New review paper: Global look at nutritional and functional iron deficiency in infancy

Iron deficiency is a widespread global problem which affects many infants, especially in low- and middle income countries[1]. Iron deficiency can lead to anaemia, and to impaired infant growth and development[2,3]. Iron deficiency at the time of infant vaccination may also impair the immune response to a number of vaccines[4]. 

As a result, iron  supplementation is common. But it is difficult, as iron absorption from supplements is generally low (<10%), meaning most of this valuable mineral reaches the colon unabsorbed[5]. This has adverse effects on the infant’s gut microbiome and can lead to gut inflammation and diarrhoea[6,7].   

Prof. Dr. Zimmermann of the Swiss Federal Institute of Technology (ETH) in Zurich reviewed the adverse effects of iron supplementation in infants and studied potential approaches to reduce these adverse effects by optimizing iron absorption with the help of other nutrients. In his work, prebiotic galacto–oligosaccharides (GOS) and apo-lactoferrin (LF) showed good results in enhancing iron absorption and mitigating the negative impact of iron supplementation.  

Potential role of Galacto-oligosaccharides (GOS)  

Earlier in 2017, galacto-oligosaccharides (Vivinal® GOS) were used in studies in Kenyan infants to determine their effect on iron supplementation. The studies showed that GOS increased iron absorption from a micronutrient powder by 62%[8]. In addition, the Zimmermann research group found that GOS in combination with the iron supplement increased levels of Bifidobacteria and Lactobacilli in the gut, reduced the prevalence of Clostridiales, and lowered respiratory tract infections compared to the iron supplement alone[7].  

Potential role of Lactoferrin (LF) 

Apo-lactoferrin (the iron-free form of lactoferrin) has recently also been shown to increase iron absorption from an iron supplement by 56%[9]. It had already previously been concluded that iron–fortified infant formula supplemented with lactoferrin was associated with reduced incidence and duration of diarrhoea compared to  lactoferrin-free formula[10]. 

Conclusions and follow-up research 

Prof. Dr. Zimmermann states: “From this review, we can conclude that prebiotic GOS and bovine apo-lactoferrin may prove useful in iron formulations for infants, because they increase iron absorption. At the same time, they may mitigate the adverse effects of unabsorbed iron on the infant gut. Currently we are running a large clinical trial with iron-supplemented Kenyan infants to determine the impact of GOS, lactoferrin and their combination on gut microbiota, diarrhoea and more.”  

The full review can be downloaded for free here.

References 

1. World Health Organization. The Global Prevalence of Anaemia in 2011. Geneva, Switzerland: World Health Organization; 2015 
2. Soliman, A., De Sanctis, V. & Kalra, S. Anemia and growth. Indian J. Endocrinol. Metab. 18, S1–S5 (2014). 
3. Lozoff, B. Iron deficiency and child development. Food Nutr Bull 28, S560-571 (2007). 
4. Stoffel, N. U. et al. Iron Deficiency Anemia at Time of Vaccination Predicts Decreased Vaccine Response and Iron Supplementation at Time of Vaccination Increases Humoral Vaccine Response: A Birth Cohort Study and a Randomized Trial Follow-Up Study in Kenyan Infants. Front. Immunol. 11, 1–16 (2020). 
5. Zimmermann et al., 2007, Nutritional iron deficiency, Lancet, 370(9586):511-520 
6. Jaeggi et al., 2015, Iron fortification adversely affects the gut microbiome, increases pathogen abundance and induces intestinal inflammation in Kenyan infants, Gut, 64(5):731-742 
7. Paganini et al., 2017, Prebiotic galactooligosaccharides mitigate the adverse effects of iron fortification on the gut microbiome: a randomised controlled study in Kenyan infants, Gut, 66(11):1956-1967 
8. Paganini et al., 2017, The effects of iron fortification and supplementation on the gut microbiome and diarrhea in infants and children: a review, Am J Clin Nutr, 106(suppl 6):1688S-1693S 
9. Mikulic et al., 2020, Iron absorption is greater from apo–lactoferrin and is similar between holo-lactoferrin and ferrous sulfate: stable iron isotope studies in Kenyan infants, J Nutr, 10;150(12):3200-3207 
10. Chen et al., 2016, Effect of bovine lactoferrin from iron-fortified formulas on diarrhea and respiratory tract infections of weaned infants in a randomized controlled trial, Nutrition, 32(2):222-227