The results of the recent randomized controlled trial (RCT) in Pemba, where there was more severe child morbidity and mortality in the group receiving supplements of iron and folic acid, brought to a halt the unsupervised use of iron supplements to remove iron deficiency anemia – especially in malaria-endemic areas. However, there is uncertainty whether the adverse effects of the supplements were due to interactions between iron the physiological effects of the microbiota on the host. To understand the interaction of iron and the microbiota, the source of the inflammation and /or the bacteria involved must be characterized first. and malaria, iron and enteric infections, impaired effectiveness of anti-malarial treatment due to the folate, a combination of all three, or some other explanation. In this issue of Sight and Life, I will discuss the issue of iron and its apparent effects on enteric bacteria, following a recent article in which the authors described the impact of poorly bioavailable fortification iron on the profile of the gut microbiota of African children. In this study, the additional iron appeared to increase the proportion of pathogenic bacteria and act as a biomarker of inflammation in the feces. Nevertheless, there was no evidence of any increase in systemic infection in the children receiving the iron. To try to understand the meaning of the observations, I will also describe some results from two other papers where the authors examined individual sub-strains of commensal Clostridium bacteria and showed that they had both individual and collective effects on immune cells within the lining of the gut, and can have both pro- and anti-inflammatory effects in different circumstances. Such results indicate that quantitation of the major bacterial strains within the microbiota may, in fact, tell us very little about
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