EFFECTIVENESS OF PROBIOTIC SUPPLEMENTATION IN ENHANCING IRON THERAPY FOR IRON DEFICIENCY ANEMIA IN CHILDREN AGED 1 TO 15 YEARS: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background:
Iron deficiency anemia (IDA) remains a leading cause of childhood morbidity worldwide. While oral iron therapy is the standard treatment, its efficacy is often limited by gastrointestinal side effects and suboptimal absorption. Probiotics, particularly Lactobacillus rhamnosus GG, may improve iron uptake and gastrointestinal tolerance, but pediatric data remain limited.

Objective:
To evaluate the efficacy of probiotic (Lactobacillus rhamnosus GG) supplementation as an adjunct to oral iron therapy in improving hematological outcomes and reducing gastrointestinal side effects in children with IDA.

Methods:
In this prospective, randomized controlled trial, 100 children aged 1–15 years with confirmed IDA were randomized to receive either oral ferrous sulfate alone or ferrous sulfate plus Lactobacillus rhamnosus GG for 8 weeks. Primary outcome was change in hemoglobin concentration. Secondary outcomes included changes in serum ferritin, symptom resolution, and gastrointestinal side effects. Statistical comparisons were made using t-tests, chi-square tests, and multivariate logistic regression.

Results:
Both groups were comparable at baseline. After 8 weeks, the probiotic + iron group showed a significantly greater increase in hemoglobin (mean rise: 3.4 ± 0.8 g/dL vs. 2.1 ± 0.9 g/dL; p < 0.001) and serum ferritin (Δ = +15.4 ng/mL vs. +9.4 ng/mL; p < 0.001). Clinical symptoms such as fatigue, appetite loss, pallor, and headache resolved more frequently in the probiotic group (p < 0.05). Incidence of abdominal pain and constipation was significantly lower in the probiotic group. Multivariate analysis identified probiotic use as the sole significant predictor of hemoglobin rise >3 g/dL (aOR = 4.6; p < 0.001).

Conclusion:
Probiotic supplementation with Lactobacillus rhamnosus GG significantly enhances hematologic response and reduces gastrointestinal side effects in children receiving iron therapy for IDA. This combined approach offers a safe, effective, and well-tolerated strategy to optimize pediatric anemia management, particularly in resource-limited settings.