Anna Christofides

Publications (8)24.54 Total impact

• Source

  Available from: Brenda Hartman

  Article: Relative bioavailability of iron and folic acid from a new powdered supplement compared to a traditional tablet in pregnant women.

  Brenda Hartman-Craven, Anna Christofides, Deborah L O'Connor, Stanley Zlotkin
  [show abstract] [hide abstract]
  ABSTRACT: Deficiencies of iron and folic acid during pregnancy can lead to adverse outcomes for the fetus, thus supplements are recommended. Adherence to current tablet-based supplements is documented to be poor. Recently a powdered form of micronutrients has been developed which may decrease side-effects and thus improve adherence. However, before testing the efficacy of the supplement as an alternate choice for supplementation during pregnancy, the bioavailability of the iron needs to be determined. Our objective was to measure the relative bioavailability of iron and folic acid from a powdered supplement that can be sprinkled on semi-solid foods or beverages versus a traditional tablet supplement in pregnant women. Eighteen healthy pregnant women (24 - 32 weeks gestation) were randomized to receive the supplements in a crossover design. Following ingestion of each supplement, the changes (over baseline) in serum iron and folate over 8 hours were determined. The powdered supplement contained 30 mg of iron as micronized dispersible ferric pyrophosphate with an emulsifier coating and 600 mug folic acid; the tablet contained 27 mg iron from ferrous fumarate and 1000 mug folic acid. Overall absorption of iron from the powdered supplement was significantly lower than the tablet (p = 0.003). There was no difference in the overall absorption of folic acid between supplements. Based on the differences in the area under the curve and doses, the relative bioavailability of iron from powdered supplement was lower than from the tablet (0.22). The unexpected lower bioavailability of iron from the powdered supplement is contrary to previously published reports. However, since pills and capsules are known to be poorly accepted by some women during pregnancy, it is reasonable to continue to explore alternative micronutrient delivery systems and forms of iron for this purpose. ClinicalTrials.gov NCT00789490.
  BMC Pregnancy and Childbirth 08/2009; 9:33. · 2.83 Impact Factor
• Article: Low dose 'Sprinkles'-- an innovative approach to treat iron deficiency anemia in infants and young children.

  Siddhivinayak Hirve, Sheila Bhave, Ashish Bavdekar, Sadanand Naik, Anand Pandit, Claudia Schauer, Anna Christofides, Ziauddin Hyder, Stanley Zlotkin
  [show abstract] [hide abstract]
  ABSTRACT: Iron supplementation programs using pediatric tablets or drops have not been successful in the control of anemia amongst infants and children in India. Sprinkles is an innovative multi-micronutrient home fortification strategy to control iron deficiency and anemia. We aimed to determine the hematologic response to different doses and forms of iron in Sprinkles and iron drops. Twenty two villages of Vadu Rural Health Program, KEM Hospital, Pune. Double blind clustered randomized community-based trial. Children (n=432) aged 6 to 18 mo age with Hb between 70 to 100 g/L were enrolled. Selected villages were randomized into 5 groups: Sprinkles 12.5, 20 or 30 mg ferrous fumarate, Sprinkles 20 mg micronized ferric pyrophosphate or drops 20 mg ferrous glycine sulphate (DROPS) for 8 weeks. Household socio-demographic information was collected at baseline. Side effects and compliance were monitored through weekly visits. Hemoglobin was estimated at baseline, 3 and 8 weeks. Ferritin was assessed at baseline and 8 weeks. Baseline characteristics were similar across all groups. Hemoglobin increased significantly (P<0.0001) in all groups at 8 weeks with no difference between groups. Ferritin increased (P<0.0001) significantly in all groups with no difference across the groups. Compliance (overall range: 42 to 62 %) was lowest for DROPS. Side effects were significantly higher among DROPS compared to Sprinkles (p>0.05). Sprinkles 12.5 mg FF dose is as efficacious as higher doses of iron in Sprinkles or DROPS in increasing hemoglobin. Sprinkles FF 12.5 mg is recommended as it has fewer reported side effects and better compliance compared to DROPS.
  Indian pediatrics 02/2007; 44(2):91-100. · 1.05 Impact Factor
• Article: Multi-micronutrient Sprinkles including a low dose of iron provided as microencapsulated ferrous fumarate improves haematologic indices in anaemic children: a randomized clinical trial.

  Anna Christofides, Kwaku Poku Asante, Claudia Schauer, Waseem Sharieff, Seth Owusu-Agyei, Stanley Zlotkin
  [show abstract] [hide abstract]
  ABSTRACT: Home-fortification of complementary foods with micronutrients (including iron) as Sprinkles is a new strategy to control iron deficiency and anaemia in developing countries. However, the most effective dose and form of iron is not known. The purpose of this study was to compare the efficacy of various doses (12.5, 20 or 30 mg) and treatment methods (multi-micronutrient Sprinkles vs. ferrous sulphate drops) on haemoglobin (Hb) concentration after 8 weeks of treatment in anaemic children. In total, 133 anaemic Ghanaian children (Hb 70-99 g L(-1)) aged 6-18 months were randomly assigned to one of five daily interventions for 8 weeks. Out of the five interventions, four used Sprinkles, and one used iron drops. Of the four Sprinkles groups, three included 12.5, 20 or 30 mg of iron as ferrous fumarate, and one included 20 mg of iron as ferric pyrophosphate. The iron drops group included 12.5 mg of iron as liquid ferrous sulphate. Hb concentrations were measured at baseline, week 3 and week 8. The primary outcome measure was Hb concentration at 8 weeks after treatment. We compared differences in Hb and ferritin concentrations and prevalence of iron deficiency anaemia (Hb < 100 g L(-1) and soluble transferrin receptor concentrations >8.5 mg L(-1)) from baseline to 8 weeks within and between groups. Adherence and reporting of side effects (staining of the teeth, ease of use, diarrhoea and darkening of stools) were compared between groups. Mean change in Hb was 1.4 g L(-1) (SD = 1.8) (P = 0.0001). Change in Hb concentrations from baseline to 8 weeks was significant in all groups (P = 0.0001-0.0007), with no differences across groups. Geometric means of serum ferritin varied from 18.6 to 44.0 microg L(-1) at baseline. At week 8, these means were in the interval of 48.0-78.3 microg L(-1), with no group differences. Prevalence of iron deficiency anaemia decreased significantly from baseline to 8 weeks in all groups with the exception of the iron drops group, with no group differences. Adherence was lower in the drops group (64%) as compared with Sprinkles groups (84%). Greater staining of the teeth and less ease of use were reported in the drops group as compared with Sprinkles groups. A dose as low as 12.5 mg of iron as ferrous fumarate when provided as Sprinkles may be effective in anaemic children.
  Maternal and Child Nutrition 07/2006; 2(3):169-80. · 1.61 Impact Factor
• Article: Iron deficiency anemia among children: Addressing a global public health problem within a Canadian context.

  Anna Christofides, Claudia Schauer, Stanley H Zlotkin
  [show abstract] [hide abstract]
  ABSTRACT: Despite current Canadian pre- and perinatal nutrition programs, the prevalence of both iron deficiency and iron deficiency anemia (IDA) is very high among young Aboriginal children from Canada's remote north. The major risk factors for IDA include prolonged consumption of evaporated cow's milk, chronic infection and prolonged exclusive breastfeeding. In the present article, the authors discuss IDA as a significant public health problem in Canadian Aboriginal communities. Whereas the prevalence of IDA in Canadian children is between 3.5% and 10.5% in the general population, in two Northern Ontario First Nations communities and one Inuit community, the anemia rate was 36%, with 56% having depleted iron stores. Traditional methods of preventing IDA, including targeted fortification, dietary diversification and supplementation, have not solved the problem. The authors' research group at The Hospital for Sick Children in Toronto, Ontario, conceived of the strategy of 'home fortification' with 'Sprinkles' - single-dose sachets containing micronutrients in a powder form, which are easily sprinkled onto any foods prepared in the household. In Sprinkles, the iron (ferrous fumarate) is encapsulated within a thin lipid layer to prevent the iron from interacting with food. Sprinkles have been shown to be efficacious in the treatment of anemia in many developing countries. Their use in Aboriginal communities to treat and prevent anemia is described in the present paper. The authors believe that children in Aboriginal communities across Canada would potentially benefit if Sprinkles were incorporated into Health Canada's current distribution system, in combination with a social marketing strategy to encourage their use.
  Paediatrics & child health 01/2006; 10(10):597-601. · 0.78 Impact Factor
• Source

  Available from: phac-aspc.gc.ca

  Article: Acceptability of micronutrient sprinkles: a new food-based approach for delivering iron to First Nations and Inuit children in Northern Canada.

  Anna Christofides, Claudia Schauer, Waseem Sharieff, Stanely H Zlotkin
  [show abstract] [hide abstract]
  ABSTRACT: Iron deficiency anemia (IDA) is a significant public health problem among Canadian Aboriginal children. The objectives of this study were to determine the acceptability and safety of microencapsulated-iron sprinkles, a new powdered form of iron packaged in a single-serving sachet for prevention of IDA. A total of 102 non-anemic children aged 4 to 18 months from three communities were randomized to receive sprinkles containing 30 mg Fe/day (NR = 49) or placebo (NR = 53) for six months. To assess acceptability, adherence and side effects were monitored bi-weekly. To assess safety, serum ferritin (SF) concentration and anthropometry were measured at baseline and end. Mean adherence was 59.6 +/- 27.7 percent. There were no differences in adherence, SF, anthropometric status or side effects between groups. Although there were no differences in hemoglobin (Hb) concentration and anemia prevalence from baseline to end and between groups, the Hb curve shifted to the right (increased) for the sprinkles group and to the left (decreased) for the placebo group. Sprinkles may provide a safe and acceptable option to the current standard of care (i.e. ferrous sulphate drops) for the provision of iron in Canadian Aboriginal populations.
  Chronic diseases in Canada 02/2005; 26(4):114-20. · 0.98 Impact Factor
• Source

  Available from: PubMed Central

  Article: Micronutrient sprinkles to control childhood anaemia.

  Stanley H Zlotkin, Claudia Schauer, Anna Christofides, Waseem Sharieff, Mélody C Tondeur, S M Ziauddin Hyder
  PLoS Medicine 02/2005; 2(1):e1. · 16.27 Impact Factor
• Article: Authors' reply: sprinkles as a home fortification strategy to improve the quality of complementary foods.

  Zlotkin Stanley H, Claudia Schauer, Anna Christofides, Waseem Sharieff, Tondeur Mélody C, Hyder S. M. Ziauddin
  PLoS Medicine. 01/2005;
• Source

  Available from: cpha.ca

  Article: Iron deficiency and anemia prevalence and associated etiologic risk factors in First Nations and Inuit communities in Northern Ontario and Nunavut.

  Anna Christofides, Claudia Schauer, Stanley H Zlotkin
  [show abstract] [hide abstract]
  ABSTRACT: Anemia is common among children in Aboriginal communities in Canada. The objectives of this study were to determine the prevalence of anemia and to identify its associated risk factors among young children in Aboriginal communities in northern Ontario and Nunavut. 115 children from one Inuit and two Cree First Nations communities participated. We collected information on demographic and dietary factors and measured hemoglobin (Hb), ferritin (SF), serum transferrin receptor (sTfR) and Helicobacter pylori IgG antibodies. Odds ratios and 95% confidence intervals were determined to examine risk factors associated with anemia and iron deficiency (ID) and further analyzed using stepwise regression procedures. Prevalence of anemia (Hb<110 g/L) was 36.0%. Iron deficiency (sTfR>8.5 mg/L) was present in 27.6% of the study population. Approximately 53.3% had depleted iron stores (SF<12 microg/L). Consumption of cow/evaporated milk was the only independent risk factor associated with anemia. Infection with H. pylori and prolonged consumption of breastmilk were also associated, although not independently, with anemia. Formula intake was negatively associated with ID. The prevalence of anemia in Aboriginal children was eight times higher than among similar populations in urban Canada and was especially high among Inuit children. ID was the major cause of anemia, but not the only one, since 10% of anemic children were not iron deficient. Given that the consumption of cow/evaporated milk was found to be a significant independent risk factor associated with anemia, public health strategies should include promotion of breastfeeding, combined with iron-rich complementary foods, while addressing socio-economic conditions that may be preventing these practices from being adopted. H. pylori may be a major contributing factor to anemia, thus improvements in water quality and sanitation also need to be considered.
  Canadian journal of public health. Revue canadienne de santé publique 96(4):304-7. · 1.02 Impact Factor