Abstract
BackgroundThe World Health Organization recommends exclusive breastfeeding until 6 months followed by introduction of iron-rich complementary foods (CFs). The aim of this study was to determine the impact of different iron-rich CFs on infant gut inflammation and microbiota.MethodsEighty-seven exclusively breastfed infants were randomly assigned to receive one of the following as their first CF: iron-fortified cereal (Cer), iron-fortified cereal with fruit (Cer + Fr), or meat (M). Urine and stool samples were collected to assess reactive oxygen species (ROS) generation, gut microbiota and inflammation.ResultsFecal iron differed across feeding groups (p < 0.001); levels were highest in the Cer group and lowest in M group. A significant increase of fecal ROS formation (p < 0.002) after the introduction of CFs was observed, but did not differ across feeding groups. Fecal calprotectin increased within all groups after the introduction of CFs (p = 0.004). Gut microbiota richness increased after introduction of M or Cer + Fr. Regardless of feeding group, Coriobacteriaceae were positively correlated with ROS and Staphylococcaceae were negatively correlated with calprotectin.ConclusionsChoice of first CF may influence gut inflammation and microbiota, potentially due to variations in iron absorption from different foods. Further research is warranted to fully characterize these associations and to establish implications for infant health. This study was registered in the ClinicalTrial.gov registry (Identifier No. NCT01790542).Trial registrationThis study was registered in the ClinicalTrial.gov registry under the name “Assessment of Complementary Feeding of Canadian Infants” (Identifier No. NCT01790542) February 6, 2013.
Highlights
The World Health Organization recommends exclusive breastfeeding until 6 months followed by introduction of iron-rich complementary foods (CFs)
Trial registration: This study was registered in the ClinicalTrial.gov registry under the name “Assessment of Complementary Feeding of Canadian Infants” (Identifier No NCT01790542) February 6, 2013
By 6 months of age, breastfed infants become dependent on complementary foods (CFs) as a source of iron to prevent iron deficiency (ID), as a result of declining iron stores present at birth and low levels of iron in breast milk [1]
Summary
The World Health Organization recommends exclusive breastfeeding until 6 months followed by introduction of iron-rich complementary foods (CFs). Available evidence suggests an association between excessive iron exposure in the intestinal tract and initiation of the inflammatory process by reactive oxygen species (ROS) generation [7, 8]. With such a high amount of iron in fortified cereals and low absorption rates, concerns have been raised about the possibility of the unabsorbed excess iron in these CFs causing ROS generation and inflammation in the large intestine of infants [9]. Infants introduced to iron-fortified cereals are receiving an equivalent dose of iron per kilogram body weight to adults in the Orozco et al study and may be producing ROS, leaving them prone to inflammation [12, 13]
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