Association between iron supplementation and the presence of diarrhoea in Peruvian children aged 6–59 months: analysis of the database of the Demographic and Family Health Survey in Peru (DHS, Peru), years 2009–2019

Abstract

Introduction: According to the World Health Organization (WHO), anemia is a severe public health problem when the prevalence is ≥ 40%. In 2019, in Peru, 40.1% of children (age 6 to 35 months) are diagnosed as anemic. This is a concern since, despite the efforts of the governments to reduce the prevalence, the problem has stagnated since 2011. The treatment applied to deal with anemia is iron supplementation. Although iron is essential for cell function, an excess can produce adverse responses, such as gut inflammation affecting microbiota and resulting in diarrheic episodes. Objective: To determine the association between diarrhea and iron supplementation in children with and without anemia, controlling for different socio-demographic variables. Design: We conducted via logistic regression to obtain diarrhea prevalence ratios, adjusted by age, sex, geographic region, water and sanitation service, and rurality. The survey asked for recent episodes of diarrhea during the last 7 days; similarly, after the consumption of iron supplements during the last 12 months before the survey. Setting: Peru Subjects: The Demographic and Health Survey (DHS) is conducted annually at home among 14,202 children on average (2009 – 2019). Results: Iron supplementation in the last seven days (PR=1.09) or the last twelve months (PR=1.19) (p<0.0001) was associated with an increased risk of diarrhea. The same association was observed between iron supplementation and the presence of anemia. Conclusions: Iron supplementation is associated with diarrhea and over-use in children should be avoided.

Comparative Efficacy and Acceptability of 12 Phosphorus-Lowering Drugs in Adults with Hyperphosphatemia and Chronic Kidney Disease: A Systematic Review and Network Meta-Analysis

“…Despite the fact that the main side effect of ferric citrate was gastrointestinal [29], there was no appreciable difference in the adverse effects of constipation between the ferric citrate, placebo, or active treatment [30]. Simultaneously, other studies had found that iron-induced diarrhea was associated with an inflammatory response caused by intestinal flora, which usually occurred early in treatment and was mild [31]. Iron citrate reduces anemia by raising the serum iron reserve and suppressing FGF-23 production, which might contribute to cardiovascular remodeling [32, 33], in addition to lowering blood phosphate by decomposing ferric ions (Fe3+) and interacting with phosphate [12, 34].…”

Intracellular Regulation Limits the Response of Intestinal Ferroportin to Iron Status in Suckling Rats

“…Numerous studies have shown that excessive iron supplementation would damage the intestinal immune system of infants increasing the risk of diarrhea and lead to increased iron content in the hippocampus damaging social cognition, etc. [ 6,7 ] Besides, excessive iron intake would antagonize the absorption of copper in the diet, finally affecting copper homeostasis in the body. [ 8,9 ] Thus, maintaining iron homeostasis in infants during suckling is important.…”