Dietary fiber favorably modulates gut microbiota and may be protective against
diarrhea in sub-Saharan Africa where rates in infants and young children are high.
Soybean hull is high in fiber and accessible in rural Africa; however, its use in
complementary feeding has not been evaluated. The objective of this study was to
determine the acceptability and feasibility of a soybean, soy hull fiber, and maize
(SFM) blend food; the primary outcome was compliance to the feeding protocol.
Secondary outcomes were stool form and frequency, fecal microbiota composition,
growth and dietary intake. In a parallel, single-blind study, children 6-36 months of age
from the Lilongwe district of Malawi were randomized to receive daily SFM (n=69) or
maize only (n=10) porridge (
phala) for 6 months. Anthropometrics were measured
monthly, and compliance, stool frequency, and stool form, weekly. At baseline, 3-month, and 6-month (study end) time points, dietary intake (24-h recall) was assessed,
and fecal samples were collected. Fecal DNA was analyzed by Real-Time polymerase
chain reaction (PCR) for microbes of interest and 16S rRNA gene amplicon
sequencing. Mothers accessed the acceptability and feasibility of the study foods at
study end. Mothers reported excellent compliance to feeding the SFM porridge, rated it
more acceptable than maize, and noted improved appetite, weight, and stool
consistency of their children. Stool frequency at baseline (2±1 stools/d) was unchanged
with intervention; however, there were significantly fewer diarrhea-type stools reported
during study months 4-6
vs. 1-3 for the SFM group, whereas no improvement was seen
for the maize group. At study end, the fecal abundance of
Akkermansia muciniphila
was enriched in children receiving the SFM, compared to maize (p<0.05), and a trend
for increased
Faecalibacterium prausnitzii
(p=0.07) was seen. A comparison of fecal
microbiota composition using linear discriminant analysis effect size (LEfSe) showed
notable differences in numerous taxa in the SFM group compared to baseline, whereas
the maize comparator exhibited fewer changes. Fiber intake was higher for the SFM
group, compared to maize at 6 months (13.7±3.8 vs. 8.4±4.5 g/day, p<0.01). Weight-for-height and BMI-for-age Z-scores were significantly higher for the SFM group. In
young Malawian children, feeding a blend of soybean, soy hulls and maize reduced
diarrhea-type stools and increased the abundance of
Akkermansia muciniphila, a
bacterial species involved in maintaining intestinal health, and thus may provide a
feasible means of improving wellness in children in resource-poor settings through the
modulation of microbiota composition.
