Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic iron-deficient adults: a systematic review of randomised controlled trials Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls Reversal of developmental delays in iron-deficient anaemic infants treated with iron A comparison between intravenous iron polymaltose complex (Ferrum Hausmann®) and oral ferrous fumarate in the treatment of iron deficiency anaemia in pregnancy Associations between non-anaemic iron deficiency and outcomes following surgery for colorectal cancer: An exploratory study of outcomes relevant to prospective observational studies Plexafer-F in the Management of Latent Iron Deficiency in Pregnancy Prevalence & etiology of nutritional anaemias in early childhood in an urban slum. Iron deficiency anaemia: continuous versus intermittent treatment in anaemic children. A randomized controlled trial comparing intravenous ferric carboxymaltose with oral iron for treatment of iron deficiency anaemia of non-dialysis-dependent chronic kidney disease patients 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 Multi-micronutrient Sprinkles including a low dose of iron provided as microencapsulated ferrous fumarate improves haematologic indices in anaemic children: a randomized clinical trial. Randomized double-blind safety comparison of intravenous iron dextran versus iron sucrose in an adult non-hemodialysis outpatient population: A feasibility study Non-anaemic iron deficiency impairs response to pulmonary rehabilitation in COPD. Anaemia of pregnancy in northern India. Nature and therapeutic follow-up. Intravenous iron supplementation for the treatment of anaemia in pre-dialyzed chronic renal failure patients. Iron-deficiency anaemia and its effect on worker productivity and activity patterns. Supplementation with vitamin A and iron for nutritional anaemia in pregnant women in West Java, Indonesia Comparative assessment of the bioavailability, efficacy and safety of a modified-release (MR) carbonyl iron tablet and oral conventional iron preparation in adult Indian patients with nutritional iron deficiency anaemia. Efficacy of daily vs. weekly supplementation of iron in schoolchildren with low iron status. Efficacy of Iron Therapy: A Comparative Evaluation of Four Iron Preparations Administered to Anaemic Pregnant Women Haematological response to haem iron or ferrous sulphate mixed with refried black beans in moderately anaemic Guatemalan pre-school children. The effect of iron fortification and de-worming on anaemia and iron status of Vietnamese schoolchildren. Safety and Efficacy of Intravenous Ferric Carboxymaltose (750 mg) in the Treatment of Iron Deficiency Anemia: Two Randomized, Controlled Trials Clinical evaluation of iron treatment efficiency among non-anemic but iron-deficient female blood donors: a randomized controlled trial The effect of intravenous ferric carboxymaltose on health-related quality of life in patients with chronic heart failure and iron deficiency: a subanalysis of the FAIR-HF study Iron deficiency and its management in patients undergoing lipoprotein apheresis. Comparison of two parenteral iron formulations. 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 Effect of Prenatal Zinc Supplementation on Birthweight Intravenous ferric carboxymaltose in iron-deficient chronic heart failure patients with and without anaemia: a subanalysis of the FAIR-HF trial Effect of Consuming Zinc-fortified Bread on Serum Zinc and Iron Status of Zinc-deficient Women: A Double Blind, Randomized Clinical Trial Dietary and Supplement Treatment of Iron Deficiency Results in Improvements in General Health and Fatigue in Australian Women of Childbearing Age Iron-deficiency anaemia and its response to oral iron: report of a study in rural Gambian children treated at home by their mothers. Iron status at 12 months of age — effects of body size, growth and diet in a population with high birth weight Work Capacity, Heart Rate and Blood Lactate Responses to Iron Treatment Anaemia treatment trials in a rural population of Tanzania. Effects of administration of iron, iodine and simultaneous iron-plus-iodine on the thyroid hormone profile in iron-deficient adolescent Iranian girls Iron protein succinylate in the treatment of iron deficiency: controlled, double-blind, multicenter clinical trial on over 1,000 patients.
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 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 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 Abstract : Anaemia is the most common medical disorder in pregnancy with iron deficiency anaemia accounting for the majority of cases . Over 90 % of the iron deficiency anaemia is due to red cell iron deficiency associated with depleted iron stores and deficient intake . The two main modalities of treating iron deficiency anaemia are oral or parenteral iron . Ferrous Hausmann ® ( iron dextrin ) is the latest iron preparation which can be used for intravenous parenteral administration as a total dose infusion . This study compares the efficacy of Ferrum Hausmann ® with oral ferrous fumarate therapy in the treatment of iron deficiency anaemia in pregnancy . Our study shows that treatment with intravenous Ferrum Hausmann ® ( iron dextrin ) result ed in a significantly better level and rate of increase of haemoglobin ( p<0.001 ) . Serum ferritin , which is the best indicator of iron stores , was significantly higher ( p<0.001 ) in the intravenous group . Other indices of iron status such as serum iron , serum transferrin and zinc protoporphyrin also showed a significant improvement in the intravenous group compared to those given oral iron . The results suggest that intravenous iron as a total dose infusion is able to replenish iron stores more efficiently , completely and at a faster rate than oral iron therapy , thus providing the fuel for stimulation of full erythopoiesis compared to oral iron . There were also no reports of any adverse reactions with intravenous iron dextrin , whereas there were a considerable proportion of women on oral iron therapy who reported side effects . In conclusion , intravenous iron therapy with Ferrous Hausmann ® ( iron dextrin ) is a suitable , effective and safe alternative to oral iron therapy in the treatment of iron deficiency anaemia in pregnancy Iron deficiency is common in colorectal cancer . Despite perioperative guidelines advocating for the correction of non-anaemic iron deficiency prior to major surgery , the impact of this pathology on postoperative outcome is unclear . We conducted a single-centre , historical cohort study of 141 elective resections for colorectal cancer . We stratified non-anaemic patients into iron deficient and iron replete groups , and collected data on baseline characteristics , preoperative laboratory results , intraoperative events and postoperative outcomes . As this study was an exploratory work for future research , a P-value of 0.25 was considered relevant . Patients in the deficient group demonstrated lower baseline ferritin ( median ( interquartile range , IQR ) 76 ( 41–141 ) µg/L versus 207 ( 140–334 ) µg/L , P < 0.001 ) and transferrin saturation ( mean ( st and ard deviation , SD ) 18 % ( 8 % ) versus 32 % ( 12 % ) , P < 0.001 ) than those in the replete group , and lower starting haemoglobin ( mean ( SD ) 138 ( 10 ) g/L versus 144 ( 12 ) g/L , P = 0.01 ) . The deficient group had increased re-admission ( 25 % ( 24 % ) versus 4 % ( 11 % ) , P = 0.15 ) and all-cause infection ( 25 % ( 24 % ) versus 5 % ( 14 % ) , P = 0.24 ) . A decrease of two days in days alive and out of hospital at postoperative day 90 was seen in the deficient group on univariate analysis ( median ( IQR ) 81 ( 75–84 ) versus 83 ( 78–84 ) , P = 0.25 ) . This reduced to 1.24 days in multivariate adjusted quantile regression analysis ( P = 0.22 ) . Days alive and out of hospital at day 90 , postoperative re-admission and postoperative infection may be meaningful outcome measures for future prospect i ve observational work examining non-anaemic iron deficiency in patients undergoing major surgery for colorectal cancer The failure to prescribe in antenatal clinics a well tolerated form of supplementary oral iron that provides an adequate iron supply for the successful maintainance of active erythropoiesis in pregnant women largely accounts for the frequent development of latent iron deficiency in the child-bearing age . The potential value of Plexafer-F * , a slow release ferrous sulphate preparation supplemented with folic acid , in reducing the high incidence of latent iron deficiency in pregnancy was assessed by conducting a r and omized clinical trial of Plexafer-F and ordinary ferrous sulphate B.P. with folic acid in eighty women presenting early in pregnancy with latent iron deficiency . At the end of the trial , which was started at the sixteenth week of pregnancy and which lasted for twenty weeks , normal haematological values were obtained in thirty-eight out of forty patients ( 95 % ) taking Plexafer-F , but only in twenty-four out of forty patients ( 60 % ) taking ferrous sulphate . A simple screening test run on stool specimens provided during antenatal visits to check regular ingestion of the iron preparations prescribed , revealed regular drug intake and no intolerance in all the patients receiving Plexafer-F , against an intolerance leading to failure of regular drug intake in 37.5 % of patients receiving ordinary ferrous sulphate 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 Iron deficiency anaemia is a common disorder among paediatric population . Traditionally , oral iron is given for treatment on daily basis . We undertook this study to compare the results of intermittent with continuous oral iron therapy in children . The study was conducted at Combined Military Hospital ( CMH ) , Lahore . Children ( aged 1 to 6 ) with iron deficiency anaemia ( Hb 11 g/dl ) were allocated at r and om into two groups , A ( n = 27 ) and B ( n = 28 ) . The mean Hb of group A , before treatment , was 8.56 ( + /- 1.51 ) g/dl and that of group B was 8.32 ( + /- 1.68 ) g/dl . Group A was given daily oral dosage of 6 mg/kg of elementAL iron whereas group B was given the same dosage of iron but only 3 days a week . After 2 months of treatment the Hb of group A rose to a mean of 11.06 ( + /- 0.72 ) g/dl and that of group B was increased to 11.3 ( + /- 0.90 ) g/dl , respectively . The difference , in the rise of Hb of two groups , was not statistically significant . It was concluded that in our sample of population , the results of intermittent and continuous oral iron therapy , for iron deficiency anaemia in children aged 1 to 6 years , were identical Background . Iron deficiency is a common cause of anaemia and hyporesponsiveness to erythropoiesis-stimulating agents ( ESAs ) in non-dialysis-dependent chronic kidney disease ( ND-CKD ) patients .  Current intravenous iron agents can not be administered in a single high dose because of adverse effects . Ferric carboxymaltose , a non-dextran parenteral iron preparation , can be rapidly administered in high doses . Methods . This open-label trial r and omized 255 subjects with glomerular filtration rates ≤ 45 mL/min/1.73 m2 , haemoglobin ≤ 11 g/dL , transferrin saturation ≤ 25 % , ferritin ≤ 300 ng/mL , and stable ESA dose to either intravenous ferric carboxymaltose 1000 mg over 15 min ( with up to two additional doses of 500 mg at 2-week intervals ) or oral ferrous sulphate 325 mg thrice daily for a total of 195 mg elemental iron daily for 56 days . Results . In the modified intent-to-treat population , the proportion of subjects achieving a haemoglobin increase ≥ 1 g/dL at any time was 60.4 % with ferric carboxymaltose and 34.7 % with oral iron ( P < 0.001 ) . At Day 42 , mean increase in haemoglobin was 0.95 ± 1.12 vs 0.50 ± 1.23 g/dL ( P = 0.005 ) , mean increase in ferritin was 432 ± 189 ng/mL vs 18 ± 45 ng/mL ( P < 0.001 ) and mean increase in transferrin saturation was 13.6 ± 11.9 % vs 6.1 ± 8.1 % ( P < 0.001 ) . Treatment-related adverse events were significantly fewer with ferric carboxymaltose than with oral iron ( 2.7 % and 26.2 % , respectively ; P < 0.0001 ) . Conclusions . We conclude that 1000 mg ferric carboxymaltose can be rapidly administered , is more effective and is better tolerated than oral iron for treatment of iron deficiency in ND-CKD patients 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 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 Background Intravenous iron therapy is a treatment option for iron deficient patients who are intolerant to oral iron or where oral iron is ineffective , but with possible adverse effects . Currently , prospect i ve studies comparing different intravenous iron formulations are needed to determine safety and efficacy of these agents . Methods We conducted a prospect i ve , double-blind , r and omized controlled trial ( RCT ) to assess the feasibility of a trial comparing the safety of high molecular weight intravenous iron dextran , Infufer ® , with intravenous iron sucrose , Venofer ® , in non-hemodialysis adult out patients . Primary outcome was the occurrence of immediate severe drug reactions . Results We enrolled 143 patients in a one-year period . Overall , 45/143 ( 31.5 % ) patients ( 20 iron dextran , 25 iron sucrose ) developed 48 infusion reactions ( 14 immediate , 28 delayed , and 3 both ) . The risk of an immediate reaction was similar in both groups , 9/73 ( 12.3 % ) iron dextran versus 8/70 ( 11.4 % ) iron sucrose , RR = 0.93 ( 95 % CI ; 0.38 to 2.27 ) . The risk of a delayed reaction was significantly higher in the iron sucrose group 22/70 ( 31.4 % ) versus the iron dextran group 9/73 ( 12.3 % ) , RR = 2.55 ( 95 % CI ; 1.26 to 5.15 ; p = 0.0078 ) . Conclusion In this limited feasibility study , no major differences in immediate reactions were seen , but a significantly higher number of delayed reactions were seen in the iron sucrose group . Further , under our assumptions and design a full RCT to evaluate the safety of different intravenous iron preparations is not feasible . Future studies should consider modifying the clinical outcomes , utilize multiple centers , and consider other emerging parenteral iron formulations . ( Clinical Trials.gov NCT005936197 January 3 , 2008 ) BACKGROUND AND OBJECTIVE Non-anaemic iron deficiency ( NAID ) might alter the oxygen pathway in health and disease . The current study aims at assessing the impact of NAID on aerobic capacity in patients with chronic obstructive pulmonary disease ( COPD ) . METHODS A prospect i ve sample of 70 non-anaemic COPD patients c and i date to participate in an 8-week pulmonary rehabilitation ( PR ) programme  was studied . Incremental cycling exercise to peak oxygen uptake ( V'O2peak ) and constant work-rate exercise at 80 % V'O2peak to exhaustion were assessed pre- and post-PR . Training-induced increase of endurance time ( ET ) ≥33 % , which represented the minimal clinical ly important difference , classified patients as responders to exercise training . RESULTS The prevalence of NAID was 48 % ( n = 34 ) showing no relationship with the Global Initiative for Chronic Obstructive Lung Disease stages ( P = 0.209 ) . Patients with NAID showed lower pre-training ET ( P = 0.033 ) and V'O2peak ( P = 0.007 ) than normal iron status ( NIS ) patients after adjustment for potential covariates . Significant training-induced physiological changes were seen in the NIS group ( ΔV'O2peak 68(132 ) mL/min ; P = 0.009 ) , but not in the NAID group ( ΔV'O2peak 26 ( 126 ) mL/min ; P = 0.269 ) . The NAID group showed lower percentage of responders to training ( 56 % ) than the NIS group ( 78 % ) ( P = 0.041 ) . CONCLUSIONS COPD patients with NAID showed lower pre-training aerobic capacity and reduced training-induced response than NIS patients after adjusting for potential confounding variables 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 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 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 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 The objective of the study is to evaluate the bioavailability , efficacy and safety of a new modified-release ( MR ) formulation of carbonyl iron ( 45 mg ) relative to a commercially available conventional formulation of ferrous fumarate ( 300 mg ) in adult Indian patients with clinical and laboratory diagnosis of nutritional iron deficiency anaemia . This prospect i ve , comparative , r and omised , double-blind study was carried out among 60 patients received a single daily dose of either MR carbonyl iron or ferrous fumarate for 12 weeks . The effect of therapy on haematological parameters and iron status and estimation of bioavailability were the main efficacy outcomes . There was a significant ( p<0.05 ) increase in mean haemoglobin levels , reticulocyte counts , haematocrit and mean corpuscular volume in MR carbonyl iron group compared to ferrous fumarate group . There was also an increase in mean serum iron and ferritin levels and a corresponding decrease in total iron binding capacity in MR carbonyl iron group compared to ferrous fumarate group at the end of 12 weeks therapy . The estimated overall bioavailability of MR carbonyl iron was about 147 % that of ferrous fumarate . Both the formulations were equally well-tolerated and adverse events were mainly gastrointestinal in nature . The prevalence of adverse events was slightly more in the ferrous fumarate group . It can be concluded that the MR formulation of carbonyl iron was more efficacious than ferrous fumarate in correcting haematologic abnormalities and improving iron status in patients with nutritional iron deficiency anaemia . In conditions where efficacy is an important consideration , the higher bioavailability of MR carbonyl iron may make it the treatment of choice for nutritional iron deficiency anaemia Iron deficiency anemia ( IDA ) is still a major nutritional and public health problem in developing countries . The prevalence among young children and pregnant women is particularly high . Daily oral supplementation with medicinal iron is considered an effective strategy for reducing the incidence of IDA but non-compliance is a major problem with this strategy . We undertook this study to compare the results of once-weekly vs. daily oral iron supplementation in schoolchildren . Sixty children ranging between 5 and 10 years with iron deficiency anemia were selected from a school in Karachi , Pakistan and were divided into two equal groups , i.e. , daily and weekly supplementation groups . Hemoglobin ( Hb ) , hematocrit ( Hct ) , serum iron , total iron binding capacity ( TIBC ) , and serum ferritin were determined before the start of the study . Ferrous sulfate ( 200 mg ) was given daily to the daily supplementation group and once-weekly to the weekly supplementation group for 2 months . When post-supplementation values of the above-mentioned parameters were determined , a significant improvement was observed in all parameters in both groups . It is concluded that once-weekly iron supplementation is as effective as daily supplementation for the treatment of iron deficiency anemia . Moreover , weekly iron supplementation is cost effective and has no or fewer side-effects The authors conducted a clinical investigation on sixty-nine pregnant women , anaemic and non-anaemic , the purpose being to assess the effect of 50 days treatment with four different medicinal iron preparations , namely , ferrous sulphate , iron chondroitinsulfuric acid complex , and ferritin alone or associated with folinic acid and cobamamide , on various haematological parameters ( Hb , RCC , Ht , CV , Iron , and Transferrin IBC ) . The four products demonstrated a similar efficacy in maintaining anaemic conditions under control ; moreover , the results confirmed our hypothesis of the absorption of iron ferritin . While three products were well tolerated , ferrous sulphate induced , in some cases , side-effects 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 Previous data from Vietnam show that anaemia is highly prevalent among schoolchildren , who are considered not to be iron deficient . Trichuris infection doubled the risk of anaemia . The present study aim ed to evaluate the hypothesis that de-worming is more effective than iron fortification in an anaemic , infection-prone population . In a trial with a 2 x 2 factorial design , 425 anaemic children aged 6 - 8 years were r and omly assigned to receive either iron-fortified noodles or placebo , and mebendazole or placebo . Outcomes considered were change in haematological indicators of iron status ( Hb , serum ferritin ( SF ) , serum transferrin receptor ( TfR ) and haemoglobinopathies analysis ) ; inflammations ( C-reactive protein ( CRP ) ) ; parasite infection status ( hookworm , Trichuris and Ascaris infection ) ; and IgE. ANOVA and logistic regression were used to assess the effects of iron fortification and de-worming on Hb , SF , TfR , body iron and anaemia . Hb improved in all groups after 6 months of intervention . Iron fortification significantly improved Hb , SF and body iron ( 2.6 g/l , 16.3 microg/l and 1 mg/kg , respectively ) . Prevalence of elevated IgE was very high at baseline ( 99 % ) and significantly reduced to about 75 % in all groups after intervention . De-worming unexpectedly showed no effect on Hb , iron status and IgE level . It is concluded that iron fortification slightly improved anaemia and iron status in anaemic schoolchildren in rural Vietnam that were not considered iron deficient . Chronic infection or other unidentified factors may play an important role in the seasonal reduction of anaemia seen in all treatment groups Background . Iron deficiency anemia ( IDA ) is a common hematological complication with potentially serious clinical consequences that may require intravenous iron therapy . Ferric carboxymaltose ( FCM ) is a stable , nondextran iron formulation administered intravenously in large single doses to treat IDA . Objective . Two open-label , r and omized , placebo-controlled trials evaluated safety of multiple or single 750 mg FCM doses compared to st and ard medical care ( SMC ) in IDA patients . Secondary endpoints were improvements in hemoglobin and iron indices . Design and Patients . Adults with hemoglobin ≤12 g/dL , ferritin ≤100 or ≤300 ng/mL with transferrin saturation ≤30 % were r and omized to receive single ( n = 366 ) or weekly ( n = 343 ) FCM or SMC ( n = 360 and n = 366 ) . Results . Significantly greater ( P ≤ 0.001 ) increases in hemoglobin and iron indices occurred in FCM groups versus SMC . In the multidose study , up to two infusions of FCM were needed to reach target iron levels versus 3–5 of intravenous iron comparators . FCM and SMC groups had similar incidences and types of adverse events and serious adverse events . Transient hypophosphatemia not associated with adverse events or clinical sequelae occurred in the FCM groups . Conclusion . Intravenous FCM is safe , well tolerated , and associated with improvements in hemoglobin and iron indices comparable to SMC when administered in single doses of up to 750 mg at a rate of 100 mg/min . Fewer FCM infusions were required to reach target iron levels compared to other intravenous iron preparations 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 : Aims Patients with chronic heart failure ( CHF ) show impaired health-related quality of life ( HRQoL ) , an important target for therapeutic intervention . Impaired iron homeostasis may be one mechanism underlying the poor physical condition of CHF patients . This detailed sub analysis of the previously published FAIR-HF study evaluated baseline HRQoL in iron-deficient patients with CHF and the effect of intravenous ferric carboxymaltose ( FCM ) on HRQoL. Methods and results FAIR-HF r and omized 459 patients with reduced left ventricular ejection fraction and iron deficiency , with or without anaemia , to FCM or placebo ( 2:1 ) . Health-related quality of life was assessed at baseline and after 4 , 12 , and 24 weeks of therapy using the generic EQ-5D question naire and disease-specific Kansas City Cardiomyopathy Question naire ( KCCQ ) . Baseline mean Visual Analogue Scale ( VAS ) score was 54.3 ± 16.4 and KCCQ overall summary score was 52.4 ± 18.8 . Ferric carboxymaltose significantly improved VAS and KCCQ ( mean differences from baseline in KCCQ overall , clinical and total symptom scores , P < 0.001 vs. placebo ) at all time points . At Week 24 , significant improvement vs. placebo was observed in four of the five EQ-5D dimensions : mobility ( P= 0.004 ) , self-care ( P < 0.001 ) , pain/discomfort ( P= 0.006 ) , anxiety/depression ( P= 0.012 ) , and usual activity  ( P= 0.035 ) . Ferric carboxymaltose improved all KCCQ domain mean scores from Week 4 onward ( P≤ 0.05 ) , except for self-efficacy and social limitation . Effects were present in both anaemic and non-anaemic patients . Conclusions HRQoL is impaired in iron-deficient patients with CHF .  Intravenous FCM significantly improved HRQoL after 4 weeks , and throughout the remaining study period . The positive effects of FCM were independent of anaemia status OBJECTIVES There is evidence of iron deficiency ( ID ) in patients treated with lipoprotein apheresis .  Aim of this study was to assess ID in apheresis patients and to study its management comparing safety and efficacy of two approved intravenous ( i.v . ) iron formulations . METHODS Inclusion criteria were defined as a ) serum ferritin < 300 μg/l and transferrin saturation < 20 % , b ) ferritin < 100 μg/l . Both iron deficient alone and ID anemic ( IDA ) patients were included . Other causes for anemia were ruled out by thorough history-taking and examination/blood tests . Patients were treated with six different lipoprotein apheresis methods : DALI , Liposorber D , TheraSorb LDL , HELP , MONET and Lipidfiltration .  50 patients were r and omized to either ferric carboxymaltose ( FCM , 500 - 1000 mg as single shot infusion over 20 min ) or ferric gluconate ( FG , 62.5 mg once weekly ) . RESULTS 50 of 67 patients of our Lipoprotein Apheresis Center showed iron deficiency . Both i.v . iron formulations studied were equally safe ( no serious adverse events ( SAEs ) , 6 patients /group showed adverse events ( AEs ) ) and both effective ( clinical ly and with respect to laboratory data ) in lipoprotein apheresis patients , however FCM led to a more rapid and steeper rise of iron parameters . CONCLUSIONS ID and IDA are common findings in lipoprotein apheresis patients . The pathogenesis remains yet poorly understood and is probably multifactorial . Differential diagnosis of ID/IDA is as essential as differential therapy . H and led with care , older i.v . iron preparations like FG appear to be safe and effective in lipoprotein apheresis patients . However , novel formulations like FCM can be administered rapidly at higher doses due to high complex stability , allowing faster filling of iron stores . Newer laboratory parameters ( Reticulocyte-He , low/medium/high fluorescence reticulocytes ( LFR/MFR/HFR ) ) assessing iron status may be helpful in early detection of ID and in monitoring iron replacement therapy BACKGROUND 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 Although iron and zinc deficiencies are known to occur together and also appear to be high in Ghana , a few supplementation studies addressed this concurrently in pregnancy . In a double-blind , r and omized controlled trial , 600 pregnant women in Ghana were r and omly assigned to receive either a combined supplement of 40 mg of zinc as zinc gluconate and 40 mg of iron as ferrous sulphate or 40 mg of elemental iron as ferrous sulphate . Overall , there was no detectable difference in the mean birthweight between the study groups , although the effect of  iron-zinc supplementation on the mean birthweight was masked by a strong interaction between the type of supplement and the iron status of participants [ F (1,179)=5.614 , p=0.019 ] . Prenatal iron-zinc supplementation was effective in increasing the mean birthweight among anaemic and iron-deficient women but not among women with elevated iron stores in early pregnancy Aims Therapy with i.v . iron in patients with chronic heart failure ( CHF ) and iron deficiency ( ID ) improves symptoms , functional capacity , and quality of life . We sought to investigate whether these beneficial outcomes are independent of anaemia . Methods and results FAIR-HF r and omized 459 patients with CHF [ NYHA class II or III , LVEF ≤40 % ( NYHA II ) or ≤45 % ( NYHA III ) ] and ID to i.v . iron as ferric carboxymaltose ( FCM ) or placebo in a 2:1 ratio . We analysed the efficacy and safety according to the presence or absence of anaemia ( haemoglobin ≤120 g/L ) at baseline . Of 459 patients , 232 had anaemia at baseline ( 51 % ) . The effect of FCM on the primary endpoints of self-reported Patient Global Assessment ( PGA ) and NYHA class at week 24 was similar in patients with and without anaemia [ odds ratio ( OR ) for improvement , 2.48 vs. 2.60 , P = 0.97 for PGA and 1.90 vs. 3.39 , P = 0.51 for NYHA ) . Results were also similar for the secondary endpoints , including PGA and NYHA at weeks 4 and 12 , 6 min walk test distance , Kansas City Cardiomyopathy Question naire overall score , and European Quality of Life-5 Dimensions Visual Analogue Scale at most time points . Regarding safety , no differences were noticed in the rates of death or first hospitalization  between FCM and placebo both in anaemic and in non-anaemic patients . Conclusions Treatment of ID with FCM in patients with CHF is equally efficacious and shows a similar favourable safety profile irrespective of anaemia . Iron status should be assessed in symptomatic CHF patients both with and without anaemia and treatment of ID should be considered After iron deficiency , zinc deficiency is the major micronutrient deficiency in developing countries , and staple food fortification is an effective strategy to prevent and improve it among at-risk- population s. No action has been taken to reduce zinc deficiency via flour fortification so far in Iran , and little is known about the influence of zinc fortification of flour on serum zinc and the iron status , and also about the optimum and effective amount of zinc compound that is used in food fortification . The objective of this study is to evaluate the influence of consuming zinc-fortified breads on the zinc and iron status in the blood serum . In this study , three types of bread were prepared from non-fortified and fortified flours , with 50 and 100 ppm elemental zinc in the form of sulfate .  Eighty zinc-deficient women aged 19 to 49 years were r and omly assigned to three groups ; The volunteers received , daily , ( 1 ) a non-fortified bread , ( 2 ) a high-zinc bread , and ( 3 ) a low-zinc bread for one month .  Serum zinc and iron were measured by Atomic Absorption before and after the study . Results showed a significant increase in serum zinc and iron levels in all groups ( p < 0.001 ) except in the control ( p > 0.05 ) . Absorption of zinc and iron in the group that consumed high-zinc bread was significantly greater than that in the group that received low-zinc bread ( p < 0.01 ) . It was concluded that fortification of flour with 50–100 ppm zinc was an effective way to achieve adequate zinc intake and absorption in zinc-deficient people . It also appeared that consuming zinc-fortified bread improved iron absorption 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 Haematological and iron parameters , measured in 907 children aged from 6 months to 5 years in rural Gambia at the start of the rainy season , differed from those in American reference population s as follows : mean haemoglobin levels were much lower at ages 1 and 2 years and mean levels of mean corpuscular volume ( MCV ) were lower at all ages ( at age 1 year mean haemoglobin was 11.2 g/dl and mean MCV 68.2 fl ) ; in a sample of 249 children r and omly selected from the whole study population , mean serum iron levels were similar but mean transferrin saturation and mean serum ferritin levels were lower , especially at ages 1 - 3 years ( at age 1 year mean serum iron was 11.1 mumol/l , mean transferrin saturation 16.9 % , and geometric mean serum ferritin 8.8 ng/ml . A total of 213 children ( 23 % ) whose haemoglobin and mean corpuscular volume were both less than the 3rd percentile of the reference population received oral iron or placebo from their mothers during the rainy season when malaria transmission is maximal . Mean levels of haemoglobin , mean corpuscular volume , serum iron , transferrin saturation and serum ferritin rose in the iron-treated group and fell in the placebo group at all ages , except under 1 year for serum ferritin , to produce significant differences between the groups by the end of the study . Total iron-binding capacity showed no significant changes during the study . We concluded that oral iron given by the mother during the rainy season can be used to treat iron-deficiency anaemia in Gambian children who would otherwise become more anaemic Objective : To investigate effects of growth and food intake in infancy on iron status at the age of 12 months in a population with high birth weight and high frequency of breast-feeding . Design : In a longitudinal observational study infants ' consumption and growth were recorded . Weighed 2 day food records at the ages of 6 , 9 and 12 months were used to analyse food and nutrient intake . Setting : Healthy-born participants were recruited from four maternity wards .  Blood sample s and growth data were collected from healthcare centres and food consumption data at home . Subjects : Newborn infants ( n=180 ) were selected r and omly according to the mother 's domicile and 77 % ( n=138 ) participated , of them , 83 % ( n=114 ) , or 63 % of original sample , came in for blood sampling . Results : Every fifth child was iron-deficient ( serum ferritin<12 µg/l and mean corpuscular volume<74 fl ) and 2.7 % were also anaemic ( Hb<105 g/l ) . Higher weight gain from 0 to 12 months was seen in infants who were iron-deficient at 12 months ( 6.7±0.9 kg ) than in non-iron-deficient infants ( 6.2±0.9 kg ) ( P=0.050 ) . Serum transferrin receptors at 12 months were positively associated with length gain from 0 to 12 months ( adjusted r 2=0.14 ; P=0.045 ) and mean corpuscular volume negatively to ponderal index at birth ( adjusted r 2=0.14 ; P=0.019 ) and 12 months ( adjusted r 2=0.17 ; P=0.006 ) . Iron-deficient infants had shorter breast-feeding duration ( 5.3±2.2 months ) than non-iron-deficient ( 7.9±3.2 months ; P=0.001 ) . Iron status indices were negatively associated with cow 's milk consumption at 9–12 months , significant above 460 g/day , but were positively associated with iron-fortified breakfast cereals , fish and meat consumption . Conclusions : In a population of high birth weight , iron deficiency at 12 months is associated with faster growth and shorter breast-feeding duration from 0 to 12 months of age . The results suggest that a diet of 9–12-month-olds should avoid cow 's milk above 500 g/day and include fish , meat and iron-fortified breakfast cereals to improve iron status . Sponsorship : The Icel and ic Research Council , Research Fund of the University of Icel and 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 In a coastal population in whom anaemia was common , two r and omised controlled trials were undertaken to investigate the effectiveness of treating iron deficiency anaemia at a dispensary and at primary schools . For anaemic adult villagers treated at a dispensary , one dose of tetrachlorethylene for hookworm infection and a once per week visit to collect medicines were found to be satisfactory . A small but significant increase in haemoglobin level was produced by four weeks oral iron therapy , but this was only maintained after seven months by the group that had initially also received tetrachlorethylene . In children ( 5 - 14 years ) no significant rise in haemoglobin level was obtained by using oral iron and /or TCE , either at the dispensary or at the primary schools . This suggests that malaria was a more potent cause of anaemia in these children Objective : To investigate whether iron supplementation can improve thyroid hormone function in iron-deficient adolescent girls . Design : A double-blind r and omized intervention study . Setting : The study was performed from 2002 through 2003 in the Islamic Republic of Iran . Subjects:103 iron-deficient non-anaemic girls who fulfilled all inclusion criteria were included , and 94 subjects successfully completed the study . Interventions : Patients were r and omly assigned to one of four groups and treated with a single oral dose of 190 mg iodine plus 300 mg ferrous sulphate 5 times/week ( n=24 ) , 300 mg ferrous sulphate 5 times/week ( n=23 ) , a single oral dose of 190 mg iodine ( n=25 ) , or a placebo ( n=22 ) for 12 weeks . Results : All groups were comparable at baseline . After the intervention , there was a significant increase in ferritin and transferrin saturation in the iron+iodine group ( 17.6 vs 8.7 μg/dl , and 18.8 vs 7.2 % , respectively , P<0.001 for both ) and in the iron group ( P<0.001 for both ) . Urinary iodine doubled in the iron+iodine group and in the iodine group ( P<0.001 for both ) . Thyroid indices tT4 , tT3 and T3RU increased and reverse RT3 decreased in the iron+iodine group ( 10 vs 8.9 μg/dl , P < 0.001 ; 143 vs 138 μg/dl , P<0.05 ; 32.3 vs 28.4 % , P<0.001 and 24.8 vs 44.2 ng/dl , P<0.001 , respectively ) and in the iron group . These two groups did not differ for any of the four indices , but both differed significantly from the iodine and placebo groups . Conclusions : Our results indicate that improvement of iron status was accompanied by an improvement in some indices of thyroid hormones . Sponsorship : This study was supported by the Dean of Research Affairs of the Tehran University of Medical Sciences A prospect i ve , controlled , double-blind , double-dummy , multicenter clinical trial was made to assess the efficacy and tolerability of iron-protein-succinylate ( ITF 282 ) in comparison with a well known iron preparation in the treatment of iron deficiency or iron deficient anemia . One thous and and ninety-five patients affected with iron deficiency or overt iron deficient anemia were r and omized to receive either two ITF 282 tablets/day ( 60 mg iron each ) or a commercially available ferrous sulphate controlled release tablet ( one tablet containing 105 mg iron/day ) . Five hundred and forty-nine patients received ITF 282 ; 546 patients were treated with ferrous sulphate . Both treatments lasted 60 days . The treatment outcome was checked by evaluating special hematology , symptomatology , safety hematology and hematochemistry . After two months of treatment , the normalization of the main hematologic parameters in both groups was detected . Although in the first month the reference treatment appears to provide somewhat faster results , at the end of the observation , the values of hematocrit , hemoglobin and ferritin were greater in the ITF 282 group , indicating a more progressive and steady therapeutic effect . The overall clinical rating was significantly in favor of ITF 282 , with 78.9 % of favorable results vs 67.6 % . By dividing the patient population according to pathological conditions ( iron deficiency or overt anemia ) , or according to the etiopathogenesis of the iron deficiency ( increased requirement , or increased loss in adults and in the elderly ) , separate analyses on the treatment outcome were made ( and have been included ) . The general tolerability , although favorable with both treatments , was significantly more favorable with ITF 282 . With this medication , 63 patients ( 11.5 % ) complained of 69 adverse reactions ( 25 heartburn , 19 constipation , 25 abdominal pain ) vs 141 events reported by 127 patients ( 26.3 % ) with the reference medication ( 33 heartburn , 31 epigastric pain , 23 constipation , 32 abdominal pain , 8 skin rash , 14 nausea ) . These observations confirm that , although the most modern preparations of ferrous sulphate exhibit a relatively low frequency of adverse events of limited clinical concern , it is nevertheless possible to decrease both the prevalence and the duration of such events without prejudice for the clinical efficacy , with the use of more " physiological " preparations in which the iron is reversibly bound to a protein carrier , thus effectively removing one of the main obstacles to the correct compliance with treatments that must be administered for prolonged periods of time
Quality -of-life scores ( Piper Fatigue Scale MD 0.73 , 95 % CI 0.29 to 1.18 ; I2 = 0 % ; studies = 3 ) and peak oxygen consumption ( MD 2.77 mL/kg/min , 95 % CI -0.89 to 6.43 ; I2 = 36 % ; 2 studies , 32 participants ) were associated with very low- quality evidence , and we remain uncertain about the role of intravenous iron for these metrics .
Current evidence is insufficient to show benefit of intravenous iron preparations for the treatment of non-anaemic iron deficiency across a variety of patient population s , beyond stating that it may result in a small , clinical ly insignificant increase in haemoglobin concentration .
BACKGROUND Iron deficiency is one of the most common nutritional deficiencies , and has a number of physiological manifestations .
Early , or non-anaemic iron deficiency can result in fatigue and diminished exercise capacity .
Oral iron preparations have a high incidence of intolerable side effects , and are ineffective in certain forms of iron deficiency .
Consequently , intravenous iron preparations are increasingly used in the treatment of non-anaemic iron deficiency .
The newer , more stable iron preparations in particular purport to have a lower incidence of side effects , and are now used across a range of different patient population s. OBJECTIVES To assess the effects of intravenous iron therapy in the treatment of adults with non-anaemic iron deficiency .