The effect of weekly iron and vitamin A supplementation on hemoglobin levels and iron status in adolescent schoolgirls in western Kenya Concomitant supplemental vitamin A enhances the response to weekly supplemental iron and folic acid in anemic teenagers in urban Bangladesh. Impact of Multi-Micronutrient Fortified Rice on Hemoglobin, Iron and Vitamin A Status of Cambodian Schoolchildren: a Double-Blind Cluster-Randomized Controlled Trial Vitamin A status and hemoglobin concentrations are improved in Indonesian children with vitamin A and deworming interventions Combined iron and zinc supplementation in infants improved iron and zinc status, but interactions reduced efficacy in a multicountry trial in southeast Asia. A micronutrient-fortified food enhances iron and selenium status of Zambian infants but has limited efficacy on zinc. Vitamin A supplementation in children with poor vitamin A and iron status increases erythropoietin and hemoglobin concentrations without changing total body iron. A micronutrient-fortified beverage prevents iron deficiency, reduces anemia and improves the hemoglobin concentration of pregnant Tanzanian women. Subclinical inflammation influences the association between vitamin A- and iron status among schoolchildren in Ghana Community-level micronutrient fortification of a food supplement in India: a controlled trial in preschool children aged 36-66 mo. Effect of maternal and neonatal vitamin A supplementation and other postnatal factors on anemia in Zimbabwean infants: a prospective, randomized study. Nutritional Consequences of Adjustable Gastric Banding and Gastric Bypass: A 1-year Prospective Study Chlorella pyrenoidosa Supplementation Reduces the Risk of Anemia, Proteinuria and Edema in Pregnant Women Anemia in older persons: etiology and evaluation. Lack of hemoglobin response to iron supplementation in anemic mexican preschoolers with multiple micronutrient deficiencies. Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, and growth in South African infants. Supplementation with iron and riboflavin enhances dark adaptation response to vitamin A-fortified rice in iron-deficient, pregnant, nightblind Nepali women. Triple fortification of salt with microcapsules of iodine, iron, and vitamin A. Supplementation with micronutrients in addition to iron and folic acid does not further improve the hematologic status of pregnant women in rural Nepal. Supplemental vitamin A improves anemia and growth in anemic school children in Tanzania. Multiple micronutrient supplements improve micronutrient status and anemia but not growth and morbidity of Indonesian infants: a randomized, double-blind, placebo-controlled trial. Efficacy of daily vs. weekly supplementation of iron in schoolchildren with low iron status. Efficacy of twice-weekly multiple micronutrient supplementation for improving the hemoglobin and micronutrient status of anemic adolescent schoolgirls in Bangladesh.
Background / Objectives : Iron deficiency anemia is a major public health problem in developing countries and may affect school performance and physical work capacity in nonpregnant adolescents , and may increase the risk of anemia during subsequent teenage pregnancies . We assessed the effect of weekly iron ( 120 mg elemental iron ) and vitamin A ( 25 000 IU ) supplementation on hemoglobin , iron status and malaria and nonmalaria morbidity in adolescent schoolgirls . Subjects/ Methods : A total of 279 schoolgirls aged 12–18 years from public primary schools in Kisumu , western Kenya . Double-blind r and omized placebo-controlled trial using a factorial design . Results : Five months of iron supplementation was associated with a 0.52 g dl−1 ( 0.21 , 0.82 ) greater increase in hemoglobin relative to iron placebo . The effect was only observed in girls with iron deficiency on enrollment ( 1.34 g dl−1 ( 0.79 , 1.88 ) ) , but not in iron-replete girls ( −0.20 g dl−1 ( −0.59 , 0.18 ) ) . Similar differences in treatment effect were seen between menstruating and nonmenstruating girls . The effect of iron was independent of vitamin A. The baseline prevalence of vitamin A deficiency was low ( 6.7 % ) and no sustained increase in hemoglobin was seen with weekly vitamin A ( −0.07 g dl−1 ( −0.38 , 0.25 ) ) . Incidence of malaria parasitemia was higher in the iron than iron-placebo groups ( Rate ratio 1.33 ( 0.94 , 1.88 ) ) . Conclusions : Weekly iron supplementation results in substantial increases in hemoglobin concentration in adolescent schoolgirls in western Kenya , which may outweigh possible risks caused by malaria , but only in iron-deficient or menstruating girls and not in iron-replete and nonmenstruating girls BACKGROUND Iron deficiency is the most common micronutrient deficiency and affects > 2 billion persons worldwide , leading to anemia in > 40 % of women of reproductive age in the developing world . OBJECTIVE The objective was to determine whether weekly supplementation with iron and folate would reduce the frequency of anemia in teenage women in urban Bangladesh before they became pregnant . DESIGN Participants with a hemoglobin concentration of 80 - 120 g/L were entered into a r and omized , double-blind , placebo-controlled trial and received supplements of placebo , vitamin A , iron + folic acid , or iron + folic acid + vitamin A weekly for 12 wk . The supplements contained 2.42 mg vitamin A ( retinol ) as retinyl palmitate , 120 mg elemental Fe as ferrous sulfate , and 3.5 mg folic acid . RESULTS Hemoglobin concentrations increased significantly more after supplementation with iron + folic acid or iron + folic acid + vitamin A than after either the placebo or vitamin A alone . There was a significantly greater increase in hemoglobin after iron + folic acid + vitamin A than after iron + folic acid , but the additional effect disappeared after adjustment for baseline hemoglobin , serum vitamin A , and ferritin and the number of supplements taken . Those with the lowest baseline hemoglobin had the greatest increase in hemoglobin . Compared with the placebo , iron + folic acid + vitamin A reduced anemia by 92 % , iron deficiency by 90 % , and vitamin A deficiency by 76 % . CONCLUSION There may be significant health benefits from a program that enhances the nutritional status of iron , folate , and vitamin A in poor urban young women before they become pregnant In Cambodia , micronutrient deficiencies remain a critical public health problem . Our objective was to evaluate the impact of multi-micronutrient fortified rice ( MMFR ) formulations , distributed through a World Food Program school-meals program ( WFP-SMP ) , on the hemoglobin concentrations and iron and vitamin A ( VA ) status of Cambodian schoolchildren . The FORISCA-UltraRice+NutriRice study was a double-blind , cluster-r and omized , placebo-controlled trial . Sixteen schools participating in WFP-SMP were r and omly assigned to receive extrusion-fortified rice ( UltraRice Original , UltraRice New ( URN ) , or NutriRice ) or unfortified rice ( placebo ) six days a week for six months . Four additional schools not participating in WFP-SMP were r and omly selected as controls . A total of 2440 schoolchildren ( 6–16 years old ) participated in the biochemical study . Hemoglobin , iron status , estimated using inflammation-adjusted ferritin and transferrin receptors concentrations , and VA status , assessed using inflammation-adjusted retinol-binding protein concentration , were measured at the baseline , as well as at three and six months . Baseline prevalence of anemia , depleted iron stores , tissue iron deficiency , marginal VA status and VA deficiency were 15.6 % , 1.4 % , 51.0 % , 7.9 % , and 0.7 % , respectively . The strongest risk factors for anemia were hemoglobinopathy , VA deficiency , and depleted iron stores ( all p < 0.01 ) . After six months , children receiving NutriRice and URN had 4 and 5 times less risk of low VA status , respectively , in comparison to the placebo group . Hemoglobin significantly increased ( + 0.8 g/L ) after three months for the URN group in comparison to the placebo group ; however , this difference was no longer significant after six months , except for children without inflammation . MMFR containing VA effectively improved the VA status of schoolchildren . The impact on hemoglobin and iron status was limited , partly by sub- clinical inflammation . MMFR combined with non-nutritional approaches addressing anemia and inflammation should be further investigated Objective : Anemia is a major public health problem caused by multiple factors . Vitamin A ( VA ) depletion can affect hemoglobin concentration ( Hb ) . This study investigated the improvement in Hb and VA status in preschool Indonesian children following supplementation with 210 μmol VA and deworming with 400 mg albendazole . Subjects and design : Indonesian children ( n=131 ) infected with Ascaris lumbricoides and /or Trichuris trichiura were enrolled . The children were grouped by length of time since receiving 210 μmol VA through the local health system . Group 1 ( VA administered ≥4 month before baseline ) included 51 children with Ascaris and 29 children with Trichuris . Group 2 had received VA ≤1 month of baseline from the local health post and included 51 children . Intervention and methods : Immediately following baseline Hb and VA status assessment ( modified relative dose response ( MRDR ) test ) , Group 1 children were given 210 μmol VA and 400 mg albendazole . Group 2 were r and omized to be dewormed either 1 week before , at the same time or 1 week after baseline MRDR and Hb measures . Follow-up assessment was 3–4 weeks after baseline . Results : VA status in Group 1 significantly improved in children with either Ascaris ( P<0.0001 ) or Trichuris ( P=0.028 ) . Although the prevalence of anemia declined , the improvement in Hb was not significant ( P=0.08 ) . In Group 2 , improvement in VA status from the VA delivered through the public health system was maintained for more than 1 month . Hb improved ( P=0.0037 ) and this improvement appeared to be associated with the length of time between deworming and follow-up assessment s. Conclusion : Public health supplementation programs to improve VA status may also increase Hb concentrations and decrease anemia prevalence , especially when linked to deworming . Sponsorship : These studies were supported by the Thrasher Research Fund , SmithKline Beecham and Hatch-Wisconsin Agricultural Experiment Station number WIS04533 Deficiencies of iron and zinc are prevalent worldwide . Interactions between these micronutrients therefore have important consequences , also for supplementation . To investigate effects on hemoglobin and zinc concentrations and interactions of iron and zinc supplementation in infants , data from 4 parallel , r and omized , placebo-controlled , double-blind trials in Indonesia , Thail and , and Vietnam were pooled . Infants ( n=2468 ) , aged 4 - 6 mo , were supplemented daily with iron ( 10 mg ) and /or zinc ( 10 mg ) for 6 mo . At 3 sites , infants were given vitamin A capsules ( VAC ) at recruitment . Combined supplementation reduced prevalences of anemia by 21 % ( P<0.01 ) and zinc deficiency by 10 % ( P<0.05 ) but was less effective ( P<0.05 ) than supplementation with either iron ( 28 % reduction in anemia ) or zinc alone ( 18 % reduction in zinc deficiency ) . Iron reduced the effect of zinc supplementation ( interaction P<0.01 ) , but had no separate effect on zinc status , whereas zinc supplementation had a negative effect on hemoglobin concentrations ( -2.5 g/L , P<0.001 ) , independent of iron supplementation ( Pinteraction=0.25 ) . The effect of iron supplementation on hemoglobin concentrations was almost twice as large in boys than in girls ( effect size 12.0 vs. 6.8 g/L , respectively ) . In infants not receiving iron , VAC administration tended to be associated with lower ( 3.2 % , P=0.07 ) hemoglobin concentrations .  Combined supplementation of iron and zinc was safe and effective in reducing the high prevalences of anemia and iron and zinc deficiencies . Zinc supplementation may negatively affect iron status but iron supplementation does not seem to affect zinc status . Furthermore , VAC administration in the absence of iron supplementation may increase the incidence of anemia Micronutrient-fortified , cereal-based infant foods are recommended for reducing multiple micronutrient deficiencies in low-income countries , but their nutritional quality is not always optimal . In a double-blind r and omized trial , we compared the efficacy of a locally produced porridge based on maize , beans , bambaranuts , and groundnuts fortified with 19 ( rich ) or 9 ( basal ) micronutrients .  Infants aged 6 mo from Lusaka , Zambia were r and omized to receive the richly fortified ( n = 373 ) or basal ( n = 370 ) porridge daily for 12 mo along with routine vitamin A supplements .  Baseline and final micronutrient status and inflammation ( based on α-1-glycoprotein ) were assessed using nonfasting blood sample s. Baseline prevalence of anemia ( 39 % ) and zinc deficiency ( 51 % ) were a public health concern . There were overall treatment effects on hemoglobin ( Hb ) ( P = 0.001 ) , serum transferrin receptor ( P < 0.001 ) , serum ferritin ( P < 0.001 ) , and serum selenium ( P = 0.009 ) ; biomarker responses for iron and zinc were modified by baseline concentrations , and for Hb and iron by socioeconomic status . At 18 mo , the adjusted odds of anemia , iron deficiency anemia ( Hb < 105 g/L and transferrin receptor > 11.0 mg/L ) , and iron deficiency were 0.37 ( 95 % CI = 0.25 , 0.55 ) , 0.18 ( 0.09 , 0.35 ) , and 0.30 ( 0.18 , 0.50 ) times those in the basal group , respectively . The rich level of fortification had no overall treatment effect on serum zinc ( 1.09 ; 0.66 , 1.80 ) but improved serum zinc in children with lower Hb concentrations at baseline ( P = 0.024 ) . A locally produced cereal- and legume-based infant food richly fortified with micronutrients  reduced anemia and improved iron and selenium status but may require reformulation to improve the biochemical zinc status of urban Zambian infants BACKGROUND Vitamin A deficiency impairs iron metabolism ; vitamin A supplementation of vitamin A-deficient population s may reduce anemia . The mechanism of these effects is unclear . In vitro and in animal models , vitamin A treatment increases the production of erythropoietin ( EPO ) , a stimulant of erythropoiesis . OBJECTIVE We measured the effect of vitamin A supplementation on hemoglobin , iron status , and circulating EPO concentrations in children with poor iron and vitamin A status . DESIGN In a double-blind , r and omized trial , Moroccan schoolchildren ( n = 81 ) were given either vitamin A ( 200,000 IU ) or placebo at baseline and at 5 mo . At baseline , 5 mo , and 10 mo , hemoglobin , indicators of iron and vitamin A status , and EPO were measured . RESULTS At baseline , 54 % of children were anemic ; 77 % had low vitamin A status . In the vitamin A group at 10 mo , serum retinol improved significantly compared with the control group ( P < 0.02 ) . Vitamin A treatment increased mean hemoglobin by 7 g/L ( P < 0.02 ) and reduced the prevalence of anemia from 54 % to 38 % ( P < 0.01 ) . Vitamin A treatment increased mean corpuscular volume ( P < 0.001 ) and decreased serum transferrin receptor ( P < 0.001 ) , indicating improved iron-deficient erythropoiesis .  Vitamin A decreased serum ferritin ( P < 0.02 ) , suggesting mobilization of hepatic iron stores . Calculated from the ratio of transferrin receptor to serum ferritin , overall body iron stores remained unchanged . In the vitamin A group at 10 mo , we observed an increase in EPO ( P < 0.05 ) and a decrease in the slope of the regression line of log10(EPO ) on hemoglobin ( P < 0.01 ) . CONCLUSION In children deficient in vitamin A and iron , vitamin A supplementation mobilizes iron from existing stores to support increased erythropoiesis , an effect likely mediated by increases in circulating EPO Maternal malnutrition continues to be a major contributor to adverse reproductive outcomes in developing countries , despite longst and ing efforts to fortify foods or to distribute medicinal supplements to pregnant women . The objective of this study was to test the effect of a micronutrient-fortified beverage containing 11 micronutrients ( iron , iodine , zinc , vitamin A , vitamin C , niacin , riboflavin , folate , vitamin B-12 , vitamin B-6 and vitamin E ) on the hemoglobin , iron and vitamin A status of pregnant women in Tanzania . A group of 259 pregnant women with gestational ages of 8 to 34 wk were enrolled in a r and omized double-blind controlled trial in which study women received 8 wk of supplementation .  Hemoglobin , ferritin and dried blood spot retinol were measured at baseline and at the end of the supplementation period . The supplement result ed in a 4.16 g/L increase in hemoglobin concentration and a 3 micro g/L increase in ferritin and reduced the risk of anemia and iron deficiency anemia by 51 and 56 % , respectively . The risk of iron deficiency was reduced by 70 % among those who had iron deficiency at baseline and by 92 % among those who had adequate stores . The micronutrient-fortified beverage may be a useful and convenient preventative measure , one that could help improve the nutritional status of women both before and during pregnancy and thereby help avoid some of the potential maternal and fetal consequences of micronutrient deficiencies Background and objective In re source -poor setting s , micronutrient deficiencies such as vitamin A deficiency may co-exist with iron-deficiency . In this study we assessed the iron and vitamin A status of schoolchildren and the association between vitamin A and iron status . Methods A cross-sectional design using the baseline data of a dietary intervention trial conducted among r and omly selected 5–12 years old schoolchildren ( n = 224 ) from 2 rural schools in northern Ghana .  Hemoglobin ( Hb ) , serum ferritin ( SF ) and serum transferrin receptor ( sTfR ) concentrations were used as measures of iron status . Retinol binding protein ( RBP ) was used as a measure of vitamin A status . Sub clinical inflammation ( SCI ) was measured using C-reactive protein ( CRP ) and α1-acid glycoprotein ( AGP ) concentrations . We examined the cross-sectional association between vitamin A and iron status biomarkers with multiple linear regressions . Results The proportions of schoolchildren with anemia ( WHO criteria ) , iron-deficiency ( ID , SF < 15μg/l and /or sTfR > 8.5mg/l ) and  iron-deficiency anemia  ( IDA , concurrent anemia and ID ) were 63.8 % , 68.3 % and 46.4 % respectively . Low or marginal vitamin A status ( 0.70 μmol/l ≤ RBP < 1.05μmol/l ) was present in 48.2 % while 37.5 % of the schoolchildren had vitamin A deficiency ( VAD , RBP < 0.70 μmol/l ) . The prevalence of SCI as well as concurrent VAD and ID were 48.7 % and 25 % respectively . RBP was associated with Hb ( β = 7.2 , P = 0.05 ) but not SF ( β = 20.7 , P = 0.33 ) and sTfR concentration ( β = 12.0 , P = 0.63 ) . In the presence of SCI , RBP was not associated with hemoglobin status but a significant positive association was observed among children without SCI . Conclusions The study shows that RBP is significantly associated with Hb concentration but not with SF and sTfR. The observed relationship between RBP and Hb is only significant in the absence of SCI BACKGROUND Children participating in the Integrated Child Development Service ( ICDS ) in India have high rates of iron and vitamin A deficiency . OBJECTIVE The objective was to assess the efficacy of a premix fortified with iron and vitamin A and added at the community level to prepared khichdi , a rice and dal mixture , in increasing iron and vitamin A stores and decreasing the prevalence of iron deficiency , anemia , and vitamin A deficiency . DESIGN This cluster , r and omized , double-blind , controlled trial was initiated in 30 Anganwadi centers ( daycare centers ) in West Bengal state , India . Children aged 36 - 66 mo ( n = 516 ) attending village-based ICDS centers were r and omly assigned to receive either a fortified or a nonfortified premix for 24 wk . Blood was drawn at 0 and 24 wk by venipuncture for the measurement of hemoglobin , serum ferritin , and serum retinol . RESULTS The change in the hemoglobin concentration of anemic children was significantly different between fortified and nonfortified khichdi groups ( P < 0.001 ) . Prevalence rates of anemia , iron deficiency , and iron deficiency anemia were significantly lower after 24 wk in the fortified-khichdi group than in the nonfortified-khichdi group ( P < 0.001 ) . There were no significant differences in serum retinol concentrations or in the prevalence of vitamin A deficiency between the fortified- and nonfortified-khichdi groups . CONCLUSION A premix fortified with iron , vitamin A , and folic acid and added to supplementary food at the community level can be effective at increasing iron stores and reducing the prevalence of iron deficiency and anemia BACKGROUND Anemia is prevalent in infants in developing countries . Its etiology is multifactorial and includes vitamin A deficiency . OBJECTIVE Our primary aim was to measure the effect of maternal or neonatal vitamin A supplementation ( or both ) on hemoglobin and anemia in Zimbabwean infants . Our secondary aim was to identify the underlying causes of postnatal anemia . DESIGN A r and omized , placebo-controlled trial was conducted in 14 110 mothers and their infants ; 2854 infants were r and omly selected for the anemia sub study , of whom 1592 were successfully observed for 8 - 14 mo and formed the study sample . Infants were r and omly assigned within 96 h of delivery to 1 of 4 treatment groups : mothers and infants received vitamin A ; mothers received vitamin A and infants received placebo ; mothers received placebo and infants received vitamin A ; and mothers and infants received placebo . The vitamin A doses were 400,000 and 50,000 IU in the mothers and infants , respectively . RESULTS Vitamin A supplementation had no effect on hemoglobin or anemia ( hemoglobin < 105 g/L ) in unadjusted or adjusted analyses . Infant HIV infection independently increased anemia risk > 6-fold . Additional predictors of anemia  in HIV-negative and -positive infants were male sex and lower total body iron at birth . In addition , in HIV-positive infants , the risk of anemia increased with early infection , low maternal CD4 + lymphocyte count at recruitment , and frequent morbidity . Six-month plasma ferritin concentrations < 12 microg/L were a risk factor in HIV-negative but not in HIV-positive infants . Maternal HIV infection alone did not cause anemia . CONCLUSION Prevention of infantile anemia should include efforts to increase the birth endowment of iron and prevent HIV infection Background Gastric bypass ( GBP ) is more efficient than adjustable gastric b and ing ( AGB ) on weight loss and comorbidities , but potentially induces more nutritional deficits . However , no study has compared the prevalence of nutritional deficiencies after these two bariatric procedures .We prospect ively comparedTo prospect ively compare the prevalence of nutritional deficiencies after AGB and GBP . Methods We have performed a 1-year prospect i ve study of nutritional parameters in 70 consecutive severe obese patients , who had undergone bariatric surgery , 21 AGB and 49 GBP .  After GBP , multivitamin supplements were systematic ally prescribed and vitamin B12 supplementation was introduced if a deficiency was observed . Results Patients lost more weight after GBP than after AGB ( 40 ± 13 vs 16 ± 8 kg , p < 0.001 ) . Vitamins B1 and C and iron deficiencies were frequent before surgery but were not worsened by GBP . AGB only induced a slight decrease of vitamin B1 at 1 year , whereas GBP induced significant decreases of vitamins B12 and E , serum prealbumin , and creatinine concentrations , with only minor clinical consequences . Anemia was observed in 10 % of the patients after bariatric surgery . Hemoglobin concentration was not correlated to vitamin B12 or folate concentrations but was related to iron status . Risk of iron deficiency anemia was better assessed by transferrin saturation than by serum ferritin concentration in this obese population . ConclusionS evere nutritional deficits can be avoided after bariatric surgery if patients are systematic ally supplemented with multivitamin and carefully monitored . However , specific care is required to avoid iron and vitamin B12 deficiencies , anemia , and protein malnutrition Pregnancy anemia and pregnancy-induced hypertension ( PIH ) are common and potentially dangerous disorder in human pregnancy , and nutritional status of pregnant women is one of the leading causes . Chlorella contains large quantities of folate , vitamin B-12 and iron , and can help improve anemia and hypertensive disorder . Our objective was to investigate the preventive effects of Chlorella supplement on pregnancy anemia and PIH in Japanese pregnant women . A total of 70 pregnant women were placed into the  control group  ( n = 38 ) or the Chlorella group ( n = 32 ) . The subjects in the Chlorella group were supplemented daily from 12th–18th wk of gestation until delivery with 6 g of Chlorella supplement . The proportion of anemic ( hemoglobin level < 11 g/dL ) subjects in the Chlorella group were significantly lower compared with the control group at the second and third trimesters . Additionally , in the Chlorella group , the incidences of proteinuria and edema , signs of PIH , were significantly lower during the third trimester . These results suggest that Chlorella supplementation significantly reduces the risk of pregnancy associated anemia , proteinuria and edema .  Chlorella supplement may be useful as a re source of natural folate , vitamin B-12 and iron for pregnant women The aim of this study was to prospect ively determine the etiology of anemia in a cohort of community-dwelling older out patients with a comprehensive hematologic evaluation . Participants were men and women age 65 and older with anemia as defined by World Health Organization criteria recruited from outpatient hematology clinics at Stanford Hospital and Clinics ( SHC ) and Veterans Affairs Palo Alto Health Care System ( VAPAHCS ) . Each participant underwent a history and physical examination , followed by a comprehensive hematologic evaluation  , which in all participants included  complete blood count , red cell indices , review of the blood smear ,  and  assessment of vitamin B12 , folate , iron status and renal function .  Additional evaluation was obtained by clinical providers as per their discretion . 190 participants enrolled and completed the evaluation . Twelve percent of participants had iron deficiency anemia . Of those with iron deficiency in whom there was follow-up information , half normalized their hemoglobin in response to iron repletion , and half did not . Thirty-five percent of participants had unexplained anemia . Those with unexplained anemia had mildly increased inflammatory markers compared to non-anemic controls , and , at the lower hemoglobin ranges had relatively low erythropoietin levels . Sixteen percent of participants were categorized as being " suspicious for myelodysplastic syndrome . " Thus , even with comprehensive hematologic evaluation , unexplained anemia is common in older anemic out patients . Iron deficiency anemia is also common and can be difficult to diagnose , and frequently the anemia is not fully corrected with iron repletion BACKGROUND In developing countries , incomplete resolution of anemia with iron supplementation is often attributed to poor compliance or inadequate duration of supplementation , but it could result from deficiencies of other micronutrients . OBJECTIVE Our objective was to assess children 's hematologic  response to supervised , long-term iron supplementation and the relation of this response to other micronutrient deficiencies , anthropometry , morbidity , and usual dietary intake . DESIGN Rural Mexican children aged 18 - 36 mo ( n = 219 ) were supplemented for 12 mo with either 20 mg Fe , 20 mg Zn , both iron and zinc , or placebo . Children were categorized as iron-unsupplemented ( IUS ; n = 109 ) or iron supplemented ( IS ; n = 108 ) . Hemoglobin , hematocrit , mean corpuscular volume , mean cell hemoglobin , plasma concentrations of micronutrients that can affect hematopoiesis , anthropometry , and diet were assessed at 0 , 6 , and 12 mo ; morbidity was assessed biweekly . RESULTS At baseline , 70 % of children had low hemoglobin ( < /=115 g/L ) , 60 % had low hematocrit , 48 % were ferritin deficient , 10 % had deficient and 33 % had low plasma vitamin B-12 concentrations , 29 % had deficient vitamin A concentrations , and 70 % had deficient vitamin E concentrations . Iron supplementation increased ferritin from 11 + /- 14 microg/L at baseline to 31 + /- 18 microg/L after 6 mo ( P < 0.001 ) and 41 + /- 17 microg/L after 12 mo . However , anemia persisted in 30 % and 31 % of supplemented children at 6 and 12 mo , respectively , and was not significantly different between the IUS and IS groups at 12 mo . Initial plasma vitamin B-12 , height-for-age , and dietary quality predicted the hematopoietic response to iron . CONCLUSION Lack of hemoglobin response to iron was associated with indicators of chronic undernutrition and multiple micronutrient deficiencies Growth faltering , anemia , and multiple micronutrient deficiency are common during infancy in developing countries . This South African trial was part of a multicenter study aim ed at testing the efficacy of multiple micronutrient supplementation on growth , anemia , micronutrient status , and morbidity during infancy across 4 countries . A total of 265 infants aged 6 - 12 mo were individually r and omized to 1 of 4 intervention groups : a daily multiple micronutrient supplement ( DMM ) , a daily placebo supplement ( P ) ; a multiple micronutrient supplement 1 d of the week and placebo supplement on the other days of the week ( WMM ) , and a daily iron supplement ( DI ) . For 6 mo , the blinded supplements were provided to mothers at monthly health clinic sessions , and consumption was verified during weekly household visits by community health workers , when morbidity was also checked . Weight and height of the infants were measured monthly , and blood sample s were taken at the beginning and at the end for assessing the infants micronutrient status . There were no significant differences in nutritional status of the groups at baseline with 40 % of infants with anemia ( hemoglobin < 110 g/L ) , 16 % vitamin A deficiency ( plasma retinol < 0.7 micromol/L ) , 47 % zinc deficiency ( plasma zinc < 10.7 micromol/L ) , 2 % underweight , and 11 % stunting . There was no difference in growth or morbidity between the micronutrient supplemented groups and the P group during the 6-mo study . The DMM was the most effective intervention tested , not only for improving anemia but also for improving iron , zinc , riboflavin , and tocopherol status BACKGROUND Nightblindness affects 16 - 52 % of pregnant women in areas of Nepal and in some cases persists after vitamin A treatment . Iron and riboflavin affect vitamin A utilization and photoreceptor function , respectively , and pilot data in the study population showed a high prevalence of iron and riboflavin deficiencies . OBJECTIVE The objective was to assess the effect of supplemental iron and riboflavin on pupillary threshold ( PT ) and plasma retinol in nightblind , pregnant Nepali women given vitamin A-fortified rice . DESIGN Nightblind pregnant women were r and omly assigned to receive , 6 d/wk under supervision for 6 wk , a vitamin A-fortified rice curry dish providing 850 microg retinal activity equivalents/d with either a 30-mg Fe and 6-mg riboflavin ( FeR + VA ) capsule or a placebo control ( VA only ) capsule . Hemoglobin , erythrocyte riboflavin , and plasma ferritin and retinol were measured before and after the intervention . Dark adaptation was assessed by PT score . RESULTS Women who were iron deficient at baseline ( n=38 ) had significantly greater improvement in PT score with  iron and riboflavin supplementation  than without ( P=0.05 ) . Iron and riboflavin supplements significantly reduced the prevalences of riboflavin deficiency ( from 60 % to 6 % ; P<0.0001 ) , iron deficiency anemia ( from 35 % to 15 % ; P<0.007 ) , and abnormal PT ( from 87 % to 30 % ; P<0.05 ) from baseline . Mean increases in erythrocyte riboflavin ( P<0.0001 ) and plasma ferritin ( P=0.01 ) were greater in the FeR + VA group than in the VA only group . CONCLUSIONS Iron deficiency may limit the efficacy of vitamin A to normalize dark adaptation in pregnant Nepali women . Further studies are needed to assess the effect of simultaneous delivery of iron and vitamin A for the treatment of nightblindness BACKGROUND In many developing countries , children are at high risk of goiter , vitamin A deficiency , and iron deficiency anemia . OBJECTIVE We aim ed to develop a stable , efficacious salt fortified with iodine , iron , and vitamin A. DESIGN A novel spray-cooling technique was used with hydrogenated palm oil to package potassium io date , micronized ferric pyrophosphate , and retinyl palmitate into microcapsules ( mean particle size : 100 mum ) . We used the microcapsules to create triple-fortified salt ( TFS ) with 30 mug I , 2 mg Fe , and 60 mug vitamin A/g salt . After storage trials , we compared the efficacy of TFS with that of iodized salt in a 10-mo , r and omized , double-blind trial in goitrous schoolchildren ( n = 157 ) who had a high prevalence of vitamin A deficiency and iron deficiency anemia . RESULTS After storage for 6 mo , losses of iodine and vitamin A from the TFS were approximately 12 - 15 % , and color was stable . In the TFS group , mean hemoglobin increased by 15 g/L at 10 mo ( P < 0.01 ) , iron status indexes and body iron stores improved significantly ( P < 0.05 ) , and mean serum retinol , retinol-binding protein , and the ratio of retinol-binding protein to prealbumin increased significantly ( P < 0.01 ) . At 10 mo , prevalences of vitamin A deficiency and iron deficiency anemia were significantly lower in the TFS group than in the iodized salt group ( P < 0.001 ) . CONCLUSION Newly developed microcapsules containing iodine , iron , and vitamin A are highly stable when added to local African salt . TFS was efficacious in reducing the prevalence of iron , iodine , and vitamin A deficiencies in school-age children Iron deficiency is one of the main causes of anemia during pregnancy , although other micronutrient deficiencies may play a role . We examined the effects of daily antenatal and postnatal supplementation with four combinations of micronutrients on  maternal hematologic indicators  in a double-masked r and omized controlled community trial . Communities , called sectors , were r and omly assigned to supplementation with folic acid ( 400 microg ) , folic acid plus iron ( 60 mg ) , folic acid plus iron and zinc ( 30 mg ) and folic acid plus iron , zinc and 11 other micronutrients , each at the approximate recommended daily allowance for pregnancy all given with vitamin A as retinol acetate ( 1000 microg retinol equivalent ) , or vitamin A alone as the control group .  Hemoglobin ( Hb ) and indicators of iron status were assessed at baseline and at 32 wk of gestation . At 6-wk postpartum , Hb assessment was repeated using a finger stick . Severely anemic women ( Hb < 70 g/L ) were treated according to WHO recommendations . Folic acid alone had no effect on maternal anemia or iron status . Hb concentrations were 14 g/L , [ 95 % confidence limits ( CL ) , 8.3 - 19.2 ] , 10.0 g/L ( CL , 5.2 - 14.8 ) and 9.4 g/L ( CL , 4.7 - 14.1 ) higher in the groups receiving folic acid plus iron , folic acid plus iron and zinc and folic acid plus iron , zinc and multiple micronutrients , respectively , relative to the control . Anemia in the third trimester was reduced by 54 % with folic acid plus iron , by 48 % with folic acid plus iron and zinc and by 36 % with folic acid plus iron , zinc and multiple micronutrients supplementation , relative to the control ( P < 0.05 ) . Thus , the combinations of folic acid plus iron and zinc and folic acid plus iron , zinc and multiple micronutrients provided no additional benefit in improving maternal hematologic status during pregnancy compared with folic acid plus iron . The level of compliance and baseline Hb concentrations modified the effect of iron We conducted a r and omized controlled trial of the effects of dietary supplements on anemia , weight and height in 136 anemic school children from a low socioeconomic background in Bagamoyo District schools in Tanzania . The aim of the current study was to investigate the impact of dietary supplements on anemia and anthropometric indices of anemic school children . The supplements were vitamin A alone , iron and vitamin A , iron alone or placebo , administered in a double-blinded design for 3 mo . All supplements were provided with local corn meals .  Hemoglobin concentration , body weight and height were measured at baseline and at follow-up after supplementation . Vitamin A supplementation increased the mean hemoglobin concentration by 13.5 g/L compared with 3.5 g/L for placebo [ P < 0.0001 , 95 % confidence interval ( CI ) 6.19 - 13.57 ) , the mean body weight by 0.6 kg compared with 0.2 kg for placebo ( P < 0.0001 , 95 % CI 0.19 - 0.65 ) and the mean height by 0.4 cm compared with 0.1 cm for placebo ( P = 0.0009 , 95 % CI 0.08 - 0.42 ) . However , the group of children who received combined vitamin A and iron supplementation had the greatest improvements in all indicators compared with placebo ( 18.5 g/L , P < 0.0001 , 95 % CI 14.81 - 22.23 ; 0.7 kg , P < 0 . 0001 , 95 % CI 0.43 - 0.88 and 0.4 cm , P < 0.0001 , 95 % CI 0.22 - 0.56 for hemoglobin , weight and height , respectively ) . It is likely that vitamin A supplementation may have a useful role in combating the problems of vitamin A deficiency and anemia , as well as in improving children 's growth , in developing countries Multiple micronutrient deficiencies are highly prevalent in Indonesia , but the interventions are still focused on single micronutrients . This study aim ed to investigate the efficacy of multiple micronutrient supplements for improving micronutrient status , anemia , growth , and morbidity of Indonesian infants . In this double-blind , placebo-controlled trial , 284 infants aged 6 - 12 mo were r and omly allocated to 4 treatment groups for 23 wk ; 260 ( 92 % ) infants completed the study . Group 1 ( DMM ) received one adequate intake of multiple micronutrient supplements daily ( n = 66 ) ; group 2 ( WMM ) received 2 adequate intakes of multiple micronutrient on 1d plus 6 d of placebo ( n = 60 ) ; group 3 ( DI ) received 10 mg of iron supplement daily ( n = 69 ) ; group 4 received a placebo supplement daily ( n = 65 ) . Blood sample s were collected at baseline and at posttreatment to assess anemia and micronutrient status . Anthropometric measurements were taken monthly , and morbidity was recorded daily . At baseline , 58.1 % of infants were anemic , 34.2 % were iron deficient , 21.3 % were vitamin A deficient , and 11 % were zinc deficient . The DMM and DI supplements both corrected iron deficiency , but DMM supplements were more efficacious in improving hemoglobin levels of anemic infants than the other supplements . However , anemia still persisted in one-third of DMM infants posttreatment . The DMM supplement was more efficacious than WMM or DI supplementation in improving infant status of other micronutrients , including zinc , tocopherol , and riboflavin , whereas DI exacerbated zinc deficiency . There were no significant differences in growth and morbidity among treatment groups , and growth faltering was not prevented 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 BACKGROUND Although iron deficiency is a major cause of anemia , other micronutrient deficiencies may also play a role . OBJECTIVE We examined whether multiple micronutrient supplementation is more efficacious than is supplementation with iron and folic acid alone for improving the hemoglobin and iron status of anemic adolescent girls in Bangladesh . DESIGN Anemic ( hemoglobin < 12.0 g/dL ) girls ( n = 197 ) aged 14 - 18 y from rural schools in Dhaka District were entered into a r and omized double-blind trial and received twice-weekly supplements of iron and folic acid ( IFA group ) or multiple micronutrients ( 15 micronutrients , including iron and folic acid ; MMN group ) for 12 wk . RESULTS At recruitment , the characteristics of the girls in the 2 groups were not significantly different , except for family size and body mass index . At the end of the study , although both groups benefited significantly from supplementation , mean changes in hemoglobin and serum ferritin concentrations were not significantly different between groups . Compared with the IFA group , girls in the MMN group had significantly greater increases in mean serum vitamin A , plasma vitamin C , red blood cell folic acid , and riboflavin concentrations ( assessed as erythrocyte glutathione reductase activation coefficient ) . After 12 wk of supplementation , only the prevalence of vitamins A and C and riboflavin deficiencies decreased more significantly in the MMN group than in the IFA group . CONCLUSIONS Twice-weekly MMN supplementation for 12 wk significantly improved the status of the micronutrients assessed but was not more efficacious than was supplementation with iron and folic acid alone in improving the hematologic status of anemic adolescent girls . More frequent doses may be needed to achieve full benefit
Therefore , vitamin A supplementation alone may reduce the risk of anemia , by improving hemoglobin and ferritin levels in individuals with low serum retinol levels
ABSTRACT Anemia is a worldwide public health problem that can be related to many causes , including vitamin A deficiency .
The aim of this study was to assess and estimate the effect of vitamin A supplementation ( VAS ) on iron status biomarkers and anemia in humans .