ferrous-fumarate and Anemia--Iron-Deficiency

Oral contraceptive use has been associated with decreased menstrual blood losses; thus, can independently reduce the risk of anemia and iron deficiency in women. Manufacturers have recently started to include supplemental iron in the non-hormonal placebo tablets of some contraceptives. The aims of this narrative review are: (i) to describe the relationship between oral contraceptive use and both anemia and iron status in women; (ii) to describe the current formulations of iron-containing oral contraceptives (ICOC) available on the market; and (iii) to systematically review the existing literature on the effect of ICOC on biomarkers of anemia and iron status in women. We discovered 21 brands of ICOC, most commonly including 25 mg elemental iron as ferrous fumarate, for seven days, per monthly tablet package. Our search identified one randomized trial evaluating the effectiveness of ICOC use compared to two non-ICOC on increasing hemoglobin (Hb) and iron status biomarker concentrations in women; whereafter 12 months of contraception use, there were no significant differences in Hb concentration nor markers of iron status between the groups. ICOC has the potential to be a cost-effective solution to address both family planning needs and iron deficiency anemia. Yet, more rigorous trials evaluating the effectiveness of ICOC on improving markers of anemia and iron deficiency, as well as investigating the safety of its consumption among iron-replete populations, are warranted.

Topics: Adult; Anemia, Iron-Deficiency; Biomarkers; Contraceptives, Oral; Family Planning Services; Female; Ferrous Compounds; Hemoglobins; Humans; Iron

Approximately 600 million children of preschool and school age are anaemic worldwide. It is estimated that at least half of the cases are due to iron deficiency. Point-of-use fortification of foods with micronutrient powders (MNP) has been proposed as a feasible intervention to prevent and treat anaemia. It refers to the addition of iron alone or in combination with other vitamins and minerals in powder form, to energy-containing foods (excluding beverages) at home or in any other place where meals are to be consumed. MNPs can be added to foods either during or after cooking or immediately before consumption without the explicit purpose of improving the flavour or colour.. To assess the effects of point-of-use fortification of foods with iron-containing MNP alone, or in combination with other vitamins and minerals on nutrition, health and development among children at preschool (24 to 59 months) and school (five to 12 years) age, compared with no intervention, a placebo or iron-containing supplements.. In December 2016, we searched the following databases: CENTRAL, MEDLINE, Embase, BIOSIS, Science Citation Index, Social Science Citation Index, CINAHL, LILACS, IBECS, Popline and SciELO. We also searched two trials registers in April 2017, and contacted relevant organisations to identify ongoing and unpublished trials.. Randomised controlled trials (RCTs) and quasi-RCTs trials with either individual or cluster randomisation. Participants were children aged between 24 months and 12 years at the time of intervention. For trials with children outside this age range, we included studies where we were able to disaggregate the data for children aged 24 months to 12 years, or when more than half of the participants were within the requisite age range. We included trials with apparently healthy children; however, we included studies carried out in settings where anaemia and iron deficiency are prevalent, and thus participants may have had these conditions at baseline.. Two review authors independently assessed the eligibility of trials against the inclusion criteria, extracted data from included trials, assessed the risk of bias of the included trials and graded the quality of the evidence.. We included 13 studies involving 5810 participants from Latin America, Africa and Asia. We excluded 38 studies and identified six ongoing/unpublished trials. All trials compared the provision of MNP for point-of-use fortification with no intervention or placebo. No trials compared the effects of MNP versus iron-containing supplements (as drops, tablets or syrup).The sample sizes in the included trials ranged from 90 to 2193 participants. Six trials included participants younger than 59 months of age only, four included only children aged 60 months or older, and three trials included children both younger and older than 59 months of age.MNPs contained from two to 18 vitamins and minerals. The iron doses varied from 2.5 mg to 30 mg of elemental iron. Four trials reported giving 10 mg of elemental iron as sodium iron ethylenediaminetetraacetic acid (NaFeEDTA), chelated ferrous sulphate or microencapsulated ferrous fumarate. Three trials gave 12.5 mg of elemental iron as microencapsulated ferrous fumarate. Three trials gave 2.5 mg or 2.86 mg of elemental iron as NaFeEDTA. One trial gave 30 mg and one trial provided 14 mg of elemental iron as microencapsulated ferrous fumarate, while one trial gave 28 mg of iron as ferrous glycine phosphate.In comparison with receiving no intervention or a placebo, children receiving iron-containing MNP for point-of-use fortification of foods had lower risk of anaemia prevalence ratio (PR) 0.66, 95% confidence interval (CI) 0.49 to 0.88, 10 trials, 2448 children; moderate-quality evidence) and iron deficiency (PR 0.35, 95% CI 0.27 to 0.47, 5 trials, 1364 children; moderate-quality evidence) and had higher haemoglobin (mean difference (MD) 3.37 g/L, 95% CI 0.94 to 5.80, 11 trials, 2746 children; low-quality evidence).Only one trial with 115 children reported on all-cause mortality (zero cases; low-quality evidence). There was no effect on diarrhoea (risk ratio (RR) 0.97, 95% CI 0.53 to 1.78, 2 trials, 366 children; low-quality evidence).. Point-of-use fortification of foods with MNPs containing iron reduces anaemia and iron deficiency in preschool- and school-age children. However, information on mortality, morbidity, developmental outcomes and adverse effects is still scarce.

Topics: Anemia, Iron-Deficiency; Child; Child, Preschool; Dietary Supplements; Edetic Acid; Ferric Compounds; Ferrous Compounds; Food, Fortified; Humans; Iron; Micronutrients; Point-of-Care Systems; Powders; Trace Elements; Vitamins

A systematic review was conducted to analyze the tolerability of several oral iron supplements based on data obtained in available publications and to report the incidence of adverse effects (AEs) for each supplement both overall and gastrointestinal.. Electronic databases - Medline, the Cochrane Library, and Embase were searched for studies published up to January 2009. Clinical or observational studies reporting data on the tolerability of oral iron supplements were included. Results were described statistically and a quasi-binomial logistic regression model was developed to evaluate and compare the tolerability of the supplements studied.. For this review 111 studies were included, with data on 10,695 patients. Ferrous sulfate with mucoproteose had the lowest incidence of AEs (4.1% for overall AEs, 3.7% for gastrointestinal AEs [GAEs]) and was used as the reference supplement in the regression model. Incidence rates of overall AEs for the other supplements were 7.3% for iron protein succinylate [GAEs: 7%; OR for AE compared to the reference supplement, 1.96], 23.5% for ferrous glycine sulfate [GAEs: 18.5%; OR: 5.90], 30.9% for ferrous gluconate [GAEs: 29.9%; OR: 11.06], 32.3% for ferrous sulfate without mucoproteose [GAEs: 30.2%; OR: 11.21], and 47.0% for ferrous fumarate [GAEs: 43.4%; OR: 19.87]. The differences in incidence of AEs between extended-release ferrous sulfate with mucoproteose and all other supplements except iron protein succinylate were statistically significant at p < 0.001. These findings are subject to some limitations as the designs and methodologies of the studies included show heterogeneity among them that has partially been counteracted by the large sample size provided by the substantial number of trials, which is considered a strength in tolerability studies.. Extended-release ferrous sulfate with mucoproteose appears to be the best tolerated of the different oral iron supplements evaluated.

Topics: Anemia, Iron-Deficiency; Dietary Supplements; Ferric Compounds; Ferrous Compounds; Glycine; Humans; Metalloproteins; Succinates

To compare the efficacy of intravenous (IV) iron (ferric derisomaltose) with oral iron (ferrous fumarate) in women 14-21 weeks pregnant with persistent iron deficiency (ferritin < 30 µg/L).. In a single-centre, open-label, randomised controlled trial at a Danish hospital, women with persistent iron deficiency after routine oral iron treatment were allocated to receive 1000 mg IV iron (single-dose) or 100 mg elemental oral iron daily. Outcomes were assessed during an 18-week follow-up period. The primary endpoint was the proportion of non-anaemic (haemoglobin [Hb] ≥ 11 g/dL) women throughout follow-up. Other outcomes included changes in haematological parameters, patient-reported fatigue, and quality of life (QoL). Safety was assessed by recording adverse events.. From July 2017 to February 2020, 100 women were randomised to IV iron and 101 to oral iron. Throughout follow-up, 91% of women were non-anaemic in the IV iron group compared with 73% in the oral iron group (18% difference [95% confidence interval 0.10-0.25]; p < 0.001). The mean Hb increase was significantly greater with IV iron versus oral iron at Weeks 6 (0.4 versus - 0.2 g/dL; p < 0.001), 12 (0.5 versus 0.1 g/dL; p < 0.001), and 18 (0.8 versus 0.5 g/dL; p = 0.01). Improvements in fatigue and QoL were greater with IV iron versus oral iron at Weeks 3 and 6. The incidence of treatment-related adverse events was comparable between treatment groups.. IV iron was superior in preventing anaemia compared with oral iron in pregnant women with persistent iron deficiency; biochemical superiority was accompanied by improved fatigue and QoL.. European Clinical Trials Database: EudraCT no.: 2017-000776-29 (3 May 2017); ClinicalTrials.gov: NCT03188445 (13 June 2017). The trial protocol has been published: https://dx.doi.org/10.1186%2Fs13063-020-04637-z .

Topics: Administration, Intravenous; Administration, Oral; Adult; Anemia, Iron-Deficiency; Denmark; Female; Ferric Compounds; Humans; Pregnancy; Pregnancy Trimester, Second; Trace Elements; Treatment Outcome

To determine whether intravenous (IV) or oral iron suppletion is superior in improving physical fitness in anemic children with inflammatory bowel disease (IBD).. We conducted a clinical trial at 11 centers. Children aged 8-18 with IBD and anemia (defined as hemoglobin [Hb] z-score < -2) were randomly assigned to a single IV dose of ferric carboxymaltose or 12 weeks of oral ferrous fumarate. Primary end point was the change in 6-minute walking distance (6MWD) from baseline, expressed as z-score. Secondary outcome was a change in Hb z-score from baseline.. We randomized 64 patients (33 IV iron and 31 oral iron) and followed them for 6 months. One month after the start of iron therapy, the 6MWD z-score of patients in the IV group had increased by 0.71 compared with -0.11 in the oral group (P = .01). At 3- and 6-month follow-ups, no significant differences in 6MWD z-scores were observed. Hb z-scores gradually increased in both groups and the rate of increase was not different between groups at 1, 3, and 6 months after initiation of iron therapy (overall P = .97).. In this trial involving anemic children with IBD, a single dose of IV ferric carboxymaltose was superior to oral ferrous fumarate with respect to quick improvement of physical fitness. At 3 and 6 months after initiation of therapy, no differences were discovered between oral and IV therapies. The increase of Hb over time was comparable in both treatment groups.. NTR4487 [Netherlands Trial Registry].

Topics: Administration, Oral; Anemia; Anemia, Iron-Deficiency; Child; Ferric Compounds; Hemoglobins; Humans; Inflammatory Bowel Diseases; Iron; Maltose; Treatment Outcome

Iron deficiency anemia (IDA) is a common health problem in developing countries. Many studies have shown that low-dose oral iron could have similar efficacy and less gastrointestinal effects in iron deficiency without anemia. This prospective open-labeled randomized controlled study was designed to compare the response of 200 mg ferrous fumarate thrice-weekly (TIW) as not inferior to the thrice-daily (TID) regimen and to assess the incidence of adverse events (AEs) between two regimens in treating adult patients with IDA. The primary endpoint was either an increase in Hb ≥ 3 g/dL, having Hb of 12 g/dL in females or 13 g/dL in males at the 12th week of treatment. Secondary outcomes included adverse events (AEs), red blood cell indices, iron profiles, and patient compliance. Sixty-four patients were randomized: 32 in the TIW arm and the other 32 in the TID arm. The response rates were not different between two arms either with intention to treat analysis (72.0%, 95%CI 56.6-88.5 vs. 71.9%, 95%CI 53.3-86.3, p = 0.777); or per-protocol analysis (88.9%, 95%CI 70.8-97.6 vs. 88.5%, 95%CI 69.8-97.6, p = 1.0), respectively. The trial demonstrated non-inferiority at a margin of 23%. Although the iron profile response of the TID arm was earlier than the TIW arm, almost all patients recovered from anemic symptoms at week 4, and hematologic responses were not different at week 12. There were more gastrointestinal AEs in the TID arm. In conclusion, this study showed that the TIW was non-inferior to the TID iron treatment of IDA patients but less AEs and costs.

Topics: Adult; Anemia; Anemia, Iron-Deficiency; Female; Ferrous Compounds; Hemoglobins; Humans; Iron; Male; Prospective Studies

Iron deficiency in pregnancy is a major public health problem that causes maternal complications. The objective of this randomized, controlled trial was to examine the bioavailability, efficacy, and safety of oral ferrous bisglycinate plus folinic acid supplementation in pregnant women with iron deficiency. Subjects (12−16 weeks of gestation, n = 120) were randomly allocated to receive oral iron as ferrous bisglycinate (equiv. iron 24 mg) in supplement form with folinic acid and multivitamins (test group, n = 60) or as ferrous fumarate (equiv. iron 66 mg iron, control group, n = 60) after breakfast daily. Iron absorption was assessed by measuring fasted serum iron levels at 1 and 2 h immediately after supplementation. Hematological biomarkers and iron status were assessed before intervention, and at 3 and 6 months. Side effects were monitored throughout the intervention. A significant increase in serum iron was seen in both groups (p < 0.001) during the bioavailability assessment; however, the test group increases were comparatively higher than the control values at each timepoint (p < 0.001). Similarly, both test and control groups demonstrated a statistically significant increases in hemoglobin (Hb) (p < 0.001), erythrocytes (p < 0.001), reticulocytes (p < 0.001), mean corpuscular volume (MCV) (p < 0.001), mean corpuscular hemoglobin (MCH) (p < 0.001), mean corpuscular hemoglobin concentration (MCHC) (p < 0.001), % transferrin saturation (p < 0.001), and ferritin (p < 0.001) at 3 and 6 months after supplementation. However, in all cases, the test group increases were numerically larger than the control group increases at each timepoint. The test intervention was also associated with significantly fewer reports of nausea, abdominal pain, bloating, constipation, or metallic taste (p < 0.001). In conclusion, ferrous bisglycinate with folinic acid as a multivitamin nutraceutical format is comparable to standard ferrous fumarate for the clinical management of iron deficiency during pregnancy, with comparatively better absorption, tolerability, and efficacy and with a lower elemental iron dosage.

Topics: Anemia, Iron-Deficiency; Biomarkers; Female; Ferrous Compounds; Glycine; Humans; Iron Deficiencies; Leucovorin; Pregnancy; Pregnancy Complications

Anaemia in young sub-Saharan African children may be due to the double burden of malaria and iron deficiency. Primary analysis of a double-blind, cluster randomized trial of iron containing micronutrient powder supplementation in Ghanaian children aged 6 to 35 months found no difference in malaria risk between intervention and placebo groups. Here, we performed a secondary analysis of the trial data to assess the impact of long-term prophylactic iron fortificant on the risk of iron deficiency and anaemia in trial subjects. This population-based randomized-cluster trial involved 1958 children aged between 6 to 35 months, identified at home and able to eat semi-solid foods. The intervention group (n = 967) received a daily dose containing 12.5 mg elemental iron (as ferrous fumarate), vitamin A (400 μg), ascorbic acid (30 mg) and zinc (5 mg). The placebo group (n = 991) received a similar micronutrient powder but without iron. Micronutrient powder was provided daily to both groups for 5 months. At baseline and endline, health assessment questionnaires were administered and blood samples collected for analysis. The two groups had similar baseline anthropometry, anaemia, iron status, demographic characteristics, and dietary intakes (p > 0.05). Of the 1904 (97.2%) children who remained at the end of the intervention, the intervention group had significantly higher haemoglobin (p = 0.0001) and serum ferritin (p = 0.0002) levels than the placebo group. Soluble transferrin receptor levels were more saturated among children from the iron group compared to non-iron group (p = 0.012). Anaemia status in the iron group improved compared to the placebo group (p = 0.03). Continued long-term routine use of micronutrient powder containing prophylactic iron reduced anaemia, iron deficiency and iron deficiency anaemia among pre-school children living in rural Ghana's malaria endemic area.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Child, Preschool; Dietary Supplements; Female; Ferrous Compounds; Ghana; Hemoglobins; Humans; Infant; Male; Placebo Effect; Trace Elements; Vitamin A; Vitamins; Zinc

To compare the effect of Iberet Folic. This randomised controlled trial conducted from January 2018 until December 2018. Pregnant women below 34 weeks of gestation, with Hb concentration less than 11 g/dL and serum ferritin level less than 12 ug/L were randomised to receive either one tablet Zincofer. Hundred and thirty patients were recruited in this study with 68 patients in Iberet Folic group and 62 patients in Zincofer group. The change in the Hb and serum ferritin level from baseline to day 30 did not differ significantly between treatment groups. The mean (±SD) change from baseline to day 30 was 2.15 (±0.59) g/dL in the Iberet Folic group, and 1.98 (±0.49) in the Zincofer (p value = 0.08). Mean serum ferritin at day 30 was 17.2 (±3.68) ug/L and 16.7 (±4.28) ug/L with 8.44 (±3.41) and 8.55 (±3.50) difference, respectively (p = 0.86). Adverse events were comparable in between groups, with p value >0.05. GI intolerance and constipation were among the common side effects, occurred in 34.6 and 29.2% cases, respectively.. Zincofer

Topics: Adult; Anemia, Iron-Deficiency; Erythrocyte Indices; Female; Ferritins; Ferrous Compounds; Gastrointestinal Diseases; Hemoglobins; Humans; Parity; Pregnancy; Pregnancy Complications, Hematologic; Prospective Studies; Recurrence; Socioeconomic Factors

Animal studies suggest prebiotics can increase iron absorption, but results from human studies are equivocal.. In iron-depleted women, before (baseline) and after daily consumption of galacto-oligosaccharides (GOS) for 4 wk, we sought to assess fractional iron absorption (FIA) from an iron supplement given with and without single doses of GOS in test meals or water.. In all women (n = 34; median serum ferritin concentration = 16.4 µg/L), FIA from doses of 14 mg iron labeled with stable isotopes was measured in the following conditions at baseline: 1) FIA from ferrous fumarate (FeFum) in water given with and without 15 g GOS; 2) FIA from FeFum in a test meal given with and without 15 g GOS; 3) FIA from ferrous sulfate (FeSO4) in a test meal given without 15 g GOS. All subjects then consumed ∼15 g GOS daily for 4 wk. Then the following conditions were tested: 4) FIA from FeFum in a test meal with and without 15 g GOS; and 5) FIA from FeSO4 in a test meal with 15 g GOS. FIA was measured as erythrocyte incorporation of stable isotopes.. At baseline, GOS significantly increased FIA from FeFum when given with water (+61%; P < 0.001) and the meal (+28%; P = 0.002). After 4 wk of GOS consumption, GOS again significantly increased FIA from FeFum in the meal (+29%; P = 0.044). However, compared with baseline, consumption of GOS for 4 wk did not significantly enhance absorption from FeFum in the meal given without GOS. FIA from FeSO4 given with GOS in a meal after 4 wk of GOS consumption was not significantly greater than FIA from FeSO4 in a meal without GOS at baseline.. In iron-depleted women, GOS given with FeFum increases FIA, but 4 wk of GOS consumption did not enhance this effect. The study was registered at clinicaltrials.gov as NCT03325270.

Topics: Adult; Anemia, Iron-Deficiency; Dietary Supplements; Erythrocytes; Female; Ferritins; Ferrous Compounds; Galactose; Humans; Intestinal Absorption; Iron; Iron Isotopes; Meals; Oligosaccharides; Prebiotics; Young Adult

Topics: Administration, Oral; Aged; Anemia, Iron-Deficiency; Chronic Disease; Dietary Supplements; Female; Ferric Compounds; Ferrous Compounds; Follow-Up Studies; Heart Failure; Hematinics; Hospitalization; Humans; Male; Prognosis; Prospective Studies; Time Factors; Trace Elements

Topics: Age Factors; Anemia, Iron-Deficiency; Biomarkers; Body Height; Child Development; Diarrhea; Dietary Supplements; Ethiopia; Female; Ferrous Compounds; Growth Disorders; Hemoglobins; Humans; Incidence; Infant; Infant Nutritional Physiological Phenomena; Iron; Male; Micronutrients; Nutritional Status; Powders; Prevalence; Program Evaluation; Risk Factors; Weight Gain

The objective of this study was to compare the efficacy, safety and tolerability of intravenous iron sucrose with that of oral ferrous fumarate in iron deficiency anemia during 14 to 34 weeks of pregnancy.. A randomized controlled trial was performed involving 112 patients attending the antenatal clinic at Shri B.M.Patil Medical college Hospital, Bijapur from October 2011 to August 2012,with hemoglobin levels between 70-110 g/L and serum ferritin of < 15 ng/ml. In the intravenous group,200 mg of iron sucrose was administered in 100 ml 0.9% sodium chloride per day. Participants in the oral group were given 200 mg of ferrous fumarate per day. The primary outcome measures for the trial, haemoglobin and serum ferritin levels were measured after 4 weeks. Statistical significance was assessed using Student's t-test.. The change in haemoglobin in women receiving intravenous iron was higher than with oral ferrous fumarate 22 ± 11.5 g/L vs 12 ± 9 g/L (p < 0.0001).Similarly the change of serum ferritin was significantly higher in women receiving intravenous iron compared to oral iron. 55% participants in the intravenous group had an improvement in haemoglobin more than 20 g/L compared to only 11% of the oral therapy group.48% of patients in I.V group showed increase in ferritin level between 51 to 100 ng/ml in comparison to only 3.5% in oral group. Intravenous iron sucrose is an effective in correction of anemia in pregnancy or iron store depletion.. Intravenous iron sucrose is more effective than 200 mg a day ferrous fumarate in increasing maternal iron stores.. The trial registration number is CTRI/2016/12/007552 registered in Clinical Trial Registry India on 8/12/2016. It is a retrospectively registered trial.

Topics: Administration, Intravenous; Administration, Oral; Adult; Anemia, Iron-Deficiency; Female; Ferric Compounds; Ferric Oxide, Saccharated; Ferritins; Ferrous Compounds; Glucaric Acid; Hematinics; Hemoglobins; Humans; Pregnancy; Pregnancy Complications; Prospective Studies; Treatment Outcome

In a 4-month, controlled, double-blind trial, we randomised Kenyan infants aged 6.5-9.5 months (n=155) to receive daily (1) a MNP without iron (control); (2) the identical MNP but with 5 mg iron (2.5 mg as sodium iron ethylenediaminetetraacetate and 2.5 mg as ferrous fumarate) (Fe group); or (3) the identical MNP as the Fe group but with 7.5 g GOS (FeGOS group).. Anaemia decreased by ≈50% in the Fe and FeGOS groups (p<0.001). Compared with the control or FeGOS group, in the Fe group there were (1) lower abundances of. A MNP containing a low dose of highly bioavailable iron reduces anaemia, and the addition of GOS mitigates most of the adverse effects of iron on the gut microbiome and morbidity in African infants.. NCT02118402.

Topics: Anemia, Iron-Deficiency; Double-Blind Method; Edetic Acid; Female; Ferric Compounds; Ferrous Compounds; Gastrointestinal Microbiome; Humans; Infant; Kenya; Male; Micronutrients; Oligosaccharides; Prebiotics

Fe fortification of wheat flour was proposed in Haiti to combat Fe deficiency, but Fe bioavailability from fortificants has never been investigated in Haitian women or preschool children, two key target groups. We aimed to investigate the bioavailability of ferrous fumarate (FeFum), NaFeEDTA and their combination from fortified wheat flour. We recruited twenty-two healthy mother-child pairs in Port au Prince, Haiti, for an Fe-absorption study. We administered stable Fe isotopes as FeFum or NaFeEDTA individually in low-extraction wheat flour bread rolls consumed by all participants in a randomised, cross-over design. In a final, identical meal, consumed only by the women, FeFum+NaFeEDTA was administered. We measured Fe absorption by using erythrocyte incorporation of stable isotopes 14 d after consumption of each meal, and determined Fe status, inflammatory markers and Helicobacter pylori infection. Fe absorption (geometric mean was 9·24 (95 % CI 6·35, 13·44) and 9·26 (95 % CI 7·00, 12·31) from FeFum and 13·06 (95 % CI 9·23, 19·10) and 12·99 (95 % CI 9·18, 18·39) from NaFeEDTA in mothers and children, respectively (P<0·05 between compounds). Fe absorption from FeFum+NaFeEDTA was 11·09 (95 % CI 7·45, 17·34) and did not differ from the other two meals. H. pylori infection did not influence Fe absorption in children. In conclusion, in Haitian women and children, Fe absorption from NaFeEDTA was 40 % higher than from FeFum, and the combination FeFum+NaFeEDTA did not significantly increase Fe absorption compared with FeFum alone. In the context of Haiti, where the high costs of NaFeEDTA may not be affordable, the use of FeFum at 60 mg Fe/kg flour may be a preferable, cost-effective fortification strategy.

Topics: Adult; Anemia, Iron-Deficiency; Biological Availability; Bread; Child, Preschool; Diet; Edetic Acid; Erythrocytes; Female; Ferric Compounds; Ferrous Compounds; Flour; Food, Fortified; Haiti; Helicobacter Infections; Helicobacter pylori; Humans; Intestinal Absorption; Iron; Iron Deficiencies; Male; Meals; Triticum; Young Adult

The aim of this study was to compare the efficacy and tolerability of iron amino acid chelate (IAAC) and ferrous fumarate (FF) in treatment of iron deficiency anemia (IDA) with pregnancy.. A total of 150 pregnant women having iron deficiency anemia (IDA) were randomized to receive either IAAC or FF for 12 weeks. Hemoglobin, red cell indices, serum iron, and serum ferritin were measured at baseline and then 4, 8, and 12 weeks after treatment. Adverse effects were questioned in both groups.. The mean values of hemoglobin, red cell indices, serum iron, and serum ferritin were not significantly different between both groups after 12 weeks of treatment. However, the rise in hemoglobin level after 4, 8, and 12 weeks of treatment was significantly faster in the IAAC group (p=<0.001). Constipation and abdominal colicky pain were significantly more common in the FF group (p=0.022 and 0.031 respectively).. IAAC and FF are comparable in curing IDA with pregnancy; however, IAAC has the advantage of providing a faster rate of improvement of hemoglobin level and is better tolerated by the patients.

Topics: Abdominal Pain; Adult; Amino Acids; Anemia, Iron-Deficiency; Constipation; Female; Ferrous Compounds; Humans; Pregnancy; Pregnancy Complications, Hematologic; Trace Elements; Young Adult

Concerns have been raised about the benefits of Fe-containing supplements on infant birth weight among women with normal/high Hb levels at baseline. Thus far, no clinical trials have examined whether the effects of prenatal Fe-containing supplements on birth weight vary by maternal Hb levels. We compared the effects of Fe-folic acid (IFA) or multiple micronutrients (MMN) with folic acid (FA) supplements on birth weight among pregnant women with mild/no anaemia or high Hb levels. A double-blind randomised controlled trial was conducted in 2006-2009. In total, 18 775 pregnant women with mild/no anaemia (145 g/l) baseline Hb levels, IFA and MMN supplements increased birth weight by 91·44 (95% CI 3·37, 179·51) g and 107·63 (95% CI 21·98, 193·28) g (P<0·05), respectively, compared with the FA group. No differences were found between the IFA and the MMN group, regardless of maternal Hb concentration. In conclusion, the effects of Fe-containing supplements on birth weight depended on baseline Hb concentrations. The Fe-containing supplements improved birth weight in women with very high Hb levels before 20 weeks of gestation.

Topics: Adult; Anemia, Iron-Deficiency; Birth Weight; China; Dietary Supplements; Double-Blind Method; Female; Ferrous Compounds; Fetal Growth Retardation; Hematinics; Hemoglobins; Humans; Iron, Dietary; Maternal Nutritional Physiological Phenomena; Nutritional Status; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Second; Risk; Rural Health; Severity of Illness Index; Young Adult

Iron deficiency prevalence rates frequently exceed 50 % in young children in low-income countries. The World Health Organization (WHO) recommended universal supplementation of young children where anaemia rates are >40 %. However, large randomized trials have revealed that provision of iron to young children caused serious adverse effects because iron powerfully promotes microbial growth. Hepcidin - the master regulator of iron metabolism that integrates signals of infection and iron deficiency - offers the possibility of new solutions to diagnose and combat global iron deficiency. We aim to evaluate a hepcidin-screening-based iron supplementation intervention using hepcidin cut-offs designed to indicate that an individual requires iron, is safe to receive it and will absorb it.. The study is a proof-of-concept, three-arm, double blind, randomised controlled, prospective, parallel-group non-inferiority trial. Children will be randomised to receive, for a duration of 12 weeks, one of three multiple micronutrient powders (MNP) containing: A) 12 mg iron daily; B) 12 mg or 0 mg iron daily based on a weekly hepcidin screening indicating if iron can be given for the next seven days or not; C) 6 mg or 0 mg iron daily based on a weekly hepcidin screening indicating if iron can be given for the next seven days or not. The inclusion criteria are age 6-23 months, haemoglobin (Hb) concentration between 7 and 11 g/dL, z-scores for Height-for-Age, Weight-for-Age and Weight-for-Height > -3 SD and free of malaria. Hb concentration at 12 weeks will be used to test whether the screen-and-treat approaches are non-inferior to universal supplementation. Safety will be assessed using caregiver reports of infections, in vitro bacterial and P. falciparum growth assays and by determining the changes in the gut microbiota during the study period.. A screen-and-treat approach using hepcidin has the potential to make iron administration safer in areas with widespread infections. If this proof-of-concept study shows promising results the development of a point-of-care diagnostic test will be the next step.. ISRCTN07210906 , 07/16/2014.

Topics: Anemia, Iron-Deficiency; Biomarkers; Clinical Protocols; Developing Countries; Dietary Supplements; Double-Blind Method; Female; Ferrous Compounds; Follow-Up Studies; Gambia; Hemoglobins; Hepcidins; Humans; Infant; Male; Mass Screening; Micronutrients; Prospective Studies; Rural Health; Rural Health Services

Poor iron status affects 50% of Indian women and compromises work productivity, cognitive performance, and reproduction. Among the many strategies to reduce iron deficiency is the commercial fortification of iodized table salt with iron to produce a double-fortified salt (DFS). The objective of this study was to test the efficacy of DFS in reducing iron deficiency in rural women of reproductive age from northern West Bengal, India. The participants were 212 women between 18 and 55 y of age who worked as full-time tea pickers on a large tea estate. Participants in the randomized, controlled, double-blind study were assigned to use either DFS or a control iodized salt for 7.5 to 9 mo. The DFS was fortified with 3.3-mg ferrous fumarate (1.1-mg elemental iron) per kg of iodized salt, whereas the control salt contained only iodine (47 mg/kg potassium iodate), and both salt varieties were distributed gratis to the families of participants at 0.5 kg/mo for each 2 household members. At baseline, 53% of participants were anemic (hemoglobin <120 g/L), 25% were iron deficient (serum ferritin <12 μg/L), and 23% were iron-deficient anemic. Also, 22% had a transferrin receptor concentration >8.6 mg/L and 22% had negative (<0.0 mg/kg) body iron stores. After 9 mo the participants receiving DFS showed significant improvements compared with controls in hemoglobin (+2.4 g/L), ferritin (+0.13 log10 μg/L), soluble transferrin receptor (-0.59 mg/L), and body iron (+1.43 mg/kg), with change in status analyzed by general linear models controlling for baseline values. This study demonstrated that DFS is an efficacious approach to improving iron status and should be further evaluated for effectiveness in the general population. This trial was registered at clinicaltrials.gov as NCT01032005.

Topics: Adolescent; Adult; Anemia, Iron-Deficiency; Anthropometry; Double-Blind Method; Female; Ferritins; Ferrous Compounds; Follow-Up Studies; Food, Fortified; Hemoglobins; Humans; India; Iodates; Iodine; Iron, Dietary; Linear Models; Middle Aged; Potassium Compounds; Receptors, Transferrin; Sodium Chloride, Dietary; White People; Young Adult

Correct evaluation of iron status is important in young infants because both iron deficiency and excess may have negative effects on development, growth, and morbidity.. We evaluated iron status using erythrocyte parameters, including reticulocyte hemoglobin content (CHr) in infants with birth weight <3,000 g (n = 80). Blood samples and infant characteristics were recorded at 6 wk and at 4 and 6 months. Infants with a birth weight ≤2,500 g (n = 36) were recommended for iron supplementation.. Despite a significantly poorer status at 6 wk, iron-supplemented infants had significantly higher hemoglobin level (Hb): 12.2 (SD = 0.8) g/dl and CHr: 28.3 (SD = 1.4) pg at 6 mo, as compared with nonsupplemented infants, Hb: 11.7 (SD = 1.0) g/dl, P = 0.02 and CHr: 26.5 (SD = 2.5) pg, P < 0.001. Prolonged exclusive breastfeeding, high weight gain, and male gender were the predisposing factors for a low iron status at 6 mo. A CHr cutoff level of 26.9 pg at 4 mo proved to be a sensitive predictor for anemia at 6 mo.. Signs of an iron-restricted erythropoiesis were observed in nonsupplemented infants (birth weight 2,501-3,000 g), and CHr was a useful tool for evaluating iron status. The need for iron supplementation in certain infant risk populations should be further evaluated.

Topics: Anemia, Iron-Deficiency; Biomarkers; Birth Weight; Breast Feeding; Chi-Square Distribution; Dietary Supplements; Erythrocyte Count; Erythrocyte Indices; Erythrocytes; Erythropoiesis; Female; Ferrous Compounds; Hemoglobins; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Iron; Male; Nonlinear Dynamics; Norway; Predictive Value of Tests; Prognosis; Reticulocytes; Risk Factors; Sex Factors; Time Factors; Weight Gain

To investigate the effect of iron supplementation on iron deficiency anemia of childbearing age women, and to find out the optimal amount of iron intake for maintaining their health.. 74 childbearing age women aged 21 to 45 years with anemia were randomly assigned to intervention or control group by hemoglobin content, and a iron nutrition packet (mainly composed of ferric pyrophosphate and ferrous fumarate, containing iron 8 mg) or a placebo packet was given daily for six months, respectively. Hemoglobin, serum ferritin, food frequency and 24h dietary recall survey were performed before intervention and three and six months after intervention.. Hemoglobin and serum ferritin of the intervention group were significantly higher (P < 0.01) than that in control group after six months. The number of women with hemoglobin > or = 120 g/L in intervention and control group was 15 (44.1%) and 5 (14.3%), respectively (P < 0.01). The number of women with serum ferritin > or = 15 micro g/L in intervention and control group was 11 (34.4%) and 4 (12.5%), respectively (P < 0.05). The average dietary iron intake was 14.0 mg/d, mainly from plant foods. There was a positive correlation of total iron intake (dietary iron plus iron supplements) with hemoglobin (r = 0.57, P < 0.01). More menstrual blood and dietary fiber were the risk factors for iron deficiency anemia (P < 0.05).. The anemic status in childbearing age women could be improved by providing iron 8 mg daily for six months consecutively. Daily dietary intake of iron 23.2 mg can meet the requirement of maintaining normal iron storage for childbearing age women.

Topics: Adult; Anemia, Iron-Deficiency; Diphosphates; Female; Ferrous Compounds; Humans; Iron; Middle Aged; Young Adult

Anaemia is a frequent complication after cardiopulmonary bypass surgery. Iron therapy has been variably employed by medical centres over the years. In our study we test the clinical effectiveness of intravenous and oral iron supplementation in correcting anaemia, and its impact on blood transfusion requirements, in patients undergoing cardiopulmonary bypass surgery.. A double-blind, randomized, placebo-controlled clinical trial with three parallel groups of patients. Group I (n = 54): intravenous iron(III)-hydroxide sucrose complex, three doses of 100 mg/24 h during pre- and postoperative hospitalization and 1 pill/24 h of oral placebo in the same period and during 1 month after discharge. Group II (n = 53): oral ferrous fumarate iron 1 pill/24 h pre- and postoperatively and during 1 month after discharge, and intravenous placebo while hospitalized. Group III (n = 52): oral and intravenous placebo pre- and postoperatively, following the same protocol. Data were collected preoperatively, at theatre, at intensive care unit admission, before hospital discharge and 1 month later.. (1) Baseline clinical and demographic characteristics and surgical procedures were similar in the three groups; (2) no inter-group differences were found in haemoglobin and haematocrit during the postoperative period; (3) the intravenous iron group showed higher serum ferritin levels at hospital discharge (1321 ± 495 ng/ml; P < 0.001) and 1 month later (610 ± 387; P < 0.001) compared with the other groups and (4) we did not observe statistical differences in blood transfusion requirements between the three groups.. The use of intravenous or oral iron supplementation proved ineffective in correcting anaemia after cardiopulmonary bypass and did not reduce blood transfusion requirements. [Current Controlled Trials number: NCT01078818 (oral and intravenous iron in patients postoperative cardiovascular surgery under EC)].

Topics: Administration, Oral; Aged; Analysis of Variance; Anemia, Iron-Deficiency; Blood Transfusion; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Chi-Square Distribution; Double-Blind Method; Elective Surgical Procedures; Female; Ferric Compounds; Ferric Oxide, Saccharated; Ferrous Compounds; Glucaric Acid; Hematinics; Humans; Infusions, Intravenous; Male; Middle Aged; Spain; Sucrose; Tablets; Time Factors; Treatment Failure

Ferrous fumarate is recommended for the fortification of complementary foods based on similar iron absorption to ferrous sulfate in adults. Two recent studies in young children have reported that it is only 30% as well absorbed as ferrous sulfate. The objective of this study was to compare iron absorption from ferrous fumarate and ferrous sulfate in infants, young children and mothers.. Non-anemic Mexican infants (6-24 months), young children (2-5 years) and adult women were randomly assigned to receive either 4 mg Fe (women) or 2.5 mg Fe (infants and young children) as either [(57)Fe]-ferrous fumarate or [(58)Fe]-ferrous sulfate added to a sweetened drink based on degermed maize flour and milk powder. Iron absorption was calculated based on incorporation of isotopes into erythrocytes after 14 days.. Within each population group, no significant differences (P > 0.05) in iron absorption were found between ferrous fumarate and ferrous sulfate. Mean iron absorption from ferrous fumarate vs ferrous sulfate was 17.5 vs 20.5% in women (relative bioavailability (RBV) =86), 7.0 vs 7.2% in infants (RBV = 97) and 6.3 vs 5.9% in young children (RBV = 106).. Ferrous fumarate is as well absorbed as ferrous sulfate in non-anemic, iron sufficient infants and young children, and can be recommended as a useful fortification compound for complementary foods designed to prevent iron deficiency. Further studies are needed to clarify its usefulness in foods designed to treat iron deficiency.

Topics: Adult; Anemia, Iron-Deficiency; Beverages; Biological Availability; Child, Preschool; Dairy Products; Drug Evaluation; Female; Ferrous Compounds; Flour; Food, Fortified; Humans; Infant; Intestinal Absorption; Iron; Iron, Dietary; Linear Models; Mexico; Sweetening Agents; Zea mays

Precooked, instant (dry) infant cereals in the US are fortified with electrolytic iron, a source of low reactivity and suspected low bioavailability. Iron from ferrous fumarate is presumed to be more available. In this study, we compared a dry infant rice cereal (Cereal L) fortified with electrolytic iron (54.5 mg iron/100 g cereal) to a similar cereal (Cereal M) fortified with ferrous fumarate (52.2 mg Fe/100 g) for efficacy in maintaining iron status and preventing iron deficiency (ID) in breast-fed infants. Ascorbic acid was included in both cereals. In this prospective, randomized double-blind trial, exclusively breast-fed infants were enrolled at 1 mo and iron status was determined periodically. At 4 mo, 3 infants had ID anemia and were excluded. Ninety-five infants were randomized at 4 mo, and 69 (36 Cereal L, 33 Cereal M) completed the intervention at 9 mo. From 4 to 9 mo, they consumed daily one of the study cereals. With each cereal, 2 infants had mild ID, a prevalence of 4.2%, but no infant developed ID anemia. There were no differences in iron status between study groups. Iron intake from the study cereals was (mean ± SD) 1.21 ± 0.31 mg⋅kg(-1)⋅d(-1) from Cereal L and 1.07 ± 0.40 mg⋅kg(-1)⋅d(-1) from Cereal M. Eleven infants had low birth iron endowment (plasma ferritin < 55 μg/L at 2 mo) and 54% of these infants had ID with or without anemia by 4 mo. We conclude that electrolytic iron and ferrous fumarate were equally efficacious as fortificants of this infant cereal.

Topics: Anemia, Iron-Deficiency; Breast Feeding; Double-Blind Method; Edible Grain; Electrolysis; Female; Ferritins; Ferrous Compounds; Food, Fortified; Humans; Infant; Iron; Iron, Dietary; Male; Oryza; Prevalence; Prospective Studies; Trace Elements; United States

Iron absorption in humans is highly variable even after iron status and dietary components that influence iron absorption are controlled for. Inherited factors may help explain this variance.. Our objective was to compare nonheme-iron absorption from a noninhibitory, stable-isotope-labeled test meal in preschool-aged children and their mothers.. We provided 72 test meals based on degermed maize flour and milk powder and fortified with [(57)Fe]ferrous fumarate or [(58)Fe]ferrous sulfate to healthy Mexican preschool children [n = 18; mean (+/-SD) age: 3.6 +/- 1.0 y] and their mothers [n = 18; mean (+/-SD) age: 28.0 +/- 5.2 y]. Iron absorption was calculated on the basis of incorporation of isotopes into erythrocytes after 14 d and was adjusted for differences in iron status.. There was a wide variation in iron absorption from the test meals: in the mothers and children, the median fractional absorption of ferrous sulfate was 22.55% (range: 1.65-54.83%) and 5.51% (range: 2.23-17.20%), respectively (P < 0.0001). After adjustment for serum ferritin, the significant difference in absorption between mothers and their children disappeared. Despite this broad range of iron absorption, corrected fractional iron absorption from the ferrous fumarate-fortified (r(2) = 0.582) and the ferrous sulfate-fortified test meals (r(2) = 0.557) was strongly correlated in mothers and their children (P < 0.0001). There was a striking positive correlation between the mean corrected fractional iron absorption from both test meals in mothers and their children (r(2) = 0.782, P < 0.0001). In regression analyses that included age, sex, and hemoglobin, the only significant predictor of corrected fractional iron absorption in children was corrected fractional iron absorption in their mothers (standardized beta = 0.884, P < 0.001).. Nonheme-iron absorption exhibits a strong familial tendency. After differences in meal matrix and serum ferritin are accounted for, these data suggest that inheritance and/or shared environmental factors explain most of the variance in dietary iron absorption.

Topics: Adult; Anemia, Iron-Deficiency; Animals; Child, Preschool; Diet; Erythrocytes; Female; Ferritins; Ferrous Compounds; Food, Fortified; Humans; Intestinal Absorption; Iron; Iron Isotopes; Iron, Dietary; Male; Mexico; Milk; Mothers; Reference Values; Young Adult; Zea mays

On June 30, 2009, the United States Food and Drug Administration (FDA) approved ferumoxytol (Feraheme injection, AMAG Pharmaceuticals), an iron-containing product for intravenous (IV) administration, for the treatment of iron deficiency anemia in adult patients with chronic kidney disease (CKD). The safety and efficacy of ferumoxytol were assessed in three randomized, open-label, controlled clinical trials. Two trials evaluated patients with nondialysis dependent CKD and a third trial assessed patients undergoing hemodialysis. Randomization was either to ferumoxytol or oral iron. Ferumoxytol was administered as two 510 mg IV injections, separated by 3-8 days. Oral iron, Ferro-Sequels, was administered at a dose of 100 mg twice daily for 21 days. In all three clinical trials, ferumoxytol administration increased the mean blood hemoglobin (Hgb) concentrations by approximately 1.0 g/dL over the 35 day period, a mean increase that was greater than what was observed in patients receiving oral iron. Patients receiving ferumoxytol also had increases in blood transferrin saturation (TSAT) and ferritin values. For the proposed ferumoxytol dosing regimen, 4.9% of patients had serum ferritin >or=800 ng/mL and TSAT >or=50% post-treatment. The most important ferumoxytol safety concerns were hypersensitivity reactions and/or hypotension. Anaphylaxis or anaphylactoid reactions were reported in 0.2% of subjects, and other adverse reactions potentially associated with hypersensitivity (e.g., pruritus, rash, urticaria, or wheezing) were reported in 3.7%. Hypotension was observed in 1.9%, including three patients with serious hypotensive reactions. Ferumoxytol administration may transiently affect the diagnostic ability of magnetic resonance imaging and the drug label provides further information regarding this effect.

Topics: Administration, Oral; Anemia, Iron-Deficiency; Drug Approval; Drug Hypersensitivity; Female; Ferrosoferric Oxide; Ferrous Compounds; Hematinics; Hemoglobins; Humans; Hypotension; Infusions, Intravenous; Kidney Failure, Chronic; Male; Middle Aged

To determine whether low-income infants' adherence to nutritional supplementation with ferrous fumarate sprinkles was better than that with ferrous sulfate drops.. The study was a randomized clinical trial of healthy 6-month-old infants. Each infant received either a daily packet of sprinkles or a dropperful of liquid. Follow-up included alternating telephone and home visits biweekly for 3 months. Adherence was defined as high if the infant's caregiver reported supplement use on 5 to 7 days during the week before assessment. Side effects and caregiver attitude about supplements were secondary outcomes. Analyses were conducted using generalized estimating equations and chi(2) and Wilcoxon rank-sum tests.. A total of 150 of 225 eligible infants were enrolled. Adherence to supplementation was generally poor. High adherence ranged from 32% to 63% at any assessment in the subjects receiving drops, compared with 30% to 46% in those receiving sprinkles. The drops group was more likely to have at least four assessments with high adherence (22% vs 9.5%; P = .03). Caregivers of the drops infants were more likely to report greater than usual fussiness (P < .01); however, fussiness had no consistent impact on adherence.. The use of ferrous fumarate sprinkles rather than traditional ferrous sulfate drops did not improve adherence with daily iron supplementation in low-income infants.

Topics: Anemia, Iron-Deficiency; Attitude to Health; Caregivers; Dietary Supplements; Dosage Forms; Feasibility Studies; Female; Ferrous Compounds; Humans; Income; Infant; Male; Medication Adherence; Patient Acceptance of Health Care; Pilot Projects; Trace Elements; United States

Non-water-soluble iron compounds have been reported to be less well absorbed than ferrous sulfate in young children, and concern has been raised about their usefulness as food fortificants.. The objective was to evaluate the usefulness of ferrous fumarate and ferric pyrophosphate, compared with ferrous sulfate, in maintaining hemoglobin concentrations >105 g/L in Bangladeshi children.. Two hundred thirty-five children aged 7-24 mo (hemoglobin >105 g/L) were randomly assigned in a double-blind study to receive an infant cereal fortified with ferrous fumarate, ferric pyrophosphate, or ferrous sulfate. One serving of cereal (9.3 mg Fe; molar ratio of ascorbic acid to iron of 3:1) was consumed per day, 6 d/wk, for 9 mo. Blood samples were drawn at 4.5 and 9 mo.. Raw data were reformatted, and a "time to event" was calculated that corresponded to reaching the following thresholds: hemoglobin <105 g/L, plasma ferritin <12 microg/L, or plasma C-reactive protein >10 mg/L at baseline, 4.5 mo, or 9 mo. Data were censored when children did not reach the threshold or were lost to follow-up. A Kaplan-Meier approach was used to compare the 3 groups. No statistically significant differences were observed for hemoglobin <105 g/L (P = 0.943), plasma ferritin <12 microg/L (P = 0.601), or plasma C-reactive protein >10 mg/L (P = 0.508).. Contrary to earlier concerns, these results do not indicate differences in usefulness between water-soluble and non-water-soluble iron compounds in maintaining hemoglobin concentrations and preventing iron deficiency. These data will be important in the development of food-fortification strategies to combat anemia and iron deficiency in highly vulnerable population groups.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Bangladesh; C-Reactive Protein; Child, Preschool; Diphosphates; Female; Ferritins; Ferrous Compounds; Food, Fortified; Hemoglobins; Humans; Infant; Iron; Iron, Dietary; Male; Trace Elements

Many investigators found that iron deficiency anemia (IDA) had a great influence on cognitive functions in infants and children. However, studies of such topic in adults are few and controversial. We prospectively assessed the possible influence of IDA and iron supplementation (for 3 months) on cognitive function and intelligence of 28 young adults with IDA. We used group of hematological, cognitive, neurophysiological tests for assessment including: mini-mental state examination (MMSE), Wechsler memory scale-revised (WMS-R), Wechsler adult intelligence scale-revised (WAIS-R), event-related potentials (ERPs), and electroencephalography (EEG). Compared to controls, patients demonstrated lower scores of different cognitive tests (MMSE, WMS-R, and WAIS-R), which showed significant improvement after treatment. Prolongation of ERPs latencies (N200 and P300) and reduction in their amplitudes (P200 and P300) were identified with significant increase in amplitude occurred after treatment. EEG abnormalities were observed in 55% of patients which showed improvement in 35% after treatment. Positive correlation was identified before and after treatment between hemoglobin levels and MMSE (P=0.01, 0.05), total verbal (P=0.04) and performance (P=0.05, 0.04) IQ scores. Negative correlation was identified between before and after treatment between P300 latency and total IQ of WAIS-R (P=0.03, 0.008) and hemoglobin level (P=0.4, 0.01). Positive correlation was found before and after treatment between P300 amplitude and total IQ (P=0.028, 0.01) and serum iron (P=0.01, 0.001). In conclusion, IDA is a significant factor in cognitive performance in adult population, which can be partially reversed by treatment.

Topics: Analysis of Variance; Anemia, Iron-Deficiency; Cognition; Electroencephalography; Evoked Potentials; Female; Ferrous Compounds; Hemoglobins; Humans; Intelligence; Iron; Male; Neurophysiology; Neuropsychological Tests; Neuropsychology; Psychomotor Performance; Reaction Time; Spectrophotometry, Atomic; Trace Elements; Treatment Outcome; Wechsler Scales

Dual fortification of salt with iodine and iron could be a sustainable approach to combating iodine and iron deficiencies.. We compared the efficacy of dual-fortified salt (DFS) made by using 2 proposed contrasting formulas-one fortifying with iron as micronized ground ferric pyrophosphate (MGFePP) and the other with iron as encapsulated ferrous fumarate (EFF)-with the efficacy of iodized salt (IS) in schoolchildren in rural southern India.. After stability and acceptability testing, a double-blind, household-based intervention was conducted in 5-15-y-old children (n = 458) randomly assigned into 3 groups to receive IS or DFS with iron as MGFePP or EFF, both at 2 mg/g salt. We measured hemoglobin, iron status, and urinary iodine at baseline, 5 mo, and 10 mo.. Median serum ferritin and calculated median body iron improved significantly in the 2 groups receiving iron. After 10 mo, the prevalence of anemia decreased from 16.8% to 7.7% in the MGFePP group (P < 0.05) and from 15.1% to 5.0% in the EFF group (P < 0.01). The median urinary iodine concentration increased significantly in the IS and EFF groups (P < 0.001) but not in the MGFePP group. Losses of iodine in salt with 1.8% moisture were high for MGFePP, whereas the EFF segregated in salt with 0.5% moisture and caused color changes in some local foods.. Both DFSs were efficacious in reducing the prevalence of anemia and iron deficiency in school-age children. Local salt characteristics should be taken into consideration when choosing an iron fortificant for DFS to achieve optimal iodine stability and color.

Topics: Adolescent; Anemia, Iron-Deficiency; Biological Availability; Child; Child Nutritional Physiological Phenomena; Child, Preschool; Diphosphates; Double-Blind Method; Female; Ferritins; Ferrous Compounds; Food, Fortified; Goiter; Hemoglobins; Humans; India; Iodine; Iron; Iron Deficiencies; Iron, Dietary; Male; Prevalence; Rural Health; Sodium Chloride, Dietary; Treatment Outcome

The choice of iron fortificant usually represents a balance between bioavailability of the compound and its tendency to cause organoleptic problems. The aim of this study was to evaluate the efficacy of sodium iron EDTA (NaFeEDTA) and ferrous fumarate at levels compatible with South African brown bread (10 mg/kg flour for NaFeEDTA and 20 mg/kg flour for ferrous fumarate) in a randomized controlled trial; electrolytic iron was evaluated at the level currently used in South Africa (35 mg/kg flour). Schoolchildren (n = 361), aged 6-11 y, from a low socioeconomic community with hemoglobin (Hb) < or = 125 g/L were randomly assigned to 1 of 4 groups that received 4 slices of brown bread supplying either: 1) no fortification iron 2) 2.35 mg iron as NaFeEDTA; 3) 4.70 mg iron as ferrous fumarate; and 4) 8.30 mg iron as electrolytic iron per intervention day. These amounts simulated a bread intake of 6 slices per day over the 34-wk study period at fortification levels of 0, 10, 20, and 35 mg/kg flour, respectively. Hb concentration and iron status were assessed at baseline and after 34 wk of intervention. The iron interventions did not affect Hb concentration, transferrin saturation, or serum ferritin, iron, or transferrin receptor concentrations relative to the control group. Our results suggest that electrolytic iron at the level currently used in South Africa is not effective in improving iron or Hb status. Neither do NaFeEDTA or ferrous fumarate appear to be suitable alternatives for the fortification of wheat flour when included at levels that do not cause color changes.

Topics: Anemia, Iron-Deficiency; Bread; Child; Dose-Response Relationship, Drug; Edetic Acid; Ferric Compounds; Ferrous Compounds; Food, Fortified; Hemoglobins; Humans; Iron; South Africa

Iron deficiency anaemia is a major health problem in India especially in women of reproductive age group. The World Health Organisation recommends that the haemoglobin concentration should not fall below 11.0 g/dl at any time during pregnancy. The aim of study was to compare the efficacy and safety of two doses of sodium feredetate with ferrous fumarate in improving haemoglobin profile in pregnant anaemic women. Pregnant women with gestation period between 12 and 26 weeks having serum haemoglobin < 10 g/dl, serum ferritin levels less than 12 microg/l were included in the study. Patients were divided into 3 groups and drugs administered accordingly. A total of 48 patients were available for analysis which included 37 patients who had completed all the visits up to 75 days follow-up and 11 patients who were treatment failures. In group A combination of sodium feredetate (containing 33 mg of elemental iron) along with vitamin B12 (15 microg) and folic acid (1.5 mg) was administered twice a day. In group B combination of sodium feredetate (containing 66 mg of elemental iron) along with vitamin B12 (15 microg) and folic acid (1.5 mg) was administered twice a day. In group C combination of ferrous fumarate (containing 100 mg of elemental iron) along with vitamin B12 (15 microg) and folic acid (1.5 mg) was administered twice a day. Patients were evaluated for Hb, RBC count, MCV, MCH and MCHC at day 0, 30, 45, 60 and 75. Serum ferritin, serum iron, TIBC and transferrin saturation were assessed at recruitment and end study. Mean rise of haemoglobin at the completion of study, over that of basal values was 1.79 g/dl (0.71 to 2.87, 95% CI, p < 0.05) in group A, 1.84 g/dl (0.82 to 2.86, 95% CI, p < 0.05) in group B and 1.63 g/dl (0.38 to 2.88, 95% CI, p < 0.05) in group C. Safety assessment was done by doing liver and kidney function test at the time of recruitment and end study. Low doses of sodium feredetate (33 mg and 66 mg of elemental iron given twice daily) produce comparable results as higher dose of ferrous fumarate (100 mg elemental iron given twice daily). As there were no adverse effects reported with sodium feredetate, it can be concluded from this study that this new formulation appears to be effective in improving haemoglobin profile in pregnant anaemic women and is tolerated well.

Topics: Adult; Anemia, Iron-Deficiency; Double-Blind Method; Edetic Acid; Female; Ferric Compounds; Ferrous Compounds; Humans; Iron Chelating Agents; Pregnancy; Pregnancy Complications, Hematologic; Trace Elements

This study aims to evaluate iron prophylaxis in pregnant women from the individual aspect, i.e. according to serum ferritin levels at the beginning of pregnancy, and to assess which dose of iron would be adequate to prevent iron deficiency (ID) and iron deficiency anaemia (IDA) during pregnancy and postpartum. A randomised, double-blind study comprising 301 healthy Danish pregnant women allocated into four groups taking ferrous iron (as fumarate) in doses of 20 mg (n=74), 40 mg (n=76), 60 mg (n=77) and 80 mg (n=75) from 18 weeks gestation (inclusion) to 8 weeks postpartum. Iron status markers [serum ferritin, serum soluble transferrin receptor (sTfR), haemoglobin] were recorded at 18, 32 and 39 weeks gestation and 8 weeks postpartum. Body iron was calculated using the serum sTfR/serum ferritin ratio. ID was defined by serum ferritin <12 microg/l in pregnancy and <15 microg/l postpartum; IDA as serum ferritin <12 microg/l and haemoglobin <5th percentile in iron-replete pregnant women. Women in the iron supplement groups were stratified according to serum ferritin levels at inclusion; 50.7% had ferritin 70 microg/l. At 32 weeks, women with ferritin 30 microg/l had an ID frequency of: 20-mg group 20.0%, 40 mg 13.9%, 60 mg 5.7%, 80 mg 5.1% (p<0.001). Women with ferritin >70 microg/l had no ID. Postpartum, ID was found in 4.7% in 20-mg group, 2.9% in group 40 mg and 0% in group 60 and 80 mg. IDA: At 32 weeks, women with ferritin 30 microg/l displayed IDA. Body iron at 18 weeks was 10.4 mg/kg, similar in the four iron groups. Later in pregnancy body iron declined significantly, being lower the 20 mg group, and similar in the 40, 60 and 80-mg groups. Postpartum body iron rose to inclusion levels being 9.3 mg/kg in the 20-mg group and 10.5 mg/kg in the 40-, 60- and 80-mg groups. This study gives an estimate of iron dosage in individual iron prophylaxis adjusted to serum ferritin levels in early pregnancy. In the prevention of ID, we suggest 80-100 mg ferrous iron/day to women having ferritin

Topics: Adult; Anemia, Iron-Deficiency; Dose-Response Relationship, Drug; Double-Blind Method; Female; Ferritins; Ferrous Compounds; Humans; Postpartum Period; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Receptors, Transferrin; Trace Elements; Transferrin

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.

Topics: Administration, Oral; Anemia, Iron-Deficiency; Capsules; Dietary Supplements; Diphosphates; Dose-Response Relationship, Drug; Female; Ferrous Compounds; Food, Fortified; Ghana; Hemoglobins; Humans; Infant; Iron; Male; Micronutrients; Patient Compliance; Prospective Studies; Treatment Outcome

The objective of the study is to evaluate the bioavailability, efficacy and safety of a new modified-release (MR) formulation of carbonyl iron (45 mg) relative to a commercially available conventional formulation of ferrous fumarate (300 mg) in adult Indian patients with clinical and laboratory diagnosis of nutritional iron deficiency anaemia. This prospective, comparative, randomised, double-blind study was carried out among 60 patients received a single daily dose of either MR carbonyl iron or ferrous fumarate for 12 weeks. The effect of therapy on haematological parameters and iron status and estimation of bioavailability were the main efficacy outcomes. There was a significant (p<0.05) increase in mean haemoglobin levels, reticulocyte counts, haematocrit and mean corpuscular volume in MR carbonyl iron group compared to ferrous fumarate group. There was also an increase in mean serum iron and ferritin levels and a corresponding decrease in total iron binding capacity in MR carbonyl iron group compared to ferrous fumarate group at the end of 12 weeks therapy. The estimated overall bioavailability of MR carbonyl iron was about 147% that of ferrous fumarate. Both the formulations were equally well-tolerated and adverse events were mainly gastrointestinal in nature. The prevalence of adverse events was slightly more in the ferrous fumarate group. It can be concluded that the MR formulation of carbonyl iron was more efficacious than ferrous fumarate in correcting haematologic abnormalities and improving iron status in patients with nutritional iron deficiency anaemia. In conditions where efficacy is an important consideration, the higher bioavailability of MR carbonyl iron may make it the treatment of choice for nutritional iron deficiency anaemia.

Topics: Administration, Oral; Adolescent; Adult; Aged; Anemia, Iron-Deficiency; Biological Availability; Delayed-Action Preparations; Double-Blind Method; Female; Ferrous Compounds; Humans; Iron; Iron Carbonyl Compounds; Male; Middle Aged; Organometallic Compounds

The use of microencapsulated ferrous fumarate sprinkles is a new approach for home fortification. Iron and hematologic status may affect the absorption of iron from sprinkles.. The objective was to measure the absorption (corrected erythrocyte incorporation of (57)Fe) of 2 different doses of iron from sprinkles added to a maize-based complementary food provided to infants with different iron and hematologic status.. Infants aged 6-18 mo were randomly assigned to receive either 30 (n = 45) or 45 (n = 45) mg elemental Fe as (57)Fe-labeled sprinkles added to a maize-based porridge on 3 consecutive days. A (58)Fe tracer (0.2 mg as ferrous citrate) was also infused intravenously (n = 46). Blood was drawn at baseline and 14 d later to determine erythrocyte incorporation of (57)Fe and (58)Fe by using inductively coupled plasma mass spectrometry. On the basis of hemoglobin and soluble transferrin receptor concentrations, subjects were classified as having iron deficiency anemia (IDA), iron deficiency (ID), or sufficient iron status.. There was no significant effect of dose on iron absorption (P > 0.05). Geometric mean iron absorption was 8.25% (range: 2.9-17.8%) in infants with IDA (n = 32), 4.48% (range: 1.1-10.6%) in infants with ID (n = 20), and 4.65% (range: 1.5-12.3%) in iron-sufficient infants (n = 20). Geometric mean iron absorption was significantly higher in infants with IDA than in infants with ID or iron-sufficient infants (P = 0.0004); however, there were no significant differences between infants with ID and iron-sufficient infants.. During infancy, iron absorption from sprinkles in a maize-based porridge meets and surpasses requirements for absorbed iron and is up-regulated in infants with IDA.

Topics: Absorption; Algorithms; Anemia, Iron-Deficiency; Drug Compounding; Female; Ferrous Compounds; Humans; Infant; Male

Despite efforts to improve iron supplements for iron deficiency anemia, there is no consensus on products that balance efficacy, safety and tolerability, and cost. Ferrous products are effective, but they are associated with more gastrointestinal side effects than ferric products. Ferric products tend to have lower absorption. We present results from a 12-week study that randomized 72 people with uncomplicated iron deficiency anemia to receive a ferrous iron supplement (Ferall, a combination of ferrous fumarate with ascorbic acid, folic acid, and cyanocobalamin) or a ferric iron polysaccharide complex (Niferex, ferro-glycine sulfate) plus ascorbic acid. The ferrous product was significantly more effective, the primary and secondary endpoints including changes in levels of hemoglobin and serum ferritin. There was a slightly higher frequency of gastrointestinal side effects in patients taking the ferrous product, but both supplements were well tolerated. No participant withdrew from the study because of side effects. We concluded that the ferrous product is safe and effective for use in uncomplicated iron deficiency anemia. The lack of direct comparison between single-agent ferrous fumarate and the combination ferrous product limited interpretation of results in terms of possible effects due to other components, such as ascorbic acid.

Topics: Administration, Oral; Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Female; Ferritins; Ferrous Compounds; Folic Acid; Hemoglobins; Humans; Intestinal Absorption; Iron; Iron, Dietary; Male; Middle Aged; Polysaccharides; Taiwan; Treatment Outcome

Interest in assessing iron status in the population of women during their child-bearing age has grown recently both in terms of detecting iron stores and evaluating whether they are sufficient to meet increasing needs during pregnancy. The fact that iron deficiency anaemia often develops in pregnancy indicates that that iron stores and dietary iron are insufficient to requirements and iron supplementation is needed. The aim of the present study was to determine the effect of vitamin, macro and microelement supplementation on iron status of pregnant women and of their newborns. It is shown that serum total iron concentration in the group of women without supplementation decreased in the III trimester to 60% of that observed after 12 weeks of pregnancy (p < 0.0001). In supplemented group the decrease was not statistically significant. Increased value of transferin in III trimester in comparison to the I trimester by 38% (p < 0.0001) and by 55% (p < 0.0001) respectively in non supplemented and supplemented groups were found. It was accompanied by significant increase of total iron-binding capacity (TIBC) (p < 0.0001). In both studied groups the level of ferritin was lower in the III than in the I trimester. In serum of women without supplementation, ferritin concentration decreased by 35% (p < 0.003); whereas in supplemented group it was statistically insignificant. In serum of umbilical cord blood concentration of total iron, transferin and ferritin were similar in newborns of both groups of mothers. The above results suggested that vitamin, macro and microelement supplementation of pregnant women improved iron status in mothers and in their children. It seems that administration Vibovitmama formula can be recommended as a dietary supplement in pregnancy in order to prevent subclinical deficiency of iron.

Topics: Adult; Anemia, Iron-Deficiency; Biomarkers; Dose-Response Relationship, Drug; Double-Blind Method; Female; Ferrous Compounds; Humans; Iron; Iron, Dietary; Micronutrients; Poland; Pregnancy; Pregnancy Complications, Hematologic; Prenatal Care; Trace Elements; Treatment Outcome; Vitamins

To compare the effectiveness of microencapsulated iron(II) fumarate sprinkles (with and without vitamin A), iron(II) sulfate drops, and placebo sprinkles in preventing recurrence of anaemia and to determine the long-term haematological outcomes in children at high risk of recurrence of anaemia 12 months after the end of supplementation.. A prospective, randomized, placebo-controlled design was used to study 437 Ghanaian children aged 8-20 months who were not anaemic (haemoglobin > or = 100 g/l). Four groups were given microencapsulated iron(II) fumarate sprinkles, microencapsulated iron(II) fumarate sprinkles with vitamin A, iron(II) sulfate drops or placebo sprinkles daily for six months. Primary outcome measures were change in haemoglobin and anaemic status at baseline and study end. Non-anaemic children at the end of the supplementation period were reassessed 12 months after supplementation ended.. Overall, 324 children completed the supplementation period. Among the four groups, no significant changes were seen in mean haemoglobin, ferritin or serum retinol values from baseline to the end of the supplementation period. During the trial, 82.4% (267/324) of children maintained their non-anaemic status. Sprinkles were well accepted without complications. At 12 months post-supplementation, 77.1% (162/210) of children with no intervention remained non-anaemic. This proportion was similar for children among the four groups.. In most children previously treated for anaemia, further supplementation was not needed to maintain their non-anaemic status. These results may have important implications for community intervention programmes in which initial high-dose treatment is needed because of a high prevalence of anaemia.

Topics: Administration, Oral; Anemia, Iron-Deficiency; Ascorbic Acid; Child, Preschool; Dietary Supplements; Ferrous Compounds; Ghana; Humans; Infant; Placebos; Prospective Studies; Risk Factors; Secondary Prevention

To improve the iron status of infants an effort was made to increase the iron content of complementary foods by adding 12.5 mg of elemental iron to the meal in the form of micro-encapsulated ferrous fumarate coated with a lipid. The contents of the packet were sprinkled directly on to infant foods. Relative absorption of iron from this supplement was determined in a prospective randomized study with 39 infants (mean age 33.6 +/- 5.2 weeks) with initial hemoglobin values greater than 100 g/L. They were fed two complementary foods (rice-based and wheat-based) in which the supplement labeled with stable isotopes of iron 57Fe and 58Fe was incorporated. The erythrocyte iron incorporation was measured in the blood by inductively coupled plasma mass spectrophotometry. The incorporation of iron was significantly higher 11.9% p < .001 and 13.3% p < .001 and no difference was observed with the type of cereal in complementary foods. The use of ferrous fumarate sprinkles has proved to be efficacious in increasing the available iron intake of the infants.

Topics: Anemia, Iron-Deficiency; Biological Availability; Drug Compounding; Erythrocytes; Ferrous Compounds; Food, Fortified; Humans; Infant; Infant Food; Intestinal Absorption; Iron Isotopes; Iron, Dietary; Mass Spectrometry; Nutritive Value; Oryza; Prospective Studies; Triticum

We conducted a randomized clinical intervention trial over 24 weeks on a tea estate in north-east Bangladesh to investigate the effect of iron supplementation and anthelmintic treatment on the labour productivity of adult female tea pluckers. A total of 553 full-time tea pluckers, not pregnant and not breastfeeding, were randomly assigned to one of the four intervention groups: group 1 received iron supplementation on a weekly basis, group 2 received anthelmintic treatment at the beginning and half-way through the trial (week 12), group 3 received both iron supplementation as group 1 and anthelmintic treatment as group 2, and group 4 was a control group and received placebos. No significant difference in labour productivity was found between the four intervention groups over the trial period. However, there was a negative association for all three worms (Ascaris lumbricoides, Trichuris trichiura and hookworms) between the intensity of helminth infections (eggs/g faeces) and all measures of labour productivity. Lower haemoglobin values and anaemia (< 120 g/l Hb) were both associated with lower labour productivity and more days sick and absent. Taller women with greater arm circumference were able to pluck more green leaves, earn higher wages and were absent less often.

Topics: Adolescent; Adult; Aged; Agriculture; Albendazole; Anemia, Iron-Deficiency; Anthelmintics; Ascariasis; Bangladesh; Dietary Supplements; Drug Therapy, Combination; Efficiency; Female; Ferrous Compounds; Folic Acid; Helminthiasis; Hookworm Infections; Humans; Income; Middle Aged; Nutritional Status; Sick Leave; Tea; Trichuriasis

Treatment of iron deficiency anaemia with conventional oral preparations is handicapped by unpredictable haematological response in addition to potential for irritating gastrointestinal adverse events. Iron polymaltose complex (IPC), a novel oral iron formulation with better absorbability, predictable haematinic response and less side effects was compared with oral ferrous fumarate in 100 female patients with documented iron deficiency anaemia. Clinical parameters (pallor, weakness) as well as biochemical parameters (Hb, serum iron, total iron binding capacity) show favourable changes with IPC; the physician and patient assessment also favour IPC over ferrous fumarate.

Topics: Adult; Anemia, Iron-Deficiency; Developing Countries; Drug Combinations; Female; Ferric Compounds; Ferrous Compounds; Folic Acid; Humans; Prospective Studies; Treatment Outcome

Standard therapy for anemia in infants is ferrous sulfate drops administered 3 times/d. Adherence to treatment, however, is often poor. One likely reason for poor adherence is the unpleasant side effects associated with drops.. The objective was to evaluate the use of a new form of iron and a delivery system to treat anemia in infants that is likely to produce better adherence to treatment.. Using a prospective, randomized, controlled design, we studied 557 anemic children aged 6-18 mo (hemoglobin: 70-99 g/L) in rural Ghana. One group received a daily sachet of microencapsulated ferrous fumarate (80 mg elemental Fe) in powder form plus ascorbic acid to be sprinkled onto any complementary food eaten (sprinkles group); a control group received ferrous sulfate drops 3 times/d for 2 mo (total dose: 40 mg elemental Fe). Hemoglobin and serum ferritin concentrations were measured at baseline and at the end of treatment.. Successful treatment of anemia (hemoglobin > 100 g/L) occurred in 58% of the sprinkles group and in 56% of the drops group, with minimal side effects in both groups. Geometric mean ferritin concentrations increased significantly in each group from baseline to the end of treatment (P < 0.001).. Use of ferrous sulfate drops or a single daily dose of microencapsulated ferrous fumarate sprinkles plus ascorbic acid resulted in a similar rate of successful treatment of anemia without side effects. To our knowledge, this is the first demonstration of the use of microencapsulated iron sprinkles to treat anemia. Improved ease of use may favor the use of sprinkles to deliver iron.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Drug Administration Schedule; Drug Compounding; Drug Therapy, Combination; Female; Ferritins; Ferrous Compounds; Ghana; Hemoglobins; Humans; Infant; Infant Food; Male; Patient Compliance; Prospective Studies; Rural Population; Weaning

The aim of this study was to compare two different doses and means of administration of iron in recombinant human erythropoietin (rHuEPO)-treated very low birth-weight (VLBW) infants. VLBW infants (n = 41) were randomized to one of three groups. Fourteen infants were treated with rHuEPO (300 IU/kg three times a week s.c.) and oral iron (ferrofumarate, 6 mg of iron/kg per day). Another 14 infants received the same erythropoietin dose and intramuscular iron (ferroxypolymaltose, once 12 mg of iron/kg weekly). Thirteen infants were treated with the same dose of intramuscular iron but did not receive rHuEPO. After the 3-week study period, haemoglobin concentrations and reticulocyte counts were similar in the rHuEPO-treated groups and both were higher than in the group not receiving rHuEPO (P < 0.001). In both rHuEPO-treated groups the transferrin receptor concentration increased from 6.8-7.2 mg/l to 10.5-11.3 mg/l.. In erythropoietin-treated very low birth weight infants the iron need for erythropoiesis can be met by oral administration of iron.

Topics: Administration, Oral; Anemia, Iron-Deficiency; Drug Therapy, Combination; Erythropoietin; Ferric Compounds; Ferrous Compounds; Humans; Infant, Newborn; Infant, Very Low Birth Weight; Injections, Intramuscular; Iron; Recombinant Proteins; Regression Analysis; Statistics, Nonparametric; Time Factors

Anaemia is the most common medical disorder in pregnancy with iron deficiency anaemia accounting for the majority of cases. Over 90% of the iron deficiency anaemia is due to red cell iron deficiency associated with depleted iron stores and deficient intake. The two main modalities of treating iron deficiency anaemia are oral or parenteral iron. Ferrous Hausmann (iron dextrin) is the latest iron preparation which can be used for intravenous parenteral administration as a total dose infusion. This study compares the efficacy of Ferrum Hausmann with oral ferrous fumarate therapy in the treatment of iron deficiency anaemia in pregnancy. Our study shows that treatment with intravenous Ferrum Hausmann (iron dextrin) resulted in a significantly better level and rate of increase of haemoglobin (p<0.001). Serum ferritin, which is the best indicator of iron stores, was significantly higher (p<0.001) in the intravenous group. Other indices of iron status such as serum iron, serum transferrin and zinc protoporphyrin also showed a significant improvement in the intravenous group compared to those given oral iron. The results suggest that intravenous iron as a total dose infusion is able to replenish iron stores more efficiently, completely and at a faster rate than oral iron therapy, thus providing the fuel for stimulation of full erythopoiesis compared to oral iron. There were also no reports of any adverse reactions with intravenous iron dextrin, whereas there were a considerable proportion of women on oral iron therapy who reported side effects. In conclusion, intravenous iron therapy with Ferrous Hausmann (iron dextrin) is a suitable, effective and safe alternative to oral iron therapy in the treatment of iron deficiency anaemia in pregnancy.

Topics: Administration, Oral; Adolescent; Adult; Anemia, Iron-Deficiency; Female; Ferric Compounds; Ferrous Compounds; Hematinics; Hemoglobins; Humans; Injections, Intravenous; Iron; Middle Aged; Pregnancy; Pregnancy Complications, Hematologic; Treatment Outcome

Iron supplementation is required by most dialysis patients receiving recombinant human erythropoietin. The efficacy of oral iron is variable in these patients, and many require the use of intravenous iron dextran to maintain adequate iron levels, defined as transferrin saturation greater than 20%, serum ferritin greater than 100 ng/mL, and serum iron greater than 80 micrograms/dL. To determine the efficacy of different oral iron preparations in maintenance of iron status, we prospectively studied 46 recombinant human erythropoietin-treated patients and randomized them to receive different oral iron preparations. These four preparations included Chromagen (ferrous fumarate; Savage Laboratories, Melville, NY), Feosol (ferrous sulfate; SmithKline Beecham, Inc, Pittsburgh, PA), Niferex (polysaccharide; Central Pharmaceuticals, Inc, Seymour, IN), or Tabron (ferrous fumarate; Parke-Davis, Morris Plains, NJ). All patients were prescribed approximately 200 mg of elemental iron daily of their assigned iron preparation with at least 100 mg ascorbic acid daily for 6 months. At baseline and bimonthly during the study, serum iron, transferrin saturation, ferritin, hematocrit, and recombinant human erythropoietin dose were monitored; in addition, compliance and side effects were recorded by patient interview. All patients were able to maintain target hematocrit during the 6 months of study. However, there were differences in the trends of serum iron, percent transferrin saturation, and ferritin when considered singly or in combination between the four groups of iron medications. The percent of laboratory values measured over the study period in each group that met the criteria of transferrin saturation more than 20% was greatest in the Tabron group (58%), followed by the Feosol (47%), Chromagen (33%), and Niferex (31%) groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Anemia; Anemia, Iron-Deficiency; Delayed-Action Preparations; Erythropoietin; Female; Ferrous Compounds; Hematocrit; Humans; Iron; Kidney Failure, Chronic; Male; Middle Aged; Patient Compliance; Polysaccharides; Prospective Studies; Recombinant Proteins; Renal Dialysis

We studied effects of dose and treatment duration during low-dose iron supplementation in premenopausal, non-pregnant women, with initial serum ferritin and haemoglobin concentrations < 20 micrograms x l-1 and > or = 120 g x l-1, respectively. The study was randomized, double-blind and placebo-controlled. Three groups completed a 6-month study: placebo (n = 27), FE-9 (9 mg iron x day-1, n = 18) and FE-27 group (27 mg iron x day-1, n = 19). The supplement consisted of 11% heme and 89% inorganic iron. In FE-27, serum ferritin increased from (mean, 95% confidence interval) 11.8 (9.7; 14.4) to 25.3 (18.6; 34.4) micrograms x l-1 in 1 month, and remained stable after that (ANOVA: group effect, P = 0.0003). In both FE-9 and FE-27, blood haemoglobin levels increased from 136 (132; 140) to 142 (139; 145) g x l-1 in 1 month, remaining constant after that (group effect, P = 0.001). Hence, the 27 mg daily dose of organic/inorganic iron corrected both mild anaemia and storage iron depletion, whereas the 9 mg dose did not affect iron stores. Elongation of treatment duration above 1 month brought about only minor changes.

Topics: Adult; Analysis of Variance; Anemia, Iron-Deficiency; Confidence Intervals; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Drug Combinations; Effect Modifier, Epidemiologic; Female; Ferritins; Ferrous Compounds; Heme; Hemoglobins; Humans; Time Factors

Anemia does not correct in many kidney transplant recipients, probably due to iron deficiency or inadequate erythropoietin (Epo) production. We evaluated effects of iron (Fe) availability on correction of anemia in renal transplant recipients and sought to characterize patterns of early Epo production by transplanted kidneys as related to peritransplant factors. In a prospective randomized trial, 51 consecutive renal transplant patients were followed for 6 months. Epo was measured on days 0, 3, 14, 48 and 168 posttransplantation. Fe status was monitored on days 14, 48 and 168. Pts were randomized at day 14 based on Fe status. Iron-deficient (FeD) patients (n = 24) were randomized to receive daily Fe supplementation (FeDs, n = 12) or no supplementation (FeDns, n = 12). Those with normal Fe status (FeN, n = 27) were followed as controls. No differences were found between groups at day 0 for Hct, Cr, Epo, age, dialysis history, or type of donor. Day 3 Creatinine and Hct were similar among groups, while Epo was significantly higher in FeD groups vs FeN (p < 0.004), and continued higher at 6 months. Though each pt improved Hct, most FeDns and FeN were anemic and Fe deficient at 6 months while all FeDs patients had corrected their anemia (p < or = 0.009) and Fe status. Four FeDs patients developed polycythemia. Epo production correlated inversely to cold ischemia time in cadaver renal allografts (p < 0.008).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Anemia, Iron-Deficiency; Creatinine; Erythropoietin; Female; Ferritins; Ferrous Compounds; Follow-Up Studies; Humans; Immunosuppressive Agents; Iron; Kidney Transplantation; Male; Prospective Studies; Time Factors; Transferrin

Although acute consumption of high doses of prebiotic galacto-oligosaccharides (GOS) increases fractional iron absorption (FIA) from ferrous fumarate (FeFum), it is uncertain if low doses of GOS have this effect. Furthermore, whether GOS improve iron absorption from other commonly used iron compounds and whether ascorbic acid (AA) enhances the effect of GOS on iron absorption from FeFum is unclear.. In iron-depleted women [serum ferritin (SF) <30 μg/L], we assessed: 1) whether the acute enhancing effect of GOS on FeFum is dose dependent; 2) if GOS would affect FIA from ferrous sulfate (FeSO4) or ferric pyrophosphate (FePP); and 3) if AA and GOS given together enhance FIA from FeFum to a greater extent compared with GOS alone.. We recruited 46 women (mean age 22.0 y, mean BMI 21.3 kg/m2, median SF 17.1 μg/L), and measured FIA from 14 mg iron labeled with stable isotopes in the following conditions: 1) FIA from FeFum given with 3.5 g, 7 g GOS, and without GOS; 2) FIA from FeSO4 and FePP given with and without 15 g GOS; and 3) FIA from FeFum given with 7 g GOS with and without 93 mg AA. FIA was measured as erythrocyte incorporation of stable isotopes after 14 d. Comparisons were made using paired samples t-test or Wilcoxon rank sum test where appropriate.. Giving 7 g of GOS significantly increased FIA from FeFum (+26%; P = 0.039), whereas 3.5 g GOS did not (P = 0.130). GOS did not significantly increase FIA from FeSO4 (P = 0.998) or FePP (P = 0.059). FIA from FeFum given with GOS and AA was significantly higher compared with FeFum given with GOS alone (+30%; P <0.001).. In iron-depleted women, GOS does not increase FIA from FeSO4 or FePP, but it increases FIA from FeFum. Thus, a combination of FeFum and GOS may be a well-absorbed formula for iron supplements. The study was registered at clinicaltrials.gov as NCT03762148.

Topics: Anemia, Iron-Deficiency; Biological Transport; Cross-Over Studies; Diphosphates; Drug Administration Schedule; Female; Ferrous Compounds; Humans; Iron; Iron Isotopes; Prebiotics; Prospective Studies; Young Adult

Iron deficiency anaemia is a common problem. The majority of patients are treated with oral iron supplements. The current recommended dosage for oral supplementation of 200 mg ferrous fumarate 3x per day however, is based on a single small study of poor quality. There is no consensus concerning parenteral dosing. In recent years, new insights have been gained regarding both the dosage of oral supplementation and the indication for parenteral supplementation. Oral therapy is preferred. In principle, 100 mg ferrous fumarate once a day is sufficient for the treatment of symptom-free patients with anaemia. In cases of severe anaemia, or in patients with symptoms, 200 mg/day should be prescribed. If side effects appear, it can be dosed every other day. Where oral therapy does not show effectiveness, the anaemia is severe, or rapid increase of haemoglobin is indicated, parenteral supplementation should be chosen. Parenteral supplementation is more effective than oral supplementation in specific conditions, such as dialysis-dependent renal insufficiency, heart failure or active IBD.

Topics: Administration, Oral; Anemia, Iron-Deficiency; Dietary Supplements; Drug Administration Schedule; Female; Ferrous Compounds; Humans; Male; Middle Aged; Parenteral Nutrition; Renal Dialysis

Micronutrient deficiencies (including iodine and iron deficiency) is a global health problem affecting one third of the world's population. Salt is an ideal carrier for food fortification as it is universally consumed at equal rates, independently of economic status, and it is industrially processed. Addressing iron and iodine deficiencies together is a challenge, due to interaction between iodine and iron, negating the effect of added iodine. This paper explains the development of an improved microencapsulation-based technology to produce iron premix, which, when added to iodized salt, is stable and organoleptically indistinguishable. Ferrous fumarate was extruded, followed by cutting, sieving to achieve a size of 300-710 μm (salt grain size). Agglomerated extrudates were microencapsulated (5% hydroxypropyl methylcellulose and 5% soy stearin) to form iron premix. Microencapsulation ensures that the added micronutrients are stable without interaction or degradation. Double Fortified Salt is formed by blending iron premix with iodized salt (1:200 ratio). This technology was transferred to India for industrial scale-up. The public distribution system was utilized to establish and monitor an efficient distribution network for DFS in a transparent manner. The scale-up process was initially demonstrated in the state of Uttar Pradesh, following its success two more Indian states have started distribution of DFS. At present, the DFS with iron and iodine is reaching 60 million people in India. This important health intervention technology through food fortification has the potential to be scaled globally to ensure a world free from iron deficiency anemia.

Topics: Anemia, Iron-Deficiency; Biological Availability; Drug Compounding; Ferrous Compounds; Food Technology; Food, Fortified; Humans; India; Iodine; Iron; Micronutrients; Sodium Chloride, Dietary; Trace Elements

Despite existent fortification initiatives in the Philippines, approximately 50% of the population still suffers from iron deficiency anemia (IDA), mainly in rural areas. Fortification of staple foods has been proved successful in China and Vietnam. Coconut spiced vinegar (SV) is an inexpensive, widely available, and culturally acceptable condiment in Filipino households; however, no technical evidence exists on its potential as fortification vehicle. This study aimed to physicochemically characterize and evaluate the consumer acceptability of SV fortified with ferrous sulfate (FS), ferrous fumarate (FF), or sodium iron ethylenediaminetetraacetate (NaFeEDTA) at 0.2 mg Fe/mL. Iron fortificants were added directly to SV, vortexed, and stored for analysis. A nonfortified SV served as a control. Physicochemical analyses (pH, titratable acidity, color, turbidity, and iron recovery) were conducted from 0 to 6 months postfortification. Consumer acceptability (9-point hedonic scale: color, appearance, aroma, sourness, and overall acceptability) was conducted using 1-month fortified vinegar in 96 students and 27 women. Iron recovery of fortified samples was high and similar (>97%) after 3 days of fortification and remained >87% at 6 months postfortification. All samples had minimum acidity of 5.31% and pH between 3.12 and 3.3. Color difference against the control followed the next order: SV-NaFeEDTA < SV-FS = SV-FF. Among students, acceptability of SV-FS and SV-FF were lower than the control and SV-NaFeEDTA for all attributes (P < 0.05) except aroma. In women, overall acceptability and aroma were not different among samples (P > 0.05). Overall, SV-NaFeEDTA had similar acceptability to the control, and was the most accepted fortified vinegar. SV-NaFeEDTA shows potential (in terms of physicochemical stability and consumer acceptability) to be used as an iron-delivery vehicle to address IDA.. The present study addresses the technical and organoleptic challenges of fortifying Filipino spiced vinegar with three iron sources. About 50% of the Filipino population (especially women and children) still suffers from iron deficiency, thus, more effective ways to deliver iron are needed. If successful, our study could pose as the base milestone for implementing mass iron fortification of spiced vinegar, given its frequent consumption and reach of all socioeconomic pockets of the Filipino population. Our aim is to improve the overall nutritional health of at-risk populations, and our study is one step closer to achieve this goal.

Topics: Acetic Acid; Adolescent; Adult; Anemia, Iron-Deficiency; Color; Edetic Acid; Female; Ferric Compounds; Ferrous Compounds; Food, Fortified; Humans; Iron; Male; Middle Aged; Odorants; Philippines; Sensation; Spices; Taste; Young Adult

Food fortification is one approach for addressing anemia, but information on program effectiveness is limited.. We evaluated the impact of Costa Rica's fortification program on anemia in women aged 15-45 y and children aged 1-7 y.. Reduced iron, an ineffective fortificant, was replaced by ferrous fumarate in wheat flour in 2002, and ferrous bisglycinate was added to maize flour in 1999 and to liquid and powdered milk in 2001. We used a one-group pretest-posttest design and national survey data from 1996 (baseline; 910 women, 965 children) and 2008-2009 (endline; 863 women, 403 children) to assess changes in iron deficiency (children only) and anemia. Data were also available for sentinel sites (1 urban, 1 rural) for 1999-2000 (405 women, 404 children) and 2008-2009 (474 women, 195 children), including 24-h recall data in children. Monitoring of fortification levels was routine.. Foods were fortified as mandated. Fortification provided about one-half the estimated average requirement for iron in children, mostly and equally through wheat flour and milk. Anemia was reduced in children and women in national and sentinel site comparisons. At the national level, anemia declined in children from 19.3% (95% CI: 16.8%, 21.8%) to 4.0% (95% CI: 2.1%, 5.9%) and in women from 18.4% (95% CI: 15.8%, 20.9%) to 10.2% (95% CI: 8.2%, 12.2%). In children, iron deficiency declined from 26.9% (95% CI: 21.1%, 32.7%) to 6.8% (95% CI: 4.2%, 9.3%), and iron deficiency anemia, which was 6.2% (95% CI: 3.0%, 9.3%) at baseline, could no longer be detected at the endline.. A plausible impact pathway suggests that fortification improved iron status and reduced anemia. Although unlikely in the Costa Rican context, other explanations cannot be excluded in a pre/post comparison.

Topics: Adolescent; Adult; Anemia, Iron-Deficiency; Animals; Child; Child, Preschool; Costa Rica; Female; Ferrous Compounds; Food, Fortified; Glycine; Hemoglobins; Humans; Infant; Iron, Dietary; Male; Mandatory Programs; Middle Aged; Nutrition Policy; Nutrition Surveys; Prevalence; Program Evaluation; Sentinel Surveillance; Young Adult

Following the 2008 Wenchuan earthquake, the Chinese government instituted an infant and young and child nutrition program that included promotion of in-home fortification of complementary food with ying yang bao (YYB), a soy-based powder containing iron, 2.5 mg as iron-EDTA and 5 mg as ferrous fumarate, and other micronutrients. Ying yang bao was provided to participating families in 8 poor rural counties in Sichuan, Shaanxi, and Gansu provinces by the Ministry of Health. We assessed hemoglobin levels among infants and young children (IYC) aged 6 to 23 months at baseline in May 2010 (n = 1290) and during follow-up in November 2010 (n = 1142), May 2011 (n = 1118), and November 2011 (n = 1040), using the Hemocue method. Interviewers collected basic demographic information and child feeding practices from the children's caretakers. Altitude-adjusted hemoglobin level averaged 10.8 g/dL, and total anemia prevalence was 49.5% at baseline. Average hemoglobin was 11.3 g/dL at 6 months, 11.6 g/dL at 12 months, and 11.7 g/dL at 18 months after introduction of YYB. Moderate anemia (hemoglobin: 70-99 g/dL) decreased from 20.3% at baseline to 7.5%, 5.8%, and 7.3% after 6, 12, and 18 months of home fortification, respectively (P < .001), whereas mild anemia (hemoglobin: 100-110 g/dL) decreased from 29.0% to 16.7%, 18.1%, and 15.4%, respectively (P < .001). Among infants aged 6 to 23 months, 95% had regularly been fed YYB during the observation period. Regression analysis showed that the duration of YYB consumption and number of sachets consumed per week correlated positively with hemoglobin levels and negatively with anemia rates. Home food fortification with YYB is feasible and effective for nutrition promotion among IYC in high-risk regions of China.

Topics: Anemia; Anemia, Iron-Deficiency; China; Dietary Supplements; Edetic Acid; Ferrous Compounds; Food Assistance; Food, Fortified; Glycine max; Government Programs; Hemoglobins; Humans; Infant; Infant Nutritional Physiological Phenomena; Iron Deficiencies; Iron, Dietary; Poverty; Rural Population

Topics: Aged; Anemia, Iron-Deficiency; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Rheumatoid; Chronic Disease; Female; Ferritins; Ferrous Compounds; Glucocorticoids; Hemoglobins; Hepcidins; Humans; Inflammation; Iron Deficiencies; Male; Middle Aged; Prognosis; Reticulocytes

The benefit of oral iron therapy (OIT) and factors predictive of OIT response are not established in hemodialysis (HD) patients with iron deficiency anemia (IDA). We examined the values of hepcidin-25, mean corpuscular volume (MCV), and ferritin as predictors of OIT response. Oral ferrous fumarate (50 mg/day, 8 weeks) was given to 51 HD patients with IDA (hemoglobin (Hb) < 12 g/dL, ferritin < 100 ng/mL) treated with an erythropoietin activator. Sixteen patients were responders (improvement of Hb (ΔHb) ≥ 2 g/dL) and 35 were non-responders (ΔHb < 2g/dL). Baseline Hb, MCV, serum hepcidin-25, ferritin, iron parameters, and C-reactive protein (CRP) before and ΔHb after OIT were compared between groups. Hepcidin-25, MCV, ferritin, and transferrin saturation were lower in the responders than in the non-responders. Hepcidin-25 positively correlated with ferritin. Hepcidin-25, MCV, and ferritin positively correlated with baseline Hb and negatively correlated with ΔHb. Despite normal CRP levels in all patients, CRP correlated positively with hepcidin-25 and ferritin. Stepwise multiple linear regression analysis and receiver operating characteristics curve analysis revealed that hepcidin-25, MCV, and ferritin could predict OIT response. We conclude that hepcidin-25, MCV, and ferritin could be useful markers of iron storage status and may help predict OIT response in HD patients.

Topics: Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Biomarkers; Body Mass Index; C-Reactive Protein; Dietary Supplements; Erythrocyte Indices; Erythropoietin; Female; Ferritins; Ferrous Compounds; Hemoglobins; Hepcidins; Humans; Iron, Dietary; Linear Models; Male; Middle Aged; Renal Dialysis

Although oral iron preparations are widely prescribed to prevent and to treat iron deficiency anemia in pregnancy, comparative data on their effects to the mother, fetus and placenta are limited. In this study, the effects of oral iron polymaltose complex (IPC), ferrous fumarate (FF) and ferrous sulfate (FS) were compared in anemic pregnant rats, their fetuses and placentas. Hematological variables and oxidative stress markers in the liver, heart and kidneys of the dams and fetuses as well as the markers for oxidative stress, inflammation and hypoxia in placentas were assessed. Pregnancy outcome was measured by number of fetuses, and by neonate and placental weight. All therapies were comparably effective in correcting anemia. FS and FF, but not IPC, resulted in liver damage in dams and oxidative stress in dams, fetuses and placentas. FS group presented the highest catalase and GPx levels in dams, fetuses and placentas. IPC, but not FF or FS, restored normal TNF-α and IL6 expression levels in placentas whereas FS-treated animals presented the highest cytokine levels, suggesting a local inflammatory reaction. Anemia-induced high levels of HIF-1α were partially lowered by IPC and FF but further elevated by FS. Most of the negative effects associated with IDA were resolved by IPC treatment. Especially FS treatment was found to elicit hepatic damage in the dams, oxidative stress in the dams, fetuses and placenta as well as inflammation and high levels of HIF-1α in the placenta. Pregnancy outcome of FFand FS-treated animals was worse than that of IPC-treated animals.

Topics: Administration, Oral; Anemia, Iron-Deficiency; Animals; Disease Models, Animal; Female; Ferric Compounds; Ferrous Compounds; Humans; Hypoxia-Inducible Factor 1, alpha Subunit; Inflammation Mediators; Interleukin-6; Oxidative Stress; Placenta; Pregnancy; Pregnancy Outcome; Rats, Sprague-Dawley; Tumor Necrosis Factor-alpha

Topics: Adult; Alopecia; Amines; Analgesics; Anemia, Iron-Deficiency; Ascorbic Acid; Cyclohexanecarboxylic Acids; Diagnosis, Differential; Drug Combinations; Female; Ferrous Compounds; Gabapentin; gamma-Aminobutyric Acid; Humans; Menorrhagia; Thyroid Diseases; Thyroid Function Tests

Topics: Anemia, Iron-Deficiency; Contrast Media; Diagnosis, Differential; Diagnostic Techniques, Digestive System; Diarrhea; Fatal Outcome; Female; Ferrous Compounds; Humans; Laxatives; Middle Aged; Radiography, Abdominal

Flour was fortified with premix containing ferrous fumarate and folic acid. Organic acids such as citric acid, malic acid and tartaric acid, which are promoters of iron bioavailability, were added at three levels and their influence on rheological and bread-making characteristics was studied. Farinograph water absorption increased with fortificants, but with addition of organic acids there was a decrease. Maximum pressure was 77 mm in control, which increased to 78-88 mm with the addition of different acids to the fortified flour. Addition of organic acids to fortified flour brought about a decrease in peak viscosity, hot paste viscosity, cold paste viscosity and setback values. The L, a and b values of fortified breads were similar to that of control. Sensory analysis revealed marginal differences in the overall quality of breads prepared with fortified flour with the addition of organic acids.

Topics: Acids, Acyclic; Anemia, Iron-Deficiency; Biological Availability; Bread; Color; Diet; Ferrous Compounds; Flour; Folic Acid; Folic Acid Deficiency; Food Technology; Food, Fortified; Humans; Iron, Dietary; Pressure; Rheology; Triticum; Viscosity; Water

To evaluate the use of reticulocyte hemoglobin content (CHr) and mean corpuscular volume (MCV) to identify truly iron-deficient women with postpartum anemia (PPA), in order to reduce unnecessary iron supplementation.. Three hundred women with more than 500 mL of blood loss or clinical signs of anemia were divided in a control (Hb ≥ 10.5 g/dL, N = 150) and postpartum anemia group (PPA, Hb < 10.5 g/dL; N = 150). PPA women were given ferrous fumarate for a period of 4 weeks. Efficacy of the treatment was evaluated by comparing Hb, CHr, and MCV at baseline (T(0)) and after 4 weeks (T(4)). Using standard iron deficiency cut off values for MCV (80 fL) and CHr (28 pg) at T(0), we divided the PPA group of both parameters into two subgroups, one suggestive for iron deficiency and one suggestive for noniron deficiency.. Irrespective of the parameter or the subdivision, delta Hb concentrations (T(4) -T(0)) showed a similar increase in all PPA subgroups investigated. Both parameters in the PPA subgroups below their respective cut off value showed a significant improvement toward normalization, while the MCV and CHr in the PPA subgroups above their respective cut off value did not show any significant increase.. Our data suggest that the etiology of the anemia in postpartum anemic women is not always iron deficiency. Using a combination of Hb, MCV and CHr, we increased the stringency to identify truly iron-deficient postpartum anemic women, thereby reducing unnecessary iron supplementation in those women with sufficient iron stores.

Topics: Adult; Anemia; Anemia, Iron-Deficiency; Erythrocyte Indices; Female; Ferrous Compounds; Hemoglobins; Humans; Postpartum Period; Predictive Value of Tests; Reticulocytes; Time Factors; Trace Elements; Young Adult

Topics: Anemia, Iron-Deficiency; Blood Transfusion; Cardiac Surgical Procedures; Female; Ferric Compounds; Ferric Oxide, Saccharated; Ferrous Compounds; Glucaric Acid; Hematinics; Humans; Male; Sucrose

Iron deficiency is common in cyanotic congenital heart disease (CHD) and results in reduced exercise tolerance. Currently, iron replacement is advocated with limited evidence in cyanotic CHD. We investigated the safety and efficacy of iron replacement therapy in this population.. Twenty-five iron-deficient cyanotic CHD patients were prospectively studied between August 2008 and January 2009. Oral ferrous fumarate was titrated to a maximum dose of 200mg thrice-daily. The CAMPHOR QoL questionnaire, 6 minute walk test (6MWT) and cardiopulmonary exercise testing were conducted at baseline and after 3 months of treatment.. Mean age was 39.9 ± 10.9 years, 80% females. Fourteen had Eisenmenger syndrome, 6 complex cyanotic disease and 5 Fontan circulation. There were no adverse effects necessitating termination of treatment. After 3 months of treatment, hemoglobin (19.0 ± 2.9 g/dL to 20.4 ± 2.7 g/dL, p<0.001), ferritin (13.3 ± 4.7 μg/L to 54.1 ± 24.2 μg/L, p<0.001) and transferrin saturation (17.8 ± 9.6% to 34.8 ± 23.4%, p<0.001) significantly increased. Significant improvements were also detected in the total CAMPHOR score (20.7 ± 10.9 to 16.2 ± 10.4, p=0.001) and 6MWT distance (371.7 ± 84.7 m to 402.8.0±74.9m, p=0.001). Peak VO(2) remained unchanged (40.7 ± 9.2% to 43.8 ± 12.4% of predicted, p=0.15).. Three months of iron replacement therapy in iron-deficient cyanotic CHD patients was safe and resulted in significant improvement in exercise tolerance and quality of life. Identification of iron deficiency and appropriate replacement should be advocated in these patients.

Topics: Adult; Anemia, Iron-Deficiency; Eisenmenger Complex; Exercise Test; Exercise Tolerance; Female; Ferrous Compounds; Follow-Up Studies; Heart Defects, Congenital; Humans; Male; Middle Aged; Prospective Studies; Quality of Life; Treatment Outcome

Bariatric surgery before pregnancy may help prevent obesity-related gestational complications. However, maternal malnutrition is not without potential risks during pregnancy. The objective was to evaluate the influence of time to conception after silastic ring Roux-en-Y gastric bypass (SRYGB) on maternal anemia.. Patients who underwent SRYGB for morbid obesity and who subsequently became pregnant were followed up at the prenatal. Thirty pregnancies occurred between July 2001 and September 2009. The patients were analyzed according to time to conception after bariatric surgery: 17 patients with time to conception <4 years (48 months) and 13 patients with ≥ 4 years.. First trimester hemoglobin levels were significantly lower in patients with time to conception ≥ 4 years (48 months) (median 9.6 g/dL, range 5.8-13.2 g/dL) than in patients with time to conception <4 years (median 11.1 g/dL, range 9.8-13.6 g/dL; p=0.047). The need for intravenous iron therapy or packed red cell transfusion was significantly more frequent among women who became pregnant ≥ 4 years after SRYGB compared to <4 years (30.8% vs. 0%, p=0.026).. Pregnancy after 4 years of SRYGB is associated with maternal anemia and the need for more strict iron supplementation.

Topics: Adult; Anemia, Iron-Deficiency; Dietary Supplements; Female; Ferrous Compounds; Fertilization; Follow-Up Studies; Gastric Bypass; Humans; Iron; Pregnancy; Pregnancy Complications; Risk Factors; Time Factors; Vitamins

A microencapsulation-based technology platform has been developed for salt double fortification with iron and iodine, aiming to address two globally prevalent micronutrient deficiencies simultaneously. Specifically, ferrous fumarate was microencapsulated into a form of salt grain-sized premix, and then added into iodised salt. The earlier process involved fluidised-bed agglomeration followed by lipid coating. To improve physico-chemical properties of the iron premix, the use of cold-forming extrusion for agglomerating and microencapsulating ferrous fumarate was investigated and optimized in this study, leading to optimal formulations and operation parameters. Grain flours were suitable for forming an extrudable dough incorporating high percentages of ferrous fumarate. All extruded iron particles, regardless of binders used, were rich in iron and had excellent iron in vitro digestibility. The extruded iron particles formed the basis of the final, microencapsulated iron premixes with desired particle size (300-700 µm), and other physical, chemical, nutritional, and organoleptic properties suitable for salt fortification.

Topics: Anemia, Iron-Deficiency; Cold Temperature; Drug Compounding; Ferrous Compounds; Food, Fortified; Humans; Iodine; Particle Size; Sodium Chloride, Dietary; Time Factors; Treatment Outcome

Reported here are three studies performed with the objective of finding ways to improve the iron status of breastfed infants and to prevent iron deficiency (ID). Participating infants were exclusively breastfed until 4 months of age; thereafter, they could receive complementary foods and, in some studies, supplemental formula. In the first study, infants were given medicinal iron between the ages of 1 and 5.5 months. During this period, iron status improved and ID was prevented; however, these benefits did not continue after the intervention ceased. In the second study, infants received medicinal iron or an equivalent amount of iron from an iron-fortified cereal between the ages of 4 and 9 months. Again, iron supplementation largely prevented ID from occurring, while non-anemic ID and ID anemia occurred in the control group as well as in the intervention groups before the intervention began. In the third study, infants received dry cereals fortified with electrolytic iron or with ferrous fumarate between the ages of 4 and 9 months. The cereals were equally effective in providing relative protection from ID. The results of these three studies indicate it is possible to protect breastfed infants from ID and IDA.

Topics: Anemia, Iron-Deficiency; Breast Feeding; Child Development; Child, Preschool; Dietary Supplements; Edible Grain; Ferrous Compounds; Food, Fortified; Humans; Infant; Iron, Dietary; Randomized Controlled Trials as Topic

Topics: Anemia, Iron-Deficiency; Animals; Bedbugs; Ferrous Compounds; Hemoglobins; Humans; Insect Bites and Stings; Male; Middle Aged; Trace Elements

Ferrous fumarate is useful in iron fortification because of its high bioavailability, mild taste, and relatively low cost. A ferrous fumarate premix for incorporation into salt has been developed by agglomerating ferrous fumarate with appropriate binder materials into salt-size particles followed by microencapsulation.. The bioavailability of iron is critical for the usefulness of double-fortified salt. This study examined the in vitro bioavailability of various iron forms in double-fortified salt and microencapsulated ferrous fumarate premixes prepared by various techniques in an effort to identify key processing factors affecting iron bioavailability.. Iron in vitro bioavailability was approximated through the rate of dissolution of iron in 0.1 N HCl, which closely approximates the acid in gastric juice. Iron in vivo bioavailability was tested using the hemoglobin repletion assay in rats.. The materials and techniques used in microencapsulating ferrous fumarate had little effect on iron in vitro bioavailability: more than 90% of iron in the premixes was released during 2 hours of digestion in the simulated gastric fluid. By incorporating titanium dioxide in the coating materials, the dark reddish-brown color of ferrous fumarate was effectively masked, resulting in acceptable sensory qualities, while maintaining the stability of iodine in the salt. Iron in vivo tests in rats have confirmed that the ferrous fumarate microencapsulated in a lipid is highly bioavailable, with a bioavailability of 95% relative to ferrous sulfate.. These findings were corroborated by field tests in southern India which demonstrated that double-fortified salt containing microencapsulated ferrous fumarate was effective in reducing the prevalence of iron-deficiency anemia and iodine-deficiency disorders.

Topics: Anemia, Iron-Deficiency; Animals; Biological Availability; Capsules; Color; Dietary Supplements; Digestion; Dose-Response Relationship, Drug; Drug Stability; Ferrous Compounds; Food Handling; Food, Fortified; Gastric Juice; Hemoglobins; Hydrochloric Acid; Hydrogen-Ion Concentration; Iodine; Iron Deficiencies; Iron, Dietary; Rats; Sodium Chloride, Dietary; Titanium

Food fortification with iron is effective in combating iron-deficiency anemia. As iron is reactive, it can destroy micronutrients, contribute to poor taste, and discolor the food. Encapsulation could be used to prevent the reaction of iron with food components. The stability of thiamin (vitamin B1) and its effects on organoleptic properties in Ultra Rice were investigated in the presence of encapsulated ferrous fumarate. The preparation of simulated rice grains did not affect the solubility of encapsulated ferrous fumarate in simulated gastric juice. After 20 weeks at 40 degrees C/ approximately 100% relative humidity, essentially all of the vitamin B1 and ferrous iron were retained. Antioxidants were effective in preventing the loss of thiamin and retarding oxidative rancidity catalyzed by ferrous iron. This study demonstrated the feasibility of incorporating both iron and vitamin B1 in a stable Ultra Rice formulation. Inclusion of other stable B vitamins in the formulation should be also feasible.

Topics: Anemia, Iron-Deficiency; Biological Availability; Drug Compounding; Ferrous Compounds; Food Handling; Food Technology; Food, Fortified; Humans; Iron; Iron, Dietary; Models, Biological; Oryza; Thiamine

To study the efficacy of oral ferrous fumarate, an inexpensive, readily available preparation on iron deficiency in infants in Africa.. Four months old (group 1, n = 252) and 6-18 months old (group 2, n = 360) healthy infants attending four primary health care centers (PHC) for vaccination/well-child visits in Benin were studied. Ninety-six pregnant women (PW) over 36 weeks gestational age attending the same PHC during the study period were also studied. Infants were offered 2 months supplementation with oral powdered generic ferrous fumarate (GFF), that is, 5 mg/kg/day of elemental iron, given twice and were reevaluated 2 months later for hematological indices. The prevalence of anemia and iron deficiency among pregnant women was assessed using hematological indices and transferrin saturation.. The prevalence of anemia was 42.0%, 61.9%, and 37.5% in groups 1, 2, and PW, respectively. All anemic PW were iron deficient. Hemoglobin level shifted towards high values after supplementation. In addition, 24 infants from group 1 whose mothers interrupted the treatment, showed a significant decrease in hemoglobin level values, and similar improvement after two additional months of supplementation.. Programs to prevent iron deficiency in Africa should utilize inexpensive preparations, start during pregnancy, continue in infants at 3 months of age and address problems of noncompliance.

Topics: Administration, Oral; Africa South of the Sahara; Age Factors; Anemia, Iron-Deficiency; Dietary Supplements; Female; Ferrous Compounds; Hemoglobins; Humans; Infant; Male; Pregnancy; Treatment Outcome

Food iron fortification can be a good strategy to prevent iron deficiency. Iron bioavailability from cocoa powder enriched with ferric pyrophosphate encapsulated in liposomes or ferrous fumarate was assessed in rats.. Three groups of rats consumed during 28 days either a control diet or two diets prepared with ferric pyrophosphate- or ferrous fumarate-enriched cocoa powder as the unique source of iron. Body weight and food intake were monitored and last-week feces were collected. On day 28, animals were sacrificed and livers and spleens were removed. Hemoglobin and total iron binding capacity (TIBC) were determined.. There were no significant differences in body weight and food intake. Apparent iron absorption and % absorption/intake were significantly lower in rats consuming enriched cocoa compared to the control group, without significant differences due to the iron form. Enriched cocoa groups showed significantly lower spleen iron content and concentration than the control. Liver iron was lower in the ferric pyrophosphate group compared to the other two groups. Hemoglobin and TIBC values showed a deficient iron status in ferric pyrophosphate rats.. Cocoa powder is a good vehicle for iron fortification when enriched with ferrous fumarate compared to ferric pyrophosphate encapsulated in liposomes.

Topics: Anemia, Iron-Deficiency; Animals; Biological Availability; Cacao; Diet; Diphosphates; Female; Ferrous Compounds; Food, Fortified; Hemoglobins; Iron; Iron, Dietary; Liposomes; Liver; Male; Random Allocation; Rats; Rats, Wistar; Spleen

Nonheme-iron absorption requires an acidic milieu. Reduced gastric acid output as a consequence of Helicobacter pylori infection could be an important limiting factor for iron absorption.. We measured gastric acid output and iron absorption from a non-water-soluble iron compound (ferrous fumarate) and a water-soluble iron compound (ferrous sulfate) in children with and without H. pylori infection.. Gastric acid output was quantified before (basal acid output, or BAO) and after pentagastrin stimulation (stimulated acid output, or SAO) in 2-5-y-old children with iron deficiency anemia who were (n = 13) or were not (n = 12) infected with H. pylori. Iron absorption was measured by using a double-stable-isotope technique. H. pylori-infected children were studied before and after eradication therapy.. BAO and SAO were significantly lower in the H. pylori-infected children (0.2 +/- 0.2 and 1.6 +/- 0.9 mmol/h, respectively) than in the uninfected children (0.9 +/- 0.7 and 3.1 +/- 0.9 mmol/h, respectively; P = 0.01 and P < 0.005). BAO and SAO improved to 0.8 +/- 1.3 and 3.3 +/- 2.4 mmol/h, respectively, after therapy. Iron absorption from ferrous sulfate was significantly greater than that from ferrous fumarate both before (geometric : 19.7% compared with 5.3%; P < 0.0001) and after (22.5% compared with 6.4%; P < 0.0001) treatment in H. pylori-infected children. Corresponding values for uninfected children were 15.6% and 5.4%, respectively (P < 0.001; n = 12).. Iron absorption from ferrous fumarate was significantly lower than that from ferrous sulfate in both H. pylori-infected and uninfected Bangladeshi children. Treatment of H. pylori infection improved gastric acid output but did not significantly influence iron absorption. The efficacy of ferrous fumarate in iron fortification programs to prevent iron deficiency in young children should be evaluated.

Topics: Anemia, Iron-Deficiency; Bangladesh; Biological Availability; Child, Preschool; Female; Ferrous Compounds; Food, Fortified; Gastric Acid; Gastric Acidity Determination; Helicobacter Infections; Helicobacter pylori; Humans; Intestinal Absorption; Iron; Male; Treatment Outcome

An estimated 60-80% of the world's population is affected by iron deficiency. It is the most common preventable nutritional deficiency in the world, despite global goals for its reduction. Young children are the highest risk group, particularly during their rapid period of growth. Anemia in infants and young children is known to have a negative impact on motor and socioemotional development and cognitive function. A new intervention, microencapsulated ferrous fumarate Sprinkles, has been developed to treat iron deficiency. The development process took the intervention from the idea stage to the research stage to the implementation stage. Multiple micronutrient Sprinkles are a breakthrough in meeting the global challenge to reduce childhood anemia due to iron and other micronutrient deficiencies. The goal of the Sprinkles project is to reduce the global burden of childhood anemia by promoting healthy weaning practices, by advocating home-fortification strategies to increase the micronutrient content of weaning foods, and by making Sprinkles widely available, particularly in developing countries.

Topics: Anemia, Iron-Deficiency; Child; Child, Preschool; Dietary Supplements; Drug Compounding; Ferrous Compounds; Food, Fortified; Humans; Infant; Infant Food; Infant Nutritional Physiological Phenomena; Infant, Newborn; Intestinal Absorption; Patient Compliance; Risk Factors; Weaning

The stability of table salt double-fortified with iron as ferrous fumarate, and with iodine as potassium iodide or potassium iodate, has been investigated under actual field conditions of storage and distribution in the coastal and highland regions of Kenya. Seven 200-g sample packets of double-fortified salt in sealed polyethylene bags and a similar packet containing a datalogger for monitoring temperature and humidity were packaged with 21 sample bags of salt from another study into a bundle, which then entered the distribution network from a salt manufacturer's facility to the consumer. Iodine retention values of up to 90% or more were obtained during the three-month study. Double-fortified salt was prepared using ferrous fumarate microencapsulated with a combination of binders and coloring agents and coated with soy stearine, in combination with either iodated salt or salt iodized with potassium iodide microencapsulated with dextrin and coated with soy stearine. Most of the ferrous iron was retained, with less than 17% being oxidized to the ferric state. The polyethylene film overwrap of salt packs in the bundles provided significant protection from ambient humidity. Salt double-fortified with iodine and microencapsulated iron ferrous fumarate premix was generally quite stable, because both iodine and ferrous iron were protected during distribution and retail in typical tropical conditions in Kenya's highlands and humid lowlands.

Topics: Anemia, Iron-Deficiency; Drug Compounding; Drug Stability; Ferrous Compounds; Food Handling; Food Packaging; Food Preservation; Food, Fortified; Goiter; Humans; Humidity; Iodates; Iron, Dietary; Kenya; Potassium Compounds; Potassium Iodide; Sodium Chloride, Dietary; Temperature; Time Factors

Iron deficiency anaemia is a frequent complication of Crohn disease. Treatment with ferrous iron (Fe2-) compounds is often unsatisfactory and is associated with gastrointestinal side effects. Theoretically, oral iron supplementation may even be harmful, because iron may reinforce intestinal inflammation by catalysing production of reactive oxygen species. We investigated the effect of ferrous iron on disease activity and plasma antioxidant status in patients with active Crohn disease.. Ten patients with Crohn disease and iron deficiency and 10 healthy controls were given ferrous fumarate 120 mg for 7 days. The Crohn Disease Activity Index, gastrointestinal complaints and blood samples for antioxidant status, anaemia, inflammation and iron absorption were investigated on day 1 and day 8.. During 1 week of ferrous fumarate supplementation, the Crohn Disease Activity Index tended to increase (P = 0.071). Patients experienced aggravation of diarrhoea, abdominal pain and nausea. Plasma-reduced cysteine was lower (P = 0.038) in patients than it was in controls. One week of ferrous iron supplementation further decreased reduced cysteine (P < 0.001) and significantly decreased plasma-reduced glutathione (P = 0.004) in the patients. Serum iron increased significantly in patients after an oral iron load test (from 5.8 +/- 3.2 micromol/L to 30.9 +/- 13.1 micromol/L).. Treatment of iron deficiency with ferrous fumarate deteriorated plasma antioxidant status and increased specific clinical symptoms in patients with active Crohn disease. Plasma reduced cysteine may be a sensitive indicator for oxidative stress in the intestine.

Topics: Adult; Aged; Anemia, Iron-Deficiency; Antioxidants; Crohn Disease; Cysteine; Dietary Supplements; Disease Progression; Female; Ferrous Compounds; Humans; Male; Middle Aged; Oxidative Stress; Reactive Oxygen Species

Iron absorption from rice fortified with different iron fortificants, e.g., ferrous sulfate (FeS04), sodium iron EDTA (NaFeEDTA), ferrous fumarate (FeFum), and ferrous bisglycinate (FeBis) was determined using an in vitro enzymatic digestion method simulating conditions in the small intestine and an in vivo method using radioisotope techniques. The in vitro method showed that the percentage of dialyzable iron from NaFeEDTA (15.7 +/- 0.9) and FeS04-fortified rice (13.2 +/- 1.5) was significantly greater than that from FeFum (6.4 +/- 0.6; p < .05) and FeBis fortified rice (3.3 +/- 0.8; p < .05). Iron absorption in vivo was investigated from FeS04 and NaFeEDTA fortified rice with and without fish and vegetables in 10 borderline iron-deficient subjects. Iron absorption (mg) from NaFeEDTA fortified rice (0.44 +/- 0.11) was significantly greater than from FeS04-fortified rice (0.22 +/- 0.05; p < .05) and the unfortified rice (0.17 +/- 0.02; p < .05). Iron absorption (mg) from a meal consisting of iron-fortified rice, fish, and vegetables was significantly greater from NaFeEDTA (0.88 +/- 0.24) and FeS04 (0.67 +/- 0.10) -fortified rice than from the unfortified rice (0.41 +/- 0.08; p < .05). This study concluded that both NaFeEDTA and FeSO4 are effective iron fortificants for rice. The binder used in the study may have a significant role in the release of iron from iron-fortified rice for absorption. Further studies on the use of other binders to maximize iron release and minimize iron loss during cooking should be conducted to improve iron absorption from the fortified rice/rice-fish-vegetable meals. Results from this study can be used as a basis for food iron fortification programs as well as in the establishment of recommended dietary allowances for iron among Filipinos.

Topics: Adult; Anemia, Iron-Deficiency; Cooking; Digestion; Edetic Acid; Female; Ferric Compounds; Ferrous Compounds; Food, Fortified; Humans; Intestinal Absorption; Iron, Dietary; Male; Nutrition Policy; Oryza; Philippines; Radioisotope Dilution Technique

Topics: Anemia, Iron-Deficiency; Anti-Infective Agents; Antinematodal Agents; Child Nutrition Disorders; Child, Preschool; Ferrous Compounds; Giardiasis; Growth; Humans; Infant; Infant Nutrition Disorders; Intestinal Diseases, Parasitic; Mebendazole; Metronidazole; Nutritional Status; Senegal; Time Factors; Vitamin A; Vitamin A Deficiency

Iron supplementation is probably the best available option to effectively address iron deficiency in pregnant women and young children because it can be targeted specifically to these high-risk groups. However, technical and practical barriers exist: limited information on the effectiveness of supplementation interventions, side effects that affect compliance, and supply/distribution constraints. An innovative approach to addressing these constraints is the use of sprinkles of powdered, microencapsulated ferrous fumarate that can be added directly to any semi-liquid food without changing their taste or consistency. This technique has been tested in initial trials in Ghana and found to be as effective as iron drops. Another approach to improve the effectiveness of iron interventions is through information, education and communication (IEC) programs. These interventions can help modify consumer behavior in some cases, but in some countries, geographic location, variations in language and population size can make the cost of IEC programs very high. IEC strategies in Indonesia aimed at increasing demand for iron supplements by systematic dissemination of specific messages, improving the quality and variety of tablets, increasing the availability and access to supplements by engaging the commercial sector, enrolling traditional birth attendants and other community volunteers in selling supplements. Key issues to be addressed include clarifying optimal starting points and duration of supplementation interventions--based on individual status or population prevalence, defining hemoglobin and ferritin cutoffs at which treatment should be instigated and evaluating the effectiveness of intermittent supplementation with multiple micronutrients.

Topics: Adult; Anemia, Iron-Deficiency; Child; Female; Ferrous Compounds; Humans; Infant; Iron, Dietary; Pregnancy

Topics: Anemia, Iron-Deficiency; Aspirin; Coronary Artery Bypass; Ferric Compounds; Ferrous Compounds; Hemoglobinometry; Humans; Iatrogenic Disease; Male; Middle Aged; Postoperative Complications; Treatment Failure

Topics: Adult; Anemia, Iron-Deficiency; Drug Eruptions; Female; Ferrous Compounds; Humans; Patch Tests

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Drug Therapy; Female; Ferrous Compounds; Fumarates; Humans; Iron; Postpartum Period; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Ferrous Compounds; Iron; Maleates

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Ferrous Compounds; Maleates

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Ferrous Compounds; Hematologic Diseases; Iron; Maleates

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Child; Ferrous Compounds; Humans; Infant; Iron