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Investigation of the causes of suboptimal haemoglobin response to iron supplementation
P Charoenlarp1, S Srinophakhun, P Pootrakul
1Bangkok Hospital for Tropical Diseases, Faculty of Tropical Medicine, Thailand.
Insights
Strict supervision and long-term iron supplementation are crucial for improving hemoglobin levels in children. This study found that consistent iron intake, even with additional nutrients, significantly boosted hemoglobin response.
Area of Science:
- Pediatric Nutrition
- Hematology
- Public Health Interventions
Background:
- Iron deficiency anemia is a prevalent global health issue, particularly affecting children.
- Suboptimal hemoglobin concentrations can impair cognitive development and overall health in school-aged children.
- Supplementation strategies aim to improve iron status and prevent anemia in vulnerable populations.
Purpose of the Study:
- To evaluate the impact of iron-folic acid supplementation, with and without additional micronutrients and protein, on hemoglobin concentrations in school-aged children.
- To compare the effectiveness of different supplementation regimens in urban and rural settings.
- To determine the importance of supervised intake for optimal therapeutic response.
Main Methods:
- A controlled supplementation trial involving 572 children aged 6-11 years, divided into urban control, rural control, and rural study groups.
- Phase 1: Daily iron-folic acid supplementation for 60 school days.
- Phase 2: Continued iron-folic acid supplementation for all groups, with the rural study group receiving additional protein, vitamins, and minerals.
Main Results:
- Initial iron-folic acid supplementation resulted in suboptimal hemoglobin concentrations across groups.
- No significant difference in mean hemoglobin was observed between the rural study group (with added nutrients) and the rural control group after the second phase.
- Overall, only 1.5% of children had hemoglobin below 12 g/dl, indicating a general improvement in iron status.
Conclusions:
- Strict supervision of iron tablet intake is essential for achieving optimal hemoglobin response.
- Long-term, consistent iron supplementation is a key factor in improving hemoglobin levels.
- While additional nutrients may offer some benefit, supervised iron intake appears to be the most critical element for efficacy.
Abstract:
The investigation concerned 572 children, 6-11 years of age, who were divided into three groups: urban control, rural control and rural study. During the first phase of supplementation, each child received 120 mg of elemental iron (as ferrous sulphate) with 0.50 mg of folic acid daily for 60 school days (five days a week) which resulted in a suboptimal haemoglobin concentration. During the second phase, all groups continued to take iron-folate tablets for 60 school days while the children in the study group also received protein, vitamins and minerals. Final blood examinations showed no significant difference in mean haemoglobin concentrations between the rural study and rural control groups. Only 1.5% of all children had haemoglobin below 12 g/dl. It can therefore be concluded that strict supervision of iron tablet intake and long-term supplementation with iron are essential for optimal haemoglobin response.