Introduction
This review aims to assess the effect of oral administration of probiotics and/or prebiotics in children and women of reproductive age (WRA) to improve intestinal iron absorption, hemoglobin, and ferritin levels.
Methods
Randomized controlled trials from published literature on probiotics and or prebiotics for prevention or treatment of anemia as a supplement or fortification in children or WRA till Jan 31, 2023, were included. Studies on probiotics and prebiotics in patients with anemia due to other causes were excluded. Screening and data extraction was done using Distiller SR and meta-analysis was performed using Revman 5.4.1.
Results
Total 1925 records were identified from Pubmed, Embase, and Cochrane, of which 29 were included in the systematic review (14 supplementation and 15 fortification studies; 15 studies in children and 14 studies in WRA). The major interventions included galacto-oligosaccharide, inulin, heat-killed H61, Lactobacillus plantarum 299v, Lactobacillus reuteri, Lactobacillus acidophilus.
Meta-analysis of 9 studies (3 in WRA and 6 in children) showed that the use of prebiotics and/or probiotics was associated with little or no effect on hemoglobin as compared to control [Very low certainty of evidence]. Use of prebiotic and/or probiotic led to a significant increase in ferritin levels in WRA (mean increase 2.39 ng/ml, 95% CI 0.48-4.29, p=0.01, n=133) vs control (n=129) but not in children [Low certainty of evidence]. Administration of a prebiotic and/or probiotic along with oral iron was not associated with increased hemoglobin or ferritin vs administration of iron only (2 studies in WRA and children each) [Low to moderate certainty of evidence]. Use of prebiotics and/or probiotics was associated with 1.39% and 6.92% increase in fractional iron absorption in WRA when given alone or along with iron. However, iron absorption was not found to be increased in children [Low certainty of evidence].
Conclusion
There is some evidence to show that the use of prebiotics or probiotics (especially Lp299v and GOS) can improve iron absorption in women and children and lead to improvement in ferritin levels in women. However, the current evidence does not conclusively show the benefit of these interventions in improving hemoglobin levels in women and children.