Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic iron-deficient adults: a systematic review of randomised controlled trials 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 Iron-deficiency anaemia and its effect on worker productivity and activity patterns. Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls Iron supplementation improves energetic efficiency in iron-depleted female rowers. Dietary and Supplement Treatment of Iron Deficiency Results in Improvements in General Health and Fatigue in Australian Women of Childbearing Age Supplementation with vitamin A and iron for nutritional anaemia in pregnant women in West Java, Indonesia Treatment for iron deficiency anaemia with a combined supplementation of iron, vitamin A and zinc in women of Dinajpur, Bangladesh Prevalence & etiology of nutritional anaemias in early childhood in an urban slum. Efficacy of iron fortification compared to iron supplementation among Vietnamese schoolchildren Weekly Iron Folate Supplementation in Adolescent Girls – An Effective Nutritional Measure for the Management of Iron Deficiency Anaemia Reversal of developmental delays in iron-deficient anaemic infants treated with iron Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial Intravenous iron supplementation for the treatment of anaemia in pre-dialyzed chronic renal failure patients. Anaemia of pregnancy in northern India. Nature and therapeutic follow-up. Dual fortification of salt with iron and iodine in women and children in rural Ghana. Clinical evaluation of iron treatment efficiency among non-anemic but iron-deficient female blood donors: a randomized controlled trial Use of microencapsulated iron(II) fumarate sprinkles to prevent recurrence of anaemia in infants and young children at high risk. Iron plus folate is more effective than iron alone in the treatment of iron deficiency anaemia in pregnancy: a randomised, double blind clinical trial
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 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 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 BACKGROUND Up to 25 % of adolescent girls in the USA are iron deficient . This double-blind , placebo-controlled clinical trial assessed the effects of iron supplementation on cognitive function in adolescent girls with non-anaemic iron deficiency . METHODS 716 girls who enrolled at four Baltimore high schools were screened for non-anaemic iron deficiency ( serum ferritin < or = 12 micrograms/L with normal haemoglobin ) . 98 ( 13.7 % ) girls had non-anaemic iron deficiency of whom 81 were enrolled in the trial . Participants were r and omly assigned oral ferrous sulphate ( 650 mg twice daily ) or placebo for 8 weeks . The effect of iron treatment was assessed by question naires and haematological and cognitive tests , which were done before treatment started and repeated after the intervention . We used four tests of attention and memory to measure cognitive functioning . Intention-to-treat and per- protocol analyses were done . FINDINGS Of the 81 enrolled girls with non-anaemic iron deficiency , 78 ( 96 % ) completed the study ( 39 in each group ) . Five girls ( three control , two treatment ) developed anaemia during the intervention and were excluded from the analyses . Thus , 73 girls were included in the per- protocol analysis . Ethnic distribution , mean age , serum ferritin concentrations , haemoglobin concentrations , and cognitive test scores of the groups did not differ significantly at baseline . Postintervention haematological measures of iron status were significantly improved in the treatment group ( serum ferritin 27.3 vs 12.1 micrograms/L , p < 0.001 ) . Regression analysis showed that girls who received iron performed better on a test of verbal learning and memory than girls in the control group ( p < 0.02 ) . INTERPRETATION In this urban population of non-anaemic iron-deficient adolescent girls , iron supplementation improved verbal learning and memory PURPOSE Studies in both animals and humans show a relationship between iron depletion without anemia ( IDNA ) and physical performance . Compared with their sedentary counterparts , female endurance athletes are at greater risk of IDNA , and consequences relevant to endurance athletes include reduced work capacity and energetic efficiency ( EF ) . We conducted a r and omized placebo-controlled trial to investigate the effects of iron ( Fe ) supplementation on Fe status and performance in nonanemic female rowers during training . METHODS At the beginning of a training season , 40 rowers were r and omized to receive either 100 mg·d FeSO4 ( n = 21 ) or placebo ( n = 19 ) using a double-blind design . Thirty-one ( n = 15 Fe , 16 placebo ) completed the 6-wk trial . Fe status ( hemoglobin , serum ferritin , soluble transferrin receptor ) , body composition , and laboratory tests of physical performance ( 4-km time trial , V˙O2peak , energetic EF , and blood lactate ) were assessed at baseline and after training . RESULTS Rowers in both groups increased their fat-free mass ( P < 0.001 ) and V˙O2peak ( P < 0.001 ) after training . Multiple regression analyses revealed improvements in Fe stores ( serum ferritin ) in the Fe treatment group after controlling for baseline Fe stores ( P = 0.07 ) . Rowers in the Fe group had slower lactate response during the first half of the time trial and after 5 min of recovery ( P = 0.05 ) and showed greater improvements in energy expenditure ( P = 0.01 for group-by time ) and energetic EF compared with placebo ( P = 0.03 for group-by time ) . CONCLUSIONS Female rowers with depleted Fe stores who consumed supplemental Fe during training improved their Fe status and energetic EF during endurance exercise . These results are important for endurance athletes whose dietary patterns and physical training increase their risk of IDNA and suggest that Fe supplementation may maximize the benefits of endurance training Objective : To examine the effects of iron deficiency and its treatment by iron supplementation or a high iron diet on fatigue and general health measures in women of childbearing age . Design : R and omised controlled trial to compare supplement and dietary treatment of iron deficiency . Subjects : 44 iron deficient ( serum ferritin < 15 μg/L or serum ferritin 15–20 μg/L , plus two of the following : serum iron < 10 μmol/L , total iron binding capacity > 68 μmol/L or transferrin saturation < 15 % ) and 22 iron replete ( hemoglobin ≥120 g/L and serum ferritin > 20 μg/L ) women 18 to 50 years of age were matched for age and parity . Interventions : Iron deficient women were r and omly allocated to either iron supplementation or a high iron diet for 12 weeks . Measures of Outcome : Iron deficient and iron replete participants had iron studies performed and completed the Piper Fatigue Scale ( PFS ) and the SF-36 general health and well-being question naire at baseline ( T0 ) , following the 12 week intervention ( T1 ) and again after a six-month non-intervention phase ( T2 ) . The SF-36 includes measures of physical ( PCS ) and mental ( MCS ) health and vitality ( VT ) . Results : MCS and VT scores were lower and PFS scores were higher for iron deficient women ( diet and supplement groups ) than iron replete women at baseline . Both intervention groups showed similar improvements in MCS , VT and PFS scores during the intervention phase , but mean increases in serum ferritin were greater in the supplement than the diet group . PCS scores were not related to iron status . Conclusions : Treatment of iron deficiency with either supplementation or a high iron diet results in improved mental health and decreased fatigue among women of childbearing age Nutritional anaemia , thought to be caused by iron deficiency , affects 50 - 70 % of pregnant women in the developing world . The influence of vitamin A and iron supplementation was studied in anaemic pregnant women in West Java , in a r and omised , double-masked , placebo-controlled field trial . 251 women aged 17 - 35 years , parity 0 - 4 , gestation 16 - 24 weeks , and haemoglobin between 80 and 109 g/L were r and omly allocated to four groups : vitamin A ( 2.4 mg retinol ) and placebo iron tablets ; iron ( 60 mg elemental iron ) and placebo vitamin A ; vitamin A and iron ; or both placebos , all daily for 8 weeks . Maximum haemoglobin was achieved with both vitamin A and iron supplementation ( 12.78 g/L , 95 % Cl 10.86 to 14.70 ) , with one-third of the response attributable to vitamin A ( 3.68 g/L , 2.03 to 5.33 ) and two-thirds to iron ( 7.71 g/L , 5.97 to 9.45 ) . After supplementation , the proportion of women who became non-anaemic was 35 % in the vitamin-A-supplemented group , 68 % in the iron-supplemented group , 97 % in the group supplemented with both , and 16 % in the placebo group . Improvement in vitamin A status may contribute to the control of anaemic pregnant women Objective : The study was set up to determine to what extent the addition of a supplement of vitamin A alone or in combination with zinc would improve st and ard iron treatment and correction of iron deficiency anaemia . Design : 216 non-pregnant anaemic women of 15–45 years of age with haemoglobin levels ≤100 g/l were r and omly assigned to three treatment groups . One group ( A ) received iron alone , a second group ( B ) received iron and vitamin A , and a third group ( C ) received iron , vitamin A and zinc . Every woman was given one iron capsule per day for 60 days as FeSO4 containing 60 mg of elemental iron . In addition , groups B and C received 200 000 IU of vitamin A , given as a supervised dose , on the first day of the treatment after collection of the blood sample . Group C received one zinc tablet per day for 60 days as zinc gluconate containing 15 mg of elemental zinc . Setting : The north-western part of Bangladesh in the urban slums of Dinajpur district between February and August 1995.Subjects : To select women with a haemoglobin level of ≤100 g/l , all the women of four r and omly selected municipal slums of the district in the targeted age group ( 328 ) were invited to take part in the study . Blood sample s were analysed for haemoglobin , serum iron , total iron binding capacity ( TIBC ) , ferritin , retinol and zinc . Results : Out of the 328 women screened , 254 ( 77.5 % ) had a haemoglobin level ≤100 g/l and 322 ( 98 % ) ≤120 g/l . The three treatment schedules significantly increased haemoglobin levels and improved iron parameters , except for serum iron in the group who received iron alone . The group who received iron , vitamin A and zinc responded best with an increase in haemoglobin of 17.9 g/l as compared to the group receiving iron alone ( 13.4 g/l ) . Iron and vitamin A treatment gave an intermediate response of 15.9 g/l . However , these differences are only statistically significant only for the group who received iron , vitamin A and zinc and only for the increase in haemoglobin , P=0.03 . Conclusion : The results are suggestive that the addition of vitamin A and zinc to the treatment for anaemia can increase haemoglobin levels more than with iron alone . Sponsorship : The present study was financed by grant FWO 1.5.092.96 and Nutrition Tiers Monde The present study was carried out to find out the prevalence and etiology of nutritional anaemia among preschool children from an urban slum . R and omly selected 300 children aged 3 months-3 yr were analysed over a period of one year for estimating prevalence of nutritional anaemia . Prevalence was also assessed by the rise in haemoglobin after 8 wk of haematinic supplementation in 159 of the 300 subjects . Ninety anaemic children were evaluated for the etiology of anaemia . Prevalence of anaemia , as judged by WHO recommended ' cut-off ' value of haemoglobin < 11 g/dl , was 76 per cent while comparable value of 74.8 per cent was derived by response to haematinic supplementation .  Pure iron deficiency anaemia ( IDA ) was detected in 41.4 per cent ( 37/90 ) of anaemic children . Vitamin B12 deficiency alone or in combination with iron was diagnosed in 14.4 and 22.2 per cent anaemic children respectively . Similarly folate deficiency , IDA with infection and anaemia of chronic diseases ( ACD ) was diagnosed in 2.2 , 3.3 and 12.2 per cent cases respectively . Childhood anaemia continues to be a significant public health problem in preschoolers and iron deficiency is by far the commonest nutritional cause of anaemia . Vitamin B12 deficiency per se or in combination with iron is an important yet not commonly recognised cause of anaemias in preschool children in the community 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 Introduction : Nutritional anaemia in India is common morbidity seen in late adolescent and young female population . There are many conflicting opinions regarding dosage of iron folic acid supplementation for managing this simple nutritional deficiency disorder . Hence , this ‘ R and omized Controlled Trial ’ was undertaken in adolescent girls suffering from Iron Deficiency Anaemia visiting ‘ Urban Health and Training Centre ’ situated in urban slum area . The aim of this study was to assess the ( a ) Impact of weekly iron folic acid supplementation in comparison with daily iron supplementation for the management of Iron Deficiency Anaemia in adolescent girls visiting ‘ Urban Health and Training Centre ’ ; ( b ) Adverse drug reaction profile in ‘ Weekly Iron Folic Acid Supplementation ’ and ‘ Daily Iron Folic Acid Supplementation ’ regimes ; ( c ) Compliance profile for ‘ Weekly Iron Folic Acid Supplementation ’ and ‘ Daily Iron Folic Acid Supplementation ’ regimes in adolescent girls . Methods and Material : R and omized controlled trial was conducted in adolescent girls visiting ‘ Urban Health and Training Centre ’ during the study period June , 2011 to October , 2012 . The 120 anaemic ( Haemoglobin < 12 gm% ) adolescent girls ( 10 - 19 years ) were distributed r and omly by block r and omization in two groups ; one receiving daily Iron and Folic Acid supplementation and in other group receiving weekly Iron and Folic Acid supplementation for 3 months . All the study subjects were given de-worming ( Albendazole 400 mg ) and required health education separately . Both the groups were monitored for Haemoglobin estimation , compliance and adverse drug reactions , if any . Open-Epi Statistical Software was used for data analysis . Results : The mean age of study subjects in ‘ Daily Iron and Folic Acid Supplementation ’  and  ‘ Weekly Iron and Folic Acid Supplementation ’ group was 13.48 and 13.55 years respectively . Their mean pre intervention Haemoglobin was 10.1±1.1 gm/dl and 10.4±1.1 gm/dl respectively . The mean rise in Haemoglobin after lean period of 1 month in respective groups was almost equal i.e. 1.0±0.7 gm/dl and 1.0±0.8 gm/dl . Adverse Drug Reactions were 8.3 % in weekly regime as compared to 13.35 % in daily regime , abdominal pain being the commonest adverse drug reaction seen . The compliance calculated as mean of unconsumed ‘ Iron and Folic Acid ’ tablets was 6.1±10.98 in ‘ Daily Iron Folic Acid Supplementation ’ group , while it was 1.3±3.15 in ‘ Weekly Iron Folic Acid Supplementation ’ group ( p=0.0012 ) , making weekly regime more promising than daily regime with better treatment compliance . Conclusions : Weekly supplementation of ‘ Iron and Folic Acid ’ in ‘ Iron Deficiency Anaemia ’ patients is as good as daily supplementation with added benefits of less adverse reactions and better compliance Iron-deficient anaemic infants perform worse in tests of mental and motor development than do iron-sufficient infants of a comparable age . A r and omised , double-blind trial was done to monitor the effects of iron supplementation on performance in the Bayley scales of mental and motor development among 12 - 18-month-old infants in Indonesia . Iron-deficient anaemic infants ( n = 50 ) were assigned r and omly to receive dietary ferrous sulphate or placebo for 4 month . Similar treatment r and omisation was done among nonanaemic iron-deficient ( n = 29 ) and iron-sufficient ( n = 47 ) infants . Before intervention , the mean mental and motor scores of the iron-deficient anaemic infants were significantly ( p < 0.01 ) lower than those of the nonanaemic iron-deficient and iron-sufficient classes . After intervention , developmental delays were reversed among iron-deficient anaemic infants who had received iron but they remained the same among placebo-treated iron-deficient anaemic infants . Neither ferrous sulphate nor placebo had significant effects on the scores of the other two iron-status classes . The poor performance of 12 - 18-month-old iron-deficient anaemic infants in the Bayley scales of mental and motor development can be improved to the level of performance of iron-sufficient infants by treatment with ferrous sulphate BACKGROUND Anaemia caused by iron deficiency is common in children younger than age 5 years in eastern Africa . However , there is concern that universal supplementation of children with iron and folic acid in areas of high malaria transmission might be harmful . METHODS We did a r and omised , placebo-controlled trial , of children aged 1 - 35 months and living in Pemba , Zanzibar . We assigned children to daily oral supplementation with : iron ( 12.5 mg ) and folic acid ( 50 mug ; n=7950 ) , iron , folic acid , and zinc ( n=8120 ) , or placebo ( n=8006 ) ; children aged 1 - 11 months received half the dose . Our primary endpoints were all-cause mortality and admission to hospital . Analyses were by intention to treat . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N59549825 . FINDINGS The iron and folic acid-containing groups of the trial were stopped early on Aug 19 , 2003 , on the recommendation of the data and safety monitoring board . To this date , 24 076 children contributed a follow-up of 25,524 child-years . Those who received iron and folic acid with or without zinc were 12 % ( 95 % CI 2 - 23 , p=0.02 ) more likely to die or need treatment in hospital for an adverse event and 11 % ( 1 - 23 % , p=0.03 ) more likely to be admitted to hospital ; there were also 15 % ( -7 to 41 , p=0.19 ) more deaths in these groups . INTERPRETATION Routine supplementation with iron and folic acid in preschool children in a population with high rates of malaria can result in an increased risk of severe illness and death . In the presence of an active programme to detect and treat malaria and other infections , iron-deficient and anaemic children can benefit from supplementation . However , supplementation of those who are not iron deficient might be harmful . As such , current guidelines for universal supplementation with iron and folic acid should be revised BACKGROUND Intravenous iron is a recognized therapy of anaemia in chronic haemodialyzed patients , especially in those receiving erythropoietin ( Epo ) , while its role in the anaemia of pre-dialyzed chronic renal failure ( CRF ) patients is much less clear . This study attempted to evaluate the effects of intravenous iron in anaemic pre-dialyzed patients . METHODS Sixty anaemic ( haemoglobin<11 g/dl ) non-diabetic patients with moderate CRF [ 32 males , 28 females ; mean age 52.2+/-12.5 years ; mean glomerular filtration rate 36.2+/-5.2 ml/min ] , without iron deficiency , iron overload or inflammation , without concomitant erythropoietin treatment and without any previous iron therapy were enrolled .  Intravenous iron was administered as iron sucrose , 200 mg elemental iron per month for 12 months , with 1 month pre- study survey and 1 month follow-up after the last iron dose . RESULTS Intravenous iron supplementation was associated with a significant increase in haemoglobin ( from 9.7+/-1.1 at the baseline to 11.3+/-2.5 g/dl after 12 months , a mean increase of 1.6 g/dl ) , a further 36 % of patients reaching the target haemoglobin of 10 g/dl . There was a significant increase in serum iron from 73.9+/-17.2 to 101.8+/-12.2 microg/dl , in serum ferritin from 98.0 ( 24.8 - 139.0 ) to 442.5 ( 86.0 - 496.0 ) microg/l and in transferrin saturation from 21.6+/-2.6 to 33.6+/-3.2 % . No worsening of renal function , no increase in blood pressure and no other side effects were noted . CONCLUSIONS Intravenous iron therapy in pre-dialysis patients with no Epo seems often to ameliorate the anaemia , avoiding the necessity of Epo or blood transfusions in one-third of pre-dialyzed non-diabetic patients . Intravenous iron supplementation appears to be an effective and safe treatment for anaemia in pre-dialysis CRF patients Investigations on 114 anaemic pregnant women revealed that megaloblastosis  occurred in more than half . A therapeutic follow-up approach clearly indicated that vitamin B12-deficiency was fairly common in such patients ; the need of iron supplementation in many of them for achieving complete remission emphasized the poor status of iron stores . All patients with normoblastic marrow achieved full remission with iron therapy alone . The deficiency of haematinic factors appears to be largely due to poor nutrition OBJECTIVE To test the efficacy of double-fortified salt ( DFS ) on the  anaemia and iodine deficiency ( ID ) status of women and their children . DESIGN Double-blind r and omised controlled trial . SETTING Sekyere West District of Ghana . SUBJECTS In this eight-month trial , mildly anaemic or non-anaemic , non-pregnant , non-lactating women were r and omised into three groups receiving : DFS plus weekly placebo ( n = 61 ) ; iodised salt plus weekly 70 mg iron supplement ( n = 65 ) ; or iodised salt ( IS ) plus weekly placebo ( control group , n = 58 ) . Correspondingly , their mildly anaemic and non-anaemic children aged 1 - 5 years were r and omised into two groups receiving either the DFS ( n = 23 ) or IS alone ( control group , n = 59 ) . RESULTS At the end of the intervention , prevalence of anaemia in women remained unchanged in the DFS or IS plus weekly iron supplement group , but significantly increased by 19.5 % in the control group ( P = 0.039 ) . In children , prevalence of anaemia in the DFS group significantly decreased by 21.7 % ( P = 0.025 ) while no change was observed in the control group . ID decreased significantly in all groups of women ( P < 0.001 ) and children ( P < 0.05 ) , with no difference among groups of women and children . CONCLUSION While the use of DFS prevented anaemia in women , it had a significant role in both the prevention and treatment of anaemia in children . Both the DFS and IS significantly reduced ID in women and children to a similar degree Background Iron deficiency without anemia is related to adverse symptoms that can be relieved by supplementation . Since a blood donation can induce such an iron deficiency , we investigated the clinical impact of iron treatment after a blood donation . Methods One week after donation , we r and omly assigned 154 female donors with iron deficiency without anemia , aged below 50 years , to a four-week oral treatment of ferrous sulfate versus a placebo . The main outcome was the change in the level of fatigue before and after the intervention . Aerobic capacity , mood disorder , quality of life , compliance and adverse events were also evaluated . Hemoglobin and ferritin were used as biological markers . Results The effect of the treatment from baseline to four weeks of iron treatment was an increase in hemoglobin and ferritin levels to 5.2 g/L ( P < 0.01 ) and 14.8 ng/mL ( P < 0.01 ) , respectively . No significant clinical effect was observed for fatigue ( -0.15 points , 95 % confidence interval -0.9 points to 0.6 points , P = 0.697 ) or for other outcomes . Compliance and interruption for side effects was similar in both groups . Additionally , blood donation did not induce overt symptoms of fatigue in spite of the significant biological changes it produces . Conclusions These data are valuable as they enable us to conclude that donors with iron deficiency without anemia after a blood donation would not clinical ly benefit from iron supplementation . Trial Registration Clinical Trials.gov : 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 Objective To evaluate whether folate supplementation to iron is able to accelerate solving of iron deficiency anaemia in pregnancy
In IDNA adults  , iron supplementation is associated with reduced subjective measures of fatigue but not with objective improvements in physical capacity .
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 .