Iron2026-06

Effect of combined probiotic and iron-folic acid supplementation on iron status and gut inflammation markers: a randomized controlled trial among anaemic children.

Palika Ravindranadh, Seeli Haswanth, Banjara Santosh Kumar, Challa Sai Ram et al. — European journal of clinical nutrition

Summary

This study investigated whether adding probiotics to standard iron and folic acid supplements would further improve iron levels or gut health in anemic children. Researchers found that while both groups improved significantly, the probiotics did not offer any additional benefits compared to iron and folic acid alone. This suggests that for these children, probiotics did not enhance iron treatment outcomes or gut health markers.

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Key points

The study examined if adding probiotics to iron and folic acid supplements helped anemic children more than iron alone.
Both groups of children, whether they received probiotics or not, showed significant improvements in their iron levels and reduced anemia.
Probiotics did not provide any additional benefits for improving iron status, reducing side effects, or enhancing gut health markers.
This suggests that for these children, standard iron and folic acid supplementation was effective on its own.

What the study looked at

What question the study asked: This study investigated whether adding probiotics to standard iron and folic acid supplements could further improve iron status and gut health markers in anemic children, compared to iron and folic acid alone. The researchers were interested because iron supplementation can sometimes negatively affect the gut, and probiotics are known to potentially aid iron absorption and gut health. How it was studied (design/participants): A randomized controlled trial was conducted involving 248 anemic children under five years old. Participants were divided into two groups: one received iron-folic acid (IFA) syrup along with a specific probiotic (Lactobacillus plantarum), and the other received IFA syrup with a placebo. The intervention lasted 90 days, and researchers measured hemoglobin, iron status, and gut health markers at the beginning and end of the study. What it found: Both groups showed significant improvements in their hemoglobin levels and a reduction in anemia prevalence by the end of the study. However, the study found no significant differences between the probiotic group and the placebo group regarding improvements in hemoglobin, overall iron status, or gut health markers. This suggests that for these anemic children, adding probiotics did not provide additional benefits beyond what was achieved with iron and folic acid supplementation alone.

Dietary takeaway

This study suggests that for anemic children, standard iron and folic acid supplements are effective, and adding probiotics may not provide extra benefits for improving iron levels or gut health. While probiotics are generally considered healthy, this research indicates they might not be a necessary addition when treating iron deficiency anemia with standard supplements. Remember, this is just one study, and individual needs can vary, so always consult a healthcare professional for personalized advice on iron supplementation and dietary choices.

Abstract

BACKGROUND: Iron supplementation can negatively affect gut health, while probiotics may improve intestinal iron absorption and gut health. Therefore, combined supplementation of iron and probiotics could be beneficial. METHODS: A placebo-controlled randomised controlled trial was conducted among 248 anaemic (Hb 7-10.9 g/dL) children under 5 years of age. Participants were randomly assigned to receive intervention either with Iron-Folic acid (IFA) syrup (3 mg elemental iron/kg body weight/day) along with probiotic (Lactobacillus plantarum UBLP40, 10CFU) or control (IFA along with placebo) for 90 days. Compliance and morbidity were assessed, and haemoglobin, iron status, inflammatory and gut-health markers were assessed at baseline and endline. The primary per-protocol analysis included participants with haemoglobin assessments available at both time points. RESULTS: At the end of the intervention, mean haemoglobin significantly increased from baseline in both groups (intervention: n = 79, 1.96 ± 1.35 g/dL vs. control: n = 86, 1.91 ± 1.36 g/dL, p < 0.001, paired t-test for within-group comparisons). The prevalence of anaemia reduced by (77.4% vs. 79.8%), iron deficiency (98.0% vs. 94.8%) and iron deficiency anaemia (100%) in intervention and control groups, respectively. No significant between-group differences were observed in haemoglobin, anaemia prevalence, iron status, morbidity, or gut health. In multiple regression analysis, rise in haemoglobin was associated with baseline haemoglobin, but not with probiotic use. CONCLUSIONS: Probiotic supplementation alongside IFA provided no additional benefits on iron status, adverse effects or gut health markers among anaemic Indian children. The absence of a placebo-only group, due to ethical considerations, limited the ability to isolate the net effect of the intervention.

View on PubMed →DOI: 10.1038/s41430-026-01777-4