Concomitant supplemental vitamin A enhances the response to weekly supplemental iron and folic acid in anemic teenagers in urban Bangladesh.
What this study found
Weekly iron plus folic acid improved hemoglobin and reduced anemia, and adding vitamin A produced the largest hemoglobin increase and further reductions in anemia and vitamin A deficiency. Hemoglobin rose by 9.1 g/L with iron plus folic acid, 3.3 g/L with vitamin A, and 12.2 g/L with iron plus folic acid plus vitamin A; the increase in the combination group was significantly greater than iron plus folic acid alone. Compared with placebo, post-intervention anemia odds ratios were 0.44 (0.20, 0.96) for vitamin A, 0.15 (0.07, 0.33) for iron plus folic acid, and 0.08 (0.03, 0.19) for the…
- Study & population
- Randomized 1:1:1:1 trial in postmenarcheal, nonpregnant teenage girls aged 14 to 19 years working in garment factories in Dhaka, Bangladesh.
- Intervention
- Weekly supplementation was given for 12 weeks in three active regimens: vitamin A alone, 2.42 mg retinol as retinyl palmitate weekly; iron plus folic acid, 120 mg elemental iron as ferrous sulfate plus 3.5 mg folic acid weekly; or iron plus folic acid plus vitamin A, combining all three weekly doses.
- Key limitation
- Attrition was substantial, with only 67, 74, and 77 participants completing the three active arms out of 120 randomized per arm.
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Open PDFOriginal abstract
BACKGROUND Iron deficiency is the most common micronutrient deficiency and affects >2 billion persons worldwide, leading to anemia in >40% of women of reproductive age in the developing world. OBJECTIVE The objective was to determine whether weekly supplementation with iron and folate would reduce the frequency of anemia in teenage women in urban Bangladesh before they became pregnant. DESIGN Participants with a hemoglobin concentration of 80-120 g/L were entered into a randomized, double-blind, placebo-controlled trial and received supplements of placebo, vitamin A, iron + folic acid, or iron + folic acid + vitamin A weekly for 12 wk. The supplements contained 2.42 mg vitamin A (retinol) as retinyl palmitate, 120 mg elemental Fe as ferrous sulfate, and 3.5 mg folic acid. RESULTS Hemoglobin concentrations increased significantly more after supplementation with iron + folic acid or iron + folic acid + vitamin A than after either the placebo or vitamin A alone. There was a significantly greater increase in hemoglobin after iron + folic acid + vitamin A than after iron + folic acid, but the additional effect disappeared after adjustment for baseline hemoglobin, serum vitamin A, and ferritin and the number of supplements taken. Those with the lowest baseline hemoglobin had the greatest increase in hemoglobin. Compared with the placebo, iron + folic acid + vitamin A reduced anemia by 92%, iron deficiency by 90%, and vitamin A deficiency by 76%. CONCLUSION There may be significant health benefits from a program that enhances the nutritional status of iron, folate, and vitamin A in poor urban young women before they become pregnant.