Cited by 172Infant Nutrition and HealthGut microbiota and healthChild Nutrition and Water Access

Prebiotic Galacto-Oligosaccharides Mitigate the Adverse Effects of Iron Fortification on the Gut Microbiome: A Randomised Controlled Study in Kenyan Infants

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Paganini, Daniela, Uyoga, Mary A, Kortman, Guus A M, Cercamondi, Colin I, Moretti, Diego, Barth-Jaeggi, Tanja, Schwab, Clarissa, Boekhorst, Jos +4 more·2017·Gut

Abstract

Objective: Iron-containing micronutrient powders (MNPs) reduce anaemia in African infants, but the current high iron dose (12.5 mg/day) may decrease gut Bifidobacteriaceae and Lactobacillaceae , and increase enteropathogens, diarrhoea and respiratory tract infections (RTIs). We evaluated the efficacy and safety of a new MNP formula with prebiotic galacto-oligosaccharides (GOS) combined with a low dose (5 mg/day) of highly bioavailable iron. Design: In a 4-month, controlled, double-blind trial, we randomised Kenyan infants aged 6.5–9.5 months (n=155) to receive daily (1) a MNP without iron (control); (2) the identical MNP but with 5 mg iron (2.5 mg as sodium iron ethylenediaminetetraacetate and 2.5 mg as ferrous fumarate) (Fe group); or (3) the identical MNP as the Fe group but with 7.5 g GOS (FeGOS group). Results: Anaemia decreased by ≈50% in the Fe and FeGOS groups (p<0.001). Compared with the control or FeGOS group, in the Fe group there were (1) lower abundances of Bifidobacterium and Lactobacillus and higher abundances of Clostridiales (p<0.01); (2) higher abundances of virulence and toxin genes (VTGs) of pathogens (p<0.01); (3) higher plasma intestinal fatty acid-binding protein (a biomarker of enterocyte damage) (p<0.05); and (4) a higher incidence of treated RTIs (p<0.05). In contrast, there were no significant differences in these variables comparing the control and FeGOS groups, with the exception that the abundance of VTGs of all pathogens was significantly lower in the FeGOS group compared with the control and Fe groups (p<0.01). Conclusion: A MNP containing a low dose of highly bioavailable iron reduces anaemia, and the addition of GOS mitigates most of the adverse effects of iron on the gut microbiome and morbidity in African infants. Trial registration number: NCT02118402.

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  • Galacto-oligosaccharides and probiotics decrease the pH of the intestines, which aids iron absorption, in addition to enhancing commensal bacteria to protect against enteropathogens, which prevents colonisation and overgrowth.

    “This is because GOS and probiotics decrease the pH of the intestines, which aids iron absorption [52] in addition to enhancing the commensal bacteria to protect against enteropathogens, which prevents colonisation and overgrowth [51].”

    From Oral Iron Supplementation—Gastrointestinal Side Effects and the Impact on the Gut Microbiota (2021) · cites this paper as [51]

    The Gut microbiota and Discussion sections say GOS promotes commensal bacteria and lowers luminal pH; the Discussion also describes a barrier against enteropathogen growth and reports lower pathogen-gene abundance in the GOS group. The paper does not say that the lower pH aids iron absorption, and its intervention tested GOS, not probiotics. Page numbers are unavailable in our copy. (LLM, conf=0.88)

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  • Studies supplementing Kenyan infants with an iron-containing micronutrient powder with and without the prebiotic galacto-oligosaccharides found that galacto-oligosaccharides mitigated adverse effects of iron on the gut microbiota.

    “studies investigating supplementing Kenyan infants with an iron-containing micronutrient powder with and without the prebiotic galacto-oligosaccharides (GOS) found GOS mitigated adverse effects of iron on the gut microbiota [51].”

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Authors
Paganini, D., Uyoga, M. A., Kortman, G. A. M., Cercamondi, C. I., Moretti, D., Barth-Jaeggi, T., Schwab, C., Boekhorst, J., Timmerman, H. M., Lacroix, C., Karanja, S., & Zimmermann, M. B.
Affiliations
  • ETH Zurich (CH)
  • Jomo Kenyatta University of Agriculture and Technology (KE)
  • Nederlands Instituut Voor Zuivel Oonderzoek (NL)
  • Health Systems Support Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
Corresponding author
Zimmermann, Michael B
Venue
Gut
Publisher
BMJ
Published
2017-08-03
Volume
66
Issue
11
Pages
1956-1967
ISSN
  • 0017-5749 (ISSN-L)
  • 1468-3288
OpenAlex
W2743057074
Cited by
172
References
40
Citations by year
2026: 5 · 2025: 15 · 2024: 27 · 2023: 18 · 2022: 27 · 2021: 27 · 2020: 15 · 2019: 16 · 2018: 16 · 2017: 6
FWCI
11.98
Type
journal article
Language
en
Open access
Locations
  • Gut (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
ETH Global and the Sawiris Foundation, ETH Zurich, Switzerland
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Infant Nutrition and Health
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
Keywords
iron fortification, micronutrient powders, infant anemia, gut microbiota, Bifidobacterium, Lactobacillus, Clostridiales, enteric pathogens, intestinal fatty acid binding protein, respiratory infections, ferrous fumarate, infant nutrition
MeSH terms
Gastrointestinal Microbiome, Double-Blind Method, Edetic Acid, Female, Ferric Compounds, Ferrous Compounds, Humans, Infant, Kenya, Male, Oligosaccharides, Anemia, Iron-Deficiency, Micronutrients, Prebiotics

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