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
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 randomized Kenyan infants (n=191) to receive daily for 3 weeks a cereal containing iron and either 7.5g GOS/FOS (7.5g+iron group), 3g (3g+iron group) GOS/FOS, or no prebiotics (iron group). A subset of infants in the two prebiotic+iron groups (n=66) consumed 4 stable iron isotope labelled 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 weeks of consumption. Secondary outcomes included: fecal gut microbiota, iron and inflammation status, and effects of prebiotic dose. We registered the study at Clinicaltrials.gov(NCT03894358).
RESULTS
Median(25th-75th percentiles) FIAs from meals before intervention were: 16.3%[8.0-27.6] without prebiotics versus 20.5%[10.4-33.4] with prebiotics (Cohen's 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's 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…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 191 participants or records.
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