Multi-Nutrient Fortified Dairy-Based Drink Reduces Anaemia without Observed Adverse Effects on Gut Microbiota in Anaemic Malnourished Nigerian Toddlers: A Randomised Dose-Response Study.

Adedotun J. Owolabi,Anne Schaafsma,Alida Melse-Boonstra,Kazeem A. Oshikoya,Jeske H. J. Hageman,Folake Samuel,Robyn T. Eijlander,Guus A. M. Kortman,Idowu O. Senbanjo,Jos Boekhorst

doi:10.3390/nu13051566

Abstract

Prevalence of anaemia among Nigerian toddlers is reported to be high, and may cause significant morbidity, affects brain development and function, and results in weakness and fatigue. Although, iron fortification can reduce anaemia, yet the effect on gut microbiota is unclear. This open-label randomised study in anaemic malnourished Nigerian toddlers aimed to decrease anaemia without affecting pathogenic gut bacteria using a multi-nutrient fortified dairy-based drink. The test product was provided daily in different amounts (200, 400 or 600 mL, supplying 2.24, 4.48 and 6.72 mg of elemental iron, respectively) for 6 months. Haemoglobin, ferritin, and C-reactive protein concentrations were measured to determine anaemia, iron deficiency (ID) and iron deficiency anaemia (IDA) prevalence. Faecal samples were collected to analyse gut microbiota composition. All three dosages reduced anaemia prevalence, to 47%, 27% and 18%, respectively. ID and IDA prevalence was low and did not significantly decrease over time. Regarding gut microbiota, Enterobacteriaceae decreased over time without differences between groups, whereas Bifidobacteriaceae and pathogenic E. coli were not affected. In conclusion, the multi-nutrient fortified dairy-based drink reduced anaemia in a dose-dependent way, without stimulating intestinal potential pathogenic bacteria, and thus appears to be safe and effective in treating anaemia in Nigerian toddlers.

Highlights

Anaemia, which is characterised by a haemoglobin level below 11.0 g/dL, continues to be a serious global public health problem that affects young children and pregnant women [1]
The baseline characteristics of both intention to treat (ITT) and Per Protocol (PP) populations can be found in Table S2 and were comparable between populations except for inflammation prevalence, which was higher in the ITT population (30.6%) compared to the PP population (17.6%)
This study showed that daily consumption of different doses (200, 400 or 600 mL) of multi-nutrient fortified dairy-based drink for 6 months dose-dependently reduced anaemia prevalence in anaemic malnourished Nigerian children aged 1–3 years

Summary

Introduction

Anaemia, which is characterised by a haemoglobin level below 11.0 g/dL, continues to be a serious global public health problem that affects young children and pregnant women [1]. The total amount of iron, and free iron, in particular, is guarded by a controlled absorption (via iron stores in the enterocyte), body iron status (via hepcidin blockade of iron transport into the blood), and by transport and storage proteins such as lactoferrin, transferrin, ferritin and hemosiderin in circulation and organs [9,10,11,12]. Synthesis of both hepcidin and ferritin (acute phase protein) is increased during infection and inflammation. Due to inflammation may overestimate iron status, and that is why the ferritin cut-off value for iron deficiency is increased when CRP is increased

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