Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic iron-deficient adults: a systematic review of randomised controlled trials Marginal iron deficiency without anemia impairs aerobic adaptation among previously untrained women. Efficacy of daily vs. weekly supplementation of iron in schoolchildren with low iron status. Iron and Energy Supplementation Improves the Physical Work Capacity of Female College Students Clinical evaluation of iron treatment efficiency among non-anemic but iron-deficient female blood donors: a randomized controlled trial Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls The efficacy of micronutrient supplementation in reducing the prevalence of anaemia and deficiencies of zinc and iron among adolescents in Sri Lanka Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial Effects of iron supplementation and nutrition education on haemoglobin, ferritin and oxidative stress in iron-deficient female adolescents in Palestine: randomized control trial. Iron supplementation maintains ventilatory threshold and improves energetic efficiency in iron-deficient nonanemic athletes Iron supplementation improves energetic efficiency in iron-depleted female rowers. Once Weekly Low-dose Iron Supplementation Effectively Improved Iron Status in Adolescent Girls Efficacy of iron fortification compared to iron supplementation among Vietnamese schoolchildren Rationale and design of the IRON-HF study: a randomized trial to assess the effects of iron supplementation in heart failure patients with anemia. Weekly Iron Folate Supplementation in Adolescent Girls – An Effective Nutritional Measure for the Management of Iron Deficiency Anaemia Effect of recombinant human erythropoietin and intravenous iron on anemia and disease activity in rheumatoid arthritis. The impact of iron supplementation efficiency in female blood donors with a decreased ferritin level and no anaemia. Rationale and design of a randomised controlled trial: a study protocol
Objective Iron supplementation in iron-deficiency anaemia is st and ard practice , but the benefits of iron supplementation in iron-deficient non-anaemic ( IDNA ) individuals remains controversial . Our objective is to identify the effects of iron therapy on fatigue and physical capacity in IDNA adults . Design Systematic review and meta- analysis of r and omised controlled trials ( RCTs ) . Setting Primary care . Participants Adults ( ≥18 years ) who were iron deficient but non-anaemic . Interventions Oral , intramuscular or intravenous iron supplementation ; all therapy doses , frequencies and duration s were included . Comparators Placebo or active therapy . Results We identified RCTs in Medline , Embase , Cochrane Central Register of Controlled Trials , Cumulative Index of Nursing and Allied Health , SportD iscus and CAB Abstract s from inception to 31 October 2016 . We search ed the WHO ’s International Clinical Trials Registry Platform for relevant ongoing trials and performed forward search es of included trials and relevant review s in Web of Science . We assessed internal validity of included trials using the Cochrane Risk of Bias tool and the external validity using the Grading of Recommendations Assessment , Development and Evaluation methodology . From 11 580 citations , we included 18 unique trials and 2 companion papers enrolling 1170 patients . Using a Mantel-Haenszel r and om-effects model , iron supplementation was associated with reduced self-reported fatigue ( st and ardised mean difference ( SMD ) −0.38 ; 95 % CI −0.52 to −0.23 ; I2 0 % ; 4 trials ; 714 participants ) but was not associated with differences in objective measures of physical capacity , including maximal oxygen consumption ( SMD 0.11 ; 95 % CI −0.15 to 0.37 ; I2 0 % ; 9 trials ; 235 participants ) and timed methods of exercise testing  . Iron supplementation significantly increased serum haemoglobin concentration ( MD 4.01 g/L ; 95 % CI 1.22 to 6.81 ; I2 48 % ; 12 trials ; 298 participants ) and serum ferritin ( MD 9.23 µmol/L ; 95 % CI 6.48 to 11.97 ; I2 58 % ; 14 trials ; 616 participants ) . Conclusion In IDNA adults , iron supplementation is associated with reduced subjective measures of fatigue but not with objective improvements in physical capacity . Given the global prevalence of both iron deficiency and fatigue , patients and practitioners could consider consumption of iron-rich foods or iron supplementation to improve symptoms of fatigue in the absence of documented anaemia . PROSPERO registration number CRD42014007085 BACKGROUND Iron deficiency without anemia has been shown to reduce both muscle-tissue oxidative capacity and endurance in animals . However , the consequences of iron deficiency in humans remain unclear . OBJECTIVE We investigated the effects of iron supplementation on adaptation to aerobic training among marginally iron-depleted women . We hypothesized that iron supplementation for 6 wk would significantly improve iron status and maximal oxygen uptake ( VO(2)max ) after 4 wk of concurrent aerobic training . DESIGN Forty-one untrained , iron-depleted , nonanemic women were r and omly assigned to receive either 50 mg FeSO(4 ) or a placebo twice daily for 6 wk in a double-blind trial . All subjects trained on cycle ergometers 5 d/wk for 4 wk , beginning on week 3 of the study . RESULTS Six weeks of iron supplementation significantly improved serum ferritin and serum transferrin receptor ( sTfR ) concentrations and transferrin saturation without affecting hemoglobin concentrations or hematocrit . Average VO(2)max and maximal respiratory exchange ratio improved in both the placebo and iron groups after training ; however , the iron group experienced significantly greater improvements in VO(2)max . Both iron-status and fitness outcomes were analyzed after stratifying by baseline sTfR concentration ( > and < or = 8.0 mg/L ) , which showed that the previously observed treatment effects were due to iron-status and fitness improvements among subjects with poor baseline iron status . CONCLUSIONS Our findings strongly suggest that iron deficiency without anemia but with elevated sTfR status impairs aerobic adaptation among previously untrained women and that this can be corrected with iron supplementation Iron deficiency anemia ( IDA ) is still a major nutritional and public health problem in developing countries . The prevalence among young children and pregnant women is particularly high . Daily oral supplementation with medicinal iron is considered an effective strategy for reducing the incidence of IDA but non-compliance is a major problem with this strategy . We undertook this study to compare the results of once-weekly vs. daily oral iron supplementation in schoolchildren . Sixty children ranging between 5 and 10 years with iron deficiency anemia were selected from a school in Karachi , Pakistan and were divided into two equal groups , i.e. , daily and weekly supplementation groups . Hemoglobin ( Hb ) , hematocrit ( Hct ) , serum iron , total iron binding capacity ( TIBC ) , and serum ferritin were determined before the start of the study . Ferrous sulfate ( 200 mg ) was given daily to the daily supplementation group and once-weekly to the weekly supplementation group for 2 months . When post-supplementation values of the above-mentioned parameters were determined , a significant improvement was observed in all parameters in both groups . It is concluded that once-weekly iron supplementation is as effective as daily supplementation for the treatment of iron deficiency anemia . Moreover , weekly iron supplementation is cost effective and has no or fewer side-effects A nutritionally controlled study was conducted on two groups of 15 female college students aged 16 to 20 years , selected from Punjab Agricultural University , Ludhiana , Punjab , India . the girls were either anemic ( hemoglobin 7.7 g/dl ) but energy adequate ( AEA ) , or anemic ( hemoglobin 7.4 g/dl ) and energy deficient ( AED ) . the AEA group was given iron supplementation ( 60 mg iron/day ) for 6 to 9 months along with 100 mg of ascorbic acid , and the AED group was given iron as well as energy supplementation for 3 months . There was a significant ( p < .01 ) increase in weight , body mass index , mid-upper-arm circumference , and body fat in the AED group after iron – energy supplementation . Hemoglobin , serum iron , transferrin saturation , total iron-binding capacity , and unsaturated iron-binding capacity were below normal in both groups ; however , after iron and iron – energy supplementation , there was a significant ( p < .01 ) increase , and these indices were in the normal range . There was a significant ( p < .01 ) increase in exercise time and maximum work load tolerance after iron and iron – energy supplementation . Combined energy and iron deficiency had a greater adverse effect on physical work capacity than energy or iron deficiency alone Background Iron deficiency without anemia is related to adverse symptoms that can be relieved by supplementation . Since a blood donation can induce such an iron deficiency , we investigated the clinical impact of iron treatment after a blood donation . Methods One week after donation , we r and omly assigned 154 female donors with iron deficiency without anemia , aged below 50 years , to a four-week oral treatment of ferrous sulfate versus a placebo . The main outcome was the change in the level of fatigue before and after the intervention . Aerobic capacity , mood disorder , quality of life , compliance and adverse events were also evaluated . Hemoglobin and ferritin were used as biological markers . Results The effect of the treatment from baseline to four weeks of iron treatment was an increase in hemoglobin and ferritin levels to 5.2 g/L ( P < 0.01 ) and 14.8 ng/mL ( P < 0.01 ) , respectively . No significant clinical effect was observed for fatigue ( -0.15 points , 95 % confidence interval -0.9 points to 0.6 points , P = 0.697 ) or for other outcomes . Compliance and interruption for side effects was similar in both groups . Additionally , blood donation did not induce overt symptoms of fatigue in spite of the significant biological changes it produces . Conclusions These data are valuable as they enable us to conclude that donors with iron deficiency without anemia after a blood donation would not clinical ly benefit from iron supplementation . Trial Registration Clinical Trials.gov : BACKGROUND Up to 25 % of adolescent girls in the USA are iron deficient . This double-blind , placebo-controlled clinical trial assessed the effects of iron supplementation on cognitive function in adolescent girls with non-anaemic iron deficiency . METHODS 716 girls who enrolled at four Baltimore high schools were screened for non-anaemic iron deficiency ( serum ferritin < or = 12 micrograms/L with normal haemoglobin ) . 98 ( 13.7 % ) girls had non-anaemic iron deficiency of whom 81 were enrolled in the trial . Participants were r and omly assigned oral ferrous sulphate ( 650 mg twice daily ) or placebo for 8 weeks . The effect of iron treatment was assessed by question naires and haematological and cognitive tests , which were done before treatment started and repeated after the intervention . We used four tests of attention and memory to measure cognitive functioning . Intention-to-treat and per- protocol analyses were done . FINDINGS Of the 81 enrolled girls with non-anaemic iron deficiency , 78 ( 96 % ) completed the study ( 39 in each group ) . Five girls ( three control , two treatment ) developed anaemia during the intervention and were excluded from the analyses . Thus , 73 girls were included in the per- protocol analysis . Ethnic distribution , mean age , serum ferritin concentrations , haemoglobin concentrations , and cognitive test scores of the groups did not differ significantly at baseline . Postintervention haematological measures of iron status were significantly improved in the treatment group ( serum ferritin 27.3 vs 12.1 micrograms/L , p < 0.001 ) . Regression analysis showed that girls who received iron performed better on a test of verbal learning and memory than girls in the control group ( p < 0.02 ) . INTERPRETATION In this urban population of non-anaemic iron-deficient adolescent girls , iron supplementation improved verbal learning and memory Objective : To determine the effectiveness of combined iron and zinc over the iron or zinc-only supplementation in correcting deficiency and possible interactive effects in a group of adolescent school children . Subjects and methods : Schoolchildren ( n=821 ) of 12–16 years of age were r and omized into four groups and supplemented with iron ( 50 mg/day ) , zinc ( 14 mg/day ) , iron+zinc or placebo capsules 5 days per week for 24 weeks . Anthropometry , and haemoglobin ( Hb ) , serum zinc ( SZn ) and serum ferritin ( SF ) concentrations were determined before and after the intervention . Results : There were no significant effects between-groups in their weight , height and Hb concentrations with the intervention when compared with the placebo group . Iron-only and combination-supplemented groups had reached mean SF concentrations of 55.1 μg/l with no difference between them ( P=0.99 ) . The zinc-only group had a mean change of 4.3 μmol//l whereas the combine-supplemented group had a mean change of 4.0 μmol/l ( P=0.82 ) . The prevalence of anaemia was found to be 70.3 % in the iron group at baseline ; this was reduced to 14.5 % after the supplementation . In the combine-supplemented group anaemia , prevalence was reduced from 64.8 to 19.3 % . Conclusions : Zinc alone or in combination with iron has not shown a significant improvement in growth in adolescence . Severe and moderate forms of anaemia were successfully treated in children who received iron supplementation . Initial high prevalence of low SZn and iron stores was significantly improved with micronutrient supplementation Abstract Objective To determine the subjective response to iron therapy in non-anaemic women with unexplained fatigue . Design Double blind r and omised placebo controlled trial . Setting Academic primary care centre and eight general practice s in western Switzerl and . Participants 144 women aged 18 to 55 , assigned to either oral ferrous sulphate ( 80 mg/day of elemental iron daily ; n=75 ) or placebo ( n=69 ) for four weeks . Main outcome measures Level of fatigue , measured by a 10 point visual analogue scale . Results 136 ( 94 % ) women completed the study . Most had a low serum ferritin concentration ; ≤ 20 μg/l in 69 ( 51 % ) women . Mean age , haemoglobin concentration , serum ferritin concentration , level of fatigue , depression , and anxiety were similar in both groups at baseline . Both groups were also similar for compliance and dropout rates . The level of fatigue after one month decreased by −1.82/6.37 points ( 29 % ) in the iron group compared with −0.85/6.46 points ( 13 % ) in the placebo group ( difference 0.95 points , 95 % confidence interval 0.32 to 1.62 ; P=0.004 ) . Subgroups analysis showed that only women with ferritin concentrations ≤ 50 μg/l improved with oral supplementation . Conclusion Non-anaemic women with unexplained fatigue may benefit from iron supplementation . The effect may be restricted to women with low or borderline serum ferritin concentrations Background Iron deficiency and iron-deficiency anaemia are associated with oxidative stress , but their role is largely unclear . Information is scarce on the effects of iron supplementation on biomarkers of oxidative stress in humans . Aims This study evaluated the effectiveness of iron supplementation and nutrition education on improving the levels of haemoglobin and ferritin , and decreasing oxidative stress among iron-deficient female adolescents in Gaza , Palestine . Methods A total 131 iron-deficient female adolescents were recruited and allocated r and omly into 3 different groups . The iron supplementation group ( A ) received 200 mg of ferrous fumarate weekly during the 3-month intervention , the iron supplementation with nutrition education group ( B ) received iron supplements with nutrition education sessions , and the control group ( C ) did not receive any intervention . The levels of haemoglobin , ferritin and malonyl dialdehyde were measured at baseline , after 3 months ( at which point the intervention was stopped ) , and then 3 months later . Trial registration number : ACTRN12618000960257 . Results Haemoglobin levels increased significantly after supplementation in both groups A and B. At the follow-up stage ( 3 months after stopping the intervention ) , iron and haemoglobin levels in group B continued to increase and malonyl dialdehyde decreased . In Group A , haemoglobin , ferritin and malonyl dialdehyde levels decreased after 3 months of stopping the intervention . No changes were seen in Group C. Conclusions A nutrition programme should be adopted and integrated into comprehensive intervention programmes to target iron-deficiency anaemia among female adolescents in Palestine Objective : To determine the effect of iron supplementation on iron status and endurance capacity . Design : R and omized , double-blind iron supplementation . Setting : University of Missouri-Columbia and surrounding community . Subjects : Twenty iron-deficient ( serum ferritin , sFer<16 μg/l ; serum transferrin receptor , sTfR>8.0 mg/l ; or sTfR/log sFer index > 4.5 ) , nonanemic ( hemoglobin , Hb>120 g/l , women ; > 130 g/l , men ) men and women ( 18–41 years ) were recruited via fliers and newspaper advertisements ; 20 of 31 eligible subjects participated . Interventions : A 30 mg measure of elemental iron as ferrous sulfate or placebo daily for 6 weeks . Results : Dietary iron intake and physical activity did not differ between groups before or after supplementation . Iron supplementation significantly increased sFer compared to placebo ( P=0.01 ) , but did not affect Hb or hematocrit . Iron supplementation prevented the decline in ventilatory threshold ( VT ) observed in the placebo group from pre- to post-supplementation ( P=0.01 ) ; this effect was greater in individuals with lower sFer before intervention ( P<0.05 ) . Changes in sFer from pre- to post-treatment were positively correlated with changes in VT ( P=0.03 ) , independent of supplementation . The iron group significantly increased gross energetic efficiency during the submaximal test ( P=0.04 ) . Changes in sFer were negatively correlated with changes in average respiratory exchange ratio during the submaximal test ( P<0.05 ) . Conclusions : Iron supplementation significantly improves iron status and endurance capacity in iron-deficient , nonanemic trained male and female subjects . Sponsorship : Missouri University Alumni Association , by the Elizabeth Hegarty Foundation and by the Department of Nutritional Sciences PURPOSE Studies in both animals and humans show a relationship between iron depletion without anemia ( IDNA ) and physical performance . Compared with their sedentary counterparts , female endurance athletes are at greater risk of IDNA , and consequences relevant to endurance athletes include reduced work capacity and energetic efficiency ( EF ) . We conducted a r and omized placebo-controlled trial to investigate the effects of iron ( Fe ) supplementation on Fe status and performance in nonanemic female rowers during training . METHODS At the beginning of a training season , 40 rowers were r and omized to receive either 100 mg·d FeSO4 ( n = 21 ) or placebo ( n = 19 ) using a double-blind design . Thirty-one ( n = 15 Fe , 16 placebo ) completed the 6-wk trial . Fe status ( hemoglobin , serum ferritin , soluble transferrin receptor ) , body composition , and laboratory tests of physical performance ( 4-km time trial , V˙O2peak , energetic EF , and blood lactate ) were assessed at baseline and after training . RESULTS Rowers in both groups increased their fat-free mass ( P < 0.001 ) and V˙O2peak ( P < 0.001 ) after training . Multiple regression analyses revealed improvements in Fe stores ( serum ferritin ) in the Fe treatment group after controlling for baseline Fe stores ( P = 0.07 ) . Rowers in the Fe group had slower lactate response during the first half of the time trial and after 5 min of recovery ( P = 0.05 ) and showed greater improvements in energy expenditure ( P = 0.01 for group-by time ) and energetic EF compared with placebo ( P = 0.03 for group-by time ) . CONCLUSIONS Female rowers with depleted Fe stores who consumed supplemental Fe during training improved their Fe status and energetic EF during endurance exercise . These results are important for endurance athletes whose dietary patterns and physical training increase their risk of IDNA and suggest that Fe supplementation may maximize the benefits of endurance training Iron supplementation has been suggested as a strategy for prevention and treatment of iron deficiency ( ID ) and iron deficiency anemia ( IDA ) in many countries , but non-compliance of daily regimens and common dosage remain as major challenges . The aim of this study was to investigate the effects of low dose once weekly iron supplementation in adolescent girls . The study was design ed as a community-based , r and omized , supplementation trial . The initial sample consisted of 200 female high school students , aged 14–16 years old , of whom 193 students concluded the study . They were r and omly selected and assigned into either iron-supplemented group ( ISG ) or iron-unsupplemented group ( IUG ) . The ISG received 150 mg ferrous sulfate once weekly for 16 weeks , whereas the IUG received nothing .  Weight , height , and hematological parameters were measured and compared between the two groups before and after the intervention . There was no significant difference between the initial measures of the two groups before the intervention . After 16 weeks of intervention , mean of hemoglobin and serum ferritin improved significantly in ISG compared to IUG . At the beginning of the study , percent of anemia , IDA , and ID in ISG were 12.5 % , 8.3 % , and 30.2 % , whereas these figures for IUG in this period of study were 14.4 , 10.3 , and 38.2 , respectively , which were not significantly different between the two groups . However , percentages of the above items at the end of study in ISG were 2.1 % , 0 % , and 21.9 % , respectively . In contrast to IUG , all cases of IDA were abolished in the ISG . Our study showed that once weekly supplementation of 150 mg ferrous sulfate for 16 weeks significantly improved iron status in female adolescents and effectively treated IDA . There is no need for higher dosage of iron for supplementation that may cause adverse effects and bear higher costs The effect of iron fortification is generally assumed to be less than iron supplementation ; however , the magnitude of difference in effects is not known . The present study aims to compare the efficacy of these two strategies on anaemia and iron status . After screening on low Hb , 425 anaemic children in six primary schools in Tam Nong district of Phu Tho province were included in a r and omized , placebo-controlled trial comparing two groups receiving iron fortified instant noodles or iron supplementation for 6 months and a control group , with children in all groups having been dewormed .  Blood sample s were collected before and after intervention for haemoglobin , serum ferritin ( SF ) , serum transferrin receptor ( TfR ) , C-reactive protein ( CRP ) , and haemoglobinopathies analysis . Regression analysis was used to assess the effect of iron fortification and iron supplementation on haemoglobin concentration , SF , TfR , body iron , and anaemic status as outcome variables . The improvement of haemoglobin , SF , and body iron level in the group receiving iron fortification was 42 % ( 2.6 g/L versus 6.2 g/L ) , 20 % ( 23.5 μg/L versus 117.3 μg/L ) , and 31.3 % ( 1.4 mg/kg versus 4.4 mg/kg ) of that in the iron supplementation group . The prevalence of anaemia dropped to 15.1 % in the control group , with an additional reduction of anaemia of 8.5 % in the iron supplementation group . The additional reduction due to iron fortification was 5.4 % , which amounts to well over 50 % of the impact of supplementation . In conclusion , the efficacy of iron fortification based on reduction of prevalence of anaemia , and on the change in haemoglobin level , is about half of the maximum impact of supplementation in case of optimal compliance . Thus , in a population of anaemic children with mild iron deficiency , iron fortification should be the preferred strategy to combat anaemia BACKGROUND Anemia is a common finding in heart failure ( HF ) patients and has been associated with increased morbidity and mortality . It is generally denominated as anemia of chronic disease ( ACD ) , but the association with true ferropenic anemia is common . Many studies have investigated the effects of treating anemia in HF patients with either erythropoietin alone or combination of erythropoietin and intravenous iron . However , the effect of iron supplementation alone in HF patients with ACD , ferropenic anemia , or both is unknown . METHODS AND RESULTS IRON-HF study is a multicenter , investigator initiated , r and omized , double-blind , placebo controlled trial that will enroll anemic HF patients with relatively preserved renal function , low transferrin saturation , low iron levels , and low to moderately elevated ferritin levels . Interventions are iron sucrose intravenously 200 mg once per week for 5 weeks , ferrous sulfate 200 mg by mouth 3 times per day for 8 weeks , or placebo . The primary objective is to assess the impact of iron supplementation  ( intravenously or by mouth ) compared with placebo in HF patients with anemia from deficient iron availability . The primary end point is variation of peak oxygen consumption assessed by ergospirometry over 3-month follow-up . Secondary end points include functional class , brain natriuretic peptide levels , quality of life scores , left ventricular ejection fraction , adverse events , HF hospitalization , and death . CONCLUSIONS The results of IRON-HF should help to clarify the potential clinical impact of mild to moderate anemia correction in HF patients Introduction : Nutritional anaemia in India is common morbidity seen in late adolescent and young female population . There are many conflicting opinions regarding dosage of iron folic acid supplementation for managing this simple nutritional deficiency disorder . Hence , this ‘ R and omized Controlled Trial ’ was undertaken in adolescent girls suffering from Iron Deficiency Anaemia visiting ‘ Urban Health and Training Centre ’ situated in urban slum area . The aim of this study was to assess the ( a ) Impact of weekly iron folic acid supplementation in comparison with daily iron supplementation for the management of Iron Deficiency Anaemia in adolescent girls visiting ‘ Urban Health and Training Centre ’ ; ( b ) Adverse drug reaction profile in ‘ Weekly Iron Folic Acid Supplementation ’ and ‘ Daily Iron Folic Acid Supplementation ’ regimes ; ( c ) Compliance profile for ‘ Weekly Iron Folic Acid Supplementation ’ and ‘ Daily Iron Folic Acid Supplementation ’ regimes in adolescent girls . Methods and Material : R and omized controlled trial was conducted in adolescent girls visiting ‘ Urban Health and Training Centre ’ during the study period June , 2011 to October , 2012 . The 120 anaemic ( Haemoglobin < 12 gm% ) adolescent girls ( 10 - 19 years ) were distributed r and omly by block r and omization in two groups ; one receiving daily Iron and Folic Acid supplementation and in other group receiving weekly Iron and Folic Acid supplementation for 3 months . All the study subjects were given de-worming ( Albendazole 400 mg ) and required health education separately . Both the groups were monitored for Haemoglobin estimation , compliance and adverse drug reactions , if any . Open-Epi Statistical Software was used for data analysis . Results : The mean age of study subjects in ‘ Daily Iron and Folic Acid Supplementation ’  and  ‘ Weekly Iron and Folic Acid Supplementation ’ group was 13.48 and 13.55 years respectively . Their mean pre intervention Haemoglobin was 10.1±1.1 gm/dl and 10.4±1.1 gm/dl respectively . The mean rise in Haemoglobin after lean period of 1 month in respective groups was almost equal i.e. 1.0±0.7 gm/dl and 1.0±0.8 gm/dl . Adverse Drug Reactions were 8.3 % in weekly regime as compared to 13.35 % in daily regime , abdominal pain being the commonest adverse drug reaction seen . The compliance calculated as mean of unconsumed ‘ Iron and Folic Acid ’ tablets was 6.1±10.98 in ‘ Daily Iron Folic Acid Supplementation ’ group , while it was 1.3±3.15 in ‘ Weekly Iron Folic Acid Supplementation ’ group ( p=0.0012 ) , making weekly regime more promising than daily regime with better treatment compliance . Conclusions : Weekly supplementation of ‘ Iron and Folic Acid ’ in ‘ Iron Deficiency Anaemia ’ patients is as good as daily supplementation with added benefits of less adverse reactions and better compliance OBJECTIVE To investigate whether treatment of anemia of chronic disease ( ACD ) in patients with rheumatoid arthritis ( RA ) with recombinant human erythropoietin ( rHu-Epo ) in combination with intravenous ( i.v . ) iron influences health related quality of life ( HRQoL ) and clinical outcome including disease activity . METHODS Thirty patients with ACD and RA were treated with 150 IU/kg rHu-Epo twice weekly for 12 weeks . As well , in case of functional iron deficiency 200 mg of iron-sucrose per week was given intravenously . Vitality and fatigue as dimensions of HRQoL were evaluated by the vitality subscale of the Short Form-36 ( SF-36-VT ) and the Multidimensional Assessment of Fatigue ( MAF ) . Muscle strength was measured by the Muscle Strength Index . RESULTS All 28 patients completing the study responded to treatment ; 23/28 patients developed functional iron deficiency and received i.v . iron ( mean absolute dose 710 + /- 560 mg ) . Average hemoglobin concentration increased from 10.7 + /- 1.1 to 13.2 + /- 1.0 g/dl after a mean treatment period of 8.7 + /- 2.3 weeks . Muscle strength increased from 43.5 + /- 11.2 to 49.1 + /- 12.9 and SF-36-VT from 28.2 % + /- 14.3 % to 47.1 % + /- 20.8 % . while fatigue decreased ( MAF from 34.7 + /- 9.3 to 25.0 + /- 11.3 ) . Among the disease activity variables the number of swollen/tender joints , erythrocyte sedimentation rate , Disease Activity Score , and RA Disease Activity Index improved significantly during treatment . CONCLUSION Treatment of ACD in RA patients with rHu-Epo and i.v . iron is safe and effective in correction of anemia , increases muscle strength . improves vitality , and lowers fatigue . In addition we observed a reduction of disease activity Background There is no recommendation to screen ferritin level in blood donors , even though several studies have noted the high prevalence of iron deficiency after blood donation , particularly among menstruating females . Furthermore , some clinical trials have shown that non-anaemic women with unexplained fatigue may benefit from iron supplementation . Our objective is to determine the clinical effect of iron supplementation on fatigue in female blood donors without anaemia , but with a mean serum ferritin ≤ 30 ng/ml . Methods / Design In a double blind r and omised controlled trial , we will measure blood count and ferritin level of women under age 50 yr , who donate blood to the University Hospital of Lausanne Blood Transfusion Department , at the time of the donation and after 1 week . One hundred and forty donors with a ferritin level ≤ 30 ng/ml and haemoglobin level ≥ 120 g/l ( non-anaemic ) a week after the donation will be included in the study and r and omised . A one-month course of oral ferrous sulphate ( 80 mg/day of elemental iron ) will be introduced vs. placebo . Self-reported fatigue will be measured using a visual analogue scale . Secondary outcomes are : score of fatigue ( Fatigue Severity Scale ) , maximal aerobic power ( Chester Step Test ) , quality of life ( SF-12 ) , and mood disorders ( Prime-MD ) . Haemoglobin and ferritin concentration will be monitored before and after the intervention . Discussion Iron deficiency is a potential problem for all blood donors , especially menstruating women . To our knowledge , no other intervention study has yet evaluated the impact of iron supplementation on subjective symptoms after a blood donation . Trial registration
In IDNA adults  , iron supplementation is associated with reduced subjective measures of fatigue but not with objective improvements in physical capacity .
OBJECTIVE Iron supplementation in iron-deficiency anaemia is st and ard practice , but the benefits of iron supplementation in iron-deficient non-anaemic ( IDNA ) individuals remains controversial .
Our objective is to identify the effects of iron therapy on fatigue and physical capacity in IDNA adults .