Effect of iron or multiple micronutrient supplements on the prevalence of anaemia among anaemic young children of a malaria-endemic area: a randomized double-blind trial. Multiple micronutrients including iron are not more effective than iron alone for improving hemoglobin and iron status of Malian school children. Multiple micronutrient supplements during pregnancy do not reduce anemia or improve iron status compared to iron-only supplements in Semirural Mexico. Efficacy of combined iron and zinc supplementation on micronutrient status and growth in Vietnamese infants Multi-micronutrient-fortified biscuits decreased the prevalence of anaemia and improved iron status, whereas weekly iron supplementation only improved iron status in Vietnamese school children. Effect of long-term intermittent supplementation with multiple micronutrients compared with iron-and-folic acid supplementation on Hb and micronutrient status of non-anaemic adolescent schoolgirls in rural Bangladesh. Effects of an iron supplementation trial on the Fe status of Thai schoolchildren. Haematological response to iron supplementation is reduced in children with asymptomatic Helicobacter pylori infection. Behavioural responses of young anaemic Indian children to iron-folic acid supplements. Lack of hemoglobin response to iron supplementation in anemic mexican preschoolers with multiple micronutrient deficiencies. Effect of Daily Supplementation with Iron and Zinc on Iron Status of Childbearing Age Women A community-based randomized controlled trial of iron and zinc supplementation in Indonesian infants: interactions between iron and zinc. Multiple micronutrient supplementation during early childhood increases child size at 2 y of age only among high compliers. Early invitation to food and/or multiple micronutrient supplementation in pregnancy does not affect body composition in offspring at 54 months: follow-up of the MINIMat randomised trial, Bangladesh. Effects of prenatal food and micronutrient supplementation on child growth from birth to 54 months of age: a randomized trial in Bangladesh Effectiveness of daily and weekly iron supplementation in the prevention of anemia in infants. A community-based randomized controlled trial of iron and zinc supplementation in Indonesian infants: effects on growth and development. Hematological effect of supplementing anemic children with vitamin A alone and in combination with iron. Effect of daily and weekly micronutrient supplementation on micronutrient deficiencies and growth in young Vietnamese children. Prevalence and type of anaemia in female cotton mill workers in Beijing, China. Home-fortification with iron and zinc sprinkles or iron sprinkles alone successfully treats anemia in infants and young children. Effects of prenatal food and micronutrient supplementation on infant development: a randomized trial from the Maternal and Infant Nutrition Interventions, Matlab (MINIMat) study. Supplementation of iron alone and combined with vitamins improves haematological status, erythrocyte membrane fluidity and oxidative stress in anaemic pregnant women. Leaf concentrate as an alternative to iron and folic acid supplements for anaemic adolescent girls: a randomised controlled trial in India. Iron and zinc supplementation improves indicators of vitamin A status of Mexican preschoolers. Weekly micronutrient supplementation to build iron stores in female Indonesian adolescents. Effect of daily or weekly multiple-micronutrient and iron foodlike tablets on body iron stores of Indonesian infants aged 6-12 mo: a double-blind, randomized, placebo-controlled trial. Changing the zinc:iron ratio in a cereal-based nutritional supplement has no effect on percent absorption of iron and zinc in Sri Lankan children. Redistribution of vitamin A after iron supplementation in Indonesian infants. Effect of multiple-micronutrient supplementation on maternal nutrient status, infant birth weight and gestational age at birth in a low-income, multi-ethnic population. Multivitamin-mineral supplementation is not as efficacious as is iron supplementation in improving hemoglobin concentrations in nonpregnant anemic women living in Mexico. Impact of small‐quantity lipid‐based nutrient supplement on hemoglobin, iron status and biomarkers of inflammation in pregnant Ghanaian women The efficacy of ferrous bisglycinate and electrolytic iron as fortificants in bread in iron-deficient school children. Zinc supplementation reduced morbidity, but neither zinc nor iron supplementation affected growth or body composition of Mexican preschoolers. Effect of iron supplementation during pregnancy on the behaviour of children at early school age: long-term follow-up of a randomised controlled trial. Influence of an iron intervention on the zinc status of young adult New Zealand women with mild iron deficiency.
OBJECTIVE To assess the effect of supplementation with iron or multiple micronutrients ( MM ) on the prevalence of anaemia in a malaria-endemic area . METHODS A community-based r and omized double-blind trial was conducted in rural Burkina Faso , including children aged 6 - 23 months with haemoglobin ( Hb ) concentrations of 70 - 109 g/l who were r and omized into an iron group ( Fe , n = 96 ) , an iron and zinc group ( IZ , n = 100 ) or an MM group ( MM , n = 100 ) , 5 days/week for 6 months . All children were provided with insecticide-treated bednets ; those who had a Plasmodium falciparum ( PF ) positive-smear at baseline and /or at each monthly checking received antimalarial therapy . RESULTS The mean ( SD ) endpoint Hb concentration was higher in the MM group [ 113.2 ( 13.6 ) g/l ] than in the IZ group [ 106.3 ( 15.6 ) g/l ] and the Fe group [ 107.1 ( 12.9 ) g/l ] ( P = 0.001 ) . Children in the MM group were more likely to recover from anaemia than those in the Fe group [ prevalence rate ratios , PRR ( 95 % confidence interval , CI ) = 1.62 ( 1.22 - 2.15 ) , P < 0.001 ] . The IZ group did not differ from the Fe group [ PRR ( 95 % CI ) = 0.94 ( 0.65 - 1.35 ) , P = 0.72 ] . None of the interactions on the effect of supplementation of baseline age ( 0.13 ) , or baseline height-for-age z-score ( P = 0.33 ) , or incident PF parasitemia ( P = 0.99 ) , was significant . CONCLUSION In this malaria-endemic area , in combination with malaria management , the MM supplement was more efficacious than the Fe supplement and the IZ supplement for reducing anaemia . Further investigation into limiting factors and amounts of micronutrients that would be more efficacious for reducing anaemia is recommended Iron deficiency and anemia remain among the most important global public health problems facing school children . Helminth infections often peak at school age and aggravate nutritional risks . We conducted a 12-wk r and omized controlled trial in 406 Malian anemic schoolchildren infected with Schistosoma hematobium to examine the effects of 2 doses of praziquantel ( P ) ( 40 mg/kg body weight ) , P + 60 mg/d iron ( Fe ) , and /or a multiple micronutrient supplement ( MM ) that included 18 mg/d Fe . Supplements were administered to the children each school day ( 5 d/wk ) throughout the study . Changes in hemoglobin ( Hb ) , serum ferritin ( SF ) , and serum transferrin receptors ( s-TfR ) were followed . We also examined interactions between Fe and MM supplements on Hb and SF concentrations and malaria incidence . The effects of Fe on Hb and SF concentrations were greater than the effects of P alone and MM with or without added Fe at 6 and 12 wk ( P < 0.001 ) . In all groups , s-TfR decreased at 6 and 12 wk compared with baseline . The decrease was most pronounced in the P + Fe group compared with the other 3 groups at wk 6 ( P = 0.05 ) . Fe and MM interacted negatively at wk 6 and 12 to affect Hb ( beta = -0.43 , 95 % CI = -0.77 , -0.09 ; P = 0.01 and beta = -0.47 , 95 % CI = -0.83 , -0.11 ; P = 0.01 , respectively ) and SF ( beta = -0.42 , 95 % CI = -25.60 , 12.31 ; P < 0.001 , and beta = -0.37 , 95 % CI = -0.63 , -0.12 ; P = 0.004 , respectively ) . Malaria incidence was higher in the groups treated with added Fe ( relative risk : 1.66 ; 95 % CI : 0.75 , 3.67 ) . In this context , MM with added iron were not more effective than Fe without MM . Fe supplementation of schoolchildren with 60 mg/d for anemia control should be considered carefully The impact of iron-only supplements ( FE ) versus multiple micronutrient supplements containing iron ( MM ) during pregnancy on iron status was assessed in a sub sample ( n = 453 ) of women who participated in a r and omized double-blind trial in Mexico . Compliance , monitored by observation , was high ( > 85 % ) . The two groups were similar at recruitment ( < 13 wk gestation ) for various sociodemographic characteristics and for mean hemoglobin ( Hb ) concentrations and prevalence of anemia ( Hb < 110 g/L ; 11 % ) . However , mean serum ferritin was higher ( P < 0.05 ) in the MM group ( n = 142 ) compared to the FE group ( n = 148 ) and the prevalence of iron deficiency ( serum ferritin < 12 micro g/L ) was lower in the MM group ( 44.4 % ) compared to the FE group ( 57.4 % ) . By the third trimester , almost half the women were anemic in both groups , and mean Hb ( g/L ) was lower for the MM group ( 104.2 ; 95 % CI : 102.5 , 106.0 ) compared to the FE group ( 108.1 ; 95 % CI : 106.4 , 109.8 ) after adjusting for baseline serum ferritin . In contrast , there were no differences in Hb concentrations at 1 mo postpartum or in mean ferritin and prevalence of iron deficiency at 32 wk gestation and 1 mo postpartum ( 90.9 and 45.1 % for the MM group ; 92.6 and 47.3 % for the FE group , respectively ) . In conclusion , rather than improve Hb or iron status relative to FE-only supplements as hypothesized , MM supplements may have slightly reduced Hb concentrations during pregnancy . Neither supplement was able to meet iron needs as evidence d by dramatic increases in anemia and iron deficiency by the end of pregnancy Objective : To evaluate the effect of combined iron – zinc supplementation on micronutrient status , growth and morbidity . Design : R and omized , double-masked , placebo-controlled supplementation trial . Setting : Rural district of Que Vo , in the Red River Delta in Vietnam . Subjects : A total of 915 breast-fed infants aged 4–7 months were included and 784 completed the study . Interventions : The Fe-group received daily and for a 6-month period 10 mg of iron , the Zn-group 10 mg zinc , the Fe – Zn group 10 mg iron+10 mg zinc and the placebo group a placebo . Hemoglobin ( Hb ) , serum ferritin ( SF ) and zinc ( SZn ) , and anthropometry were measured before and at the end of the intervention . Morbidity was recorded daily . Results : Changes of Hb and SF were higher in both Fe and Fe+Zn groups ( respectively 22.6 and 20.6 g/l for Hb ; 36.0 and 24.8 μg/l for SF ) compared to Zn and placebo groups ( Hb : 6.4 and 9.8 g/l ; SF : −18.2 and −16.9 μg/l , P<0.0001 ) . SZn increased more in Zn group ( 10.3 μmol/l ) than in Fe+Zn group ( 8.0 μmol/l , P=0.03 ) and more in these groups compared to Fe and placebo groups ( 1.6 and 1.2 μmol/l , P<0.0001 ) . Weight gain was higher in the Zn group . No significant effects of supplementations on growth in length or morbidity . Conclusions : Combined iron – zinc supplementation had a positive effect on iron and zinc status in infants . However , the positive effect of zinc alone on SZn and weight would indicate a negative interaction of iron when added to zinc supplements . Sponsorship : UNICEF New York In Vietnam , nutrition interventions do not target school children despite a high prevalence of micronutrient deficiencies . The present r and omised , placebo-controlled study evaluated the impact of providing school children ( n 403 ) with daily multiple micronutrient-fortified biscuits ( FB ) or a weekly Fe supplement ( SUP ) on anaemia and Fe deficiency . Micronutrient status was assessed by concentrations of Hb , and plasma ferritin ( PF ) , transferrin receptor ( TfR ) , Zn and retinol . After 6 months of intervention , children receiving FB or SUP had a significantly better Fe status when compared with the control children ( C ) , indicated by higher PF ( FB : geometric mean 36·9 ( 95 % CI 28·0 , 55·4 ) μg/l ; SUP : geometric mean 46·0 ( 95 % CI 33·0 , 71·7 ) μg/l ; C : geometric mean 34·4 ( 95 % CI 15·2 , 51·2 ) μg/l ; P < 0·001 ) and lower TfR concentrations ( FB : geometric mean 5·7 ( 95 % CI 4·8 , 6·52 ) mg/l ; SUP : geometric mean 5·5 ( 95 % CI 4·9 , 6·2 ) mg/l ; C : geometric mean 5·9 ( 95 % CI 5·1 , 7·1 ) mg/l ; P = 0·007 ) . Consequently , body Fe was higher in children receiving FB ( mean 5·6 ( sd 2·2 ) mg/kg body weight ) and SUP ( mean 6·1 ( sd 2·5 ) mg/kg body weight ) compared with the C group ( mean 4·2 ( sd 3·3 ) mg/kg body weight , P < 0·001 ) . However , anaemia prevalence was significantly lower only in the FB group ( 1·0 % ) compared with the C group ( 10·4 % , P = 0·006 ) , with the SUP group being intermediate ( 7·4 % ) . Children receiving FB had better weight-for-height Z-scores after the intervention than children receiving the SUP ( P = 0·009 ) . Vitamin A deficiency at baseline modified the intervention effect , with higher Hb concentrations in vitamin A-deficient children receiving FB but not in those receiving the SUP . This indicates that vitamin A deficiency is implicated in the high prevalence of anaemia in Vietnamese school children , and that interventions should take other deficiencies besides Fe into account to improve Hb concentrations . Provision of biscuits fortified with multiple micronutrients is effective in reducing anaemia prevalence in school children The present study examined whether long-term supplementation with once- and twice-weekly multiple micronutrients ( MMN-1 and MMN-2 ) can improve Hb and micronutrient status more than twice-weekly Fe-folic acid ( IFA-2 ) supplementation in non-anaemic adolescent girls in Bangladesh . An equal number of 324 rural schoolgirls aged 11 - 17 years were given MMN-1 or MMN-2 or IFA-2 supplements for 52 weeks in a r and omised , double-blind trial . Blood sample s were collected at baseline , and at 26 and 52 weeks of supplementation . The girls receiving IFA-2 supplements were more likely to be anaemic than the girls receiving MMN-2 supplements for 26 weeks ( OR 5·1 , 95 % CI 1·3 , 19·5 ; P = 0·018 ) . All three supplements reduced Fe deficiency effectively . Both the MMN-1 and MMN-2 groups showed significantly greater improvements in vitamins A , B(2 ) and C status than the girls in the IFA-2 group , as might be expected . Receiving a MMN-1 supplement was found to be less effective than MMN-2 supplement in improving Fe , vitamins A , B(2 ) and folic acid status . Receiving micronutrient supplements beyond 26 weeks showed little additional benefit in improving micronutrient status . In conclusion , given twice-weekly for 26 weeks , MMN supplements can improve micronutrient status effectively with no significant increase in Hb concentration compared with IFA supplements in non-anaemic Bangladeshi adolescent girls . However , it significantly reduces the risk of anaemia . Before any recommendations can be made , further research , including into cost-effectiveness , is needed to see whether MMN supplementation has any additional longer-term health benefits over that of IFA supplementation in this population A double-blind clinical trial was conducted among 9- to 11-year-old children in sixteen schools in the Chon Buri province of Thail and to assess the effects of an iron supplement combined with an anthelminthic agent ( i.e. albendazole ) . In addition to the albendazole , Fe or placebo tablets were distributed to 2268 children enrolled in grade s three to five without knowledge of the Fe status of the children . Criteria for case inclusion were : ( a ) absence of A E Bart 's or haemoglobin ( Hb ) H disease , ( b ) absence of abnormal Hb EE , and ( c ) age , 108 - 144 months . The results showed a significant improvement in the Fe status of the children after 16 weeks of treatment . The increments were : Hb from 124 to 128 g/l , serum ferritin from 34.54 to 104.72 micrograms/l , transferrin saturation from 24.09 to 35.05 % ; free erythrocyte protoporphyrin decreased from 444.7 to 281.4 micrograms/l erythrocytes . These changes were significantly greater than in the control group that received only the anthelminthic agent . However , the administration of albendazole only also result ed in significant changes in the same Fe indicators We evaluated the adverse effect of asymptomatic Helicobacter pylori infection in children on the response to Fe supplementation .  One hundred and sixty-nine children aged 1 - 10 years from the urban poor community underwent a [13C]urea breath test for H. pylori and haematological tests at admission and after 8 weeks . Both H. pylori-positive and -negative children were r and omly assigned to receive ferrous fumarate syrup ( 20 mg elemental Fe twice daily ) or placebo for 8 weeks and a single dose of vitamin A ( 33,000 microg ) . Admission findings were compared between H. pylori-positive and -negative children . Response to Fe was compared between Fe-supplemented H. pylori-positive and -negative children . Seventy-nine per cent of the children were aged 1 - 5 years and half of them were boys . In eighty-five H. pylori-positive and eighty-four H. pylori-negative children , the differences in mean Hb ( 112 ( sd 12.6 ) v. 113 ( sd 12.0 ) g/l ) , haematocrit ( 34 ( sd 3.5 ) v. 35 ( sd 3.2 ) % ) and ferritin ( 23.8 v. 21.0 microg/l ) were similar . After 8 weeks of Fe supplementation , mean Hb was 5.3 g/l more ( 95 % CI 1.59 , 9.0 ) and haematocrit was 1.4 % more ( 95 % CI 0.2 , 2.6 ) in H. pylori-negative ( n 44 ) compared with H. pylori-positive ( n 42 ) children . Mean ferritin was similar at admission and improved in both H. pylori-positive and -negative children . Asymptomatic H. pylori infection was not associated with higher rates of anaemia or Fe deficiency in children , but had a significant adverse effect on response to Fe therapy . However , this result is based on exploratory analysis and needs confirmation 1 . Behavioural responses of young anaemic Indian children to iron-folic acid supplements were assessed in two separate studies using the Indian adaptation of Wechsler 's ( 1967 ) intelligence scale for children ( WISC ) . 2 . The first study was an exploratory study in which the cognitive behaviour of 5 - 8-year-old children of both sexes was assessed before and after supplementation with 20 mg elemental Fe and 0.1 mg folic acid given daily for a period of 60 d. 3 . The supplemented children showed a significant improvement in haemoglobin ( Hb ) as well as the WISC scores while the control children who did not receive any supplements failed to show an improvement either in Hb or in the WISC scores . However , within the supplemented group when the initially-anaemic children were compared with the initially-non-anaemic ones , only the 7-year-old anaemic children performed significantly poor in the tests than the non-anaemic group of the same age . The study raised the possibility that in addition to increasing the blood Hb levels , Fe-folic acid supplements may have additional benefits in improving the cognitive performance of children . 4 . In the second study , cognitive behaviour of fourteen matched pairs of anaemic children in the age-range of 5 - 6 years was assessed before and after supplementation with 40 mg Fe and 0.2 mg folic acid given daily in two divided doses or sugar placebos for a period of 60 d. The tester did not know the groups to which each child belonged . 5 . The supplemented children showed a significant improvement in Hb as well as in the verbal and performance IQ of WISC . The control children showed no improvement in Hb but their verbal IQ improved significantly . However , there was no significant improvement in their performance IQ . 6 . The results indicated that Fe-folic acid supplements to anaemic children not only raised Hb levels but also improved intelligence test results , particularly in the performance section BACKGROUND In developing countries , incomplete resolution of anemia with iron supplementation is often attributed to poor compliance or inadequate duration of supplementation , but it could result from deficiencies of other micronutrients . OBJECTIVE Our objective was to assess children 's hematologic  response to supervised , long-term iron supplementation and the relation of this response to other micronutrient deficiencies , anthropometry , morbidity , and usual dietary intake . DESIGN Rural Mexican children aged 18 - 36 mo ( n = 219 ) were supplemented for 12 mo with either 20 mg Fe , 20 mg Zn , both iron and zinc , or placebo . Children were categorized as iron-unsupplemented ( IUS ; n = 109 ) or iron supplemented ( IS ; n = 108 ) . Hemoglobin , hematocrit , mean corpuscular volume , mean cell hemoglobin , plasma concentrations of micronutrients that can affect hematopoiesis , anthropometry , and diet were assessed at 0 , 6 , and 12 mo ; morbidity was assessed biweekly . RESULTS At baseline , 70 % of children had low hemoglobin ( < /=115 g/L ) , 60 % had low hematocrit , 48 % were ferritin deficient , 10 % had deficient and 33 % had low plasma vitamin B-12 concentrations , 29 % had deficient vitamin A concentrations , and 70 % had deficient vitamin E concentrations . Iron supplementation increased ferritin from 11 + /- 14 microg/L at baseline to 31 + /- 18 microg/L after 6 mo ( P < 0.001 ) and 41 + /- 17 microg/L after 12 mo . However , anemia persisted in 30 % and 31 % of supplemented children at 6 and 12 mo , respectively , and was not significantly different between the IUS and IS groups at 12 mo . Initial plasma vitamin B-12 , height-for-age , and dietary quality predicted the hematopoietic response to iron . CONCLUSION Lack of hemoglobin response to iron was associated with indicators of chronic undernutrition and multiple micronutrient deficiencies The objective was to determine the effect of daily supplementation with 30 mg of iron ( Fe ) plus 30 mg of zinc ( Zn ) for 3 months on Fe status of women of childbearing age . This was a r and omized double-blind , placebo-controlled trial . Eighty-one women ( 18–45 years ) were r and omly assigned to receive either a daily single dose of 30 mg of Fe ( group 1 ; n = 28 ) and 30 mg of Fe plus 30 mg of Zn ( group 2 ; n = 26 ) or placebo ( n = 27 ) for 3 months . Hemoglobin ( Hb ) , mean corpuscular volume , serum Fe , total iron-binding capacity , transferrin saturation , erythrocyte Zn protoporphyrin , serum ferritin ( SF ) , serum transferrin receptor ( TfR ) , total body Fe , serum Zn , and high-sensitivity C-reactive protein were measured at baseline and at the end of the study . At baseline , 3.7 , 28.4 , and 3.7 % of women had iron-deficiency anemia ( IDA ) , Fe deficiency without anemia , and depleted Fe stores , respectively . No significant differences on Fe status were found between groups before supplementation . After supplementation , group 2 showed a significant increase of Hb and total body Fe and a significant decrease of TfR compared with placebo ( p < 0.05 ) . Moreover , serum Zn increased significantly in group 2 compared with group 1 ( p < 0.01 ) and placebo ( p < 0.01 ) . In conclusion , daily supplementation with 30 mg of Fe plus 30 mg of Zn for 3 months improved significantly the Fe and Zn status of women , compared with those who received placebo . The positive effect of Fe supplementation on Fe status is enhanced by combined Zn supplementation BACKGROUND Combined supplementation with iron and zinc during infancy may be effective in preventing deficiencies of these micronutrients , but knowledge of their potential interactions when given together is insufficient . OBJECTIVE The goal was to compare the effect in infants of combined supplementation with iron and zinc  and of supplementation with single micronutrients on  iron and zinc status . DESIGN Indonesian infants ( n = 680 ) were r and omly assigned to daily supplementation with 10 mg Fe ( Fe group ) , 10 mg Zn ( Zn group ) , 10 mg Fe + 10 mg Zn ( Fe+Zn group ) , or placebo from 6 to 12 mo of age . Venous blood sample s were collected at the start and end of the study . Five hundred forty-nine infants completed the supplementation and had both baseline and follow-up blood sample s available for analysis . RESULTS Baseline prevalences of anemia , iron deficiency anemia ( anemia and low serum ferritin ) , and low serum zinc ( < 10.7 micromol/L ) were 41 % , 8 % , and 78 % , respectively . After supplementation , the Fe group had higher hemoglobin ( 119.4 compared with 115.3 g/L ; P < 0.05 ) and serum ferritin ( 46.5 compared with 32.3 microg/L ; P < 0.05 ) values than did the Fe+Zn group , indicating an effect of zinc on iron absorption . The Zn group had higher serum zinc ( 11.58 compared with 9.06 micromol/L ; P < 0.05 ) than did the placebo group . There was a dose effect on serum ferritin in the Fe and Fe+Zn groups , but at different levels . There was a significant dose effect on serum zinc in the Zn group , whereas no dose effect was found in the Fe+Zn group beyond 7 mg Zn/d . CONCLUSION Supplementation with iron and zinc was less efficacious than were single supplements in improving iron and zinc status , with evidence of an interaction between iron and zinc when the combined supplement was given BACKGROUND Micronutrient deficiencies are common , even in middle-income countries . OBJECTIVE The objectives were to determine whether multiple micronutrient ( MM ) supplementation from 3 to 24 mo of age improves growth and whether the effect is modified by MM supplementation during pregnancy . DESIGN We conducted a r and omized , double-blind , controlled trial in central Mexico . Singleton live births ( n = 650 ) from a prenatal MM trial were r and omly assigned to receive either MM supplements ( 1 - 1.5 times the Recommended Dietary Allowance of vitamins A , B-6 , B-12 , and C ; folic acid ; iron ; zinc ; and other nutrients ) or supplements containing similar amounts of iron and vitamin A ( Fe-A ) within the maternal supplementation groups ( MM and iron only ) 6 d/wk from 3 to 24 mo of age . Anthropometric measurements were obtained at 3 and 24 mo of age . RESULTS There was no effect of supplement group on child growth in intention-to-treat analyses . However , infants who consumed MM supplements regularly ( greater than the median compliance of 79 % ) were 0.8 ( 95 % CI : -0.4 , 1.9 ) and 1.6 ( 95 % CI : 0.4 , 2.8 ) cm taller at 24 mo in the maternal MM and iron-only groups , respectively , than were those in the Fe-A group ; these differences were 0.2 ( 95 % CI : -1.0 , 1.4 ) and -0.5 ( 95 % CI : -1.7 , 0.7 ) cm among those with compliance below the median . Mean body mass index ( in kg/m(2 ) ) was significantly higher in those exposed to iron only in utero and Fe-A during childhood ( 16.2 ) than in the other groups ( 15.8 ) . CONCLUSIONS MM supplements increased the length of children who consumed them regularly from 3 to 24 mo . Strategies that promote compliance through effective delivery of micronutrient interventions are needed Growth patterns in early life are associated with later health . The effect of nutrition during in utero development on later body composition is unclear . We evaluated whether prenatal early invitation to food and /or multiple micronutrient supplementation ( MMS ) in pregnancy has an effect on offspring body composition at 54 months of age . In Maternal and Infant Nutrition Interventions in Matlab trial ( IS RCT N16581394 ) in Bangladesh , 4436 pregnant women were r and omised into six equally sized groups : double-masked supplementation with capsules of either 30 mg Fe and 400 μg folic acid , or 60 mg Fe and 400 μg folic acid , or MMS ( 15 micronutrients ) , was combined with a r and omised early invitation ( around 9 weeks ) or a usual invitation ( around 20 weeks ) to start food supplementation ( 608 kcal 6 days per week ) . At 54 months , the body composition of the offspring was assessed by leg-to-leg bioelectrical impedance analysis . Of the 3267 live singletons with birth anthropometry , 2290 children were measured at 54 months , representing 70 % of the live births . There was no interaction between the food and micronutrient supplementation on body composition outcomes . There were no significant differences in a range of anthropometric and body composition measurements , including weight , height , mid-upper arm circumference , head circumference , skinfold thickness , and fat mass and fat-free mass between the different prenatal food and micronutrient groups using an intention-to-treat analysis . This analysis shows that early invitation to food supplementation and MMS provided to rural Bangladeshi women during pregnancy did not affect offspring body composition at 54 months of age Background There is a lack of information on the optimal timing of food supplementation to malnourished pregnant women and possible combined effects of food and multiple micronutrient supplementations ( MMS ) on their offspring 's growth . We evaluated the effects of prenatal food and micronutrient interventions on postnatal child growth . The hypothesis was that prenatal MMS and early invitation to food supplementation would increase physical growth in the offspring during 0 - 54 months and a combination of these interventions would further improve these outcomes . Methods In the large , r and omized MINIMat trial ( Maternal and Infant Nutrition Interventions in Matlab ) , Bangladesh , 4436 pregnant women were enrolled between November 2001 and October 2003 and their children were followed until March 2009 . Participants were r and omized into six groups comprising 30 mg Fe and 400 μg folic acid ( Fe30F ) , 60 mg Fe and 400 μg folic acid ( Fe60F ) or MMS combined with either an early ( immediately after identification of pregnancy ) or a later usual ( at the time of their choosing , i.e. , usual care in this community ) program invitation to food supplementation .  The anthropometry of 3267 children was followed from birth to 54 months , and 2735 children were available for analysis at 54 months . Results There were no differences in characteristics of mothers and households among the different intervention groups . The average birth weight was 2694 g and birth length was 47.7 cm , with no difference among intervention groups . Early invitation to food supplementation ( in comparison with usual invitation ) reduced the proportion of stunting from early infancy up to 54 months for boys ( p = 0.01 ) , but not for girls ( p = 0.31 ) . MMS result ed in more stunting than st and ard Fe60F ( p = 0.02 ) . There was no interaction between the food and micronutrient supplementation on the growth outcome . Conclusions Early food supplementation in pregnancy reduced the occurrence of stunting during 0 - 54 months in boys , but not in girls , and prenatal MMS  increased the proportion of stunting in boys . These effects on postnatal growth suggest programming effects in early fetal life . Trial registration numberIS RCT N : IS RCT OBJECTIVE To evaluate the effectiveness of universal prophylactic targeting with iron sulfate on daily or weekly basis in the prevention of anemia in infants . METHODS R and omized clinical field trial with children between ages six and 12 months seen at primary health care units in the municipality of Rio de Janeiro , Brazil , between 2004 and 2005 . Three concurrent cohorts were compared : daily group ( n=150 ; 12.5 mg Fe/day ) ; weekly group ( n=147 ; 25 mg Fe/week ) and control group . The intervention consisted of universal supplementation with iron sulfate for 24 weeks , combined with educational adherence-promoting measures . OUTCOME mean serum hemoglobin concentration , distribution and prevalence of anemia ( Hb<110.0 g/l ) at age 12 months . Effectiveness was evaluated considering both intent to treat and adherence to protocol , using multiple regression analysis ( linear and Poisson ) . RESULTS Groups were homogeneous in terms of descriptive variables . The intervention was implemented successfully , with high adhesion to protocol in both groups , and no statistical difference between them . After adjustment , only the daily regimen showed a protective effect . Adherence analysis demonstrated an evident dose-response effect on mean Hb and prevalence of anemia only for the daily regimen . No protective effect was detected for the weekly regimen . CONCLUSIONS Universal supplementation with iron sulfate from six to 12 months of age was effective in increasing serum Hb and decreasing risk of anemia only when administered on a daily basis BACKGROUND Deficiencies of iron and zinc are associated with delayed development , growth faltering , and increased infectious-disease morbidity during infancy and childhood . Combined iron and zinc supplementation may therefore be a logical preventive strategy . OBJECTIVE The objective of the study was to compare the effects of combined iron and zinc supplementation in infancy with the effects of iron and zinc as single micronutrients on growth , psychomotor development , and incidence of infectious disease . DESIGN Indonesian infants ( n = 680 ) were r and omly assigned to daily supplementation with 10 mg Fe ( Fe group ) , 10 mg Zn ( Zn group ) , 10 mg Fe and 10 mg Zn ( Fe+Zn group ) , or placebo from 6 to 12 mo of age . Anthropometric indexes , developmental indexes ( Bayley Scales of Infant Development ; BSID ) , and morbidity were recorded . RESULTS At 12 mo , two-factor analysis of variance showed a significant interaction between iron and zinc for weight-for-age z score , knee-heel length , and BSID psychomotor development . Weight-for-age z score was higher in the Zn group than in the placebo and Fe+Zn groups , knee-heel length was higher in the Zn and Fe groups than in the placebo group , and the BSID psychomotor development index was higher in the Fe group than in the placebo group . No significant effect on morbidity was found . CONCLUSIONS Single supplementation with zinc significantly improved growth , and single supplementation with iron significantly improved growth and psychomotor development , but combined supplementation with iron and zinc had no significant effect on growth or development . Combined , simultaneous supplementation with iron and zinc to infants can not be routinely recommended at the iron-to-zinc ratio used in this study Ninety-nine anemic children aged 1 - 8 y were divided into four groups . Each group was supplemented for 2 mo with vitamin A , iron , vitamin A plus Fe , or a placebo .  Clinical , hematological , and Fe biochemical evaluations were performed at the beginning and end of the study . Vitamin A supplementation produced significant elevations in the serum levels of retinol , blood hemoglobin , hematocrit , erythrocytes , serum Fe , and percent transferrin saturation ( % TS ) and had no effect on total Fe binding capacity ( TIBC ) or serum ferritin . Fe supplementation did not affect serum retinol . However , it improved hematological and Fe nutrition indicators , including TIBC and serum ferritin . The simultaneous administration of vitamin A and Fe result ed in a better response of serum Fe and % TS than when the supplement consisted only of vitamin A or Fe alone . Vitamin A benefits hematological condition and Fe metabolism BACKGROUND Micronutrient deficiencies remain common in preschool children in developing countries . Interventions focus on single micronutrients and often lack effectiveness . Weekly instead of daily supplementation may improve effectiveness . OBJECTIVE The efficacy of weekly and daily supplementation in reducing anemia prevalence and in improving the zinc , vitamin A , and growth status of 6 - 24-mo-old Vietnamese children was investigated . DESIGN In this double-blind , placebo-controlled trial , the daily group ( n = 55 ) received 8 mg elemental Fe ( as iron sulfate ) , 5 mg elemental Zn ( as zinc sulfate ) , 333 microg retinol , and 20 mg vitamin C 5 d/wk for 3 mo . The weekly group ( n = 54 ) received 20 mg Fe , 17 mg Zn , 1700 microg retinol , and 20 mg vitamin C once a week . A third group ( n = 54 ) received a placebo only .  Venous blood sample s were collected at the start and end of the supplementation period and anthropometric measurements were taken at the start and 3 mo after the end of supplementation . RESULTS At baseline , 45.6 % of subjects had hemoglobin concentrations < 110 g/L , 36.3 % had zinc concentrations < 10.71 micromol/L , and 45.6 % had retinol concentrations < 0.70 micromol/L. Hemoglobin , retinol , and zinc concentrations of both the weekly and daily groups increased similarly compared with the placebo group ( P < 0.001 ) . There was no significant difference in growth between the supplemented groups and the placebo group . However , the height-for-age of subjects stunted at baseline increased with z scores of 0.48 ( P < 0.001 ) and 0.37 ( P < 0.001 ) for the daily and weekly groups , respectively . CONCLUSIONS Weekly and daily supplementation improved hemoglobin , zinc , and retinol concentrations similarly . Neither intervention affected growth of the overall population , but growth of children stunted at baseline was improved through both types of supplementation The present study investigates the prevalence and type of anaemia in Chinese female cotton mill workers . The prevalence of anaemia is reported in 447 non-pregnant female workers aged between 19 and 45 years . The mean value for haemoglobin ( Hb ) was 123 ( SD 15 ) g/l and 150 of the total 447 subjects had Hb values below 120 g/l ; thus 34 % of the population was anaemic according to World Health Organization ( WHO , 1975 ) criteria . The mean value for free erythrocyte protoporphyrin ( FEP ) was 419 ( SD 215 ) micrograms/l ; 55 % of the total population had FEP values higher than 350 micrograms/l and 72 % among the anaemic subjects . Serum ferritin ( SF ) was tested in all the women with a Hb value less than 120 g/l and 71 % of them had SF values below 12.0 micrograms/l . Eighty women diagnosed as either Fe deficient or with Fe-deficient anaemia were selected for a diagnostic supplementation trial . They were r and omly assigned to FeSO4 ( 60 or 120 mg Fe/d ) or placebo treatment for 12 weeks . Fe supplementation increased mean Hb values from 114 to 127 g/l ( P < 0.001 ) and SF levels from 9.7 to 30.0 micrograms/l ( P < 0.001 ) , and decreased mean FEP values from 570 to 277 micrograms/l ( P < 0.001 ) . The response rate of Hb in the whole Fe-treated group or Fe-treated subjects with an Hb level less than 120 g/l was 90 % or 92 % respectively . These findings indicate that the type of anaemia in this population was mainly Fe deficiency . It was also found that in this population the severity of anaemia , not the prevalence , was significantly related to the use of intra-uterine devices ( IUD ) Although iron deficiency is the most common single-nutrient deficiency in infants and children , other deficiencies may develop concurrently , including zinc deficiency . In previous studies , we used home-fortification with " Sprinkles , " single-serve sachets containing microencapsulated ferrous fumarate added to weaning foods , to successfully treat anemia . This mode of micronutrient delivery is amenable to the delivery of other micronutrients . However , the relative efficacy of multiple micronutrient supplements for the treatment of anemia requires evaluation due to possible nutrient interactions . Thus , we evaluated the relative efficacy of Sprinkles formulated with iron and zinc in anemic infants , compared with Sprinkles formulated with iron alone . We studied 304 anemic infants ( mean age 10.3 + /- 2.5 mo ; hemoglobin 87.4 + /- 8.4 g/L ) in rural Ghana . A combined supplementation group ( FeZn ) received daily Sprinkles containing 80 mg iron and 10 mg zinc ; a comparison group ( Fe ) received Sprinkles ( 80 mg iron ) without zinc for 2 mo . The rate of recovery from anemia was higher in the Fe group compared with the FeZn group ( 74.8 vs. 62.9 % ; P = 0.048 ) . The plasma zinc concentration decreased significantly in both groups ( P < 0.05 ) . A significant decline in the height for age Z-score was observed in the FeZn group ( P = 0.0011 ) , but there was no change in the Fe group . These results suggest that in a controlled setting , home-fortification using micronutrient Sprinkles with iron , or iron and zinc , was very successful in treating anemia ; however , this intervention alone was insufficient to improve zinc status or promote catch-up growth in this stunted and wasted population BACKGROUND Few data exist for the effects of multiple micronutrient ( MM ) or food supplementation to undernourished pregnant women on their offsprings ' development . OBJECTIVE We aim ed to compare the effects on infant development of early ( 8 - 10 wk gestation ) or usual ( approximately 17 wk gestation ) supplementation with food and MM , 30 mg Fe + 400 microg folate , or 60 mg Fe + 400 microg folate . DESIGN A large , r and omized , controlled trial of pregnancy supplementation was conducted in Bangladesh . A sub sample of infants ( n = 2853 ) were assessed on 2 problem-solving tests ( support and cover tests ) , the motor index of the Bayley Scales of Infant Development , and Wolke 's behavior ratings at 7 mo of age . RESULTS There were no significant effects of any intervention in the group as a whole . However , infants of undernourished mothers [ body mass index ( BMI ; in kg/m2 ) < 18.5 ] who received early food supplementation performed slightly but significantly ( P = 0.035 ) better on the support test than did infants of mothers who received usual food supplementation ( z score : 0.17 ; 95 % CI : 0.01 , 0.33 ) . There were no benefits in infants of higher- BMI mothers ( P = 0.024 for BMI x food interaction ) . Children of low- BMI mothers who received MMs had slightly better motor scores ( z score : 0.28 ; 95 % CI : 0.08 , 0.48 ) and activity ratings ( z score : 0.24 ; 95 % CI : 0.037 , 0.45 ) than did those who received 30 mg Fe + 400 microg folate , whereas other children did not benefit ( P = 0.05 for both motor scores and BMI x micronutrients and for activity and BMI x micronutrients ) . CONCLUSIONS Small benefits from early food and MM supplementation were found in infants of low- BMI but not of high- BMI mothers . However , the benefits were of doubtful functional importance , and longer follow-up is required to determine programmatic implication Pregnancy is a condition exhibiting increased susceptibility to oxidative stress , and Fe plays a central role in generating harmful oxygen species . The objective of the present study is to investigate the changes in haematological status , oxidative stress and erythrocyte membrane fluidity in anaemic pregnant women after Fe supplementation with and without combined vitamins .  The study was a 2 months double-blind , r and omised trial . Pregnant women ( n 164 ) were allocated to four groups : group C was the placebo control group ; group I was supplemented daily with 60 mg Fe ( ferrous sulphate ) daily ; group IF was supplemented daily with Fe plus 400 μg folic acid ; group IM was supplemented daily with Fe plus 2 mg retinol and 1 mg riboflavin , respectively . After the 2-month trial , Hb significantly increased by 15.8 , 17.3 and 21.8 g/l , and ferritin by 2.8 , 3.6 and 11.0 μg/l , in the I , IF and IM groups compared with placebo . Polarisation ( ρ ) and microviscosity ( η ) decreased significantly in other groups compared with placebo , indicating an increase in membrane fluidity . Significant decreases of ρ and η values compared with group C were 0.033 and 0.959 for group I , 0.037 and 1.074 for group IF and 0.064 and 1.865 for group IM , respectively . In addition , significant increases of glutathione peroxidase activities and decreases of malondialdehyde were shown in all treated groups , as well as increases of plasma retinol and urine riboflavin in group IM . The findings show that supplementation with Fe and particularly in combination with vitamins  could improve the haematological status as well as oxidative stress and erythrocyte membrane fluidity OBJECTIVE Despite public health campaigns based on Fe and folic acid supplements , Fe-deficiency anaemia remains highly prevalent among women in India . We investigated leaf concentrate as an alternative to Fe and folic acid supplements for treating  anaemia in adolescent girls . DESIGN R and omised controlled two-arm trial over 3 months : one group received daily Fe and folic acid ( IFA ; 60 mg Fe , 500 microg folic acid ) ; the other daily leaf concentrate ( LC ; 5 mg Fe , 13 microg folic acid ) . Hb concentration , mean cell volume , serum Fe , serum ferritin and total Fe-binding capacity were measured pre- and post-intervention . SETTING Jaipur , India . SUBJECTS One hundred and two adolescent girls aged 14 - 18 years . RESULTS Of the 102 girls r and omized to the two arms of the trial , four ( 3.9 % ) were severely anaemic  ( Hb < 7 g/dl ) , twenty-eight ( 27.5 % ) were moderately anaemic ( Hb > or = 7 g/dl , < 10 g/dl ) and seventy ( 68.6 % ) were mildly anaemic ( Hb > or = 10 g/dl , < 12 g/dl ) . In the IFA group , eleven girls ( 20.4 % ) withdrew due to side-effects , compared with one girl ( 2.1 % ) in the LC group ( P = 0.005 ) . Total losses to follow-up were 14/54 in the IFA group and 2/48 in the LC group . At the end of the trial , none of the eighty-six remaining girls were severely anaemic , nine ( 10.5 % ) were moderately anaemic and twenty-six ( 30.2 % ) were mildly anaemic ; fifty-one ( 59.3 % ) had normal Hb levels ( > or = 12 g/dl ) . After adjustment for baseline values , LC was as effective as IFA in improving serum Fe parameters and treating anaemia . CONCLUSIONS Leaf concentrate is an effective , and more palatable , alternative to Fe and folic acid supplements for treating anaemia in adolescent girls BACKGROUND The coexistence of multiple micronutrient deficiencies is a widespread public health problem in many regions of the world . Interactions between zinc deficiency and vitamin A metabolism have been reported but no longitudinal studies have evaluated the effect of iron deficiency on vitamin A. OBJECTIVE The objective of this study was to investigate the effect of supplementation with iron , zinc , or both on vitamin A and its metabolically related proteins retinol binding protein ( RBP ) and transthyretin . DESIGN The study was a longitudinal , double-blind , placebo-controlled trial in which 219 rural Mexican children aged 18 - 36 mo were r and omly assigned to receive 20 mg Zn/d , 20 mg Fe/d , 20 mg Zn/d plus 20 mg Fe/d , or placebo . RESULTS Six months after supplementation , plasma retinol increased in all supplemented groups . Compared with placebo , zinc supplementation was associated with significantly higher plasma retinol and transthyretin but the increase in RBP was not significant . Iron supplementation significantly increased plasma retinol , RBP , and transthyretin . Supplementation with zinc plus iron significantly increased plasma retinol but not RBP or transthyretin .  Children deficient in zinc , iron , or vitamin A ( as indicated by nutrient plasma concentration ) at the beginning of the study had a significantly greater increase in retinol than did children with adequate nutrient status . CONCLUSIONS Supplementation with zinc , iron , or both improved indicators of vitamin A status . The results of this study agree with previous observations of a metabolic interaction between zinc and vitamin A and suggest an interaction between iron and vitamin A metabolism Different supplementation schemes to build iron stores in female Indonesian adolescents were investigated . Subjects were 273 high-school girls allocated r and omly to four treatment groups . During a 3-mo period one group received 60 mg Fe , 750 micrograms retinol , 250 micrograms folic acid , and 60 mg vitamin C per day ; a second group received 60 mg Fe , 6000 micrograms retinol , 500 mg folic acid , and 60 mg vitamin C once a week ; a third group received 120 mg Fe and the same amount of the other three micronutrients as the second group once a week ; and a fourth group received only placebos . All subjects were dewormed and supplement allocation was double blind . Blood sample s were collected at baseline , after 2 and 3 mo of supplementation , and 6 mo after the last supplement . After 2 mo of supplementation , groups supplemented weekly and daily showed similar significant improvements ( P < 0.001 ) in hemoglobin and retinol concentrations , and supplementation for 3 instead of 2 mo did not significantly increase these two indicators . After 3 mo , the increase in ferritin was approximately equal to 27 micrograms/L in the daily and 14 - 15 micrograms/L in the weekly groups ( P < 0.001 ) , the latter having a final concentration of 42 - 45 micrograms/L. At 6 mo postsupplementation there were no significant differences among daily and weekly groups , but the ferritin concentration was still approximately equal to 10 - 12-micrograms/L higher ( P < 0.001 ) than in the placebo group . The group supplemented weekly with 60 mg Fe complained less about side effects than the other supplemented groups ( P < 0.05 ) . Weekly supplementation with 60 mg Fe and 6000 micrograms retinol for 3 mo was optimal for improving the iron status of the adolescents for approximately equal to 9 mo BACKGROUND There is still uncertainty about the best procedure to alleviate iron deficiency . Additionally more reliable methods are needed to assess the effect of iron intervention . OBJECTIVE We examined the efficacy of daily iron ( 10 mg ) , daily and weekly multiple-micronutrient supplementation ( 10 and 20 mg Fe , respectively ) in improving body iron stores of Indonesian infants . DESIGN Infants aged 6 - 12 mo were r and omly allocated to 1 of 4 groups : daily multiple-micronutrients ( DMM ) foodlike tablets ( foodLETs ) , weekly multiple-micronutrient ( WMM ) foodLETs , daily iron ( DI ) foodLETs , or daily placebo .  Hemoglobin , ferritin , transferrin receptors , and C-reactive protein data were obtained at baseline and 23 wk . RESULTS Body iron estimated from the ratio of transferrin receptors to ferritin was analyzed for 244 infants . At baseline , mean iron stores ( 0.5 + /- 4.1 mg/kg ) did not differ among the groups , and 45.5 % infants had deficits in tissue iron ( body iron < 0 ) . At week 23 , the group DI had the highest increment in mean body iron ( 4.0 mg/kg ) , followed by the DMM group ( 2.3 mg/kg ; P < 0.001 for both ) . The iron stores in the WMM group did not change , whereas the mean body iron declined in the daily placebo group ( -2.2 mg/kg ; P < 0.001 ) . Compared with the daily placebo group , the DMM group gained 4.55 mg Fe/kg , the DI group gained 6.23 mg Fe/kg ( both P < 0.001 ) , and the WMM group gained 2.54 mg Fe/kg ( P = 0.001 ) . CONCLUSIONS When compliance can be ensured , DI and DMM foodLETs are efficacious in improving and WMM is efficacious in maintaining iron stores among Indonesian infants The Thriposha programme is a community-level nutrition intervention in Sri Lanka that provides a combination of energy , protein and micronutrients as a ' ready-to-eat ' cereal-based food . We measured the bioavailability of Fe and Zn from Thriposha formula at two different molar ratios of Zn : Fe in order to determine the effect on Fe and Zn absorption . Children 4 - 7 years ( n 53 ) were given a meal prepared with 50 g Thriposha containing 1.5 mg Zn as zinc sulphate and either 9 mg ( high Fe concentration ( HiFe ) ) or 4.5 mg ( low Fe concentration ( LoFe ) ) Fe as ferrous fumarate .  Zn and Fe percent absorption were measured using stable isotopes by tracer : tracee ratio and by incorporation of erythrocytes , respectively . Percent Fe absorption from the two meals was similar ( 6.6 % ( 4.8 ) v. 4.8 % ( 2.6 ) ; P = 0.15 ) , but total Fe absorption was significantly higher from the HiFe meal ( 0.59 ( 0.43 ) mg ) than the LoFe meal ( 0.20 ( 0.12 ) mg ; P = 0.01 ) . There was no significant difference between the two groups in Zn absorption ( 10.7 % ( 0.9 ) v. 8.8 % ( 1.4 ) , P = 0.13 , respectively ) . Decreasing the amount of Fe in Thriposha did not cause a significant change in the percent absorption of Fe and Zn , but significantly lowered the total amount of absorbed Fe . These results demonstrate the utility of maintaining a higher Fe content in this supplement . Further studies to increase Zn content are warranted while maintaining a HiFe BACKGROUND Deficiencies of iron and vitamin A are prevalent worldwide . Single-micronutrient supplementation is widely used to combat these deficiencies . However , micronutrient deficiencies often occur concurrently , and there are many interactions between micronutrients . OBJECTIVE This study investigated interactions among 3 important micronutrients -- iron , vitamin A , and zinc -- when they are given as supplements . DESIGN In a r and omized , double-blind , placebo-controlled supplementation trial , 387 Indonesian infants aged 4 mo were supplemented 5 d/wk for 6 mo with 10 mg Fe , 10 mg Zn , 2.4 mg beta-carotene , 10 mg each of Fe and Zn , 10 mg Zn + 2.4 mg beta-carotene , or placebo . Complete data on micronutrient status , including hemoglobin , ferritin , retinol , zinc , and the modified relative dose response ( a measure of liver retinol stores ) , were available from 256 infants at the end of the study . RESULTS Iron-supplemented infants had significantly lower plasma retinol concentrations and a significantly higher prevalence of vitamin A deficiency , as defined by a plasma retinol concentration < 0.70 micromol/L , than did the non-supplemented infants . In contrast , the modified relative dose response of the iron-supplemented infants indicated greater liver stores of vitamin A.  Iron supplementation improved iron status , and zinc supplementation improved zinc status , but beta-carotene supplementation did not significantly improve vitamin A status . CONCLUSIONS In this study , iron supplementation in infants with marginal vitamin A status led to lower plasma vitamin A concentrations and simultaneously to greater vitamin A liver stores . This implies a redistribution of retinol after iron supplementation , which might induce vitamin A deficiency . Therefore , iron supplementation in infants should be accompanied by measures to improve vitamin A status Poor nutrient intake during pregnancy can adversely affect both infant and maternal health . The aim was to investigate the efficacy of multiple-micronutrient supplementation during pregnancy in a socially deprived population in the developed world . We conducted a r and omised , double-blind , placebo-controlled trial of multiple-micronutrient supplementation including 20 mg Fe and 400 microg folic acid , from the first trimester of pregnancy in 402 mothers , in East London , UK .  Nutrient status was measured at recruitment , and at 26 and 34 weeks of gestation . Infants were weighed at birth . At recruitment the prevalence of anaemia was 13 % , vitamin D insufficiency 72 % , thiamin deficiency 12 % and folate deficiency 5 % , with no differences between groups . Only 39 % of women completed the study ; rates of non-compliance were similar in both groups . Intention-to-treat analysis showed that participants receiving treatment had higher mean Hb at 26 weeks of gestation ( 110 ( sd 10 ) v.108 ( sd 10 ) g/l ; P = 0.041 ) and 34 weeks of gestation ( 113 ( sd 12 ) v.109 ( sd 10 ) g/l ; P = 0.003 ) and packed cell volume concentrations at 26 weeks of gestation ( 0.330 ( sd 0.025 ) v. 0.323 ( sd 0.026 ) l/l ; P = 0.011 ) and 34 weeks of gestation ( 0.338 ( sd 0.029 ) v. 0.330 ( sd 0.028 ) l/l ; P = 0.014 ) compared with controls . Analysis of compliant women showed supplemented women had higher median concentrations of serum ferritin , erythrocyte folate and 25-hydroxyvitamin D later in gestation than controls . In the compliant subset ( n 149 ) , placebo mothers had more small-for-gestational age ( SGA ) infants ( eight SGA v. thirteen ; P = 0.042 ) than treatment mothers . Baseline micronutrient deficiencies were common ; the multiple-micronutrient supplement was well-tolerated and improved nutrient status .  Multiple-micronutrient supplements from early pregnancy may be beneficial and larger studies are required to assess impact on birth outcomes and infant development BACKGROUND Iron supplements improve hemoglobin status and reduce  anemia  due to iron deficiency . It is not known whether multiple micronutrient ( MM ) supplements are as efficacious as are iron supplements alone in improving hemoglobin concentrations . OBJECTIVE We conducted a r and omized , double-blind community trial in Mexico to compare the efficacy of MM supplements containing iron with that of iron alone in improving hemoglobin concentrations in nonpregnant women . DESIGN Nonpregnant women ( n = 158 ) were recruited from a semirural community in Mexico and were r and omly assigned to receive iron alone ( 60 mg ; Fe group ) or MM supplements ( vitamins A , B complex , C , D , E , and K and iron , zinc , and magnesium ; MM group ) 6 d/wk in their home for 12 wk . Hemoglobin concentrations were measured in capillary blood sample s at baseline and follow-up . RESULTS The treatment groups ( MM : n = 75 ; Fe : n = 77 ) did not differ significantly at recruitment in age , schooling , literacy , or socioeconomic status . There were no significant differences between groups in compliance ( median : 97.5 % ) , baseline hemoglobin concentrations , or prevalence of anemia ( 20 % ) . Losses to follow-up ( 4 % ) and mean ( + /-SD ) changes in hemoglobin ( MM group : 6.7 + /- 10.6 g/L ; Fe group : 7.1 + /- 13.6 g/L ) were not significantly different between groups . However , the change in hemoglobin in anemic subjects was greater in the Fe group than in the MM group ( P < 0.05 for interaction ) , and there was no significant difference in nonanemic subjects . CONCLUSIONS MM supplements may not be as efficacious as is iron alone in improving the hemoglobin status of anemic women Abstract We examined hemoglobin ( Hb , g/L ) , iron status ( zinc protoporphyrin , ZPP , & mgr;mol/mol heme , and transferrin receptor , TfR , mg/L ) and inflammation ( C‐reactive protein , CRP and alpha‐1 glycoprotein , AGP ) in pregnant Ghanaian women who participated in a r and omized controlled trial . Women ( n = 1320 ) received either 60 mg Fe + 400‐&mgr;g folic acid ( IFA ) ; 18 micronutrients including 20‐mg Fe ( MMN ) or small‐quantity lipid‐based nutrient supplements ( SQ‐LNS , 118 kcal/d ) with the same micronutrient levels as in MMN , plus four additional minerals ( LNS ) daily during pregnancy . Intention‐to‐treat analysis included 349 , 354 and 354 women in the IFA , MMN and LNS groups , respectively , with overall baseline mean Hb and anemia ( Hb < 100 ) prevalence of 112 and 13.3 % , respectively . At 36 gestational weeks , overall Hb was 117 , and anemia prevalence was 5.3 % . Compared with the IFA group , the LNS and MMN groups had lower mean Hb ( 120 ± 11 vs. 115 ± 12 and 117 ± 12 , respectively ; P < 0.001 ) , higher mean ZPP ( 42 ± 30 vs. 50 ± 29 and 49 ± 30 ; P = 0.010 ) and TfR ( 4.0 ± 1.3 vs. 4.9 ± 1.8 and 4.6 ± 1.7 ; P < 0.001 ) , and greater prevalence of anemia ( 2.2 % vs. 7.9 % and 5.8 % ; P = 0.019 ) , elevated ZPP ( > 60 ) [ 9.4 % vs. 18.6 % and 19.2 % ; P = 0.003 ] and elevated TfR ( > 6.0 ) [ 9.0 % vs. 19.2 % and 15.1 % ; P = 0.004 ] . CRP and AGP concentrations did not differ among groups . We conclude that among pregnant women in a semi‐urban setting in Ghana , supplementation with SQ‐LNS or MMN containing 20 mg iron result ed in lower Hb and iron status but had no impact on inflammation , when compared with iron ( 60 mg ) plus folic acid ( 400 & mgr;g ) . The amount of iron in such supplements that is most effective for improving both maternal Hb/iron status and birth outcomes requires further evaluation . This trial was registered at Clinical Trials.gov as : NCT00970866 Food fortification is an important long-term strategy for addressing micronutrient deficiencies . Finding the ideal Fe fortification compound , however , remains a challenge . In the present study the effect of ferrous bisglycinate as fortificant in brown bread was compared with that of electrolytic Fe among Fe-deficient school children in a r and omised controlled trial . Children ( n 160 ) , aged 6 - 11 years , with serum ferritin < 20 microg/l , were r and omly assigned to one of three treatment categories : ( i ) st and ard unfortified bread ; ( ii ) bread with electrolytic Fe as fortificant ; and ( iii ) bread with ferrous bisglycinate as fortificant . Each child received four slices of bread ( 120 g ) on school days , which supplied an average of 3.66 mg elemental Fe per intervention day for 137 d ( 2.52 mg/d for 75 d and 5.04 mg/d for 62 d ) over a period of 7.5 months . Hb , serum ferritin , serum Fe and transferrin saturation were measured at baseline and at the end of the intervention . Significant treatment effects were observed for Hb ( P = 0.013 ) , serum Fe ( P = 0.041 ) and transferrin saturation ( P = 0.042 ) in the ferrous bisglycinate group , but not in the electrolytic Fe group . There were no significant intervention effects for serum ferritin in either treatment group . Overall , ferrous bisglycinate as Fe fortificant in brown bread performed better than electrolytic Fe in a group of Fe-deficient school children over a period of 7.5 months In rural Mexico and in many developing countries micronutrient deficiencies , growth stunting , and morbidity from infectious diseases are highly prevalent in young children . We assessed the extent to which growth stunting could be reversed and the number of infectious disease episodes reduced by zinc and /or iron supplementation . In a double-blind , r and omized community trial 219 Mexican preschoolers were supplemented with either 20 mg Zn as zinc methionine , 20 mg Fe as ferrous sulfate , 20 mg Zn + 20 mg Fe , or a placebo . After 12 mo , plasma zinc increased significantly in the two zinc-treated groups , and plasma ferritin was significantly higher in the two iron-treated groups . There was no effect of treatments on growth velocity or body composition . Children in both zinc-supplemented groups had fewer episodes of disease ( zinc alone , 3.9 + /- 0.3 ; zinc+iron , 3.7 + /- 0.4 ; placebo , 4.6 + /- 0.5 ; P < 0.03 ) , including diarrhea ( zinc alone , 0.7 + /- 0.1 ; zinc+iron , 0.8 + /- 0.1 ; placebo , 1.1 + /- 0.2 ; P < 0.01 ) . Zinc and zinc+iron supplements reduced morbidity but had no effect on growth or body composition Although routine Fe supplementation in pregnancy is a common practice , its clinical benefits or risks are uncertain . Children born to mothers in the Fe group in a trial of Fe supplementation in pregnancy have been found to have a significantly higher risk of abnormal behaviour at 4 years of age than those born to mothers in the placebo group . The objective of the present study therefore was to determine whether Fe supplementation in pregnancy influences child behaviour at early school age . The study was a follow-up of children at 6 - 8 years of age after women ( n 430 ) were r and omly allocated to receive a daily Fe supplement ( 20 mg ) or placebo from 20 weeks gestation until delivery . The supplement reduced the incidence of Fe-deficiency anaemia at delivery from 9 % to 1 % . Child behaviour and temperament were assessed using the Strengths and Difficulties Question naire and the Short Temperament Scale for Children . Of the children , 264 ( 61 % ) participated in the follow-up . Mean behaviour and temperament scores and the proportion of parent-rated and teacher-rated abnormal total difficulties scores did not differ between the Fe and placebo groups . However , the incidence of children with an abnormal teacher-rated peer problems subscale score was higher in the Fe group ( eleven of 112 subjects ; 8 % ) than in the placebo group ( three of 113 subjects ; 2 % ) ; the relative risk was 3.70 ( 95 % CI 1.06 , 12.91 ; P = 0.026 ) . We conclude that prenatal Fe supplementation had no consistent effect on child behaviour at early school age in this study population . Further investigation regarding the long-term effects of this common practice is warranted Interventions to combat mild Fe deficiency in women of childbearing age may affect Zn nutriture . We used dietary and laboratory indices to assess change in Zn status during a 4-month partially blinded placebo-controlled Fe intervention in women with low Fe stores ( serum ferritin < 20 microg/l and Hb > or = 120 g/l ) from Dunedin , New Zeal and . Subjects aged 18 - 40 years were r and omly assigned to three groups : dietary advice ( diet group ; DG ; n 29 ) , daily Fe supplement with meals ( supplement group ; SG ; n 23 ; 50 mg Fe as amino acid chelate ) and placebo ( placebo group ; PG , n 26 ) . A vali date d semi-quantitative FFQ ( SFFQ ) was administered at baseline , and at 4 , 8 and 15 weeks ; fasting morning blood sample s were assayed for serum Zn , alkaline phosphatase ( ALP ) and C-reactive protein at baseline , and at 4 , 8 , 12 and 16 weeks ; hair Zn and taste detection thresholds by electrogustometry were measured at baseline and at 16 weeks . Intakes of flesh foods and vitamin C but not Zn or Fe increased , whereas phytate and phytate : Zn molar ratios decreased ( all P < or = 0.01 ) in the DG compared with the PG and SG , based on three SFFQ . Serum Zn increased in both the DG and PG ( adjusted , P < or = 0.002 ) , so the between-group difference was not significant ; the lack of a parallel rise in the SG was significant when compared with the PG ( P = 0.02 ) . ALP activity ( but not hair Zn or taste acuity ) followed a similar trend . In conclusion , Zn status was not improved compared with placebo by an Fe-based dietary intervention . However , a daily moderate-dose Fe supplement with meals appeared to lower Zn status in these young adult women
Synthesized evidence indicates that addition of multiple micronutrients to Fe supplementation may only marginally improve Hb response compared with Fe supplementation alone .
However , addition of ' other micronutrients ' may have a negative effect .
Routine addition of unselected multiple micronutrients to Fe therefore appears unjustified for nutritional anaemia control programmes
OBJECTIVES To study the effect of combining multiple ( two or more ) micronutrients with Fe supplementation on Hb response , when compared with placebo and with Fe supplementation , in children .