Efficacy and safety of probiotics in the treatment of iron deficiency anemia in Chinese children: a systematic review and meta-analysis.

Objective: This meta-analysis, combined with trial sequential analysis (TSA), aimed to evaluate the effects of probiotics on hematologic parameters and iron-regulation biomarkers in Chinese children with iron deficiency anemia (IDA). Methods: Ten electronic databases were systematically searched for eligible studies published up to April 30, 2026. Meta-analyses were conducted using RevMan (version 5.3), and TSA was performed with TSA software (version 0.9.5.10 beta). Dichotomous and continuous outcomes were pooled as risk ratios (RRs) and mean differences (MDs), respectively. Publication bias was assessed using Egger's and Harbord's tests. Results: Twelve randomized controlled trials involving 1,342 children with IDA were included. In terms of efficacy, probiotics significantly increased hemoglobin (Hb) (MD 8.64 g/L, 95% CI 6.77-10.52), red blood cell (MD 0.47 × 10 Conclusion: Probiotics may improve anemia-related parameters and iron metabolism in Chinese children with IDA. However, the pooled increase in Hb remains below the minimal clinically important difference, and evidence on total adverse events remains inconclusive. Therefore, probiotics should be considered as an adjunct to oral iron supplementation rather than a standalone intervention. These findings should be interpreted with caution due to potential biases and the inclusion of only Chinese children.