An alternative oat-containing, ready-to-use, therapeutic food does not alter intestinal permeability or the 16S ribosomal RNA fecal microbiome configuration among children with severe malnutrition in Sierra Leone: A RCT

Authors: HENDRIXSON, D TAYLOR - University Of Washington; NASKIDASHVILI, NINO - Project Peanut Butter; STEPHENSON, KEVIN - Washington University School Of Medicine; LAURY, MARIE - Washington University; KOROMA, AMINATA - Ministry Of Health & Sanitation; MANARY, MARK - Washington University

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/15/2022
Publication Date: 12/12/2022
Citation: Hendrixson, D., Naskidashvili, N., Stephenson, K.B., Laury, M.L., Koroma, A.S., Manary, M.J. 2022. An alternative oat-containing, ready-to-use, therapeutic food does not alter intestinal permeability or the 16S ribosomal RNA fecal microbiome configuration among children with severe malnutrition in Sierra Leone: A Randomized Controlled Trial. Journal of Nutrition. 152:2744-2753. https://doi.org/10.1093/jn/nxac207.
DOI: https://doi.org/10.1093/jn/nxac207

Interpretive Summary: Oat ready-to-use therapeutic food (o-RUTF) has previously shown improved recovery from severe acute malnutrition (SAM) when compared to the standard ready-to-use therapeutic food (s-RUTF) for children in rural Sierra Leone. This clinical trial explored the differences in sugar absorption and 16s rRNA makeup for children who received o-RUTF versus s-RUTF. No differences in sugar absorption or 16s rRNA makeup were found among children with SAM who received these foods.

Technical Abstract: Previously, a novel oat ready-to-use therapeutic food (o-RUTF) resulted in improved recovery from severe acute malnutrition (SAM) when compared to a standard RUTF (s-RUTF). The o-RUTF contained 18% oat, while the s-RUTF has no cereal ingredients. We determined the effects of o-RUTF on intestinal permeability, as measured by lactulose permeability, and the 16S ribosomal RNA (rRNA) fecal microbiome configuration of children with SAM. This was a prospective, randomized, double-blinded, controlled clinical trial. Sierra Leonean children aged 6–59 mo with SAM, defined by a midupper arm circumference < 11.5 cm, were randomized to receive o-RUTF or s-RUTF. All children received 7 d of amoxicillin per guidelines. Lactulose permeability testing and fecal 16S rRNA sequencing were performed at baseline and after 4 wk of therapy. The change in lactulose permeability was the primary outcome, while the fecal 16S rRNA configuration at 4 wk was a secondary outcome. Of the 129 children enrolled, lactulose permeability testing was completed by 100 at baseline and 82 at week 4. After 4 wk of therapeutic feeding, there were no differences in lactulose permeability between the o-RUTF and s-RUTF groups (P = 0.84), and over half of children had increased lactulose permeability (50% s-RUTF compared with 58% o-RUTF, mean difference=-7.5%; 95% CI: -29.2, 15.2; P = 0.50). After 4 wk of feeding, there were no differences in the 16S rRNA configurations between the o-RUTF and s-RUTF groups (Permanova, 999 permutations; P = 0.648; pseudo- F = 0.581), nor were there differences in a or ß diversity. Despite remarkably different compositions of o-RUTF and s-RUTF, no differences were identified in lactulose permeability or the fecal 16S rRNA configuration among childrenwith SAM receiving these foods. These results suggest that the o-RUTF exerts its beneficial effects through mechanisms other than reducing intestinal permeability or altering the fecal 16S configuration.