The Comparative Impact of Iron, the B-Complex Vitamins, Vitamins C and E, and Selenium on Diarrheal Pathogen Outcomes Relative to the Impact Produced by Vitamin A and Zinc

Abstract

Micronutrient supplementation offers one of the most cost-effective means of improving the health and survival of children in developing countries. However, the effects of supplementation with single micronutrients on diarrhea are not always consistent, and supplementation with multi-micronutrient supplements can have negative effects. These inconsistencies may result from the failure to consider the diverse etiological agents that cause diarrhea and the unique effects each micronutrient has on the immune response to each of these agents. This review examines the separate effects that supplementation with the B-complex vitamins, vitamin C, vitamin E, selenium, and iron have on diarrheal disease-related outcomes. Supplementation with iron may increase the risk of infection by invasive diarrheal pathogens, while supplementation with the remaining micronutrients may reduce this risk. These differences may be due to distinct regulatory effects each micronutrient has on the pathogen-specific immune response, as well as on the virulence of specific pathogens. The findings of these studies suggest that micronutrient supplementation of children must take into account the pathogens prevalent within communities as reflected by their diarrheal disease burdens. The effectiveness of combining multiple micronutrients into one supplement must also be reconsidered.

Effect of Preventive Supplementation with Zinc and Other Micronutrients on Non-Malarial Morbidity in Tanzanian Pre-School Children: A Randomized Trial

“…At the doses provided, it is unlikely that magnesium or vitamin C caused osmotic diarrhea; we also found no evidence, which otherwise might have been expected, that the increased diarrhea rates were larger in the youngest children who received a larger dose per body weight that older children (Figure 3). Whilst most micronutrients seem to protect against diarrhea [17], supplementation with iron may increase the diarrhea incidence [18], possibly by enhancing proliferation and virulence of enteric pathogens, or facilitating pathogen invasion by increasing permeability of the small intestine [19], [20]. Iron may also influence or impair the immune responses to pathogens [17].…”

“…Whilst most micronutrients seem to protect against diarrhea [17], supplementation with iron may increase the diarrhea incidence [18], possibly by enhancing proliferation and virulence of enteric pathogens, or facilitating pathogen invasion by increasing permeability of the small intestine [19], [20]. Iron may also influence or impair the immune responses to pathogens [17]. In vitro studies using Caco-2 cells suggest that copper may also impair intestinal barrier function by enhancing paracellular permeability [21], [22].…”

The causes of porotic hyperostosis and cribra orbitalia: A reappraisal of the iron‐deficiency‐anemia hypothesis

“…Diarrheal disease is currently a leading cause of death among children less than 5 years of age (Fischer Walker and Black, 2007) and undoubtedly was also a major cause of child mortality in earlier human societies. An important synergy exists between malnutrition and diarrheal disease (Keusch and Farthing, 1986); diarrheal disease contributes to the depletion of B-complex vitamins, vitamin C, vitamin E, selenium, and iron (Long et al, 2007), and there is also a 20-60% decrease in caloric intake during diarrhea bouts (Mata, 1992;DuPont, 1993).…”

Isolation, characterization and pharmacological potentials of methanol extract of Cassia fistula leaves: Evidenced from mice model along with molecular docking analysis

“…It is reported that beta-sitosterol, found in GC-MS/MS analysis, can act as an antidiarrheal compound [ 65 ] which has been corroborated in the Insilco investigation with kappa receptor. Scientists had reported that, when tocopherol was administered intramuscularly to patients suffering from Shigella dysentery, clinical symptoms decreased and their immunological response improved as compared to those who did not receive tocopherol [ 66 ].…”