Iron supplementation benefits physical performance in women of reproductive age: a systematic review and meta-analysis.
What this study found
Daily oral iron supplementation improved maximal and submaximal exercise performance in women of reproductive age. The clearest benefits were seen in iron-deficient and trained women, with improved maximal aerobic capacity and better efficiency during submaximal exercise; some evidence also suggested benefit when baseline iron status was not established. Across the review, maximal VO2 max and other maximal outcomes generally favored iron in several subgroups, and submaximal measures such as heart rate and percentage of VO2max required also improved. Adverse gastrointestinal events were…
- Study & population
- Systematic review and meta-analysis of controlled trials in women of reproductive age who were not pregnant or lactating.
- Intervention
- Daily oral iron supplementation was evaluated across trials, most commonly as elemental iron given as ferrous sulfate, with doses ranging from 1 mg/day to 150 mg/day and one regimen using 100 mg elemental iron twice per day.
- Key limitation
- The evidence base was heterogeneous, with variation in iron status, training status, doses, and co-interventions across trials.
View source
Open PDFOriginal abstract
Animal and human observational studies suggest that iron deficiency impairs physical exercise performance, but findings from randomized trials on the effects of iron are equivocal. Iron deficiency and anemia are especially common in women of reproductive age (WRA). Clear evidence of benefit from iron supplementation would inform clinical and public health guidelines. Therefore, we performed a systematic review and meta-analysis to determine the effect of iron supplementation compared with control on exercise performance in WRA. We searched the Cochrane Central Register of Clinical Trials, MEDLINE, Scopus (comprising Embase and MEDLINE), WHO regional databases, and other sources in July 2013. Randomized controlled trials that measured exercise outcomes in WRA randomized to daily oral iron supplementation vs. control were eligible. Random-effects meta-analysis was used to calculate mean differences (MDs) and standardized MDs (SMDs). Risk of bias was assessed using the Cochrane risk-of-bias tool. Of 6757 titles screened, 24 eligible studies were identified, 22 of which contained extractable data. Only 3 studies were at overall low risk of bias. Iron supplementation improved both maximal exercise performance, demonstrated by an increase in maximal oxygen consumption (VO2 max) [for relative VO2 max, MD: 2.35 mL/(kg ⋅ min); 95% CI: 0.82, 3.88; P = 0.003, 18 studies; for absolute VO2 max, MD: 0.11 L/min; 95% CI: 0.03, 0.20; P = 0.01, 9 studies; for overall VO2 max, SMD: 0.37; 95% CI: 0.11, 0.62; P = 0.005, 20 studies], and submaximal exercise performance, demonstrated by a lower heart rate (MD: -4.05 beats per minute; 95% CI: -7.25, -0.85; P = 0.01, 6 studies) and proportion of VO2 max (MD: -2.68%; 95% CI: -4.94, -0.41; P = 0.02, 6 studies) required to achieve defined workloads. Daily iron supplementation significantly improves maximal and submaximal exercise performance in WRA, providing a rationale to prevent and treat iron deficiency in this group. This trial was registered with PROSPERO (http://www.crd.york.ac.uk/PROSPERO/prospero.asp) as CRD42013005166.