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

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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, Timmerman, Harro M, Lacroix, Christophe, Karanja, Simon, Zimmermann, Michael B·2017·Gut

DOI 10.1136/gutjnl-2017-314418

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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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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
ORCID: Uyoga, Mary A
Kortman, Guus A M
Cercamondi, Colin I
Moretti, Diego
Schwab, Clarissa
Boekhorst, Jos
Timmerman, Harro M
Lacroix, Christophe
Karanja, Simon
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
DOI: 10.1136/gutjnl-2017-314418
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: bronze
doi.org
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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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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