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)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Clostridium is independently associated with underweight children in coastal areas of Central Sulawesi
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 gut microbiota composition and underweight among infants in coastal areas of Central Sulawesi, Indonesia.
Methods:
A follow-up observational study was conducted among 88 six-month-old infants in coasta areas of Banggai, Central Sulawesi. Maternal and infant characteristics were collected through structured interviews and anthropometric assessments. Weight-for-age Z-scores (WAZ) were calculated based on WHO growth standards, and underweight was defined as WAZ < −2 SD. Fecal samples were analyzed by quantitative PCR to quantify the bacterial genera Bifidobacterium, Lactobacillus, Bacteroides, Clostridium, and Escherichia coli. Group differences were assessed using chi-square, Mann–Whitney U, and Wilcoxon signed-rank tests. Associations between bacterial abundance and WAZ were evaluated using multivariable linear regression, adjusted for relevant maternal, environmental, and infant factors.
Results:
The mean WAZ was −0.47 ± 1.09, and 8.0 % of infants were classified as underweight. Beneficial genera (Bifidobacterium, Lactobacillus) predominated over opportunistic bacteria (Wilcoxon signed-rank, p = 0.0017). Higher Clostridium abundance was inversely associated with WAZ (unadjusted β = −0.094, 95 % CI –0.173 to –0.015; p = 0.021; adjusted β = −0.089, 95 % CI –0.166 to –0.014; p = 0.030). No significant associations were observed for other bacterial genera.
Conclusions:
An increased abundance of Clostridium was independently associated with underweight status among infants in coastal Central Sulawesi. These findings highlight the potential role of gut microbiota imbalance in early growth faltering and support the need for longitudinal studies to clarify causal mechanisms and inform microbiota-targeted nutritional interventions in coastal Indonesian populations.
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