1
|
Iddrisu I, Monteagudo-Mera A, Poveda C, Shahzad M, Walton GE, Andrews SC. A review of the effect of iron supplementation on the gut microbiota of children in developing countries and the impact of prebiotics. Nutr Res Rev 2025; 38:229-237. [PMID: 38586996 DOI: 10.1017/s0954422424000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Iron is essential for many physiological functions of the body, and it is required for normal growth and development. Iron deficiency (ID) is the most common form of micronutrient malnutrition and is particularly prevalent in infants and young children in developing countries. Iron supplementation is considered the most effective strategy to combat the risk of ID and ID anaemia (IDA) in infants, although iron supplements cause a range of deleterious gut-related problems in malnourished children. The purpose of this review is to assess the available evidence on the effect of iron supplementation on the gut microbiota during childhood ID and to further assess whether prebiotics offer any benefits for iron supplementation. Prebiotics are well known to improve gut-microbial health in children, and recent reports indicate that prebiotics can mitigate the adverse gut-related effects of iron supplementation in children with ID and IDA. Thus, provision of prebiotics alongside iron supplements has the potential for an enhanced strategy for combatting ID and IDA among children in the developing world. However, further understanding is required before the benefit of such combined treatments of ID in nutritionally deprived children across populations can be fully confirmed. Such enhanced understanding is of high relevance in resource-poor countries where ID, poor sanitation and hygiene, alongside inadequate access to good drinking water and poor health systems, are serious public health concerns.
Collapse
Affiliation(s)
- Ishawu Iddrisu
- Rose Ward, Prospect Park Hospital, Berkshire Healthcare NHS Foundation Trust, Reading, RG30 4EJ, UK
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6AP, UK
- School of Biological Sciences, University of Reading, Whiteknights, Reading, RG6 6EX, UK
| | - Andrea Monteagudo-Mera
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6AP, UK
| | - Carlos Poveda
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6AP, UK
| | - Muhammed Shahzad
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
- Faculty of Dentistry, Zarqa University, Zarqa, 13110, Jordan
| | - Gemma E Walton
- Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6AP, UK
| | - Simon C Andrews
- School of Biological Sciences, University of Reading, Whiteknights, Reading, RG6 6EX, UK
| |
Collapse
|
2
|
Apte A, Parge A, Nimkar R, Sinha A. Effect of probiotic and prebiotics supplementation on hemoglobin levels and iron absorption among women of reproductive age and children: a systematic review and meta-analysis. BMC Nutr 2025; 11:31. [PMID: 39920867 PMCID: PMC11803929 DOI: 10.1186/s40795-025-01015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 01/29/2025] [Indexed: 02/09/2025] Open
Abstract
BACKGROUND This review aims to assess the effect of oral administration of probiotics and/or prebiotics in children and women of reproductive age (WRA) to improve intestinal iron absorption, hemoglobin, and ferritin levels. METHODS Randomized controlled trials from published literature on probiotics and or prebiotics for prevention or treatment of anemia as a supplement or fortification in children or WRA till Jan 31, 2023, were included. Studies on probiotics and prebiotics in patients with anemia due to other causes were excluded. Screening and data extraction was done using Distiller SR and meta-analysis was performed using Revman 5.4.1. RESULTS A total of 1925 records were identified from Pubmed, Embase, and Cochrane, of which 29 were included in the systematic review (14 supplementation and 15 fortification studies; 15 studies in children and 14 studies in WRA). The major interventions included galacto-oligosaccharide, inulin, heat-killed H61, Lactobacillus plantarum 299v, Lactobacillus reuteri, Lactobacillus acidophilus. Meta-analysis of 5 studies in WRA showed that the use of prebiotics and/or probiotics with or without iron was associated with little or no effect on hemoglobin. However, there is low certainty of evidence that the intervention led to improvement in fractional absorption of iron as compared to placebo or iron [8 studies, n = 335, mean increase 0.74%, 95%CI-0.11-1.38, p = 0.02]. Meta-analysis of 6 studies in WRA using prebiotics and/or probiotics with or without iron led to a significant increase in ferritin levels in WRA (mean increase 2.45 ng/ml, 95% CI 0.61-4.3, p = 0.009, n = 320) [Moderate certainty of evidence]. In children, meta-analysis of up to 8 studies did not result in any significant change in hemoglobin, ferritin and fractional iron absorption [low or very low certainty of evidence]. CONCLUSION There is some evidence to show that the use of prebiotics or probiotics (especially Lp299v and GOS) with or without oral iron can improve iron absorption in women and lead to improvement in ferritin levels in women. However, the current evidence does not conclusively show the benefit of these interventions in improving hemoglobin levels in women and children.
Collapse
Affiliation(s)
- Aditi Apte
- KEM Hospital Research Centre, Pune, India.
| | | | | | - Anju Sinha
- Indian Council of Medical Research, New Delhi, India
| |
Collapse
|
3
|
Rachmühl C, Lacroix C, Ferragamo A, Giorgetti A, Stoffel NU, Zimmermann MB, Brittenham GM, Geirnaert A. Galacto-oligosaccharides alone and combined with lactoferrin impact the Kenyan infant gut microbiota and epithelial barrier integrity during iron supplementation in vitro. MICROBIOME RESEARCH REPORTS 2024; 4:9. [PMID: 40207277 PMCID: PMC11978484 DOI: 10.20517/mrr.2024.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 11/20/2024] [Accepted: 12/17/2024] [Indexed: 04/11/2025]
Abstract
Aim: Iron supplementation to African weaning infants was associated with increased enteropathogen levels. While cohort studies demonstrated that specific prebiotics inhibit enteropathogens during iron supplementation, their mechanisms remain elusive. Here, we investigated the in vitro impact of galacto-oligosaccharides (GOS) and iron-sequestering bovine lactoferrin (bLF) alone and combined on the gut microbiota of Kenyan infants during low-dose iron supplementation. Methods: Different doses of iron, GOS, and bLF were first screened during batch fermentations (n = 3), and the effect of these factors was studied on microbiota community structure and activity in the new Kenyan infant continuous intestinal PolyFermS model. The impact of different fermentation treatments on barrier integrity, enterotoxigenic Escherichia coli (ETEC) infection, and inflammatory response was assessed using a transwell co-culture of epithelial and immune cells. Results: A dose-dependent increase in short-chain fatty acid (SCFA) production, Bifidobacterium and Lactobacillus/Leuconostoc/Pediococcus (LLP) growth was detected with GOS alone and combined with bLF during iron supplementation in batches. This was confirmed in the continuous PolyFermS model, which also showed a treatment-induced inhibition of opportunistic pathogens C. difficile and C. perfringens. In all tests, supplementation of iron alone and combined with bLF did not have a significant effect on microbiota composition and activity. We observed a strengthening of the epithelial barrier and a decrease in cell death and pro-inflammatory response during ETEC infection with microbiota fermentation supernatants from iron + GOS, iron + bLF, and iron + GOS + bLF treatments compared to iron alone. Conclusion: Overall, beneficial effects on infant gut microbiota were shown using advanced in vitro models for GOS alone and combined with bLF during low-dose iron supplementation.
Collapse
Affiliation(s)
- Carole Rachmühl
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zürich, Zürich 8092, Switzerland
| | - Christophe Lacroix
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zürich, Zürich 8092, Switzerland
| | - Adele Ferragamo
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zürich, Zürich 8092, Switzerland
- Current address: Clean Mouse Facility, Experimental Animal Center, Department for Biomedical Research, University of Bern, Bern 3008, Switzerland
| | - Ambra Giorgetti
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zürich, Zürich 8092, Switzerland
| | - Nicole U. Stoffel
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zürich, Zürich 8092, Switzerland
| | - Michael B. Zimmermann
- Medical Research Council Translational Immune Discovery Unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DS, UK
| | - Gary M. Brittenham
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Annelies Geirnaert
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zürich, Zürich 8092, Switzerland
| |
Collapse
|
4
|
Gallahan S, Brower S, Wapshott-Stehli H, Santos J, Ho TTB. A Systematic Review of Isotopically Measured Iron Absorption in Infants and Children Under 2 Years. Nutrients 2024; 16:3834. [PMID: 39599621 PMCID: PMC11597703 DOI: 10.3390/nu16223834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 10/29/2024] [Accepted: 10/31/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND Iron is an essential element for critical biological functions, with iron deficiency negatively affecting growth and brain development and iron excess associated with adverse effects. The goal of this review is to provide a comprehensive assessment of up-to-date evidence on iron absorption measured isotopically in children, preterm infants, and full-term infants, up to 24 months of age. METHODS Search databases included Pubmed, Cochrane, Web of Science, and Scopus from a date range of 1 January 1953 to 22 July 2024. The included articles were experimental studies with iron absorption outcomes measured by isotopic techniques. The risk of bias was assessed using the Cochrane Risk of Bias Tool. RESULTS A total of 1594 records were identified from databases, and 37 studies were included in the quality review with a total of 1531 participants. Article results were grouped by study commonality: absorption and red blood cell incorporation, type of milk feedings, additives to improve absorption, how and when to supplement with iron, and iron forms and complimentary foods. CONCLUSIONS The results from this review support the current recommendations of oral iron supplementation. Iron from breast milk has high bioavailability, and unmodified cow's milk reduces iron absorption. Supplemental iron is required at 4-6 months for healthy, full-term infants and sooner for preterm infants. Ascorbic acid increases iron absorption in full-term infants and children. Lactoferrin and prebiotics are promising candidates for enhancing iron absorption, but they require further investigation. Research evidence of iron absorption mechanisms and modulating factors in preterm infants is limited and should be a research priority.
Collapse
Affiliation(s)
- Samantha Gallahan
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA; (S.G.); (S.B.)
| | - Stephanie Brower
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA; (S.G.); (S.B.)
| | - Hannah Wapshott-Stehli
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA;
| | - Joelle Santos
- College of Arts and Sciences, University of South Florida, Tampa, FL 33602, USA;
| | - Thao T. B. Ho
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA;
| |
Collapse
|
5
|
Scheuchzer P, Sinawat S, Donzé AS, Zeder C, Sabatier M, Garcia-Garcera M, Ricci C, Kamontham T, Zimmermann MB, Baumgartner J. Iron Absorption from an Iron-Fortified Follow-Up Formula with and without the Addition of a Synbiotic or a Human-Identical Milk Oligosaccharide: A Randomized Crossover Stable Isotope Study in Young Thai Children. J Nutr 2024; 154:2988-2998. [PMID: 39179207 PMCID: PMC11522886 DOI: 10.1016/j.tjnut.2024.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 07/26/2024] [Accepted: 08/17/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Previous studies showed that pre- and probiotics may enhance iron absorption. Probiotics combined with prebiotics (synbiotics), including human-identical milk oligosaccharides (HiMOs), are commonly added to infant and follow-up formula (FUF). Whether these additions enhance iron absorption from iron-fortified commercial milk formula is uncertain. OBJECTIVES We determined the effect of adding 1) a synbiotic [galacto-oligosaccharide [GOS] + Limosilactobacillus reuteri (L. reuteri)] or 2) the HiMO 2'-fucosyllactose (2'FL) to iron-fortified FUF on iron absorption in young Thai children. METHODS In a randomized, controlled, single-blinded (participants) crossover study, 82 Thai children aged 8-14 mo were enrolled to consume single servings (235 mL) of FUF with isotopically labeled ferrous sulfate (2.2 mg iron) with 1) the synbiotic (400 mg/100 mL GOS and L. reuteri DSM 17938), 2) the HiMO 2'FL (100 mg/100 mL), and 3) without synbiotic and 2'FL (control) in random order and a 3-d washout period between administrations. Fractional iron absorption [FIA (%)] was assessed by measuring erythrocyte incorporation of isotopic labels 14 d (n = 26) and 28 d (n = 76) after consumption of the last test FUF. RESULTS Median (IQR) FIA from iron-fortified FUF with the synbiotic [8.2 (5.2, 12.9)%] and with 2'FL [8.4 (5.5, 14.1)%] did not differ from the control FUF [8.1 (4.8,14.7)%] (synbiotic compared with control, P = 0.24; 2'FL compared with control, P = 0.95). FIA from all FUF did not differ when measured after 14 and 28 d of erythrocyte incorporation (Time, P = 0.368; FUF, P = 0.435; Time × FUF, P = 0.937). Fecal pH and hemoglobin were negatively associated with FIA. CONCLUSIONS In young Thai children, the addition of a synbiotic (GOS + L. reuteri) or 2'FL to iron-fortified FUF did not impact FIA from a single serving. The study was registered at clinicaltrials.gov as NCT04774016.
Collapse
Affiliation(s)
- Pornpimol Scheuchzer
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Sangsom Sinawat
- College of Allied Health Sciences, Suan Sunandha Rajabhat University, Bang Kaeo, Samut Songkhram, Thailand
| | - Anne-Sophie Donzé
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Christophe Zeder
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Magalie Sabatier
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., Vers-Chez-Les-Blanc, Lausanne, Switzerland
| | - Marc Garcia-Garcera
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., Vers-Chez-Les-Blanc, Lausanne, Switzerland
| | - Cristian Ricci
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Thavatchai Kamontham
- College of Allied Health Sciences, Suan Sunandha Rajabhat University, Bang Kaeo, Samut Songkhram, Thailand
| | - Michael B Zimmermann
- Medical Research Council Translational Immune Discovery Unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Jeannine Baumgartner
- Department of Nutritional Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.
| |
Collapse
|
6
|
Mikulic N, Uyoga MA, Stoffel NU, Derrien M, Nyilima S, Kostopoulos I, Roeselers G, Chenoll E, Mwasi E, Pironaci G, Karanja S, Bourdet-Sicard R, Zimmermann MB. Prebiotics increase iron absorption and reduce the adverse effects of iron on the gut microbiome and inflammation: a randomized controlled trial using iron stable isotopes in Kenyan infants. Am J Clin Nutr 2024; 119:456-469. [PMID: 38042412 PMCID: PMC10884607 DOI: 10.1016/j.ajcnut.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/18/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Iron fortificants tend to be poorly absorbed and may adversely affect the gut, especially in African children. OBJECTIVE We assessed the effects of prebiotic galacto-oligosaccharides/fructo-oligosaccharides (GOS/FOS) on iron absorption and gut health when added to iron-fortified infant cereal. METHODS We randomly assigned Kenyan infants (n = 191) to receive daily for 3 wk a cereal containing iron and 7.5 g GOS/FOS (7.5 g+iron group), 3 g (3-g+iron group) GOS/FOS, or no prebiotics (iron group). A subset of infants in the 2 prebiotic+iron groups (n = 66) consumed 4 stable iron isotope-labeled test meals without and with prebiotics, both before and after the intervention. Primary outcome was fractional iron absorption (FIA) from the cereal with or without prebiotics regardless of dose, before and after 3 wk of consumption. Secondary outcomes included fecal gut microbiota, iron and inflammation status, and effects of prebiotic dose. RESULTS Median (25th-75th percentiles) FIAs from meals before intervention were as follows: 16.3% (8.0%-27.6%) without prebiotics compared with 20.5% (10.4%-33.4%) with prebiotics (Cohen d = 0.53; P < 0.001). FIA from the meal consumed without prebiotics after intervention was 22.9% (8.5%-32.4%), 41% higher than from the meal without prebiotics before intervention (Cohen d = 0.36; P = 0.002). FIA from the meal consumed with prebiotics after intervention was 26.0% (12.2%-36.1%), 60% higher than from the meal without prebiotics before intervention (Cohen d = 0.45; P = 0.007). After 3 wk, compared with the iron group, the following results were observed: 1) Lactobacillus sp. abundances were higher in both prebiotic+iron groups (P < 0.05); 2) Enterobacteriaceae sp. abundances (P = 0.022) and the sum of pathogens (P < 0.001) were lower in the 7.5-g+iron group; 3) the abundance of bacterial toxin-encoding genes was lower in the 3-g+iron group (false discovery rate < 0.05); 4) fecal pH (P < 0.001) and calprotectin (P = 0.033) were lower in the 7.5-g+iron group. CONCLUSIONS Adding prebiotics to iron-fortified infant cereal increases iron absorption and reduces the adverse effects of iron on the gut microbiome and inflammation in Kenyan infants. This trial was registered at clinicaltrials.gov as NCT03894358.
Collapse
Affiliation(s)
- Nadja Mikulic
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Mary A Uyoga
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Nicole U Stoffel
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | | | - Suzane Nyilima
- Public and Community Health Department, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | | | | | - Edith Mwasi
- Paediatrics Department, Msambweni County Referral Hospital, Msambweni, Kenya
| | - Giulia Pironaci
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Simon Karanja
- Public and Community Health Department, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | - Michael B Zimmermann
- Medical Research Council Translational Immune Discovery Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Headington, Oxford, United Kingdom.
| |
Collapse
|
7
|
von Siebenthal HK, Galetti V, Zimmermann MB, Stoffel NU. Regulation of iron absorption in infants. Am J Clin Nutr 2023; 117:607-615. [PMID: 36811475 DOI: 10.1016/j.ajcnut.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/14/2022] [Accepted: 10/28/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Iron programs in low- and middle-income countries often target infants and young children. Limited data from human infants and mouse models suggest that homeostatic control of iron absorption is incomplete in early infancy. Excess iron absorption during infancy may have detrimental effects. OBJECTIVES Our aims were to 1) investigate determinants of iron absorption in infants aged 3-15 mo and assess whether regulation of iron absorption is fully mature during this period and 2) define the threshold ferritin and hepcidin concentrations in infancy that trigger upregulation of iron absorption. METHODS We performed a pooled analysis of standardized, stable iron isotope absorption studies performed by our laboratory in infants and toddlers. We used generalized additive mixed modeling (GAMM) to examine relationships between ferritin, hepcidin, and fractional iron absorption (FIA). RESULTS Kenyan and Thai infants aged 2.9-15.1 mo (n = 269) were included; 66.8% were iron deficient and 50.4% were anemic. In regression models, hepcidin, ferritin, and serum transferrin receptor were significant predictors of FIA, whereas C-reactive protein was not. In the model including hepcidin, hepcidin was the strongest predictor of FIA (β = -0.435). In all models, interaction terms, including age, were not significant predictors of FIA or hepcidin. The fitted GAMM trend of ferritin versus FIA showed a significant negative slope until ferritin of 46.3 μg/L (95% CI: 42.1, 50.5 μg/L), which corresponded to an FIA decrease from 26.5% to 8.3%; above this ferritin value, FIA remained stable. The fitted GAMM trend of hepcidin versus FIA showed a significant negative slope until hepcidin of 3.15 nmol/L (95% CI: 2.67, 3.63 nmol/L), above which FIA remained stable. CONCLUSIONS Our findings suggest that the regulatory pathways of iron absorption are intact in infancy. In infants, iron absorption begins to increase at threshold ferritin and hepcidin values of ∼46 μg/L and ∼3 nmol/L, respectively, similar to adult values.
Collapse
Affiliation(s)
- Hanna K von Siebenthal
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland.
| | - Valeria Galetti
- VMMT Research, Cagiallo, Switzerland; GroundWork, Fläsch, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland; MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Nicole U Stoffel
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland; MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| |
Collapse
|
8
|
Giorgetti A, Paganini D, Nyilima S, Kottler R, Frick M, Karanja S, Hennet T, Zimmermann MB. The effects of 2'-fucosyllactose and lacto-N-neotetraose, galacto-oligosaccharides, and maternal human milk oligosaccharide profile on iron absorption in Kenyan infants. Am J Clin Nutr 2023; 117:64-72. [PMID: 36789945 DOI: 10.1016/j.ajcnut.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/25/2022] [Accepted: 10/28/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Whether prebiotic human milk oligosaccharides (HMO), such as 2'-fucosyllactose (2'-FL) and lacto-N-neotetraose (LNnT), enhance iron absorption in infants is unknown. Moreover, whether maternal HMO profile affects absorption of iron fortificants or the effects of prebiotic galacto-oligosaccharides (GOS) and/or HMO on iron absorption is uncertain. OBJECTIVES The aim of this study was to test whether consumption of 3.0 g GOS or HMO enhances iron absorption from iron-fortified maize porridge in partially breastfed Kenyan infants and whether maternal HMO profile modulates these effects. METHODS In a randomized, prospective crossover study, 55 infants (aged 8-12 mo) were fed test meals fortified with 1 of the following: 1) 5.0 mg iron as 54Fe-labeled ferrous fumarate (FeFum); 2) 5.0 mg iron as 58FeFum and 3.0 g GOS (FeFum+GOS); and 3) 5.0 mg iron as 57FeFum and 2.0 g 2'-FL and 1.0 g LNnT (FeFum+HMO). Fractional iron absorption (FIA) was assessed by erythrocyte incorporation of iron isotopes. HMO profiles were determined by capillary gel electrophoresis with laser-induced florescence detection. Data were analyzed with mixed-effect models, and iron dialyzability was measured in vitro. RESULTS Of the 55 infants included, 49 were fed as instructed. FIA from the FeFum+GOS group [median (IQR) 22.2% (16.5%-25.9%)] was higher than that from the FeFum group [12.5% (9.5%-20.9%)] (P = 0.005). FIA from the FeFum+HMO group was 13.3% (7.1%-24.4%) and did not differ from the FeFum group (P = 0.923). Maternal HMO profile did not predict FIA or modulate the effects of GOS or HMO on FIA. Iron dialyzability ratios at pH 2 of FeFum+GOS to FeFum and FeFum+HMO to FeFum were 2.1 and 0.9 (P = 0.001 and P = 0.322), respectively. CONCLUSIONS In Kenyan infants consuming FeFum-fortified maize porridge, co-provision of 3.0 g GOS increased FIA by 78%, whereas co-provision of 3.0 g HMO did not affect FIA. Variations in maternal HMO profile, including secretor and Lewis phenotype, did not predict FIA. These data argue against a physiologic role for 2'-FL and LNnT in facilitating iron absorption in infancy. The study was registered at clinicaltrials.gov as NCT04163406 (https://clinicaltrials.gov/ct2/show/NCT04163406).
Collapse
Affiliation(s)
- Ambra Giorgetti
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Daniela Paganini
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; Department of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Suzane Nyilima
- Department of Medical Epidemiology, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | | | - Simon Karanja
- Department of Medical Epidemiology, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Thierry Hennet
- Department of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| |
Collapse
|
9
|
Husmann FMD, Zimmermann MB, Herter-Aeberli I. The Effect of Prebiotics on Human Iron Absorption: A Review. Adv Nutr 2022; 13:2296-2304. [PMID: 35816457 PMCID: PMC9776726 DOI: 10.1093/advances/nmac079] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/22/2022] [Accepted: 07/06/2022] [Indexed: 01/29/2023] Open
Abstract
Iron deficiency remains the most common nutritional deficiency. Oral iron supplementation is the recommended first-line treatment and used as a preventive measure as well. Enhancers of iron absorption are highly sought after to improve supplementation outcomes. Evidence from animal and human studies exists that prebiotics can enhance iron absorption. The purpose of this present narrative review of the literature is to summarize the existing evidence on the effects of prebiotics on human iron absorption. Relevant articles were identified from PUBMED, Scopus, and Web of Science from inception to November 2021. Only human trials investigating the effect of prebiotics on iron absorption were included. Eleven articles were identified and included for review. There are promising findings supporting an enhancing effect of certain prebiotics, but inconsistencies between the studies and results exist. The most convincing evidence exists for the prebiotics galacto-oligosaccharides and fructo-oligosaccharides combined with the commonly used iron compound ferrous fumarate, from studies in adult women with low iron stores and in anemic infants. Many factors seem to play a role in the enhancing effect of prebiotics on iron absorption such as type of prebiotic, dose, acute (single-dose) or chronic (long-term) prebiotic consumption, iron compound, iron status, inflammatory status, and age of the population studied. More research investigating the optimal combination of prebiotic, iron compound, and dose as well as the effect of long-term application on iron status outcomes is needed.
Collapse
Affiliation(s)
- Frederike M D Husmann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and
Health, ETH Zurich, Zurich, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and
Health, ETH Zurich, Zurich, Switzerland
| | - Isabelle Herter-Aeberli
- Laboratory of Human Nutrition, Institute of Food, Nutrition and
Health, ETH Zurich, Zurich, Switzerland
| |
Collapse
|
10
|
Prebiotics, Probiotics, and Postbiotics in the Prevention and Treatment of Anemia. Microorganisms 2022; 10:microorganisms10071330. [PMID: 35889049 PMCID: PMC9317605 DOI: 10.3390/microorganisms10071330] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022] Open
Abstract
Iron deficiency anemia (IDA) is very common and affects approximately 1/3 of the world’s human population. There are strong research data that some probiotics, such as Lactobacillus acidophilus and Bifidobacterium longum improve iron absorption and influence the course of anemia. Furthermore, prebiotics, including galactooligosaccharides (GOS) and fructooligosaccharides (FOS), increase iron bioavailability and decrease its destructive effect on the intestinal microbiota. In addition, multiple postbiotics, which are probiotic metabolites, including vitamins, short-chain fatty acids (SCFA), and tryptophan, are involved in the regulation of intestinal absorption and may influence iron status in humans. This review presents the actual data from research studies on the influence of probiotics, prebiotics, and postbiotics on the prevention and therapy of IDA and the latest findings regarding their mechanisms of action. A comparison of the latest research data and theories regarding the role of pre-, post-, and probiotics and the mechanism of their action in anemias is also presented and discussed.
Collapse
|
11
|
Agrizzi Verediano T, Agarwal N, Juste Contin Gomes M, Martino HSD, Tako E. Effects of dietary fiber on intestinal iron absorption, and physiological status: a systematic review of in vivo and clinical studies. Crit Rev Food Sci Nutr 2022; 63:9017-9032. [PMID: 35403512 DOI: 10.1080/10408398.2022.2060933] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The benefits of dietary fiber on intestinal health have been well established. However, there is no consensus on the dietary fiber effects on mineral absorption. The objective of this systematic review is to discuss the evidence on the dietary fiber effects on iron absorption and iron status-related biomarkers. A comprehensive search of 3 databases: PubMed, Scopus and Web of Science was carried out. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, and a total of 32 studies were included with 9 of them clinical studies and 23 in vivo. The studies included assessment of dietary fiber in the form of fructo-oligosaccharides, galacto-oligosaccharides, inulin, pectin, guar gum, oligofructose, xylo-oligosaccharides, and mannan-oligosaccharide. Hemoglobin (n = 21) and fractional iron absorption (n = 6) were the most frequently reported outcomes. The results showed no significant correlations between consumption of dietary fiber to iron absorption/status-related biomarkers. However, the current evidence may not be substantial to invalidate the recommendation of dietary fiber as an agent to improve dietary iron bioavailability, and absorption. In conclusion, there is a need to conduct further clinical trials with long dietary fiber intervention focusing on population at high risk for iron deficiency.
Collapse
Affiliation(s)
| | - Nikita Agarwal
- Department of Food Science, Cornell University, Ithaca, New York, USA
| | | | | | - Elad Tako
- Department of Food Science, Cornell University, Ithaca, New York, USA
| |
Collapse
|
12
|
Chen J, Wang Y, Pan J, Lu LW, Yu J, Liu B, Chen F, Deng H. Prebiotic Oligosaccharides Enhance Iron Absorption Via Modulation of Protein Expression and Gut Microbiota in a Dose‐response Manner in Iron‐deficient Growing Rats. Mol Nutr Food Res 2022; 66:e2101064. [DOI: 10.1002/mnfr.202101064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/03/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Jie‐Hua Chen
- Institute for Innovat ive Development of Food Industry Shenzhen University Shenzhen 518060 China
- Shenzhen Key Laboratory of Marine Microbiome Engineering Institute for Advanced Study Shenzhen University Shenzhen 518060 China
- Department of Nutrition and food Hygiene School of Public Health Southern Medical University Guangzhou 510515 China
| | - Yiyuan Wang
- Department of Nutrition and food Hygiene School of Public Health Southern Medical University Guangzhou 510515 China
- Department of Nutrition and food Hygiene School of Public Health Southern Medical University, Guangzhou, China Zhuhai Maternity and Child Health Hospital Zhuhai 519001 China
| | - Jialiang Pan
- Department of Inspection and Quarantine School of Public Health Southern Medical University Guangzhou 510515 China
| | - Louise Weiwei Lu
- Human Nutrition Unit School of Biological Sciences University of Auckland Auckland 1010 New Zealand
- High Value Nutrition National Science Challenge Auckland 1142 New Zealand
| | - Jianfeng Yu
- Institute for Innovat ive Development of Food Industry Shenzhen University Shenzhen 518060 China
- Shenzhen Key Laboratory of Marine Microbiome Engineering Institute for Advanced Study Shenzhen University Shenzhen 518060 China
| | - Bin Liu
- Institute for Innovat ive Development of Food Industry Shenzhen University Shenzhen 518060 China
- Shenzhen Key Laboratory of Marine Microbiome Engineering Institute for Advanced Study Shenzhen University Shenzhen 518060 China
| | - Feng Chen
- Institute for Innovat ive Development of Food Industry Shenzhen University Shenzhen 518060 China
- Shenzhen Key Laboratory of Marine Microbiome Engineering Institute for Advanced Study Shenzhen University Shenzhen 518060 China
| | - Hong Deng
- Department of Nutrition and food Hygiene School of Public Health Southern Medical University Guangzhou 510515 China
| |
Collapse
|
13
|
Giorgetti A, Hussman FMD, Zeder C, Herter-Aeberli I, Zimmermann MB. Prebiotic Galacto-oligosaccharides and Fructo-oligosaccharides, but not Acacia Gum, Increase Iron Absorption from a Single High-dose Ferrous Fumarate Supplement in Iron-depleted Women. J Nutr 2022; 152:1015-1021. [PMID: 36967158 DOI: 10.1093/jn/nxac003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/27/2021] [Accepted: 01/04/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Prebiotic galacto-oligosaccharides (GOS) increase iron absorption from fortification-level iron doses given as ferrous fumarate (FeFum) in women and children. Whether GOS or other fibers, such as prebiotic fructo-oligosaccharides (FOS) and acacia gum, increase iron absorption from higher supplemental doses of FeFum is unclear. OBJECTIVES In iron-depleted [serum ferritin (SF)< 25μg/L] women, we tested if oral co-administration of 15g of GOS, FOS or acacia gum increases iron absorption from a 100mg iron supplement given as FeFum. METHODS In a randomized, single-blind cross-over study, 30 women (median age 26.2 years, median SF 12.9μg/L) consumed a 100mg iron tablet labelled with 4mg of 57Fe or 58Fe, given with either: a) 15g GOS; b) 15g FOS; c) 15g acacia gum; or d) 6.1g lactose and 1.5g sucrose (control; matching the amounts of sucrose and lactose present in the GOS powder providing 15 g GOS), dissolved in water. The primary outcome, fractional iron absorption (FIA), was assessed by erythrocyte isotopic incorporation 14 days after administration. Data were analysed using a linear mixed-effect model. We also tested, in vitro, iron solubility at different pH and dialyzability from the different supplement combinations administered in vivo. RESULTS FIA from FeFum given with GOS and FOS was significantly higher (+45% and 51%, respectively; P < 0.001 for both) compared with control; total iron absorption [median (IQR)] was 34.6 (28.4; 49.1); 36.1 (29.0; 46.2) and 23.9 (20.5; 34.0) mg, respectively. Acacia gum did not significantly affect FIA from FeFum (P = 0.688). In vitro, iron dialyzability of FeFum + GOS was 46% higher than of FeFum alone (P = 0.003). CONCLUSIONS In iron-depleted women, both GOS and FOS co-administration with FeFum increase iron absorption by ∼50% from a 100mg oral iron dose, resulting in an additional 10-12mg of absorbed iron. Thus, GOS and FOS may be promising new enhancers of supplemental iron absorption.The study was registered at clinicaltrials.gov as NCT04194255 (https://clinicaltrials.gov/ct2/show/NCT04194255).
Collapse
|
14
|
Husmann FMD, Stierli L, Bräm DS, Zeder C, Krämer SD, Zimmermann MB, Herter-Aeberli I. Kinetics of iron absorption from ferrous fumarate with and without galacto-oligosaccharides determined from stable isotope appearance curves in women. Am J Clin Nutr 2021; 115:949-957. [PMID: 34726703 PMCID: PMC8895218 DOI: 10.1093/ajcn/nqab361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/25/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Prebiotic galacto-oligosaccharides (GOS) are novel enhancers of iron absorption from ferrous fumarate (FeFum). However, the mechanism(s) of this effect, and whether it occurs in the proximal or distal gut, are uncertain. OBJECTIVES We studied: 1) in vitro, the effect of GOS on iron solubility and dialyzability from FeFum; 2) in volunteers, the absorption kinetics of FeFum given with and without GOS using stable isotope appearance curves (SIAC). METHODS We measured iron solubility at various pH and dialyzability from FeFum with and without GOS. In crossover design, iron-depleted women [n = 11; median serum ferritin (SF) 15.2; IQR: 12.6-21.2 µg/L] received 2 14-mg iron doses as labeled (57Fe,58Fe) FeFum 14 d apart with and without 15 g GOS in randomly assigned order. Multiple blood samples were collected over a time period of 24 h and 14 d later to determine SIAC and fractional iron absorption (FIA), respectively. SIAC data were fitted using nonlinear mixed effects modeling to a 1-compartment model with first-order absorption, and AUC and time of peak serum isotope concentration (tmax) were calculated. RESULTS Iron dialyzability was 75% higher with GOS (P < 0.001) and iron solubility was more than doubled at pH 4 and 6 with GOS [both P < 0.001]. Mean ± SD AUC (5830.9 ± 4717.3 μg/min with GOS, 4454.0 ± 3260.7 μg/min for control), and median (IQR) FIA (20.3% (8.6%-38.7%) with GOS, and 15.6% (10.6%-24.8% f)or control) were not different with compared to without GOS (P = 0.064; P = 0.080). Mean ±SD tmax was not altered with GOS (3.08 ± 0.47 h with GOS; 2.80 ±0.50 h for control; P = 0.096). Iron bioavailability significantly increased with decreasing SF and this effect was significantly enhanced by GOS (P = 0.037, interaction of GOS with SF). CONCLUSIONS GOS increases iron solubility from FeFum at physiological pH characteristic of the proximal duodenum. The absorption kinetics in vivo are consistent with effects on iron absorption in the proximal, rather than distal, parts of the gut. There was no overall effect of GOS on FIA in vivo, but the interaction of GOS and SF on FIA might benefit iron-deficient women, an effect potentially mediated by the higher solubility shown in vitro. This study was registered at clinicaltrials.gov as NCT03996421.
Collapse
Affiliation(s)
- Frederike M D Husmann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland
| | - Laura Stierli
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland
| | - Dominic S Bräm
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Switzerland
| | - Christophe Zeder
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland
| | - Stefanie D Krämer
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland
| | | |
Collapse
|