Assessing the Intestinal Microbiota in the SHINE Trial

Abstract

Advances in DNA sequencing technology now allow us to explore the dynamics and functions of the microbes that inhabit the human body, the microbiota. Recent studies involving experimental animal models suggest a role of the gut microbiota in growth. However, the specific changes in the human gut microbiota that contribute to growth remain unclear, and studies investigating the gut microbiota as a determinant of environmental enteric dysfunction (EED) and child stunting are lacking. In this article, we review the evidence for a link between the developing infant gut microbiota, infant feeding, EED, and stunting, and discuss the potential causal pathways relating these variables. We outline the analytic approaches we will use to investigate these relationships, by capitalizing on the longitudinal design and randomized interventions of the Sanitation Hygiene Infant Nutrition Efficacy trial in Zimbabwe.

Keywords: environmental enteric dysfunction; infant; microbiota; stunting.

Figure 1.

Schematic of the 2 hypothesized causal pathways linking the gut microbiota to infant growth faltering. Abbreviation: EED, environmental enteric dysfunction.

Figure 2.

Schematic illustrating the analysis plan for the investigation of the microbiota in early and late infant growth as part of the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial. Abbreviations: EBF, exclusive breastfeeding; EED, environmental enteric dysfunction; MBF, mixed breastfeeding [69]; PBF, partial breastfeeding; WASH, water, sanitation, and hygiene intervention.