Systematic review and meta-analysis of liposomal iron versus conventional iron in pediatric iron deficiency anemia

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European journal of pediatrics Published May 25, 2026 Medically reviewed May 25, 2026 Study authors: Alharran Abdullah M, Almutairi Esraa Yousef, Alazemi Waleed Bader, Alnejadah Fatemah Adel, Hasan Has… PubMed ↗ DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Consider liposomal iron for pediatric IDA pending confirmation in larger trials.

This systematic review and meta-analysis compared liposomal iron with conventional oral iron in pediatric patients with iron deficiency anemia. The study included 454 children and assessed outcomes over a six-month follow-up period. The authors synthesized data on hemoglobin increase, total iron-binding capacity, mean corpuscular hemoglobin, and adverse events.

Results showed a significantly greater increase in hemoglobin with liposomal iron compared with conventional iron, with a mean difference of 0.96 g/dL (95% CI 0.09-1.82; P = 0.03). Total iron-binding capacity was reduced with liposomal iron (MD -35.52 µg/dL; P < 0.0001), and mean corpuscular hemoglobin increased (MD 1.83 pg; P < 0.0001). Adverse events were fewer with liposomal iron (RR 0.29; P = 0.02), and the risk of constipation was lower (RR 0.56; P = 0.02).

The authors acknowledge substantial heterogeneity with an I-squared value of 92.9%. They describe the evidence as preliminary and state that larger randomized controlled trials are needed to confirm efficacy. The review does not report serious adverse events or discontinuations. Practice relevance was not reported in the source.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

PMID42183880

View Original Abstract ↓

Iron deficiency anemia (IDA) remains a public health problem in children. Conventional iron therapy is effective but often causes gastrointestinal adverse effects that reduce adherence. Liposomal iron has been developed to enhance absorption and improve tolerability. This systematic review and meta-analysis evaluated the efficacy and safety of liposomal iron compared with conventional iron formulations in pediatric patients with IDA. We searched PubMed, Scopus, Web of Science, and the Cochrane Library up to February 21, 2026 for randomized controlled trials (RCTs) comparing liposomal iron with conventional oral iron in children with IDA. Analyses were performed using R software with the meta package. Continuous outcomes were pooled as mean differences (MDs) and dichotomous outcomes as risk ratios (RRs) with 95% confidence intervals (CIs) using a random-effects model. Subgroup analyses according to follow-up duration. Four RCTs involving 454 children were included. At 6 months, liposomal iron produced a significantly greater increase in hemoglobin compared with conventional iron (MD 0.96 g/dL, 95% CI 0.09-1.82; P = 0.03), although heterogeneity was substantial (I = 92.9%). No significant differences were observed at earlier time points. Liposomal iron significantly reduced total iron-binding capacity (MD - 35.52 μg/dL; P < 0.0001) and increased mean corpuscular hemoglobin (MD 1.83 pg; P < 0.0001). Liposomal iron was associated with fewer adverse events (RR 0.29; P = 0.02) and lower risk of constipation (RR 0.56; P = 0.02).Conclusion: Liposomal iron offered better tolerability and was non-inferior to conventional iron for most hematologic outcomes. Evidence remains preliminary and larger RCTs are needed to confirm its efficacy in pediatric IDA.