Low prevalence of iron-deficiency anaemia among Inuit preschool children: Nunavut Inuit Child Health Survey, 2007-2008. Efficacy of Daily and Weekly Iron Supplementation on Iron Status in Exclusively Breast-Fed Infants Low dose daily iron supplementation improves iron status and appetite but not anemia, whereas quarterly anthelminthic treatment improves growth, appetite and anemia in Zanzibari preschool children. Positive association between dietary iron intake and iron status in HIV-infected children in Johannesburg, South Africa. Iron fortification of whole wheat flour reduces iron deficiency and iron deficiency anemia and increases body iron stores in Indian school-aged children. Relationship between iron deficiency and anemia in children younger than 4 years. Micronutrient Fortified Milk Improves Iron Status, Anemia and Growth among Children 1–4 Years: A Double Masked, Randomized, Controlled Trial Once Weekly Low-dose Iron Supplementation Effectively Improved Iron Status in Adolescent Girls Iron Supplements Reduce the Risk of Iron Deficiency Anemia in Marginally Low Birth Weight Infants Causal relationship of Helicobacter pylori with iron-deficiency anemia or failure of iron supplementation in children. [Prevalence of iron deficiency in healthy 12-month-old infants]. Iron Supplementation Until 6 Months Protects Marginally Low-Birth-Weight Infants From Iron Deficiency During Their First Year of Life [Effect of daily or once weekly iron supplementation on growth and iron status of preschool children]. Effect of daily iron supplementation on iron status, cell-mediated immunity, and incidence of infections in 6–36 month old Togolese children Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial Effectiveness of Intermittent Iron Treatment of Two- to Six-Year-Old Jordanian Children with Iron-Deficiency Anemia A controlled, household-randomized, open-label trial of the effect that treatment of Helicobacter pylori infection has on iron deficiency in children in rural Alaska. Controlled, household-randomized, open-label trial of the effect of treatment of Helicobacter pylori infection on iron deficiency among children in rural Alaska: results at 40 months. The impact of systematic dietary counseling during the first year of life on prevalence rates of anemia and iron deficiency at 12-16 months. Whole cowpea meal fortified with NaFeEDTA reduces iron deficiency among Ghanaian school children in a malaria endemic area. Iron deficiency and its management in patients undergoing lipoprotein apheresis. Comparison of two parenteral iron formulations. Subclinical inflammation influences the association between vitamin A- and iron status among schoolchildren in Ghana Iron and zinc supplementation improved iron and zinc status, but not physical growth, of apparently healthy, breast-fed infants in rural communities of northeast Thailand. Iron-containing micronutrient supplementation of Chinese women with no or mild anemia during pregnancy improved iron status but did not affect perinatal anemia. The use of sweet rolls fortified with iron bis-glycinate chelate in the prevention of iron deficiency anemia in preschool children. Effects of iron deficiency on attention and learning processes in preschool children: Bandung, Indonesia.
OBJECTIVE To report the prevalence rates and correlates for anaemia , iron deficiency ( ID ) and iron-deficiency anaemia ( IDA ) among Inuit preschool-aged children . DESIGN A cross-sectional study  assessed iron intake , demographic information , medical history , anthropometrics , Hb , ferritin , C-reactive protein and antibodies to Helicobacter pylori . SETTING Sixteen selected Inuit communities in Nunavut Territory , Canada . SUBJECTS Inuit ( n 388 ) aged 3 - 5 years r and omly recruited from communities . RESULTS Anaemia ( 3 - 4 years : Hb < 110 g/l ; 5 years : Hb < 115 g/l ) was prevalent in 16·8 % of children . The prevalence of ID ( ferritin < 12 μg/l ) was 18·0 % and that of IDA was 5·4 % . When ID was defined as ferritin < 10 μg/l , 10·8 % of children were iron deficient and 3·3 % had IDA . In multiple logistic regression , boys were more likely to be iron deficient ( OR = 2·28 , 95 % CI 1·17 , 8·25 ) , but no other risk factor emerged for ID . Three- to 4-year-olds were less likely than 5-year-olds to have anaemia from causes other than ID ( OR = 0·11 , 95 % CI 0·08 , 0·58 ) . Anaemia from other causes was more common among children residing in crowded homes ( OR = 2·30 , 95 % CI 1·37 , 12·31 ) and those treated for past-year ear infection ( OR = 1·35 , 95 % CI 1·05 , 7·21 ) . CONCLUSIONS The low prevalence of ID and IDA is encouraging , but efforts are still needed to reduce rates as they continue to be higher than general population rates . Household crowding and infections may contribute to anaemia and warrant further research Iron deficiency anemia ( IDA ) remains the most prevalent nutritional deficiency in infants worldwide . The purpose of this study was to determine the efficacy of daily and weekly iron supplementation for 3 months to improve the iron status in 4-month-old , exclusively breast-fed healthy infants . Infants 4 months of age were eligible for the open , r and omized controlled trial if their mothers intended to continue exclusive breast-feeding until the infants were 6 months of age . Infants or mothers with iron deficiency ( ID ) or IDA on admission were excluded . The infants ( n = 79 ) were r and omly assigned to three groups , the first group receiving daily ( 1 mg/kg daily ) , the second group weekly ( 7 mg/kg weekly ) , and the third group no iron supplementation .  Anthropometric measurements were taken on admission and at 6 and 7 months of age . Iron status was analyzed on admission and monthly for 3 months . Both hematologic parameters and anthropometric measurements were found to be similar among the three groups during the study period . Seven infants ( 31.8 % ) in the control group , six ( 26.0 % ) in the daily group , and three ( 13.6 % ) in the weekly group developed ID or IDA ( P > 0.05 ) . Infants whose mothers had ID or IDA during the study period were more likely to develop ID or IDA independently from iron supplementation . Serum ferritin levels decreased between 4 and 6 months of age in the control and daily groups ; the weekly group showed no such decrease . In all groups , the mean levels of serum ferritin were significantly increased from 6 months to 7 months of age during the weaning period . In this study , which had a limited number of cases , weekly or daily iron supplementation was not found to decrease the likelihood of IDA . In conclusion , exclusively breast-fed infants with maternal IDA appeared to be at increased risk of developing IDA Iron deficiency and helminth infections are two common conditions of children in developing countries . The consequences of helminth infection in young children are not well described , and the efficacy of low dose iron supplementation is not well documented in malaria-endemic setting s. A 12-mo r and omized , placebo controlled , double-blind trial of 10 mg daily iron and /or mebendazole ( 500 mg ) every 3 mo was conducted in a community-based sample of 459 Zanzibari children age 6 - 71 mo with hemoglobin > 70 g/L at baseline . The trial was design ed to examine treatment effects on growth , anemia and appetite in two age subgroups . Iron did not affect growth retardation , hemoglobin concentration or mild or moderate anemia ( hemoglobin < 110 g/L or < 90 g/L , respectively ) , but iron significantly improved serum ferritin and erythrocyte protoporphyrin .  Mebendazole significantly reduced wasting malnutrition . but only in children < 30 mo old . The adjusted odds ratios ( AORs ) for mebendazole in this age group were 0.38 ( 95 % CI : 0.16 , 0.90 ) for weight-for-height less than -1 Z-score and 0.29 ( 0.09 , 0.91 ) for small arm circumference . In children < 24 mo old , mebendazole also reduced moderate anemia ( AOR : 0.41 , 0.18 , 0.94 ) . Both iron and mebendazole improved children 's appetite , according to mothers ' report . In this study , iron 's effect on anemia was limited , likely constrained by infection , inflammation and perhaps other nutrient deficiencies . Mebendazole treatment caused unexpected and significant reductions in wasting malnutrition and anemia in very young children with light infections . We hypothesize that incident helminth infections may stimulate inflammatory immune responses in young children , with deleterious effects on protein metabolism and erythropoiesis Anemia is a common complication of pediatric HIV infection and is associated with suboptimal cognitive performance and growth failure . Routine iron supplementation is not provided to South African HIV-infected children . We hypothesized that dietary iron intake without supplementation is sufficient to protect against iron deficiency ( ID ) in HIV-infected children receiving highly active antiretroviral therapy . In this prospect i ve study , the difference between dietary intakes of iron-deficient children  ( soluble transferrin receptor > 9.4 mg/L ) and iron-sufficient children after 18 months on highly active antiretroviral therapy was examined . The association between iron intake and hemoglobin ( Hb ) concentration was also assessed . Longitudinal data collected for 18 months from 58 HIV-infected African children were assessed by generalized estimation equations , with adjustment for demographic information , dietary intakes , growth parameters , and CD4 % . After adjustment for covariates , the longitudinal association between dietary iron intake and Hb concentration remained significant . This association shows that for every 1-mg increase in iron intake per day , Hb increases by 1.1 g/L ( P < .001 ) . Mean Hb increased significantly after 18 months of follow-up ( 106 ± 14 to 129 ± 14 g/L , P < .01 ) , but soluble transferrin receptor also increased ( 7.7 ± 2.7 to 8.9 ± 3.0 mg/L , P < .01 ) . The incidence of ID increased from 15.2 % at baseline to 37.2 % after 18 months . Children with animal protein intakes greater than > 20 g/d had significantly lower odds for ID at 18 months than did children with lower intakes ( odds ratio , 0.40 ; 95 % confidence interval , 0.21 - 0.77 ) . Dietary iron intake was insufficient to protect against ID , pointing to a need for low-dose iron supplementation for iron-deficient HIV-infected children and interventions to increase the consumption of animal protein Wheat is the primary staple food for nearly one-third of the world 's population . NaFeEDTA is the only iron ( Fe ) compound suitable for fortifying high extraction flours . We tested the hypothesis that NaFeEDTA-fortified , whole wheat flour reduces Fe deficiency ( ID ) and improves body Fe stores ( BIS ) and cognitive performance in Indian children . In a r and omized , double-blind , controlled , school feeding trial , 6- to 15-y-old , Fe-depleted children ( n = 401 ) were r and omly assigned to either a daily wheat-based lunch meal fortified with 6 mg of Fe as NaFeEDTA or an otherwise identical unfortified control meal .  Hemoglobin ( Hb ) and Fe status were measured at baseline , 3.5 mo , and 7 mo . Cognitive performance was evaluated at baseline and 7 mo in children ( n = 170 ) at one of the study sites . After 7 mo , the prevalence of ID and ID anemia in the treatment group significantly decreased from 62 to 21 % and 18 to 9 % , respectively . There was a time x treatment interaction for Hb , serum ferritin , transferrin receptor , zinc protoporphyrin , and BIS ( all P < 0.0001 ) . Changes in BIS differed between the groups ; it increased in the treatment group ( 0.04 ± 0.04 mmol/kg body weight ) and decreased in the control group ( -0.02 ± 0.04 mmol/kg body weight ) ( P < 0.0001 ) . In sensory tests , NaFeEDTA-fortified flour could not be differentiated from unfortified flour . There were no significant differences in cognitive performance tests between the groups . NaFeEDTA-fortified wheat flour markedly improved BIS and reduced ID  in Fe-depleted children . It may be recommended for wider use in national school feeding programs OBJECTIVE To evaluate the prevalence of anemia , iron deficiency and iron deficiency anemia in a cohort of children . METHODS A cohort study nested in a r and omized field trial . Children were recruited at birth at the maternity unit of the only public hospital in the city of São Leopoldo , southern Brazil . This study assessed  iron status ( hemoglobin and serum ferritin ) when children were 12 - 16 months old and later at the age of 3 - 4 years .  Anemia was defined as hemoglobin concentration < 11.0 g/dL ; iron deficiency as serum ferritin < 15.0 µg/L ; and iron deficiency anemia as hemoglobin concentration < 11.0 g/dL with iron deficiency . RESULTS At age 12 - 16 months , the overall prevalence of anemia , iron deficiency and iron deficiency anemia was 63.7 , 90.3 and 58.8 % , respectively . The values for age group 3 - 4 years were 38.1 , 16.1 and 7.4 % , respectively . At age 12 - 16 months , 95 % of anemia cases were associated with iron deficiency against only 19.3 % of cases at age 3 - 4 years . CONCLUSIONS Iron deficiency was the main cause of anemia in the second year of life , but not at age 3 - 4 years . Thus , we point out that anemia in preschool children may have other causes and deserves careful assessment Background Multiple micronutrient deficiencies are highly prevalent among preschool children and often lead to anemia and growth faltering . Given the limited success of supplementation and health education programs , fortification of foods could be a viable and sustainable option . We report results from a community based double-masked , r and omized trial among children 1–4 years evaluating the effects of micronutrients ( especially of zinc and iron ) delivered through fortified milk on growth , anemia and iron status markers as part of a four group study design , running two studies simultaneously . Methods and Findings Enrolled children ( n = 633 ) were r and omly allocated to receive either micronutrients fortified milk ( MN = 316 ) or control milk ( Co = 317 ) . Intervention of MN milk provided additional 7.8 mg zinc , 9.6 mg iron , 4.2 µg selenium , 0.27 mg copper , 156 µg vitamin A , 40.2 mg vitamin C , and 7.5 mg vitamin E per day ( three serves ) for one year . Anthropometry was recorded at baseline , mid- and end- study . Hematological parameters were estimated at baseline and end- study . Both groups were comparable at baseline . Compliance was over 85 % and did not vary between groups . Compared to children consuming Co milk , children consuming MN milk showed significant improvement in weight gain ( difference of mean : 0.21 kg/year ; 95 % confidence interval [ CI ] 0.12 to 0.31 , p<0.001 ) and height gain ( difference of mean : 0.51 cm/year ; 95 % CI 0.27 to 0.75 , p<0.001 ) . Mean hemoglobin ( Hb ) ( difference of 13.6 g/L ; 95 % CI 11.1 to 16.0 , p<0.001 ) and serum ferritin levels ( difference of 7.9 µg/L ; 95 % CI 5.4 to 10.5 , p<0.001 ) also improved . Children in MN group had 88 % ( odds ratio = 0.12 , 95 % CI 0.08 to 0.20 , p<0.001 ) lower risk of iron deficiency anemia . Conclusions / Significance Milk provides an acceptable and effective vehicle for delivery of specific micronutrients , especially zinc and iron . Micronutrient bundle improved growth and iron status and reduced anemia in children 1–4 years old . Trial Registration Clinical Trials.gov Iron supplementation has been suggested as a strategy for prevention and treatment of iron deficiency ( ID ) and iron deficiency anemia ( IDA ) in many countries , but non-compliance of daily regimens and common dosage remain as major challenges . The aim of this study was to investigate the effects of low dose once weekly iron supplementation in adolescent girls . The study was design ed as a community-based , r and omized , supplementation trial . The initial sample consisted of 200 female high school students , aged 14–16 years old , of whom 193 students concluded the study . They were r and omly selected and assigned into either iron-supplemented group ( ISG ) or iron-unsupplemented group ( IUG ) . The ISG received 150 mg ferrous sulfate once weekly for 16 weeks , whereas the IUG received nothing .  Weight , height , and hematological parameters were measured and compared between the two groups before and after the intervention . There was no significant difference between the initial measures of the two groups before the intervention . After 16 weeks of intervention , mean of hemoglobin and serum ferritin improved significantly in ISG compared to IUG . At the beginning of the study , percent of anemia , IDA , and ID in ISG were 12.5 % , 8.3 % , and 30.2 % , whereas these figures for IUG in this period of study were 14.4 , 10.3 , and 38.2 , respectively , which were not significantly different between the two groups . However , percentages of the above items at the end of study in ISG were 2.1 % , 0 % , and 21.9 % , respectively . In contrast to IUG , all cases of IDA were abolished in the ISG . Our study showed that once weekly supplementation of 150 mg ferrous sulfate for 16 weeks significantly improved iron status in female adolescents and effectively treated IDA . There is no need for higher dosage of iron for supplementation that may cause adverse effects and bear higher costs OBJECTIVE : Low birth weight infants are at risk for iron deficiency ( ID ) . Most LBW infants have marginally low birth weight ( MLBW , 2000–2500 g ) and it is not known whether they benefit from iron supplements . The objective of this trial was to study the effects of iron supplementation in MLBW infants . METHOD : In a r and omized controlled trial , we assigned 285 healthy , MLBW infants to receive iron supplements at a dose of 0 ( placebo ) , 1 , or 2 mg/kg per day between 6 weeks and 6 months of age .  Hemoglobin levels , ferritin levels , transferrin saturation , mean cell volume , and transferrin receptor levels were analyzed at 6 months . Growth and morbidity were monitored . RESULTS : Iron supplementation result ed in significant dose-dependent effects on hemoglobin and all iron status indicators at 6 months . The prevalence of ID at 6 months was 36 % in the placebo group , 8.2 % in the 1 mg/kg per day group , and 3.8 % in the 2 mg/kg per day group ( P < .001 ) . The prevalence rates of ID anemia ( IDA ) were 9.9 % , 2.7 % , and 0 % , respectively ( P = .004 ) . Among infants who were exclusively breastfed at 6 weeks , the prevalence of IDA was 18 % in the placebo group . There were no significant differences between groups in growth or morbidity . CONCLUSIONS : MLBW infants have relatively high risks of ID and IDA , especially if they are breastfed . Iron supplementation at 2 mg/kg per day from 6 weeks to 6 months reduces this risk effectively , with no short-term adverse effects on morbidity or growth BACKGROUND & AIMS We investigated Helicobacter pylori ( H pylori)-infection as a cause of iron deficiency ( ID ) and iron-deficiency anemia ( IDA ) or treatment failure of iron supplementation . METHODS We r and omized 200 Hp-infected children ( positive urea breath test ) 2 - 5 years of age with IDA ( hemoglobin level < 110 g/L ; serum ferritin level < 12 microg/L ; and soluble transferrin receptor > 8.3 mg/L ) or ID ( serum ferritin level < 12 microg/L or soluble transferrin receptor level > 8.3 mg/L ) to 1 of 4 regimens : 2-week anti-Hp therapy ( amoxicillin , clarithromycin , and omeprazole ) plus 90-day oral ferrous sulfate ( anti-Hp plus iron ) , 2-week anti-Hp therapy alone , 90-day oral iron alone , or placebo .  Sixty noninfected children with IDA received iron treatment as negative control . RESULTS Hp-infected children receiving iron had significantly less frequent treatment failure compared with those with no iron in correcting IDA ( 11 % [ 95 % confidence interval ( CI ) , 2%-20 % ] for anti-Hp plus iron , 0 % for iron alone vs 33 % [ 95 % CI , 26%-46 % ] for anti-Hp and 45 % [ 95 % CI , 31%-59 % ] for placebo ; chi(2 ) = 127 ; P < .0001 ) , ID ( 19 % [ 95 % CI , 8%-30 % ] for anti-Hp plus iron , 7 % [ 95 % CI , 0%-14 % ] for iron alone vs 65 % [ 95 % CI , 52%-78 % ] for anti-Hp alone , and 78 % [ 95 % CI , 66%-90 % ] for placebo ; chi(2 ) = 124 ; P < .0001 ) , or anemia ( 34 % [ 95 % CI , 20%-40 % ] for anti-Hp plus iron , 27 % [ 95 % CI , 14%-40 % ] for iron alone vs 65 % [ 95 % CI , 52%-78 % ] for anti-Hp alone and 78 % [ 95 % CI , 66%-90 % ] for placebo ; chi(2 ) = 46 ; P < .0001 ) . Cure rates of IDA , ID , or anemia with iron were comparable with that of the negative control group . Improvements in iron status also were significantly greater in groups with iron . CONCLUSIONS H pylori is neither a cause of IDA/ID nor a reason for treatment failure of iron supplementation in young Bangladeshi children BACKGROUND Iron deficiency is the most prevalent nutritional deficiency among infants in industrialized countries . There is ample documentation of both short- and long-term adverse effects of iron deficiency . OBJECTIVE To study the prevalence of iron deficiency in 12-month-old infants and to investigate the influence of several factors ( dietary , growth , etc . ) on iron status . MATERIAL AND METHODS A r and om sample of 94 healthy infants from a basic health district was studied . Maternal and perinatal variables , dietary intake and anthropometry were assessed at regular intervals from birth to the age of 12 months . Hemoglobin , mean corpuscular volume , transferrin saturation and serum ferritin were also evaluated . RESULTS The prevalence of iron deficiency was 9.6 % and that of iron deficiency anemia was 4.3 % . Of the nine infants with iron deficiency , four had been breast-fed for more than 6 months with late introduction of complementary foods and another had not been fed an iron-fortified formula while the 85 children without iron deficiency had received an appropriate diet ( p < 0.05 ) . Weight increase in the first year of life was significantly and positively correlated with hemoglobin and serum ferritin . CONCLUSIONS Iron deficiency is relatively common in 12-month-old-infants but is limited to groups with inadequate feeding practice s. Iron deficiency screening should be performed only in children with risk factors and /or inadequate diets Objectives : Low-birth-weight ( LBW ) infants ( < 2500 g ) have an increased risk of iron deficiency ( ID ) during their first 6 months of life . The optimal dose and duration of iron supplementation to LBW infants are , however , unknown . The objective of the present study was to investigate the long-term effect on iron status and growth in marginally LBW ( 2000–2500 g ) infants , of iron supplements given until 6 months of life . Methods : In a r and omized controlled trial , 285 healthy marginally LBW infants received  0 , 1 , or 2 mg · kg−1 · day−1 of iron supplements from 6 weeks to 6 months of age . At 12 months and 3.5 years of life we measured length , weight , head circumference , and indicators of iron status ( hemoglobin , ferritin , mean corpuscular volume , and transferrin saturation ) and assessed the prevalence of iron depletion , functional ID , and ID anemia . Results : At 12 months of age , there was a significant difference in ferritin between the groups ( P = 0.006 ) . Furthermore , there was a significant difference in the prevalence of iron depletion ( 23.7 % , 10.6 % , and 6.8 % , respectively , in the placebo , 1-mg , and 2-mg groups , P = 0.009 ) and similar nonsignificant trends for functional ID and ID anemia . At 3.5 years of life there were no significant differences in iron status and the mean prevalence of iron depletion was 3.2 % . Anthropometric data were not affected by the intervention . Conclusions : Iron supplements with 2 mg · kg−1 · day−1 until 6 months of life effectively reduces the risk of ID during the first 12 months of life and is an effective intervention for preventing early ID in marginally LBW infants OBJECTIVE The effect of daily and once weekly iron supplementation on hemoglobin(Hb ) , serum ferritin ( SF ) , erythrocyte protoporphyrin ( EFP ) in whole blood , prevalence of iron deficiency , body weight and height of preschool children was compared in this study . METHODS Preschool children ( n = 353 ) from one kindergarten in Baotou City , was recruited . All children were divided into three groups by class , and received either daily or once weekly iron supplementation , or a placebo ( control ) for 14 weeks . RESULTS The prevalence of iron deficiency was reduced in both intervention groups , and the rate in the group supplemented with iron once weekly was significantly lower than that of the control group(P < 0.05 ) . The levels of Hb , SF , increased after once weekly and daily iron supplementation . Weight gain and WAZ were greater in children who received daily supplement than in those who received placebo .  Height gain and HAZ were not significantly different among three groups . CONCLUSION Daily micronutrient supplement can improve growth of preschool children . Once weekly iron supplement is effective same as daily supplement in improving iron status and reducing the prevalence of iron deficiency in the preschool children Objective : To assess the impact of a daily oral iron supplementation on hematological status , cell-mediated immunity and susceptibility to infections in children living in an environment where iron deficiency , malaria and other infections are frequent . Design : R and omized , double-blind iron supplementation including a placebo group . Setting : A village in Togo , West Africa . Subjects : Of the 229 6–36-month-old children of both sexes recruited , 197 with hemoglobin concentration ≥80 g/l were included and 163 completed the study .Intervention : Children received daily a placebo ( n=79 ) or a dose of 2–3 mg of elemental iron per kg of body weight ( n=84 ) for 3 months . Hematological , nutritional and immune status were assessed at the beginning and at the end of the supplementation period , and 6 months later . Morbidity was recorded throughout the study . Results : Iron supplementation had a significant and positive effect on iron status of children and no impact on the incidence of infections , especially malaria . Its probable effect on immune status was masked by interference of infections and their treatment , which contributed to improve hematological and immune status in both groups . Conclusion : According to the negative consequences of anemia and iron deficiency on global child development , control of iron deficiency by oral iron supplementation in young children has to be conducted , associated with prophylaxis and treatment of malaria and repeated deworming . Sponsorship : Program supported by IRD.European Journal of Clinical Nutrition ( 2000 ) 54 , BACKGROUND Anaemia caused by iron deficiency is common in children younger than age 5 years in eastern Africa . However , there is concern that universal supplementation of children with iron and folic acid in areas of high malaria transmission might be harmful . METHODS We did a r and omised , placebo-controlled trial , of children aged 1 - 35 months and living in Pemba , Zanzibar . We assigned children to daily oral supplementation with : iron ( 12.5 mg ) and folic acid ( 50 mug ; n=7950 ) , iron , folic acid , and zinc ( n=8120 ) , or placebo ( n=8006 ) ; children aged 1 - 11 months received half the dose . Our primary endpoints were all-cause mortality and admission to hospital . Analyses were by intention to treat . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N59549825 . FINDINGS The iron and folic acid-containing groups of the trial were stopped early on Aug 19 , 2003 , on the recommendation of the data and safety monitoring board . To this date , 24 076 children contributed a follow-up of 25,524 child-years . Those who received iron and folic acid with or without zinc were 12 % ( 95 % CI 2 - 23 , p=0.02 ) more likely to die or need treatment in hospital for an adverse event and 11 % ( 1 - 23 % , p=0.03 ) more likely to be admitted to hospital ; there were also 15 % ( -7 to 41 , p=0.19 ) more deaths in these groups . INTERPRETATION Routine supplementation with iron and folic acid in preschool children in a population with high rates of malaria can result in an increased risk of severe illness and death . In the presence of an active programme to detect and treat malaria and other infections , iron-deficient and anaemic children can benefit from supplementation . However , supplementation of those who are not iron deficient might be harmful . As such , current guidelines for universal supplementation with iron and folic acid should be revised Background Iron deficiency is a common nutritional problem in young children among vulnerable population s in Jordan . Several studies have shown the effectiveness of intermittent iron supplementation in improving iron status . Such a study has not been carried out in 2- to-6-year-old Jordanian children diagnosed with iron deficiency anemia in a clinical setting . Objective To study the effectiveness of intermittent versus daily iron treatment in a clinical setting in 2- to 6-year-old Jordanian children with iron-deficiency anemia . Methods About 4,400 children aged 2 to 6 years who visited Prince Hashim Military Hospital in Zarqa , Jordan , from August 2000 to June 2001 were screened for age , general health , and birthweight . About 10 % of these children were screened for anemia , using complete blood count ( defined as a hemoglobin level ≤ 10.5 g/dL , and a mean corpuscular volume ≤ 75 fL ) . Anemic children underwent further screening for iron deficiency , defined as serum ferritin level ≤ 12 μ g/L. Children with iron-deficiency anemia , as indicated by hemoglobin ≤ 10.5 g/dL , mean corpuscular volume ≤ 75 fL , and serum ferritin ≤ 12 μ g/L , or as indicated by mean corpuscular volume ≤ 75 fL and hemoglobin ≤ 10.5 g/dL , were enrolled in the study after informed oral consent by their parents . Study children ( n = 134 ) were assigned r and omly to one of three groups . Subjects in group 1 ( n = 45 ) , group 2 ( n = 45 ) , and group 3 ( n = 44 ) received iron treatment daily , weekly , and twice weekly , respectively . Out of 134 children recruited for the study , only 63 ( 39 boys and 24 girls ) completed the 3-month treatment period . All of the children received medicinal iron drops at a dosage of 5 mg elemental iron as ferrous sulfate per kilogram of body weight . The parents also received nutritional counseling . Results At the end of treatment , hemoglobin , serum ferritin , hematocrit , mean corpuscular volume , mean corpuscular hemoglobin , and mean corpuscular hemoglobin concentration increased significantly in all groups with no significant differences between groups . The increases in hemoglobin in groups 1 , 2 , and 3 were 2.47 ± 0.17 , 2.12 ± 0.18 , and 2.18 ± 0.18 g/dL , respectively . Measurements of final serum ferritin concentration were available for only 12 , 12 , and 10 children in groups 1 , 2 , and 3 , respectively . In all children who completed the study , except for one in group 1 , hemoglobin , mean corpuscular volume , and serum ferritin reached normal values in response to iron treatment . Conclusions Weekly and twice-weekly iron therapy with 5 mg elemental iron as ferrous sulfate per kilogram of body weight accompanied by nutritional counseling was as effective as daily iron therapy in correcting iron-deficiency anemia in 2- to 6-year-old children under the clinical conditions of this study BACKGROUND Helicobacter pylori infection and iron deficiency are prevalent in disadvantaged population s worldwide . Previous small or uncontrolled studies have reported that successful treatment of H. pylori infection may resolve iron deficiency or anemia . METHODS We screened 68 % of children 7 - 11 years old living in 10 western Alaska villages . The 219 children with iron deficiency ( serum ferritin level , < 22.5 pmol/L [ < 10 microg/L ] ) and H. pylori infection ( diagnosed on the basis of (13)C-labeled urea breath tests ) were enrolled in a household-r and omized , unblinded trial . All children received iron supplementation for 6 weeks ; children in the intervention group also received a 2-week course of treatment for H. pylori infection plus another 2-week course of treatment if the infection had not resolved at 2 months after treatment initiation . RESULTS At 2 months after treatment initiation , 32 % of children in the intervention group and 39 % of children in the control group had iron deficiency . At 14 months after treatment initiation , 65 % of children in the intervention group and 72 % of children in the control group had iron deficiency ( adjusted relative risk [ ARR ] , 0.90 [ 95 % confidence interval [ CI ] , 0.74 - 1.1 ] ) ; in addition , 22 % of children in the intervention group and 14 % of children in the control group had anemia ( ARR , 1.6 [ 95 % CI , 0.86 - 2.9 ] ) . Results were similar when children were compared by H. pylori infection status . CONCLUSIONS In a high-prevalence population , treatment and resolution of H. pylori infection did not improve isolated iron deficiency or mild anemia up to 14 months after treatment initiation BACKGROUND Helicobacter pylori infection treatment was found not to reduce the prevalence of iron deficiency or anemia among Alaska Native children at 14 months after treatment initiation . We hypothesized that 14 months was to early to resolve H. pylori-induced gastric damage . Consequently , we conducted a 40-month follow-up . METHODS We enrolled 219 children 7 - 11 years old who had H. pylori infection ( as diagnosed by (13)C-labeled urea breath test ) and iron deficiency ( serum ferritin level , < 22.47 pmol/L ) in a controlled , household-r and omized trial of the effect of treatment of H. pylori on iron deficiency and anemia ( hemoglobin level , < 115 g/L ) . At 40 months , 176 children were evaluated . RESULTS Forty-four ( 52 % ) of 85 children in the intervention group and 53 ( 58 % ) of 91 in the control group had iron deficiency ( adjusted relative risk [ ARR ] , 0.92 [ 95 % confidence interval { CI } , 0.68 - 1.26 ] ) , versus 4 ( 5 % ) and 17(19 % ) , respectively , with both iron deficiency and anemia ( ARR , 0.25 [ 95 % CI , 0.09 - 0.73 ] ) . Reinfection occurred among 33 ( 52 % ) of 64 children who had cleared their infection . H. pylori-negative children had lower prevalences of iron deficiency ( ARR , 0.62 [ 95 % CI , 0.38 - 1.01 ] ) and iron deficiency and anemia ( ARR , 0.22 [ 95 % CI , 0.03 - 1.50 ] ) , compared with H. pylori -positive children . CONCLUSIONS The resolution of H. pylori infection for > 14 months modestly reduced the prevalence of iron deficiency and substantially reduced the prevalence of iron deficiency and anemia . H. pylori likely plays a casual role in hematological outcomes for some children OBJECTIVE To evaluate the impact that a program based on maternal dietary counseling covering breastfeeding and healthy complementary feeding had on the prevalence of  iron deficiency , anemia and iron deficiency anemia in children aged 12 to 16 months . METHODS Newborn infants were r and omized at birth to an intervention or a control group . Mothers in the intervention group received home visits during the children 's first year of life on a monthly basis up to 6 months , and at 8 , 10 and 12 months . The mothers in the control group received visits for data collection when children reached 6 and 12 months . All children were visited at ages between 12 and 16 months and 24-hour dietary recalls and hemoglobin and ferritin tests were conducted . RESULTS There was no evidence that the intervention had an effect on anemia incidence , which was 66.5 % in the intervention group and 61.8 % in the control group . There was also no evidence of any difference between the groups in the prevalence of iron deficiency anemia or of iron deficiency . However , a higher percentage of children in the intervention group were exclusively breastfed at 4 and 6 months , and breastfed at 6 and 12 months . Intervention group children also consumed more meat and were fed diets with better iron bioavailability and consumed less cow 's milk and calcium than children from the control group . CONCLUSION This intervention had no effect on the prevalence of anemia , iron deficiency or iron deficiency anemia . Clinical trial registry identification number : NCT00629629 Cowpeas , like other legumes , contain high amounts of native iron but are rich in phytic acid ( PA ) and polyphenols ( PP ) that inhibit iron absorption . NaFeEDTA may overcome the combined inhibitory effect of PA and PP . Our objective was to test the efficacy of NaFeEDTA-fortified cowpea meal in improving iron status of school children in a malaria endemic area . We conducted a double-blind , controlled trial with 5- to 12-y-old school children from 2 rural communities in northern Ghana ( n = 241 ) . Eligible children were r and omly assigned to 2 treatment groups to receive either cowpea meal fortified with 10 mg Fe/meal as NaFeEDTA , or an identical but nonfortified cowpea meal . Meals were provided 3 d/wk for a period of ~7 mo under strict supervision . Mass deworming and malaria antigenemia screening and treatment were carried out at baseline and 3.5 mo into the trial . Consumption of cowpea flour fortified with NaFeEDTA result ed in improvement of hemoglobin ( P < 0.05 ) , serum ferritin ( P < 0.001 ) , and body iron stores ( P < 0.001 ) and reduction of transferrin receptor ( P < 0.001 ) compared with nonfortified flour . Fortification result ed in a 30 and 47 % reduction in the prevalence of iron deficiency ( ID ) and iron deficiency anemia ( IDA ) ( P < 0.05 ) , respectively . The results indicate that fortification of cowpea flour with NaFeEDTA overcomes the combined inhibitory effect of PA and PP and , when used for targeted school-based fortification of cowpea flour , is effective in reducing the prevalence of ID and IDA among school children in malaria endemic rural northern Ghana OBJECTIVES There is evidence of iron deficiency ( ID ) in patients treated with lipoprotein apheresis .  Aim of this study was to assess ID in apheresis patients and to study its management comparing safety and efficacy of two approved intravenous ( i.v . ) iron formulations . METHODS Inclusion criteria were defined as a ) serum ferritin < 300 μg/l and transferrin saturation < 20 % , b ) ferritin < 100 μg/l . Both iron deficient alone and ID anemic ( IDA ) patients were included . Other causes for anemia were ruled out by thorough history-taking and examination/blood tests . Patients were treated with six different lipoprotein apheresis methods : DALI , Liposorber D , TheraSorb LDL , HELP , MONET and Lipidfiltration .  50 patients were r and omized to either ferric carboxymaltose ( FCM , 500 - 1000 mg as single shot infusion over 20 min ) or ferric gluconate ( FG , 62.5 mg once weekly ) . RESULTS 50 of 67 patients of our Lipoprotein Apheresis Center showed iron deficiency . Both i.v . iron formulations studied were equally safe ( no serious adverse events ( SAEs ) , 6 patients /group showed adverse events ( AEs ) ) and both effective ( clinical ly and with respect to laboratory data ) in lipoprotein apheresis patients , however FCM led to a more rapid and steeper rise of iron parameters . CONCLUSIONS ID and IDA are common findings in lipoprotein apheresis patients . The pathogenesis remains yet poorly understood and is probably multifactorial . Differential diagnosis of ID/IDA is as essential as differential therapy . H and led with care , older i.v . iron preparations like FG appear to be safe and effective in lipoprotein apheresis patients . However , novel formulations like FCM can be administered rapidly at higher doses due to high complex stability , allowing faster filling of iron stores . Newer laboratory parameters ( Reticulocyte-He , low/medium/high fluorescence reticulocytes ( LFR/MFR/HFR ) ) assessing iron status may be helpful in early detection of ID and in monitoring iron replacement therapy Background and objective In re source -poor setting s , micronutrient deficiencies such as vitamin A deficiency may co-exist with iron-deficiency . In this study we assessed the iron and vitamin A status of schoolchildren and the association between vitamin A and iron status . Methods A cross-sectional design using the baseline data of a dietary intervention trial conducted among r and omly selected 5–12 years old schoolchildren ( n = 224 ) from 2 rural schools in northern Ghana .  Hemoglobin ( Hb ) , serum ferritin ( SF ) and serum transferrin receptor ( sTfR ) concentrations were used as measures of iron status . Retinol binding protein ( RBP ) was used as a measure of vitamin A status . Sub clinical inflammation ( SCI ) was measured using C-reactive protein ( CRP ) and α1-acid glycoprotein ( AGP ) concentrations . We examined the cross-sectional association between vitamin A and iron status biomarkers with multiple linear regressions . Results The proportions of schoolchildren with anemia ( WHO criteria ) , iron-deficiency ( ID , SF < 15μg/l and /or sTfR > 8.5mg/l ) and  iron-deficiency anemia  ( IDA , concurrent anemia and ID ) were 63.8 % , 68.3 % and 46.4 % respectively . Low or marginal vitamin A status ( 0.70 μmol/l ≤ RBP < 1.05μmol/l ) was present in 48.2 % while 37.5 % of the schoolchildren had vitamin A deficiency ( VAD , RBP < 0.70 μmol/l ) . The prevalence of SCI as well as concurrent VAD and ID were 48.7 % and 25 % respectively . RBP was associated with Hb ( β = 7.2 , P = 0.05 ) but not SF ( β = 20.7 , P = 0.33 ) and sTfR concentration ( β = 12.0 , P = 0.63 ) . In the presence of SCI , RBP was not associated with hemoglobin status but a significant positive association was observed among children without SCI . Conclusions The study shows that RBP is significantly associated with Hb concentration but not with SF and sTfR. The observed relationship between RBP and Hb is only significant in the absence of SCI Iron deficiency is prevalent in children and infants worldwide . Zinc deficiency may be prevalent , but data are lacking . Both iron and zinc deficiency negatively affect growth and psychomotor development . Combined iron and zinc supplementation might be beneficial , but the potential interactions need to be verified . In a r and omized , placebo-controlled trial using 2 x 2 factorial design , 609 Thai infants aged 4 - 6 mo were supplemented daily with 10 mg of iron and /or 10 mg of zinc for 6 mo to investigate effects and interactions on micronutrient status and growth . Iron supplementation alone increased hemoglobin and ferritin concentrations more than iron and zinc combined . Anemia prevalence was significantly lower in infants receiving only iron than in infants receiving iron and zinc combined .  Baseline iron deficiency was very low , and iron deficiency anemia was almost nil . After supplementation , prevalence of iron deficiency and iron deficiency anemia were significantly higher in infants receiving placebo and zinc than in those receiving iron or iron and zinc .  Serum zinc was higher in infants receiving zinc ( 16.7 + /- 5.2 micromol/L ) , iron and zinc ( 12.1 + /- 3.8 micromol/L ) or iron alone ( 11.5 + /- 2.5 micromol/L ) than in the placebo group ( 9.8 + /- 1.9 micromol/L ) . Iron and zinc interacted to affect iron and zinc status , but not hemoglobin . Iron supplementation had a small but significant effect on ponderal growth , whereas zinc supplementation did not . To conclude , in Thai infants , iron supplementation improved hemoglobin , iron status , and ponderal growth , whereas zinc supplementation improved zinc status . Overall , for infants , combined iron and zinc supplementation is preferable to iron or zinc supplementation alone Universal prenatal daily iron-folic acid ( IFA ) and multiple micronutrient ( MM ) supplements are recommended to reduce the risk of low birth weight , maternal anemia , and iron deficiency ( ID ) during pregnancy , but the evidence of their effect on iron status among women with mild or no anemia is limited . The aim of this study was to describe the iron status [ serum ferritin ( SF ) , serum soluble transferrin receptor ( sTfR ) , and body iron ( BI ) ] before and after micronutrient supplementation during pregnancy . We examined 834 pregnant women with hemoglobin > 100 g/L at enrollment before 20 wk of gestation and with iron measurement data from a subset of a r and omized , double-blind trial in China . Women were r and omly assigned to take daily 400 μg of folic acid ( FA ) ( control ) , FA plus 30 mg of iron , or FA , iron , plus 13 additional MMs provided before 20 wk of gestation to delivery . Venous blood was collected in this subset during study enrollment ( before 20 wk of gestation ) and 28 - 32 wk of gestation . We found that , at 28 - 32 wk of gestation , compared with the FA group , both the IFA and MM groups had significantly lower prevalence of ID regardless of which indicator ( SF , sTfR , or BI ) was used for defining ID . The prevalence of ID at 28 - 32 wk of gestation for IFA , MM , and FA were 35.3 % , 42.7 % , and 59.6 % by using low SF , 53.6 % , 59.9 % , and 69.9 % by using high sTfR , and 34.5 % , 41.2 % , and 59.6 % by using low BI , respectively . However , there was no difference in anemia prevalence ( hemoglobin < 110 g/L ) between FA and IFA or MM groups . We concluded that , compared with FA alone , prenatal IFA and MM supplements provided to women with no or mild anemia improved iron status later during pregnancy but did not affect perinatal anemia . This trial was registered at clinical trials.gov as NCT00137744 The effectiveness of bread fortified with iron bis-glycinate chelate for the control of iron deficiency and iron deficiency anemia was evaluated in 89 preschool children from families of low socioeconomic level attending 2 day nurseries of the Sao Paulo City Council . During the intervention 's time of 6 months the children received besides their usual center 's diet , a daily supplement of two sweet rolls fortified with 2 mg each of iron from the chelate for a total daily iron intake of 4 mg . After six months of intervention there was a significant decrease in the prevalence of iron deficiency anemia from 62 to 22 % . There was a mean hemoglobin improvement of 1.1 g/dL , and in children with initial hemoglobin levels < 11 g/dL the mean increase in hemoglobin was 1.42 g/dL. The total mean plasma ferritin values increased from 11.34 to 20.2 micrograms/L , and in those children originally iron depleted the ferritin values normalized . A significant increase in the " z " score for weight/height was also observed . We concluded that the use of sweet rolls fortified with 2 mg of iron from the bis-glycinate chelate is highly effective for the control of iron deficiency and iron deficiency anemia in young children A double-blind clinical trial was conducted in Indonesia to assess effects of iron supplementation on performance of iron-depleted and iron-deficient anemic children in discrimination and oddity learning tasks . Half these children received elemental Fe for 8 wk ; the others received a placebo . There were significant changes from pre- to postintervention evaluations in ferritin , transferrin saturation , free erythrocyte protoporphyrin , and hemoglobin among the anemic and iron-depleted children ; no changes were observed among the placebos or any of the iron-replete children . The magnitude of hematological changes in anemic children treated with iron was small ; yet , after treatment the children 's mean ferritin , transferrin saturation , and hemoglobin values were above the cutoff points used for the definition of iron-deficiency anemia ( IDA ) . Pre- and posttreatment psychological test data show that IDA produces alterations in cognitive processes related to visual attention and concept acquisition , alterations reversed with iron treatment
Limited evidence suggested that iron supplementation produced a small improvement in cognitive development but had no effect on physical growth .
CONCLUSIONS : In 2 to 5 year olds , daily iron supplementation increases hemoglobin and ferritin .
There is a concerning lack of data on the effect of iron supplementation on clinical ly important outcomes including anemia , ID anemia , ID , and cognitive development .
BACKGROUND AND OBJECTIVES : Iron deficiency ( ID ) is the most common cause of anemia worldwide .
The prevalence is highest among preschool-aged children .
Iron is widely administered to children with or at risk for ID , but evidence of benefit among 2- to 5-year-old children has not been evaluated by systematic review .
We summarize the evidence for the benefit and safety of daily iron supplementation with regard to hematologic , growth , and cognitive parameters in 2 to 5 year olds .