Iron fortification adversely affects the gut microbiome, increases pathogen abundance and induces intestinal inflammation in Kenyan infants

Tanja Jaeggi,Michael B Zimmermann,Harro M Timmerman,Diego Moretti,Harold Tjalsma,Jane Njenga,Jane Kvalsvig,Guus A M Kortman,Alexandra Dostal,Dorine W Swinkels,Alice Mwangi,Jos Boekhorst,Penny Holding,Christophe Chassard,Christophe Lacroix

doi:10.1136/gutjnl-2014-307720

Abstract

BackgroundIn-home iron fortification for infants in developing countries is recommended for control of anaemia, but low absorption typically results in >80% of the iron passing into the colon. Iron is...

Highlights

While infants have the highest rates of iron deficiency anaemia (IDA), they are the group less well covered by universal fortification programmes
What are the new findings? ▸ This is the first controlled intervention trial to examine the effect of iron fortification on the African infant gut microbiome. ▸ Iron fortification modifies the gut microbiome in weaning African infants, increasing enterobacteria and decreasing bifidobacteria, and increases abundances of specific enteropathogens, for example, pathogenic Escherichia coli. ▸ Iron fortification in weaning African infants increases faecal calprotectin levels, indicating intestinal inflammation. ▸ These data provide a probable mechanism for the increases in diarrhoea seen in recent infant fortification studies
Our findings indicate that the iron in micronutrient powder (MNP) favours growth of several of these potentially pathogenic subgroups

Summary

Introduction

While infants have the highest rates of iron deficiency anaemia (IDA), they are the group less well covered by universal fortification programmes. ▸ There is little known about the composition of the African infant gut microbiota during the weaning period, or the effects of iron fortification at this age. ▸ These data provide a probable mechanism for the increases in diarrhoea seen in recent infant fortification studies. ▸ This is the first controlled intervention trial to examine the effect of iron fortification on the African infant gut microbiome. ▸ Iron fortification modifies the gut microbiome in weaning African infants, increasing enterobacteria and decreasing bifidobacteria, and increases abundances of specific enteropathogens, for example, pathogenic Escherichia coli. How might it impact on clinical practice in the foreseeable future? We determined the effect of high and low dose in-home iron fortification on the infant gut microbiome and intestinal inflammation

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Results

Conclusion