title: Supplemental vitamin A improves anemia and growth in anemic school children in Tanzania. Once weekly is superior to daily iron supplementation on height gain but not on hematological improvement among schoolchildren in Thailand. Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras. Iron supplementation improves appetite and growth in anemic Kenyan primary school children. Iron supplementation and physical growth of rural Indonesian children. 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. Effect of iron-fortified candies on the iron status of children aged 4-6 y in East Jakarta, Indonesia. Effects of iron and zinc supplementation in Indonesian infants on micronutrient status and growth. Ferrous sulfate is more bioavailable among preschoolers than other forms of iron in a milk-based weaning food distributed by PROGRESA, a national program in Mexico. Long-term supplementation with iron does not enhance growth in malnourished Bangladeshi children. A preliminary simulated iron fortification trial in South Indian preschool children. Impact of iron supplementation and deworming on growth performance in preschool Beninese children Effect of infant formula on stool characteristics of young infants. School-administered weekly iron supplementation – Effect on the growth and hemoglobin status of non-anemic Bolivian school-age children
  A randomized placebo-controlled trial Iron Nutrition and Growth of Breast- and Formula‐Fed Infants During the First 9 Months of Life Effects of an energy and micronutrient supplement on anthropometry in undernourished children in Indonesia 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. Zinc supplementation reduced morbidity, but neither zinc nor iron supplementation affected growth or body composition of Mexican preschoolers. Effectiveness of iron-fortified infant cereal in prevention of iron deficiency anemia. Iron supplementation of the diet in full-term infants: a controlled study. Follow‐on formula in the prevention of iron deficiency: a multicentre study Daily Multivitamins with Iron to Prevent Anemia in Infancy: A Randomized Clinical Trial Prevention of anaemia in inner city toddlers by an iron supplemented cows' milk formula. The impact of weekly iron supplementation on the iron status and growth of adolescent girls in Tanzania. Prevention of iron deficiency and psychomotor decline in high-risk infants through use of iron-fortified infant formula: a randomized clinical trial. The effect of different anthelmintic treatment regimens combined with iron supplementation on the nutritional status of schoolchildren in KwaZulu-Natal, South Africa: a randomized controlled trial. Interactions between Infections, Malnutrition and Ironnutritional Status in Pakistani Infants A Longitudinal Study Studies in iron supplementation of preschool children. Supplementation with iron and folic acid enhances growth in adolescent Indian girls. Adverse effect of iron supplementation on weight gain of iron-replete young children Growth performance in anemia and following iron supplementation.
abstract: 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 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 Iron supplements are often prescribed during infancy but their benefits and risks have not been well documented . We examined whether iron supplements affect growth or morbidity of breast-fed infants . Full-term infants in Sweden ( n = 101 ) and Honduras ( n = 131 ) were r and omly assigned to three groups at 4 mo of age : 1 ) placebo from 4 to 9 mo ; 2 ) placebo from 4 to 6 mo and iron supplements [ 1 mg/(kg . d ) ] from 6 to 9 mo ; or 3 ) iron supplements from 4 to 9 mo . All infants were exclusively or nearly exclusively breast-fed to 6 mo and continued to be breast-fed to at least 9 mo . Growth was measured monthly and morbidity data were collected every 2 wk . Among the Swedish infants , gains in length and head circumference were significantly lower in those who received iron than in those given placebo from 4 to 9 mo . The same effect on length was seen in Honduras , but only at 4 - 6 mo among those with initial hemoglobin ( Hb ) > or = 110 g/L. There was no significant main effect of  iron supplementation on morbidity , nor any significant interaction between iron supplementation and site , but for diarrhea ( with both sites combined ) , there was an interaction between iron supplementation and initial Hb . Among infants with Hb < 110 g/L at 4 mo , diarrhea was less common among those given iron than in those given placebo from 4 - 9 mo , whereas the opposite was true among those with Hb > or = 110 g/L ( P < 0.05 ) . We conclude that routine iron supplementation of breast-fed infants may benefit those with low Hb but may present risks for those with normal Hb 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 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 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 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 After 1 y of distributing a milk-based fortified weaning food provided by the Mexican social program PROGRESA , positive effects on physical growth , prevalence of anemia , and several vitamin deficiencies were observed . There was no effect on iron status , which we hypothesized was related to the poor bioavailability of the reduced iron used as a fortificant in PROGRESA . The objective of this study was to compare the iron bioavailability from different iron sources added as fortificants to the weaning food . Children ( n = 54 ) aged 2 - 4 y were r and omly assigned to receive 44 g of the weaning food fortified with ferrous sulfate , ferrous fumarate , or reduced iron + Na(2)EDTA .  Iron absorption was measured using an established double-tracer isotopic methodology . Iron absorption from ferrous sulfate ( 7.9 + /- 9.8 % ) was greater than from either ferrous fumarate ( 2.43 + /- 2.3 % ) or reduced iron + Na(2)EDTA ( 1.4 + /- 1.3 % ) ( P < 0.01 ) . The absorption of log-(58)Fe sulfate given with the iron source correlated with serum ferritin ( s-ferritin ) concentration ( n = 13 , r = 0.63 , P = 0.01 ) and log-(57)Fe absorption ( reference dose ) ( n = 14 , r = -0.52 , P = 0.02 ) . Absorption from ferrous fumarate and reduced iron + Na2EDTA did not correlate with s-ferritin or absorption of (57)Fe . The recommended daily portion of the fortified complementary food provides an average of 0.256 , 0.096 , 0.046 mmol ( 1.44 , 0.54 , and 0.26 mg ) of absorbed iron , if fortified with sulfate , fumarate and reduced iron + Na(2)EDTA , respectively . Ferrous sulfate was more bioavailable than either ferrous fumarate or reduced iron + Na(2)EDTA when added to the milk-based fortified food and more readily met the average daily iron requirements for children 2 - 3 y of age To evaluate the effect of long-term oral iron supplementation on growth , 250 children aged 6 - 71 mo were studied in a r and omized double-blind controlled trial . The intervention group received 125 mg of ferrous gluconate ( 15 mg elemental iron ) plus multivitamins ( vitamins A , D and C ) ; the comparison group received only multivitamins daily for 12 mo .  Weight ( kg ) and height ( cm ) were measured every month . Eighty three percent of the children continued the treatment for one year . The weight increment over the 12-mo period was 1.35 + /- 0.65 kg ( mean + /- SD ) in the intervention group and 1.39 + /- 0.54 kg in the comparison group . The height increments were 6.01 + /- 1.47 and 6.18 + /- 1.58 cm in the intervention and comparison groups , respectively . Mean weight and height increments did not differ ; in an analysis stratified according to different age and nutritional categories , they also did not differ between the two groups , indicating that long-term iron supplementation does not increase growth in children 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 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 , BACKGROUND Many infants are switched between multiple formula preparations early in life because of perceived abnormalities in stooling pattern as well as gastrointestinal symptoms . OBJECTIVE To investigate the relationship between the type of formula consumed and the stooling characteristics and gastrointestinal  symptoms of young infants . METHODS Healthy 1-month-old infants were fed one of four commercial formula preparations ( Enfamil , Enfamil with Iron , ProSobee , and Nutramigen ) for 12 to 14 days in a prospect i ve double-blinded ( parent/physician ) fashion . Parents completed a daily diary of stool characteristics as well as severity of spitting , gas , and crying for the last 7 days of the study period . A breast-fed infant group was studied as well . RESULTS Two hundred eighty five infants were enrolled and 238 completed the study . Infants receiving breast milk or Nutramigen had twice as many stools as other formula groups ( P < .001 ) . Infants receiving ProSobee had hard/firm stools more often than breast-fed or other formula-fed groups ( P < .00001 ) . Watery stools were more common in infants fed Nutramigen than other formula groups ( P < .04 ) . Green stools were more common in 12 mg/L iron preparations ( Enfamil with iron , ProSobee , Nutramigen ) than in those with 1 mg/L ( Enfamil , breast milk ) ( P < .00001 ) . Spitting , gassiness , and crying were of equal severity in all formula groups . CONCLUSIONS The interpretation of stool frequency , color , and consistency must take into account the infant 's formula type as significant variations in normal infants occur . Parental education on the range of infant stooling characteristics as well as the common occurrence of spitting , gas , and crying may alleviate concern for formula intolerance and underlying gastrointestinal disease 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 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 Objectives : This paper reports the effects of early supplementary feeding on body weight , length , head circumference and arm circumference among the children in the Pangalengan 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 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 . Results : Body weight showed effects on both cohorts at 2 , 8 and 12 months ; head circumference showed effects at 4 months in the 12-month-old cohort and at 10 months among the females of the 18-month-old cohort ; and arm circumference showed effects across cohorts at 2 , 8 and 12 months . In general the benefits are clearer for females and for the 12-month-old cohort . Sponsorship : Nestlé Foundation . European Journal of Clinical Nutrition ( 2000 ) 54 , Suppl 2 , 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 In rural Mexico and in many developing countries micronutrient deficiencies , growth stunting , and morbidity from infectious diseases are highly prevalent in young children . We assessed the extent to which growth stunting could be reversed and the number of infectious disease episodes reduced by zinc and /or iron supplementation . In a double-blind , r and omized community trial 219 Mexican preschoolers were supplemented with either 20 mg Zn as zinc methionine , 20 mg Fe as ferrous sulfate , 20 mg Zn + 20 mg Fe , or a placebo . After 12 mo , plasma zinc increased significantly in the two zinc-treated groups , and plasma ferritin was significantly higher in the two iron-treated groups . There was no effect of treatments on growth velocity or body composition . Children in both zinc-supplemented groups had fewer episodes of disease ( zinc alone , 3.9 + /- 0.3 ; zinc+iron , 3.7 + /- 0.4 ; placebo , 4.6 + /- 0.5 ; P < 0.03 ) , including diarrhea ( zinc alone , 0.7 + /- 0.1 ; zinc+iron , 0.8 + /- 0.1 ; placebo , 1.1 + /- 0.2 ; P < 0.01 ) . Zinc and zinc+iron supplements reduced morbidity but had no effect on growth or body composition 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 To determine the clinical and laboratory effects of medicinal iron supplementation,602  healthy full-term infants were studied . Three hundred twenty-nine infants were given 30 mg . of elemental iron per day , and 273 were given a placebo . Fifty-five per cent of the original group completed the supplement program ( 11 months ) , and 46.5 per cent completed the total 18 months of the study period . Forty-one per cent were followed for a total of two years ; these infants were evaluated in detail . No objective benefit from the iron medication was found , but a transient decrease in the serum iron saturation was noted in the placebo group . Side effects were minimal . Subjectively the mothers of the iron-supplemented group had less complaints about their children 's sleep pattern or daytime irritability , and reported fewer illnesses . However , the more objective evidence of illnesses recorded in the infants ' charts did not support this difference . It is our belief that normal healthy infants who readily accept solid food will not be subject to iron deficiency anemia and do not benefit from iron supplementation 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 This study assessed the effectiveness of multivitamins ( MV ) with iron as prophylaxis against  iron deficiency ( ID ) and anemia in infancy . The study was a double-blind , r and omized trial at 2 urban primary care clinics . Subjects included healthy , full-term infants enrolled at their 6-month well-child visit . Parents administered MV , either with iron or without iron , by mouth daily for 3 months . At 9 months of age , 28.3 % of 310 had either anemia or ID without anemia . Among infants with any adherence , anemia was found in 11.1 % of the iron group and 21.7 % in the noniron group ( RR=0.5 , 95 % CI=0.3 - 1.0 ) . Iron deficiency without anemia was found in 18.5 % of the iron group ; 14.4 % of the noniron group ( p=0.46 ) . When administered daily starting at age 6 months , st and ard-dose multivitamins with iron appear to reduce anemia prevalence at 9 months of age There are few data to support the use of follow-on formulas in infants from the age of 6 months . In a prospect i ve trial in a deprived inner city area of Birmingham 100 infants who were already receiving pasteurised cows ' milk by 6 months of age were enrolled and r and omised either to receive a follow-on formula or to continue on cows ' milk from 6 months until 18 months . At 18 months of age the follow-on formula group returned to cows ' milk and both groups were followed up until 24 months . Iron status , growth , and nutritional status were analysed at intervals of six months . At enrollment , no differences in haematological status were evident . However , by 12 months of age , 31 % of the cows ' milk group were anaemic ( haemoglobin concentration < 110 g/l ) compared with only 3 % of those receiving follow-on formulas . At 18 months , 33 % of the cows ' milk group were anaemic compared with only 2 % of the follow-on formula group and by 24 months of age none of the follow-on formula group was anaemic , whereas 26 % in the cows ' milk group still had a haemoglobin of < 110 g/l . Mean corpuscular volume was significantly smaller and ferritin significantly lower in the cows ' milk group at 12 , 18 , and 24 months . Dietary iron intake was higher in the follow-on formula group at 12 and 18 months but not at 24 months , when both groups were back on cows ' milk . Infants and toddlers at high risk of iron deficiency are therefore unlikely to become anaemic if receiving a follow-on formula , although the relative merits of follow-on formula compared with an ordinary infant formula remain uncertain 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 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 A r and omized controlled trial in KwaZulu-Natal ( South Africa ) of 428 primary -school pupils ( stratified into 6 groups by age , sex and intervention ) measured the effect of different anthelmintic treatments and iron supplementation regimens provided twice at 6-monthly intervals for 1 year ( 1996/97 ) . Half the pupils received iron supplementation ( ferrous fumarate 200 mg weekly for 10 weeks ) . Pupils received 2 anthelmintic regimens , either ( i ) albendazole 400 mg plus praziquantel 40 mg/kg or ( ii ) albendazole 400 mg on 3 consecutive days plus praziquantel 40 mg/kg or ( iii ) placebo . Baseline prevalences of Ascaris 55.9 % , Trichuris 83.6 % , hookworm spp . 59.4 % , were reduced after 12 months for single-dose albendazole treatment to Ascaris 17.4 % ( P < 0.005 ) , Trichuris 61.5 % ( NS ) , hookworm spp . 0 % ( P < 0.005 ) , and for triple-dose albendazole treatment to Ascaris 14.8 % ( P < 0.005 ) , Trichuris 25.0 % ( P < 0.01 ) , hookworm 0 % ( P < 0.005 ) . Schistosoma haematobium 43.4 % was reduced among treated groups to 8.3 % ( P < 0.005 ) . There were no significant changes in the anthropometry of the different treatment groups at either 6 or 12 months post treatment . Twelve months after treatment there was a significant increase in haemoglobin levels ( P = 0.02 ) among pupils receiving triple-dose albendazole , praziquantel and ferrous fumarate ; pupils receiving no anthelmintic treatment showed a significant decrease as did pupils who received triple-dose albendazole and praziquantel but no iron . Regular 6-monthly anthelmintic treatment significantly reduced the prevalence of Ascaris , hookworm spp . and S. haematobium infections ( P < 0.05 ) . Triple-dose treatment for Trichuris was significantly more effective than a single dose of albendazole 400 mg ( P = 0.002 ) . In areas with schistosomiasis , hookworm infection and high prevalence of Trichuris infection , combination treatment with praziquantel , triple-dose albendazole , plus iron supplementation , is likely to improve pupils ' health and haemoglobin levels 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 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 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 The efficacy of iron supplementation for iron-deficient subjects is in no doubt . However , the assumption that iron supplementation of iron-replete subjects is harmless may not be valid . We have studied the effect of iron supplementation on growth rate in 47 iron-sufficient young children ( 12 - 18 months ) in Indonesia . The children were r and omly assigned either ferrous sulphate ( 3 mg/kg daily ) or placebo every day for 4 months . Before treatment the length , weight , and arm circumference of the two groups were similar . During the 4 months of supplementation the rate of weight gain was significantly greater in the placebo group than in the iron-supplemented group ( 0.106 [ SE 0.010 ] vs 0.070 [ 0.011 ] kg every 2 weeks , p = 0.02 ) . The rates of gain in length and arm circumference did not differ significantly by treatment . There were no differences between the groups in rates of respiratory and gastrointestinal infections . These results suggest that iron supplementation of iron-replete children may retard their growth 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: Significant heterogeneity was evident , and its predictors included greater weight-for-age in supplemented children in malaria hyperendemic regions and greater weight-for-height for children above 5 years of age , but a negative effect on linear growth in developed countries and with supplementation for 6 months or longer .
  This review did not document a positive effect of iron supplementation on the physical growth of children .
background: OBJECTIVE To evaluate the effect of iron supplementation on  physical growth in children through a systematic review of r and omised controlled trials ( RCTs ) .