Milk Matters in malnutrition, is it the lactose or protein?

The objective of this study is to conduct a feeding trial with supplementary foods among moderately malnourished (MAM) children in Sierra Leone to determine if lactose, dairy protein, or both affect weight gain and intestinal permeability. The sub objective will be to elucidate how lactose and milk protein affect the microbiome and fecal metabolomic configuration in moderately malnourished children.

By: Grith Mortensen

The primary outcomes will be the rate of weight gain (g/kg/d) and percent lactulose excretion of the malnourished children. The rate of weight gain will determine which of the four groups has optimal feeding for recovery from moderate malnutrition. The percent of lactulose excretion is a way to determine the intestinal permeability. By comparing intestinal permeability across groups, we will be able to determine which composition of protein and sugar allows for healing of the intestinal tract. The secondary outcomes will be configuration of the microbiome and fecal metabolomic configuration. This will help identify if lactose or dairy protein are important not only for increasing the nutrition of the child but also by creating a healthier, more physiologic microbiome which would prevent the children from relapsing back to moderate malnutrition after their supplemental feeding is completed.

These outcomes are important for the participants as it will elucidate the optimal type of protein and sugar for fastest recovery from malnutrition both in terms of weight gain and healing of the intestinal mucosa. This will impact the future of supplemental feeds for MAM. If the hypothesis - that lactose and dairy protein will both improve time to recovery and contribute to gut health by repairing the intestinal permeability as well as creating a healthier microbiome - holds, then milk proteins and lactose should be incorporated as part of feedings for moderate malnourished children.

This study will determine not only which formulation of sugars and proteins allows for fastest recovery from MAM, but also which formulation restores gut health.

Project: November 2019 -April 2023

Budget: 4,251,192 DKK

Financing: Danish Dairy Research Foundation, Arla Foods/AFI, Washington University 

Project manager: Mark Manary

Institution: Project Peanut Butter, Washington University, Missouri