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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
Open accessAbstract
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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“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]
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“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].”
From Oral Iron Supplementation—Gastrointestinal Side Effects and the Impact on the Gut Microbiota (2021) · cites this paper as [51]
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Metadata
- 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
- 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
- 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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