeted therapies as well
- 22. Key Bacterial at Different Stages of 1000 Days That Contribute to Healthy versus Undernourished Growth. Source : Ruairi C. Robertson et al. 2019
- 23. The Pathways by Which Microbes in the Intestinal Lumen Interact with Host Growth in Healthy versus Malnourished Children.
- 24. Complementary feeding increases gut microbial diversity and production of BCFAs and SCFAs with potential implication for growth, neuro, bone, and immune development Source : Laursen, 2021
- 25. Conceptual model describing how the maternal gut microbiome may mediate effects of malnutrition on early neurodevelopment. Source : EJL. Coley, 2021
- 26. Outline 3 THE ROLES OF PROBIOTIC , PREBIOTIC, AND SYNBIOTIC
- 27. Impaired development of the gut microbiota causes stunted children to have an immature gut microbiota as compared with nonstunted children of the same age. The evidence for a causal role of the gut microbiota in delayed growth is increasing. An immature and less diverse microbiota, which is often present in children with delayed growth, may reduce or prevent the success of nutritional interventions aiming to promote growth Therefore, in recent decades the scientific focus has shifted to interventions targeting the gut microbiota such as probiotics, prebiotics, and synbiotics because they may have the potential to address stunting effectively
- 28. A probiotic contains live microorganisms which, when administered in adequate amounts, confer a health benefit on the host . Probiotics are strain-specific and can result in different health benefits. They may improve child growth through modulation of the gut microbiota and immune system, inhibition of pathogen growth, prevention of infections, lowering diarrhea incidence, improvement of the absorption of energy, and improvement of the absorption of several micronutrients PROBIOTICS
- 29. A prebiotic is a substrate that is selectively utilized by host microorganisms conferring a health benefit. Prebiotics promote the growth of โฅ1 specific bacteria, mainly bifidobacteria and lactobacilli, leading to among other things the production of SCFAs which inhibit pathogen growth. In addition, prebiotics enhance the uptake of micronutrients, delay gastric emptying, improve gut barrier function, and modulate the immune system PREBIOTICS
- 30. A synbiotic is a mixture comprising live microorganisms and substrates selectively utilized by host microorganisms that confers a health benefit on the host. The beneficial effects of prebiotics and probiotics taken separately may be enhanced further if combined SYNBIOTICS
- 32. Manuscript received May 18, 2021. Initial review completed July 19, 2021. Revision accepted September 22, 2021. Published online September 29, 2021. doi: https://doi.org/10.1093/cdn/nzab124
- 37. โข The 11 studies gave little evidence that probiotics affect the growth of children when compared with control. A higher percentage of studies including undernourished children showed an effect than of studies including healthy children. โข Probiotics may be more effective in undernourished children than in healthy children, because they may restore their dysbiotic microbiota, affecting growth โข A limitation of the probiotic analysis was that antibiotic usage was not taken into account owing to the small number of included studies, yet this could affect the outcomes. Antibiotics reduce gut colonization and hence the efficacy of probiotics MAIN FINDING PROBIOTICS
- 38. โข The 6 identified studies in the current review did not show an effect of prebiotics on any of the growth outcomes of children living in LMICs โข To date, no reviews are available concerning the effects of prebiotics on the growth of children living in LMICs โข Most research is performed on healthy infants living in high-income countries. โข In the meta-analysis by Mugambi et al. 2012, prebiotics significantly increased weight gain of full-term healthy infants aged 0โ1 y as compared with control โข The effect of prebiotics in healthy children might be different than in undernourished children, because undernourished children have immature, less diverse, and dysbiotic gut microbiota โข No evidence for the effect of prebiotics in undernourished children from a well- powered study is present MAIN FINDING PREBIOTICS
- 39. โข The 4 included studies showed overall a beneficial effect of synbiotics on growth outcomes, especially weight โข In contrast, these studies did not show an increase in height or weight of full-term infants โข This difference in outcome compared with our study could be explained by the fact that our review only included studies in LMICs, where the potential of synbiotics might be larger than in developed countries owing to the environment and other related factors. MAIN FINDING SYNBIOTICS
- 41. RECOMMENDATION โข This review indicated that, to date, overall no firm conclusions can be made about the effect of probiotics, prebiotics, and synbiotics on the growth of children living in Low Middle Income Countries (LMICs) owing to high heterogeneity, the limited number of studies present, and the low certainty of the evidence โข More research is required to further investigate the efficacy of gut-targeted nutritional interventions on growth in children living in Low Middle Income Countries.(LMICs) โข As a next step, it would be of interest to include promising gut-targeted interventions in combination with proven nutrition or water, sanitation, and hygiene (WASH) interventions to assess whether these have additional or synergistic effects on growth outcomes โข Specific attention should be paid to the role of the microbiota, antibiotic use, and the initial nutritional and health status of the children. โข Proper and balanced nutrient intake is expected to maintain the composition of the protective gut microbiota and result in beneficial interaction
Editor's Notes
- Assalamualaikum WW. Good Morning, Thanks for giving me an opportunity to deliver my presentation entitled โ The Roles of Probiotics Supplementation Improving Gut Microbiota in Stunting Childrenโ
- I would like to convey a brief outline of my presentation
- This is my brief CV
- Letโs strat from the Global situation of stunting. UNICEF/WHO/ World Bank Group Joint Malnutrition reported that was about 149 Million Children Stunted Globally in 2020
- How about in Asia, According to FANTA III Project mentioned that is about 5- 10 million stunted children in 11 countries in Asia, Including Indonesia
- The highest percentage of stunted childred spread out in Aceh, West Nusa Tenggara, East Nusa Tenggara, South Kalimantan, west sulawesi, Southeast Sulawesi , west Nusa Tenggara, and East Nusa Tenggara which were 30 โ 39 %
- Look at this picture. There are two children on the same age but with different High. A child on the left is using school uniform, but another one is none. Therefore, stunting is not merely about short stature performance but is regarding cognitive capacity impairment as well .
- The consequences of malnutrition especially stunting due to Short term impact and long term impact. Therefore early diagnose and prompt treatment of stunting Children can avoid from these Consequences
- Scientist define ...........The largest microbiota of the Human Gut is found in the Gastrointestinal Tract (GIT) with about from 10 to the power of 13 to 10 to the power of 14 microorganism
- There are at least four functions of the Gut Microbiota in the body such as :
- Dysbiosis, reduced diversity in the gut microbial community, or microbial immaturity are involved in several intestinal and metabolic diseases that affect growth. It is essential that an intense increases in body size, especially in infancy, occur in parallel with the dynamic succession of gut microbiota.
- The gut microbiota has close links to food digestion, absorption and intestinal function. Persistent undernutrition in childhood will alter the normal (healthy) composition of the intestinal (or gut) microbiota, leading to dysbiosis . Vice versa, gut microbiota dysbiosis is associated with malnutrition and reduced plasma essential amino acid levels. Metabolites produced by the gut microbiota have been shown to play a role in weight regulation, particularly the short-chain fatty acids (SCFA) . Also, in stunting, an altered gut microbiota is linked to the pathophysiology of stunting. This alteration may even be detected prior to actually observing stunted growth between 6 and 23 months of life.
- This is an existing condiotion the gut microbiota in Malnutrition Children. Summary of changes in the gut microbiota associated with childhood malnutrition and key factors linked with such changes. Red arrows indicate factors that increase or decrease during childhood malnutrition (Iddrisu, 2021). The Shipt of Gut Micobiota in malnourished children is unstable due to Dysbiosis, because the number of comensen gut microbiota is falling down and the pathogen microbiota is going up.
- Gut microbiota vary by term of birth, mode of birth, oral antibiotics, mode of feeding, maternal diet, presence of furred pets, host genetics, presence of siblings and family members, complementary diet, and local environment, such as urban versus rural and geographical location/ population. Mode of milk feeding and complementary diet has been identified as the strongest determinants of infant gut micro- biota composition as indicated by the arrow sizes (Laursen, 2021). Impaired development of the gut microbiota causes stunted children to have an immature gut microbiota as compared with children of the same age
- Maturation of the gut microbiota. The composition of the gut microbiota in children varies greatly during the first year of life before reaching a more stable and mature composition. Maturation into an adult state is due to several factors such as genetics, environment, gut physiology and diet M. Tidjani Alou et al, 2016).
- In addition, Mode of feeding influences early infancy microbiota and sac- charolytic versus proteolytic fermentation in the gut with potential implications for health. a Breast milk contains HMOs, which upon ingestion by the infant pass undigested through the upper GI tract until they reach the colon. Here, they are digested by specific HMO- degrading Bifidobacterium species into various metabolites with potential beneficial health effects. b Formula milk contain excess proteins, some of which, upon ingestion, is incompletely digested and absorbed in the upper GI tract and reaches the colon. Partly digested protein, peptides, and individual amino acids are metabolized by gut microbes, including opportunistic pathogenic bacteria, such as Clostridium and Enterobacteriaceae species, yielding various amino acid catabolites, some of which have potential detrimental health effects. (Laursen, 2021).
- The mediating role of intestinal microbiota in child growth consists of participation in metabolic pro cesses through the production of biologically active metabolites, mainly short-chain fatty acids (SCFAs) in the metabolism of human milk oligosaccharides (HMO) and bile acids (Bas), participation in the hormonal activity of the host through indirect impact on the hormone levels, including insulin-like growth factor-1 (IGF-1), peptide YY (PYY), glucagon-like peptide-1 (GLP-1), or serotonin (5HT), and stimulation of the innate immune system, as well as the initiation of the inflammatory process (through the synthesis of lipopolysaccharides, LPS) (Masny, 2022).
- Early colonization of the gastro-intestinal tract in newborns. Early colonizers of the gastrointestinal tract are specific to the type of delivery. In the case of a vaginal delivery, early colonizers originate from the motherโs vaginal and fecal microbiota whereas for Cesar -sections, early colonizers belong to the environment of birth and the motherโs skin microbiota. Breast milk microbiota also colonizes the gastrointestinal of newborns (M. Tidjani Alou et al, 2016
- This is an interesting review artcle written by Ruari et al 2019 mentioned that ...
- This is the difference pathway of healthy and undernourished growth. Current evidence suggests that a number of bacterial signatures are associated with either undernutrition or healthy growth during the first 1000 days. During pregnancy, a vaginal microbiota with low diversity and rich in Lactobacillus is associated with term birth and normal birth weight in high-income settings. Healthy growth is associated with greater Bifidobacterium longum and Streptococcus thermophilus in the first 6 months of life, which are less prevalent in early-life undernutrition. Breastfeeding during this period is associated with greater Bacteroides and Bifidobacterium with healthy growth, while Escherichia coli, Staphylococcus aureus and other species are associated with severe acute malnutrition.
- This is mechanism of Microbes in the Intestinal Lumen interact with Growth. The commensal gut microbiota regulates a number of processes that affect child growth in the first 1000 days. The structural and functional integrity of the intestinal barrier (mucus layer, antimicrobial peptides, epithelium and tight junctions) is tightly regulated by gut microbial composition in healthy infants but becomes perturbed in undernutrition. A healthy microbiome also provides colonization resistance against invading pathogens. The interaction between the commensal microbiome and the innate immune system maintains immune homeostasis and recognition of antigens.. The microbiome plays a critical role in nutrient and host metabolism, thereby affecting digestion, absorption, and energy storage. A dysbiotic microbiome in early life may impair each of these pathways related to growth whereby an immature microbiota fails to protect the intestinal barrier leading to villous blunting, mucus degradation, intestinal permeability, and impaired immune responses. These intestinal impairments may contribute to environmental enteric dysfunction (EED), chronic systemic inflammation, infectious morbidity and diarrhea, each of which may impair the trajectories of growth. A disturbed gut microbiota composition may impair the normal production of growth hormones. Both SAM (Severe acute malnutrition) and stunting are associated with disturbed host metabolic phenotypes, particularly energy metabolism, nutrient metabolism, and amino acid turnover .
- Complementary feeding increases gut microbial diversity and production of BCFAs (branched short-chain fatty acidsย ) and SCFAs (ย short chain fatty acids) with potential implica- tion for growth, neuro, bone, and immune development. As complementary feeding progresses, the milk-based component is gradually replaced by other foods such as meats and dairy, fruits and vegetables, and bread and cereals, which are directly and possibly indirectly (through the gut microbiota) impacting growth and devel- opment. These foods contain protein and dietary fibers that modulate the infant gut microbiota, increasing alpha diversity and the abundance of key bacterial families that produce SCFAs (note that acetate is also produced in high amount during early infancy) and BCFAs during comple- mentary feeding (Laursen, 2021).
- Conceptual model describing how the maternal gut microbiome may mediate effects of malnutrition on early neurodevelopment. Panel 1: both over- and undernutrition, and alterations in ratios of macro- or micronutrients, lead to perturbations in the maternal microbiome during gestation. These perturbations include alterations in diversity and relative abundances of specific taxa. Panel 2: changes in maternal nutrition effects circulating biomolecules, immune homeostasis, and endocrine function. These changes may be mediated by observed shifts in the maternal microbiome. Panel 3: these changes in maternal biology can in turn directly or indirectly impact the fetus, including the developing fetal brain (E.J.L. Coley, 2021).
- The objective of this systematic literature review was to evaluate the efficacy of probiotic, prebiotic, and synbiotic interventions compared with control on improving growth outcomes of children living in low- and middle-income countries (LMICs).
- Based on this review article there is a different roles of Probiotics, prebiotics and synbiotics in improving balance of gut microbiota in order to keep healthy Gastro Intetine Tract (GIT). Firstly, ...
- Secondly Prebiotics Roles , There are 6 ....
- Lastly, Synbiotics
- Thank you so much for your participation in this seminar , and see you in another seminar and have a nice day