Current Nutrition & Food Science   Siti Helmyati 1,2,* , Endang Sutriswati Rahayu 3 , Bernadette Josephine Istiti Kandarina 2,4 and Mohammad Juffrie 5 1 Department of Nutrition and Health, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yog- yakarta 55281, Indonesia, 2 Center for Health and Human Nutrition, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta 55281, Indonesia, 3 Faculty of Agricultural Technology, Universitas Gadjah Ma- da, Yogyakarta 55281, Indonesia, 4 Department of Biostatistics, Epidemiology and Population Health, Faculty of Medi- cine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia, 5 Department of Pediatric Health, General Hospital Dr. Sardjito/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yog- yakarta 55281, Indonesia Abstract: Background: Iron deficiency may inhibit the height increase and weight gain of children. On the other hand, the supplementation of iron causes gut microbiota imbalance which leads to in- flammation and diarrhea. The addition of synbiotic fermented milk is expected to have beneficial ef- fects on iron supplementation. This study aimed to determine the effects of iron supplementation on- ly and its administration with synbiotic fermented milk on iron status, body height and weight, and gut microbiota profile of iron deficient elementary school children. Methods: This research was an experimental study with pre and post test conducted on 59 iron- deficient children. Subjects were given iron supplementation in syrups (IS group) or given iron sup- plementation in syrup with fermented milk (containing synbiotic Lactobacillus plantarum Dad 13 and fructo-oligosaccharide) (ISFM group) for 3 months. The body weight and height, hemoglobin and serum ferritin levels, and total number of Lactobacilli, Enterobacteria, Bifidobacteria, and Esch- erichia coli were measured at the beginning and the end of the study. Results: The body height in the ISFM group increased significantly than that in IS group after the in- tervention (1.67 vs. 2.42, p<0.05). The hemoglobin and serum ferritin levels in IS and ISFM groups were improved significantly (p<0.05) although the difference between the two groups was not signif- icant (p>0.05). The results showed no significant difference of gut microbiota profile between the IS and ISFM groups (p>0.05). Conclusion: There is no difference on the iron status, height, weight, and gut microbiota profile of iron-deficient primary school children received iron supplementation only or iron supplementation with synbiotic fermented milk. A R T I C L E H I S T O R Y Received: December 21, 2017 Revised: May 23, 2018 Accepted: October 10, 2018 DOI: 10.2174/1573401314666181017110706 Keywords: Child growth, fermented milk, gut microbiota, iron deficiency, iron supplementation, synbiotic. 1. INTRODUCTION Iron deficiency is a common form of micronutrient dis- order which leads to anemia, neurocognitive alteration, and physical growth failure of the children, and makes them in greater risk of some illnesses and lower productivity in the future [1-3]. The prevalence of iron deficiency is one of the highest in the world, although it is difficult to measure in large populations due to lack of rapid and friendly *Address correspondence to this author at the School of Health Nutrition, Faculty of Medicine, Universitas Gadjah Mada, Jalan Farmako, Sekip Utara, Yogyakarta, 55281, Indonesia; Tel/Fax : +6227454775; E-mail: siti.helmyati@gmail.com biomarkers [3]. Iron deficiency condition is often followed by iron deficiency anemia (IDA). Stoltfuz stated up to 50% of anemia incidence in the world are contributed to iron deficiency while Burke et al. according to World Health Organization (2001), estimated that the incidence of iron deficiency is 2.5 times higher than that of IDA [2, 3]. In Indonesia, anemia due to iron deficiency is a serious problem since several studies found high numbers of anemic children. Indonesian Basic Health Research 2013 stated ap- proximately 28% of children aged 12-59 month-old and 26% of the children aged 5-14 years-old were anemic [4]. A study 2212-3881/20 $65.00+.00 © 2020 Bentham Science Publishers Send Orders for Reprints to reprints@benthamscience.net 220 Current Nutrition & Food Science, 2020, 16, 220-227 RESEARCH ARTICLE No Difference Between Iron Supplementation Only and Iron Supplementa- tion with Synbiotic Fermented Milk on Iron Status, Growth, and Gut Microbiota Profile in Elementary School Children with Iron Deficiency