Impact of daily-supervised administration of a package of iron and folic acid and vitamin B12 on hemoglobin levels among adolescent girls (12–19 years): a cluster randomized control trial

Gupta, Aakriti; Kant, Shashi; Pandey, Ravindra Mohan; Khandelwal, Ritika; Kapil, Umesh; Sachdev, Harshpal Singh

doi:10.1038/s41430-021-00878-6

Cited by 10 publications

(5 citation statements)

References 21 publications

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“…8 The status of vitamin B 12 , an important erythropoietic micronutrient, was not measured here, but it has been shown that this de ciency is unlikely to be a major cause of anaemia, 8 and vitamin B 12 supplementation does not improve Hb concentration in Indian studies. 9 Haemoglobinopathies were not excluded, and that is a true limitation. We also did not evaluate red cell indices like mean corpuscular volume or haemoglobin concentration, but it has been shown that changes in Hb are the most sensitive to supplementation, 20 and there was a su cient duration of intervention for the change to occur.…”

Section: Discussionmentioning

confidence: 99%

“…The remaining proportion was due to other causes like folate or vitamin B 12 de ciency (25.6%), hemoglobinopathies or unknown aetiologies (33.3%). The occurrence of the additional biochemical nutrient de ciencies could be coincidental since vitamin B 12 supplementation along with IFA did not result in any additional Hb gain in anaemic Indian adolescents 9 . In support, systematic reviews have also indicated a marginal effect of multiple micronutrient supplements on Hb improvements 10 .…”

Section: Introductionmentioning

confidence: 95%

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Haemoglobin diagnostic cut-offs for anaemia in Indian women of reproductive age

et al. 2023

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BackgroundThe persistent high prevalence of anaemia among Indian women of reproductive age (WRA) despite aggressive long-term iron supplementation, could be related to over-diagnosis from an inappropriately high haemoglobin (Hb) diagnostic cut-off. To develop an appropriate cut-off for Indian WRA, we hypothesized that during iron-folic acid (IFA) supplementation to a mixed (anaemic/non-anaemic) WRA population, the positive slope of the Hb-plasma ferritin (PF) response in anaemic women would in ect into a plateau (zero-response) as a non-anaemic status is reached. The 2•5th percentile of the Hb distribution at this in ection point will be the diagnostic Hb cut-off for iron-responsive anaemia. MethodA hierarchical mixed effects model, with a polynomial mean and variance model to account for intraclass correlation due to repeated measures, was used to estimate the response curve of Hb to PF, or body iron stores (BIS), in anaemic and non-anaemic WRA (without in ammation), who were receiving a 90-day ironfolic acid (IFA) supplementation. ResultsThe Hb response curve at low PF values showed a steep increase, which in ected into a plateau at a PF of 10.1 µg/L. The Hb distribution at the in ection was a normal probability distribution, with mean of 12•3 g/dL. The 2•5th percentile value of this distribution, orthe putative diagnostic Hb cut-off for anaemia, was 10•8 g/dL. ConclusionThe derived Hb cut-off is lower than the current adult values of 12 g/dL and could partly explain the persistently high prevalence of iron de ciency and anaemia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

Haemoglobin diagnostic cut-offs for anaemia in Indian women of reproductive age

et al. 2023

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“…This is because the administration of TTD as recommended with the dose for adolescent girls is a dose of 60 mg elemental (in the dosage form of Ferro Sulfate, Ferrous Fumarate or Ferrous Gluconate and Folic Acid 0.400 mg given once a week and once a day during menstruation can increase adolescent HB levels (Kementerian Kesehatan, 2014). This is supported by research (Gupta et al, 2021) on the effectiveness of daily monitoring of Iron Folic Acid (IFA) administration on increasing HB levels in adolescent girls aged 12-19 years in India shows that giving IFA tablets alone can increase HB levels from 10.6 g before intervention to…”

Section: The Effect Of Direct Supervision Of the Consumption Of Blood...mentioning

confidence: 88%

Direct Supervision of Daily Consumption of Blood Supplement Tablets During Menstruation Can Increase Adolescent Hemoglobin Levels

Dewi,

Asmawati,

Buston

et al. 2023

jkt

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Consumption of blood supplement tablets (TTD) during menstruation is one effort to prevent anemia. The Ministry of Health recommends taking one tablet supplements weekly and one tablet daily during menstruation. However, adherence of TTD consumption still low among adolescence. The purpose of this study was to determine the effect of direct supervision of tablets consumption on hemoglobin level of adolescent girls. This research is a quasi-experimental with pretest-post-test with control group. Samples are female students of Islamic Boarding School at Bengkulu City. A total sample of 56 female students consisting of 28 intervention group and 28 control group was taken by systematic random sampling. Data were analyzed using t-test. TTD were given every day during menstruation until 2 months. Hemoglobin levels baseline were measured at the first day after menstruation and post HB level were measured at the third month of menstruation. The results showed that the baseline of mean HB in intervention group was 12.2 gr and control group was 12.74 gr and after intervention, the mean of HB increases in intervention group by 1.13 gr and in control group by 0.4 gr. There was a difference in average of hemoglobin levels before and after intervention between the two groups, the difference was 0.79 gr (p 0.000 < α 0.005). Supervision of TTD consumption by the closest person like teacher was important for students, it can promote adherence of TTD consumption, which can increase HB levels and lower anemia among adolescent.

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“…Initially, about 49% of adolescents had marginal iron stores, and significant improvement of serum folate, serum ferritin and Hb concentrations was observed compared to control. A RCT testing daily supplements of iron+folic acid with/without vitamin B 12 for 90 days in 760 adolescent anaemic Indian girls showed correction of iron status and of vitamin B 12 deficiency, the addition of B 12 having no significant effect [30 ▪ ]. A RCT investigating a multi-micronutrient supplement containing 10 mg iron, 10 mg zinc and 400 μg vitamin A in 347 Vietnamese school children over 22 weeks [31 ▪ ] showed a significant increase of the mean corpuscular volume (MCV), serum ferritin, plasma zinc and plasma retinol.…”

Section: Recent Intervention Studiesmentioning

confidence: 99%

Micronutrient deficiency and supplements in schoolchildren and teenagers

Berger,

Shenkin

2024

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of review The essential micronutrients are corner stones in the functional and physical development. Early deficiency has life-long consequences. While awareness about iron deficiency is relatively high, it remains lower for other micronutrients. This review aims at reporting on recent data and attracting attention to the high prevalence of micronutrient deficiencies in school-age and adolescent individuals. Recent findings Iron deficiency anaemia remains highly prevalent worldwide and the most frequent deficiency but can be corrected with simple tools ranging from food fortification, nutritional intervention, and to supplements. The link between micronutrient (MN) deficiency and neurobehavioral disorders is increasingly established and is worrying even in Western countries. Paediatric individuals are prone to imbalanced diets and picky eating behaviour, and their diets may then become incomplete: the highest risk for deficiency is observed for iron, zinc and vitamin D. Summary There is not much new information, but rather confirmation of the importance of health policies. Well conducted randomized controlled trials confirm that deficiencies can be corrected efficiently including with food fortification, and result in clinical benefits. Individual complementation should be considered in children and adolescents with proven deficiency.

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Impact of daily-supervised administration of a package of iron and folic acid and vitamin B12 on hemoglobin levels among adolescent girls (12–19 years): a cluster randomized control trial

Cited by 10 publications

References 21 publications

Haemoglobin diagnostic cut-offs for anaemia in Indian women of reproductive age

Haemoglobin diagnostic cut-offs for anaemia in Indian women of reproductive age

Direct Supervision of Daily Consumption of Blood Supplement Tablets During Menstruation Can Increase Adolescent Hemoglobin Levels

Micronutrient deficiency and supplements in schoolchildren and teenagers

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