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Randomized Controlled Trial
. 2017 Feb 14;17(1):54.
doi: 10.1186/s12887-017-0805-0.

Assessment of complementary feeding of Canadian infants: effects on microbiome & oxidative stress, a randomized controlled trial

Wafaa Qasem  1   2 , Meghan B Azad  3   4 , Zakir Hossain  5   6 , Elnaz Azad  7 , Sarah Jorgensen  6 , Sandra Castillo San Juan  5   6 , Chenxi Cai  5   6 , Ehsan Khafipour  4   7   8 , Trust Beta  9 , L Jackson Roberts 2nd  10 , James Friel  5   6   4
Affiliations
Randomized Controlled Trial

Assessment of complementary feeding of Canadian infants: effects on microbiome & oxidative stress, a randomized controlled trial

Wafaa Qasem et al. BMC Pediatr. .

Abstract

Background: The World Health Organization recommends exclusive breastfeeding until 6 months followed by introduction of iron-rich complementary foods (CFs). The aim of this study was to determine the impact of different iron-rich CFs on infant gut inflammation and microbiota.

Methods: Eighty-seven exclusively breastfed infants were randomly assigned to receive one of the following as their first CF: iron-fortified cereal (Cer), iron-fortified cereal with fruit (Cer + Fr), or meat (M). Urine and stool samples were collected to assess reactive oxygen species (ROS) generation, gut microbiota and inflammation.

Results: Fecal iron differed across feeding groups (p < 0.001); levels were highest in the Cer group and lowest in M group. A significant increase of fecal ROS formation (p < 0.002) after the introduction of CFs was observed, but did not differ across feeding groups. Fecal calprotectin increased within all groups after the introduction of CFs (p = 0.004). Gut microbiota richness increased after introduction of M or Cer + Fr. Regardless of feeding group, Coriobacteriaceae were positively correlated with ROS and Staphylococcaceae were negatively correlated with calprotectin.

Conclusions: Choice of first CF may influence gut inflammation and microbiota, potentially due to variations in iron absorption from different foods. Further research is warranted to fully characterize these associations and to establish implications for infant health. This study was registered in the ClinicalTrial.gov registry (Identifier No. NCT01790542 ).

Trial registration: This study was registered in the ClinicalTrial.gov registry under the name "Assessment of Complementary Feeding of Canadian Infants" (Identifier No. NCT01790542 ) February 6, 2013.

Keywords: Breastfed infants; Complementary feeding; Iron fortified cereal; Meat; Microbiome.

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Figures

Fig. 1
Fig. 1
Study design
Fig. 2
Fig. 2
Comparisons between the feeding groups and over time for fecal iron, ROS, and inflammatory biomarkers at before and after introduction of complementary foods. Error bars indicate +/- 2 SE; comparisons by repeated measures ANOVA; (a) Average creatinine corrected F2-isoprostanes in urine (n = 25). No significant differences between groups or over time. b Fecal iron in the three study groups (n = 77).*Significant difference (p < 0.05) over time. **Significant difference between the groups. c Total hydroxylated products in the three study groups (n = 66). *Significant difference (p < 0.05) over time. d Fecal calprotectin concentration in the three study groups (n = 43). *Significant difference (p < 0.05) over time
Fig. 3
Fig. 3
Change in microbiota richness and diversity after introduction of complementary foods. a Microbiota richness and diversity by feeding group. b Chao1 richness estimator. c Shannon diversity index. Bars indicate means with 95% confidence intervals. Between-group comparison by ANOVA. *Significant change from baseline (p < 0.05)
Fig. 4
Fig. 4
Gut microbiota composition before and after introduction of complementary foods (CFs). a Median relative abundance of dominant phyla and families before and after introduction of CFs, by feeding group. Dominant taxa are those with >0% median relative abundance. *Significant difference (p < 0.05) by Wilcoxon ranked sum test, compared to Cer group. b Mean relative abundance of dominant microbiota phyla by feeding group, before and after introduction of CFs. c Relative abundance of Enterobacteriaceae after introduction of CFs. Bars indicate medians. *Significant difference (p < 0.05) by Wilcoxon rank-sum test. d Principal components analysis of microbiota community structures (unweighted UniFrac distance) after introduction of CFs; statistical comparison by PERMANOVA with 500 permutations
Fig. 5
Fig. 5
Correlations of fecal microbiota, iron, ROS and calprotectin, before and after introduction of complementary foods (CFs). a Spearman correlation matrix of dominant taxa (phyla and families with median relative abundance >0%) with fecal iron, ROS and calprotectin. b Correlation of microbiota richness and ROS, before CF: r = 0.51, p = 0.0001; after CF: r = 0.15, p = 0.29. c Correlation of Coriobacteriaceae and ROS, before CF: r = 0.39, p = 0.005; after CF: r = 0.46, p = 0.001. d Correlation of Staphylococcaceae and calprotectin, before CF: r = -0.54, p = 0.001; after CF: r = -0.59, p = 0.0003
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