GUT MICROBIOME

The gut microbiome plays a crucial role in the body's function. It affects health in numerous ways, including brain function. In paediatric health, the relationship between the gut and bone health is being recognised as an important part of early development.

During NNI Workshop 102, Nicolas Bonnet’s presentation titled Impact of Gut Microbiome on Child Musculoskeletal Health and Development highlights a system where the gut microbiome directly impacts bone quality and muscle strength in early childhood.

Bone development is most crucial in toddlerhood. During this phase, two processes are important:

• Endochondral Ossification: Drives bone length and contributes to height and Intramembranous
• Ossification:  Builds bone strength through geometry and mineral density

Although bone length is continuous from birth, bone quality follows a U-shaped path, reaching the critical "curvature point" occurring between 4 and 6 months. The time frame is significant, as it coincides with changes in the gut microbiome, including changes in bacterial populations like Bifidobacterium and Bacteroides, and the production of essential microbial metabolites such as short-chain fatty acids (SCFAs).

The bone and gut axis is explained by four mechanisms:

• Metabolite Production: Bacteria produce SCFAs and other metabolites to support bone and muscle function
• pH Regulation: gut bacteria activity changes gut pH, improving calcium and magnesium absorption
• Hormonal Modulation: Gut bacteria regulate hormones, including serotonin and GLP-1, influencing bone and muscle tissue development.
• Immune Response: A healthy gut microbiome reduces systemic inflammation that can impair musculoskeletal development

Studies conducted in Filipino toddlers aged 2-3 years provided the first clinical evidence of the gut-musculoskeletal axis concept. The study compared three groups: children on their normal diet, those receiving formula, and those receiving a specialised young child formula with a symbiotic combination of Lactobacillus reuteri, GOS, calcium, and essential minerals.

The results found that the symbiotic group showed improvements in musculoskeletal health. Their tibia bone quality showed significant development at both three and six months. Additionally, their muscle strength saw a considerable boost, as illustrated by a significant improvement in grip strength. Bone turnover markers were also improved, indicating active and healthy musculoskeletal development.

Favourable gut microbiome changes, including rapid colonisation by Lactobacillus reuteri and an increased production of beneficial metabolites, accompanied these positive changes.

This study indicates new insights about nutrition, gut microbiome and bone development in toddlers. For healthcare professionals, this offers ways to better treat patients at this critical age of development. Bonnet suggests the following:

• Early Intervention: The critical period between 4-6 months of age represents a key window for gut microbiome-targeted intervention
• Comprehensive Approach: Successful interventions require carefully designed combinations of probiotics, prebiotics, and supporting nutrients rather than single-component strategies
• Long-term Perspective: Early gut microbiome optimisation may have lasting effects on musculoskeletal health throughout life.
• Personalised Nutrition: Future approaches may need to consider individual microbiome profiles for optimal effectiveness

With all this new information, the role played by nutrition and how it shapes the gut microbiota cannot be underestimated. The guidelines shared on how to best facilitate the development of gut microbiota can be applied by healthcare professionals to improve their daily practice.

For more resources on the instrumental role played by the microbiome. You can visit these resources on our website.