Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-22T14:54:36.198Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of iron supplementation on physical growth in children: systematic review of randomised controlled trials

Published online by Cambridge University Press:  02 January 2007

HPS Sachdev ,
Tarun Gera  and
Penelope Nestel
HPS Sachdev*
Affiliation:
Division of Clinical Epidemiology, Department of Paediatrics, Maulana Azad Medical College, New Delhi, 110 002, India
Tarun Gera
Affiliation:
SL Jain Hospital, New Delhi, 110 052, India
Penelope Nestel
Affiliation:
HarvestPlus, International Food Policy Research Institute, 2033 K Street NW, Washington, DC 20006-1002, USA
*
*corresponding author: Email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective

To evaluate the effect of iron supplementation on physical growth in children through a systematic review of randomised controlled trials (RCTs).

Data sources

Electronic databases, personal files, and hand search of reviews, bibliographies of books, abstracts and proceedings of international conferences.

Review methods

RCTs evaluating change in anthropometry with interventions that included oral or parenteral iron supplementation, or iron-fortified formula milk or cereals, were analysed.

Results

Twenty-five trials (26 cohorts) had relevant information. There was no evidence of publication bias. The pooled estimates (random effects model) did not document a statistically significant (P<0.05) positive effect of iron supplementation on any anthropometric variable (weight-for-age, weight-for-height, height-for-age, mid upper-arm circumference, skinfold thickness, head circumference). Significant heterogeneity was evident, and its predictors included greater weight-for-age in supplemented children in malaria hyperendemic regions and greater weight-for-height for children above 5 years of age, but a negative effect on linear growth in developed countries and with supplementation for 6 months or longer.

Conclusions

This review did not document a positive effect of iron supplementation on the physical growth of children. The identified predictors of heterogeneity should be considered as exploratory and requiring confirmation, not conclusive

Keywords

AnaemiaAnthropometryGrowthHeight-for-ageIron deficiencyIron supplementationMeta-analysisRandomised controlled trialsWeight-for-ageWeight-for-height
Type
Research Article
Information
Public Health Nutrition , Volume 9 , Issue 7 , October 2006 , pp. 904 - 920
Copyright
Copyright © The Authors 2006

References

1United Nations Administrative Committee on Coordination, Sub-Committee on Nutrition (ACC/SCN). Fourth Report on the World Nutrition Situation. Geneva: ACC/SCN in collaboration with International Food Policy Research Institute, 2000.Google Scholar
2Nestel, P, ed. Iron Interventions for Child Survival. Proceedings of Workshop held in London17–18 May 1996Arlington, VAUSAID/OMNI and Institute of Child Health 1995.Google Scholar
3Singh, P, Toteja, GS. Micronutrient profile of Indian children and women: summary of available data for iron and vitamin A. Indian Pediatrics 2003; 40: 477–9.Google Scholar
4Allen, L, Casterline-Sabel, J. Prevalence and causes of nutritional anemia. In: Ramakrishnan, U, ed. Nutritional Anemias. New York: CRC Press, 2001; 7–22.Google Scholar
5Van den Broek, NR, Letsky, EA. Etiology of anaemia in pregnancy in south Malawi. American Journal of Clinical Nutrition 2000; 72: 247S–56S.CrossRefGoogle ScholarPubMed
6Staubli Asobayire, F, Adou, P, Davidsson, L, Cook, JD, Hurrell, RF. Prevalence of iron deficiency with and without concurrent anaemia in population groups with high prevalence of malaria and other infections: a study in Côte d'Ivoire. American Journal of Clinical Nutrition 2001; 74: 776–82.CrossRefGoogle Scholar
7Owen, GM, Lubin, AH, Garry, PJ. Preschool children in the United States: who has iron deficiency? Journal of Pediatrics 1971; 79: 563–8.CrossRefGoogle ScholarPubMed
8Rao, KV, Radhiah, G, Raju, SV. Association of growth status and prevalence of anemia in preschool children. Indian Journal of Medical Research 1980; 71: 237–46.Google ScholarPubMed
9Lawless, JW, Latham, MC, Stephenson, LS, Kinoti, SN, Pertet, AM. Iron supplementation improves appetite and growth in anemic Kenyan preschool children. Journal of Nutrition 1994; 124: 645–54.CrossRefGoogle Scholar
10Beard, J, Hass, JD, Hurtado, GL. The relationship of nutritional status to oxygen transport and growth in highland Bolivian children. Human Biology 1983; 55: 151–64.Google ScholarPubMed
11Aukett, MA, Parks, YA, Scott, PH, Wharton, BA. Treatment with iron increases weight gain and psychomotor development. Archives of Disease in Childhood 1986; 61: 849–57.CrossRefGoogle ScholarPubMed
12Rosado, JL, Lopez, P, Munoz, E, Martinez, H, Allen, LH. Zinc supplementation reduced morbidity, but neither zinc nor iron supplementation affected growth or body composition of Mexican preschoolers. American Journal of Clinical Nutrition 1997; 65: 13–9.CrossRefGoogle ScholarPubMed
13Idjradinata, P, Watkins, WE, Pollitt, E. Adverse effect of iron supplementation on weight gain of iron-replete young children. Lancet 1994; 343: 1252–4.CrossRefGoogle ScholarPubMed
14Juni, P, Altman, DG, Egger, M. Assessing the quality of randomised controlled trials. In: Egger, M, Smith, GD, Altman, DG, eds. Systematic Reviews in Health Care: Meta-analysis in Context. London: BMJ Books, 2001; 87–108.CrossRefGoogle Scholar
15Clarke, M, Oxman, AD, eds. Assessment of study quality. Cochrane Reviewers Handbook 4.1.1 [updated December 2000]. In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.Google Scholar
16Follmann, D, Elliott, P, Suh, I, Cutler, J. Variance imputation for overviews of clinical trials with continuous response. Journal of Clinical Epidemiology 1992; 45: 769–73.CrossRefGoogle ScholarPubMed
17Sterne, JAC, Egger, M, Smith, GD. Investigating and dealing with publication and other biases. In: Egger, M, Smith, GD, Altman, DG, eds. Systematic Reviews in Health Care: Meta-analysis in Context. London: BMJ Books, 2001; 189–208.CrossRefGoogle Scholar
18Sterne, JAC, Bradburn, MJ, Egger, M. Meta-analysis in STATAe. In: Egger, M, Smith, GD, Altman, DG, eds. Systematic Reviews in Health Care: Meta-analysis in Context. London: BMJ Books, 2001; 347–69.CrossRefGoogle Scholar
19Fuerth, JH. Iron supplementation of the diet in full-term infants: a controlled study. Journal of Pediatrics 1972; 80: 974–9.CrossRefGoogle ScholarPubMed
20Mejia, LA, Chew, F. Hematological effect of supplementing anemic children with vitamin A alone and in combination with iron. American Journal of Clinical Nutrition 1988; 48: 595–600.CrossRefGoogle ScholarPubMed
21Haschke, F, Vanura, H, Male, C, Owen, G, Pietschnig, B, Schuster, E. Iron nutrition and growth of breast- and formula-fed infants during the first 9 months of life. Journal of Pediatric Gastroenterology and Nutrition 1993; 16: 151–6.Google ScholarPubMed
22Walter, T, Dallman, PR, Pizarro, F, Velozo, L, Pena, G, Bartholmey, SJ. Effectiveness of iron fortified infant cereal in prevention of iron deficiency anemia. Pediatrics 1993; 91: 976–82.CrossRefGoogle ScholarPubMed
23Moffatt, MEK, Longstaffe, S, Besant, J, Dureski, C. Prevention of iron deficiency and psychomotor decline in high risk infants through use of iron fortified infant formula: a randomized clinical trial. Journal of Pediatrics 1994; 125: 527–34.CrossRefGoogle ScholarPubMed
24Hyams, JS, Treem, WR, Etienne, NL, Weinerman, H, MacGilpin, D, Hine, P, et al. Effect of infant formula on stool characteristics of young infants. Pediatrics 1995; 95: 50–4.CrossRefGoogle ScholarPubMed
25van den Hombergh, J, Dalderop, E, Smit, Y. Does iron therapy benefit children with severe malaria-associated anaemia? A clinical trial with 12 weeks supplementation of oral iron in young children from the Turiani division, Tanzania. Journal of Tropical Pediatrics 1996; 42: 220–7.CrossRefGoogle ScholarPubMed
26Daly, A, MacDonald, A, Aukett, A, Williams, J, Wolf, A, Davidson, J. Prevention of anaemia in inner city toddlers by an iron supplemented cows' milk formula. Archives of Disease in Childhood 1996; 75: 9–16.CrossRefGoogle ScholarPubMed
27Beckett, C, Durnin, JV, Aitchison, TC, Pollitt, E. Effects of an energy and micronutrient supplement on anthropometry in undernourished children in Indonesia. European Journal of Clinical Nutrition 2000; 54(Suppl. 2): S52–9.CrossRefGoogle ScholarPubMed
28Beasley, NMR, Tomkins, AM, Hall, A, Lorri, W, Kihamia, CM, Bundy, DAP. The impact of weekly iron supplementation on the iron status and growth of adolescent girls in Tanzania. Tropical Medicine & International Health 2000; 5: 794–9.CrossRefGoogle ScholarPubMed
29Kanani, SJ, Poojara, RH. Supplementation with iron and folic acid enhances growth in adolescent Indian girls. Journal of Nutrition 2000; 130(2S Suppl.): 452S–5S.CrossRefGoogle ScholarPubMed
30Sharma, A, Prasad, K, Rao, KV. Identification of an appropriate strategy to control anemia in adolescent girls of poor communities. Indian Pediatrics 2000; 37: 261–7.Google ScholarPubMed
31Taylor, M, Jinabhai, CC, Couper, I, Klienschmidt, I, Jogessar, VB. The effect of different anthelminthic treatment regimens combined with iron supplementation on the nutritional status of schoolchildren in KwaZulu-Natal, South Africa: a randomized controlled trial. Transactions of the Royal Society of Tropical Medicine and Hygiene 2001; 95: 211–6.CrossRefGoogle ScholarPubMed
32Sari, M, Bloem, MW, de Pee, S, Schultnik, WJ, Sastroamidjojo, S. Effect of iron fortified candies on the iron status of children aged 4–6 y in East Jakarta, Indonesia. American Journal of Clinical Nutrition 2001; 73: 1034–9.CrossRefGoogle ScholarPubMed
33Pereira, SM, Begum, A, Baker, SJ. Studies in iron supplementation of preschool children. British Journal of Nutrition 1978; 39: 493–9.CrossRefGoogle ScholarPubMed
34Pereira, SM, Begum, A, Mathan, VI, Baker, SJ. A preliminary simulated iron fortification trial in South Indian preschool children. British Journal of Nutrition 1979; 41: 413–7.CrossRefGoogle ScholarPubMed
35Chwang, L, Soemantri, AG, Pollitt, E. Iron supplementation and physical growth of rural Indonesian children. American Journal of Clinical Nutrition 1988; 47: 496–501.CrossRefGoogle ScholarPubMed
36Latham, MC, Stephenson, LS, Kinoti, SN, Zaman, MS, Kurz, KM. Improvements in growth following iron supplementation in young Kenyan school children. Nutrition 1990; 6: 159–65.Google ScholarPubMed
37Javaid, N, Haschke, F, Pietschnig, B, Schuster, E, Huemer, C, Shebaz, A, et al. Interactions between infections, malnutrition and iron nutritional status in Pakistani infants. Acta Paediatrica Scandinavica 1991; 374: 141–50.CrossRefGoogle ScholarPubMed
38Bhatia, D, Seshadri, S. Growth performance in anemia and following iron supplementation. Indian Pediatrics 1993; 30: 195–200.Google ScholarPubMed
39Brunser, O, Espinoza, J, Araya, M, Pacheco, I, Cruchet, S. Chronic iron intake and diarrheal disease in infants: a field study in a less-developed country. European Journal of Clinical Nutrition 1993; 47: 317–26.Google Scholar
40Angeles, IT, Schultink, WJ, Matulessi, P, Gross, R, Sastroamidjojo, S. Decreased rate of stunting among anemic Indonesian preschool children through iron supplementation. American Journal of Clinical Nutrition 1993; 58: 339–42.CrossRefGoogle ScholarPubMed
41Hemminki, E, Nemet, K, Horvath, M, Malin, M, Schuler, D, Hollan, S. Impact of iron fortification of milk formulas on infants growth and health. Nutrition Research 1995; 4: 491–503.CrossRefGoogle Scholar
42Palupi, L, Schultnik, W, Achadi, E, Gross, R. Effective community intervention to improve hemoglobin status in preschoolers receiving once-weekly iron supplementation. American Journal of Clinical Nutrition 1997; 65: 1057–61.CrossRefGoogle ScholarPubMed
43Gill, DG, Vincent, S, Segal, DS. Follow-on formula in the prevention of iron deficiency: a multicentre study. Acta Paediatrica 1997; 86: 683–9.CrossRefGoogle ScholarPubMed
44Morley, R, Abbott, R, Fairweather-Tait, S, Macfayden, U, Stephenson, T, Lucas, A. Iron fortified follow on formula from 9 to 18 months improves iron status but not development or growth: a randomized trial. Archives of Disease in Childhood 1999; 81: 247–52.CrossRefGoogle Scholar
45Rahman, MM, Akramuzzaman, SM, Mitra, AK, Fuchs, GJ, Mahalanabis, D. Long-term supplementation with iron does not enhance growth in malnourished Bangladeshi children. Journal of Nutrition 1999; 129: 1319–22.CrossRefGoogle Scholar
46Aguayo, VM. School administered weekly iron supplementation – effect on growth and hemoglobin status of non-anemic Bolivian school-age children: a randomized placebo-controlled trial. European Journal of Nutrition 2000; 39: 263–9.CrossRefGoogle ScholarPubMed
47Mwanri, L, Worsley, A, Ryan, P, Masika, J. Supplemental vitamin A improves anemia and growth in anemic school children in Tanzania. Journal of Nutrition 2000; 130: 2691–6.CrossRefGoogle ScholarPubMed
48Dossa, RAM, Ategbo, EAD, de Koning, FLHA, van Raaij, JMA, Hautvast, JGAJ. Impact of iron supplementation and deworming on growth performance in preschool Beninese children. European Journal of Clinical Nutrition 2001; 55: 223–8.CrossRefGoogle ScholarPubMed
49Geltman, PL, Meyers, AF, Bauchner, H. Daily multivitamins with iron to prevent anemia in infancy: a randomized clinical trial. Clinical Pediatrics 2001; 40: 549–54.CrossRefGoogle ScholarPubMed
50Dijkhuizen, MA, Wieringa, FT, West, CE, Martuti, S, Muhilal, . Effects of iron and zinc supplementation in Indonesian infants on micronutrient status and growth. Journal of Nutrition 2001; 131: 2860–5.CrossRefGoogle ScholarPubMed
51Sungthong, R, Mo-uswan, L, Chongsuvivatwong, V, Geater, AF. Once weekly is superior to daily iron supplementation on height gain but not on hematological improvement among schoolchildren in Thailand. Journal of Nutrition 2002; 132: 418–22.CrossRefGoogle Scholar
52Dewey, KG, Domellof, M, Cohen, RJ, Landa Rivera, L, Hernell, O, Lonnerdal, B. Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras. Journal of Nutrition 2002; 132: 3249–55.CrossRefGoogle ScholarPubMed
53Ramakrishnan, U, Aburto, N, McCabe, G, Martorell, R. Multimicronutrient interventions but not vitamin A or iron interventions alone improve child growth: results of 3 meta-analyses. Journal of Nutrition 2004; 134: 2592–602.CrossRefGoogle ScholarPubMed
54Sarker, SA, Davidsson, L, Mahmud, H, Walczyc, T, Hurrell, RF, Gyr, N, et al. Helicobacter pylori infection, iron absorption, and gastric acid secretion in Bangladeshi children. American Journal of Clinical Nutrition 2004; 80: 149–53.CrossRefGoogle ScholarPubMed
55Perez-Exposito, AB, Villalpando, S, Rivera, JA, Griffin, IJ, Abrams, SA. Ferrous sulfate is more bioavailable among preschoolers than other forms of iron in a milk-based weaning food distributed by PROGRESA, a national program in Mexico. Journal of Nutrition 2005; 135: 64–9.CrossRefGoogle Scholar
56Gera, T, Sachdev, HPS. Effect of iron supplementation on incidence of infectious illness in children: systematic review. British Medical Journal 2002; 325: 1142–4.CrossRefGoogle ScholarPubMed
57Shah, D, Sachdev, HPS. Zinc availability and interactions with other micronutrients. Proceedings of Nutrition Society of India 2000; 48: 67–80.Google Scholar
58Brown, KH, Peerson, JM, Rivera, J, Allen, LH. Effect of supplemental zinc on the growth and serum zinc concentrations of prepubertal children: a meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition 2002; 75: 1062–71.CrossRefGoogle ScholarPubMed