Dates a Food Treasure in Alleviating Anemia
Condition: Anemia, Iron Deficiency
MeSH terms: Anemia; Anemia, Iron-Deficiency; Iron Deficiencies
Study type: Interventional

Summary: 
      Introduction: In May 2016, seven villages in three governorates of Egypt were declared to be
      the first villages free from hepatitis C upon eliminating HCV virus by treatment with
      Sofosbuvir plus ribavirin (an interferon-free regimen). These patients were amounted to 2340
      cases out of 19,991 screened residents of the seven villages within three governorates of
      Egypt. Although this combination was proved effective (95 %) in treatment of HCV genotype 4
      among Egyptians, yet it resulted in anaemia with decreased quality of life for the majority
      of the treated HCV patients.

      Aim of the project: To assess and manage therapy-induced anaemia among 2340 treated chronic
      hepatitis C patients with Sofosbuvir plus ribavirin, and improving their quality of life by
      provision of a comprehensive nutritional interventions that is based on Dates fruit intake.

      Methodology: Dates fruit intake for all the diagnosed anaemic patients was provided for 16
      weeks (four months). Five pieces of Dates fruit were taken as breakfast on daily basis (each
      date fruits is about 10 -20 gm). The Dates fruit that was used was Saudi's Dates extract
      known as Barni which is organic Dates. This Barni is known for its very high nutritive value
      (vitamins, minerals and antioxidants) compared with other Dates types. This Dates was
      imported from Saudi Arabia as donation through collaboration between NRC with Taibah
      University and Sustainable Development Project in the Kingdom of Saudi Arabia (KSA). In
      addition to Dates fruit intake, nutritional education to alleviate their anaemia was also
      provided. Haemoglobin level, risk of malnutrition and health-related quality of life (HRQoL)
      were assessed in all anemic patients before and after four months of intervention.
    

Detailed description: 
      Anaemia is a condition in which the number of red blood cells or their oxygen-carrying
      capacity is insufficient to meet physiologic needs. Anemia is a condition characterized by a
      decrease in the concentration of hemoglobin in the blood. Hemoglobin is necessary for
      transporting oxygen to tissues and organs in the body. Iron deficiency is thought to be the
      most common cause of anaemia globally. Iron deficiency anemia is due to insufficient iron
      that is necessary to produce enough red blood cells that enables them to carry oxygen
      (hemoglobin). As a result, iron deficiency anemia is associated with fatigue, general body
      weakness, frequent tiredness, dizziness and lowered resistance to disease and drowsiness.
      Overall, morbidity and mortality risks increase for individuals suffering from anemia, a
      condition in which blood lacks adequate healthy red blood cells. Red blood cells carry oxygen
      to the body's tissues.

      Anemia is considered a serious public health problem worldwide with prevalence of 43% in the
      developing countries and of 9% in the developed ones. Research demonstrates that the majority
      of HCV treated patients with ribavirin became anaemic after treatment and they claimed that
      their quality of life was affected because of anaemia. Anaemia is one of the common side
      effects for Hepatitis C treated with ribavirin and remains a prominent concern. Partially,
      because Ribavirin destroys red blood cells by causing them to break open, or rupture and
      partially because of malnutrition due to the loss of appetite accompanying the treatment.
      Moreover addition of direct acting antiviral as Sofosbuvir to peginterferon plus ribavirin
      (PegIFN/RBV) increases the frequency as well as the severity, and hence, clinical relevance
      of anaemia, which has now become one of the major complications associated with hepatitis C
      therapy. Most significant factors associated with anaemia in patients receiving triple
      therapy include older age, lower body mass index (BMI), advanced fibrosis, and lower baseline
      haemoglobin.

      Hemoglobin lower than normallevels indicate anemia; The normal hemoglobin range is generally
      defined as 13.2 to 16.6 grams (g) of hemoglobin per deciliter (dL) of blood for men and 11.6
      to 15. g/dL for women. Severe anemia is manifested when Hb level is less than 8 grams (g) of
      hemoglobin per deciliter (dL) for both adult men aged 15 years and above and non- pregnant
      women aged 15 years and above Overall objective To help program planners plan regimens and
      guidelines to overcome therapy-induced anaemia with the use of functional food Objectives for
      direct beneficiaries

        1. Improving the lives of the anaemic patients by providing a set of interventions for to
           alleviate their anaemia

        2. improving participants' quality of life which was Dates fruits dependant.

      This study was conducted as three phases:

      The first phase included:

        1. Equipping the three main primary health care units by automated cell counter

        2. Training of the primary health care technicians to carry out screening for risk of
           anaemia

        3. Screening and assessing incidence of anaemia and measuring haemoglobin concentration
           (Hb) among 2341 HCV treated cases (>18 years to 70 years) followed by confirming the
           anaemic status

        4. Assessing the nutritional pattern and quality of life for the anaemic cases

      The second phase included:

        -  Development of recipe book to increase the number of nutritionally balanced meals and
           increase the frequency of iron-rich foods per week

        -  Provision of awareness and educational sessions at the community based associations for
           improving the patients' own nutrition situation through nutritional education about food
           rich in iron and counselling. Special focus will be on increasing patients' awareness
           for self-management of their status.

        -  Provision of Dates : Dates fruit intake for all the anaemic patients was provided for 16
           weeks (four months):Diagnosed anemic patients were given five pieces of Dates on daily
           basis for 16 weeks (each date fruits is about 10 -20 gm), of Dates. Dates was taken as
           breakfast on daily base.

        -  Provision of demonstration kitchen model

      the third phase was the evaluation phase for :

        1. Measuring change in the haemoglobin level

        2. Measuring the change of the nutritional habits for all anaemic cases'

        3. Measuring change of the quality of life indicators

      Monitoring process:

      A monthly monitoring sheet containing pictures and photos for the types of food was used for
      follow up of dietary habits. It was filled daily by the cases starting from the first day
      after the session for one month. Follow up was done for 6 months
    

Intervention name(s): Nutritional Education; model nutrition kitchen; recipe book; Provision of Dates
Intervention type(s): Other; Other; Other; Other
Intervention description(s): Provision of weekly awareness and educational sessions for 6 months. Sessions were conducted at the community based associations within the cases respective villages. Cases were subjected to 24 sessions for improving the patients' own nutrition situation through nutritional education about food rich in iron and counselling. The sessions focused on basic knowledge on iron deficiency anaemia, the most common presenting symptoms, iron rich dietary sources, factors that enhance and inhibit iron absorption, effects of anaemia on health and how to prevent it, Role of dates fruit in preventing and treating anaemia. Th e sessions also focused on the provision of a diverse range of local iron rich food. Special focus was on increasing patients' awareness for self-management of their status; Implementing model nutrition kitchen; once every month for six months with six sessions for each village (6 sessions/village) with cooking sessions was done to promote eating healthy and provide innovative ideas for feeding anaemic cases. 117 patients were reached by the nutritional kitchen activities with 6 sessions until the end of the project. Special focus was done on skills like sharing cooking, meal planning, and label reading that help support healthy eating patterns. Suggesting ways that individuals can model healthy eating behaviors for friends and family members that is based on Dates fruit was encouraged.; 3) Development of recipe book that is based on the local food in the market to increase the number of nutritionally balanced meals and increase the frequency of iron-rich foods per day and improve current and risky nutritional habits; Dates fruit intake for all the anaemic patients was provided for 16 weeks (four months):
• Diagnosed anemic patients were given five to seven pieces of Dates (dependent on its weight) on daily basis for 16 weeks (each date fruits is about 10 -20 gm). Dates was taken as breakfast on daily base.
The Dates fruit that was used during the proposed trial is Saudi's Dates extract know as Barni which is organic Dates. The fruit is mentioned more than 20 times in the Quran, This Barni is known for its very high nutritive value (vitamins, minerals and antioxidants) compared with other Dates types. The nutritive value of Barni is shown in the below table, calculated per every 100 gram (range 5- 10 pieces) of dry weight (DW) :
The nutritive value of Barni calculated per every 100 gram (average 7-10 pieces) of dry weight (DW) of which iron constitutes 6.78 mg that represent 67.8 % of the recommended dietary allowance (RDA) of the males and 45.20 % of the RDA of the females
Intervention model: Single Group Assignment
Intervention model description: providing Dates fruits as a potential palliative remedy to mitigate anaemia combined with nutritional education
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: HCV treated patients; Anemia; Dates