Abstract
Child malnutrition remains a critical public health challenge in Sub-Saharan Africa, contributing to linear growth faltering (stunting) and gut microbiome dysbiosis. This double-blind randomized controlled trial evaluated the effects of a micronutrient-fortified sorghum-cowpea complementary food (FSC) compared to a traditional unfortified maize porridge (control) on gut microbiota composition and linear growth in 220 malnourished infants aged 6 to 12 months in rural East Africa over a 6-month intervention period. Anthropometric measurements, including length-for-age Z-scores (LAZ), were assessed monthly, while fecal samples were collected at baseline and 6 months post-intervention for 16S rRNA gene sequencing. Infants receiving FSC exhibited a statistically significant improvement in LAZ compared to the control group (+0.38 vs. +0.09, p < 0.001). Microbiome analysis revealed that FSC consumption led to higher alpha diversity and a significant enrichment in beneficial taxa, particularly Bifidobacterium longum subsp. infantis and Faecalibacterium prausnitzii, along with a marked reduction in pathogenic Enterobacteriaceae. Changes in gut microbiota composition correlated positively with changes in LAZ and reductions in fecal markers of gut inflammation. These findings demonstrate that locally sourced, fortified sorghum-cowpea complementary foods effectively reshape the gut microbiome and promote linear growth in malnourished infants, offering a sustainable, community-based strategy to combat childhood stunting in low-resource settings.
