Iron Supplementation Research Articles

Development of the "KARUNI" (young adolescents community) model to prevent stunting: a phenomenological study on adolescents in Gunungkidul regency, Yogyakarta, Indonesia.

Stunting is a major health problem in developing countries due to chronic malnutrition that impacts physical growth, cognitive ability, and long-term productivity. The focus of stunting prevention is generally aimed at pregnant women and toddlers, while adolescents, especially adolescent girls, are often neglected. In fact, theywill be thefuture mothers who determine the qualityof the next generation. Malnutrition and anemia in adolescents increase the risk of giving birth to stunted children. Innovative nutritional intervention programs, such as nutrition education and iron supplements, are needed to break the cycle of stunting, involving adolescents as important targets in prevention. Karuni is a program specifically designed for teenagers aged 12-15 years with the main focus being on empowering teenagers through nutrition education, reproductive health and clean and healthy living behavior as well as involving parents to optimize the program. This study used a phenomenological approach toexplore the understanding of adolescent girls aged 12-15years about the stunting prevention program in Gunungkidul Regency, Indonesia. Data were collected through in-depth interviews and FGDs with adolescents, officials running the Adolescent Health Care (PKPR) program, and related agencies. Data validity was guaranteed by triangulation of sources and NVivo was used for analysis. The identified five themes related to the adolescent intervention program for stunting prevention: program implementation, achievements, barriers, needs, and KARUNI model design. Program monitoring is important, butfaces barriers such as the lack of prioritization and motivation. Cross-sectoral collaboration, innovation, and appropriate media are needed in the implementation of theKARUNI model to increase the effectiveness of the stunting prevention program for adolescents. The importance of the role of adolescents in efforts to reduce the prevalence of stunting, especially through collaboration between health centers (Puskesmas) and schools in implementing the PKPR program, providing iron tablets, and health screening.

The efficacy of dietary supplements on health status and performance of football players: a systematic review.

This study aimed to review the efficacy of commonly used supplements on the health status and performance of football players. We searched several databases forrelevant publications published in English upto June 2024 using keywords such as nutritional supplementation, performance, football, and football players. The available literature indicated that l-arginine supplements may improve cardiovascular function, ventilation, the serum level of lactate, and maximal oxygen consumption (VO2 Max) of football players. Branched-chain amino acids (BCAAs) may improve multiple-choice reaction time. Creatine supplements improve jumping, sprinting, change of direction speed, and reduce fatigue. Among thevitamins, vitamin D improves the serum level of injury-related hormones such as cortisol and testosterone. Bvitamins reduce the level of blood lactate in the recovery periods. Vitamin E and vitamin C may improve performance by decreasing oxidative stress and increasing the antioxidant capacity and oxygen delivery to exercising skeletal muscles. Iron supplementation improves endurance capacity. Further studies are warranted to confirm the effects of the supplements on football players, to identify the appropriate dosage ofthe supplements and also to determine their mechanism ofaction.

Institutional Capacity and Practices for Maternal Anemia in China.

In China, a range of anemia prevention and treatment measures have been developed and implemented in recent decades. These measures provide a regulatory basis for implementing standardized maternal anemia prevention and treatment services in China. However, little is known about the adoption of these interventions by health professionals, the capacity of health facilities to screen for iron deficiency and anemia, or the level of compliance among pregnant and lactating women (PLW). Thus, this study explored the alignment between maternal anemia prevention and control services provided and generated evidence for potential policy and program revisions and updates. A cross-sectional survey was conducted between November 2019 and January 2020. A total of 11 counties from 6 provinces across eastern, central and western regions of China were selected for the survey. In the surveyed sites, a total of 42 health institutions were enrolled in the survey, and a total of 201 health providers and 1714 PLW were enrolled in the suervey and completed the questionnaires. The results of this study showed that iron supplements containing 30 and 60 mg of iron were available in one third of the health facilities surveyed. All obstetricians reported ordering the Hb test for pregnant women receiving antenatal care (ANC) services, and 87.6% ordered the ferritin test. The proportion of obstetricians who ordered the ferritin test at the township level facilities (79.4%) was significantly lower than that at the provincial (100%), prefectural (87.5%) and county (87.1%) level facilities (p < 0.05). Around 89.6% and 90.5% of obstetricians prescribed iron to pregnant women when they were diagnosed with anemia and ID, respectively. 41.3% of obstetricians advised women to take preventive iron throughout their pregnancy. The proportion of obstetricians from township level hospitals that advised women to take preventative iron throughout their pregnancy (61.5%) was significantly lower than that from provincial facilities (23.5%) (p < 0.05). A total of 95.2% and 47.9% of PLW reported receiving the Hb test and the serum ferritin test during their pregnancy, respectively. There are some barriers and bottlenecks in the effective implementation of anemia intervention measures for pregnant women in China. Therefore, to achieve international and national targets on further reducing maternal anemia prevalence, comprehensive actions need to be taken.

The Role of Nutritional Interventions in Integrated Care for Malaria and Anemia Management

Malaria and anemia are interrelated public health challenges that disproportionately affect vulnerable populations in sub-Saharan Africa, particularly children and pregnant women. The dual burden of these conditions requires integrated care strategies to effectively manage and reduce their prevalence. Nutritional interventions, such as dietary improvements and iron supplementation, are essential in this context, as they address iron deficiencies, bolster immune function, and mitigate the severity of both conditions. This review explores the role of nutritional interventions in managing malaria and anemia, evaluating the effectiveness of dietary programs and iron supplementation within African public health frameworks. It examines the complexities of integrating nutritional strategies with malaria control measures and highlights the challenges, including resource limitations, cultural barriers, and fragmented policies. The review underscores the importance of coordinated policy frameworks, community engagement, and increased resource allocation to optimize the impact of integrated care strategies. Recommendations for strengthening these approaches are provided to enhance health outcomes and reduce the disease burden in malaria-endemic regions. Keywords: Malaria, Anemia, Nutritional Interventions, Iron Supplementation, Public Health Strategies.

Oral lactoferrin as a treatment of pediatrics’ anemia resulted from chronic kidney diseases: a randomized controlled trial

Anemia in pediatrics is often associated with chronic conditions such as chronic kidney disease (CKD). It can worsen the disease prognosis and affect quality of life. Injectable dosage forms are predominantly used in its treatment with various side effects. This randomized and parallel clinical trial aimed to compare the effectiveness of oral lactoferrin with intravenous (IV) iron dextran in managing anemia resulted from CKD in pediatrics. The study involved 60 children diagnosed with CKD-related anemia who were allocated into two separate groups. Group 1 consisted of 30 pediatric patients who received 100 mg of oral lactoferrin daily for a period of 3 months. Group 2 included 30 pediatric patients who were given IV iron dextran at a dosage of 50 mg three times weekly for 3 months. Both treatments are effective in treating CKD-induced anemia in pediatrics; however, oral lactoferrin demonstrated superior efficacy as there was a significant change within that group in levels of Hb, RBCs, MCH, iron, RDW-SD, MCHC, IL-6, and GDF-15 before and after treatment. In contrast, IV iron dextran showed significant changes within its group in iron, GFR, IL-6, GDF-15, and RDW-SD. After 3 months of treatment, no significant differences were observed between the two groups.

Association of Perinatal Factors and Family Sociodemographic Characteristics With Cardiometabolic Health in Pre-Adolescence: Cross-Sectional Results From Healthy Growth Study.

Study the influence of a variety of perinatal factors on the presence of metabolic syndrome and its parameters in prepubertal age, considering socio-demographic factors, sex, Tanner stage and weight status of the preadolescent. Data collected from the cross-sectional Healthy Growth Study (2007) in students from four prefectures of Greece and their families. Cardiometabolic risk factors (waist circumference, blood pressure and blood indices) and perinatal data (from parents and health records) were collected. Single and a multiple logistic regression performed to assess the associations with cardiometabolic risk in preadolescence. Dependent variables included waist circumference, blood glucose, HDL-C, TG, blood pressure and metabolic syndrome presence, while independent variables encompassed perinatal factors categorised as pre-pregnancy, during and post-pregnancy. 2666 pre-adolescents (mean age 11.2 year) participated in the study. After adjustment for parental educational level, family income, sex, Tanner stage and weight category, maternal pre-pregnancy weight was positively associated with high waist circumference (OR, 95% CI 1.02 (1.00-1.04)), low HDL-C levels (OR, 95% CI 1.01 (1.00-1.03)) and metabolic syndrome (OR, 95% CI 1.02 (1.00-1.05)). Timing of solid foods' introduction was positively associated with high waist circumference (OR, 95% CI 1.09 (1.01-1.08)), gestational age with high glucose levels (OR, 95% CI 1.12 (1.04-1.19)), smoking (OR, 95% CI 1.07 (1.00-1.14)) and alcohol consumption (OR, 95% CI 2.35 (1.05-5.27)) during the first trimester of breastfeeding with high glucose levels and low HDL-C levels, respectively. Number of previous miscarriages was positively associated with low HDL-C levels (OR, 95% CI 1.28 (1.04-1.57)). Gestational age was negatively associated with high waist circumference (OR, 95% CI 0.87 (0.80-0.95)) and iron supplementation in the third pregnancy trimester negatively association with high TG levels (OR, 95% CI 0.34 (0.12-0.91)). Maternal weight, perinatal behaviours, infant feeding and miscarriages influence pre-pubertal cardiometabolic health, independent of sociodemographics, sex, Tanner stage and weight.

Intravenous Sodium Ferric Gluconate Complex for Hospitalized Pediatric Patients with Iron Deficiency Anemia

Background/Objectives: Iron deficiency anemia is common in the pediatric population. Red blood cell transfusions, a common acute treatment, pose well-recognized risks including lung injury, circulatory overload, and immune dysfunction. Intravenous iron, specifically sodium ferric gluconate complex (SFGC), is a potential alternative, however investigation on its use in hospitalized children is lacking. This study aims to describe the physiologic response via change in hematologic values to cumulative dose of SFGC, investigate the effect of cumulative dosing on the amount of RBC transfusions received, and comment on its safety. Methods: This is a retrospective investigation of pediatric patients with iron deficiency who received SFGC during their admission to the Helen DeVos Children’s Hospital between 2016 and 2018 (N = 85). Results: A total of 258 doses of intravenous SFGC were provided to 85 patients. The average pre-treatment serum hemoglobin was 8.73 ± 1.33, and 7 days post-treatment this increased to 10.41 ± 1.43. Mean corpuscular volume, ferritin, serum ion, total iron binding capacity, reticulocyte percentage, and reticulocyte hemoglobin all increased 7 days post-treatment, as would be suspected, but without any statistically significant difference between hematologic outcomes and cumulative dose of SFGC. Our study did not reveal any correlation between the cumulative dose of SFGC administered and the amount of RBC transfusions received. Only one adverse event was recorded. Conclusion: Our results complement the trend of increased use and emerging evidence of favorable safety profiles of IV iron in the pediatric population. This descriptive investigation revealed that administering higher cumulative doses of SFGC provided no further benefits in terms of hematologic response or RBC transfusion administration.

Iron optimisation in pregnancy: a Haematology in Obstetric and Women's Health Collaborative consensus statement.

Anaemia is a well-recognised and widely accepted consequence of iron deficiency (ID); however, the two diagnoses are not synonymous with the effects of ID occurring long before the development of anaemia. In adults,ID can cause physical and neuropsychological symptoms, including lethargy, altered mood and poor concentration, reducing an individual's quality of life. Foetal and neonatal ID has been associated with impaired neurocognitive development with lasting effects despite iron replacement in early life. Obstetric ID is common, affecting up to 70% of Australian pregnancies. The impact, at both an individual and a population level, remains underappreciated and consensus on the identification and management of obstetric ID is lacking. This consensus statement was developed by the Haematology in Obstetrics and Women's Health (HOW) Collaborative and utilised the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to evaluate evidence and strength of recommendations. Recommendations are as follows: (i) Routine ferritin screening should be performed in all pregnant women (GRADE 1C) at booking and 24-28 weeks. Repeat testing should be performed at 36 weeks if clinically indicated or if the woman is previously unscreened. (ii) ID in pregnancy should be defined as a ferritin level <30 μg/L (GRADE 1D). (iii) An appropriate oral iron formulation should be offered as first-line therapy for obstetric ID (GRADE 1B). (iv) Alternate-day oral dosing can be considered to limit side effects in women with obstetric ID (GRADE 2B). (v) Intravenous iron should be offered to women with ID/ID anaemia who are intolerant of or refractory to oral iron or in the third trimester (GRADE 1B).

Screening and treatment of iron deficiency among heart failure patients with impaired ejection fraction: The impact of a pharmacist‐led protocol

AbstractBackgroundDespite guideline‐recommended routine screening and iron deficiency (ID) treatment among heart failure (HF) patients, these practices are often underutilized. Currently, limited data are available on the outcomes of pharmacists' programs to enhance ID screening and management. Accordingly, we sought to describe the frequency and yield of screening for ID and intravenous (IV) iron replacement rates among our cohort of HF patients and examined the impact of implementing a pharmacist‐led protocol (PLP) aimed at enhancing these rates.MethodsWe conducted a retrospective study involving HF patients with left ventricular ejection fraction (LVEF) &lt;45% at a quaternary care hospital in the Middle East/Gulf region. The PLP was introduced in August 2022. Data on demographics, comorbidities, echocardiographic parameters, laboratory findings (including ID screening and its findings), and rates of treatment with IV iron replacement were analyzed and compared between the pre‐implementation group (n = 432, October 2015–February 2020) and the post‐implementation group (n = 154, August 2022–January 2023).ResultsBefore the PLP, 63.2% (n = 273) of eligible patients underwent ID screening, with 80.6% (n = 220) found to have ID. Following the implementation of the PLP, screening rates significantly increased to 86.4% (n = 133) (p = 0.03), with 53.4% (n = 71) diagnosed with ID. The rate of IV iron replacement in ID patients improved from 30.4% (n = 67) in the pre‐PLP group to 73% (n = 52) in the post‐PLP group (p &lt; 0.001). Multivariable logistic regression identified baseline glomerular filtration rate (GFR) and hemoglobin levels as significant predictors of IV iron replacement in the pre‐PLP cohort.ConclusionsImplementing a pharmacist‐led protocol was significantly associated with enhancing the screening and treatment of ID in patients with HF and LVEF &lt;45%. This study demonstrates the crucial role of pharmacists in optimizing guideline‐directed therapies, which can be replicated in various healthcare settings.

Single dose intravenous iron versus oral iron for treatment of maternal iron deficiency anemia: A randomized clinical trial.

Maternal iron deficiency anemia is a persistent global health challenge with increased risk of adverse perinatal outcomes. Obstetric guidelines advocate for first line treatment of moderate iron deficiency anemia with twice daily oral iron, however rates of iron deficiency anemia in pregnancy remain above global targets and are rising. Determine whether single dose intravenous (IV) iron for maternal iron deficiency anemia in the second trimester is superior to twice daily oral iron in reducing incidence of low birthweight (LBW) infants and maternal anemia at delivery. This is a parallel, three-arm, semi-blind superiority randomized controlled multicenter trial across four sites in India from March 15, 2021-May 12th 2023. Participants were singleton pregnancies at 14-17 weeks with moderate iron deficiency anemia (Hb 7.0-9.9g/dL) who were randomized 1:1:1 to (1) 60mg oral ferrous sulphate twice daily; or single dose infusion of (2) IV ferric derisomaltose or (3) IV ferric carboxymaltose. Two IV arms were selected as these are the only two IV iron formulations publicly available in India. All participants received folic acid supplementation throughout pregnancy and anti-helminthic therapy, as recommended by national guidelines. The dual primary outcomes were: (1) LBW (<2500 grams [g]) and (2) attainment of a maternal non-anemic state (NAS) (Hb ≥11·0 g/dL at 30-34 weeks or delivery) for each IV iron arm vs oral iron; IV iron arms were not compared to each other. Secondary outcomes included safety measures, and other maternal and infant outcomes. Participants with Hb<7g/dL or <1g/dL improvement on therapy received rescue treatment with IV iron or blood transfusion as determined by their provider. Sensitivity analyses included defining NAS as achieving Hb≥11.0 without need for rescue therapy. Comparison of each IV iron arm to oral iron was conducted with a two-sided alpha set at 0.0005 for achieving non-anemic state and 0.0245 for low birthweight for each IV iron arm using a Cochran-Mantel-Haenszel (CMH) chi-square test stratified by enrollment site. The oral iron, ferric derisomaltose, and ferric carboxymaltose arms included 1450, 456, and 1462 participants respectively. There was a reduced rate of LBW with IV ferric carboxymaltose (25·2%, Relative Risk [RR] 0·87 [97·55% CI 0·75,0·99], p=.017), but not IV ferric derisomaltose (29·1%, RR 0·98 [97·55% CI 0·86,1·12], p=.71) vs oral iron (29.3%). Achievement of NAS was not improved: IV ferric carboxymaltose (RR 1·05 [99·95% CI 0·97-1·15]) and IV ferric derisomaltose (RR 1·06 [99·95% CI 0·98, 1·16]) vs oral (69.7%). In sensitivity analysis, there was increased rate of NAS in both IV ferric derisomaltose (RR 1.25 (1.13-1.396), p<0.0001) and IV ferric carboxymaltose (RR 1.24 (1.12-1.38), p<0.0001) vs oral iron. First-line treatment of moderate maternal iron deficiency anemia with single dose infusion of IV iron results in a reduced incidence of LBW infants (IV ferric carboxymaltose vs oral) and a higher incidence of attaining maternal NAS without use of additional iron or blood transfusion (IV ferric carboxymaltose and ferric derisomaltose vs oral). Clinical guidelines should address the potential benefit of single dose IV iron as the primary treatment of moderate iron deficiency anemia in pregnancy.

The experiences of ferric carboxymaltose desensitization and provocation.

To present the characteristics of drug hypersensitivity reactions (DHR) among iron preparations and to describe the outcomes of rapid drug desensitization (RDD) and drug provocation tests (DPT) of ferric carboxymaltose (FCM). The retrospective descriptive study comprised patients with hypersensitivy to iron supplements. Low-risk according to the index reaction with iron, 10 patients underwent a 4-step DPT with FCM; an 11-step RDD protocol was administered to 21 patients not classified as low-risk. RDD success was evaluated for each cycle separately, defining successful completion as the implementation of all steps in both RDD and DPT protocols without subsequent early and/or late reactions. Among the 21 patients (mean age: 41.73±10.98 years, all female) hypersensitive to iron underwent FCM RDD, 20 patients (95.2%) successfully completed FCM treatment with RDD. RDD failed in only 1 patient (4.8%). The total number of desensitization cycles was 29, of which 28 (96.5%) were successful. Urticaria was the most common breakthrough hypersensitivity reaction and observed in 7 (33.3%) patients. Ten patients received FCM with DPT. The iron replacement therapy for these 10 patients was successfully completed. Urticaria developed in 2 patients after the completion of DPT. RDD is a dependable procedure facilitating the efficient delivery and completion of FCM treatments in patients with iron hypersensitivity. Additionally, FCM can be applied with DPT in low-risk patients.

Ferric carboxymaltose with or without phosphate substitution in iron deficiency or iron deficiency anemia before elective surgery - The DeFICIT trial.

Iron deficiency anemia in the perioperative setting is treated predominantly with intravenous iron formulation, of which ferric carboxymaltose may induce hypophosphatemia by modulating fibroblast growth factor 23. In this single-center, prospective, randomized, double-blind trial, we consented 92 adult patients scheduled for elective major abdominal or thoracic surgery. These patients either had isolated iron deficiency (plasma ferritin <100ng/mL or transferrin saturation<20%) or iron deficiency anemia (hemoglobin (Hb) 100-130g/L with plasma ferritin <100ng/mL or transferrin saturation<20%). Preoperatively, participants received a single preoperative intravenous dose of ferric carboxymaltose and were then randomly assigned to receive either phosphate or placebo, administered orally three times a day for 30days corresponding to an 18mmol dose of daily phosphate supplementation in the intervention group. The primary endpoint was the minimum serum phosphate concentration during follow-up visits. The key secondary efficacy endpoint was mean perioperative hemoglobin concentration of postoperative days 0, 2 and 4, assessing the non-inferiority of additional phosphate supplementation. We randomly consented 46 patients in each group (mean±SD age 56±17years, 57% female). Minimal phosphate concentration was 0.49±0.21mmol/L in the treatment group and 0.42±0.17mmol/L in the placebo group (p=0.12, two-sided p-value). Average mean hemoglobin was 110±16g/L in the treatment and 113±13g/L in the placebo group (p=0.023, one-sided p-value for non-inferiority). Hypophosphatemia occurred in 32 patients (70%) of the treatment group and in 39 patients (85%) of the placebo group (odds ratio 0.15, 95% CI from 0.02 to 0.77, p=0.014). Secondary outcomes, such as rescue medication use, core muscle strength and MOCA test scores, did not differ between groups. Co-administration of oral phosphate supplementation to ferric carboxymaltose cannot prevent hypophosphatemia. However, hypophosphatemia occurs in fewer patients. Phosphate co-administration did not impede the treatment of iron deficiency anemia with ferric carboxymaltose.

The prognostic role of iron deficiency in acute ischemic stroke patients: A prospective multicentric cohort study.

Iron deficiency (ID) is a prognostic factor in heart failure and acute coronary syndrome. However, its role in cerebrovascular diseases is controversial. We aimed to determine the impact of ID on the functional outcome of acute ischemic stroke patients. This was an observational prospective multicentric cohort study. From January to December 2023, we enrolled acute ischemic stroke patients admitted to the stroke units of four comprehensive stroke centers. Venous blood samples were collected at admission to determine the iron status (serum iron, ferritin, transferrin). ID was defined as a serum ferritin concentration<100ng/mL or 100-299ng/mL with transferrin saturation (TSAT) <20%. The primary endpoint was the poor functional outcome at 90days defined as modified Rankin Scale (mRS) 3-6. We used binary logistic regression models including confounding factors to test the association between ID and the primary outcome. The analysis included 442 patients (mean age 73±13, 47.5% female, median NIHSS 7 [IQR 3-15], 61.3% treated with intravenous thrombolysis and/or endovascular treatment). ID prevalence was 65.6%. In all binary logistic regression models, ID predicted poor functional outcome at 3months irrespective from demographics, stroke severity and characteristics, anemia, risk factors, signs/symptoms of heart failure, glucose at admission, and inflammatory biomarkers (aOR 2.328, 95% CI 1.272-4.263, p=0.006). ID was strongly associated with poor functional outcome at 90days in acute ischemic stroke patients. Further research is required to explore whether iron supplementation could be a potential therapeutic strategy to improve patient outcomes.

A NIR fluorescent probe based on carbamoyl oxime with high specificity for detecting ferrous ions in food and in vivo.

Ferrous ions (Fe2+), the primary form of iron in cells, play a crucial role in various biological processes. The presence and absorption of Fe2+ in food has an important impact on human health. Proper dietary intake and iron supplementation are conducive to prevent and treat iron-related diseases. Therefore, it is of great value to develop tools that can specifically and sensitively detect Fe2+ in foods and organisms. Near-infrared (NIR) fluorescent probes have attracted much attention due to their advantages including deep tissue penetration and lower background fluorescence. Herein, a NIR fluorescent probe DICO-Fe(II) with a new recognition mechanism was constructed. DICO-Fe(II) achieves the highly specific recognition of Fe2+ through its carbamoyl oxime recognition site and exhibits high sensitivity with a limit of detection of 47nM. DICO-Fe(II) can quantitatively detect Fe2+ with the naked eye through RGB values. It was also successfully applied to detect Fe2+ in food samples, cells, zebrafish, and mice tissues, confirming its potential as a modern analytical tool for the detection of Fe2+ in food and biological organisms.

Prevalence and Treatment Patterns of Anaemia in Individuals With Chronic Kidney Disease Across Asia: A Systematic Review and Meta-Analysis.

Anaemia is a significant complication of chronic kidney disease (CKD). However, its prevalence and treatment patterns in Asia are poorly understood. We sought to quantify prevalence of anaemia and its treatment in people with CKD across the region. MEDLINE and Embase (inception to 2023) were systematically searched for observational studies of adults with CKD conducted in Asia that reported the prevalence of anaemia or its treatment. Additional relevant unpublished data were obtained from national experts. Summary estimates of the prevalence of anaemia and its treatment were determined using a random-effects meta-analysis according to country and study-specific CKD inclusion criteria. Eighty-six studies from 10 Asian countries reported data on 1 342 121 participants. The overall prevalence of anaemia in individuals with CKD was 42% (95% CI 33%-52%), with wide variation (12%-57% in studies including all CKD stages; 21%-96% in studies limited to individuals with kidney failure). Anaemia prevalence progressively increased with more advanced CKD (80% in Stage 5). Studies reporting data on anaemia treatment, particularly in early CKD, were limited. The prevalence of erythropoietin-stimulating agents (ESAs) and iron therapy was 40% (95% CI 24%-58%) and 21% (95% CI 14%-31%), respectively (ESA: 7%-29% in CKD, 63%-95% in kidney failure; iron: 6%-26% in CKD, 15%-88% in kidney failure). Our findings indicate a significant, but widely varying, prevalence of anaemia and its treatment in people with CKD in Asia. Substantial variability in data availability and collection highlights the need for standardised reporting to facilitate the development of regionally relevant strategies for anaemia management in CKD.

The effects of prenatal multiple micronutrient supplementation and small-quantity lipid-based nutrient supplementation on small vulnerable newborn types in low-income and middle-income countries: a meta-analysis of individual participant data.

Small vulnerable newborn types, defined by combinations of being born too soon or too small, have distinct determinants and health consequences. We aimed to assess the effects of prenatal multiple micronutrient supplementation (MMS) and small-quantity lipid-based nutrient supplementation (SQ-LNS) on small vulnerable newborn types, which are currently unknown. In this meta-analysis, individual participant data from randomised controlled trials of MMS and randomised controlled trials of SQ-LNS in low-income and middle-income countries were used. We systematically searched the literature using PubMed, Embase, and Web of Science to identify randomised controlled trials of prenatal nutritional supplementation using MMS or SQ-LNS among pregnant people published between Jan 1, 2000, and Dec 31, 2021. Studies were excluded if they were conducted exclusively among participants selected by pre-existing health conditions, such as anaemia status, HIV infection, or diabetes. We contacted the corresponding authors of all identified studies to seek data contribution. As individual participant data became available, we mapped relevant variables and harmonised the data across studies. Iron and folic acid supplementation was the control group in most studies. Newborns were classified into ten groups through the combinations of preterm or term birth, small, appropriate, and large for gestational age, and low birthweight (LBW) or non-LBW. Newborns were also analysed using a four-group categorisation of preterm or term and LBW or non-LBW. Log-binomial models were used to estimate study-specific risk ratios (RRs), which were pooled using meta-analyses. 14 randomised controlled trials of MMS (n=42 618; the mean maternal age at study enrolment was 24·3 years [SD 5.6]; 22 086 [51·8%] male neonates and 20 532 [48·2%] female neonates) and four randomised controlled trials of SQ-LNS (n=6246; the mean maternal age at study enrolment was 23·3 years [SD 5·3]; 3137 [50·2%] male neonates and 3109 [49·8%] female neonates) were used. In the ten-group categorisation of small vulnerable newborns, prenatal MMS reduced the risk of preterm-small for gestational age (SGA)-LBW (RR 0·73, 95% CI 0·64-0·84; p=0·0003); preterm-appropriate for gestational age (AGA)-LBW (0·82, 0·74-0·91; p=0·0010); preterm-AGA-non-LBW (0·89, 0·80-0·98; p=0·019); term-SGA-LBW (0·91, 0·85-0·96; p=0·0046); and term-SGA-non-LBW (0·95, 0·90-1·00; p=0·050). In the four-group categorisation, prenatal MMS reduced the risk of preterm-SGA (0·71, 0·62-0·82; p=0·0002) and term-SGA (0·93, 0·89-0·98; p=0·0066). Prenatal SQ-LNS had no significant effects on the risk of giving birth to small vulnerable newborns except for preterm-large for gestational age-non-LBW in the ten-group categorisation (0·78, 0·65-0·94; p=0·023). Prenatal MMS and SQ-LNS reduce the risk of giving birth to small vulnerable newborns to varying extents, with the greatest magnitude of effects observed for small vulnerable newborn types that confer the greatest neonatal mortality risk. This study underscores the importance of nutritional supplements in prenatal care. Bill & Melinda Gates Foundation.

Perceived Barriers and Enablers for Taking Iron–Folic Acid Supplementation Regularly Among Adolescent Girls in Indonesia: A Pilot Study

Non-compliance with iron and folic acid (IFA) supplementation is a significant contribution to the high prevalence of anemia among adolescent girls in Indonesia. This pilot study aims to explore the perceived barriers and enablers to regular IFA supplement consumption among adolescent girls. Using a qualitative approach, data were collected through focus group discussions (FGDs) conducted in Makassar and Padang City. The FGD involved 32 grade eight and nine students from four junior high schools. In-depth interviews were also conducted with health workers, teachers, and parents to triangulate the findings. A thematic analysis was performed using a social cognitive theory framework. The average age of the informants was 13.6 ± 0.6 years. Despite receiving IFA supplements at school, only 47% of informants reported consuming them regularly. Key barriers to regular supplementation included dislike of the taste and smell, parental prohibition, negative experience consuming IFA supplements, the belief that IFA supplements increase menstrual blood flow and volume, and forgetfulness factors. Enablers include self-awareness of the supplement’s benefits, trust in school-provided supplements, and positive support from parents and peers. The findings highlight that both barriers and enablers play a crucial role in influencing IFA supplementation adherence. Addressing these factors is essential for improving compliance and reducing anemia rates among adolescent girls. Given the small sample size and convenience sampling method, this study serves as a pilot, and further research is needed to validate these findings on a larger scale.

Comparing the Treatment Outcomes of Oral and Injectable Iron Therapies for Anemia in Pregnancy: A Meta-Analysis

Comparing the Treatment Outcomes of Oral and Injectable Iron Therapies for Anemia in Pregnancy: A Meta-Analysis

467 The use of intravenous ferric carboxymaltose for iron replacement in infants with intestinal failure in the neonatal intensive care unit – a case series

467 The use of intravenous ferric carboxymaltose for iron replacement in infants with intestinal failure in the neonatal intensive care unit – a case series

Relationship between iron deficiency and severity of tuberculosis: Influence on Tcell subsets.

Tuberculosis (TB) remains a leading cause of death globally, with nearly half of TB patients experiencing iron deficiency. The role of iron supplementation as an adjunct therapy remains controversial. This study examines the impact of iron deficiency on TB progression and immune function. We conducted a case-control study involving 808 pulmonary TB patients recruited from Changzhou Third People's Hospital (2018-2022) to investigate the association between serum iron levels and TB severity. Additionally, we evaluated the relationship between baseline serum iron levels and pulmonary lesion characteristics during antituberculosis treatment using a cohort study of 89 patients. We observed that low serum iron was associated with more severe lung symptoms, decreased MAIT, Vδ2+, and Treg cell percentages, and increased interleukin-1β (IL-1β) and IL-7 levels. Findings suggest that iron deficiency may exacerbate lung lesions by altering Tcell subsets and cytokine profiles.