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How twins in Malawi may help in the fight against malnutrition

Across the world, one in four children are stunted, which means they fail to develop properly both mentally and physically.

Over 2 million deaths among children each year (around one third of the global total) have malnutrition as their underlying cause. Yet despite these stark and shocking statistics, progress on stunting and malnutrition has been slow over the last two decades.

International development charities have launched a number of high profile campaigns in 2013 aimed at tackling malnutrition, such as the SOS Children’s Villages ‘IF’ campaign. This helps support feeding programmes for undernourished and vulnerable children in countries such as Niger and Uganda.

Meanwhile, scientists are working to deepen our understanding of stunting and malnutrition. For example, it may appear obvious that the main cause of malnutrition is lack of food. However, this does not explain why some children become more malnourished than others while eating the same food.

In Malawi, scientists have been examining this phenomenon. Over two years, they followed over 300 pairs of Malawian twins who ate the same basic diet. In half of these pairs, the twins managed to thrive. In 7% of cases, both children were found to be malnourished. Most significantly, among the remaining children, one twin managed to do well on their basic diet, while the other twin showed symptoms of malnutrition.

Scientists believe the explanation for this, as reported in a recent article in The Economist, lies in the gut bacteria of individuals. Bacteria play an important role in ensuring food is broken down to provide essential nutrients to the body. But bacteria can also interfere with biochemical processes, such as how the body creates energy from sugar. If a child has the wrong bacteria in their gut, these can inhibit this process and slow down the child’s metabolism.

By studying twins in Malawi, the scientists have been able to show that varying levels of malnutrition in children on the same diet are not due to differences in genetic make-up (since identical twins share all their genes in common). Instead the health of the children reflected differences in the bacterial species of their gut, known as the microbiome. Transplants from well-nourished children into mice showed higher levels of essential amino acids than from children with malnutrition. Scientists therefore believe that in future, there may be some way of improving or ‘rebooting’ a child’s gut microbiome to help combat malnutrition.

However, microbiomic medicine is still at a very early stage. And well before new approaches and techniques can be devised, there is work to do ensuring that all the world’s malnourished children have access to even a ‘basic’ diet all year round.