Combat Iron Deficiency Anemia Research Articles

Hemoglobin Regeneration Efficiency and Relative Iron Bioavailability of Four Elemental Iron Powders in Rats.

Effective food fortification strategies using elemental iron powders (EIPs) are needed to combat iron deficiency anemia. The purpose of this study was to determine hemoglobin regeneration efficiency (HRE) and relative iron bioavailability (RBV) of four food-grade EIPs (El-Lyte (EL), Hi-Sol (HS), H-325 (H3), and A-131 (A1)) by treating anemic rats with 14 d iron repletion diets (uncooked and cooked), fortified with a 12, 24, or 36 mg iron/kg diet of the EIPs, ferrous sulfate monohydrate (FS, FeSO4•H2O), or no added iron (control), n = 9-12/group. The ability of EL and HS to maintain hemoglobin for 6 weeks on the 6 mg iron/kg diet was also studied. The dissolution rate of iron from the EIPs was measured in hydrochloric acid at pH 1.0. Compared to FS, the EL, HS, and A1 EIPs had >50% overall RBV, with the following order: HS > A1 > EL > H3 (p ≤ 0.05); the effect of cooking was not significant (p > 0.05). Dissolution testing revealed that the mean RBV of the EIPs was positively associated with the percentage of iron solubility. In the 6-week maintenance study, EL and HS maintained hemoglobin as well as FS. Overall, the findings show that at the concentrations of iron tested, these EIPs are effective fortification agents to replenish hemoglobin and correct iron deficiency anemia.

Harnessing the Power of a Novel Triple Chelate Complex in Fermented Probiotic Dairy Products: A Promising Solution for Combating Iron Deficiency Anemia.

This study discovered and examined novel triple chelate complexes involving iron, ascorbic acid, and essential amino acids (AsA-Fe-AmA triple chelate complexes) for the first time. The mechanism of complex formation was studied using FTIR spectroscopy and quantum chemical modeling. The produced complexes were shown to be suitable for fortifying food items with a pH of 3-7 that have not been exposed to heat treatment at temperatures over 75 °C for more than 15 min. Thus, it can be said that the concentration for milk fortification should be 0.005 mol/L or less. In vivo experiments in rats models revealed that the synthesized complexes increased serum iron levels after a single application to reference values within 24 h of oral administration. The iron level increased by 14.0 mmol/L at 2 mL dose of the complex. This fact makes it possible to consider the use of developed complexes and developed fermented dairy products for the prevention of iron deficiency and iron deficiency anemia. Research on the effect of discovered compounds on the physicochemical and organoleptic qualities of milk was conducted. Furthermore, iron ascorbate threoninate, iron ascorbate methioninate, iron ascorbate lysinate, and iron ascorbate tryptophanate all had a beneficial effect on Lacticaseibacillus rhamnosus at concentrations as low as 0.0005 mol/L, which is significant for milk fermentation. A study of fermented milk products revealed that the most effective AsA-Fe-AmA triple chelate complex is iron ascorbate lysinate, which might be further investigated as a viable molecule for dietary fortification in iron deficiency anemia. It was found that fortified fermented milk products had a titratable acidity of 67 ± 1°T, pH of 4.38 ± 0.05, and a viscosity of 2018 ± 142 Pa·s.

Effects of blending ratios variation on micronutrient compositions and phytate/minerals molar ratios of dabi teff-field pea based novel composite complementary flours

Mixtures of multiple grains at varied ratios can provide multiple and higher micronutrients than a single grain. Thus, this research was aimed at examining the effect of blending ratios variation on micro-compositions and phytate/minerals molar ratios of pre-processed local dabi teff-field pea based novel composite complementary flours. Inductively Coupled Plasma-Optical Emission Spectrometry was used to determine dietary minerals. Nutrisurvey software was employed to define ranges of the mixture components and they were constrained at 20–35% for dabi teff, 0–30% field pea and 5–20% maize, while the remaining were set constant at 25% barley, 15% oats and 5% linseed. Design-Expert ® software version 11, D-optimal was used to generate eleven experimental blends and to examine the effects of blending ratio variation on the responses. Mean mineral contents were significantly different (P < 0.05) among the blends (as affected by component ratios variation) and ranged from 24.01–31.58 mg/100 g for iron, 73.46 -78.81 mg/100 g for calcium, and 2.33–2.61 mg/100 g for zinc contents. The phytate/minerals molar ratios were significantly different among the blends except phytate/calcium molar ratio (Ph:Ca), ranged from 0.232–0.344 for phytate/iron molar ratio (Ph:Fe), 0.067–0.085 for (Ph:Ca), 3.356–4.18 for phytate/zinc molar ratio (Ph:Zn) and 6.457–7.943 for phytate by calcium to zinc molar ratio (Ph*Ca:Zn). A linear model was significant (P < 0.05) and adequate to describe variations in iron, zinc, Ph:Fe, Ph:Zn and Ph*Ca:Zn. There was a remarkably linear increase in iron and calcium contents with an increased dabi teff ratio in the blends accompanied by a significant decrease (P < 0.05) in phytate/minerals molar ratios. The findings showed that increasing dabi teff ratio in the blends notably increased iron content with reduced Ph:Fe molar ratio, providing the bases for developing iron-dense novel composite complementary flour with improved iron bioavailability to combat iron deficiency anemia among children.Graphical

Apparent amylose content positively influences the quality of extruded fortified rice kernels

The present research studies the impact of apparent amylose content (AAC) on the quality of fortified rice kernels (FRK), a health food designed to combat iron deficiency anemia by fortifying with iron, folic acid, and vitamin B12. Five FRK formulations with varying AAC (0.46–23.89 %) were prepared, and AAC influence on the extruder-system parameter and physicochemical, cooking, and textural properties of FRK was investigated. The torque, die-pressure, length, redness, and cooking time increased with an increase in AAC and were in the range of 12.55–22.81 Nm, 58.31–88.96 bar, 4.58–5.09 mm, 0.35–1.15, and 6.1–11.2 min, respectively. The other parameters, such as the breadth, whiteness index, and cooking loss decreased with an increase in AAC. Except for cohesiveness, all other textural properties of cooked FRK increased with an increase in AAC. These correlations of the FRK properties with AAC were confirmed through multivariate analysis. SEM, XRD, FTIR, and rheology supported the observed AAC trends in FRK properties. SEM showed a reduction in pores and cracks with an increase in AAC. The XRD and FTIR showed an increase in crystallinity with an increase in AAC due to better gelatinization leading to rapid retrogradation. This leads to better physical, cooking, and textural properties of FRK.

Optimization of a formula to develop iron-dense novel composite complementary flour with a reduced phytate/minerals molar ratio from dabi teff-field pea-based blends using a D-optimal mixture design.

Iron deficiency anemia is one of the major public health problems in children associated with the inadequate intake of bioavailable iron. Thus, this research was aimed at incorporating dabi teff, an underutilized/forgotten crop, into other pre-processed local food crops, viz., germinated maize, roasted barley, roasted field pea, dehulled oats, and linseed, to develop optimized iron-dense novel composite complementary flour with a reduced phytate/minerals molar ratio. Nutrisurvey software was employed to define ranges, and they were constrained at 20-35% dabi teff, 0-30% field pea, and 5-20% maize, while the remaining were kept constant at 25% barley, 15% oats, and 5% linseed. Eleven experimental runs were generated from the six mixture components using Stat-Ease Design Expert® software version 11, D-optimal. Inductively coupled plasma-optical emission spectrometry was used to determine micronutrients. 'Scheffe' regression was used to fit and test the model's adequacy, and numerical multi-response optimization was performed using the Design Expert® to identify the optimal points. Dabi teff had a significantly higher (p < 0.05) iron content at 86.5 mg/100 g, iron density at 24.53 mg/100 kcal, and calcium content at 123.59 mg/100 g. The new formulations had a significantly higher iron content (3.31-4.36 times), iron density (3.25-4.27 times), and calcium content (1.49-1.58 times), as compared to the control flour, and fulfilled FAO/WHO recommendations. The optimal formula was identified at 34.66% dabi teff, 25% barley, 15% oats, 15.34% field pea, 5% linseed, and 5% maize flour ratios, with response values at the overall optimization as 32.21 mg/100 g iron, 77.51 mg/100 g calcium, 2.59 mg/100 g zinc, 0.233 phytate/iron molar ratio (Ph:Fe), 0.067 phytate/calcium molar ratio (Ph:Ca), 3.43 phytate/zinc molar ratio (Ph:Zn), and 6.63 phytate by calcium to zinc molar ratio (Ph*Ca:Zn). Furthermore, it contained iron at a level that is 2.01 times higher than the standard and 4.44 times higher than the control, as well as an iron density of 8.47 mg/100 kcal, which was 4.39 times higher than that of the control. These findings showed that the optimized dabi teff-field pea based iron-dense novel composite complementary flour with enhanced bioavailability can be developed and used as a sustainable food-based strategy to combat iron deficiency anemia among children in less developed countries, such as Ethiopia.

Iron-fortified water: a new approach for reducing iron deficiency anemia in resource-constrained settings

A new approach for fortification of drinking water is presented for combating iron deficiency anemia (IDA) worldwide. The idea is to leach Fe from a bed containing granular metallic iron (Fe0), primarily using ascorbic acid (AA). AA forms very stable and bioavailable complexes with ferrous iron (FeII). Calculated amounts of the FeII-AA solution can be added daily to the drinking water of households or day-care centers for children and adults (e.g. hospitals, kindergartens/schools, refugee camps) to cover the Fe needs of the populations. Granular Fe0 (e.g., sponge iron) in filters is regarded as a locally available Fe carrier in low-income settings, and, AA is also considered to be affordable in low-income countries. The primary idea of this concept is to stabilize FeII from the Fe0 filter by using an appropriate AA solution. An experiment showed that up to 12 mg Fe can be daily leached from 1.0 g of a commercial sponge iron using a 2 mM AA solution. Fe fortification of safe drinking water is a practicable, affordable and efficient method for reducing IDA in low-income communities.

Nutritional Quality of Three Iron-Rich Porridges Blended with Moringa oleifera, Hibiscus sabdariffa, and Solanum aethiopicum to Combat Iron Deficiency Anemia among Children

Iron deficiency anemia has been a public health issue in children under five years of age in Cameroon. Very limited attempts have been carried out to develop an iron-rich food using local ingredients. The study aimed at developing functional porridges from local ingredients for iron-deficient children aged 6–23 months. Leaves of Moringa oleifera, Hibiscus sabdariffa, and Solanum aethiopicum were harvested as sources of iron, dried, ground into powder, and screened for their water and iron contents. Each vegetable powder was mixed with the other ingredients (dry whole milk, brown sugar, yellow maize flour, and refined soybean oil) to obtain three powdered porridges using linear programming (LP). Protein, lipid, carbohydrate, iron, energy, water, ash, crude fiber, and vitamin C contents, expressed in dry weight, were determined on powdered porridges. Powdered porridges were cooked in boiled water (ratio 2 : 7%w/w) for 5 min. Hedonic tests were conducted using cooked porridges with 50 untrained panelists. Leaf powders contained iron varying between 5.39 and 5.98 mg/100 g. LP models of the three porridges satisfied the nutritional requirements of children aged 6–23 months in terms of iron, lipid, protein, carbohydrate, and caloric daily intake. Protein, lipid, carbohydrate, iron, energy, water, ash, crude fiber, and vitamin C contents were, respectively, between 11.37 and 13.83 g/100g, 30.79 and 32.94 g/100g, 45.97 to 46.81 g/100g, 5.14 and 6.15 mg/100g, 509.93 and 517.48 kcal/100g, 6.42 to 7.62 g/100g, 2.20 and 2.88 g/100g, 1.65 and 2.44 g/100g, and 46.49 and 163.38 mg/100g. The cost of powdered porridges varied between 0.40 and 0.49 USD/100g. The sensory analysis showed that the moringa leaf-based porridge (82%) was the most appreciated followed by eggplant leaf-based porridge (80%) and folere leaf-based porridge (70%). Hence, these results showed that moringa, folere, and eggplant leaves can be used in functional foods to alleviate iron deficiency among children aged 6–23 months.

Haemoglobin profile of women in reproductive age group in rural area of Maharashtra

Introduction: Anaemia is a very common but hidden health problem in Indian women affecting 48.8% in reproductive age group. Iron Deficiency is main cause though other factors may exacerbate it. Anaemia has long term consequences like increased maternal and infant morbidity and mortality. This study tries to assess haemoglobin profile in villages of Maval taluka and adopt intervention measures accordingly. Materials and Methods: A cross sectional study was carried out in villages of Maval taluka. Health camps were organised by UHTC and an NGO Disha in selected villages and all women who attended camps were included in study. A pretested structured questionnaire was used for study. Data thus collected was analysed using appropriate statistical methods. Results and Discussion: Out of 495 women who attended the camp, 480 consented for Haemoglobin estimation. 347 belonged to age group of 15-45 and 133 were above age of 45. 153 women had a purely vegetarian diet and 327 consumed mixed diet. 170 women out of 480 suffered from moderate to severe Anaemia. 293 women suffered from Mild degree of Anaemia. Anaemia was seen more in reproductive age group. No relation was seen between type of diet and Anaemia. Conclusion: Inspite of several efforts undertaken by public and private organisations, to combat Iron Deficiency Anemia, it remains a Public Health problem. There is need to develop more intensive and sustainable strategies to combat Anaemia at all levels.

Evaluation of In-vitro functional potential of developed synergistic Fe-Vit C rich powder for anemic adolescent girls

Nutritional anemia is a major public health issue in India affecting more than 60% of adolescent girls. The present study was conducted for phytochemical screening, estimation of total phenolic content, antioxidant and antimicrobial potential of methanolic extracts of iron and vitamin C rich powder mix (Fe-Vit C powder mix) developed from cauliflower and turnip leaves, garden cress seeds, rice flakes and Aonla, to combat iron deficiency anemia among adolescent girls. The total phenolic content was 180.02 mg GAE/g of powder. At the concentration of 500µg/ml, the extracts showed 91.8 ± 0.370 and 91.4 ± 0.312% scavenging activity by DPPH and Hydrogen peroxide method, respectively. The methanolic extracts of powder were found to have significant antimicrobial activity against all the three test microorganisms i.e. Escherichia coli, Pseudomonas aeroginosa and Candida albicans. Qualitative phytochemical analysis of extracts showed the presence of almost all phytochemicals only, Anthocyanins and sterols were found to be absent. Fe-Vit C powder mix appeared to be successful alternative for nutrition intervention and supplementary feeding programme to reduce the prevalence of iron deficiency anemia among adolescent girls.

A Cross-sectional Study to Evaluate the Acceptance of Non-pharmacological Interventions to Control Anaemia among Adolescent Girls and Lactating Mothers in a District of Gujarat, India.

To combat Iron deficiency anemia, an innovative pilot project, anemia prevention among adolescent girls and lactating mothers through nonpharmacological measures has been started at few places in Gujarat. To evaluate the acceptability of intervention kits provided to the beneficiaries. A cross-sectional study design where 182 beneficiaries were randomly selected for interview from 12 randomly selected Anganwadi centers of intervention taluka of Junagadh district. Information Education and Communication (IEC) material though available was unread by majority of beneficiaries. Iron utensils were used by 65% of beneficiaries for cooking. Only few beneficiaries (7%) daily use the provided moringa powder. Only half of the beneficiaries (53%) had grown some of the crops from the kitchen garden kit provided and knowledge of beneficiaries regarding iron-rich food was satisfactory in less than one-fifth (19%) of them. Study results concluded that providing nonpharmacological material is of little use until beneficiaries were properly guided and motivated by regular follow-up visits and addressing their problems; otherwise, it just stands as a mere matter of rock only.

Impact assessment of dietary and nutrition education intervention on hemoglobin level moderately anemic adolescent girls

High prevalence of iron deficiency anemia among adolescent girls is a matter of great concern because of double demand of growth and activity. Therefore, the present study was conducted among moderately anemic (Hb=8–10.9 mg/dl) adolescent girls (10–18 yrs) with an objective to improve hemoglobin level of selected moderately anemic subjects through diet and nutrition education intervention. Intervention imparted to total 90 moderately anemic adolescent girls for the periods of 4 months which divided into three groups. Each group constituted 30 girls. Group-I was imparted diet as well as nutrition counseling and group-II received only nutrition counseling. Group-III formed the control group i.e. no intervention of any type was provided to them. The effectiveness of diet and nutrition intervention was evaluated for hemoglobin (Hb) level at pre and post stage of intervention. Consequently, the average Hb level of the experimental group-I and II subjects increased significantly (p<0.05) from 9.31±0.12 and 9.51±0.11 g/dl to 11.44±0.12 and 10.97±0.16 g/dl respectively, whereas non-significantly results were found in control group. Dietary intervention with nutrition education is an effective tool in increasing the level of hemoglobin and to combat iron deficiency anemia among moderately anemic girls.

Development and quality evaluation of iron rich products

Four different iron rich products namely kranky noodles, crunchy ball, nutri grans and nutri ribbon were developed to combat iron deficiency anaemia utilizing locally available, low cost and food stuffs rich in iron content. Developed iron rich products were evaluated organoleptically and nutrient content was determined. The periodical acceptability, nutrient content and microbial content was evaluated at 0, 3 and 6 months of storage period. Among the five developed iron rich products the iron content of developed product was in the range of 14.60 mg to 17.20 mg/100g. The results of storage study indicated that the developed products were acceptable while microbial content increased but it was in the safe range.

Impact of Nutritional Health Education on Knowledge and Practices of Mothers of Anemic Children in El Othmanyia Village – Egypt

BACKGROUND: In Egypt, more than one in four children suffers from some degree of anemia.&#x0D; AIM: This study was carried out to assess and improve the nutritional knowledge and risky nutritional habits of the mothers of anemic children aged 2–12 years old in El Othmanyia village.&#x0D; MATERIALS AND METHODS: An interventional study was conducted among anemic children aged 2–12 years old and their mothers in El Othmanyia village, Egypt. The study passed through three stages over 1 and ½ years; pre-interventional assessment of awareness (n = 350), educational interventions targeting anemic children and their mothers, and post-interventional evaluation of change in awareness and practice.&#x0D; RESULTS: The mean knowledge % score of mothers increased significantly after the intervention (82.2 ± 14.2 vs. 6.3 ± 5.8, respectively). Furthermore, the mean hemoglobin of the studied children increased significantly after the intervention (11.1 ± 0.7 vs. 10.5 ± 0.7). The percent of children with anemia decreased significantly from 100% to 40.3% after the intervention (p &lt; 0.001).&#x0D; CONCLUSION: The knowledge and practices of mothers are moving in a desirable direction after the health education intervention. Hence, nutrition education is an appropriate, effective, and sustainable approach to combat iron deficiency anemia. Recommendations: A multiple interventional strategies between different ministries to set policies and guidelines that support the healthy nutritional behavior among children are recommended.&#x0D;

Hepcidin-guided screen-and-treat interventions against iron-deficiency anaemia in pregnancy: a randomised controlled trial in The Gambia

SummaryBackgroundWHO recommends daily iron supplementation for pregnant women, but adherence is poor because of side-effects, effectiveness is low, and there are concerns about possible harm. The iron-regulatory hormone hepcidin can signal when an individual is ready-and-safe to receive iron. We tested whether a hepcidin-guided screen-and-treat approach to combat iron-deficiency anaemia could achieve equivalent efficacy to universal administration, but with lower exposure to iron.MethodsWe did a three-arm, randomised, double-blind, non-inferiority trial in 19 rural communities in the Jarra West and Kiang East districts of The Gambia. Eligible participants were pregnant women aged 18–45 years at between 14 weeks and 22 weeks of gestation. We randomly allocated women to either WHO's recommended regimen (ie, a daily UN University, UNICEF, and WHO international multiple-micronutrient preparation [UNIMMAP] containing 60 mg iron), a 60 mg screen-and-treat approach (ie, daily UNIMMAP containing 60 mg iron for 7 days if weekly hepcidin was <2·5 μg/L or UNIMMAP without iron if hepcidin was ≥2·5 μg/L), or a 30 mg screen-and-treat approach (ie, daily UNIMMAP containing 30 mg iron for 7 days if weekly hepcidin was <2·5 μg/L or UNIMMAP without iron if hepcidin was ≥2·5 μg/L). We used a block design stratified by amount of haemoglobin at enrolment (above and below the median amount of haemoglobin on every enrolment day) and stage of gestation (14–18 weeks vs 19–22 weeks). Participants and investigators were unaware of the random allocation. The primary outcome was the amount of haemoglobin at day 84 and was measured as the difference in haemoglobin in each screen-and-treat group compared with WHO's recommended regimen; the non-inferiority margin was set at −5·0 g/L. The primary outcome was assessed in the per-protocol population, which comprised all women who completed the study. This trial is registered with the ISRCTN registry, number ISRCTN21955180.FindingsBetween June 16, 2014, and March 3, 2016, 498 participants were randomised, of whom 167 were allocated to WHO's recommended regimen, 166 were allocated to the 60 mg per day screen-and-treat approach, and 165 were allocated to the 30 mg per day screen-and-treat approach. 78 participants were withdrawn or lost to follow-up during the study; thus, the per-protocol population comprised 140 women assigned to WHO's recommended regimen, 133 allocated to the 60 mg screen-and-treat approach, and 147 allocated to the 30 mg screen-and-treat approach. The screen-and-treat approaches did not exceed the non-inferiority margin. Compared with WHO's recommended regimen, the difference in the amount of haemoglobin at day 84 was −2·2 g/L (95% CI −4·6 to 0·1) with the 60 mg screen-and-treat approach and −2·7 g/L (–5·0 to −0·5) with the 30 mg screen-and-treat approach. Adherence, reported side-effects, and adverse events were similar between the three groups. The most frequent side-effect was stomachache, which was similar in the 60 mg screen-and-treat group (82 cases per 1906 person-weeks) and with WHO's recommended regimen (81 cases per 1974 person-weeks; effect 1·0, 95% CI 0·7 to 1·6); in the 30 mg screen-and-treat group the frequency of stomachache was slightly lower than with WHO's recommended regimen (58 cases per 2009 person-weeks; effect 0·7, 95% CI 0·5 to 1·1). No participants died during the study.InterpretationThe hepcidin-guided screen-and-treat approaches had no advantages over WHO's recommended regimen in terms of adherence, side-effects, or safety outcomes. Our results suggest that the current WHO policy for iron administration to pregnant women should remain unchanged while more effective approaches continue to be sought.FundingBill & Melinda Gates Foundation and the UK Medical Research Council.

Complementary Feeding of Sorghum-Based and Corn-Based Fortified Blended Foods Results in Similar Iron, Vitamin A, and Anthropometric Outcomes in the MFFAPP Tanzania Efficacy Study

ABSTRACTBackgroundFortified blended foods (FBFs) are micronutrient-fortified food aid products containing cereals and pulses. It has been suggested to reformulate FBFs to include whey protein concentrate, use alternative commodities (e.g., sorghum and cowpea), and utilize processing methods such as extrusion to produce them. The Micronutrient Fortified Food Aid Pilot Project (MFFAPP) efficacy study was designed to test the efficacy of complementary feeding of newly formulated FBFs.ObjectivesThe aim of this study was to test the effectiveness of 5 newly formulated FBFs in combating iron deficiency anemia and vitamin A deficiency compared with traditionally prepared corn-soy blend plus (CSB+) and no intervention. A secondary aim was to determine the impact on underweight, stunting, wasting, and middle-upper arm circumference.MethodsA 20-wk, partially randomized cluster study was completed. Two age groups (aged 6–23 and 24–53 mo) with hemoglobin status <10.3 g/dL, and weight-for-height z scores >−3 were enrolled and assigned to diet groups. Biochemical and anthropometric measurements were collected at 0, 10, and 20 wk.ResultsBoth hemoglobin concentrations and anemia ORs were significantly improved in all intervention groups except for CSB+ and the no-intervention groups at week 20. Only extruded corn-soy blend 14 and the no-intervention age groups failed to significantly decrease vitamin A deficiency risk (P < 0.04). There were no consistent significant differences among groups in anthropometric outcomes.ConclusionsFBFs reformulated with sorghum, cowpea, corn, and soy significantly improved anemia and vitamin A deficiency ORs compared with week 0 and with no intervention. Although newly formulated FBFs did not significantly improve vitamin A deficiency or anemia compared with CSB+, CSB+ was the only FBF not to significantly improve these outcomes over the study duration. Our findings suggest that newly formulated sorghum- and cowpea-based FBFs are equally efficacious in improving these micronutrient outcomes. However, further FBF refinement is warranted. This trial was registered at clinicaltrials.gov as NCT02847962.

Hepcidin-Guided Screen-and-Treat Interventions Against Iron Deficiency Anaemia in Pregnancy: A Randomised Controlled Trial in Gambian Women

Background: Iron deficiency is the most prevalent nutritional deficiency worldwide. WHO recommends daily iron supplementation for all pregnant women where anaemia exceeds 40%, but adherence is limited by side-effects, effectiveness is low, and there are concerns around possible harm. The iron-regulatory hormone, hepcidin, signals 'ready-and-safe' to receive iron. We tested a hepcidin-guided screen-and-treat (S&T) approach to combat iron deficiency anaemia (IDA) aimed at achieving equivalent efficacy to universal administration but at lower levels of supplemental iron exposure. Methods: We conducted a 3-arm randomised-controlled double-blind trial in rural Gambia to assess non-inferiority of two ST b) daily UNIMMAP containing 60mg iron for 7d if weekly hepcidin was <2·5 µg/L or UNIMMAP without iron if hepcidin was ≥2·5 µg/L (ST or c): as in b), but with 30mg iron (ST ST S&T30 n=165). Participants, all staff and data analysts were blinded to allocation and intervention. The primary endpoint was haemoglobin (Hb) at Day 84 with a non-inferiority margin of -5·0g/L. Secondary outcomes were anaemia, iron deficiency (ID), IDA, adherence and side-effects, and ex vivo assays of malaria in erythrocytes and sentinel bacteria growth in serum. The trial is registered as ISRCTN21955180. Findings: In per protocol analysis of the primary outcome the screen-and-treat approaches did not exceed the preset non-inferiority margin of -5·0g/L (endpoint haemoglobin: ST ST S&T30 -2·9g/L, 95%CI: -5·1, -0·7g/L (n=165) versus REF (n=165). For secondary outcomes, anaemia (haemoglobin <110g/L) prevalence at the end of intervention was more common in the S&T groups (S&T60=57·3%, S&T30=59·3%) compared to REF (45·3%). The frequency of supplemental iron administration in S&T60 and S&T30 groups was 46% and 52% compared to that in the REF group. The prevalence of ID and IDA at Day 84 was higher in the S&T groups compared to REF assessed using ferritin, transferrin saturation, soluble transferrin receptor or hepcidin. Adherence, reported side effects and adverse events were similar between groups. Ex vivo tests of malarial growth in erythrocytes and bacterial growth in serum were increased by iron administration but did not differ by treatment group. Interpretation: The hepcidin-guided screen-and-treat approaches were less efficacious in combatting ID and IDA than universal daily iron supplementation and had no advantages in terms of adherence, side effects or safety outcomes. Our results suggest that the current WHO policy for iron administration to pregnant women should remain unchanged. Trial Registration Number: The trial is registered as ISRCTN21955180. Funding: Bill & Melinda Gates Foundation and UK Medical Research Council. Declaration of Interest: The authors declare that they have no competing interest. Ethical Approval: The trial was approved by the Medical Research Council (MRC) Unit The Gambia Scientific Coordinating Committee (SCC), Joint Gambia Government/MRC Ethics Committee (SCC 1357, amendments L2014.56v2) and London School of Hygiene and Tropical Medicine Ethics Committee (ref 7168), overseen by a Data Safety Monitoring Board (DSMB), Trial Steering Committee and Trial Monitor, and conducted according to Good Clinical Practice (GCP) standards supervised by the MRCG at LSHTM Clinical Trials Office. All participants gave written, informed consent.

Adölesan gebelerde demir eksikliği anemisi; ilişkili faktörler ve etkilerinin incelenmesi

Introduction: Adolescent pregnancies and their maternal and fetal complications are a global health burden. Iron deficiency anemia is among the factors, which might contribute to these negative consequences. In this study, we aimed to evaluate the frequency of iron deficiency anemia among pregnant adolescents followed at the Düzce University Medical Faculty Hospital and to investigate its maternal and fetal effects. Methods: A total of 122 pregnant women under 19 years of age were included in this case-control study. The socio-economic characteristics, hematological status, and adverse maternal and perinatal outcomes possibly related to iron deficiency anemia were evaluated.Results: The incidence of anemia among the studied women was 29.5%, and 56.5% were receiving iron supplementation. Oral iron supplementation rate was 33.3% in the anemic group and 66.2% in the non-anemic group (p = 0.01). While the serum ferritin and hemoglobin levels were lower in the anemic group, iron binding capacity was lower in the non-anemic group, and the difference between the groups was statistically significant (p = 0.01, p = 0.01, and p = 0.02; respectively). Concerning adverse perinatal outcomes, preeclampsia was seen in 11.4% of the anemic group and 4.6% in the non-anemic group; the difference was statistically significant (p = 0.01). Conclusions: Iron deficiency anemia is a common problem in adolescent pregnancy. However, many anemic pregnant adolescents do not receive iron treatment. Positive effects on some maternal and perinatal outcomes can be achieved by administering iron supplementation to these women. Iron use should be increased to combat iron deficiency anemia during pregnancy.

Iron deficiency anaemia

Abstract Iron deficiency anaemia is a global heath issue in children and adults alike with the health burden being increased as there is some evidence that iron deficiency anaemia in infants and toddlers can lead to potentially irreversible long-term neurodevelopmental sequelae. In developed nations, there is a strong association with administration of inappropriate amounts of cow's milk. The onus is on healthcare professionals and paediatricians to combat iron deficiency anaemia in their patients.

Impact of nutrition education on iron deficiency anaemia among college student of Banasthali University, Rajasthan

Malnutrition encompasses a broad spectrum of deficiencies, of which the most devastating is the deficiency of one or more of the three micronutrients namely iron, vitamin A and iodine. Anemia is a condition where oxygen carrying capacity of the blood is reduced due to reduced hemoglobin concentration in the blood. Among adolescent girls, constitute a vulnerable group, particularly in developing countries due to poverty, inadequate diet, certain disease, pregnancy / lactation and poor access to health service. Nutrition education is an instructional method that promotes healthy behaviors by imparting information that individual can use to make informed decision about food, dietary habit and health. A recent study has shown the impact of Nutrition Education on the nutritional knowledge of adolescent girls. The objective was to study the prevalence of anemia among adolescent girls and to assess the dietary awareness and dietary practices of adolescent girls. Sixty girls were selected by random Sampling. The knowledge level and Practice level pre-questionnaire was prepared to collect background information on the subjects. A dietary assessment was an essential part and was done by an oral questionnaire (24 hours dietary recall). The subjects were introduced to nutrition and anemia after filling in the questionnaire. They used educational materials such as posters, charts, pamphlets, models, flash cards and leaflets. The same structured questionnaire was used to test nutritional knowledge level after the educational program. A significant difference (P>0.005) was observed in the score of pre and post test of Nutrition Education intervention. Hence Nutrition Education is an appropriate, effective and sustainable approach to combat iron deficiency anemia.

English

Edible insects have been proposed as an alternative protein source that is economically and environmentally preferable to livestock, and certain species may be high in nutrients that benefit human health. We present data describing the mineral content of five edible insects as sold in South Africa and Zimbabwe. We report high variation between and within species, and note that these insects contain significant quantities of potentially beneficial, and potentially harmful, micronutrients. Two caterpillars were notably high in Fe and Zn, which are important nutrients for combating iron deficiency anemia. Na content varied both between and within species, suggesting that some sellers add quantities of salt that could be harmful to health. Mn levels were high in edible termites. We concluded that caterpillars can be promoted as nutrient rich foods in southern Africa; that added salt should be limited in commercial products; and that further research is required to determine whether common serving sizes of termites may put consumers in danger of manganese poisoning. &nbsp; Key words: Edible insects, nutrition, mineral composition, micronutrients, Lepidoptera.