ABSTRACT
Objectives: Anaemia is a major nutritional problem in Myanmar and it is important to improve the preconceptional iron status of young women. In this study we assessed the beneficial effect of iron, folate and vitamin A supplementation on anaemia of adolescent girls. Methods: A randomized, double-blinded, placebo-controlled study (NCT: 01198574) was conducted among anaemic adolescent schoolgirls (n=402) in Ayeyarwady region, Myanmar. The schoolgirls were recruited from 6 schools after screening for anemia (Hb<120g/L) among 1269 subjects. They were assigned into one of four groups: all groups received folate (F, 2.5 mg of folate), other groups received Vitamin A (FVA, 15,000 IU), Iron (IF, 60 mg elemental iron and folate) and IF+Vitamin A (IFVA). Supplementation was done once a week for 12 weeks. Iron, vitamin A, folate and inflammation status were measured. Serum ferritin (SF) and retinol (SR) were corrected for inflammation. Results: The prevalence of iron deficiency (ID) (SF<15μg/L), low vitamin A status (SR<1.05μmol/L) and folate deficiency (serum folate<6.6nmol/L) were ~20%, 30% and 52% respectively at baseline. Compared with folate, ID was reduced significantly by IF (OR 0.24; 95%CI 0.06, 0.92) and IFA (OR 0.15; 95%CI 0.04, 0.57) respectively. Although Hb significantly increased in all groups, risk of anaemia did not differ between groups that received iron and those who received folate alone or folate plus vitamin A. Conclusions: Multiple micronutrient deficiencies coexist among adolescent girls. Weekly iron supplementation combined with folate and vitamin A alleviated only some of the anaemia and should be implemented but other causes also need to be urgently investigated.
ABSTRACT
Objectives: Children under 2-years of age are at high risk of micronutrient deficiencies and growth faltering due partly to poor complementary feeding. This study aimed to compare the effect of optimized complementary feeding recommendations (CFRs) to iron supplementation on micronutrient status and growth of Myanmar children. Methods: A randomized, partially-blinded, placebo-controlled trial (NCT01758159) was conducted for 24 weeks among 1-2 year old children from Ayeyarwady, Myanmar. Optimized CFRs were developed by Linear Programming using locally available foods. Randomization by village for CFRs or non-CFRs and by child (n=432) for iron supplements or placebo, created: 1.CFR+Fe; 2.CFR-alone; 3.Fe-alone; or 4.Placebo-control groups. Mother from CFRs received regular training on optimized CFRs and children from Fe received 15mg Ferric-NaEDTA daily. Serum ferritin(SF), transferrin-receptor(sTfR), zinc(Zn), retinol-binding-protein(RBP); C-reactive protein, α-1 acid glycoprotein and anthropometry were assessed at baseline and endline. Results: At baseline, 88.4% of children had anemia (Hb<110g/L); after adjusting for infection, 36.1% had iron-deficiency-anemia(IDA) (Hb<110g/L, SF<12μg/L), 37.2% iron-deficiency(ID) (SF<12μg/L), 33.6% zinc-deficiency (Zn<9.9μmol/L), 54.9% low vitamin-A status (RBP<1.05μmol/L); and 27.7% were stunted. At endline, anemia was reduced by all 3 interventions. Fe-alone reduced ID and IDA [OR=0.02, 95%CI(0.02,0.44), P=0.002] and [OR=0.06, 95%CI(0.01,0.41) P=0.004] respectively but increased stunting [OR=2.96, 95%CI(1.05, 8.33), P=0.04]. There was no between-groups difference for zinc and vitamin-A deficiencies at endline. Conclusions: Optimized CFRs with or without iron supplementation can reduce anemia. Iron supplementation reduce ID and IDA but also increase stunting. It is interesting to study about competitive absorption of supplemental iron or dietary iron with dietary zinc with potential to zinc deficiency and stunting.