Micronutrient and iron supplementation and effective antimalarial treatment synergistically improve childhood anaemia. Failure of twice-weekly iron supplementation to increase blood haemoglobin and serum ferritin concentrations: results of a randomized controlled trial. Cluster-randomised trial of the impact of school-based deworming and iron supplementation on the cognitive abilities of schoolchildren in Sri Lanka's plantation sector. Iron pre-load for major joint replacement. Effects of iron and multimicronutrient supplementation on geophagy: a two-by-two factorial study among Zambian schoolchildren in Lusaka. Weekly iron supplements given by teachers sustain the haemoglobin concentration of schoolchildren in the Philippines. Efficacy of iron fortification compared to iron supplementation among Vietnamese schoolchildren A randomised placebo-controlled trial to determine the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin > or = 13.2 g/dl. Is cooking food in iron pots an appropriate solution for the control of anaemia in developing countries? A randomised clinical trial in Benin. The efficacy of micronutrient supplementation in reducing the prevalence of anaemia and deficiencies of zinc and iron among adolescents in Sri Lanka Behavioural responses of young anaemic Indian children to iron-folic acid supplements. Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic iron-deficient adults: a systematic review of randomised controlled trials Effects of an iron supplementation trial on the Fe status of Thai schoolchildren. Antenatal Iron Supplementation Regimens for Pregnant Women in Rural Vietnam and Subsequent Haemoglobin Concentration and Anaemia among Their Infants Randomised comparison of the effects of Sprinkles and Foodlets with the currently recommended supplement (Drops) on micronutrient status and growth in Iranian children Intravenous versus oral iron therapy for postpartum anaemia. Effects of iron supplementation and anthelmintic treatment on motor and language development of preschool children in Zanzibar: double blind, placebo controlled study Iron supplementation during pregnancy. Effect on iron status markers, serum erythropoietin and human placental lactogen. A placebo controlled study in 207 Danish women. 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. Effectiveness of biweekly versus daily iron-folic acid administration on anaemia status in preschool children. Changes in haemoglobin levels in infants in Malawi: effect of low birth weight and fetal anaemia Does iron therapy benefit children with severe malaria-associated anaemia? A clinical trial with 12 weeks supplementation of oral iron in young children from the Turiani Division, Tanzania. Effect of daily versus weekly home fortification with multiple micronutrient powder on haemoglobin concentration of young children in a rural area, Lao People's Democratic Republic: a randomised trial Riboflavin deficiency and iron absorption in adult Gambian men. Haematological response to haem iron or ferrous sulphate mixed with refried black beans in moderately anaemic Guatemalan pre-school children. Iron supplements versus placebo during pregnancy: its effects on iron and folate status on mothers and newborns. Efficacy and safety of oral versus intravenous ascorbic acid for anaemia in haemodialysis patients. Circulating IGF-1 may mediate improvements in haemoglobin associated with vitamin A status during pregnancy in rural Nepalese women. [Effect of daily or once weekly iron supplementation on growth and iron status of preschool children]. Intermittent oral iron supplementation during pregnancy. Iron-deficiency anaemia and its effect on worker productivity and activity patterns. Effect of micronutrient fortified beverage on nutritional anaemia during pregnancy. Supplemental iron intake and the risk of glucose intolerance in pregnancy: re-analysis of a randomised controlled trial in Finland. Efficacy of different strategies to treat anemia in children: a randomized clinical trial Effect of iron supplementation on iron status during the first week after blood donation. Effectiveness of routine antihelminthic treatment on anaemia in pregnancy in Rufiji District, Tanzania: a cluster randomised controlled trial. The contribution of hookworm and other parasitic infections to haemoglobin and iron status among children and adults in western Kenya. The effect of oral iron therapy during treatment for Plasmodium falciparum malaria with sulphadoxine-pyrimethamine on Malawian children under 5 years of age. Growth performance in anemia and following iron supplementation. Effects on haemoglobin of multi-micronutrient supplementation and multi-helminth chemotherapy: a randomized, controlled trial in Kenyan school children Daily iron supplementation is more efficacious than twice weekly iron supplementation for the treatment of childhood anemia in western Kenya. Use of microencapsulated iron(II) fumarate sprinkles to prevent recurrence of anaemia in infants and young children at high risk. Positive association between dietary iron intake and iron status in HIV-infected children in Johannesburg, South Africa. Weekly iron supplementation for the prevention of anemia in pre-school children: a randomized, double-blind, placebo-controlled trial. Intravenous iron sucrose is superior to oral iron sulphate for correcting anaemia and restoring iron stores in IBD patients: A randomized, controlled, evaluator-blind, multicentre study Multi-micronutrient Sprinkles including a low dose of iron provided as microencapsulated ferrous fumarate improves haematologic indices in anaemic children: a randomized clinical trial. Effect of an iron supplement on body iron status and aerobic capacity of young training women Combined iron and folic acid supplementation with or without zinc reduces time to walking unassisted among Zanzibari infants 5- to 11-mo old. Early versus late enteral prophylactic iron supplementation in preterm very low birth weight infants: a randomised controlled trial The prevention of anaemia in pregnancy in primigravidae in the guinea savanna of Nigeria. A randomised trial in Mali of the effectiveness of weekly iron supplements given by teachers on the haemoglobin concentrations of schoolchildren. Work Capacity, Heart Rate and Blood Lactate Responses to Iron Treatment Haematological effect of iron supplementation in breast fed term low birth weight infants Iron supplementation, maternal packed cell volume, and fetal growth. Adapting iron dose supplementation in pregnancy for greater effectiveness on mother and child health: protocol of the ECLIPSES randomized clinical trial Effect of an improved local ingredient-based complementary food fortified or not with iron and selected multiple micronutrients on Hb concentration. Short course pre-operative ferrous sulphate supplementation--is it worthwhile in patients with colorectal cancer? [Efficacy of daily and weekly iron supplementation for the control of iron deficiency anaemia in infants in rural Vietnam]. The impact of weekly iron supplementation on the iron status and growth of adolescent girls in Tanzania. Iron, but not folic acid, combined with effective antimalarial therapy promotes haematological recovery in African children after acute falciparum malaria. Association of anaemia in primary care patients with chronic kidney disease: cross sectional study of quality improvement in chronic kidney disease (QICKD) trial data An individualized pre-operative blood saving protocol can increase pre-operative haemoglobin levels and reduce the need for transfusion in elective total hip or knee arthroplasty. Studies in iron supplementation of preschool children. Comparison of response between food supplemented with powdered iron and iron in syrup form for iron deficiency anemia. Effects of vitamin E supplementation during erythropoietin treatment of the anaemia of prematurity Response of hemoglobin, serum ferritin, and serum transferrin receptor during iron supplementation in pregnancy: a prospective study. Effectiveness of daily and weekly iron supplementation in the prevention of anemia in infants. The impact of iron supplementation efficiency in female blood donors with a decreased ferritin level and no anaemia. Rationale and design of a randomised controlled trial: a study protocol W.H.O. sponsored collaborative studies on nutritional anaemia in India. 1. The effects of supplemental oral iron administration to pregnant women. Multiple micronutrients including iron are not more effective than iron alone for improving hemoglobin and iron status of Malian school children.
The control of childhood anaemia in malaria holoendemic areas is a major public health challenge for which an optimal strategy remains to be determined . Malaria prevention may compromise the development of partial immunity . Regular micronutrient supplementation has been suggested as an alternative but its effectiveness remains unsettled . We therefore conducted a r and omised placebo-controlled intervention trial with 207 Tanzanian children aged 5 months to 3 years on the efficacy of supervised supplementation of low-dose micronutrients including iron ( Poly Vi-Sol with iron ) three times per week , with an average attendance of > /= 90 % . The mean haemoglobin ( Hb ) level increased by 8 g/l more in children on supplement ( 95 % CI 3 - 12 ) during the 5-month study . All age groups benefited from the intervention including severely anaemic subjects . The mean erythrocyte cell volume ( MCV ) increased but Hb in children > /= 24 months improved independently of MCV and no relation was found with hookworm infection . The data therefore suggest that micronutrients other than iron also contributed to Hb improvement . In the supplement group of children who had received sulfadoxine-pyrimethamine ( SP ) treatment , the mean Hb level increased synergistically by 22 g/l ( 95 % CI 13 - 30 ) compared to 7 g/l ( 95 % CI 3 - 10 ) in those without such treatment . Supplementation did not affect malaria incidence . In conclusion , micronutrient supplementation  improves childhood anaemia in malaria holoendemic areas and this effect is synergistically enhanced by temporary clearance of parasitaemia In order to increase the intestinal absorption of iron whilst simultaneously minimising the side-effects and thus increasing compliance , once- or twice-weekly , instead of daily , iron supplementation has been widely recommended . In a r and omized , placebo-controlled , double-blind study in western Kenya , a tablet of ferrous dextran ( containing 60 mg elemental iron ) or an identical-looking placebo tablet was provided twice-weekly for 12 months to each child or adult investigated . At baseline each subject had a moderately low blood concentration of haemoglobin ( Hb ) . Initial Hb and serum ferritin ( SF ) concentrations were determined and each subject was tested for malarial and helminth infection and treated , if necessary , with the appropriate anthelminthic drug(s ) . Overall , 200 children ( aged 4 - 15 years ) and 129 adults ( aged 16 - 63 years ) completed the 12-month study . At baseline , 47.5 % of the children and 58.1 % of the adults were anaemic  , hookworm ( detected in 60.0 % of the children and 69.9 % of the adults ) was the most common helminth infection , and malaria was endemic . The results of bivariate analyses indicated that twice-weekly iron supplementation had no significant effect on blood Hb or SF concentrations , either in the children or the adults investigated . The results were confirmed in multiple linear-regression analyses , which revealed that the predictors of the final Hb concentration in the children investigated were age and infection , after enrollment , with Ascaris lumbricoides . Gender and the serum concentration of alpha-1-antichymotrypsin ( ACT ) at final follow-up were predictors of the final SF concentration in the children . In adults , the predictors of the final Hb concentration were gender and HIV infection , and the predictors of the final SF concentration were age and the serum concentration of ACT at the final follow-up . Twice-weekly iron supplementation did not increase Hb or iron stores in children or adults . Since compliance appeared to be high , this lack of effect may be the result of an inadequate dose of iron or of subjects who have deficiencies in micronutrients other than iron OBJECTIVE To assess the impact of deworming and iron supplementation on the cognitive abilities and educational achievement of school-age children in Sri Lanka . METHODS Prospect i ve , placebo-controlled r and omised study . The treatment group received deworming and weekly iron supplementation for 6 months ; the control group received placebo for both the anthelmintic and iron . A mixed effects regression model was used to answer the main research question . To increase the precision of this study 's estimates , various background variables were controlled for that were not related to treatment but could have some impact on the outcome . RESULTS The prevalence of soil-transmitted helminth ( STH ) infection was reduced in the treatment group ( n = 615 ) , with significant differences between treatment and control groups ( n = 575 ) in the levels of Ascaris and Trichuris . No impact was found on haemoglobin ( Hb ) levels , nor any significant impact on concentration levels or on educational test scores . CONCLUSION Decline in STH prevalence alone , in the absence of improved Hb status , produced no evidence of impact on concentration levels or educational test scores Patients undergoing total hip or knee replacement frequently receive  blood transfusion . Homologous blood transfusion carries appreciable risks and should therefore be reduced to a minimum . We have investigated the use of preoperative oral iron supplements to optimize haemoglobin concentration and iron stores prior to surgery . All patients attending a preadmission clinic 4 weeks prior to primary hip or knee replacement had a haemoglobin measurement .  If the haemoglobin concentration ( Hb ) was less than 12 g dL-1 they were given a four week course of ferrous sulphate . If it was greater than or equal to 12 g dL-1 they were r and omized to a control group or given a supplementation course of ferrous sulphate .  One hundred patients were seen . Of these 18 ( 18 % ) had haemoglobin less than 12 g dL-1 and 16 were treated with iron . The mean Hb was 10.8 g dL-1 and mean cell volume ( MCV ) 86 . These patients increased their Hb by a mean 1.1 g dL-1 prior to admission ( P = 0.008 ) . MCV was the best predictor of response ( r = -0.63 , P < 0.02 ) . This group dropped their haemoglobin by a mean 1.4 g dL-1 in the first post-operative week . In the study groups there was no significant preoperative rise in Hb . However , the control group dropped their Hb by a mean 1.3 g dL-1 in the week following surgery compared with 0.4 g dL-1 in the group which had received iron supplements ( P < 0.001 ) . We conclude that at least 18 % of patients attending for hip or knee replacement in this region are frankly anaemic and benefit significantly from preoperative iron supplements over 4 weeks . Iron supplementation in patients without obvious anaemia protects against a fall in Hb during the immediate post-operative period , suggesting a widespread underlying depletion of iron stores in this group despite a normal Hb . Preoperative iron supplements may reduce transfusion requirements as part of a co-ordinated strategy in this group of patients Geophagy has been associated with iron deficiency and anaemia , but no causal relationship has been established . To clarify this , we conducted a two-by-two factorial r and omised , controlled trial on the effect of iron and multimicronutrient supplementation on geophagy in Zambian schoolchildren in Lusaka , from February to December 2001 . Of the 406 children , 212 ( 52.2 % ) were girls and the mean ( range ) age was 10.2 ( 7 - 15 ) years .  Geophagy was reported by 302 ( 74.4 % ) and more often in girls than in boys ( 80.2 vs. 67.7 % , P = 0.007 ) . The mean ( range ) daily earth intake was 25.2 ( 1 - 200 ) g. Geophageous children had more often geophageous relatives than non-geophageous children ( 79.5 vs. 1.9 % , P < 0.001 ) . Geophageous children had lower serum ferritin ( 20.5 vs. 25.0 microg/l , P = 0.032 ) but not haemoglobin ( Hb ) ( 129.2 vs. 130.4 g/l , P = 0.59 ) , than non-geophageous . Among those with Hb < 130 g/l , geophageous children had significantly higher prevalence ( 53.7 vs. 30.6 % , P = 0.024 ) of Ascaris lumbricoides infection than non-geophageous . The prevalence of geophagy ( 74.4 to 51.6 % ) and the intake of earth ( 25.3 to 15.0 g/day ) declined ( P = 0.001 and P < 0.001 , respectively ) among the 220 ( 54.2 % ) children followed-up . In bivariate analysis , non-iron supplementation reduced the prevalence of geophagy more than iron supplementation did , but this was not confirmed in the multiple logistic regression analysis . Multimicronutrients had no effect on either geophagy prevalence or earth intake . Geophagy was prevalent and associated with iron deficiency , but iron supplementation had no effects on geophageous behaviour . Geophagy could be a copied behaviour and the association between geophagy and iron deficiency due to impaired iron absorption following earth eating OBJECTIVES To examine the effectiveness of weekly iron supplements given for 10 weeks by teachers to children in rural schools in the Philippines . METHODS Forty-nine rural primary schools took part in the study and were r and omly assigned to two groups : children in 25 schools received a weekly tablet providing 108 mg iron while children in 24 schools acted as controls . All children were dewormed before the start of the iron supplementation . The haemoglobin concentration of a systematic sample of one in three children in two classes in each school was estimated before and 5 - 17 weeks after the end of the iron supplementation . RESULTS A total of 1510 children aged 7 - 12 years were studied at both surveys . The mean haemoglobin concentration of children in the intervention group did not change significantly ; in the untreated group it fell by 3.8 g/l and the prevalence of anaemia rose from 14.3 % to 25.6 % . The difference between study groups was significantly larger amongst the younger children ( 7 - 8 years ) , and was observed in both anaemic and non-anaemic children . CONCLUSION Even where anaemia is only a mild public health problem , weekly iron supplements given by teachers may prevent a fall in the haemoglobin concentration , and can benefit both anaemic and non-anaemic children The effect of iron fortification is generally assumed to be less than iron supplementation ; however , the magnitude of difference in effects is not known . The present study aims to compare the efficacy of these two strategies on anaemia and iron status . After screening on low Hb , 425 anaemic children in six primary schools in Tam Nong district of Phu Tho province were included in a r and omized , placebo-controlled trial comparing two groups receiving iron fortified instant noodles or iron supplementation for 6 months and a control group , with children in all groups having been dewormed .  Blood sample s were collected before and after intervention for haemoglobin , serum ferritin ( SF ) , serum transferrin receptor ( TfR ) , C-reactive protein ( CRP ) , and haemoglobinopathies analysis . Regression analysis was used to assess the effect of iron fortification and iron supplementation on haemoglobin concentration , SF , TfR , body iron , and anaemic status as outcome variables . The improvement of haemoglobin , SF , and body iron level in the group receiving iron fortification was 42 % ( 2.6 g/L versus 6.2 g/L ) , 20 % ( 23.5 μg/L versus 117.3 μg/L ) , and 31.3 % ( 1.4 mg/kg versus 4.4 mg/kg ) of that in the iron supplementation group . The prevalence of anaemia dropped to 15.1 % in the control group , with an additional reduction of anaemia of 8.5 % in the iron supplementation group . The additional reduction due to iron fortification was 5.4 % , which amounts to well over 50 % of the impact of supplementation . In conclusion , the efficacy of iron fortification based on reduction of prevalence of anaemia , and on the change in haemoglobin level , is about half of the maximum impact of supplementation in case of optimal compliance . Thus , in a population of anaemic children with mild iron deficiency , iron fortification should be the preferred strategy to combat anaemia OBJECTIVE To study the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin ( Hb ) > or = 13.2 g/dl . DESIGN A r and omised , double-blind , placebo-controlled trial . SETTING Routine health services . POPULATION Seven hundred and twenty-seven pregnant women with Hb > or = 13.2 g/dl in the early stage of the second trimester . METHODS Each woman took one ferrous sulphate [ DOSAGE ERROR CORRECTED ] tablet ( 150 g tablet , containing 50 mg of elemental iron ) [ DOSAGE ERROR CORRECTED ] daily in the case group ( n = 370 ) or placebo in the control group ( n = 357 ) throughout pregnancy . MAIN OUTCOME MEASURES Pregnancy outcome . RESULTS While there were no significant differences in demographic and obstetric characteristics between the two groups before any intervention , small-for-gestational-age birth rate and the number of women with hypertension disorder increased significantly in the case group in comparison with the control group ( 57 [ 15.7 % ] versus 36 [ 10.3 % ] , P = 0.035 , 10 [ 2.7 % ] versus 3 [ 8 % ] , P = 0.05 , respectively ) . CONCLUSIONS Our finding proves that routine iron supplementation in nonanaemic women is not rational and may be harmful OBJECTIVE To evaluate the effect of two types of iron pots on haemoglobin ( Hb ) and serum ferritin ( SF ) concentrations in young children ( 6 - 24 months ) , adolescent girls ( 11 - 15 years ) and women of reproductive age ( 15 - 44 years ) , whose households were provided with  iron pots  for cooking food over a period of 6 months , compared with controls . DESIGN AND METHODS We r and omly assigned 161 households including 339 individuals from the three subgroups to cast iron pots , blue steel pots or oral iron supplements ( control ) . In the control group , children received micronutrient Sprinkles , and adolescent girls and women received iron tablets daily for 6 months . We measured Hb , SF and C-reactive protein concentrations at baseline and 6 months , and compared groups using regression models . RESULTS Anaemia prevalence ( Hb < 110 g l(-1 ) in infants , Hb < 120 g l(-1 ) in girls or women ) was 47 % ( cast iron group ) , 50 % ( blue steel group ) and 50 % ( control ) at baseline . At 6 months , there were no significant differences in Hb concentrations among groups ; however , differences in SF concentrations were significant ( P < 0.0001)--the control group had higher SF concentrations compared with the groups using iron pots . Also , differences in the prevalence of iron-deficiency anaemia ( IDA ; anaemia plus SF < 15 microg l(-1 ) ) were almost significant between cast iron and control groups ( P = 0.08 ) , and blue steel and control groups ( P = 0.05 ) . CONCLUSION There is no evidence that iron cooking pots are effective against IDA . Further research is warranted to determine whether the iron leached from the pots is bioavailable Objective : To determine the effectiveness of combined iron and zinc over the iron or zinc-only supplementation in correcting deficiency and possible interactive effects in a group of adolescent school children . Subjects and methods : Schoolchildren ( n=821 ) of 12–16 years of age were r and omized into four groups and supplemented with iron ( 50 mg/day ) , zinc ( 14 mg/day ) , iron+zinc or placebo capsules 5 days per week for 24 weeks . Anthropometry , and haemoglobin ( Hb ) , serum zinc ( SZn ) and serum ferritin ( SF ) concentrations were determined before and after the intervention . Results : There were no significant effects between-groups in their weight , height and Hb concentrations with the intervention when compared with the placebo group . Iron-only and combination-supplemented groups had reached mean SF concentrations of 55.1 μg/l with no difference between them ( P=0.99 ) . The zinc-only group had a mean change of 4.3 μmol//l whereas the combine-supplemented group had a mean change of 4.0 μmol/l ( P=0.82 ) . The prevalence of anaemia was found to be 70.3 % in the iron group at baseline ; this was reduced to 14.5 % after the supplementation . In the combine-supplemented group anaemia , prevalence was reduced from 64.8 to 19.3 % . Conclusions : Zinc alone or in combination with iron has not shown a significant improvement in growth in adolescence . Severe and moderate forms of anaemia were successfully treated in children who received iron supplementation . Initial high prevalence of low SZn and iron stores was significantly improved with micronutrient supplementation 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 Objective Iron supplementation in iron-deficiency anaemia is st and ard practice , but the benefits of iron supplementation in iron-deficient non-anaemic ( IDNA ) individuals remains controversial . Our objective is to identify the effects of iron therapy on fatigue and physical capacity in IDNA adults . Design Systematic review and meta- analysis of r and omised controlled trials ( RCTs ) . Setting Primary care . Participants Adults ( ≥18 years ) who were iron deficient but non-anaemic . Interventions Oral , intramuscular or intravenous iron supplementation ; all therapy doses , frequencies and duration s were included . Comparators Placebo or active therapy . Results We identified RCTs in Medline , Embase , Cochrane Central Register of Controlled Trials , Cumulative Index of Nursing and Allied Health , SportD iscus and CAB Abstract s from inception to 31 October 2016 . We search ed the WHO ’s International Clinical Trials Registry Platform for relevant ongoing trials and performed forward search es of included trials and relevant review s in Web of Science . We assessed internal validity of included trials using the Cochrane Risk of Bias tool and the external validity using the Grading of Recommendations Assessment , Development and Evaluation methodology . From 11 580 citations , we included 18 unique trials and 2 companion papers enrolling 1170 patients . Using a Mantel-Haenszel r and om-effects model , iron supplementation was associated with reduced self-reported fatigue ( st and ardised mean difference ( SMD ) −0.38 ; 95 % CI −0.52 to −0.23 ; I2 0 % ; 4 trials ; 714 participants ) but was not associated with differences in objective measures of physical capacity , including maximal oxygen consumption ( SMD 0.11 ; 95 % CI −0.15 to 0.37 ; I2 0 % ; 9 trials ; 235 participants ) and timed methods of exercise testing  . Iron supplementation significantly increased serum haemoglobin concentration ( MD 4.01 g/L ; 95 % CI 1.22 to 6.81 ; I2 48 % ; 12 trials ; 298 participants ) and serum ferritin ( MD 9.23 µmol/L ; 95 % CI 6.48 to 11.97 ; I2 58 % ; 14 trials ; 616 participants ) . Conclusion In IDNA adults , iron supplementation is associated with reduced subjective measures of fatigue but not with objective improvements in physical capacity . Given the global prevalence of both iron deficiency and fatigue , patients and practitioners could consider consumption of iron-rich foods or iron supplementation to improve symptoms of fatigue in the absence of documented anaemia . PROSPERO registration number CRD42014007085 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 Background Little evidence about the effects of antenatal iron supplementation on infant anaemia is available . The aim was to compare effects on  six-month-old infants ’ Haemoglobin ( Hb ) concentration and anaemia of daily iron – folic acid ( IFA ) , twice-weekly IFA with or without other micronutrients ( MMN ) and usual antenatal care in rural Vietnam . Methods and Findings Secondary data analysis from : a prospect i ve population -based observational study ( OS ) which examined effects of antenatal psychosocial factors , anaemia and iron deficiency on infant development and health ; and a three-arm cluster r and omised trial ( CRT ) of different antenatal iron supplementation regimens . In the OS 497 women ( < 20 weeks gestation ) from 50 r and omly-selected communes participated , and in the CRT 1,258 pregnant women ( < 16 weeks gestation ) in 104 communes were allocated r and omly to trial arms . The main outcome was six-month-old infant Hb concentration . Baseline data included women ’s socio-demographic characteristics , reproductive health , Hb and serum ferritin . Mean differences in infant Hb and odds ratios of infant anaemia between CRT arms and OS were calculated by multivariable regression models , controlling for baseline differences and clustering , using robust st and ard errors . Infant anaemia prevalence was 68.6 % in the OS , 47.2 % daily IFA , 53.5 % weekly IFA , and 50.3 % MMN conditions . After adjustment , mean infant haemoglobin levels in daily IFA ( mean difference = 0.95 g/dL ; 95%CI 0.7 - 11.18 ) ; weekly IFA ( 0.91 ; 95%CI 0.69 - 1.12 ) and MMN ( 1.04 ; 95%CI 0.8 - 1.27 ) were higher than in the OS . After adjustment there were lower odds ratios of anaemia among infants in the daily IFA ( OR = 0.31 ; 95 % CI 0.22 - 0.43 ) , weekly IFA ( 0.38 ; 95%CI 0.26 - 0.54 ) and MMN ( 0.33 ; 95%CI 0.23 - 0.48 ) groups than in the OS . Conclusions Infant anaemia is a public health problem in Vietnam and other re source -constrained countries . All supplementation regimens could have clinical ly significant benefits for Hb and reduce anaemia risk among six-month-old infants . Universal provision of free intermittent iron supplements is warranted Background / Objectives : Multiple micronutrient supplementation with Sprinkles powder and crushable Foodlets tablets may be effective means of controlling micronutrient deficiencies in infants . Their efficacy has not been tested in countries like Iran where wheat as the staple food may affect nutrient bioavailability . This study aim ed to compare the efficacy of Sprinkles , Foodlets and the current supplement ( Drops ) for improving micronutrient status and growth among Iranian infants . Subjects/ Methods : Infants of 6–18 months of age , living in an urban district of Iran were r and omised to receive daily Sprinkles ( n=120 ) , Foodlets ( n=121 ) or Drops ( n=121 ) for 4 months . Haemoglobin ( Hb ) , serum ferritin , serum retinol , serum zinc , 25(OH ) D concentration and anthropometry were assessed at baseline and at 4 months . Results : Iron status improved with all treatments . Drops showed significantly greater changes in Hb and serum ferritin , though changes in anaemia prevalence were not different across groups . Infants having Foodlets and Sprinkles had significantly greater reductions in proportion of children with zinc deficiency compared with Drops . No significant differences in treatment effects were observed for mean serum 25(OH ) D and retinol , or for growth of infants across groups . Conclusion : The study was the first efficacy trial with Sprinkles and Foodlets in the Middle East where wheat or rice is the principal complementary foods . Differences across treatment groups were largely consistent with supplement micronutrient composition for iron and zinc , with no benefit in this population for serum retinol , 25(OH ) D , growth or anthropometric status . The trial identified trade-offs in combining multiple micronutrients in a single delivery mechanism OBJECTIVE Postpartum iron deficiency anaemia ( IDA ) is common in women . Most women are treated with either oral iron supplementation or blood transfusion . Hence , the aim of our study was to compare the effect of treatment with either oral ferrous sulphate or intravenous ferrous sucrose on postpartum IDA . DESIGN A single centre , prospect i ve r and omised controlled trial . SETTING Women 's Centre , John Radcliffe Hospital , Oxford , UK . POPULATION Forty-four women with haemoglobin ( Hb ) of < 9 g/dl and ferritin of < 15 microgram/l at 24 - 48 hours postdelivery . METHODS Women were r and omised to receive either oral ferrous sulphate 200 mg twice daily for 6 weeks ( group O ) or intravenous ferrous sucrose 200 mg ( Venofer ; Vifor International Ltd , St Gallen , Switzerl and ) , two doses given on days 2 and 4 following recruitment ( group I ) . RESULTS were analysed by the Students t-test , chi-square test and analysis of variance . MAIN OUTCOME MEASURES Hb , haematocrit , red cell indices , ferritin and serum iron levels were measured on days 0 , 5 , 14 and 40 . Results By day 5 , the Hb level in women treated with intravenous iron had risen from 7.3 + /- 0.9 to 9.9 + /- 0.7 g/dl , while there was no change in those treated with oral iron . Women treated with intravenous iron had significantly higher Hb levels on days 5 and 14 ( P < 0.01 ) than those treated with oral iron ; although by day 40 , there was no significant difference between the two groups . Throughout the study , ferritin levels rose rapidly in those treated with intravenous iron and remained significantly higher than in those treated with oral iron ( P < 0.01 ) . CONCLUSIONS Intravenous iron sucrose increases the Hb level more rapidly than oral ferrous sulphate in women with postpartum IDA . It also appears to replenish iron stores more rapidly . However , this study was not large enough to address the safety of this strategy Abstract Objective : To measure the effects of iron supplementation and anthelmintic treatment on iron status , anaemia , growth , morbidity , and development of children aged 6–59 months . Design : Double blind , placebo controlled r and omised factorial trial of iron supplementation and anthelmintic treatment . Setting : Community in Pemba Isl and , Zanzibar . Participants : 614 preschool children aged 6–59 months . Main outcome measures : Development of language and motor skills assessed by parental interview before and after treatment in age appropriate subgroups . Results : Before intervention , anaemia was prevalent and severe , and geohelminth infections were prevalent and light — Plasmodium falciparum infection was nearly universal . Iron supplementation significantly improved iron status , but not haemoglobin status . Iron supplementation improved language development by 0.8 ( 95 % confidence interval 0.2 to 1.4 ) points on the 20 point scale . Iron supplementation also improved motor development , but this effect was modified by baseline haemoglobin concentrations ( P=0.015 for interaction term ) and was apparent only in children with baseline haemoglobin concentrations < 90 g/l . In children with a baseline haemoglobin concentration of 68 g/l ( one st and ard deviation below the mean value ) , iron treatment increased scores by 1.1 ( 0.1 to 2.1 ) points on the 18 point motor scale . Mebendazole significantly reduced the number and severity of infections caused by Ascaris lumbricoides and Trichuris trichiura , but not by hookworms . Mebendazole  increased development scores by 0.4 ( −0.3 to 1.1 ) points on the motor scale and 0.3 ( −0.3 to 0.9 ) points on the language scale . Conclusions : Iron supplementation improved motor and language development of preschool children in rural Africa . The effects of iron on motor development were limited to children with more severe anaemia ( baseline haemoglobin concentration < 90 g/l ) . Mebendazole had a positive effect on motor and language development , but this was not statistically significant . What is already known on this topic Iron is needed for development and functioning of the human brain Anaemic children show developmental delays , but it is not yet clear whether iron deficiency causes these deficits or whether iron supplementation can reverse them Helminth infections in schoolchildren are associated with cognitive deficits , but few studies have been made of helminth infection and early child development What this study adds Low doses of oral iron supplementation given daily improved language development in children aged 1–4 years in Zanzibar Iron supplementation improved motor development , but only in children with initial haemoglobin concentrations below 90 g/l The effects of routine anthelmintic treatment on motor and language milestones were positive , but non-significant , with our sample The effect of iron supplementation , 66 mg elemental iron daily , from the 16th week of gestation to delivery , on iron status markers during uncomplicated pregnancies was assessed in a r and omised , double-blind , placebo controlled study of 207 healthy women ( 100 iron treated , 107 placebo treated ) and their newborn babies .  Haemoglobin ( Hb ) and serum ( S- ) human placental lactogen ( HPL ) were measured in all 207 females , while transferrin saturation , S-ferritin and S-erythropoietin ( EPO ) were measured in 120 females at monthly intervals . Hb : from 27th week of gestation to eight weeks post partum , the placebo treated group had significantly lower Hb levels than the iron treated group ( p less than 0.001 ) . Iron status markers : in the placebo group ( n = 57 ) , 92 % developed exhausted iron stores ( i.e. S-ferritin less than or equal to 20 micrograms/l ) , 65 % latent iron deficiency ( i.e. S-ferritin less than or equal to 20 micrograms/l and transferrin saturation less than 15 % ) , and 18 % iron deficiency anaemia ( i.e. S-ferritin less than or equal to 20 micrograms/l , transferrin saturation less than 15 % and Hb less than 110 g/l ) . In the iron treated group ( n = 63 ) , 54 % developed exhausted iron stores , 6 % latent iron deficiency , and none iron deficiency anaemia . S-EPO : the placebo group had significantly higher values than the iron treated group from the 27th week of gestation to one week post partum ( p less than 0.01 ) . S-HPL : levels were identical in placebo and iron treated females . Babies of iron treated mothers had higher S-ferritin than babies of placebo treated mothers ( p less than 0.02 ) . ( ABSTRACT TRUNCATED AT 250 WORDS 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 Three-quarters of preschool children in India are anaemic . With the aim of identifying a cost-effective strategy for iron supplementation , the study objective was to assess the effectiveness of daily versus biweekly iron-folic acid ( IFA : 20 mg elemental iron and 0.1 mg folic acid/tablet ) on change in haemoglobin ( Hb ) levels of preschool children ( 3 - 6 years ) . This was a rural community-based effectiveness study in Uttar Pradesh , North India .  IFA was given in two schedules : biweekly ( 2 tablets/dose ) and daily ( 1 tablet/dose ) for 1 year with fortnightly monitoring for adherence . A total of 400 and 403 children were enrolled in daily and biweekly regimes , respectively , of which 57.32 per cent and 50.25 per cent were anaemic ( Hb < 11 g/dl ) in each group . Adherence in biweekly and daily regimes was 89.05 per cent vs. 63.5 per cent . After 1 year , the mean Hb rise in daily and biweekly regime was 1.063 g/dl ( SD : 1.6 ; p = 0.000 ) and 1.053 g/dl ( SD : 1.73 ; p = 0.001 ) , respectively . Reduction in point prevalence of anaemia was 65.7 per cent daily vs. 56.1 per cent in biweekly regimen ( p = 0.0047 ) . We conclude that biweekly as well as daily IFA administration is effective in raising Hb levels and decreasing community prevalence of anaemia significantly . However , since there is better adherence and lower drug costs associated with biweekly IFA administration , this can be considered for programme use Objectives : To examine the effect of low birth weight ( LBW ) and fetal anaemia ( FA ) on haemoglobin ( Hb ) patterns in infancy . To study the additional contribution of other risk factors known at birth . To examine the effect of iron supplementation during infancy on Hb levels . Methods : A stratified cohort of infants in Malawi ( 83 with LBW ( < 2500 g ) , 111 with FA ( cord Hb < 125 g/l ) , 31 with both LBW and FA , and 176 controls ) was followed during infancy . Hb levels were measured at about 2 , 4 , 6 , 9 , and 12 months of age . Repeated measures models were used to describe the changes in Hb levels over time . Results : The mean Hb concentration in the control group was 95.5 g/l ( 95 % confidence interval ( CI ) 92.5 to 98.5 ) at 2 months , 86.9 g/l ( 95 % CI 84.4 to 89.4 ) at 9 months , and 898 g/l ( 95 % CI 874 to 92.2 ) at 12 months . Differences between LBW infants and controls increased over time ( difference at 12 months : 5.5 g/l ( 95 % CI 1.3 to 9.7 ) ) . Infants with FA had borderline significantly lower Hb at 2 months ( p = 0.07 ) , but at 6 months their levels were similar to those of controls . The LBW infants and those with FA had the lowest Hb levels ( difference from controls at 12 months 7.9 g/l ) . Parity , placental and maternal malaria at delivery , and sex significantly affected Hb levels after adjustment for LBW and FA . After iron supplementation , Hb significantly increased . Conclusions : Antimalarial control and iron supplementation throughout pregnancy should be increased to reduce the incidence of infant anaemia and improve child development and survival Oral iron supplementation is often routinely given to children with malaria-associated anaemia , but its contribution to recovery is controversial . A r and omized clinical trial , evaluating such routine , was carried out among 100 children , who had a haemoglobin of < or = 5 g/dl and a positive blood smear for malaria parasites . All children received malaria therapy ( chloroquin + fansidar ) and were r and omly allocated to two groups , one receiving additional oral iron treatment , the other being the control . In the 12-week follow-up period the haemoglobin level and malaria indices were measured at 2 , 4 , 8 , and 12 weeks . There was a 100 per cent compliance during the follow-up period . In each group 20 children ( 40 per cent ) required a blood transfusion . In the remaining 60 children , after 2 weeks the haemoglobin had risen 3.7 g/dl in the ferrous-supplemented group compared to 3.5 g/dl in the non-ferrous group . Thereafter , the increase in haemoglobin in both groups was steady . At follow-up measurements , the groups did not differ for haemoglobin levels . The mean haemoglobin at 12 weeks was 9.2 and 9.0 g/dl , respectively . It was concluded that iron supplementation did not have any effect on the rate of parasitaemia and on parasite density during the 12 weeks . However , the iron-supplemented group had a significantly increased morbidity from other causes than malaria . It appears that iron does not have an effect on the recovery of haemoglobin level in children with malaria-associated anaemia . This study provides no evidence supporting routine iron supplementation to these children Background Multiple micronutrient deficiencies , in particular iron deficiency anaemia ( IDA ) is a severe public health problem in Lao People 's Democratic Republic ( Lao PDR ) . Because of the practical difficulties encountered in improving the nutritional adequacy of traditional complementary foods and the limitations associated with the use of liquid iron supplementation for the treatment and prevention of IDA in infants and young children , recently , home-fortification with multivitamins and minerals sprinkles was recommended . This study aims to compare the effect of twice weekly versus daily supplementation with multivitamins and minerals powder ( MMP ) on anaemia prevalence , haemoglobin concentration , and growth in infants and young children in a rural community in Lao PDR . Methods A r and omized trial was conducted in six rural communities . Children aged 6 to 52 months ( n = 336 ) were r and omly assigned to a control group ( n = 110 ) or to one of two intervention groups receiving either two sachets per week ( n = 115 ) or a daily sachet ( n = 111 ) of MMP for 24 weeks ; 331 children completed the study . A finger prick of blood was taken at baseline , at week 12 , and again at week 24 to determine haemoglobin concentration . Anthropometric measurements were taken every 4 weeks . The McNemar test was used to assess within group differences at three time points in the study subjects with anaemia and one-way ANOVA was used to assess changes in mean haemoglobin concentration in the treatment groups . Results MMP supplementation result ed in significant improvements in haemoglobin concentration and in the reduction of anaemia prevalence in the two treatment groups compared with the control group ( p < 0.001 ) . The severely to moderately anaemic children ( Hb < 100 g/L ) on daily supplementation recovered faster than those on twice weekly supplementation . MMP was well accepted and compliance was high in both treatment groups . Overall , the improvement in the weight for age Z-score was very small and not statistically significant across the three study groups . Conclusions MMP supplementation had positive effects in reduction of anaemia prevalence and in improving haemoglobin concentration . For severely to moderately anaemic children , daily MMP supplementation was more effective in improving haemoglobin concentration and reducing anaemia prevalence . A longer intervention period is probably needed to have a positive effect on growth Iron absorption from 3.38 mg 58Fe was measured in  riboflavin-deficient Gambian men with haemoglobin ( Hb ) less than 11.5 g/dl before and after oral riboflavin therapy  , and the results compared with a group not receiving riboflavin .  Riboflavin status ( as determined by erythrocyte glutathione reductase activation coefficient ) and Hb increased in teh riboflavin-supplemented but not placebo group . Plasma ferritin levels were low and did not change in either group . There was very wide variation in percentage iron absorption between individuals and also within single individuals on two separate occasions but no measurable change with riboflavin supplementation . The results of the study indicate that the efficiency of iron utilization is impaired in riboflavin deficiency , but that iron absorption is unaffected OBJECTIVE Combating iron deficiency in toddlers with iron-fortified food has proved difficult in countries with phytate-rich diets . For this purpose , a new haem iron preparation was developed . The study compared changes in iron status after administration of refried beans with beans fortified with a haem iron preparation or ferrous sulphate ( FeSO4 ) . DESIGN In a masked , stratified-r and omised intervention trial , children received five 156-g cans of refried black beans per week for 10 consecutive weeks . The beans-only ( control ) , FeSO4 and haem iron groups were offered a cumulative dose of 155 mg , 1625 mg and 1700 mg of iron from the bean intervention , respectively . Haemoglobin ( Hb ) and ferritin concentrations were determined at baseline and after 5 and 10 weeks . Compliance was examined weekly . SETTING A low-income community in Guatemala City . SUBJECTS One hundred and ten children aged 12 - 36 months with initial Hb values between 100 and 115 g l(-1 ) . RESULTS The cumulative intake of beans was approximately 80 % of that offered , signifying an additional approximately 1300 mg of either haem or inorganic iron in the corresponding treatment groups over 10 weeks . Hb concentrations increased by the order of 7.3 - 11.4 g l(-1 ) during the intervention , but without significant differences across treatments . Average ferritin concentrations were unaffected by treatment assignment . However , post hoc analysis by subgroups of initial high ferritin and initial low ferritin found the Hb increments after 10 weeks in the haem iron group ( 13.1+/-7.7 g l(-1 ) ) to be significantly greater than the respective increases ( 6.8+/-11.2 and 6.4+/-8.5 g l(-1 ) ) in the inorganic iron and beans-only groups . CONCLUSIONS Canned refried beans are a c and i date vehicle for fortificant iron . Given the improved colour and organoleptic properties imparted by haem iron added to refried beans , its additional potential for benefiting the iron status of consumers with iron deficiency may recommend it over FeSO4 Iron and folate status of 203 pregnant women have been evaluated at 6 months gestation and on the same women and their newborn infants at delivery . The women who had , at 6 months gestation , a Hb level below 11 g/dl were systematic ally given iron supplements . Iron or placebo were r and omly allocated to the other women . At 6 months of pregnancy , one quarter of the women had a Hb level under 11 g/dl but one third had a serum ferritin level below 12 micrograms/l and more than half had low levels of serum and red cell folate . Iron supplements induced an increase both in Hb levels and in serum ferritin values ; however , no significant differences were observed in serum ferritin of the newborn infants , whether their mothers had received iron supplements or not . These results have led us to reconsider the value of ferritin levels at birth as an index of iron stores in the infant . Iron supplements had no effect on the folate status in mothers or infants or on the frequency of obstetrical complications . A significant relationship was found between maternal folate levels and length of gestation . Folate supplementation may reduce the incidence of premature delivery BACKGROUND Intravenous ( i.v . ) ascorbic acid ( AA ) improves anaemia in iron-overloaded , erythropoietin ( rEPO ) hyporesponsive haemodialysis patients . While oral AA is readily attainable , the efficacy and safety of oral versus i.v . AA has not been examined . METHODS We conducted an open-label r and omised parallel study on the effects of 8 weeks of 250 mg oral AA ( n=10 ) compared with 250 mg i.v . AA ( n=11 ) 3x/week on haemoglobin ( Hb ) , ferritin and rEPO dose in 21 iron-overloaded haemodialysis patients . We also examined the effect of 3 months of 500 mg oral AA 3x/week ( n=70 ) compared with no treatment ( n=83 ) on Hb , ferritin and rEPO dose in 153 haemodialysis patients . RESULTS Patients had severe AA deficiency ( mean 2.2+/-SE 0.4 mg/L ; normal range , 4.0 - 14.0 ) . Following treatment , the plasma AA level increased ( P<0.001 ) , but was not significantly different between the groups . There was no change in Hb , iron availability and rEPO dose with oral or i.v . AA . There was a significant increase in serum oxalate but no significant changes in left ventricular function or renal calculi formation . In the second study , oral AA had no effect on Hb , rEPO dose and ferritin in the whole group and a subgroup of 30 with anaemia . CONCLUSION Haemoglobin and iron availability did not improve following oral or i.v . AA in this select small group of iron-overloaded haemodialysis patients or in a larger population of haemodialysis patients given oral AA at a higher dose and for a longer duration . AA supplementation may still be warranted in view of severe AA deficiency in haemodialysis patients Pregnancy exacerbates vitamin A ( VA ) deficiency and anaemia among women in developing countries . Improving circulating haemoglobin ( Hb ) requires erythrocyte production and availability of iron . Insulin-like growth factor- 1 ( IGF-1 ) functions in erythropoiesis , but its association with VA status and pregnancy-associated anaemia has not been studied . The aim of this study was to examine the relationship between serum retinol , IGF-1 , and Hb among pregnant women in extant sample s collected during a placebo-controlled trial of VA and beta-carotene ( BC ) supplementation in rural Nepal conducted from 1994 to 1997 . Mid-pregnancy serum IGF-1 was measured in serum from n=589 r and omly selected women of n=1186 in whom anthropometric , VA ( retinol ) and iron ( Hb , erythrocyte zinc protoporphyrin ( ZP ) , and ferritin ) status data were available . Associations of IGF-1 with retinol , Hb or anaemia , and iron status were determined using multiple linear and logistic regression . Path analysis was used to explore the role of IGF-1 as a mediator between retinol and Hb , accounting for iron status . A 2.6 g/L increase in IGF-1 was observed per 0.1 mol/L increment in retinol ( p<0.0001 ) . Hb increased with each quartile of IGF-1 , and odds of anaemia declined 68.8 % from the 1st to 4th quartile . Improved iron status indicators explained only 29.1 % of the association between IGF-1 and Hb , while IGF-1 explained 25.6 % of the association between retinol and Hb . Increasing IGF-1 was likely one mechanism by which retinol improved circulating Hb in pregnant women of rural Nepal , although IGF-1 worked primarily through pathways independent of improved iron status indicators , perhaps by stimulating erythrocyte production 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 RATIONALE It has been suggested that in pregnant women weekly iron supplements are as effective as daily supplements in preventing iron deficiency anaemia ( IDA ) . OBJECTIVE To compare the effectiveness of prophylactic antenatal oral iron supplements given weekly , thrice weekly and daily in preventing IDA in pregnancy . DESIGN A r and omised control trial . SETTING University antenatal clinic , ( UANC ) Galle . SUBJECTS AND METHOD An oral iron supplement containing 100 mg of elemental iron was r and omly given weekly ( n = 26 ) thrice weekly ( n = 35 ) and daily ( n = 31 ) to 92 women who were 14 to 24 weeks pregnant .  Haemoglobin ( Hb ) , serum ferritin ( SF ) and haematocrit ( Hct ) were assessed before and after 12 to 20 weeks of supplementation and a logistic regression analysis carried out . RESULTS The risk of developing anaemia was significantly higher in the weekly ( odds ratio 15 , 95 % CI 1.4 - 165.6 , p < 0.03 ) and possibly higher in the thrice weekly ( odds ratio 3 , 95 % CI 0.3 - 30.3 , p = 0.3 ) groups . The risk of developing iron deficiency ( SF < 12 micrograms/l ) was also significantly higher in the weekly ( odds ratio 18 , 95 % CI 2.8 - 115.5 , p < 0.003 ) and thrice weekly ( odds ratio 10 , 95 % CI 1.6 - 64.8 , p < 0.02 ) groups . CONCLUSION Prophylactic oral iron supplements when given intermittently were not effective in preventing iron deficiency anaemia in pregnancy The effects of  iron-deficiency anaemia on  workers productivity  were studied in a tea plantation in Sri Lanka . The quantity of tea picked per day was studied before and after iron supplementation or placebo treatment . After one month 's treatment significantly more tea was picked when the haemoglobin ( Hb ) concentration was increased by iron supplementation than when it was not . The degree of improvement was greater in more-anaemic subjects ( those with concentrations of 6.0 - 9.0 g Hb/dl ) . The level of physical activity of anaemic subjects in their everyday environment was also recorded for four or 24 hours continuously both before and after treatment . After three weeks these levels was significantly greater in the iron-treated than matched placebo-treated subjects . The economic implication s of increased work productively with iron treatment are evident , particularly in developing countries . These results also provide strong evidence for the clinical impression that people with iron-deficiency anaemia suffer from tiredness and weakness OBJECTIVE To evaluate the efficacy of a multiple micronutrient fortified beverage containing eleven nutrients at physiological levels in prevention of anaemia and improving iron and vitamin A status  during pregnancy . DESIGN A r and omised double blind placebo controlled study . SETTING Mpwapwa and Kongwa Districts in Dodoma Region of Tanzania . SUBJECTS Five hundred and seventy nine pregnant women were screened for entry into the study and 439 women who met the study criteria were enrolled . INTERVENTIONS Study participants received either a fortified ( F ) or non-fortified ( NF ) orange flavoured drinks identical in appearance , provided in two self administered servings per day for an eight week period . MAIN OUTCOME MEASURES Comparison of haemoglobin ( Hb ) , serum ferritin ( SF ) and serum retinol ( SR ) at baseline and follow up . RESULTS After eight weeks of supplementation , the F group ( n=129 ) had a significantly higher Hb increase of 0.86 g/dL compared to 0.45 g/dL in the NF group ( n=130 ) p<0.0001 . Gestational age at entry into the study , moderated the effect on Hb of the fortified drink . Women at earlier gestational age upon entry , had a higher rise in Hb than women of late gestational age ( 0.8 g/dL versus 0.04 g/dL rise respectively , p=0.038 , n=188 ) . The risk of being anaemic at the end of the study for those in the F group was reduced by 51 % ( RR=0.49 , CI=0.28 to 0.85 ) . Iron stores ( by serum ferritin levels ) increased by 3 microg/L in the F group ( p=0.012 ) and a decrease of 2 microg/L in the NF group ( p=0.115 ) . The follow up ferritin concentration depended on initial ferritin level . Regardless of treatment group , serum retinol concentrations were significantly higher in mothers who had delivered . Mothers who had adequate levels at entry benefited more from the supplement than those with low levels ( 0.26 micromol/L versus no significant difference ) . CONCLUSIONS The multiple micronutrient-fortified beverage given for eight weeks to pregnant women improved their haemoglobin , serum ferritin and retinol status . The risk for anaemia was also significantly reduced . The important predictors of Hb increase at follow up were the fortified beverage , baseline Hb , serum retinol , baseline ferritin and gestational age at entry into study . Anthropological research showed that the beverage was highly acceptable and well liked Observational studies suggest that high iron intake during pregnancy is associated with the risk of  gestational diabetes .  As such studies are prone to bias , we re-analysed data from a r and omised controlled trial of iron supplementation to see whether it supports the risk found in observational studies . The trial was conducted in primary health care setting in five municipalities in Finl and in 1985 - 1986 . The participants were 2944 women ( 95 % of pregnant women in the area ) who were r and omly allocated either to ( 1 ) the selective iron group ( elemental iron 50 mg twice a day only if diagnosed as anaemic , continuing until their haemoglobin increased to 110 g L(-1 ) ) or ( 2 ) the routine iron group ( elemental iron 100 mg day(-1 ) throughout the pregnancy regardless of haemoglobin level ) . The numbers of women in the analyses were 1358 and 1336 , respectively . The main outcome measure was a composite variable including any glucose intolerance-related outcome ( e.g. glucosuria , gestational diabetes , large-for-gestational-age child ) in mothers ' or children 's patient records during pregnancy and post-partum . There were no statistically significant differences in the incidence of the primary outcome between the selective iron and the routine iron groups ( 13.0 vs. 11.0 % , P = 0.12 ) . The most common outcome was large-for-gestational-age calculated from children 's hospital data ( 8.3 vs. 8.2 % , P = 0.95 ) . The results were mainly similar when stratified by the mothers ' baseline haemoglobin level , body mass index or gestational weight gain . Routine iron supplementation throughout pregnancy did not increase the risk of glucose intolerance during pregnancy . The results need to be confirmed in future trials Background Anemia continues to be a major public health problem among children in many regions of the world , and it is still not clear which strategy to treat it is most effective . Objective To evaluate the efficacy and children 's acceptance of several recognized strategies to treat anemia . Methods Non-breastfed children ( n = 577 ) , 6 to 43 mo of age , were screened for the trial ; 267 were anemic ( hemoglobin < 11.7 g/dL ) , and 266 of those were r and omized into 1 of 5 treatments to received daily either : an iron supplement ( IS ) , an iron+folic acid supplement ( IFS ) , a multiple micronutrient supplement ( MMS ) , a micronutrient-fortified complementary food as porridge powder ( FCF ) , or zinc+iron+ascorbic acid fortified water ( FW ) . The iron content of each daily dose was 20 , 12.5 , 10 , 10 and 6.7 mg respectively . Hemoglobin ( Hb ) , ferritin , total iron , weight and height were measured at baseline and after 4 months of treatment . Morbidity , treatment acceptability and adherence were recorded during the intervention . Results All treatments significantly increased Hb and total iron concentration ; ferritin did not change significantly . Groups MMS , IS and IFS  increased Hb ( g/dL ) [ 1.50 ( 95%CI : 1.17 , 1.83 ) , 1.48 [ ( 1.18 , 1.78 ) and 1.57 ( 1.26 , 1.88 ) , respectively ] and total iron ( ( μg/dL ) [ 0.15 ( 0.01 , 0.29 ) , 0.19 ( 0.06 , 0.31 ) and 0.12(-0.01 , 0.25 ) , respectively ] significantly more than FCF [ 0.92 ( 0.64 , 1.20 ) ] but not to FW group [ 0.14 ( 0.04 , 0.24 ) ] . The prevalence of anemia was reduced to a greater extent in the MMS and IFS groups ( 72 % and 69 % , respectively ) than in the FCF group ( 45 % ) ( p < 0.05 ) . There were no significant differences in anthropometry or in the number of episodes of diarrhea and respiratory infections among treatment groups . The supplements MMS and IS were less acceptable to children , than IFS , FCF and FW . Conclusion The three supplements IS , ISF and MMS  increased Hb more than the FCF ; the supplements that contained micronutrients ( IFS and MMS ) were more effective for reducing the prevalence of anemia . In general , fortified foods were better accepted by the study participants than supplements . Clinical Trial.gov INTRODUCTION Frequent blood donations may lead to a negative iron balance . Iron depletion may be prevented by iron supplementation after whole blood donations . The aim of this study was to compare the short time changes in iron status after donation in two groups r and omized to iron supplementation or no additional iron . A second objective was to evaluate the effect of iron supplementation in donors having HFE-variants compared to HFE wild types . METHODS Subjects of both genders ( 199 women , 200 men ) were r and omised to receive iron supplementation or no additional iron after donation . Iron status , defined by the concentration of haemoglobin , serum ferritin , soluble transferrin receptor , concentration of haemoglobin in reticulocytes ( CHr ) and percent hypochrome mature red blood cells , was determined at the start of donation and 8 + /- 2 days after donation . HFE genotyping was performed at reappearance . RESULTS There was a significant difference between the two study groups on all the iron status parameters . CHr was an efficient , early marker of ongoing synthesis of haemoglobin . Heterozygosity for the HFE variants C282Y and H63D had no statistically significant influence on the iron status . The donor 's baseline serum ferritin value may be basis for an individual iron supplementation regimen , as donors with serum ferritin > 50 microg/l do not seem to utilize the iron supplementation , but prefer endogenous iron to restore the loss of haemoglobin . CONCLUSION Iron supplementation had a significant positive impact on the restoration of iron status one week after donation OBJECTIVE The aim of this study was to estimate the effect of an antihelminthic drug , given at booking and at term to antenatal care visits , on the prevalence of anaemia at term and 4 months post-partum in Rufiji district , Tanzania , the area with high prevalence of intestinal parasites . METHODS A cluster r and omised controlled trial was conducted on 3080 pregnant women . Out of these 1475 ( study arm ) received albendazole and 1605 ( control arm ) placebo . All women also received routine daily iron folate supplements ( 36 mg iron and 5 mg folate ) , and sulphadoxine pyramethamine ( SP ) to prevent malaria .  Haemoglobin levels were assessed at booking , at term and 4 months post-partum . RESULTS At term , median and mean haemoglobin level and the prevalence of severe ( < 70 g/l ) and moderate ( 70 - 104 g/l ) anaemia did not differ . The reduction in the prevalence of anaemia from booking to term , was significantly larger in the study arm compared to control arm ( 26.1 % vs. 18.8 % ; p < 0.001 ) . At four months postpartum , mean haemoglobin was higher in the study arm compared to the control arm ( 118 vs. 113 ; p < 0.0001 ) while the reduction in proportion of women with anaemia ( Hb < 105 g/dl ) was significantly lower ( 30.6 vs. 21.2 ; p < 0.0001 ) in the study arm compared to the control arm . CONCLUSION These findings support WHO 's recommendation for anthelmintic treatment during pregnancy . However benefits for deworming may be limited in areas with an antenatal iron supplementation programme or low intensity of hookworm infections and hence future research should be directed towards the cost-effectiveness of the de-worming compared to other interventions for reducing anaemia in pregnancy A cross-sectional study of 729 children and adults in western Kenya investigated the impact of infection with hookworm , Ascaris lumbricoides , Trichuris trichiura , Schistosoma mansoni and malaria on iron status . In bivariate analyses , hookworm intensities as low as 300 eggs/g of faeces were negatively related to levels of haemoglobin ( Hb ) and serum ferritin ( SF ) . Malaria parasitaemia was negatively related to Hb and positively related to SF , while S. mansoni intensities were negatively related to SF . Multivariate regression analysis was done to identify predictors of Hb and SF levels . In children , age ( in years ) was the only predictor for Hb ( B = 1.7 g/L ) and only malaria parasitaemia ( negative , light , moderate , heavy ) was retained in the model for log10 SF ( B = 0.097 microgram/L ) . In adults , hookworm infection and malaria parasitaemia together with age , sex , pregnancy , SF levels < 12 micrograms/L and elevated body temperature were significant predictors of low Hb . The regression coefficient for hookworm egg count ( for increments of 100 eggs/g ) was -1.3 g/L. Significant interactions between sex and age and between sex and malaria parasitaemia were revealed . Age and malaria parasitaemia were significant predictors only among females , with a regression coefficient for malaria parasitaemia of -6.9 g/L. The regression coefficient for hookworm did not change when SF < 12 micrograms/L was taken out of the model , indicating that the effect of hookworm can not be explained by low iron stores alone . Using SF as the dependent variable , hookworm and S. mansoni intensities together with age and sex were retained in the model . The regression coefficients for hookworm egg count ( increments of 100 eggs/g ) and S. mansoni egg count ( increments of 10 eggs/g ) were -0.011 microgram/L and -0.012 microgram/L , respectively . Iron deficiency was a problem in this population and hookworm infections contributed significantly to this situation In sub-Saharan countries , although malaria and malaria-associated anaemia are major public health problems , the usefulness of supplementary iron treatment for children with malaria-associated anaemia is unknown . In a 6-week period during the 1995 rainy season , 222 Malawian children aged < 5 years , who sought treatment for malaria , had > or = 500 parasites/microliter blood and at least 5 g haemoglobin (HB)/dl blood and whose parents gave consent , were r and omized into a prospect i ve study comparing the efficacy of sulphadoxine- pyrimethamine only ( SP ) , SP plus daily iron ( SPD ) and SP plus weekly iron ( SPW ) as treatment for malaria-associated anaemia . The patients had their HB concentrations measured on enrollment ( day 0 ) , just before antimalarial treatment , and on days 3 , 7 , 14 , 21 and 28 ; 215 ( 96.8 % ) completed the 28-day study . Among the children with 5 - 8 g HB/dl on enrolment , HB gain by the end of the study was significantly greater than in the children with > 8 g HB/dl initially ( 4.1 v. 2.2 g/dl ; P < 0.05 ) , and those in the SPD group gained significantly more HB by days 21 and 28 ( 3.6 and 4.9 g/dl , respectively ) than those in either the SPW ( 2.7 and 3.7 g/dl , respectively ) or the S2 groups ( 2.6 and 3.5 g/dl , respectively ) ; there was no difference in HB gain between the SP and SPW groups . Type of treatment had no apparent effect , at any time during the study , on HB gains in those patients who had > 8 g HB/dl on enrolment . Thus the children with 5 - 8 g HB/dl on enrolment benefited from daily iron therapy whereas those with > 8 g HB/dl derived no significant benefit ; improvement in HB depended most on whether enrolment HB was < or = 8.0 g/dl . As treatment with an effective antimalarial drug result ed in HB gains , irrespective of treatment group or HB concentration at enrolment , the anaemia observed may be mostly related to malaria . However , as a larger proportion of the iron-treated patients failed to clear their parasitaemias than of those given SP alone , oral iron may inhibit SP action . It is therefore recommended that , for children with both malaria and malaria-associated anaemia , the malaria should first be cleared with an effective antimalarial drug , such as SP , before the anaemia , if it still persists , is treated with iron The growth status of anemic ( n = 117 , Hb 7 - 10 g/dl ) and normal ( n = 53 , H > or = 11 g/dl ) children 3 - 5 years of age living under similar environmental and socio-economic conditions was evaluated . The dietary intake was assessed on a r and om sub sample of the anemic and normal children . The anemic children had a poorer growth status than normal children as indicated by their significantly ( p < 0.001 ) lower body weight , height and weight for age and significantly ( p < 0.001 ) larger number in Grade s II and III malnutrition . Iron supplementation ( 40 mg elemental iron/day ) for six months produced a significant ( p < 0.001 ) increase in Hb levels of both groups ( 1.6 g/dl in the anemic and 0.8 g/dl in the non-anemic ) compared to their respective controls who received sugar placebos . The growth performance of the anemic children supplemented with iron was superior to that of anemic placebo treated children as indicated by a better weight gain and a significantly higher weight for height ( p < 0.05 ) . Weight for age was a good differentiator of the anemic from normal while weight for height was a good indicator of the impact of iron  supplements on growth Objective : To assess the effects of multi-micronutrient supplementation and multi-helminth chemotherapy on haemoglobin concentration ( Hb ) , using schools as a health delivery system . Study area and population : Nine hundred seventy-seven children between 9 and 18 y of age from 19 primary schools in Bondo District , western Kenya , were included in the trial . The 746 ( 76.4 % ) children on whom baseline Hb was available were included in this study . Design : The study was a r and omized , placebo-controlled , double-blind , two-by-two factorial trial of the effects of multi-micronutrient supplementation and multi-helminth chemotherapy on Hb after 8 months . Interventions : Single treatment of infected children with albendazole ( 600 mg ) for geohelminths and praziquantel ( 40 mg/kg ) for Schistosoma mansoni and daily supplementation with 13 micronutrients . Results : Multi-micronutrient supplementation ( 3.5 g/l , 95 % CI 1.7 , 5.3 ; P=0.0002 ) and anthelminthic treatment ( 2.0 g/l , 95 % CI 0.2 , 3.9 ; P=0.03 ) increased Hb independently ( interaction , P=0.33 ) . The effects were also independent of baseline Hb and general nutritional status . The treatment effect was due to reductions in S. mansoni and hookworm intensities of infection , in that Hb increased by 0.4 and 0.2 g/l , respectively , per 100 epg reductions in egg output . Interestingly , among S. mansoni-infected children , the effect of treatment seemed stronger in those with compared to those without co-existing malaria parasitaemia ( interaction , P=0.09 ) . Conclusion : Multi-micronutrient supplementation and multi-helminth chemotherapy increased Hb  among school children , irrespective of initial Hb and nutritional status . Sponsorship : The Danish International Development Assistance A recent meta- analysis of 14 clinical trials indicated that daily compared with intermittent iron supplementation result ed in significantly greater hematological improvement in pregnant women . No such definitive beneficial effect was demonstrated in preschool children . We compared the efficacy of daily and twice weekly iron supplementation for 6 wk under supervised and unsupervised conditions in the treatment of mild and moderate anemia [ hemoglobin ( Hb ) 50 - 109 g/L ] in children aged 2 - 59 mo living in a malaria-endemic area of western Kenya . The study was a cluster-r and omized trial using a factorial design ; participants were aware of the treatment assigned . All children ( n = 1049 ) were administered a single dose of sulfadoxine-pyrimethamine at enrollment followed by 6 wk of daily supervised iron supplementation [ 3 - 6 mg/(kg.d ) ] , twice weekly supervised iron supplementation [ 6 - 12 mg/(kg.wk ) ] , daily unsupervised iron supplementation , or twice weekly unsupervised iron supplementation . In the supervised groups , Hb concentrations at 6 and 12 wk ( 6 wk postsupplementation ) were significantly higher in children given iron daily rather than twice weekly [ mean ( 95 % CI ) difference at 6-wk : 4.2 g/L ( 2.1 , 6.4 ) ; 12-wk : 4.4 g/L ( 1.8 , 7.0 ) ] . Among the unsupervised groups , Hb concentrations were not different at 6 wk [ mean ( 95 % CI ) difference : 0.86 g/L ( -1.4 , 3.1 ) ] , but significantly higher at 12 wk for those assigned daily iron [ mean ( 95 % CI ) difference : 3.4 g/L ( 0.79 , 6.0 ) , P = 0.02 ] . In this malarious area and after initial antimalarial treatment , 6 wk of daily iron supplementation results in better hematological responses than twice weekly iron supplementation in the treatment of anemia in preschool children , regardless of whether adherence can be ensured OBJECTIVE To compare the effectiveness of microencapsulated iron(II ) fumarate sprinkles ( with and without vitamin A ) , iron(II ) sulfate drops , and placebo sprinkles in preventing recurrence of anaemia and to determine the long-term haematological outcomes in children at high risk of recurrence of anaemia 12 months after the end of supplementation . METHODS A prospect i ve , r and omized , placebo-controlled design was used to study 437 Ghanaian children aged 8 - 20 months who were not anaemic ( haemoglobin > or = 100 g/l ) . Four groups were given microencapsulated iron(II ) fumarate sprinkles , microencapsulated iron(II ) fumarate sprinkles with vitamin A , iron(II ) sulfate drops or placebo sprinkles daily for six months . Primary outcome measures were change in haemoglobin and anaemic status at baseline and study end . Non-anaemic children at the end of the supplementation period were reassessed 12 months after supplementation ended . FINDINGS Overall , 324 children completed the supplementation period . Among the four groups , no significant changes were seen in mean haemoglobin , ferritin or serum retinol values from baseline to the end of the supplementation period . During the trial , 82.4 % ( 267/324 ) of children maintained their non-anaemic status . Sprinkles were well accepted without complications . At 12 months post-supplementation , 77.1 % ( 162/210 ) of children with no intervention remained non-anaemic . This proportion was similar for children among the four groups . CONCLUSION In most children previously treated for anaemia , further supplementation was not needed to maintain their non-anaemic status . These results may have important implication s for community intervention programmes in which initial high-dose treatment is needed because of a high prevalence of anaemia 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 OBJECTIVE This study analyses the impact of weekly iron supplementation with ferrous sulphate heptahydrate ( FeSO4 ) in 5-year-olds compared with placebo , on hemoglobin ( Hb ) and hematocrit ( Ht ) values and anemia . DESIGN The study concerns a cluster-r and omized , placebo-controlled double-blind trial . Intervention participants received 50 mg elemental iron for 14 weeks . SETTING The study population comprised pre-school children ( n = 135 ) from one r and omly chosen public school in the northeast of Brazil . SUBJECTS Participants were 5-year-old students from a public school . RESULTS Mean Hb and Ht values increased after iron supplementation , with p < 0.0001 . There was no statistically significant increase in the placebo group . After intervention , anemia prevalence reduced only in the intervention group , from 48.0 % to 26.0 % . CONCLUSIONS Weekly iron supplementation was effective in reducing anemia in 5-year-olds Objective . Patients with inflammatory bowel disease ( IBD ) often have low iron stores or anaemia . There is controversy about whether iron should be supplemented orally or intravenously ( i.v . ) . The purpose of this study was to investigate whether treatment with intravenous iron is superior to treatment with oral iron . The primary end-points were response and remaining anaemia at the end of treatment ( EOT ) . Material and methods . Ninety-one patients with IBD and anaemia ( B-Hb < 115 g/L ) were r and omized to oral iron sulphate ( n=46 ) or intravenous iron sucrose ( n=45 ) treatment for 20 weeks . Results . Forty-three patients in the intravenous iron group completed the study compared to 35 patients in the oral iron group ( p=0.0009 ) . Only 22 patients ( 48 % ) tolerated the prescribed oral dose , and 52 % reduced the dose or withdrew from treatment because of poor tolerance . At EOT , 47 % patients in the oral iron group increased their B-Hb by ≥20 g/L , compared with 66 % in the intravenous iron group ( p=0.07 ) . In the oral iron group , 41 % still had anaemia versus 16 % of the patients in the intravenous iron group ( p=0.007 ) , and 22 % versus 42 % reached their reference B-Hb level ( p=0.04 ) . Treatment with intravenous iron sucrose improved iron stores faster and more effectively than oral iron ( p=0.002 ) . Under treatment with intravenous iron , 74 % of the patients had no anaemia and normal S-ferritin levels ( > 25 µg/L ) at EOT compared with 48 % of patients receiving oral iron ( p=0.013 ) . Conclusions . Treatment with intravenous iron sucrose is effective , safe , well tolerated and superior to oral iron in correcting haemoglobin and iron stores in patients with IBD Home-fortification of complementary foods with micronutrients ( including iron ) as Sprinkles is a new strategy to control iron deficiency and anaemia in developing countries . However , the most effective dose and form of iron is not known . The purpose of this study was to compare the efficacy of various doses ( 12.5 , 20 or 30 mg ) and treatment methods ( multi-micronutrient Sprinkles vs. ferrous sulphate drops ) on haemoglobin ( Hb ) concentration after 8 weeks of treatment in anaemic children . In total , 133 anaemic Ghanaian children ( Hb 70 - 99 g L(-1 ) ) aged 6 - 18 months were r and omly assigned to one of five daily interventions for 8 weeks . Out of the five interventions , four used Sprinkles , and one used iron drops . Of the four Sprinkles groups , three included 12.5 , 20 or 30 mg of iron as ferrous fumarate , and one included 20 mg of iron as ferric pyrophosphate . The iron drops group included 12.5 mg of iron as liquid ferrous sulphate .  Hb concentrations were measured at baseline , week 3 and week 8 . The primary outcome measure was Hb concentration at 8 weeks after treatment . We compared differences in Hb and ferritin concentrations and prevalence of iron deficiency anaemia ( Hb < 100 g L(-1 ) and soluble transferrin receptor concentrations > 8.5 mg L(-1 ) ) from baseline to 8 weeks within and between groups . Adherence and reporting of side effects ( staining of the teeth , ease of use , diarrhoea and darkening of stools ) were compared between groups . Mean change in Hb was 1.4 g L(-1 ) ( SD = 1.8 ) ( P = 0.0001 ) . Change in Hb concentrations from baseline to 8 weeks was significant in all groups ( P = 0.0001 - 0.0007 ) , with no differences across groups . Geometric means of serum ferritin varied from 18.6 to 44.0 microg L(-1 ) at baseline . At week 8 , these means were in the interval of 48.0 - 78.3 microg L(-1 ) , with no group differences . Prevalence of iron deficiency anaemia decreased significantly from baseline to 8 weeks in all groups with the exception of the iron drops group , with no group differences . Adherence was lower in the drops group ( 64 % ) as compared with Sprinkles groups ( 84 % ) . Greater staining of the teeth and less ease of use were reported in the drops group as compared with Sprinkles groups . A dose as low as 12.5 mg of iron as ferrous fumarate when provided as Sprinkles may be effective in anaemic children Summary Serum iron deficiency has a high incidence in female athletes . We investigated the effects of a daily oral iron supplement , ( 160 mg ) administered during an intensive 7-week physical training programme , on body iron status , and the maximal aerobic capacity ( VO2max ) of 13 women ( group A ) compared to 15 who took a placebo ( group B ) . The subjects were 19 years old . Blood sample s were obtained before training began and on days 1 , 7 , 21 and 42 of training . They were analysed for packed cell volume ( PVC ) and for haemoglobin ( Hb ) , 2,3-diphosphoglycerate ( 2,3-DPG ) , haptoglobin , iron and ferritin concentrations . TheVO2max was measured on days 0 , 21 and 42 of training . Following 21 days of training Hb , PCV and ferritin were significantly higher ( P⩽0.01 ) in group A compared to group B. Over the training period Hb rose by 9.3 % and 2.4 % in groups A and B , respectively . At the end of training 66 % of group B exhibited ferritin concentrations below 10 ng·ml−1 , while none of group A had such low values . MeanVO2max of group A had increased by 7.5 % following 21 days of training ( P⩽0.01 ) and by 15.3 % after 42 days . No appreciable increase inVO2max had occurred in group B by day 21 ( significantly lower thanVO2max of group A;P⩽0.05 ) , however by day 42 it had increased by 14.3 % ( P⩽0.05 ) . In both groups 2,3-DPG·g Hb−1 had increased significantly ( P⩽0.005 ) by day 7 ( 22 % ) and remained at that level for an additional 35 days . We concluded that a daily oral iron supplement given to young women during intensive training improved several haematological variables and their body iron status . This improvement was associated with an increasedVO2max only during the early stages of their training ( day 21 ) compared with the placebo group Iron and zinc deficiencies have been associated with delayed motor development in nutritionally at-risk children , albeit inconsistently . In this community-based , r and omized double-blind trial , iron+folic acid ( FeFA ) ( 12.5 mg Fe + 50 mug folic acid ) , zinc ( Zn ) ( 10 mg ) , and iron+folic acid+zinc ( FeFA+Zn ) supplements or a placebo were given daily for 1 y to nutritionally at-risk children in Pemba , Zanzibar . The effects of these treatments on attaining unassisted walking were evaluated using survival analysis for 354 children aged 5 - 11 mo at the start of supplementation . Treatment effects on changes in hemoglobin ( Hb ) and zinc protoporphyrin ( ZPP ) and height-for-age ( HAZ ) and weight-for-age ( WAZ ) Z scores were evaluated using linear regression . Attained motor milestone was recorded every 2 wk for 1 y. Hb , ZPP , HAZ , and WAZ were measured at baseline and after 6 mo of treatment . FeFA with or without Zn reduced the time it took for children to walk assisted . Children who received any iron  walked unassisted sooner than those who received no iron [ median difference approximately 15 d , P = 0.035 , risk ratio ( RR ) = 1.28 , 95 % CI = 1.02 , 1.61 ] and this effect was stronger in those who had iron deficiency anemia ( IDA ) at baseline ( median difference was approximately 30 d ; P = 0.002 ; RR = 1.68 ; 95 % CI = 1.21 , 2.32 ) . FeFA alone and Zn alone improved Hb and ZPP compared with placebo . There were no significant treatment effects on changes in HAZ or WAZ . The effects of treatment on time to walking may have been mediated by improvements in iron status or hemoglobin , but were not mediated through improvements in growth Objectives To evaluate whether preterm very low birth weight ( VLBW ) infants receiving early iron ( EI ) supplementation ( 2 mg/kg/day elemental iron ) at 2 weeks postnatal age have improved serum ferritin levels compared with late iron ( LI ) supplementation at 6 weeks postnatal age . Design Single-blinded parallel-group interventional r and omised controlled trial . Setting Tertiary care centre in southern India . Interventions R and omised at 2 weeks postnatal age to EI and LI groups and evaluated at 2 , 6 and 12 weeks postnatal age . Outcome The primary outcome was serum ferritin level at 12 weeks , and the secondary outcomes were the incidence of neonatal morbidities , haemoglobin level , anthropometric parameters and blood transfusion requirements . Results Of the 104 babies r and omised , outcomes were analysed in 46 and 47 babies in EI and LI groups , respectively . Serum ferritin level was significantly higher ( p<0.001 ) at 12 weeks ( 82±5 vs 63±3 ng/mL ) in the EI group . Haemoglobin ( 10.1±0.4 vs 9.2±0.4 g/dL ) and mean corpuscular haemoglobin concentration ( 31±0.5 vs 29.4±0.5 g/dL ) were also significantly ( p<0.001 ) higher at 12 weeks in the EI group . There was a significant decrease of ferritin in the LI group and significant increase in ferritin in the EI group at 6 weeks compared with 2 weeks . There were no significant differences in the incidences of neonatal morbidities ( necrotising enterocolitis , periventricular leukomalacia , retinopathy of prematurity ) , anthropometric parameters and blood transfusion requirements between the two groups . Conclusions EI supplementation in preterm VLBW infants  improves serum ferritin and haemoglobin levels . Trial registration : CTRI/2013/01/003277 Two hundred Hausa primigravidae at Zaria were divided into five groups in a r and omized double-blind trial of antenatal oral antimalarial prophylaxis , and haematinic supplements . Group 1 received no active treatment . Groups 2 to 5 were given chloroquine 600 mg base once , followed by proguanil 100 mg per day . In addition , group 3 received iron 60 mg daily , group 4 folic acid 1 mg daily , and group 5 iron plus folic acid .  Forty-five percent were anaemic ( haemoglobin ( Hb ) less than 11.0 g dl-1 ) at first attendance before 24 weeks of gestation , and malaria parasitaemia ( predominantly Plasmodium falciparum ) was seen in 27 % , of whom 60 % were anaemic . The mean Hb fell during pregnancy in group 1 , and seven patients in this group had to be removed from the trial and treated for severe anaemia ( packed cell volume ( PCV ) less than 0.26 ) . Only five patients in the other groups developed severe anaemia ( P = 0.006 ) , two of whom had malaria following failure to take treatment . Patients in group 1 had the lowest mean Hb at 28 and 36 weeks of gestation , and patients receiving antimalarials and iron ( groups 3 and 5 ) had the highest Hb at 28 weeks , but differences were not significant , possibly due to removal from the trial of patients with severe anaemia . Anaemia ( Hb less than 12.0 g dl-1 ) at six weeks after delivery was observed in 61 % of those not receiving active treatment ( group 1 ) , in 39 % of those protected against malaria but not receiving iron supplements ( groups 2 and 4 ) and in only 18 % of patients receiving both antimalarials and iron ( groups 3 and 5 ) . Folic acid had no significant effect on mean Hb .  Proguanil was confirmed to be a highly effective causal prophylaxis . Prevention of malaria , without folic acid supplements , reduced the frequency of megaloblastic erythropoiesis from 56 % to 25 % . Folic acid supplements abolished megaloblastosis , except in three patients who were apparently not taking the treatment prescribed . Red cell folate ( RCF ) concentrations were higher in subjects with malaria , probably due to intracellular synthesis by plasmodia . Infants of mothers not receiving antimalarials appeared to have an erythroid hyperplasia . Maternal folate supplements raised infants ' serum folate and RCF .  Fourteen per cent had low birth weight ( less than 2500 g ) , and the perinatal death rate was 11 % ; the greatest number were in group 1 , but not significantly . A regime is proposed for the prevention of malaria , iron deficiency , folate deficiency and anaemia in pregnancy in the guinea savanna of Nigeria OBJECTIVE To assess the effect on the haemoglobin concentrations of schoolchildren of weekly iron tablets administered by teachers . DESIGN Sixty schools were r and omly assigned to two groups : in 30 schools children were given weekly for 10 weeks a tablet providing 65 mg of iron and 0.25 mg of folic acid ; in the other 30 schools  no iron tablets were given . All children were dewormed and given vitamin A before the study began . The haemoglobin concentration of up to 20 r and omly selected children in each school was estimated before and 2 weeks after the end of treatment . SETTING Rural community schools in Kolondieba district of Mali . SUBJECTS Some 1113 schoolchildren aged 6 - 19 years with a mean of 11.4 years . RESULTS The haemoglobin concentration of treated children rose on average by 1.8 g l(-1 ) and the prevalence of anaemia fell by 8.2 % ; in untreated children the haemoglobin concentration fell by an average of -2.7 g l(-1 ) and the prevalence of anaemia rose by 9.4 % . The fall in haemoglobin concentration among untreated girls of -4.0 g l(-1 ) was greater than in untreated boys ( -0.3 g l(-1 ) ) . CONCLUSIONS Weekly iron tablets given by teachers prevented a general fall in the haemoglobin concentrations of untreated children , and led to a small but statistically significant rise among treated children . Young children benefited more than children aged > or=12 years , and girls benefited more than boys Summary . Changes in haemoglobin ( Hb ) , work performance , heart rate and postexercise blood lactate were studied in iron deficient , anaemic subjects for 16 d following total dosage infusion of iron dextran , i.v . ( 30–50 ml ) . Six adult men and 14 women were subjects with initial Hb levels of 6.6±0.6 g/dl ( mean±SEM ) for the  iron treatment group ( n=10 ) and 8.0±0.7 for the placebo  group ( saline infusion , n=10 ) . Serum iron levels were 0.51±0.15 and 0.67±0.12 mg/l for the two groups , respectively . Haemoglobin and maximal work time increased significantly within 4 d after iron treatment and continued to increase up to 16 d. No changes were found in the placebo subjects . Heart rates at a given exercise intensity were lower in the iron treatment group than in control subjects who had the same Hb levels but had not been treated with iron . Post‐exercise venous blood lactate was similar on succeeding days after iron treatement even though the subjects reached higher work loads Aims : To determine the haematological effects of iron supplementation in predominantly breast fed term low birth weight ( LBW ) infants . Methods : Seventy three healthy term LBW ( < 2500 g ) , predominantly breast fed infants aged 50–80 days were r and omised into two groups to receive either iron ( 3 mg/kg/day ) ( iron supplemented ( IS ) group ; n = 37 ) or placebo drops ( placebo ( P ) group ; n = 36 ) . Haematological parameters and anthropometry were measured at baseline and repeated after four and eight weeks . Results : A total of 62 subjects ( 32 in the IS group and 30 in the P group ) came for the first follow up and 26 ( 13 in the IS group and 13 in the P group ) reported for the second visit . There were no significant differences in serum ferritin and anthropometry . However , covariates ( infant age , haemoglobin , and ferritin , and maternal haemoglobin ) adjusted haemoglobin change was significantly higher in the IS group after four weeks ( 4.6 g/l ; 95 % CI 0.5 to 8.8 ) and eight weeks ( 8.6 g/l ; 95 % CI 1.8 to 15.4 ) . Conclusions : Iron supplementation in a therapeutic dose in term breast fed LBW infants results in a marginal increase in haemoglobin . The functional benefit of this haemoglobin rise requires further evaluation Previous studies have found that there is a correlation between mothers ' haemoglobin concentration or packed cell volume and infants ' birth weight , and that iron supplementation increases mothers ' haemoglobin concentration . The purpose of this study , using the data of a large r and omised trial on iron prophylaxis during pregnancy , was to find out whether iron supplementation causes fetal growth to deteriorate . At their first antenatal visit , 2912 pregnant women were r and omised into non-routine iron and routine iron supplementation . The mean length of gestation was shorter in the non-routine group . Birth weight did not differ between the groups , but due to longer gestations boys in the group receiving routine iron were taller than in the non-routine group . In both groups , whether studied by various values of packed cell volume or correlation coefficients , the lower the packed cell volume , the heavier and taller the infant and heavier the placenta . These negative correlations could be seen even with a packed cell volume measured early in pregnancy . St and ardising for blood pressure did not influence the correlation coefficients . The correlation between a high ratio for packed cell volume and poor fetal growth thus may not be caused by iron supplementation , nor mediated by blood pressure , but by some other mechanism Abstract Background Currently , there is no consensus regarding iron supplementation dose that is most beneficial for maternal and offspring health during gestation . Recommended iron supplementation dose does not preempt anemia in around 20 % of the pregnancies , nor the risk of hemoconcentration in 15 % . This deficit , or excess , of iron prejudices the mother-child wellbeing . Therefore the aims of the study are to determine the highest level of effectiveness of iron supplementation adapted to hemoglobin ( Hb ) levels in early pregnancy , which would be optimum for mother-child health . Methods / Design Design : R and omized Clinical Trial ( RCT ) triple-blinded Setting : 10 Primary Care Centers from Catalunya ( Spain ) Study subjects : 878 non-anemic pregnant women at early gestation stage , and their subsequent newborns Methods : The study is structured as a RCT with 2 strata , depending on the Hb levels before week 12 of gestation . Stratum # 1 : If Hb from 110 to 130 g/L , r and omly assigned at week 12 to receive iron supplement of 40 or 80 mg/d . Stratum # 2 : If Hb > 130 g/L , r and omly assigned at week 12 to receive iron supplement of 40 or 20 mg/d . Measurements : In the mother : socio-economic data , clinical history , food item frequency , lifestyle and emotional state , and adherence to iron supplement prescription . Biochemical measurements include : Hb , serum ferritin , C reactive protein , cortisol , and alterations in the HFE gene ( C282Y , H63D ) . In children : ultrasound fetal biometry , anthropometric measurements , and temperament development . Statistical analyses , using the SPSS program for Windows , will include bivariate and multivariate analyses adjusted for variables associated with the relationship under study . Discussion Should conclusive outcomes be reached , the study would indicate the optimal iron supplementation dose required to promote maternal and infant health . These results would contribute towards developing guidelines for good clinical practice .Trial registration This clinical trial is registered at http://www . clinical trialsregister.eu as EudraCT number 2012 - 005480 - OBJECTIVE To assess the effect of an improved local ingredient-based gruel fortified or not with selected multiple micronutrients ( MM ) on  Hb concentration of young children . DESIGN In a nutrition centre that we opened in their villages , children received either MM supplement ( containing iron , zinc , vitamin A , vitamin C and iodine ) with the improved gruel ( MMGG ) or the improved gruel only ( GG ) , twice daily , 6 d/week , for 6 months . We assessed baseline and endpoint Hb concentration and anthropometric indices . SETTING Kongoussi , a rural and poor district of Burkina Faso . SUBJECTS In a community-based trial , we r and omly assigned 131 children aged 6 - 23 months with Hb concentrations in the range of 80 - 109 g/l into two groups . RESULTS The groups did not differ significantly at baseline . Mean baseline Hb concentration was 89·2 ( sd 6·5 ) g/l and 90·3 ( sd 8·4 ) g/l in the GG and the MMGG , respectively ( P = 0·42 ) . It increased to 104·1 ( sd 11·4 ) g/l in the GG ( P < 0·001 ) and 107·6 ( sd 14·7 ) g/l in the MMGG ( P < 0·001 ) . The between-group difference of 3·5 ( 95 % CI -1·0 , 8·1 ) g/l in mean ( sd ) endpoint Hb concentration was not significant ( P = 0·13 ) . The endpoint anthropometric indices were not different between the groups . CONCLUSIONS This MM supplement  had no additional effect on Hb concentration . Thorough studies are needed to evaluate the actual efficacy of the gruel before its introduction into household routine INTRODUCTION Pre-operative anaemia is well recognised in patients presenting with colorectal cancer ( CRC ) . While the benefits of long-term FeSO4 supplementation on Fe deficiency anaemia are well established , it is not known if short-course supplementation ( 2 - 3 weeks ) impacts significantly on pre-operative haemoglobin ( Hb ) levels . This study examines the impact of short-term , oral FeSO4 supplementation on patients undergoing surgery for CRC . PATIENTS AND METHODS All patients with CRC presenting to a single surgeon were included . At diagnosis , baseline  Hb  and  blood film  were checked on all patients who then received 200 mg tds of FeSO4 . Haemoglobin was rechecked pre-operatively and daily postoperatively . Patients requiring pre-operative blood transfusions were excluded from analysis . RESULTS Between 1 January 2004 and 31 December 2006 , 117 patients were identified , 14 of whom were excluded . Patients received a median of 39 days ' treatment with FeSO4 . Fifty-eight ( 56.3 % ) patients were anaemic at presentation gaining a mean of 1.73 g/dl ( P<0.001 ) from short-course FeSO4 supplementation . Right-sided tumours ( lower mean Hb at presentation ; P=0.008 ) responded more to FeSO4 when compared to left-sided tumours ( P<0.017 ) . Increase in Hb was unrelated to pathological stage . The transfusion rate for all curative resections was 0.69 units/patient . For the historical cohort ( patients undergoing curative resection between 1 January 2001 and 31 December 2003 ) , the mean transfusion rate fell from 1.69 units/patient . CONCLUSIONS Routine short-course supplementation with iron offers improved pre-operative Hb prior to surgery in CRC , especially in right-sided lesions and those with presenting anaemia In Vietnam the high prevalence of iron deficiency anaemia in infants and young children speaks for implementing early interventions . This study aim ed to evaluate the efficacy of the daily iron supplementation in infants given by their mothers and of the weekly iron supplementation .  Two hundred and seventy infants aged 5 to 12 months , were divided into four groups . Group 1 received a placebo daily and group 2 a daily dose of 15 mg iron ( 2.0 + /- 0.3 mg iron/day/kg body weight ) which was given by their mothers for three months . Group 3 received a daily dose of 15 mg iron and group 4 a weekly dose of 15 mg iron given during 6 months by health auxiliaries . The hemoglobin concentration ( Hb ) was measured before the intervention and after 3 months of supplementation in all groups , and again after 6 months of supplementation in groups 3 and 4 . After 3 months of iron supplementation , the hemoglobin concentration increased significantly by 21.6 + /- 12.3 g/l and the prevalence of anaemia decreased from 81.3 % to less than 9 % in group 2 . The weekly iron supplementation was significantly less effective than the daily supplementation : after 3 months , Hb increased by 15.4 + /- 13.3 g/l in group 3 and by 11.2 + /- 10.2 g/l in group 4 ( p = 0.04 ) and the prevalence of anaemia was 17.9 % and 41.5 % in groups 3 and 4 , respectively . After 6 months of supplementation , changes in Hb were not significantly different between group 3 ( 22.0 + /- 12.1 g/l ) and group 4 ( 20.0 + /- 10.0 g/l , p = 0.30 ) . However , the final hemoglobin concentration was significantly lower in group 4 ( 120.5 + /- 7.2 g/l ) than in group 3 ( 123.6 + /- 7.8 , p = 0.02 ) . Moreover , nearly 8 % of the children were still anemic in group 4 versus 0 % in group 3 . Since the early developmental period , when the brain and other specific organs are especially sensitive to iron deficiency , is critical , 3-month daily iron supplementation of infants from the age of 6 months has to be recommended , followed by a weekly iron supplementation until the age of 15 months . The community approach , where mothers informed on the importance of iron deficiency anaemia and on the consequences for the health of their infants gave the iron supplements , was shown to be effective . However , its sustainability would depend on the availability of low-cost iron supplements affordable by population s with limited economic re sources . Other interventions , such as iron supplementation of women during fertile age , especially during pregnancy and lactation periods , and the use of complementary food to breast milk , fortified with micronutrients , should be associated We evaluated the effect of weekly doses of 400 mg of ferrous sulphate for 4 months on the iron status of adolescent girls in a controlled trial in Tanga , Tanzania . Supplementation led to a significantly greater increase in serum ferritin compared with the control group ( + 15.6 microg/l vs. 8.6 microg/l ) ( P = 0.002 ) but there was no significant difference in change in haemoglobin . Children given iron showed a significantly greater weight gain than controls ( + 2.4 kg vs. + 1.4 kg ) ( P = 0.03 ) . Weekly iron supplementation may be an effective means of increasing iron stores and growth in children vulnerable to iron deficiency Whether children with malarial anaemia should receive supplementation with iron or folic acid is uncertain . Therefore , the effects of supplementary treatment with iron or folic acid , given together with chloroquine or pyrimethamine-sulfadoxine ( Fansidar ) , has been assessed in 600 Gambian children with uncomplicated falciparum malaria . After one month , haematological recovery was significantly better in the group treated with Fansidar than in the chloroquine-treated group ( difference in mean haemoglobin level = 0.54 g/dL , P = 0.01 ) . Children who received  iron had a significantly better response than those given placebo ( differences in mean haemoglobin level after one month and at dry season follow-up = 0.70 g/dL , P = 0.006 , and 0.81 g/dL , P = 0.001 , respectively ) . Iron supplementation was not associated with increased prevalence of malaria . Supplementation with folic acid did not improve the haematological response but , among children who received Fansidar , the treatment failure rate was significantly higher among those given folic acid than among those given placebo . Thus , supplementation with iron , but not folic acid , improves haematological recovery without increasing susceptibility to malaria Background Anaemia is a known risk factor for cardiovascular disease and treating anaemia in chronic kidney disease ( CKD ) may improve outcomes . However , little is known about the scope to improve primary care management of anaemia in CKD . Methods An observational study ( N = 1,099,292 ) with a nationally representative sample using anonymised routine primary care data from 127 Quality Improvement in CKD trial practice s ( IS RCT N5631023731 ) . We explored variables associated with anaemia in CKD : eGFR , haemoglobin ( Hb ) , mean corpuscular volume ( MCV ) , iron status , cardiovascular comorbidities , and use of therapy which associated with gastrointestinal bleeding , oral iron and deprivation score . We developed a linear regression model to identify variables amenable to improved primary care management . Results The prevalence of Stage 3–5 CKD was 6.76 % . Hb was lower in CKD ( 13.2 g/dl ) than without ( 13.7 g/dl ) . 22.2 % of people with CKD had World Health Organization defined anaemia ; 8.6 % had Hb ≤ 11 g/dl ; 3 % Hb ≤ 10 g/dl ; and 1 % Hb ≤ 9 g/dl . Normocytic anaemia was present in 80.5 % with Hb ≤ 11 ; 72.7 % with Hb ≤ 10 g/dl ; and 67.6 % with Hb ≤ 9 g/dl ; microcytic anaemia in 13.4 % with Hb ≤ 11 g/dl ; 20.8 % with Hb ≤ 10 g/dl ; and 24.9 % where Hb ≤ 9 g/dl . 82.7 % of people with microcytic and 58.8 % with normocytic anaemia ( Hb ≤ 11 g/dl ) had a low ferritin ( < 100ug/mL ) . Hypertension ( 67.2 % vs. 54 % ) and diabetes ( 30.7 % vs. 15.4 % ) were more prevalent in CKD and anaemia ; 61 % had been prescribed aspirin ; 73 % non-steroidal anti-inflammatory drugs ( NSAIDs ) ; 14.1 % warfarin 12.4 % clopidogrel ; and 53.1 % aspirin and NSAID . 56.3 % of people with CKD and anaemia had been prescribed oral iron . The main limitations of the study are that routine data are inevitably incomplete and definitions of anaemia have not been st and ardised . Conclusions Medication review is needed in people with CKD and anaemia prior to considering erythropoietin or parenteral iron . Iron stores may be depleted in over > 60 % of people with normocytic anaemia . Prescribing oral iron has not corrected anaemia We have prospect ively evaluated the efficacy of an individualized pre-operative blood saving protocol in elective total hip arthroplasty ( THA ) or total knee arthroplasty ( TKA ) . The primary aim was to obtain a pre-operative haemoglobin ( Hb ) level of > or = 14 g dL(-1 ) . A reduction in requirements for allogeneic transfusion was considered the second aim . Several strategies are available for increasing pre-operative Hb levels and reducing red blood cell ( RBC ) transfusions following THA or TKA , but the success of these programmes depends on selecting the most appropriate treatment for each patient . Three hundred and five patients with an indication of elective THA or TKA were individually assigned to the following strategies according to Hb and ferritin levels and medical conditions : ( a ) no pre-operative intervention , ( b ) oral iron therapy , ( c ) intravenous ( i.v . ) iron therapy , ( d ) recombinant human erythropoietin alpha with i.v . iron and ( e ) pre-operative autologous donation ( PAD ) plus oral iron . Eighty-two percent of the patients reached a pre-operative Hb level of > or = 14 g dL(-1 ) compared with 62 % of patients with Hb levels of > or = 14 g dL(-1 ) at the baseline visit . Treatment with PAD showed a significant reduction in the pre-operative Hb levels . The rate of RBC transfusion was 18.8 % compared with 31.5 % of matched historic group ( P < 0.001 ) . In conclusion , all patients scheduled to undergo THA or TKA should be c and i date s for an individualized pre-operative blood salvage programme 1 . The effect of daily supplements of 20 - 30 mg inorganic iron as ferrous sulphate on the growth , activity and haematological status of preschool children was studied for 3.5 , 7 and 12 months and compared to that of children who served as controls . All children were given their daily requirements of energy and protein . In addition , they received 5 microgram cyanocobalamin and 200 microgram folic acid . 2 . Fe supplementation increased the haemoglobin , serum Fe and percentage saturation of transferrin and reduced the unsaturated Fe-binding capacity significantly compared to corresponding values for the controls . 3 . Height and activity were unaffected by Fe supplements . 4 . Of the children 45 % had haemoglobin values below 110 g/l at the end of 7 - 12 months of Fe supplementation OBJECTIVE To evaluate and compare the response between food supplemented with iron in powdered and iron in syrup forms for the treatment of iron deficiency anemia in children aged 1 - 5 years . DESIGN Quasi-experimental study . PLACE AND DURATION OF STUDY This study was conducted at Combined Military Hospital , Multan , from January 2000 to December 2000 . PATIENTS AND METHODS Consecutive 200 cases of iron deficiency anemia , aged 1 - 5 years , were included in the study . Diagnosis was based on history , physical examination , complete blood counts ( CBC ) and serum ferritin levels . The patients were r and omized to receive either iron in syrup form ( Group A ) or equivalent doses of iron powder sprinkled over food ( Group B ) . The patients were followed up with  hemoglobin estimation ( Hb ) and reticulocyte response at 2 weeks , 4 weeks and 6 weeks .  CBC and serum ferritin were repeated at 6 weeks . RESULTS Over half ( 51 % ) of the patients were between 1 - 2 years of age . One hundred thirty-two were males and 68 females . Most of the patients belonged to poor socioeconomic class . The iron in powder form was better tolerated than iron syrup as this group witnessed fewer episodes of gastrointestinal disturbances . The rise in mean Hb level after 6 weeks of treatment in group A and B was 1.6 g/dl and 1.9 g/dl respectively . Hemoglobin rise in group B was more than group A but this was statistically non-significant ( p > 0.05 ) . There was small but significant ( p < 0.05 ) rise in serum ferritin in both the groups . There was no significant difference between the two groups for response to the two forms of iron administration . CONCLUSION The powdered form of iron is a cost-effective and better tolerated method of iron administration in children and can be considered as an alternate option for the treatment of iron deficiency anemia in children Aims : To evaluate the effects of vitamin E supplementation on haemoglobin concentration and the requirement for transfusion in premature infants treated with erythropoietin and iron .  Methods : R and omised , double blind , placebo controlled trial . Thirty infants ≤32 weeks gestation and ≤1250 g birth weight , who were defined as stable based on minimal requirements for respiratory support and phlebotomy , and absence of major congenital anomalies were enrolled . All were treated with erythropoietin and iron , and were r and omised to receive , in addition , either vitamin E 50 IU/day or placebo for eight weeks or until discharge , whichever came first . Results : Despite higher vitamin E ( α-tocopherol ) levels in the experimental group in weeks 3 ( 49.0 v 28.1 μmol/l ) and 8 ( 66.2 v 38.5 μmol/l ) , there were no differences in haemoglobin , reticulocyte count , iron concentration , or transfusion requirement . Conclusions : Oral vitamin E supplementation at 50 IU/day does not increase the response of preterm infants  to erythropoietin and iron . Vitamin E obtained through st and ard nutrition may have been sufficient or higher doses may be required OBJECTIVE We evaluated the effect of iron supplementation on biochemical indicators of iron status , namely hemoglobin ( Hb ) , serum ferritin ( SF ) , and serum transferrin receptor ( sTfR ) , during pregnancy . METHODS A prospect i ve study was conducted in 73 pregnant women who received daily supplements of 60 mg of iron and 500 microg of folic acid for 100 d from 19 wk of gestation . The indicators of  iron status ( Hb , SF , and sTfR ) at 19 , 27 , and 35 wk of gestation were analyzed . The response of iron status indicators to iron supplementation was assessed in the cohort and in pregnant women who were anemic ( n = 35 ) and non-anemic ( n = 38 ) at 19 wk . RESULTS All three indicators of iron status during supplementation ( 27 and 35 wk ) were similar to the presupplementation status . The sTfR as an indicator correlated negatively with presupplementation Hb levels ( r = -0.417 ) . Based on sTfR level in iron-adequate pregnant women , a cutoff value of at least 12.0 mg/L was derived to define iron deficiency in pregnancy . When the response was tested in anemic pregnant women , iron supplementation improved mean Hb ( P < 0.05 ) at the end of 35 wk ( 96 + /- 8.8 to 110 + /- 20.2 g/L ) of gestation , with no change in SF . Conversely , non-anemic pregnant women showed a significant increase in SF and a decrease in Hb ( 122 + /- 11.6 to 112 + /- 15.2 g/L ) at 35 wk of gestation . A significant effect of iron intake on sTfR was seen only among iron-deficient anemic women . CONCLUSIONS These observations suggest that , during pregnancy , sTfR responds to iron supplementation when there is iron-deficiency anemia and therefore can be used as an indicator 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 There is no recommendation to screen ferritin level in blood donors , even though several studies have noted the high prevalence of iron deficiency after blood donation , particularly among menstruating females . Furthermore , some clinical trials have shown that non-anaemic women with unexplained fatigue may benefit from iron supplementation . Our objective is to determine the clinical effect of iron supplementation on fatigue in female blood donors without anaemia , but with a mean serum ferritin ≤ 30 ng/ml . Methods / Design In a double blind r and omised controlled trial , we will measure blood count and ferritin level of women under age 50 yr , who donate blood to the University Hospital of Lausanne Blood Transfusion Department , at the time of the donation and after 1 week . One hundred and forty donors with a ferritin level ≤ 30 ng/ml and haemoglobin level ≥ 120 g/l ( non-anaemic ) a week after the donation will be included in the study and r and omised . A one-month course of oral ferrous sulphate ( 80 mg/day of elemental iron ) will be introduced vs. placebo . Self-reported fatigue will be measured using a visual analogue scale . Secondary outcomes are : score of fatigue ( Fatigue Severity Scale ) , maximal aerobic power ( Chester Step Test ) , quality of life ( SF-12 ) , and mood disorders ( Prime-MD ) . Haemoglobin and ferritin concentration will be monitored before and after the intervention . Discussion Iron deficiency is a potential problem for all blood donors , especially menstruating women . To our knowledge , no other intervention study has yet evaluated the impact of iron supplementation on subjective symptoms after a blood donation . Trial registration A W.H.O. sponsored collaborative study of the effects of iron supplementation to pregnant women was carried out in Delhi ( northern India ) and Vellore ( southern India ) . Supplementation was given under supervision from the 26th to the 36th or 38th week of pregnancy . A control group received only placebo ; one group received vitamin B12 and folic acid alone ; four groups received vitamin B12 , folate and a daily iron supplement ranging from 30 to 240 mg of elemental iron as ferrous fumerate , and one further group received 120 mg of iron without B12 or folate . Groups receiving no iron showed a fall in mean stet concentration . Those receiving iron showed a rise in haemoglobin , the best results being in the groups receiving 120 and 240 mg of iron together with vitamin B12 and folate . Even in these groups however there was still a high prevalence of anaemia and iron deficiency at the end of the trial period . Iron alone did not produce as good results as iron plus vitamin B12 and folate . The supplementation had no detectable effect on the birth weight of the children , nor on the haemoglobin concentration of the infants at three months of age . The daily absorption of iron in the pregnant women , as judged from the increase in haemoglobin mass , was not as satisfactory as expected . Possible reasons for this are discussed . It is concluded that to provide these women with adequate iron a daily oral supplementation of 120 mg of elemental iron or more is needed . This can only be achieved by medicinal means . Before supplementation can be recommended on a public health scale , further information regarding the cost and expected benefits of such measures must be obtained 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
This systematic review indicates that iron supplementation increases  Hb levels in children significantly but modestly .
The increase is greater in subjects who are anaemic at the start of the trial and lower in malarial hyperendemic areas and in those consuming iron-fortified food .
OBJECTIVE To evaluate the effect of iron supplementation on  haemoglobin ( Hb ) in children through a systematic review of r and omised controlled trials .