Putting a spotlight on malnutrition in Canada

Dr. Paula Littlejohn is a former member of the lab of Dr. Brett Finlay (MSL Faculty Emeritus), where she completed her PhD research on micronutrient deficiencies and their impact on the gut microbiome, particularly in children. Using different laboratory models to better understand the impacts on physiology and the microbiome, her goal was for this information to help inform the development of better therapies to address malnutrition.

After completing her PhD, she worked with Dr. Bruce Vallance and Dr. Michael Kobor as a postdoctoral fellow at BC Children’s Hospital where she focused on inflammatory bowel disease and the micronutrient deficiencies, epigenetic changes, and dysfunction in the mitochondria that characterize the disease.

Paula now works as a Clinical Research Lead in the Department of Evaluation and Research Services at the Fraser Health Authority, providing strategic and operational leadership for their mobile clinical research unit. Paula is also a member of the pediatric working group at the Canadian Malnutrition Task Force, an organization that aims to build research capacity to address malnutrition. This week they are hosting Canadian Malnutrition Awareness Week to bring attention to malnutrition and how we can work to reduce rates of malnutrition across the country. Having also just published a review on the role of the microbiome in malnutrition, we thought it would be a great time to catch up with Paula about her science journey and the importance of advancing research in this area.

What was the focus of your PhD research?

My PhD thesis was focused on hidden hunger – also known as micronutrient deficiencies – which is a category of malnutrition. I wanted to understand how early micronutrient deficiency impacts the developing microbiome. Scientists from way before I came onto the scene recognized that malnutrition has a microbial component because microbes in the gut get dysregulated, so it’s not just about the absence of nutrients. Up until that point, however, the focus was primarily on protein deficiency, and there was a gap in studying the role of micronutrients that I wanted my work to fill. Specifically, I wanted to understand what role the microbiome plays, what the impacts are, and in particular what this meant in the context of malnutrition in children.

What does a typical day look like in your current role?

No two days look the same because the work that I do is dynamic, responding daily to our priority to build research capacity within Fraser Health. Within the Department of Evaluation and Research Services we align with the belief that “research is care and care is research”, and each day for me is an opportunity to make that a reality – whether building my team, strengthening our core operational standards, forming partnerships, or engaging with our sponsors. Everything I do is part of the goal to strengthen research at Fraser Health, and that’s what makes my work so exciting.

Did you always know you wanted to pursue this career path? If not, when did you change directions?

I was trained, like many PhD students, to look at academia as your career choice, and so that was the path I was on. When this job popped up, it was one of those things where you just can’t stop looking at. I felt conflicted because I really wanted to apply, but I also knew it was a different path to the one I’d been working towards for the past few years. Ultimately what made me decide to apply was, I wanted to have a direct impact. As a basic scientist working at the lab bench on tissue and animal models, you’re more removed from the impact of your work and the actual patient on the other side. In my role now, I’m seeing what’s actually happening with patients and I’m a part of impacted care. With the patients involved in research, we’re able to catch things they typically wouldn’t catch with their primary care doctor because we’re monitoring them differently, and patients love being able to access new resources, therapies, devices, and medications through our research programs. I really love that.

How has your work evolved, from when you started your PhD to now?

My primary focus when I first started my PhD was the gut microbiome, and then malnutrition was an added part of it. Over the years this has switched, where malnutrition is now my primary focus and the gut microbiome is a component of that. This has opened things up so that I can look at malnutrition in different fields. I used to focus on malnutrition in children, but now I’m also exploring how malnutrition takes shape in different diseases. It can be expensive to sequence a patient’s gut microbiome, and we don’t have a way to action things in the clinic based on microbiome sequencing, but looking at malnutrition means generating findings that we can action. I do think that the gut microbiome is still incredibly important, and I really hope that we can start refocusing on it, even using the approach of studying it as a virtual organ to understand it better.

You just published a review paper in Nature Reviews Microbiology that further explores this idea of the gut microbiome as a virtual organ in the context of malnutrition. Can you share more about the study and the shift in perspective that helped frame it?

This paper was a really great way to wrap things up from my PhD work. The field of the gut microbiome in malnutrition has evolved from when I started my PhD just trying to understand what’s going on, to now knowing that it plays a role and wanting to better understand the impact. Looking at all the work that had been done, we wrote this review paper to contextualize the work and shift the focus.

There was a concept that was coined back in 2013, framing the gut microbiome as a virtual organ. As we were writing this paper, one of the reviewers pointed me towards a separate paper that reminded me about this concept, and I thought maybe we could bridge these together to come up with a different framework for the review. So, the question became, what if we looked at the microbiome in malnutrition as a virtual organ? This is similar to how we look at adipose tissue, which we don’t call an organ, but we do know impacts our health and metabolism. If we can look at the microbiome this way, which has the same metabolic impact overall, then we can see it differently in the context of malnutrition: how this organ is being impacted by malnutrition, and how is it also influencing malnutrition in the other direction. We could have a bigger impact on patients by treating it as a whole system, exploring metabolic changes, growth, and a variety of other things we see in malnutrition, rather than narrowing the focus and studying individual microbes.

Why is it important to study these interconnected areas – malnutrition and the gut microbiome?

What I really want to highlight is that the gut microbiome plays such an important role in nutrition as well as in disease, and I think we don’t give it enough attention. We have trillions of microbes in our gut that are metabolically active and impact our health on a daily basis, yet in our current health practices, it’s often ignored. That attention is something I would like to see the needle being moved towards, especially in the clinical space.

The other piece I always try to champion is that malnutrition does happen in Canada in very specific and concrete ways – we’re seeing it show up in our hospitals, and we’re seeing it show up in our communities. While we still need to explore this in different contexts, we are seeing this research area grow, and I’ve found a great community with the Canadian Malnutrition Task Force and NNEdPro who understand this. This week we’ve organized Malnutrition Awareness Week, which is something I would love to see more people attend, because it impacts all of us. Many of us walk around with one or more micronutrient deficiencies, but we don’t associate some of the issues that we see in our bodies with nutritional deficiencies because we’re not taught about it. This is why pushing this message and the research field forward is so important; if we continue to act like it’s not there and it doesn’t exist, then we’re not addressing the needs of the population. I believe Canada has an opportunity right now to lead a fundamental shift in how malnutrition is understood, researched, and addressed in high-income countries, setting a new global standard for recognition, measurement, prevention, and care.