Fortified Yogurt Containing Bifidobacterium and Iron Status in Adolescent Girls with Iron Deficiency: A Randomized, Placebo-Controlled Trial
DOI:
https://doi.org/10.5281/zenodo.22339482Keywords:
iron deficiency, adolescent girls, fortified yogurt, Bifidobacterium, iron bioavailabilityAbstract

Background: Iron deficiency is the leading micronutrient disorder among adolescent girls. Objective: This narrative review
synthesises evidence on iron-fortified yogurt co-formulated with Bifidobacterium for improving adolescent iron status. Methods:
We reviewed randomised trials, systematic reviews, meta-analyses, and mechanistic studies of iron-fortified dairy and
probiotic-iron interactions via PubMed, Crossref, and Europe PMC. Findings: Iron-fortified yogurt improves haemoglobin and
ferritin; co-administered Bifidobacterium may further enhance absorption and tolerance, though effects vary by strain.
Conclusions: Fortified fermented dairy is a promising, low-burden adjunct to iron supplementation for adolescent girls,
warranting confirmatory trials.
References
Pasricha SR, Tye-Din J, Muckenthaler MU, Swinkels DW. Iron deficiency. Lancet. 2021;397(10270):233-248. doi:10.1016/S0140-6736(20)32594-0.
Zimmermann MB, Hurrell RF. Nutritional iron deficiency. Lancet. 2007;370(9586):511-520. doi:10.1016/S0140-6736(07)61235-5.
Stabell N, et al. Chronic iron deficiency and anaemia were highly prevalent in a population-based longitudinal study among adolescent girls. Acta Paediatr. 2021;110(11):3059-3067. doi:10.1111/apa.16016.
Samson KLI, Fischer JAJ, Roche ML. Iron status, anemia, and iron interventions and their associations with cognitive and academic performance in adolescents: a systematic review. Nutrients. 2022;14(1):224. doi:10.3390/nu14010224.
Gutema BT, Sorrie MB, Megersa ND, Yesera GE, Yeshitila YG, Pauwels NS, De Henauw S, Abbeddou S. Effects of iron supplementation on cognitive development in school-age children: systematic review and meta-analysis. PLoS One. 2023;18(6):e0287703. doi:10.1371/journal.pone.0287703.
Hurrell RF. Ensuring the efficacious iron fortification of foods: a tale of two barriers. Nutrients. 2022;14(8):1609. doi:10.3390/nu14081609.
Sabatier M, Grathwohl D, Beaumont M, Groulx K, Guignard LF, Kastenmayer P, et al. The bioavailability of iron picolinate is comparable to iron sulfate when fortified into a complementary fruit yogurt: a stable iron isotope study in young women. Eur J Nutr. 2020;59(4):1371-1378. doi:10.1007/s00394-019-01989-4.
Henare SJ, Singh NN, Ellis AM, Moughan PJ, Thompson AK, Walczyk T. Iron bioavailability of a casein-based iron fortificant compared with that of ferrous sulfate in whole milk: a randomized trial with a crossover design in adult women. Am J Clin Nutr. 2019;110(6):1362-1369. doi:10.1093/ajcn/nqz237.
Seyoum Y, Baye K, Humblot C. Iron homeostasis in host and gut bacteria - a complex interrelationship. Gut Microbes. 2021;13(1):1874855. doi:10.1080/19490976.2021.1874855.
Rusu IG, Suharoschi R, Vodnar DC, Pop CR, Socaci SA, Vulturar R, et al. Iron supplementation influence on the gut microbiota and probiotic intake effect in iron deficiency-a literature-based review. Nutrients. 2020;12(7):1993. doi:10.3390/nu12071993.
GBD 2021 Anaemia Collaborators. Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990-2021: findings from the Global Burden of Disease Study 2021. Lancet Haematol. 2023;10(9):e713-e734. doi:10.1016/S2352-3026(23)00160-6.
Domellöf M, Braegger C, Campoy C, Colomb V, Decsi T, Fewtrell M, et al. Iron requirements of infants and toddlers. J Pediatr Gastroenterol Nutr. 2014;58(1):119-129. doi:10.1097/MPG.0000000000000206.
Le Port A, Bernard T, Hidrobo M, Birba O, Rawat R, Ruel MT. Delivery of iron-fortified yoghurt, through a dairy value chain program, increases hemoglobin concentration among children 24 to 59 months old in Northern Senegal: a cluster-randomized control trial. PLoS One. 2017;12(2):e0172198. doi:10.1371/journal.pone.0172198.
Bothwell TH, MacPhail AP. The potential role of NaFeEDTA as an iron fortificant. Int J Vitam Nutr Res. 2004;74(6):421-434. doi:10.1024/0300-9831.74.6.421.
Teshome EM, Andang'o PEA, Osoti V, Terwel SR, Otieno W, Demir AY, et al. Daily home fortification with iron as ferrous fumarate versus NaFeEDTA: a randomised, placebo-controlled, non-inferiority trial in Kenyan children. BMC Med. 2017;15(1):89. doi:10.1186/s12916-017-0839-z.
Vonderheid SC, Tussing-Humphreys L, Park C, Pauls H, OjiNjideka Hemphill N, LaBomascus B, et al. A systematic review and meta-analysis on the effects of probiotic species on iron absorption and iron status. Nutrients. 2019;11(12):2938. doi:10.3390/nu11122938.
Rosen GM, Morrissette S, Larson A, Stading P, Griffin KH, Barnes TL. Use of a probiotic to enhance iron absorption in a randomized trial of pediatric patients presenting with iron deficiency. J Pediatr. 2019;207:192-197.e1. doi:10.1016/j.jpeds.2018.12.026.
Koker G, Sahinturk Y, Ozcelik Koker G, Coskuner MA, Eren Durmus M, Mutlu Catli M, Cekin AH. Improved gastrointestinal tolerance and iron status via probiotic use in iron deficiency anaemia patients initiating oral iron replacement: a randomised controlled trial. Br J Nutr. 2024;132(10):1308-1316. doi:10.1017/S0007114524002757.
Palika R, Seeli H, Banjara SK, Challa SR, Pullakhandam R, Kulkarni B, Dasi T. Effect of combined probiotic and iron-folic acid supplementation on iron status and gut inflammation markers: a randomized controlled trial among anaemic children. Eur J Clin Nutr. 2026;80(6):594-602. doi:10.1038/s41430-026-01777-4.
Apte A, Parge A, Nimkar R, Sinha A. Effect of probiotic and prebiotics supplementation on hemoglobin levels and iron absorption among women of reproductive age and children: a systematic review and meta-analysis. BMC Nutr. 2025;11(1):31. doi:10.1186/s40795-025-01015-3.
Hallberg L, Brune M, Rossander L. Iron absorption in man: ascorbic acid and dose-dependent inhibition by phytate. Am J Clin Nutr. 1989;49(1):140-144. doi:10.1093/ajcn/49.1.140.
Cook JD, Reddy MB. Effect of ascorbic acid intake on nonheme-iron absorption from a complete diet. Am J Clin Nutr. 2001;73(1):93-98. doi:10.1093/ajcn/73.1.93.
Petry N, Egli I, Zeder C, Walczyk T, Hurrell R. Polyphenols and phytic acid contribute to the low iron bioavailability from common beans in young women. J Nutr. 2010;140(11):1977-1982. doi:10.3945/jn.110.125369.
Hurrell RF, Reddy M, Cook JD. Inhibition of non-haem iron absorption in man by polyphenolic-containing beverages. Br J Nutr. 1999;81(4):289-295. doi:10.1017/S0007114599000537.
Hurrell R, Egli I. Iron bioavailability and dietary reference values. Am J Clin Nutr. 2010;91(5):1461S-1467S. doi:10.3945/ajcn.2010.28674F.
Cercamondi CI, Egli IM, Ahouandjinou E, Dossa R, Zeder C, Salami L, et al. Afebrile Plasmodium falciparum parasitemia decreases absorption of fortification iron but does not affect systemic iron utilization: a double stable-isotope study in young Beninese women. Am J Clin Nutr. 2010;92(6):1385-1392. doi:10.3945/ajcn.2010.30051.


