Accepted for/Published in: JMIR Pediatrics and Parenting
Date Submitted: Nov 10, 2025
Open Peer Review Period: Dec 25, 2025 - Feb 25, 2026
Date Accepted: May 12, 2026
(closed for review but you can still tweet)
Clostridium Abundance and Lower Weight-for-Age Z Scores in Six-Month-Old Infants in Coastal Central Sulawesi, Indonesia: A Nested Follow-up Cross-sectional Analysis of a Maternal Supplementation Trial
ABSTRACT
Background:
The gut microbiota plays a crucial role in infant nutrition through its effects on energy metabolism, nutrient absorption, and immune regulation. However, evidence from Indonesian infants remains limited.
Objective:
This study aimed to examine the association between genus-level gut microbiota abundance and weight-for-age Z-scores (WAZ) among six-month-old infants in coastal Banggai District, Central Sulawesi, Indonesia.
Methods:
We conducted a nested follow-up cross-sectional observational analysis of 88 six-month-old infants (42 born to mothers in the MRJ group and 46 in the MMS group) originating from a maternal supplementation trial. Maternal and infant characteristics were collected via structured interviews and standardized anthropometric measurements. WAZ was calculated using WHO Child Growth Standards, and underweight (WAZ < −2 SD) was reported as a secondary indicator. Stool samples were analyzed using genus-specific qPCR to quantify Bifidobacterium, Lactobacillus, Bacteroides, Clostridium, and Escherichia coli (log10 CFU/mL). Associations between bacterial abundance and WAZ were assessed using multivariable linear regression adjusted for maternal supplementation allocation and relevant maternal, environmental, and infant covariates.
Results:
The pooled mean WAZ was −0.47 (SD 1.09), and 7/88 infants (8.0%) were underweight. The combined abundance of beneficial genera was higher than that of opportunistic bacteria (E. coli + Clostridium) (Wilcoxon signed-rank test, P=.0017). Higher Clostridium abundance was inversely associated with WAZ (unadjusted β=−0.094 (95% CI −0.173 to −0.015); P=.021; adjusted β= −0.091 (95% CI −0.172 to −0.010); P=.028). No statistically significant associations were observed for Bifidobacterium, Lactobacillus, Bacteroides, or E. coli in adjusted models.
Conclusions:
Among six-month-old infants in coastal Central Sulawesi, higher genus-level Clostridium abundance was independently associated with lower WAZ. Given the cross-sectional design and genus-level qPCR assessment, temporality and species-level mechanisms cannot be established. Longitudinal studies using more comprehensive microbiome profiling are warranted to clarify potential pathways linking gut microbiota and early-life growth.
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