Treatment for iron deficiency anaemia with a combined supplementation of iron, vitamin A and zinc in women of Dinajpur, Bangladesh

Abstract

Objective: The study was set up to determine to what extent the addition of a supplement of vitamin A alone or in combination with zinc would improve standard iron treatment and correction of iron de®ciency anaemia. Design: 216 non-pregnant anaemic women of 15 ± 45 years of age with haemoglobin levels 100 gal were randomly assigned to three treatment groups. One group (A) received iron alone, a second group (B) received iron and vitamin A, and a third group (C) received iron, vitamin A and zinc. Every woman was given one iron capsule per day for 60 days as FeSO 4 containing 60 mg of elemental iron. In addition, groups B and C received 200 000 IU of vitamin A, given as a supervised dose, on the ®rst day of the treatment after collection of the blood sample. Group C received one zinc tablet per day for 60 days as zinc gluconate containing 15 mg of elemental zinc. Setting: The north-western part of Bangladesh in the urban slums of Dinajpur district between February and August 1995. Subjects: To select women with a haemoglobin level of 100 gal, all the women of four randomly selected municipal slums of the district in the targeted age group (328) were invited to take part in the study. Blood samples were analysed for haemoglobin, serum iron, total iron binding capacity (TIBC), ferritin, retinol and zinc. Results: Out of the 328 women screened, 254 (77.5%) had a haemoglobin level 100 gal and 322 (98%) 120 gal. The three treatment schedules signi®cantly increased haemoglobin levels and improved iron parameters, except for serum iron in the group who received iron alone. The group who received iron, vitamin A and zinc responded best with an increase in haemoglobin of 17.9 gal as compared to the group receiving iron alone (13.4 gal). Iron and vitamin A treatment gave an intermediate response of 15.9 gal. However, these differences are only statistically signi®cant only for the group who received iron, vitamin A and zinc and only for the increase in haemoglobin, P 0.03. Conclusion:The results are suggestive that the addition of vitamin A and zinc to the treatment for anaemia can increase haemoglobin levels more than with iron alone. Sponsorship: The present study was ®nanced by grant FWO 1.5.092.96 and Nutrition Tiers Monde.

Efficacy of combined iron and zinc supplementation on micronutrient status and growth in Vietnamese infants

“…Supplementation with zinc alone had no effect on iron status as demonstrated by similar Hb and ferritin concentrations in the Zn and the placebo groups. The positive effect of daily zinc supplements on Hb concentration after a massive single dose of vitamin A as described in non-pregnant women in Bangladesh (Kolsteren et al, 1999) was not found here.…”

Influence of carotene-rich vegetable meals on the prevalence of anaemia and iron deficiency in Filipino schoolchildren

“…A number of studies among children, aged 1-13 years, showed significant improvement in mean haemoglobin (Hb) concentrations and a decrease in anaemia prevalence after supplementation with vitamin A capsules (Bloem et al, 1989(Bloem et al, , 1990Smith et al, 1999;Zimmermann et al, 2006). Greater improvements in iron status were also seen among anaemic 1-to 8-year-old (Mejia and Chew, 1988) and 9-to 12-year-old children (Mwanri et al, 2000) and in pregnant women (Panth et al, 1990;Suharno et al, 1993;Kolsteren et al, 1999;Muslimatum et al, 2001) when iron and vitamin A supplements were given simultaneously rather than when iron or vitamin A were supplemented alone. In addition, iron absorption from iron-fortified foods was enhanced when vitamin A in the chemical form of either retinol or b-carotene was added (Garcia-Casal et al, 1998); improvements in iron status were also seen when vitamin A-fortified foods (Mejia and Arroyave, 1982;Muhilal et al, 1988) and b-carotene-rich foods such as gac (Momordica cochinchinensis) fruit (Vuong et al, 2002), amaranth, spinach, cabbage, colocasia and radish leaves (Agte et al, 2006) and papaya and carrot (Ncube et al, 2001) were consumed.…”

The anemia of vitamin A deficiency: epidemiology and pathogenesis

“…A recent study among anemic school children in Tanzania showed that daily vitamin A supplementation was associated with an increase in hemoglobin of 13.5 g=l at 3 months following enrollment, and a larger increase of 22.1 g=l was observed in children who received both vitamin A and iron (Mwanri et al, 2000). In a study conducted in Bangladesh, women of childbearing age were randomly allocated to receive iron, vitamin A plus iron or vitamin A plus iron and zinc (Kolsteren et al, 1999). Significant increases in hemoglobin were observed only among women who received vitamin A, iron and zinc.…”