Impact Of Iron Supplementation Research Articles

A double blind randomised controlled trial comparing standard dose of iron supplementation for pregnant women with two screen-and-treat approaches using hepcidin as a biomarker for ready and safe to receive iron.

BackgroundUntil recently, WHO recommended daily iron supplementation for all pregnant women (60 mg/d iron combined with 400ug/d folic acid) where anaemia rates exceeded 40 %. Recent studies indicate that this may pose a risk to pregnant women. Therefore, there is a need to explore screen-and-treat options to minimise iron exposure during pregnancy using an overall lower dosage of iron that would achieve equivalent results as being currently recommended by the WHO. However, there is a lack of agreement on how to best assess iron deficiency when infections are prevalent. Here, we test the use of hepcidin a peptide hormone and key regulator of iron metabolism, as a potential index for ‘safe and ready to receive’ iron.Design/MethodsThis is a 3-arm randomised-controlled proof-of-concept trial. We will test the hypothesis that a screen-and-treat approach to iron supplementation using a pre-determined hepcidin cut-off value of <2.5 ng/ml will achieve similar efficacy in preventing iron deficiency and anaemia at a lower iron dose and hence will improve safety. A sample of 462 pregnant women in rural Gambia will be randomly assigned to receive: a) UNU/UNICEF/WHO international multiple micronutrient preparation (UNIMMAP) containing 60 mg/d iron (reference arm); b) UNIMMAP containing 60 mg/d iron but based on a weekly hepcidin screening indicating if iron can be given for the next 7 days or not; c) or UNIMMAP containing 30 mg/d iron as in (b) for 12 weeks in rural Gambia. The study will test if the screen-and-treat approach is non-inferior to the reference arm using the primary endpoint of haemoglobin levels at a non-inferiority margin of 0.5 g/dl. Secondary outcomes of adverse effects, compliance and the impact of iron supplementation on susceptibility to infections will also be assessed.DiscussionThis trial is expected to contribute towards minimising the exposure of pregnant women to iron that may not be needed and therefore potentially harmful. If the evidence in this study shows that the overall lower dosage of iron is non-inferior to 60 mg/day iron, this may help decrease side-effects, improve compliance and increase safety. The potential for the use of hepcidin for a simple point-of-care (PoC) diagnostic for when it is most safe and effective to give iron may improve maternal health outcomes.Trial registrationISRCTN21955180

Tu2016 Impact of Iron Supplementation on Quality of Life in Patients With Ulcerative Colitis During Remission

Tu2016 Impact of Iron Supplementation on Quality of Life in Patients With Ulcerative Colitis During Remission

Impact of iron supplementation on sexual dysfunction of women with iron deficiency anemia in short term: a preliminary study.

Iron deficiency anemia (IDA) is a common micronutrient deficiency worldwide. It is an important health problem especially in women of reproductive age. IDA may cause anxiety, which is the major factor for female sexual dysfunction (FSD). The aim of the present study was to determine the impact of IDA on FSD in women of reproductive age. In total, 207 women were enrolled. Women with IDA who were admitted in an outpatient clinic of family medicine were asked to complete Beck Anxiety Inventory (BAI), Female Sexual Function Index (FSFI), and Quality of Life (QoL) questionnaires. Questionnaires were completed before and after IDA treatments. Blood samples were obtained for measurements of hemoglobin, hematocrit, levels of serum iron, and iron-binding capacity. Outcomes of blood samples were used for diagnosing of IDA. BAI, FSFI, and QoL scores were evaluated. Paired samples t-tests and Pearson correlation analyses were used to assess relationship between findings of IDA treatments and other parameters. The mean age was 33.6 ± 8.4 years. There were statistical significant differences between pre- and posttreatment in terms of hemoglobin, hematocrit, serum iron, and serum iron-binding capacity. BAI scores were decreased and FSFI scores, which were statistically significant, increased after IDA treatments (P < 0.001). However, QoL scores were developed without statistical significance. There is a risk for anxiety as well as FSD in IDA women of reproductive age. Treatment of IDA can significantly improve sexual functions and QoL in these women population in short term.

The Effect of Iron Supplementation During Menses on Iron Markers and Performance in Active Females

Fifty percent of all active females may have some form of iron deficiency, which could lead to a compromise in athletic performance. PURPOSE: The purpose of the study was to determine the effect of 7 days iron supplementation during menses on blood markers for iron status, high intensity exercise performance, and heart rate recovery (HRREC). METHODS: Twenty five active females (age=21.1 yrs, VO2max ≥ 45 mL.kg-1.min-1 or 8 hrs vigorous training/week) completed a Yo-Yo Intermittent Recovery Test Level 2 (YY2) and a blood draw before and after 7 days of iron supplementation (IRON, 65mg ferrous sulfate N=9), or a placebo (PLC, N=16). Blood was analyzed for blood lactate, hemoglobin (Hb), serum ferritin (sFer) and Hematocrit. Participants also completed a 7-day physical activity recall, O'Connor subjective fatigue scales (PF), muscle soreness scale (MS), and a supplement adherence journal. Heart rate was monitored before, during and after the YY2. RESULTS: There were no significant differences between IRON and PLC groups at baseline. ANOVA indicated significant differences between groups in sFer (p= 0.008) and Hb (p= 0.040) following 7 days of treatment. MS tended to decrease in IRON (p=0.052) and increase in PLC (p=0.051). CONCLUSION: One week of treatment had a positive effect on sFer and Hb levels in the IRON group. The impact of iron supplementation on MS, HRREC, PF and YY2 remains unclear at this time. Funded by Morrison Bruce Center and JMU CISAT Mini Grant Award.

Impact of iron supplementation on schistosomiasis control in Zambian school children in a highly endemic area

To study impact of once weekly iron supplementation on praziquantel cure rate, Schistosoma haematobium reinfection, and haematological parameters in pupils aged between 9 and 15 years of age in Nchelenge district, Zambia. Pupils in the intervention group received once weekly dose of ferrous sulphate at 200 mg while those in the control received once weekly vitamin C at 100 mg for up to 9 months. Both study groups received a single dose of praziquantel at baseline. S haematobium reinfection intensity was significantly lower in boys in the intervention group than in boys in the control group at 6 months (P < 0.001) and 9 months (P < 0.001) of supplementation. Significantly lower S haematobium reinfection intensity was found in girls in the intervention group than in girls in the control group only at 6 months of supplementation (P = 0.018). Boys in the intervention group were 42% (Adjusted Risk Ratio = 0.58, 95% confidence interval 0.39, 0.86) less likely to be reinfected with S haematobium than in the control group at 6 months follow up. Once weekly iron supplementation can decrease S haematobium reinfection after 6 months and should be incorporated into school based schistosomiasis control programs in highly endemic areas.

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

BackgroundThere 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/DesignIn a double blind randomised 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 randomised. 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.DiscussionIron 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 registrationNCT00689793

Impact of Iron Supplementation on Anemia During Pregnancy

Impact of Iron Supplementation on Anemia During Pregnancy

Impact of Iron Supplementation on Anemia During Pregnancy

Pregnancy is a time in which the risk for developing iron deficiency anemia is highest, due to increase of iron requirement. Maternal nutrition is often considered as an important regulator of huma...

Development, Prediction, and Treatment of Anemia in Patients (pts) with Lymphoma/Multiple Myeloma (L/M): Findings of Two European Surveys (ECAS and BEPOS).

Quality of life (QOL) in cancer pts is adversely affected by several factors, including disease- or treatment-related anemia. Between January 2001 and February 2002, the European Cancer Anaemia Survey (ECAS) was conducted to provide information on pervasiveness of cancer-related anemia, impact of anemia on WHO performance status, risk factors for its development, and anemia treatment practices in Europe. Briefly, a total of 15,370 pts were enrolled, of whom 2,360 had L/M. Data analysis showed 53% of L/M pts were anemic (hemoglobin [Hb] <12 g/dL) at enrollment and 73% were anemic at some time during the survey. Low Hb levels correlated significantly with WHO performance scores of 3 or 4 (P <0.001, R =.352). The ECAS data were additionally analyzed to determine patient and disease characteristics that predicted anemia development and to construct a model for identifying pts at risk. Using logistic regression on the L/M incidence group (pts who were not anemic and not being treated for cancer at enrollment, started chemotherapy [CT] during ECAS, and had at least 2 CT cycles during the survey), 4 variables were found to significantly predict anemia development. Initial Hb, persistent/recurrent disease, female gender, and intent to treat or treatment with platinum-based CT were found to independently predict anemia (P <0.001), with an area under the ROC curve of 0.821 (95% CI; 0.763–0.878), indicating acceptable predictive accuracy of the model. Three levels of risk (low [24%], moderate [51%], and high [72%]) for developing anemia were calculated from the model (χ2(2) = 112.6, P <0.001). Mean time required for anemia development was 9.0 wks to reach Hb of <12 g/dL, 11.1 wks to reach Hb of <11 g/dL, and 13.3 wks to reach Hb of <10 g/dL. Notably, only 46% of anemic L/M pts received anemia treatment. Subsequently, a recent (2003) survey, the Belgian Erythropoietin Survey (BEPOS), extended the information gained through ECAS by examining use of recombinant human erythropoietin (rHuEPO) in pts receiving CT. Specifically, BEPOS documented when rHuEPO treatment was started, dosing schedules and dosage adjustments, length of treatment, impact of iron supplementation on rHuEPO treatment, and outcomes. Patients enrolled had either solid tumors (non-small-cell lung cancer, breast cancer) or hematologic malignancies (multiple myeloma [MM], Hodgkin's disease [HD], non-Hodgkin's lymphoma [NHL]). Interim results suggest that 72% of BEPOS pts began rHuEPO during the first 2 CT cycles, with an overall median Hb value of 10.1 g/dL at treatment initiation. For hematologic malignancy pts, the median Hb at treatment initiation was ~10 g/dL for HD; in NHL and MM, the median Hb was >9 to <10 g/dL. Mean time for all pts to achieve a 2-g/dL increase in Hb in the absence of transfusion was 6.4 wks; mean time for NHL pts (6.3 wks) was similar, while mean time for MM pts (9.1 wks) was longer, more in line with that seen in clinical trials. Achievement of the 2-g/dL increase in Hb after 6.4 wks determined in BEPOS is consistent with increases of ~1 g/dL after 4 wks and ~2 g/dL after 8 wks noted in studies of epoetin alfa (Demetri 1998, Gabrilove 2001, Littlewood 2001). Using the large ECAS database, an anemia risk model has been established that should help identify pts at risk for anemia, so that administration of rHuEPO can be initiated expeditiously, before Hb declines to considerably lower levels and/or anemia symptoms, including impaired QOL, develop.

The impact of iron supplementation on reinfection with intestinal helminths and Schistosoma mansoni in western Kenya

A randomized, placebo-controlled, double-blind trial was carried out in 1994–1996 among 231 children and 181 adults in order to determine the effects of iron on reinfection rates and intensities of hookworm, Ascaris lumbricoides, Trichuris trichiura and Schistosoma mansoni. Adults given 60 mg elemental iron twice-weekly for 12 months had significantly lower reinfection rates of A. lumbricoides (16·7% vs 31·9%, P = 0·046), T. trichiura (6·9% vs 20.6%, P = 0·03) and S. mansoni (38·3% vs 61·8%, P = 0·008) compared to adults given placebo. In contrast, adults allocated to iron had a significantly higher reinfection rate of hookworm at the 4-month examination (11·1 % vs 0%, P = 0·009), but the difference was not significant at 8- and 12-month follow-up examinations. Iron supplementation had no effect on reinfection intensities in adults. Surprisingly, iron supplementation had no effect on either reinfection rates or intensities in children. Multiple logistic regression analyses controlling for baseline infection status confirmed the effect in adults of iron on A. lumbricoides, T. trichiura and S. mansoni reinfection rates. The effect is suggested to be due to reduced risk behaviour, to improved immune function or to unfavourable host gut conditions caused by an increased oxidative stress. In each case, the lack of effect in children remains to be explained. In contrast, iron supplementation apparently was short-lived in favour of hookworm infection, an effect that needs further clarification. The findings suggest that iron supplementation has a role to play in helminth control programmes and that intraluminal factors may contribute to the regulation of some helminth infections.

PREVALENCE OF MICRONUTRIENT DEFICIENCIES AMONG PRESCHOOL CHILDREN OF PESHAWAR, N.W.F.P., PAKISTAN

F57 The results presented herein are a part of the larger study "Impact of Iron Supplementation on growth and morbidity of children in NWFP, Pakistan". A double blind, randomized controlled community based study was conducted in two semi-urban areas of Peshawar in which 325 who met the criteria of a"healthy child" were randomly recruited for the study. Blood samples were drawn from 275 children for haemoglobin, serum ferritin and serum retinol levels. On the basis of biochemical value, the children were classified as anaemic (Hb<11 g/dl); iron deficient (SF<12ng/ml): iron deficient anaemic (Hb<11g/dl and SF<12ng/ml). The children were also characterized with a low vitamin A level (serum retinol <0.7 umol/l) and vitamin A deficient (serum retinol <0.35 umol/l). The results revealed that 90% of the children were anaemic, 67% were iron deficient and 63% iron deficient anaemic and that anaemia was more prevalent in boys than girls. The mean retinol level of the children was 0.66 umol/l with 59% of the children having low vitamin A levels and 7% being vitamin A deficient. The study demonstrates that anaemia and vitamin A deficiency is widely prevalent in under two-years old children of Peshawar where basic health, education and social services are relatively better than the other parts of the province.

A Reconceptualization of the Effects of Undernutrition on Children's Biological, Psychosocial, and Behavioral Development and commentaries

A Reconceptualization of the Effects of Undernutrition on Children's Biological, Psychosocial, and Behavioral Development and commentaries

The frequency of anemia and iron deficiency in the runner.

The current consensus is that runners commonly experience a mild anemia influenced by iron deficiency. We compared hematologic parameters of 72 (35 males and 37 females) runners with 48 (27 males and 21 females) nonrunners and assessed the impact of iron supplementation. Male runners had lower hemoglobin (Hb) values than male nonrunners (14.8 vs 15.3 g.dl-1) (P less than 0.05) regardless of iron usage. Female runners had higher (P = 0.05) Hb values than female controls (13.5 vs 12.8 g.dl-1). Female runners off iron had Hbs similar to controls off iron (P = 0.30). Iron parameters (total serum iron, TSI; total iron-binding capacity, TIBC; percent saturation of the TIBC, %sat TIBC; and serum ferritin) of runners vs controls, runners vs runners (on or off iron), and nonrunners vs nonrunners (on or off iron) were comparable except 1) male runners off iron had lower (P less than 0.05) %sat TIBC values (26%) than male runners on iron (34%) and 2) female runners taking iron had ferritin values (32 ng.ml-1) similar to those of female nonrunners taking iron (39 ng.ml-1) but higher (P less than 0.05) than their counterparts off iron (15 and 15 ng.ml-1, respectively). This study concludes that running affects Hb in a variable manner and suggests that the runner's iron status is similar to that of the general population.