Effectiveness of daily and weekly iron supplementation in the prevention of anemia in infants.
ABSTRACT To evaluate the effectiveness of universal prophylactic targeting with iron sulfate on daily or weekly basis in the prevention of anemia in infants.
Randomized clinical field trial with children between ages six and 12 months seen at primary health care units in the municipality of Rio de Janeiro, Brazil, between 2004 and 2005. Three concurrent cohorts were compared: daily group (n=150; 12.5mg Fe/day); weekly group (n=147; 25mg Fe/week) and control group. The intervention consisted of universal supplementation with iron sulfate for 24 weeks, combined with educational adherence-promoting measures. Outcome: mean serum hemoglobin concentration, distribution and prevalence of anemia (Hb<110.0 g/l) at age 12 months. Effectiveness was evaluated considering both intent to treat and adherence to protocol, using multiple regression analysis (linear and Poisson).
Groups were homogeneous in terms of descriptive variables. The intervention was implemented successfully, with high adhesion to protocol in both groups, and no statistical difference between them. After adjustment, only the daily regimen showed a protective effect. Adherence analysis demonstrated an evident dose-response effect on mean Hb and prevalence of anemia only for the daily regimen. No protective effect was detected for the weekly regimen.
Universal supplementation with iron sulfate from six to 12 months of age was effective in increasing serum Hb and decreasing risk of anemia only when administered on a daily basis.
Article: Once weekly low-dose iron supplementation effectively improved iron status in adolescent girls.[show abstract] [hide abstract]
ABSTRACT: Iron supplementation has been suggested as a strategy for prevention and treatment of iron deficiency (ID) and iron deficiency anemia (IDA) in many countries, but non-compliance of daily regimens and common dosage remain as major challenges. The aim of this study was to investigate the effects of low dose once weekly iron supplementation in adolescent girls. The study was designed as a community-based, randomized, supplementation trial. The initial sample consisted of 200 female high school students, aged 14-16 years old, of whom 193 students concluded the study. They were randomly selected and assigned into either iron-supplemented group (ISG) or iron-unsupplemented group (IUG). The ISG received 150 mg ferrous sulfate once weekly for 16 weeks, whereas the IUG received nothing. Weight, height, and hematological parameters were measured and compared between the two groups before and after the intervention. There was no significant difference between the initial measures of the two groups before the intervention. After 16 weeks of intervention, mean of hemoglobin and serum ferritin improved significantly in ISG compared to IUG. At the beginning of the study, percent of anemia, IDA, and ID in ISG were 12.5%, 8.3%, and 30.2%, whereas these figures for IUG in this period of study were 14.4, 10.3, and 38.2, respectively, which were not significantly different between the two groups. However, percentages of the above items at the end of study in ISG were 2.1%, 0%, and 21.9%, respectively. In contrast to IUG, all cases of IDA were abolished in the ISG. Our study showed that once weekly supplementation of 150 mg ferrous sulfate for 16 weeks significantly improved iron status in female adolescents and effectively treated IDA. There is no need for higher dosage of iron for supplementation that may cause adverse effects and bear higher costs.Biological trace element research 09/2009; 135(1-3):22-30. · 1.92 Impact Factor
Article: Risk factors associated with hemoglobin levels and nutritional status among Brazilian children attending daycare centers in Sao Paulo City, Brazil.[show abstract] [hide abstract]
ABSTRACT: Like many other developing countries, Brazil has been going a nutritional transition which presence both malnutrition and overweight. Stunting and overweight are the major public health problems in Brazilian children. The objective of this study was to document the prevalence of stunting, overweight and anemia in preschool children and examine if those nutritional problems are related; also identify if these nutritional problems have the same risk factors. Data from the "Efficient Daycare Center Project" which include 270 children attending nurseries of eight daycare centers in Sao Paulo city, Brazil were used for this study. Data on height and weight were converted to z-scores using WHO anthro software. Hemoglobin (Hb) concentrations were determined on finger-prick blood samples. The co-occurrence of stunting, overweight and anemia was investigated by contingency tables a log-linear model. Univariate and multiple regression analyses were performed to estimate the association of HAZ, WAZ, WHZ and Hb levels with their risk factors. The results showed high prevalence of overweight (22.2%), risk of stunting (22.6%) and anemia (37%). Percent of daycare attendance, age, number of siblings under 5 years old and per capita income are associated with Hb levels. This study provides evidence that Brazil is going through a nutritional transition and suggest that the adoption of public policies to expand and improve services in daycare centers may help to prevent multi-nutritional problems in preschool children.Archivos latinoamericanos de nutrición 03/2010; 60(1):23-9. · 0.23 Impact Factor