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Trial registered on ANZCTR

Registration number
Ethics application status
Date submitted
Date registered
Date last updated
Type of registration
Retrospectively registered

Titles & IDs
Public title
Effect of resistant starch on fecal pH, short chain fatty acid concentrations, and gut bacteria in a cohort of normal and stunted children in southern India.
Scientific title
Effect of native and acetylated high amylose maize starch on fecal pH, short chain fatty acid concentrations, and microbiota in a cohort of normal and stunted children in southern India.
Secondary ID [1] 293824 0
Nil known
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Environmental Enteropathy 306246 0
Growth faltering/stunting 306248 0
Gut dysbiosis 306254 0
Condition category
Condition code
Oral and Gastrointestinal 305347 305347 0 0
Normal oral and gastrointestinal development and function
Diet and Nutrition 305348 305348 0 0
Other diet and nutrition disorders

Study type
Description of intervention(s) / exposure
Resistant starch as High Amylose Maize Starch (HAMS) was fed to participants for 2 weeks at 10 grams per day followed by normal diet during the 2 week 'washout' period and then a further 2 weeks of 10 grams per day of Resistant Starch as Acetylated High Amylose Maize Starch (HAMSA). The HAMS and HAMSA were incorporated into biscuits and consumed daily by participants under the supervision of study staff.

Intervention code [1] 300081 0
Comparator / control treatment
Active control. Participants acted as their own control with measurements taken at both baseline (before any intervention commenced) and during the washout period in between the intervention periods.
The comparator is both the control and HAMSA and statistical analysis were undertaken separately for both. This enabled us to determine the effect of each individual starch (HAMS or HAMSA) compared to baseline and washout as well as compared to each other for their separate intervention periods.
Control group

Primary outcome [1] 304497 0
pH of fecal samples
Timepoint [1] 304497 0
Assessments of this outcome will occur at day 0 before any feeding intervention and then on 12 subsequent occasions at 3-4 day intervals for 6 weeks.
The primary timepoints are multiple because more than one intervention is being tested (HAMS and HAMSA). Primary timepoints are therefore as follows:
Day 15-End of 14 day HAMS feeding intervention
Day 44-End of 14 day HAMSA feeding intervention
Secondary outcome [1] 342142 0
Concentration of short chain fatty acids (acetate, butyrate and propionate) measured in fecal samples.
Timepoint [1] 342142 0
At days 0 before any feeding intervention and then on 12 subsequent occasions at 3-4 day intervals for 6 weeks.
Secondary outcome [2] 342143 0
Relative abundance of microbiota in fecal samples was determined as follows: Fecal microbiome analysis was performed on fecal samples from a subset of subjects (3 healthy and 3 stunted children). Four fecal samples each were selected from each subject representing basal (day 0), end of HAMS feeding (day 15), end of washout period (day 29), and end of HAMSA feeding (day 44). . Fecal DNA was extracted using PowerSoil DNA isolation kits (Mo Bio Laboratories, Carlsbad, CA, USA) with the modifications as per HMP Manual of Procedures 2010. DNA extracts were treated with RNAse A (PureLink #12091-021, Invitrogen Bioservices, Bangalore, India),, quality checked by electrophoresis and 260/280 ratio on a Nanodrop spectrometer, and quantified fluorimetrically (Qubit, Invitrogen Bioservices, Bangalore, India). One microgram of DNA was fragmented in the range of 300 to 400 bases, and libraries prepared using TruSeq DNA sample preparation kit v2 (Illumina, San Diego, CA, USA) as per manufacturer’s instructions. Twenty four samples of DNA from each of the stool samples were subjected to paired end 100 cycle whole genome sequencing using an Illumina Hiseq 1000 platform at the Centre for Cellular and Molecular Platforms, Bangalore, India. Libraries were sequenced in a paired end 100 base run, using TruSeq SBS Kit v3-HS (FC-401-3001, Illumina, San Diego, CA, USA) according to manufacturer recommended protocols.
Timepoint [2] 342143 0
At days 0 before any feeding intervention and then on 12 subsequent occasions at 3-4 day intervals for 6 weeks.
Secondary outcome [3] 342144 0
Bacterial short chain fatty acid biosynthesis gene profile was determined using bioinformatic processing of shotgun metagenomic sequence data as follows: Illumina paired-end reads were adapter- and quality-filtered using Trimmomatic v0.32, resulting to an average of 248 ± 158 million (mean ± s.d.) reads for each sample. These interleaved reads were used for de novo assembly of contigs of at least 900 bp with IDBA-UD v1.1.1. Gene prediction was performed using MetaGeneMark with genes less than 100 bp discarded. A non-redundant gene catalogue of 2,115,094 genes was constructed using CD-HIT and parameters “-c 0.95 –aS 0.9” (genes with greater than 95% identity and aligned length covering over 90% of the shorter gene were grouped together). The gene catalogue was annotated to the KEGG database (release 2017-04-17) using BLASTP with e-values = 1 × 10-5. High quality reads from each sample were aligned against the gene catalogue using SOAPAligner, and gene-length normalized read counts calculated using soap.coverage. Relative gene abundances were estimated by dividing gene-length normalized read counts by total sample mapped reads. The taxonomic characterization of each sample was determined by mapping high-quality reads from each sample to the clade-specific marker genes database of MetaPhlAn2.
Timepoint [3] 342144 0
At days 0 before any feeding intervention and then on 12 subsequent occasions at 3-4 day intervals for 6 weeks.

Key inclusion criteria
a) Children aged 2-5 years resident in a village in South India (30km from Vellore in the state of Tamil Nadu)
b) Weight for Height score (WHZ) between -2 and +2 standard deviations of World Health Organization standards.
c) Informed written consent obtained from parent

Minimum age
2 Years
Maximum age
5 Years
Both males and females
Can healthy volunteers participate?
Key exclusion criteria
a) Any chronic illness
b) Peripheral edema with WHZ <-2SD or >2 SD of WHO standards

Study design
Purpose of the study
Allocation to intervention
Non-randomised trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?

Intervention assignment
Other design features
Not Applicable
Type of endpoint(s)
Statistical methods / analysis
Previous studies have indicated that fecal pH in healthy Indian children is 6.2 (SD 0.4). Using this standard deviation, and assuming that there is a true difference of 0.4 between baseline and either or both of the two feeding interventions, a sample size of 10 children was calculated for an alpha error of 5% and study power of 80%.

Recruitment status
Date of first participant enrolment
Date of last participant enrolment
Date of last data collection
Sample size
Accrual to date
Recruitment outside Australia
Country [1] 9501 0
State/province [1] 9501 0
Tamil Nadu

Funding & Sponsors
Funding source category [1] 298438 0
Name [1] 298438 0
Bill & Melinda Gates Foundation
Address [1] 298438 0
440 Fifth Avenue North
WA 98109
Country [1] 298438 0
United States of America
Primary sponsor type
Flinders University
Flinders Drive
Bedford Park,
South Australia, 5042
Secondary sponsor category [1] 297580 0
Name [1] 297580 0
Christian Medical College
Address [1] 297580 0
Ida Scudder Road
Tamil Nadu 632004
Country [1] 297580 0

Ethics approval
Ethics application status
Ethics committee name [1] 299433 0
Southern Adelaide Clinical Human Research Ethics Committee
Ethics committee address [1] 299433 0
Flinders Medical Centre
Bedford Park
SA 5042
Ethics committee country [1] 299433 0
Date submitted for ethics approval [1] 299433 0
Approval date [1] 299433 0
Ethics approval number [1] 299433 0
Ethics committee name [2] 299435 0
Institutional Review Board Christian Medical College
Ethics committee address [2] 299435 0
CMC Vellore
Vellore 632002
Ethics committee country [2] 299435 0
Date submitted for ethics approval [2] 299435 0
Approval date [2] 299435 0
Ethics approval number [2] 299435 0
IRM Min No. 7681

Brief summary
Objective: To compare the effects of two types of resistant starch (RS), high amylose maize starch (HAMS) or acetylated HAMS (HAMSA), on fecal indicators of fermentation in stunted and non-stunted (‘healthy’) children in southern India.
Design: Twenty children (10 stunted and 10 healthy) aged 2-to-5 years were fed biscuits containing HAMS (10g/day) for two weeks followed by a 2-week washout and then HAMSA biscuits (10g/day) for 2-weeks. Fecal samples were collected on day 0 and on 12 subsequent occasions at 3-4 day intervals. pH and SCFA were analyzed in all samples, while microbiota were analyzed by Illumina sequencing in 3 children each in stunted and healthy groups.
Trial website
Trial related presentations / publications
Balamurugan, R., Balachandar, G., Dharmalingam, T., Mortimer, E., Gopalsamy, G., Woodman, R.J., et al. (2014). Effect of native and acetylated high amylose maize starch on fecal pH and short chain fatty acid concentrations in a cohort of children in southern India. In Gastroenterology. The American Society for Gastrointestinal Endoscopy Digestive Disease Week. McCormick Place, Chicago, Illinois. May 2014, pp. 482-482.
Public notes
Attachments [1] 2386 2386 0 0
Attachments [2] 2387 2387 0 0

Principal investigator
Name 80386 0
Prof Balakrishnan S Ramakrishna
Address 80386 0
SRM Institutes for Medical Science
No.1, Jawaharlal Nehru Salai,
100 Feet Road,
Chennai, Tamil Nadu 600026
Country 80386 0
Phone 80386 0
+91 9994614890
Fax 80386 0
Email 80386 0
Contact person for public queries
Name 80387 0
Ms Elissa Mortimer
Address 80387 0
3L:100, Flinders Centre for Innovation in Cancer
GPO Box 2100
SA 5001
Country 80387 0
Phone 80387 0
+61 8 8404 2840
Fax 80387 0
Email 80387 0
Contact person for scientific queries
Name 80388 0
Prof Balakrishnan S Ramakrishna
Address 80388 0
SRM Institutes for Medical Science
No.1, Jawaharlal Nehru Salai,
100 Feet Road,
Chennai, Tamil Nadu 600026
Country 80388 0
Phone 80388 0
+91 9994614890
Fax 80388 0
Email 80388 0

No information has been provided regarding IPD availability
Summary results
Have study results been published in a peer-reviewed journal?
Other publications
Have study results been made publicly available in another format?
Results – basic reporting
Results – plain English summary