title: Addition of microencapsulated iron to iodized salt improves the efficacy of iodine in goitrous, iron-deficient children: a randomized, double-blind, controlled trial. A randomized controlled clinical trial of increased dietary iron in breast-fed infants. The effects of short-term oral iron therapy on developmental deficits in iron-deficient anemic infants. Supplemental vitamin A improves anemia and growth in anemic school children in Tanzania. Iron deficiency anemia and educational achievement. Once weekly is superior to daily iron supplementation on height gain but not on hematological improvement among schoolchildren in Thailand. Redistribution of vitamin A after iron supplementation in Indonesian infants. Lack of hemoglobin response to iron supplementation in anemic mexican preschoolers with multiple micronutrient deficiencies. Iron supplementation improves iron status and reduces morbidity in children with or without upper respiratory tract infections: a randomized controlled study in Colombo, Sri Lanka. Iron supplementation improves appetite and growth in anemic Kenyan primary school children. Iron supplementation and physical growth of rural Indonesian children. Treatment of iron deficiency in goitrous children improves the efficacy of iodized salt in Côte d'Ivoire. Efficacy and trial effectiveness of weekly and daily iron supplementation among pregnant women in rural Bangladesh: disentangling the issues. Iron intake and iron nutritional status of infants fed iron-fortified beikost with meat. Hematological effect of supplementing anemic children with vitamin A alone and in combination with iron. Effective community intervention to improve hemoglobin status in preschoolers receiving once-weekly iron supplementation. School-administered weekly iron-folate supplements improve hemoglobin and ferritin concentrations in Malaysian adolescent girls. Effect of iron-fortified candies on the iron status of children aged 4-6 y in East Jakarta, Indonesia. A community-based randomized controlled trial of iron and zinc supplementation in Indonesian infants: interactions between iron and zinc. Effects of iron and zinc supplementation in Indonesian infants on micronutrient status and growth. Effect of improved vitamin A status on response to iron supplementation in Pakistani infants. A preliminary simulated iron fortification trial in South Indian preschool children. Iron, but not folic acid, combined with effective antimalarial therapy promotes haematological recovery in African children after acute falciparum malaria. Randomized, placebo-controlled trial of iron supplementation in infants with low hemoglobin levels fed iron-fortified formula. Impact of iron supplementation and deworming on growth performance in preschool Beninese children Hematologic and selenium status of low-birth-weight infants fed formulas with and without iron. Preliminary findings on iron supplementation and learning achievement of rural Indonesian children. Effects of iron deficiency on attention and learning processes in preschool children: Bandung, Indonesia. Effects of iron supplementation and anthelmintic treatment on motor and language development of preschool children in Zanzibar: double blind, placebo controlled study Randomized, controlled trial of daily iron supplementation and intermittent sulfadoxine-pyrimethamine for the treatment of mild childhood anemia in western Kenya. The effect of iron in formula milk after 6 months of age. School-administered weekly iron supplementation – Effect on the growth and hemoglobin status of non-anemic Bolivian school-age children
  A randomized placebo-controlled trial Effects of an energy and micronutrient supplement on growth and activity, correcting for non-supplemental sources of energy input in undernourished children in Indonesia Randomised placebo-controlled trial of iron supplementation and malaria chemoprophylaxis for prevention of severe anaemia and malaria in Tanzanian infants Controlled, double-blind, multicenter clinical trial of iron protein succinylate in the treatment of iron deficiency in children. Iron Nutrition and Growth of Breast- and Formula‐Fed Infants During the First 9 Months of Life Iron deficiency anemia: adverse effects on infant psychomotor development. Haemoglobin fortified cereal: a source of available iron to breast-fed infants. Effect of daily iron supplementation on iron status, cell-mediated immunity, and incidence of infections in 6–36 month old Togolese children Reversal of developmental delays in iron-deficient anaemic infants treated with iron Iron fortification of infant milk formula: the effect on iron status and immune function. Improvements in growth following iron supplementation in young Kenyan school children. Chronic iron intake and diarrhoeal disease in infants. A field study in a less-developed country. Does iron therapy benefit children with severe malaria-associated anaemia? A clinical trial with 12 weeks supplementation of oral iron in young children from the Turiani Division, Tanzania. Identification of an appropriate strategy to control anemia in adolescent girls of poor communities. Iron fortified follow on formula from 9 to 18 months improves iron status but not development or growth: a randomised trial The effect of riboflavin on the hematologic changes in iron supplementation of schoolchildren. Effectiveness of iron-fortified infant cereal in prevention of iron deficiency anemia. Effects of three different iron supplementations in term healthy infants after 5 months of life. Treatment with iron increases weight gain and psychomotor development. Impact of iron supplementation on cognitive functions in preschool and school-aged children: the Indian experience. Follow‐on formula in the prevention of iron deficiency: a multicentre study The effectiveness of weekly iron supplementation regimen in improving the iron status of Chinese children and pregnant women. Running performance in Gambian children: effects of water-soluble vitamins or iron. Feeding iron-fortified premature formula during initial hospitalization to infants less than 1800 grams birth weight. Mildly anaemic toddlers respond to iron. The impact of weekly iron supplementation on the iron status and growth of adolescent girls in Tanzania. The relative effectiveness of iron and iron with riboflavin in correcting a microcytic anaemia in men and children in rural Gambia. The effect of oral iron therapy during treatment for Plasmodium falciparum malaria with sulphadoxine-pyrimethamine on Malawian children under 5 years of age. Prevention of iron deficiency and psychomotor decline in high-risk infants through use of iron-fortified infant formula: a randomized clinical trial. Iron deficiency and educational achievement in Thailand. Interactions between Infections, Malnutrition and Ironnutritional Status in Pakistani Infants A Longitudinal Study Management of severe malarial anaemia in Gambian children. Studies in iron supplementation of preschool children. Effect of daily and intermittent iron supplementation on iron status of high school girls. Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls Iron nutrition in infancy: effect of an iron-fortified milk formula. Supplementation with iron and folic acid enhances growth in adolescent Indian girls. Iron supplementation of breast-fed Honduran and Swedish infants from 4 to 9 months of age. Growth performance in anemia and following iron supplementation.
abstract: OBJECTIVE In many developing countries , children are at high risk for both goiter and anemia . Iron ( Fe ) deficiency adversely effects thyroid metabolism and reduces efficacy of iodine prophylaxis in areas of endemic goiter . The study aim was to determine if co-fortification of iodized salt with Fe would improve efficacy of the iodine in goitrous children with a high prevalence of anemia . DESIGN AND METHODS In a 9-month , r and omized , double-blind trial , 6 - 15 year-old children ( n=377 ) were given iodized salt ( 25 microg iodine/g salt ) or dual-fortified salt with iodine ( 25 microg iodine/g salt ) and Fe ( 1 mg Fe/g salt , as ferrous sulfate microencapsulated with partially hydrogenated vegetable oil ) . RESULTS In the dual-fortified salt group , hemoglobin and Fe status improved significantly compared with the iodized salt group ( P<0.05 ) . At 40 weeks , the mean decrease in thyroid volume measured by ultrasound in the dual-fortified salt group ( -38 % ) was twice that of the iodized salt group ( -18 % ) ( P<0.01 ) . Compared with the iodized salt group , serum thyroxine was significantly increased ( P<0.05 ) and the prevalence of hypothyroidism and goiter decreased ( P<0.01 ) in the dual-fortified salt group . CONCLUSION Addition of encapsulated Fe to iodized salt improves the efficacy of iodine in goitrous children with a high prevalence of anemia Six-month-old breast-fed infants were r and omly allocated to a high iron ( 8.2 + /- 2.9 mg/day , n = 36 ) weaning diet or a control group ( 5.2 + /- 3.4 mg/day , n = 26 ) . We could detect no effect of increased iron intake from weaning foods on iron status of these iron-sufficient infants at 12 months To assess the effects of iron therapy on developmental test scores in infants with iron deficiency anemia , 68 Guatemalan babies 6 to 24 months of age , with and without mild iron deficiency anemia , were tested with the Bayley Scales of Infant Development before and after one week of oral iron treatment . The two major findings of the study were developmental deficits in the anemic group prior to treatment , and lack of rapid improvement with short-term oral iron therapy . The mean pretreatment Mental Development Index of the anemic group was significantly lower than that of nonanemic infants . The anemic group 's pretreatment Psychomotor Development Index was also lower than that of the nonanemic control group . In a double-blind r and omized study , six to eight days of oral iron therapy did not reverse these deficits . Consequently , the deficits of the anemic group can not be unequivocably attributed to iron lack . However , no significant differences were found between anemic and nonanemic groups in birth histories , socioeconomic level , or general nutritional status which might otherwise explain the lower developmental test scores of the anemic babies 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 The present study investigates the effect of iron supplementation on measures of school performance among 78 iron-deficient anemic and 41 nonanemic children in an economically deprived rural area in Central Java , Indonesia . All the subjects were treated for ancylostomiasis before iron supplementation . They were r and omly assigned to either an iron or placebo group . Hematological and behavioral measurements were obtained immediately before ( T1 ) and after ( T2 ) the iron and placebo treatments . Iron treatment for a 3-mo period result ed in substantive increases in mean Hgb , Hct , and transferrin saturation among the iron-deficient anemic children . Furthermore , changes in the iron status of iron-deficient anemic children were associated with significant changes in the school achievement test scores of iron-deficient anemic children . T2 evaluation of achievement test scores indicated that the difference between iron-treated anemic and nonanemic children was still statistically significant . However , when T1 scores were entered as a covariate , iron-deficient anemic subjects treated with iron obtained significantly higher delta achievement scores . Findings from the present study indicate that iron supplementation among iron-deficient anemic children benefits learning processes as measured by the school achievement test scores Intermittent iron supplementation has been suggested as a replacement for daily iron supplements for reducing anemia in developing countries . The effects of once weekly and daily iron supplementation on hemoglobin ( Hb ) , serum ferritin ( SF ) , prevalence of anemia , weight and height are compared in this study . Primary schoolchildren ( n = 397 ) from two selected schools in the Hat Yai rural area , southern Thail and , were recruited in 1999 . All children received Albendazole and then r and omly received ferrous sulfate ( 300 mg/tablet ) either daily or weekly , or a placebo for 16 wk . The average increase in Hb was not significantly different between the daily ( mean + /- SD ; 6.5 + /- 6.0 g/L ) and weekly ( 5.7 + /- 6.3 g/L ) groups . However , the average increase in SF was greater ( P < 0.01 ) in the daily ( mean + /- SD ; 39.8 + /- 30.3 microg/L ) than the weekly ( 13.4 + /- 17.3 microg/L ) group . All cases of iron deficiency anemia were abolished in both daily and weekly groups , whereas no reduction in prevalence occurred in the placebo group . Height gain was greater in children who received weekly ( mean + /- SD ; 2.6 + /- 0.9 cm ) than in those who received daily iron ( mean + /- SD ; 2.3 + /- 0.8 cm ) , ( P < 0.01 ) . Weight gain , weight-for-age and height-for-age were not significantly different among the intervention groups . It is concluded that a weekly iron dose is more effective than a daily dose in height gain but not in hematological improvement over 16 wk of supplementation BACKGROUND Deficiencies of iron and vitamin A are prevalent worldwide . Single-micronutrient supplementation is widely used to combat these deficiencies . However , micronutrient deficiencies often occur concurrently , and there are many interactions between micronutrients . OBJECTIVE This study investigated interactions among 3 important micronutrients -- iron , vitamin A , and zinc -- when they are given as supplements . DESIGN In a r and omized , double-blind , placebo-controlled supplementation trial , 387 Indonesian infants aged 4 mo were supplemented 5 d/wk for 6 mo with 10 mg Fe , 10 mg Zn , 2.4 mg beta-carotene , 10 mg each of Fe and Zn , 10 mg Zn + 2.4 mg beta-carotene , or placebo . Complete data on micronutrient status , including hemoglobin , ferritin , retinol , zinc , and the modified relative dose response ( a measure of liver retinol stores ) , were available from 256 infants at the end of the study . RESULTS Iron-supplemented infants had significantly lower plasma retinol concentrations and a significantly higher prevalence of vitamin A deficiency , as defined by a plasma retinol concentration < 0.70 micromol/L , than did the non-supplemented infants . In contrast , the modified relative dose response of the iron-supplemented infants indicated greater liver stores of vitamin A.  Iron supplementation improved iron status , and zinc supplementation improved zinc status , but beta-carotene supplementation did not significantly improve vitamin A status . CONCLUSIONS In this study , iron supplementation in infants with marginal vitamin A status led to lower plasma vitamin A concentrations and simultaneously to greater vitamin A liver stores . This implies a redistribution of retinol after iron supplementation , which might induce vitamin A deficiency . Therefore , iron supplementation in infants should be accompanied by measures to improve vitamin A status 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 BACKGROUND Iron deficiency anemia and recurrent infections are common among children of low socioeconomic status . OBJECTIVE The objective was to evaluate the effects of iron supplementation on iron status and morbidity in children with or without infection . DESIGN Children aged 5 - 10 y were recruited for a r and omized , controlled , double-blind study from out patients attending the Children 's Hospital , Colombo , Sri Lanka . Clinical , inflammatory , nutritional , and iron statuses were determined at baseline and after the intervention . Children with a history of recurrent upper respiratory tract infections ( URTIs ) and with laboratory and clinical evidence of a current URTI constituted the infection group ( n = 179 ) , and children without infection constituted the control group ( n = 184 ) . Subjects in both groups were supplemented with ferrous sulfate ( 60 mg Fe ) or placebo once daily for 8 wk . Morbidity from URTIs , the number of gastrointestinal infections , and compliance were recorded every 2 wk . RESULTS The overall prevalence of anemia was 52.6 % . Iron supplementation significantly improved iron status by increasing hemoglobin ( P < 0.001 ) and serum ferritin ( P < 0.001 ) concentrations from baseline values in the children with or without infection . There was no significant improvement in iron status in the children who received placebo . In both the infection group and the control group , the mean number of URTI episodes and the total number of days sick with an URTI during the period of intervention were significantly lower ( P < 0.005 and P < 0.001 , respectively ) in the children who received iron supplements than in those who received placebo . CONCLUSION Iron supplementation significantly improves iron status and reduces morbidity from URTIs in children with or without infection A r and omized , double-blind , placebo-controlled iron supplementation trial was conducted in Kenya to examine the effect of iron supplements on appetite and growth in 87 primary school children .  Sustained-release ferrous sulfate ( 150 mg ) or placebo tablets were provided daily at school for 14 wk . Prior to tablet administration , baseline anthropometry , iron nutritional status ( hemoglobin and serum ferritin ) , parasitic infections and clinical indicators of morbidity were measured . A baseline appetite test was conducted twice on each child by quantitatively measuring the ad libitum consumption of a midmorning snack . In addition , each child was asked for a subjective assessment of his or her appetite . Follow-up exams and appetite tests were identical to those at baseline . Findings indicated that provision of iron supplements result ed in improved growth and improved appetite ( in terms of both energy intake of the snack and child report of appetite ) as compared with children receiving the placebo . The increased energy intake from the snack was 10 % of the daily estimated energy intake for children of this same age group living elsewhere in Kenya . Further research into the underlying physiological mechanisms may shed light on the relationship between iron nutritional status and appetite The effect of oral iron supplementation on blood Fe levels and physical growth in 119 rural Indonesian school children was assessed in this double-blind study . The children were classified into anemic and normal groups according to their initial hemoglobin and transferrin saturation levels and were r and omly assigned to either Fe or placebo treatment for 12 wk . Hematological , anthropometric , and morbidity data were collected before and after the treatment period . Before treatment , anemic subjects were smaller and had higher morbidity than normal subjects . Treatment with 10 mg ferrous sulfate.kg-1.d-1 for 12 wk result ed in a significant improvement in anemic subjects ' hematological status , growth velocity , and level or morbidity BACKGROUND In many developing countries , children are at high risk of both goiter and iron deficiency anemia . Iron deficiency adversely affects thyroid metabolism and may reduce the efficacy of iodine prophylaxis in areas of endemic goiter . OBJECTIVE The aim of this study was to determine whether iron supplementation in goitrous , iron-deficient children would improve their response to iodized salt . DESIGN We conducted a r and omized , double-blind , placebo-controlled trial in 5 - 14-y-old children in Côte d'Ivoire . Goitrous , iron-deficient children ( n = 166 ) consuming iodized salt ( 10 - 30 mg I/kg salt at the household level ) were supplemented with either iron ( 60 mg Fe/d , 4 d/wk for 16 wk ) or placebo . At 0 , 1 , 6 , 12 , and 20 wk , we measured hemoglobin , serum ferritin , serum transferrin receptor , whole-blood zinc protoporphyrin , thyrotropin , thyroxine , urinary iodine , and thyroid gl and volume ( by ultrasonography ) . RESULTS Hemoglobin and iron status at 20 wk were significantly better after iron treatment than after placebo ( P < 0.05 ) . At 20 wk , the mean reduction in thyroid size in the iron-treated group was nearly twice that in the placebo group ( x + /- SD percentage change in thyroid volume from baseline : -22.8 + /- 10.7 % compared with -12.7 + /- 10.1 % ; P < 0.01 ) . At 20 wk , goiter prevalence was 43 % in the iron-treated group compared with 62 % in the placebo group ( P < 0.02 ) . There were no significant differences between groups in whole-blood thyrotropin or serum thyroxine at baseline or during the intervention . CONCLUSIONS Iron supplementation improves the efficacy of iodized salt in goitrous children with iron deficiency . A high prevalence of iron deficiency among children in areas of endemic goiter may reduce the effectiveness of iodine prophylaxis BACKGROUND According to our current underst and ing , iron absorption with weekly iron supplements is not higher than that with daily supplements ( ie , there is no mucosal block ) . However , community-based trials have repeatedly shown that a weekly regimen is as effective as a daily one . Furthermore , when differences in absorption are found , they are commonly smaller than would be expected on the basis of differences in the amount of iron provided . The possibility of differential compliance between the regimens needs to be evaluated to explain these findings . OBJECTIVE Taking compliance into account , we compared the efficacy and trial effectiveness of weekly and daily iron supplementation during pregnancy . DESIGN In Bangladesh , 50 antenatal centers were r and omly assigned to prescribe either 2 doses of 60 mg Fe once weekly or 1 dose of 60 mg Fe/d . Compliance was monitored by using a pill bottle equipped with an electronic counting device .  Hemoglobin concentrations were measured at baseline and after 4 , 8 , and 12 wk of supplementation . RESULTS There was no differential effect per iron tablet between weekly and daily regimens . A 12-wk daily regimen ( 68 % compliance ) produced a small but significantly greater hemoglobin response than did the weekly regimen ( 104 % compliance ) . The first 20 tablets consumed produced most of the effect ; after 40 tablets , there was no further response . CONCLUSIONS There was no evidence of a mucosal block in the daily regimen . Over 12 wk , 50 % of the amount of iron in a daily regimen was sufficient for maximum hemoglobin effect . The weekly regimen provided a large part of this amount , explaining the limited difference in effect . It appears that the current international recommendation for iron supplementation in pregnancy is higher than necessary We compared iron intake and iron nutritional status of two groups of healthy term infants who received meat-containing baby foods fortified with ferrous sulphate ( 2 mg Fe/100 g ) . One group received an Fe-fortified formula ( 1.6 mg Fe/100 kcal ) and the other a nonfortified formula . Fe intake of the group fed the nonfortified formula was significantly lower ( p less than 0.0001 ) . These infants received Fe mainly from fortification Fe with beikost ( 75 - 86 % ) and less than 10 % met the recommended intake of 1 mg.kg-1.d-1 ; whereas 80 - 85 % of the infants fed the Fe-fortified formula did . Hb , Hct , FEP , and ferritin were similar in both groups with the exception of lower ferritin values at age 365 d ( p less than 0.05 ) in the group fed the nonfortified formula . No infant had hemoglobin less than 100 g/L. We conclude that regular consumption of commercially prepared Fe-fortified beikost with meat prevents most healthy term infants from Fe deficiency even if Fe intake is substantially below the recommended intake Ninety-nine anemic children aged 1 - 8 y were divided into four groups . Each group was supplemented for 2 mo with vitamin A , iron , vitamin A plus Fe , or a placebo .  Clinical , hematological , and Fe biochemical evaluations were performed at the beginning and end of the study . Vitamin A supplementation produced significant elevations in the serum levels of retinol , blood hemoglobin , hematocrit , erythrocytes , serum Fe , and percent transferrin saturation ( % TS ) and had no effect on total Fe binding capacity ( TIBC ) or serum ferritin . Fe supplementation did not affect serum retinol . However , it improved hematological and Fe nutrition indicators , including TIBC and serum ferritin . The simultaneous administration of vitamin A and Fe result ed in a better response of serum Fe and % TS than when the supplement consisted only of vitamin A or Fe alone . Vitamin A benefits hematological condition and Fe metabolism The effect of weekly iron supplementation with and without deworming on hemoglobin was investigated in a double-masked , placebo-controlled field trial . Subjects were 289 preschoolers who were r and omly divided into three groups . Groups 1 and 2 received 30 mg Fe once weekly and group 3 received a placebo . Group 1 additionally received anthelminthic treatment . Supplements were administered by the mothers , who were educated about iron deficiency beforeh and . In the iron-supplemented groups prevalence of anemia decreased from 37.2 % to 16.2 % ( P < 0.001 ) . Hemoglobin increased by an average of 6.9 + /- 9.8 g/L in the two iron-supplemented groups ( n = 191 ) , which was greater ( P < 0.001 ) than the increase of 1.9 + /- 8.0 g/L in the placebo group . None of the subjects had hookworm , and anthelminthic treatment did not have an additional effect . Iron supplements administered once weekly by mothers reduced anemia without major involvement of health staff BACKGROUND Iron deficiency and its consequent anemia constitute the commonest micronutrient deficiency in the world . OBJECTIVE We investigated whether long-term , weekly iron-folate supplements administered at school would improve hemoglobin and ferritin concentrations in adolescent girls , including those with mild-to-moderate anemia and hemoglobin concentrations indicating borderline anemia . DESIGN Subjects were 266 girls with hemoglobin concentrations of 80 - 119.9 g/L ( group A ) and 358 girls with hemoglobin concentrations of 120 - 130 g/L ( group B ) who were otherwise healthy . Two hundred sixty-six girls in group A and 268 girls in group B were r and omly assigned to receive either 60 or 120 mg Fe plus 3.5 mg folic acid weekly for 22 wk . Ninety of the girls in group B were r and omly assigned to receive only 5 mg folic acid weekly . Capillary hemoglobin and plasma ferritin were measured at baseline and after 12 and 22 wk of supplementation . RESULTS By the end of the study , 2 % of the girls had dropped out and > 96 % had taken > or = 20 of the 22 tablets ; side effects were minimal . Mean plasma ferritin increased significantly in all iron-supplemented groups , independently of initial hemoglobin values and iron doses . Ferritin concentrations decreased in the girls supplemented with folic acid only . As expected , hemoglobin responses to iron were higher in group A than in group B and increases were positively correlated with initial plasma ferritin . Hemoglobin failed to respond to folate supplementation if initial plasma ferritin concentrations were low . Mean hemoglobin increased significantly and consistently in relation to the length of treatment . CONCLUSION Long-term , weekly iron-folate supplementation was found to be a practical , safe , effective , and inexpensive method for improving iron nutrition in adolescent schoolgirls BACKGROUND Iron deficiency anemia is the most prevalent nutrition problem in young children . One possible strategy to prevent iron deficiency anemia in this population group is the fortification of affordable food . OBJECTIVE This study was design ed to assess whether iron-fortified c and ies can improve iron status and are acceptable to children aged 4 - 6 y. DESIGN A double-blind , placebo-controlled intervention study was conducted in Jakarta , INDONESIA : The children were r and omly assigned to 1 of 2 treatment groups : a fortified group ( n = 57 ) and a placebo group ( n = 60 ) . Every week for 12 wk , 30 g ( 10 pieces ) c and y was given to the children . The c and y given to the fortified group contained 1 mg elemental Fe/g and very small amounts of other vitamins and minerals . RESULTS The hemoglobin concentration of the fortified group increased by 10.2 g/L ( 95 % CI : 8.3 , 12 g/L ) whereas that of the placebo group increased by 4.0 g/L ( 2.0 , 6.0 g/L ; P < 0.001 ) . Anemia prevalence decreased from 50.9 % at the start of the intervention to 8.8 % after 12 wk of intervention in the fortified group ( P < 0.001 ) and from 43.3 % to 26.7 % in the placebo group ( P < 0.05 ) . After 12 wk of intervention , the serum ferritin concentration was 71 % higher than at baseline in the fortified group and 28 % higher in the placebo group ( P < 0.001 ) . Acceptability of the iron-fortified c and ies was good . The per capita cost of the supplement was approximately US$ 0.96 - 1.20 for the 12 wk of intervention . CONCLUSION Iron-fortified c and ies were effective for improving the iron status  of young children and might be an affordable way to combat iron deficiency in children of low-to-middle income groups BACKGROUND Combined supplementation with iron and zinc during infancy may be effective in preventing deficiencies of these micronutrients , but knowledge of their potential interactions when given together is insufficient . OBJECTIVE The goal was to compare the effect in infants of combined supplementation with iron and zinc  and of supplementation with single micronutrients on  iron and zinc status . DESIGN Indonesian infants ( n = 680 ) were r and omly assigned to daily supplementation with 10 mg Fe ( Fe group ) , 10 mg Zn ( Zn group ) , 10 mg Fe + 10 mg Zn ( Fe+Zn group ) , or placebo from 6 to 12 mo of age . Venous blood sample s were collected at the start and end of the study . Five hundred forty-nine infants completed the supplementation and had both baseline and follow-up blood sample s available for analysis . RESULTS Baseline prevalences of anemia , iron deficiency anemia ( anemia and low serum ferritin ) , and low serum zinc ( < 10.7 micromol/L ) were 41 % , 8 % , and 78 % , respectively . After supplementation , the Fe group had higher hemoglobin ( 119.4 compared with 115.3 g/L ; P < 0.05 ) and serum ferritin ( 46.5 compared with 32.3 microg/L ; P < 0.05 ) values than did the Fe+Zn group , indicating an effect of zinc on iron absorption . The Zn group had higher serum zinc ( 11.58 compared with 9.06 micromol/L ; P < 0.05 ) than did the placebo group . There was a dose effect on serum ferritin in the Fe and Fe+Zn groups , but at different levels . There was a significant dose effect on serum zinc in the Zn group , whereas no dose effect was found in the Fe+Zn group beyond 7 mg Zn/d . CONCLUSION Supplementation with iron and zinc was less efficacious than were single supplements in improving iron and zinc status , with evidence of an interaction between iron and zinc when the combined supplement was given In this study the effects of supplementation of iron and zinc , alone or combined , on iron status , zinc status and growth in Indonesian infants is investigated . Micronutrient deficiencies are prevalent in infants in developing countries , and deficiencies often coexist ; thus , combined supplementation is an attractive strategy . However , little is known about interactions between micronutrients . In a r and omized , double-blind , placebo-controlled supplementation trial , 478 infants , 4 mo of age , were supplemented for 6 mo with iron ( 10 mg/d ) , zinc ( 10 mg/d ) , iron + zinc ( 10 mg of each/d ) or placebo . Anthropometry was assessed monthly , and micronutrient status was assessed at the end of supplementation . Supplementation significantly reduced the prevalence of anemia , iron deficiency anemia and zinc deficiency . Iron supplementation did not negatively affect plasma zinc concentrations , and zinc supplementation did not increase the prevalence of anemia or iron deficiency anemia . However , iron supplementation combined with zinc was less effective than iron supplementation alone in reducing the prevalence of anemia ( 20 % vs. 38 % reduction ) and in increasing hemoglobin and plasma ferritin concentrations . There were no differences among the groups in growth . The growth of all groups was insufficient to maintain the same Z-scores for height for age and weight for height . There is a high prevalence of deficiencies of iron and zinc in these infants , which can be overcome safely and effectively by supplementation of iron and zinc combined . However , overcoming these deficiencies is not sufficient to improve growth performance in these infants We report an apparently protective effect of vitamin A in infants who received iron supplements ( 15 mg/d ) for 3 mo . Those receiving iron showed increases in hemoglobin ( 8 g/L ) , ferritin ( 3.7 micrograms/L ) , and the acute-phase protein alpha 1-antichymotrypsin ( ACT ; 0.06 g/L ) . In both the placebo and iron-supplemented groups there were increases in plasma retinol , lutein , alpha-tocopherol , immunoglobulin A , and immunoglobulin G. The improvement in vitamin A status could only have been from a seasonal increase in dietary sources of vitamin A , eg , breast milk and early weaning foods , and there were no obvious effects on iron utilization ( hemoglobin concentrations ) . However , in the infants receiving iron , those whose retinol concentrations increased also showed reductions in ACT , ferritin , immunoglobulin A , and immunoglobulin M.  Vitamin A is well known for its antiinfective properties and we suggest that these observations illustrate the importance of even small increases in dietary vitamin A or differences in vitamin A status in reducing the potentially toxic effects of iron supplements  in persons in developing countries . These conclusions should now be confirmed with an intervention study to show that the benefits of vitamin A on iron status are due to reduced levels of infection 1 . The effect of fortification of food with iron to provide 10 mg elemental Fe/child per d was studied in preschool children maintained on a cereal diet , over a 5-month period . 2 . The absorption of 5 mg Fe as ferrous sulphate mixed in one meal was 3.3 % of the test dose and when 3.3 mg was given with each of three meals over a 2 d period the corresponding value was 4.8 % . 3 . The mean absorption of a test dose of ferrous ascorbate  studied in twenty-four children midway through the trial was 42 % . 4 . The only beneficial effect of Fe fortification in this time-period in the experimental group was the prevention of the decrease in packed cell volume which occurred in the control groups Whether children with malarial anaemia should receive supplementation with iron or folic acid is uncertain . Therefore , the effects of supplementary treatment with iron or folic acid , given together with chloroquine or pyrimethamine-sulfadoxine ( Fansidar ) , has been assessed in 600 Gambian children with uncomplicated falciparum malaria . After one month , haematological recovery was significantly better in the group treated with Fansidar than in the chloroquine-treated group ( difference in mean haemoglobin level = 0.54 g/dL , P = 0.01 ) . Children who received  iron had a significantly better response than those given placebo ( differences in mean haemoglobin level after one month and at dry season follow-up = 0.70 g/dL , P = 0.006 , and 0.81 g/dL , P = 0.001 , respectively ) . Iron supplementation was not associated with increased prevalence of malaria . Supplementation with folic acid did not improve the haematological response but , among children who received Fansidar , the treatment failure rate was significantly higher among those given folic acid than among those given placebo . Thus , supplementation with iron , but not folic acid , improves haematological recovery without increasing susceptibility to malaria In spite of the declining prevalence of iron-deficiency anemia , a large proportion of low-income infants have " low-normal " ( 11 - 11.5 g/dL ) and " low " ( less than 11 g/dL ) hemoglobin ( Hgb ) values  . Because most of these infants are fed iron-fortified formulas , it was of interest whether additional iron supplementation would enhance Hgb values . A cohort of 334 healthy , inner-city , minority , 6-month-old infants , fed iron-fortified formulas , with Hgb values ranging from 9 to 11.5 g/dL , participated in a double-blind , r and omized , placebo-controlled trial of supplemental iron at 0 , 3 , and 6 mg/kg per day for 3 months . Hemoglobin values increased significantly with age , regardless of assignment to placebo or supplemental iron ( means for the entire cohort : 6 months 10.9 g/dL , 8 months 11.2 , 10 months 11.3 , and 12 months 11.4 ) . The proportion of " responders " ( Hgb level increased greater than or equal to 1 g/dL ) was 34 % and did not differ significantly by placebo or iron dose . There were no significant differences in mean corpuscular volume or levels of erythrocyte porphyrins or serum ferritin between treatment groups . The implication s of this clinical trial are twofold : ( 1 ) screening healthy infants fed iron-fortified formula at the age of 6 months is not justified , regardless of socioeconomic status ; ( 2 ) the clinical practice of routinely treating low-income , " low-Hgb " infants with iron supplementation , without regard to dietary considerations , is unwarranted Objective : To assess the effects of iron and deworming on linear growth performance of preschoolers . Design : Three-month r and omized , double-blind and placebo-controlled trial . The children were allocated to four treatments : iron ( 60 mg elemental iron/day)+albendazole ( 200 mg/day for 3 consecutive days , repeated 1 month later ) , iron+albendazole-placebo , albendazole+iron-placebo or placebos . The supplementation was supervised . Subjects : A group of 177 children aged 3–5 y was selected from low-income households in a rural area in southern Bénin . A complete data set was analysed for 140 subjects . Many children were stunted ( 58 % had height-for-age Z-score < −2 ) , none were wasted ( 2 % had weight-for-height Z-score < −2 ) and 76 % were anemic ( Hb<110 g/l).Main outcome measures : Anthropometric parameters , hemoglobin and eggs per gram feces . Results : No significant difference in changes in anthropometric parameters was observed between study groups , and also not in a sub- sample of stunted and anemic subjects . Changes in hemoglobin were highest in the iron-treated subjects at the end of the 3-month intervention period ( P=0.032 ) . The difference between the iron and the placebo groups remained significant even 7 months later ( P=0.022 ) . The difference was 5 g/l in both periods . Ascaris lumbricoides and hookworm infections decreased significantly in albendazole-treated subjects ( P<0.05 ) . Conclusions : In addition to recurrent parasitic infection burden , the children may have multiple micronutrient deficiencies . Therefore , it may be interesting to study appetite and food intake of young toddlers in relation to health and linear growth performance in poor environments . Sponsorship : The Nestlé Foundation ( Lausanne , Switzerl and ) .European Journal of Clinical Nutrition ( 2001 ) 55 , Preterm infants with birth weights between 1,001 and 1,600 gm were r and omly assigned at one week of age to three groups and fed a st and ard milk-based formula , the same formula with iron , or a soy-based formula with iron .  Hematologic values and selenium status were then studied prospect ively for five weeks . Rates of decline in hematocrit and hemoglobin did not differ significantly among the three groups and did not correlate with red cell selenium values or glutathione peroxidase activity . Attainment of vitamin E sufficiency was variable among the infants , with no significant intergroup differences . Plasma selenium concentrations did not change significantly , but plasma glutathione peroxidase activity declined consistently in all three groups . Under the conditions of this study , iron at a concentration of 12 mg/L of infant formula did not accelerate hemolysis ; nor was there evidence of a direct association between selenium values and early anemia of prematurity The effects of oral iron supplementation on blood iron levels and learning achievement in 130 rural Indonesian school children were assessed in this double-blind study . The children were classified into anemic and nonanemic groups according to their initial hemoglobin and transferrin saturation levels and were r and omly assigned to either iron or placebo treatment for 3 mo . Hematological , anthropometric , and learning-achievement data were collected before ( T1 ) and after ( T2 ) the treatment period and 3 mo later . The means and st and ard deviations suggest that supplementation with 10 mg ferrous sulfate per kilogram body weight per day for 3 mo result ed in an apparent improvement in anemic subjects ' hematological status and learning-achievement scores . No tests of statistical comparisons are reported A double-blind clinical trial was conducted in Indonesia to assess effects of iron supplementation on performance of iron-depleted and iron-deficient anemic children in discrimination and oddity learning tasks . Half these children received elemental Fe for 8 wk ; the others received a placebo . There were significant changes from pre- to postintervention evaluations in ferritin , transferrin saturation , free erythrocyte protoporphyrin , and hemoglobin among the anemic and iron-depleted children ; no changes were observed among the placebos or any of the iron-replete children . The magnitude of hematological changes in anemic children treated with iron was small ; yet , after treatment the children 's mean ferritin , transferrin saturation , and hemoglobin values were above the cutoff points used for the definition of iron-deficiency anemia ( IDA ) . Pre- and posttreatment psychological test data show that IDA produces alterations in cognitive processes related to visual attention and concept acquisition , alterations reversed with iron treatment Abstract Objective : To measure the effects of iron supplementation and anthelmintic treatment on iron status , anaemia , growth , morbidity , and development of children aged 6–59 months . Design : Double blind , placebo controlled r and omised factorial trial of iron supplementation and anthelmintic treatment . Setting : Community in Pemba Isl and , Zanzibar . Participants : 614 preschool children aged 6–59 months . Main outcome measures : Development of language and motor skills assessed by parental interview before and after treatment in age appropriate subgroups . Results : Before intervention , anaemia was prevalent and severe , and geohelminth infections were prevalent and light — Plasmodium falciparum infection was nearly universal . Iron supplementation significantly improved iron status , but not haemoglobin status . Iron supplementation improved language development by 0.8 ( 95 % confidence interval 0.2 to 1.4 ) points on the 20 point scale . Iron supplementation also improved motor development , but this effect was modified by baseline haemoglobin concentrations ( P=0.015 for interaction term ) and was apparent only in children with baseline haemoglobin concentrations < 90 g/l . In children with a baseline haemoglobin concentration of 68 g/l ( one st and ard deviation below the mean value ) , iron treatment increased scores by 1.1 ( 0.1 to 2.1 ) points on the 18 point motor scale . Mebendazole significantly reduced the number and severity of infections caused by Ascaris lumbricoides and Trichuris trichiura , but not by hookworms . Mebendazole  increased development scores by 0.4 ( −0.3 to 1.1 ) points on the motor scale and 0.3 ( −0.3 to 0.9 ) points on the language scale . Conclusions : Iron supplementation improved motor and language development of preschool children in rural Africa . The effects of iron on motor development were limited to children with more severe anaemia ( baseline haemoglobin concentration < 90 g/l ) . Mebendazole had a positive effect on motor and language development , but this was not statistically significant . What is already known on this topic Iron is needed for development and functioning of the human brain Anaemic children show developmental delays , but it is not yet clear whether iron deficiency causes these deficits or whether iron supplementation can reverse them Helminth infections in schoolchildren are associated with cognitive deficits , but few studies have been made of helminth infection and early child development What this study adds Low doses of oral iron supplementation given daily improved language development in children aged 1–4 years in Zanzibar Iron supplementation improved motor development , but only in children with initial haemoglobin concentrations below 90 g/l The effects of routine anthelmintic treatment on motor and language milestones were positive , but non-significant , with our sample A r and omized , placebo-controlled treatment trial was conducted among 546 anemic ( hemoglobin concentration , 7 - 11 g/dL ) children aged 2 - 36 months in an area with intense malaria transmission in western Kenya . All children used bednets  and received a single dose of sulfadoxine-pyrimethamine ( SP ) on enrollment , followed by either intermittent preventive treatment ( IPT ) with SP at 4 and 8 weeks and daily iron for 12 weeks , daily iron and IPT with SP placebo , IPT and daily iron placebo , or daily iron placebo and IPT with SP placebo ( double placebo ) . The mean hemoglobin concentration at 12 weeks , compared with that for the double-placebo group , was 1.14 g/dL ( 95 % confidence interval [ CI ] , 0.82 - 1.47 g/dL ) greater for the IPT+iron group , 0.79 g/dL ( 95 % CI , 0.46 - 1.10 g/dL ) greater for the iron group , and 0.17 g/dL ( 95 % CI , -0.15 - 0.49 g/dL ) greater for the IPT group . IPT reduced the incidence of malaria parasitemia and clinic visits , but iron did not . The combination of IPT and iron supplementation was most effective in the treatment of mild anemia . Although IPT prevented malaria , the hematological benefit it added to that of a single dose of SP and bednet use was modest Ninety two normal birthweight infants aged 6 months entered a double blind controlled trial which compared a follow on formula milk with no added iron against the same formula milk containing 1.2 mg of iron per 100 ml . There was no significant difference in the social class or demographic characteristics of the two treatment groups or in the proportion of each group completing the trial . There was no difference between the two groups in the quantity of milk taken but the amounts taken lessened between 6 and 18 months of age . There was no difference between the two groups with respect to mean haemoglobin and median serum ferritin at 6 , 9 , 12 , 15 , and 18 months of age . Very few infants developed iron deficiency anaemia in either group but there was a tendency for serum ferritin levels to fall between 6 and 18 months of age in both groups . The results suggest that iron added to follow on milk was not an important source of dietary iron in the infants studied Summary Background Recent data suggest that daily iron supplementation of iron-replete children could impair their growth . If verified for weekly iron supplementation these results would markedly complicate targeting and implementing school-based weekly iron supplementation programs . Aim of the study To ascertain the effect of weekly iron supplementation on the growth and hemoglobin status of non-anemic school-age children . Subjects and methods 73 Bolivian non-anemic school-age children r and omly assigned to the treatment group ( n=37 ; receiving supplements containing FeSO4 during 18 weeks ) or the control group ( n=36 ; receiving a placebo during the same period ) . Hemoglobin concentration and anthropometric measures were determined for each child at the beginning ( T0 ) and the end ( T18 ) of the study . Results The treatment group did not show any significant variation in hemoglobin concentration between T0 and T18 ( −1.6±10.4 g/L ; P=0.40 ) whereas the control group showed a significant decrease in hemoglobin concentration ( −4.6±10.9 g/L ; P=0.03 ) . Anthropometric changes were not significantly different between the treatment and the control groups for weight , ( 1.63±1,11 kg vs 1.88±0.79 kg ; P=0.30 ) , height ( 2.35±0.94 cm vs 2.11±1.03 cm ; P=0.34 ) or mid-upper arm circumference ( 0.29±0.57 cm vs 0.22±0.54 cm ; P=0.64 ) . Conclusion In our study , weekly iron supplementation of non-anemic school-age children had no negative effect on their growth while having a positive effect in preventing significant decreases in hemoglobin concentration . These results suggest that in regions where iron deficiency anemia ( IDA ) is prevalent , a simple and cost-effective way to control IDA in school-age children is to give weekly iron supplements to all children at school Objectives : This paper investigates simultaneously the growth and activity of children that received an early energy and micronutrient supplement  , adjusting for all non-supplemental energy intakes . Any additional change in growth and activity after this adjustment was then compared across supplements at three points felt to be representative of the study . Design : Two cohorts of children were r and omly assigned to three treatments : E=1171 kJ+12 mg iron ; M=209 kJ+12 mg iron ; S=104 kJ. Supplementation was given for 12 months . Setting : The sites were six tea plantations in Pangalengan , West Java . Subjects : A 12-month-old ( n=53 ) and an 18-month-old ( n=83 ) cohort were recruited from day-care-centers . Twenty children that received S belonged to the 12- and 18-month-old cohorts . Inclusion criteria were : no chronic disease ; length-for-age ≤−1 st and ard deviation ( s.d . ) and weight-for-length between −1 and −2 s.d . of the median of the reference of the World Health Organization . Methods : Length was measured with a portable measuring board ; a Detecto scale with an accuracy of 0.1 kg was used for the measurement of body weight . Arm and head circumferences were measured using similar fiberglass tapes . Motor activity was assessed through continuous 4 h observations at home and at day care centers . Anthropometry and activity were measured every two months over 12 months . Results : After correcting for non-supplemental sources of energy intake , the effects of the supplement on weight and activity were observed at 2 months ; effects on length and activity were observed at 6 months ; and effects on weight alone were observed at 12 months . Sponsorship : Nestlé Foundation . European Journal of Clinical Nutrition ( 2000 ) 54 , Suppl 2 , BACKGROUND Malaria and anaemia , especially that due to iron deficiency , are two leading causes of morbidity worldwide . Little is known about the relative contribution of Plasmodium falciparum infection and iron deficiency to the aetiology of anaemia in malaria-endemic areas . We undertook a r and omised comparison of different strategies for control of anaemia and malaria in infants , including an assessment of the effect of iron supplementation on malaria susceptibility . METHODS 832 infants born at one hospital in a malaria-hyperendemic area of Tanzania between January and October , 1995 , were r and omly assigned to group DI , receiving daily oral iron ( 2 mg/kg daily ) plus weekly Deltaprim ( 3.125 mg pyrimethamine plus 25 mg dapsone ) ; group IP , receiving iron plus weekly placebo ; group DP , receiving daily placebo plus weekly Deltaprim ; or group PP . supplementation was given from 8 to 24 weeks of age , and the weekly chemoprophylaxis from 8 to 48 weeks . The frequency of severe anaemia ( packed-cell volume < 25 % ) and malaria episodes was assessed through a combination of passive case detection and cross-sectional surveys . FINDINGS The groups that received iron supplementation had a lower frequency of severe anaemia than those that did not receive iron ( 0.62 vs 0.87 cases per person-year ; protective efficacy 28.8 % [ 95 % CI 6.3 - 45.8 ) . Iron supplementation had no effect on the frequency of malaria ( 0.87 vs 1.00 cases per person-year ; protective efficacy 12.8 % [ -12.8 to 32.5 ] ) . The groups that received malaria prophylaxis had lower frequencies of both severe anaemia ( 0.45 vs 1.04 episodes per person-year ; protective efficacy 57.3 % [ 43.0 - 67.9 ] ) and malaria ( 0.53 vs 1.34 episodes per person-year ; protective efficacy 60.5 % [ 48.2 - 69.9 ] ) than the groups that did not receive prophylaxis . After the end of the intervention period , children who had received malaria chemoprophylaxis had higher rates of severe anaemia and malaria than non-chemoprophylaxis groups ( relative risks 2.2 [ 1.3 - 3.7 ] and 1.8 [ 1.3 - 2.6 ] ) . INTERPRETATION Malaria chemoprophylaxis during the first year of life was effective in prevention of malaria and anaemia but apparently impaired the development of natural immunity . Iron supplementation was effective in preventing severe anaemia without increasing susceptibility to malaria . Our findings support iron supplementation of infants to prevent iron-deficiency anaemia , even in malaria-endemic areas A total of 502 children up to the age of 14 years were treated for iron deficiency or overt anemia .  ITF 282 was prescribed to 256 children , and a commercially available ferrous polystyrene sulphonate preparation to 246 , in a r and omized double-blind , double-dummy , ten-center trial . One oral vial of ITF 282 ( 60 mg iron ) was administered once a day to children weighing up to 40 kg ; and twice a day to children with body weight equal or superior to 40 kg . In the reference group , oral vials of polystyrene sulphonate ( 52.5 mg iron ) were administered once a day to children weighing up to 40 kg , and twice a day to children weighing 40 kg or more . Treatments lasted 60 days . The treatments ' efficacy and tolerability were evaluated taking into consideration : special hematology , symptomatology , safety hematology and hematochemistry , urinalysis . At the end of treatment , the trend was detected to the normalization of the main hematologic parameters in both groups ( hemoglobin , hematocrit , ferritin , blood iron , transferrin saturation , MCHC ) . Although in the first month the reference treatment appears to provide somewhat faster results , significantly greater values of blood iron are observed at the end of the observation in the ITF 282 group , indicating a more progressive and steady therapeutic effect . The overall clinical rating was , although not significant , in favor of ITF 282 , with a failure rate of 18.0 vs 24.0 % . The general tolerance , although favorable with both treatments , was significantly more favorable with ITF 282 . With this medication , 13 patients complained of 13 events ( 1 heartburn , 6 constipation , 6 abdominal pain ) vs 48 events reported by 43 patients with the reference medication ( 1 heartburn , 2 epigastric pain , 14 constipation , 14 abdominal pain , 3 skin rash , 14 vomiting ) . These observations confirm that , although the most modern preparations of ferrous ions exhibit a relatively low frequency of adverse events of limited clinical concern , it is nevertheless possible to decrease ( with the use of more " physiologic " preparations in which the iron is reversibly bound to a protein carrier ) the prevalence and , tendentially , duration and intensity of such events without prejudice for the clinical efficacy . Therefore , the good clinical tolerability of ITF 282 effectively removed one of the main obstacles to the correct compliance with iron treatments ( necessarily to be taken long-term ) , as reduced the risks of undesired events in a particularly susceptible population subgroup , such as children Feeding of iron (Fe)-fortified ( 12–15 mg/L ) infant formulas is an effective and convenient means to protect infants from Fe deficiency . To study lower levels of Fe fortification of infant formulas ( 3 or 6 mg/L ) compared with those currently in use , we compared Fe intake and Fe nutritional status of three groups of healthy , term infants between 90 and 274 days of age . One group received an Fe-fortified whey-predominant formula ( 3 mg/ L ) and the second group received the same formula with a higher Fe level ( 6 mg/L ) . A comparison group was breast-fed at least until 274 days of age . All infants received infant foods and cereals according to European Community recommendations . Mean Fe intake of infants fed formula fortified with 3 mg/L was significantly lower at 183 and 274 days of age ( p < 0.05 ) than that of infants fed formula fortified with 6 mg/L. None of the infants fed the formula fortified with 3 mg/L met the recommended daily allowance value ( 10 mg ) for infants between 6 and 12 months of age . Hemoglobin , hematocrit , mean corpuscular volume , free erythrocyte protoporphyrin , and serum ferritin levels were similar in the formula-fed groups ; none of the infants had depleted Fe stores ( ferritin < 10 μg/L ) at 183 and 274 days of age . Thirteen percent of breast-fed infants had depleted Fe stores at 183 days of age , but only 3 % were depleted at 273 days of age , when Fe-fortified beikost was already part of the diet . No influence of Fe nutritional status was found on zinc and copper nutritional status or on growth . We conclude that regular consumption of an infant formula fortified with 3 mg Fe/L , a level substantially below present recommendations , prevents healthy , term infants from developing Fe deficiency during the first 6 months of life . It is preferable that infants 6 months of age and older receive an Fe-fortified formula and a judicious selection of beikost to ensure an adequate dietary intake of Fe In a double-blind , placebo-control prospect i ve cohort study of 196 infants from birth to 15 months of age , assessment was made at 12 months of age of the relationship between iron status and psychomotor development , the effect of a short-term ( 10-day ) trial of oral iron vs placebo , and the effect of long-term ( 3 months ) oral iron therapy . Development was assessed with the mental and psychomotor indices and the infant behavior record of the Bayley Scales of Infant Development in 39 anemic , 30 control , and 127 nonanemic iron-deficient children . Anemic infants had significantly lower Mental and Psychomotor Developmental Index scores than control infants or nonanemic iron-deficient infants ( one-way analysis of variance , P less than .0001 ) . Control infants and nonanemic iron-deficient infants performed comparably . No difference was noted between the effect of oral administration of iron or placebo after 10 days or after 3 months of iron therapy . Among anemic infants a hemoglobin concentration less than 10.5 g/dL and duration of anemia of greater than 3 months were correlated with significantly lower motor and mental scores ( P less than .05 ) . Anemic infants failed specifically in language capabilities and body balance-coordination skills when compared with controls . These results , in a design in which intervening variables were closely controlled , suggest that when iron deficiency progresses to anemia , but not before , adverse influences in the performance of developmental tests appear and persist for at least 3 months despite correction of anemia with iron therapy . If these impairments prove to be long st and ing , prevention of iron deficiency anemia in early infancy becomes the only way to avoid them We tested in the field an extruded rice flour , fortified with a bovine haemoglobin concentrate ( Fe:14 mg/100 g of powder ) . This cereal has a high iron bioavailability , good protein quality and amino acid score . Healthy , term breast-fed infants were prospect ively studied . One group ( n = 92 ) received the fortified cereal ( from 4 to 12 months of age ) . As control , 96 infants received  regular solid foods ( cooked vegetables and meat ) from age 4 months . At the end of the field trial , a sub sample of infants in both groups was supplemented with 45 mg Fe during 90 d. Iron nutrition status was determined at 9 , 12 and 15 months . At 12 months , iron deficiency anaemia was present in 17 per cent of controls , in 10 per cent of fortified infants as a whole , but only in 6 per cent of the babies who consumed over 30 g of cereal/d . In addition , this latter group did not show any significant changes in iron nutrition status after the supplementation trial . Results demonstrate that the consumption of a haemoglobin fortified cereal is effective in markedly reducing the incidence of iron deficiency in breast-fed infants Objective : To assess the impact of a daily oral iron supplementation on hematological status , cell-mediated immunity and susceptibility to infections in children living in an environment where iron deficiency , malaria and other infections are frequent . Design : R and omized , double-blind iron supplementation including a placebo group . Setting : A village in Togo , West Africa . Subjects : Of the 229 6–36-month-old children of both sexes recruited , 197 with hemoglobin concentration ≥80 g/l were included and 163 completed the study .Intervention : Children received daily a placebo ( n=79 ) or a dose of 2–3 mg of elemental iron per kg of body weight ( n=84 ) for 3 months . Hematological , nutritional and immune status were assessed at the beginning and at the end of the supplementation period , and 6 months later . Morbidity was recorded throughout the study . Results : Iron supplementation had a significant and positive effect on iron status of children and no impact on the incidence of infections , especially malaria . Its probable effect on immune status was masked by interference of infections and their treatment , which contributed to improve hematological and immune status in both groups . Conclusion : According to the negative consequences of anemia and iron deficiency on global child development , control of iron deficiency by oral iron supplementation in young children has to be conducted , associated with prophylaxis and treatment of malaria and repeated deworming . Sponsorship : Program supported by IRD.European Journal of Clinical Nutrition ( 2000 ) 54 , Iron-deficient anaemic infants perform worse in tests of mental and motor development than do iron-sufficient infants of a comparable age . A r and omised , double-blind trial was done to monitor the effects of iron supplementation on performance in the Bayley scales of mental and motor development among 12 - 18-month-old infants in Indonesia . Iron-deficient anaemic infants ( n = 50 ) were assigned r and omly to receive dietary ferrous sulphate or placebo for 4 month . Similar treatment r and omisation was done among nonanaemic iron-deficient ( n = 29 ) and iron-sufficient ( n = 47 ) infants . Before intervention , the mean mental and motor scores of the iron-deficient anaemic infants were significantly ( p < 0.01 ) lower than those of the nonanaemic iron-deficient and iron-sufficient classes . After intervention , developmental delays were reversed among iron-deficient anaemic infants who had received iron but they remained the same among placebo-treated iron-deficient anaemic infants . Neither ferrous sulphate nor placebo had significant effects on the scores of the other two iron-status classes . The poor performance of 12 - 18-month-old iron-deficient anaemic infants in the Bayley scales of mental and motor development can be improved to the level of performance of iron-sufficient infants by treatment with ferrous sulphate We conducted a r and omized double-blind trial of a cow 's milk infant formula with increased iron fortification in order to confirm its safety and to measure its effects on iron status and immune function .  A group of full-term , well nourished and healthy infants was followed from the age of 3 months to 1 year . A control group of 74 infants was given a commercially available infant formula containing 8.3 mg Fe/100 g . The test group of 75 infants received a similar formula with 40 mg Fe/100 g. The formula with the extra iron proved to be safe and , when compared with the control group , the children in the test group had significantly improved iron status as reflected by the proportion of children classed as normal ( 25 of 61 cf . 44 of 65 ; p less than 0.003 ) , and by the mean values of the haemoglobin concentration ( 11.5 cf . 11.9 g/dl ; p = 0.04 ) , red cell distribution width ( 15.5 % cf . 14.4 % ; p = 0.0005 ) , red cell zinc protoporphyrin ( 3.4 cf . 4.0 micrograms/g Hb ; p = 0.04 ) and ferritin ( 29 cf . 17.3 micrograms/l ; p = 0.004 ) . The extra iron fortification depressed zinc concentration in plasma ( 90.6 cf . 83.5 micrograms/l ; p = 0.05 ) . There was no significant difference between the two groups for laboratory measures of immune function or for incidence of infection . No adverse effects such as infection could be attributed to the increased iron . We conclude that iron fortification of cow 's milk infant formula may be safely increased to 40 mg/100 g ( i.e. by a factor of 4.8 over the common concentration of 8.3 mg/100 g ) , but that this has less than the expected effect on iron status . Further studies are required to define ( a ) the long-term role of facilitators of iron absorption such as ascorbic acid , ( b ) the interaction of iron with absorption of divalent trace elements such as zinc , and ( c ) the effect of iron status on immune function and susceptibility to infection The study was conducted to determine whether provision of oral supplementary iron to primary school children in Kenya would improve their growth .  Children in the two lowest grade s who satisfied study criteria were allocated to either an  iron-supplementation group ( n = 29 ) or a placebo group ( n = 26 ) . At the baseline before intervention the groups did not differ significantly in age , sex ratio , prevalence and intensity of intestinal helminthic infections , most anthropometric measurements or hemoglobin levels . Although the study lasted for 32 weeks , children only took iron or placebos on school days thus omitting weekends and school holidays . Examination at the end of the study showed that the iron-supplemented children had grown significantly more in terms of weight , weight for height , arm circumference and skinfold thickness compared with the placebo group . Hemoglobin levels had also improved significantly . We conclude that where iron deficiency anemia and undernutrition are prevalent in children , iron supplementation will improve growth and hemoglobin levels The effect of chronic iron intake on diarrhoeal disease was evaluated in children in a community of low socio-economic stratum in Santiago , Chile . Children were incorporated into each of two consecutive cohorts ; each cohort was divided into two groups , one receiving iron-enriched milk ( 12 mg/l ) ( monthly average = 70 children ) and the other a control milk ( 1 mg/l ) ( monthly average = 83 children ) , and each cohort was followed up for 6 months . The incidence of diarrhoea was higher among the iron-supplemented children ( 30.4 vs 25.5 episodes/100 children/month , P < 0.025 ) . This was mainly due to results obtained in infants 3 - 8 months of age during the summer months . Supplemented infants had more bowel movements on day 1 ( P < 0.03 ) and liquid or semi-liquid stools were passed for more than 15 days more frequently ( P < 0.05 ) . While no differences were detected in aetiology , Shigella-associated episodes were less common among iron-supplemented infants ( P < 0.008 ) . Asymptomatic shedding of enteropathogens significantly increased in infants 12 - 18 months of age receiving iron-supplemented milk . In areas with inadequate environmental sanitation , chronic iron supplementation may have negative effects on diarrhoeal morbidity , despite improving iron nutritional status Oral iron supplementation is often routinely given to children with malaria-associated anaemia , but its contribution to recovery is controversial . A r and omized clinical trial , evaluating such routine , was carried out among 100 children , who had a haemoglobin of < or = 5 g/dl and a positive blood smear for malaria parasites . All children received malaria therapy ( chloroquin + fansidar ) and were r and omly allocated to two groups , one receiving additional oral iron treatment , the other being the control . In the 12-week follow-up period the haemoglobin level and malaria indices were measured at 2 , 4 , 8 , and 12 weeks . There was a 100 per cent compliance during the follow-up period . In each group 20 children ( 40 per cent ) required a blood transfusion . In the remaining 60 children , after 2 weeks the haemoglobin had risen 3.7 g/dl in the ferrous-supplemented group compared to 3.5 g/dl in the non-ferrous group . Thereafter , the increase in haemoglobin in both groups was steady . At follow-up measurements , the groups did not differ for haemoglobin levels . The mean haemoglobin at 12 weeks was 9.2 and 9.0 g/dl , respectively . It was concluded that iron supplementation did not have any effect on the rate of parasitaemia and on parasite density during the 12 weeks . However , the iron-supplemented group had a significantly increased morbidity from other causes than malaria . It appears that iron does not have an effect on the recovery of haemoglobin level in children with malaria-associated anaemia . This study provides no evidence supporting routine iron supplementation to these children OBJECTIVES To obtain baseline data on hemoglobin ( Hb ) levels of adolescent girls belonging to the low-socio-economic groups ; investigate the comparative efficacy of once ' weekly ' and ' daily ' administration of iron-folate tablets with respect to impact on the Hb levels ; and find out the effect of added ascorbic acid supplementation on the efficacy of iron-folate administration with respect to increment in Hb levels . DESIGN R and omized experimental . SETTING Adolescent girls of poor communities in urban areas of Delhi and rural parts of Bharatpur ( Rajasthan ) . METHODS The baseline investigations included measurements of height , weight , and Hb levels . The Hb levels of the participating subjects were measured again after 3 months and 6 months of supplementation . RESULTS 61.9 % of the subjects in the urban and 85.4 % in the rural area were anemic . The response of Hb levels to daily iron/folate supplementation was better in comparison to once-weekly supplementation . The increment in Hb levels of subjects due to addition of vitamin C to iron/folate supplementation was more than that with supplementation of iron/folate alone . CONCLUSIONS Considering compliance , feasibility and cost-factors , a public-health approach consisting of once-weekly distribution of iron/folate supplementation through schools and welfare centers is better and can be recommended as an appropriate strategy for combating anemia in adolescent girls of poor communities in developing countries like India AIMS Iron deficiency anaemia is associated , in observational studies , with developmental disadvantage . This study tested the hypothesis that feeding iron supplemented formula from 9 to 18 months of age would improve developmental performance . SUBJECTS AND METHODS 493 healthy children aged 9 months being fed pasteurised cows ’ milk were recruited from three UK centres . They were r and omised to : cows ’ milk as before , formula containing 0.9 mg/litre iron , or formula containing 1.2 mg/litre iron , until 18 months of age . Bayley mental and psychomotor developmental indices were measured at 18 months , as were growth and haematological indices . RESULTS Children fed iron fortified formula had higher plasma ferritin concentrations , but there were no significant intergroup differences in development or growth . CONCLUSIONS There are no developmental or growth advantages in children given iron supplemented formula , but a benefit for a minority who were anaemic , or the possibility that a benefit may emerge at a later age , can not be excluded A supplementation trial was carried out in 101 children , 6 - 12 years of age , in 3 primary schools in a rural area . Their hemoglobin level and PCV ( mean + /- SD ) were 11.64 + /- 1.21 g/dl and 0.356 + /- 0.028 respectively , 74 % of them were anemic and the hemoglobin level were correlated with the MCHC ( P < .01 ) . Fifty-one per cent of them had hookworm infection and all those with hemoglobin levels below 10 g/dl had hookworm infection , but there was no difference in mean hemoglobin level between those with hookworm infection and those without . The children were divided into 3 groups : Group I comprising 39 children who received placebo tablest ; Group II of 33 , who received ferrous sulphate ( 60 mg elemental iron ) ; Group III of 29 , who received ferrous sulphate ( 60 mg elemental iron ) with riboflavin ( 6 mg ) . Each child received one tablet after lunch on schooldays and evaluation was carried out after receiving 80 to 90 tablets . The mean hemoglobin change of Group II was 0.60 g/dl larger than that of Group I ( P < .005 ) with 52 % of them responding to iron . The mean hemoglobin change of Group III was 0.38 g/dl larger than that of Group II ( P < .005 ) with 86 % of them responding to iron and riboflavin . Thus additional riboflavin is beneficial in iron supplementation BACKGROUND Iron deficiency continues to be a common problem among infants throughout the world .  Iron-fortified formula is effective in preventing iron deficiency but the benefit of iron-fortified cereal is controversial . METHODS We compared iron-fortified rice cereal to unfortified rice cereal in infants who were exclusively breast-fed for more than 4 months and to iron-fortified formula  in infants who were weaned to formula before 4 months of age . The design was double blind in respect to the presence or absence of fortification iron in the cereal or formula and included 515 infants who were followed on the protocol from 4 to 15 months of age .  Rice cereal was fortified with 55 mg of electrolytic iron per 100 g of dry cereal and infant formula with 12 mg of ferrous sulfate per 100 g of dry powder , levels approximating those in use in the United States . Measures of iron status were obtained at 8 , 12 , and 15 months . Infants with hemoglobin levels of < 105 g/L were excluded from the study and treated . RESULTS Consumption of cereal reached plateaus at means of about 30 g/d after 6 months of age in the formula-fed groups and 26 g/d after 8 months in the breast-fed groups ; these amounts are higher than the 19-g/d mean intake by the 73 % of infants who consume such cereal in the United States . Among infants weaned to formula before 4 months , the cumulative percentages of infants excluded for anemia by 15 months were 8 % , 24 % , and 4 % , respectively , in the fortified cereal , unfortified cereal and formula , and fortified formula groups ( P < .01 unfortified vs either fortified group ; the difference between the two fortified groups was not significant ) . In infants breast-fed for more than 4 months , the corresponding values were 13 % and 27 % , respectively , in the fortified and unfortified cereal groups ( P < .05 ) . Mean hemoglobin level and other iron status measures were in accord with these findings . CONCLUSION Iron-fortified infant rice cereal can contribute substantially to preventing iron deficiency anemia The aim of this study was to investigate the effects of different doses of iron on haematological status of breastfed infants . One hundred and thirteen infants were r and omized into four groups at 5 months of age .  Iron supplementation was given at doses of 1 mg/kg/day , 2 mg/kg/day , and 2 mg/kg/every other day in the first three study groups , respectively , and the last group received placebo . The hematological values , except hemoglobin , were higher in the group supplemented with iron at a dose of 2 mg/kg/day , and ferritin values were statistically higher in the group supplemented with iron at a dose of 2 mg/kg/every other day than in the group supplemented with iron at a dose of 1 mg/kg/day . We suggest that intermittent iron supplementation is more effective than a daily regimen in equal dosages Previous work at this hospital and elsewhere has shown that anaemia in toddlers is common and is associated with psychomotor delay . It seemed unclear , however , whether this association was cause and effect or merely due to the same underprivileged environment . A double blind r and omised intervention study was , therefore , performed . After an initial assessment 97 children with anaemia ( haemoglobin 8 - 11 g/dl ) aged 17 - 19 months received either iron and vitamin C or vitamin C only ( control group ) for two months and were then reassessed . The children who received the iron had an increased rate of weight gain and more of them achieved the expected rate of development . While iron deficiency anaemia is unlikely to be the only factor in the slower development of children living in underprivileged circumstances , it can at least be easily identified and treated . Routine child health surveillance in such areas should include a haemoglobin determination Four studies examined impacts of iron supplementation on school children of various ages and both sexes . The first study investigated impact of iron-folic acid supplements for 60 d on cognition in 94 boys and girls aged 5 - 8 y. Improvement in total scores of the anemics was significantly higher than the nonanemics in 7 - 8-y-old children only . The second study assessed impacts of supplementation on cognition in 14 pairs of 5 - 6-y-old anemic boys , with clear beneficial effects on cognitive function . The third study investigated effects of varying dosages of elemental iron on cognitive function in 48 boys aged 8 - 15 y , with different levels of improvement . The fourth study investigated impacts of iron supplementation on 163 anemic girls aged 8 - 15 y with treatment and evaluations at 4 and 8 mo , with significantly improved scores in cognitive function after the eighth month Abstract Six‐month‐old infants were recruited at 21 centres in the UK and Irel and and r and omly assigned to receive matching iron‐fortified ( 12.3 mg/l iron ) or non‐fortified ( 1.4 mg/l iron ) formula for 9 months . Infants already receiving cow 's milk continued this feed . Haematological indices and iron status were evaluated at age 6 months , 9–10 months and 15 months . Four hundred and six infants entered and 302 completed the study . There were no differences between the groups for increases in weight , head circumference or length . Significant differences between the groups were observed at 15 months for haemoglobin , serum ferritin , serum iron and total iron binding capacity . Haemoglobin levels were < 110 g/l in 33 % of infants fed cow 's milk compared with 13 % and 11 % in those receiving non‐iron‐fortified and iron‐fortified formula respectively . The corresponding figures for serum ferritin < 10 µg/l were 43 % , 22 % and 6 % . Follow‐on formula provides an acceptable vehicle for preventing iron deficiency in this vulnerable group It is evident that intermittent iron supplementation is better than daily supplementation in two aspects : iron absorption is more efficient and has insignificant side effects in contrast to the daily dose . The significantly higher daily iron loss observed in the daily iron supplemented groups rats also suggests alterations in total body iron metabolism . Based on serum ferritin distribution patterns , intermittent iron supplementation avoids temporary iron overload with daily iron supplemented . We conclude that weekly iron supplementation scheme is safer and easier to administer . This feasible strategy for the control of iron  deficient anemia  in pregnant women and children would be an effective iron-supplementation program ( Baily et al. , 1993 ) Sixty-nine boys and girls between 10 and 14 years , with evidence of sub clinical vitamin deficiencies and poor iron status were enrolled into the study at the beginning of the rainy season . Children were allocated to three treatment groups to receive five times weekly either a placebo , 200 mg ferrous sulphate or 5 mg riboflavin and 150 mg ascorbic acid . Before receiving the supplement , and 9 weeks later , children performed an exercise regimen on a treadmill during which expired air was collected and heart rate measured . There was a general deterioration in the running performance of the children during the study period which was not affected by either the iron or the vitamin supplement OBJECTIVE A r and omized , double-blind study was conducted comparing high-iron content ( 15 mg/L ) with low-iron content ( 3 mg/L ) premature formula given during initial hospitalization to infants with birth weights less than 1800 g to determine the influence of these differing intakes on the iron nutritional status during the first 4 months of life . A third group of similar infants received human milk mixed with an equal volume of liquid fortifier result ing in an iron content of approximately 1.7 mg/L. PATIENTS AND METHODS Mean birth weight , gestational age , age at study entry , volume of blood removed for studies , and volume of red cells transfused were not different among the three groups . After hospitalization both formula-fed groups were given a cow milk formula with an iron content of 12 mg/L , and breast-fed infants were given an iron-containing multivitamin with a result ing iron intake of 10 mg/d . Infants were observed to 8 weeks after discharge . RESULTS There were no differences in serum iron , ferritin , transferrin , transferrin saturation , hemoglobin , hematocrit , or reticulocyte count among the three groups at study entry , although mean corpuscular hemoglobin and mean corpuscular volume were lower in infants in the low-iron formula group . Mean plasma ferritin was significantly lower in infants receiving low-iron content premature formula at the time of hospital discharge compared with the other two groups . The incidence of anemia ( hemoglobin < 9.0 g/dL ) and low transferrin saturation ( < 24 % ) was also greater in the low-iron content formula group . Eight weeks after discharge , the incidence of low plasma ferritin ( < 19 ng/mL ) remained greater in infants receiving low-iron content formula than in the other two groups . No adverse effects of iron intake were observed . Growth was not different among the three groups . CONCLUSIONS These data indicate that preterm infants with < 1800 g birth weight receiving premature infant formula benefit from formula given during initial hospitalization containing 15 mg/L iron compared with that containing 3 Thirty eight children with a haemoglobin concentration of 106 - 110 g/l were given either oral iron ( n = 17 ) or placebo ( n = 21 ) for two months . The treated group achieved a significantly higher rise in haemoglobin concentration ; in a quarter it was greater than 20 g/l . While those with the lower mean corpuscular volume and ferritin showed greater rises in haemoglobin these indices were of little value in predicting response in an individual child We evaluated the effect of weekly doses of 400 mg of ferrous sulphate for 4 months on the iron status of adolescent girls in a controlled trial in Tanga , Tanzania . Supplementation led to a significantly greater increase in serum ferritin compared with the control group ( + 15.6 microg/l vs. 8.6 microg/l ) ( P = 0.002 ) but there was no significant difference in change in haemoglobin . Children given iron showed a significantly greater weight gain than controls ( + 2.4 kg vs. + 1.4 kg ) ( P = 0.03 ) . Weekly iron supplementation may be an effective means of increasing iron stores and growth in children vulnerable to iron deficiency Adult males and children between 4 and 12 years in a subsistence farming community in The Gambia were screened for haematological status . 80 men and 80 children with initially poor status were identified and allocated to three treatment groups comprising : a placebo , ferrous sulphate , and ferrous sulphate with riboflavin . Over a period of 6 weeks of supplementation there was a general improvement in haematological status in the two supplemented groups . The inclusion of riboflavin in the supplement enhanced recovery , particularly in those individuals with strikingly low levels of haemoglobin at the outset In sub-Saharan countries , although malaria and malaria-associated anaemia are major public health problems , the usefulness of supplementary iron treatment for children with malaria-associated anaemia is unknown . In a 6-week period during the 1995 rainy season , 222 Malawian children aged < 5 years , who sought treatment for malaria , had > or = 500 parasites/microliter blood and at least 5 g haemoglobin (HB)/dl blood and whose parents gave consent , were r and omized into a prospect i ve study comparing the efficacy of sulphadoxine- pyrimethamine only ( SP ) , SP plus daily iron ( SPD ) and SP plus weekly iron ( SPW ) as treatment for malaria-associated anaemia . The patients had their HB concentrations measured on enrollment ( day 0 ) , just before antimalarial treatment , and on days 3 , 7 , 14 , 21 and 28 ; 215 ( 96.8 % ) completed the 28-day study . Among the children with 5 - 8 g HB/dl on enrolment , HB gain by the end of the study was significantly greater than in the children with > 8 g HB/dl initially ( 4.1 v. 2.2 g/dl ; P < 0.05 ) , and those in the SPD group gained significantly more HB by days 21 and 28 ( 3.6 and 4.9 g/dl , respectively ) than those in either the SPW ( 2.7 and 3.7 g/dl , respectively ) or the S2 groups ( 2.6 and 3.5 g/dl , respectively ) ; there was no difference in HB gain between the SP and SPW groups . Type of treatment had no apparent effect , at any time during the study , on HB gains in those patients who had > 8 g HB/dl on enrolment . Thus the children with 5 - 8 g HB/dl on enrolment benefited from daily iron therapy whereas those with > 8 g HB/dl derived no significant benefit ; improvement in HB depended most on whether enrolment HB was < or = 8.0 g/dl . As treatment with an effective antimalarial drug result ed in HB gains , irrespective of treatment group or HB concentration at enrolment , the anaemia observed may be mostly related to malaria . However , as a larger proportion of the iron-treated patients failed to clear their parasitaemias than of those given SP alone , oral iron may inhibit SP action . It is therefore recommended that , for children with both malaria and malaria-associated anaemia , the malaria should first be cleared with an effective antimalarial drug , such as SP , before the anaemia , if it still persists , is treated with iron OBJECTIVE To determine the efficacy of iron-fortified infant formula in preventing  developmental delays and abnormal behavior . DESIGN Double-blind , r and omized , controlled trial . SETTING Urban hospital clinic . PARTICIPANTS A total of 283 healthy , bottle-fed infants from very low income families . Children with prematurity , low birth weight , and major anomalies and those who had received more than 2 weeks of evaporated-milk feedings were excluded . The groups were similar for sociodemographic background variables . Fifty-eight infants ( 20.5 % ) dropped out before any outcome data were gathered ; 225 , 204 , 186 , and 154 remained at 6- , 9- , 12- , and 15-month assessment s , respectively . INTERVENTION Iron-fortified formula ( 12.8 mg iron per liter ) versus regular formula ( 1.1 mg iron per liter ) . MAIN OUTCOME MEASURES Iron status was measured on venous blood by determination of hemoglobin , serum iron and iron-binding capacity , serum ferritin , and free erythrocyte protoporphyrin values . The Bayley Scales of Infant Development ( mental and psychomotor indexes ) and two factors of the Infant Behavior Record ( test affect and task orientation ) were the outcomes of interest . RESULTS All measures of iron status were significantly different between groups ( p < 0.001 ) . Psychomotor development patterns differed between groups ( F3,520 , 3.4 ; p = 0.02 ) with time . Mean values were similar at 6 months but differed at 9 and 12 months of age ( p < 0.001 ) , with a decline of 6.4 points in the regular-formula group . By 15 months of age the differences were no longer significant ( p = 0.23 ) . Mental development and behavior were not affected . CONCLUSIONS Iron-fortified formula significantly reduced iron deficiency in a high-risk group of infants and prevented a decline in psychomotor development quotients . This effect may be transient , and its long-term significance needs further study This double-blind clinical trial was conducted in Thail and to assess the impact of iron treatment on the IQ and educational attainment of 1358 9 - 11-y-old children . The children were classified into one of three groups : iron replete , iron depleted , and iron-deficient anemic . The Raven Progressive Matrices was used to measure IQ . A Thai language and a math test were administered to assess school attainment . A 50-mg/d tablet of ferrous sulphate was given for 2 wk and a 100 mg/d tablet , for 14 wk . An anthelminthic drug was given on the day of the blood test before treatment and 3 mo after the intervention started . There is evidence of a positive association between iron status and IQ and a language school achievement test but there is no support for the internal validity of the hypothesis that this association is causal The interactions between infections , malnutrition and poor iron nutritional status in infants at weaning ages are poorly defined . Therefore , four groups of infants from an area with a high incidence of malnutrition ( Lahore , Pakistan ) were enrolled in a prospect i ve , r and omized nutritional intervention study . Between 122 and 365 days of age , the infants from one community received either a milk cereal without iron fortification ( n= 29 ) , a milk cereal fortified with ferrous fumarate ( 7.5 mg/100 g ; n= 30 ) , or a milk cereal fortified with ferric‐pyrophosphate ( 7.5 mg/100 g ; n= 27 ) . Forty‐four infants from a neighbouring community did not receive a nutritional supplement and served as the control group . Calculated mean daily energy‐ and protein intake with the cereals was between 259–287 kcal , and 9.6–10.6 g at 12 months of age , respectively . Mean daily iron intake with the fortified cereals was between 4.1–5.1 mg at corresponding age . Nutritional supplementation result ed in significantly lower incidence of malnutrition and heigher weight gain . Incidence of acute diarrhoea was significantly ( p<0.05 ) lower in the supplemented groups . The infants fed the iron‐fortified milk cereals had significantly higher hemoglobin ( mean 10.4 vs. 9.8 gdl‐1 ) and serum ferritin ( mean 13.3 vs. 8.5 ngml‐1 ) values than the infants fed the non‐fortified milk cereals . However , no differences in the incidence of infections were found between the supplemented groups . It is concluded that poor nutritional intake between 122 and 365 days of age substantially contributed to the high incidence of diarrhoea and malnutrition in Pakistani infants The optimum management of children with severe malarial anaemia is still uncertain . Hence , we have undertaken a study to determine whether iron treatment is as effective at restoring haemoglobin levels one month after presentation as blood transfusion without iron treatment in children with moderately severe malarial anaemia . Two hundred and eighty-seven children with a packed cell volume ( PCV ) < 15 % and malaria infection were recruited into the study ; 173 children were assigned to receive blood transfusion because they had a PCV < 12 % and /or signs of respiratory distress and the remaining 114 children were allocated at r and om to receive either blood transfusion ( 58 ) or treatment with oral iron ( 56 ) for 28 d. Twenty-four children died , 23 in the most severely anaemic group . Fifteen children ( 65 % ) died before transfusion was given and most deaths occurred within the first 4 h of admission . One child died in the iron treatment group and 10 subsequently required transfusion . Among the severely anaemic children , those with respiratory distress were at greater risk of death than those without respiratory distress . After 28 d , haematological restoration was significantly better in children who had received iron than in those treated by blood transfusion ( P = 0.02 ) . Children who received malaria chemoprophylaxis after discharge from hospital had fewer episodes of malaria and subsequent admissions to a hospital or health centre than those who did not . Children with severe anaemia and clinical signs of respiratory distress must be identified quickly and transfused as soon as possible . However , for less severely anaemic children who are clinical ly stable , iron therapy offers an alternative to transfusion provided such children can be kept under surveillance and transfused subsequently should this become necessary 1 . The effect of daily supplements of 20 - 30 mg inorganic iron as ferrous sulphate on the growth , activity and haematological status of preschool children was studied for 3.5 , 7 and 12 months and compared to that of children who served as controls . All children were given their daily requirements of energy and protein . In addition , they received 5 microgram cyanocobalamin and 200 microgram folic acid . 2 . Fe supplementation increased the haemoglobin , serum Fe and percentage saturation of transferrin and reduced the unsaturated Fe-binding capacity significantly compared to corresponding values for the controls . 3 . Height and activity were unaffected by Fe supplements . 4 . Of the children 45 % had haemoglobin values below 110 g/l at the end of 7 - 12 months of Fe supplementation This experimental study was design ed to investigate the effects of daily versus intermittent iron supplementation on iron status of high school girls in Zahedan and Rasht cities in 1996 - 1997 . The subjects were selected r and omly from among students of grade s 1 - 3 of four high schools in each city .  Anemia was determined by measuring hematological indices . 260 anemic and a similar number of non-anemic subjects of 4 high schools were selected and allocated r and omly to 4 treatment groups . During a 3-month period , the test groups were given 150 mg ferrous sulfate tablets ( 50 mg Fe ) . Subjects in group 1 received a daily dose , groups 2 & 3 received twice or once weekly doses respectively . The control group received no iron supplement . For these subjects , in addition to hematological indices biochemical iron indices were measured in the beginning and at the end of the study . The increases in hemoglobin concentration in anemic subjects were not significantly different among supplemented groups but were different from the control group ( p < 0.00001 ) . Among anemic subjects , changes in serum ferritin levels in 3 supplemented groups were significantly different from the control group . Serum ferritin in Group 1 was also increased to a greater extent than groups 2 and 3 ( P < 0.00001 ) . It is concluded that over the study period a weekly iron dose was as effective as a daily dose in treating anemia but the daily dose was more effective in improving iron stores than a weekly dose in the short run BACKGROUND Up to 25 % of adolescent girls in the USA are iron deficient . This double-blind , placebo-controlled clinical trial assessed the effects of iron supplementation on cognitive function in adolescent girls with non-anaemic iron deficiency . METHODS 716 girls who enrolled at four Baltimore high schools were screened for non-anaemic iron deficiency ( serum ferritin < or = 12 micrograms/L with normal haemoglobin ) . 98 ( 13.7 % ) girls had non-anaemic iron deficiency of whom 81 were enrolled in the trial . Participants were r and omly assigned oral ferrous sulphate ( 650 mg twice daily ) or placebo for 8 weeks . The effect of iron treatment was assessed by question naires and haematological and cognitive tests , which were done before treatment started and repeated after the intervention . We used four tests of attention and memory to measure cognitive functioning . Intention-to-treat and per- protocol analyses were done . FINDINGS Of the 81 enrolled girls with non-anaemic iron deficiency , 78 ( 96 % ) completed the study ( 39 in each group ) . Five girls ( three control , two treatment ) developed anaemia during the intervention and were excluded from the analyses . Thus , 73 girls were included in the per- protocol analysis . Ethnic distribution , mean age , serum ferritin concentrations , haemoglobin concentrations , and cognitive test scores of the groups did not differ significantly at baseline . Postintervention haematological measures of iron status were significantly improved in the treatment group ( serum ferritin 27.3 vs 12.1 micrograms/L , p < 0.001 ) . Regression analysis showed that girls who received iron performed better on a test of verbal learning and memory than girls in the control group ( p < 0.02 ) . INTERPRETATION In this urban population of non-anaemic iron-deficient adolescent girls , iron supplementation improved verbal learning and memory Iron nutrition in infants was studied in a double-blind trial with artificial milk formula . Statistically significant differences were observed with the iron-fortified formula . Not all haematological indices showed significant differences . The fragiligraph technique result was the only parameter showing differences not influenced by other variables examined The prevalence of anemia is high in adolescent girls in India , with over 70 % anemic .  Iron-folic acid ( IFA ) supplements have been shown to enhance adolescent growth elsewhere in the world . To confirm these results in India , a study was conducted in urban areas of Vadodora , India to investigate the effect of IFA supplements on hemoglobin , hunger and growth in adolescent girls 10 - 18 y of age . Results show that there was a high dem and for IFA supplements and > 90 % of the girls consumed 85 out of 90 tablets provided . There was an increment of 17.3 g/L hemoglobin in the group of girls receiving IFA supplements , whereas hemoglobin decreased slightly in girls in the control group . Girls and parents reported that girls increased their food intake . A significant weight gain of 0.83 kg was seen in the intervention group , whereas girls in the control group showed little weight gain . The growth increment was greater in the 10- to 14-y-old age group than in the 15- to 18-y-old group , as expected , due to rapid growth during the adolescent spurt . IFA supplementation is recommended for growth promotion among adolescents who are underweight OBJECTIVE The objective was to study the effects of iron supplementation on hemoglobin and iron status in 2 different population s. STUDY DESIGN In a r and omized , placebo-controlled , masked clinical trial , we assigned term Swedish ( n = 101 ) and Honduran ( n = 131 ) infants to 3 groups at 4 months of age : ( 1 ) iron supplements , 1 mg/kg/d , from 4 to 9 months , ( 2 ) placebo , 4 to 6 months and iron , 6 to 9 months , and ( 3 ) placebo , 4 to 9 months . All infants were breast-fed exclusively to 6 months and partially to 9 months . RESULTS From 4 to 6 months , the effect of  iron  ( group 1 vs 2 + 3 ) was significant and similar in both population s for hemoglobin , ferritin , and zinc protoporphyrin . From 6 to 9 months , the effect ( group 2 vs group 3 ) was significant and similar at both sites for all iron status variables except hemoglobin , for which there was a significant effect only in Honduras . In Honduras , the prevalence of iron deficiency anemia at 9 months was 29 % in the placebo group and 9 % in the supplemented groups . In Sweden , iron supplements caused no reduction in the already low prevalence of iron deficiency anemia at 9 months ( <3 % ) . CONCLUSION Iron supplementation from 4 to 9 months or 6 to 9 months significantly reduced iron deficiency anemia  in Honduran breast-fed infants . The unexpected hemoglobin response at 4 to 6 months in both population s suggests that regulation of hemoglobin synthesis is immature at this age The growth status of anemic ( n = 117 , Hb 7 - 10 g/dl ) and normal ( n = 53 , H > or = 11 g/dl ) children 3 - 5 years of age living under similar environmental and socio-economic conditions was evaluated . The dietary intake was assessed on a r and om sub sample of the anemic and normal children . The anemic children had a poorer growth status than normal children as indicated by their significantly ( p < 0.001 ) lower body weight , height and weight for age and significantly ( p < 0.001 ) larger number in Grade s II and III malnutrition . Iron supplementation ( 40 mg elemental iron/day ) for six months produced a significant ( p < 0.001 ) increase in Hb levels of both groups ( 1.6 g/dl in the anemic and 0.8 g/dl in the non-anemic ) compared to their respective controls who received sugar placebos . The growth performance of the anemic children supplemented with iron was superior to that of anemic placebo treated children as indicated by a better weight gain and a significantly higher weight for height ( p < 0.05 ) . Weight for age was a good differentiator of the anemic from normal while weight for height was a good indicator of the impact of iron  supplements on growth
target: This systematic review indicates that iron supplementation increases  Hb levels in children significantly but modestly .
  The increase is greater in subjects who are anaemic at the start of the trial and lower in malarial hyperendemic areas and in those consuming iron-fortified food .
background: OBJECTIVE To evaluate the effect of iron supplementation on  haemoglobin ( Hb ) in children through a systematic review of r and omised controlled trials .