Synergistic Effects of Standardized Moringa oleifera Leaf Extract and a Probiotic Consortium on Intestinal Permeability and Environmental Enteric Dysfunction Biomarkers in Indonesian Children: A Randomized Controlled Trial
Abstract
Background: Environmental enteric dysfunction (EED) underlies much of the residual stunting and anemia that persist in Indonesian children despite nutrition programs. Moringa oleifera Lam. (Moringaceae) leaves contain quercetin, kaempferol, chlorogenic acid, β-sitosterol and glucomoringin-derived isothiocyanates that reinforce tight junctions and dampen mucosal NF-κB signaling, whereas Lactobacillus and Bifidobacterium probiotics generate short-chain fatty acids and displace enteropathogens.
Objective: To determine whether standardized M. oleifera leaf extract co-administered with a defined probiotic consortium reduces intestinal permeability and EED biomarkers in Indonesian children aged 12–59 months.
Methods: In a three-arm, double-blind, placebo-controlled randomized trial, 150 children aged 12–59 months with biomarker-confirmed EED received, for 12 weeks, either standardized 50% ethanolic M. oleifera leaf extract 500 mg/day plus a probiotic consortium of Lactobacillus rhamnosus GG, Bifidobacterium animalis subsp. lactis Bb-12 and Lactobacillus plantarum Dad-13 (1×1010 CFU/day) [Moringa + Probiotic], M. oleifera plus placebo probiotic [Moringa alone], or double placebo [Placebo]. The primary outcome was the change in the urinary lactulose-to-mannitol (L:M) ratio at week 12.
Results: In intention-to-treat analysis the L:M ratio fell from 0.42 ± 0.09 to 0.18 ± 0.06 with Moringa + Probiotic, from 0.41 ± 0.10 to 0.27 ± 0.08 with Moringa alone and from 0.43 ± 0.09 to 0.39 ±…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 150 participants or records.
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