(P19-053-25) Evaluating the Effects of Rice Bran-Enriched Ready-to-Use-Therapeutic Food on Gut Microbiome in Indonesian Children With Severe Acute Malnutrition

Objectives: In Indonesia, severe acute malnutrition (SAM) affects over 2 million children, but only ~1% receive standard-of-care, including ready-to-use therapeutic foods (RUTFs). SAM delays gut microbiome maturation, impairing nutrient absorption and increasing growth deficits and disease risk. While RUTFs promote weight gain and reduce death rates, recovered children often continue to display harmful gut microbiome composition, increasing the potential for infections and relapse. Rice bran (RB), a low-cost, locally sourced food ingredient, has been shown to promote healthy growth and modulate the gut microbiome. This study examines the impact of adding rice bran to locally produced RUTFs on the gut microbiome of children with SAM.

Methods: Children 6–59 months with uncomplicated SAM or approaching SAM (n=200) were enrolled in a double-blind randomized controlled trial in Jember, Indonesia (CSU IRB #1823; Indonesia IRB #KE/FK/5046/EC; NCT05319717). Participants received either a locally produced RUTF or a locally produced RUTF supplemented with 5% RB daily for 8 weeks, followed by 8 weeks of monitoring. Stool samples were collected at baseline, 4 weeks, 8 weeks, and 16 weeks. 16S rRNA amplicon sequencing was performed to assess gut microbiota composition.

Results: Intention to treat analyses showed significant differences in gut microbiome composition between age groups but not between treatment arms at baseline. Stratification by age showed no significant differences in microbiome composition between treatments in children 24-59 mo. In children 6-23 mo, alpha diversity analyses revealed significant differences in microbiome diversity (Shannons; p=0.047) and richness (Chao1; p=0.043) in the RUTF + RB group at 16 weeks compared to baseline. Beta diversity analyses revealed significant differences in microbiome composition between RUTF + RB and RUTF groups at 8 (p=0.015) and 16 weeks (p.adj=0.006).

Conclusions: RB combined with the local RUTF enhanced gut microbiome diversity, an indicator of gut microbiome maturation and health, in children 6 to 23 months. Incorporating RB, a cost-effective, locally-sourced ingredient, into RUTFs may combat the delayed maturation of gut microbiomes often observed in children with SAM, thereby promoting growth and development during this critical period.

Funding Sources: NIHR21HD113211-01, Thrasher Research Fund