Marginal iron deficiency without anemia impairs aerobic adaptation among previously untrained women. Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic iron-deficient adults: a systematic review of randomised controlled trials Iron repletion decreases maximal exercise lactate concentrations in female athletes with minimal iron-deficiency anemia. Iron supplementation improves endurance after training in iron-depleted, nonanemic women. Iron depletion without anemia and physical performance in young women. Iron and Energy Supplementation Improves the Physical Work Capacity of Female College Students Effect of iron injections on aerobic-exercise performance of iron-depleted female athletes. The effect of iron supplementation on the physical work capacity in the elderly. Iron supplementation improves energetic efficiency in iron-depleted female rowers. Iron supplementation maintains ventilatory threshold and improves energetic efficiency in iron-deficient nonanemic athletes Effect of iron supplementation on endurance capacity in iron-depleted female runners. Iron supplementation improves progressive fatigue resistance during dynamic knee extensor exercise in iron-depleted, nonanemic women. Effects of iron supplementation and nutrition education on haemoglobin, ferritin and oxidative stress in iron-deficient female adolescents in Palestine: randomized control trial. Iron status in exercising women: the effect of oral iron therapy vs increased consumption of muscle foods. Tissue iron deficiency without anemia impairs adaptation in endurance capacity after aerobic training in previously untrained women. Randomized, double-blind, placebo-controlled trial of iron supplementation in female soldiers during military training: effects on iron status, physical performance, and mood. Rationale, design, methodology and sample characteristics for the Vietnam pre-conceptual micronutrient supplementation trial (PRECONCEPT): a randomized controlled study
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 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 We studied the effect of 2 weeks of iron therapy on exercise performance and exercise-induced lactate production in trained women athletes : six control subjects with normal parameters of iron status and nine with mild iron-deficiency anemia defined by low Fe/TIBC , ferritin , and minimally decreased Hgb values .  Iron therapy improved the abnormal measures of iron status and low Hgb in the second group to normal . Exercise performance in a progressive work-exercise protocol on a bicycle ergometer to exhaustion was unchanged after iron therapy in both groups ; however , blood lactate levels at maximum exercise in the iron-deficient group decreased significantly from 10.3 + /- 0.6 mmol/L before therapy to 8.42 + /- 0.7 after therapy ( p less than 0.03 ) . The control subjects did not significantly alter lactate levels after maximal exercise on iron compared to placebo : 8.3 + /- 0.8 mmol/L vs. 8.5 + /- 0.7 . Although there was not a significant difference in maximum exercise performance after iron therapy , these data support animal experiments implying that iron may play a role in oxidative metabolism and that minimal decreases in Hgb may impair arterial oxygen content enough to affect aerobic metabolism . In addition , these findings may have important implication s for competitive women athletes in whom mild iron deficiency may go unnoticed Our objective was to investigate the effects of iron depletion on adaptation to aerobic exercise , assessed by time to complete a 15-km cycle ergometer test . Forty-two iron-depleted ( serum ferritin < 16 microg/l ) , nonanemic ( Hb > 12 g/dl ) women ( 18 - 33 yr old ) received 100 mg of ferrous sulfate ( S ) or placebo ( P ) per day for 6 wk in a r and omized , double-blind trial . Subjects trained for 30 min/day , 5 days/wk at 75 - 85 % of maximum heart rate for the final 4 wk of the study . There were no group differences in baseline iron status or in 15-km time . Iron supplementation increased serum ferritin and decreased transferrin receptors in the S compared with the P group . The S and P groups decreased 15-km time and respiratory exchange ratio and increased work rate during the 15-km time trial after training . The decrease in 15-km time was greater in the S than in the P group ( P = 0.04 ) and could be partially attributed to increases in serum ferritin and Hb . These results indicate that iron deficiency without anemia impairs favorable adaptation to aerobic exercise Studies in laboratory animals found that iron deficiency without anemia decreased oxidative capacity and increased reliance on carbohydrate as the substrate for energy , thereby causing impaired endurance . The purpose of this cross-sectional study was to investigate the relation between iron deficiency without anemia and physical performance in healthy active women aged 19 - 36 y. Iron-status assessment included determination of hemoglobin , hematocrit , transferrin saturation , and serum ferritin values . Dietary iron intake was assessed by frequency question naires and physical activity level was estimated by frequency question naires and 2-wk records . Fifteen women with normal iron status and 15 women with iron depletion ( serum ferritin < 12 micrograms/L ) were chosen r and omly from a group of 69 nonanemic women and given physical-performance tests , including determinations of maximum oxygen consumption ( VO2max ) , ventilatory threshold , and delta-efficiency . There were no significant differences between the two groups in body size , body composition , physical activity level , dietary iron intake , delta-efficiency , or ventilatory threshold . Compared with the iron-depleted group , the iron-sufficient group had significantly higher hemoglobin , transferrin saturation , and serum ferritin values and a significantly greater tendency to use iron supplements . When physical activity level and fat-free mass were controlled for , the iron-depleted group had a significantly lower VO2max . The difference in VO2max was significantly associated with serum ferritin concentration ; hemoglobin value was not a significant confounder . Therefore , reduction of VO2max in nonanemic women with iron depletion was likely caused by factors related to reduced body iron storage but was unrelated to decreased oxygen-transport capacity of the blood 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 This investigation examined the effect of intramuscular iron injections on aerobic-exercise performance in iron-deficient women . Sixteen athletes performed a 10-min steady-state submaximal economy test , a VO2max test , and a timed test to exhaustion at VO2max workload . Subjects were r and omly assigned to an iron-supplemented group ( IG ) receiving intramuscular iron injections or to a placebo group ( PG ) . Twenty days after the first injection , exercise and blood testing were repeated . A final blood test occurred on Day 28 . Post supplementation , no differences were found between the groups ' submaximal or maximal VO2 , heart rate , or blood lactate ( P > 0.05 ) . Time to exhaustion was increased in the IG ( P < 0.05 ) but was not greater than that of the PG ( P > 0.05 ) . The IG 's serum ferritin ( SF ) was significantly increased on Days 20 and 28 ( mean + /- st and ard error : 19 + /- 3 to 65 + /- 11 to 57 + /- 12 microg/L ; P < 0.01 ) , with a percentage change from baseline significantly greater than in the PG ( P < 0.01 ) . It was concluded that intramuscular iron injections can effectively increase SF without enhancing submaximal or maximal aerobic-exercise performance in iron-depleted female athletes . The effect of a high oral iron supplementation ( 120 mg day ) on the physical work capacity has been studied in a group of apparently healthy men and women of ages 58–71 years , and this effect was correlated with the initial values of and changes in some variables constituting usual clinical estimates of the state of iron nutrition . The increase in physical work capacity was about 4 % higher in men and about 12 % higher in women in the group supplemented with iron than in the control ( placebo ) group . In the control group there was a positive correlation between increase in physical work capacity and initial value for stainable iron in the bone marrow , and a negative correlation between increase in physical work capacity and decrease in the value for stainable iron in the bone marrow ; it is pointed out that these findings should not be expected in the iron-supplemented group , where variations in the depot iron will be of less influence . In the iron-supplemented group the total iron binding capacity decreased significantly , while the remaining variables constituting estimates of the state of iron nutrition showed no significant changes . The increase in physical work capacity in the iron-supplemented group did not appear to be correlated to the initial value either for haemoglobin concentration or for other variables estimating the state of iron nutrition . It is concluded that in apparently healthy people the increase in physical work capacity during moderate training is related to the availability of iron 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 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 The purpose of this investigation was to examine the effects of oral iron supplementation on endurance performance in initially iron-depleted , nonanemic female distance runners . Eighteen iron-depleted ( serum ferritin less than 20 ng.ml-1 , hemoglobin greater than or equal to 12 g.dl-1 ) women ( 22 - 39 yr ) performed a VO2max test and an endurance run to exhaustion . Subjects were pair-matched on the basis of endurance time and then r and omly assigned to an iron supplement or a placebo group . Following supplementation , the iron group had a significantly higher ( P = 0.03 ) mean serum ferritin concentration ( 23.4 vs 15.7 ng.ml-1 ) and lower ( P = 0.04 ) mean total iron-binding capacity than the placebo group . Both groups increased their time to exhaustion ( 25.5 % and 22.2 % for the iron and placebo groups , respectively ) but were not significantly different ( P = 0.72 ) from each other . There were also no differences ( P greater than 0.05 ) between the groups with respect to lactate concentrations and physiological measures taken during the two exercise tests . The results of this study suggest that 8 wk of oral iron supplementation improves iron status in iron-depleted female distance runners , but does not enhance endurance capacity BACKGROUND Tissue iron depletion may negatively affect endurance performance and muscle fatigability . OBJECTIVE We investigated tissue-level iron depletion and progressive fatigue of the quadriceps during dynamic knee-extension exercise in young women . DESIGN Twenty iron-depleted ( serum ferritin < 20 micro g/L ) , nonanemic ( hemoglobin > 110 g/L ) women ( macro x + /- SEM age : 29.1 + /- 1.2 y ) received iron ( iron group ) or placebo ( placebo group ) for 6 wk in a r and omized , double-blind trial ( n = 10 per group ) . A protocol integrating 2 - 3-s maximal voluntary static contractions ( MVCs ) with dynamic knee extensions was used to assess fatigue . RESULTS No significant differences between the groups in baseline iron status , MVC at rest , or MVC at the end of the protocol were observed . After treatment , serum iron and transferrin saturation increased significantly in the iron group ( P = 0.02 and P = 0.03 , respectively ) . Serum transferrin receptor concentrations increased significantly in the placebo group ( P < 0.01 ) but not in the iron group . After treatment , the rate of decrease in MVC was attenuated in the iron group but not in the placebo group ( P = 0.01 ) . In the iron group , MVC at the sixth minute of the fatigue protocol and MVC at the end of the protocol were approximately 15 % ( P = 0.04 ) and approximately 27 % higher ( P < 0.01 ) , respectively , after treatment . These improvements were not related to changes in iron-status indexes or tissue iron stores , although power was low ( < 0.50 ) to detect these relations . CONCLUSIONS Iron supplementation was associated with a significant improvement in muscle fatigability . Interpretation regarding the direct role of tissue iron status is limited by the study 's low power to detect relations between tissue iron improvement and decreased muscle fatigue 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 Forty-seven previously sedentary women participating in a 12-wk moderate aerobic-exercise program were r and omly assigned to one of four dietary groups : 50-mg/d iron supplement and a low food-iron diet ( 50 FE + EX ) , 10-mg/d iron supplement and a low food-iron diet ( 10 FE + EX ) , placebo and unrestricted diet ( P + EX ) , and meat supplement and high food-iron diet ( M + EX ) . A sedentary control group ( n = 13 ) received no dietary interventions . Hematocrit , total iron-binding capacity , and hemoglobin , serum iron , serum ferritin , and serum albumin concentrations were measured every 4 wk . Hemoglobin values decreased at the end of 4 wk in all exercising groups compared with the control group . Iron status in the 50 FE + EX and M + EX groups improved after week 4 as indicated by an increase in serum ferritin , serum iron , and hemoglobin concentrations , and a decline in total iron-binding capacity . Thus , short-term , moderate aerobic exercise result ed in compromised iron status that was offset to varying degrees by ingesting iron or meat supplements . However , meat supplements were more effective in protecting hemoglobin and ferritin status than were iron supplements BACKGROUND We previously showed that iron supplementation significantly improves iron status and maximal work capacity in previously untrained , marginally iron-deficient women with a baseline serum transferrin receptor concentration > 8.0 mg/L. However , the effect of transferrin receptor status on adaptation in endurance capacity after aerobic training in these subjects has not been fully explored . OBJECTIVE Our objective was to examine the effect of baseline serum transferrin receptor status on adaptations in endurance capacity . DESIGN Forty-one untrained , iron-depleted , nonanemic women were r and omly assigned to receive either 100 mg FeSO(4 ) or a placebo for 6 wk in a double-blind trial . All subjects trained on cycle ergometers 5 d/wk for the last 4 wk of the study . Endurance capacity was assessed at baseline and after treatment by using a 15-km time trial conducted on a cycle ergometer . RESULTS Significant treatment effects were observed for time to complete the 15-km time trial , work rate , and percentage of maximal oxygen uptake in subjects with a baseline serum transferrin receptor concentration > 8.0 mg/L. No significant treatment effects were observed in subjects with a normal baseline transferrin receptor concentration . CONCLUSIONS Our findings suggest that , in the presence of overt tissue iron deficiency , iron deficiency without anemia impairs adaptation in endurance capacity after aerobic training in previously untrained women . This impairment can be corrected with iron supplementation BACKGROUND Decrements in iron status have been reported in female soldiers during military training . Diminished iron status adversely affects physical and cognitive performance . OBJECTIVE We wanted to determine whether iron supplementation could prevent decrements in iron status and improve measures of physical performance and cognitive status in female soldiers during basic combat training ( BCT ) . DESIGN In this 8-wk r and omized , double-blind , placebo-controlled trial , soldier volunteers ( n = 219 ) were provided with capsules containing either 100 mg ferrous sulfate or a placebo . Iron status indicator assays were performed pre- and post-BCT . Two-mile running time was assessed post-BCT ; mood was assessed by using the Profile of Mood States question naire pre- and post-BCT . RESULTS The BCT course affected iron status : red blood cell distribution width and soluble transferrin receptor were elevated ( P < 0.05 ) , and serum ferritin was lowered ( P < 0.05 ) post-BCT . Iron supplementation attenuated the decrement in iron status ; group-by-time interactions ( P < 0.01 ) were observed for serum ferritin and soluble transferrin receptor . Iron supplementation result ed in improved ( P < 0.05 ) vigor scores on the Profile of Mood States post-BCT and in faster running time ( P < 0.05 ) in volunteers reporting to BCT with iron deficiency anemia . CONCLUSIONS Iron status is affected by BCT , and iron supplementation attenuates the decrement in indicators of iron status in female soldiers . Furthermore , iron supplementation may prove to be beneficial for mood and physical performance during the training period . Future efforts should identify and treat female soldiers or athletes who begin training regimens with iron deficiency or iron deficiency anemia Background Low birth weight and maternal anemia remain intractable problems in many developing countries . The adequacy of the current strategy of providing iron-folic acid ( IFA ) supplements only during pregnancy has been question ed given many women enter pregnancy with poor iron stores , the substantial micronutrient dem and by maternal and fetal tissues , and programmatic issues related to timing and coverage of prenatal care . Weekly IFA supplementation for women of reproductive age ( WRA ) improves iron status and reduces the burden of anemia in the short term , but few studies have evaluated subsequent pregnancy and birth outcomes .The Preconcept trial aims to determine whether pre-pregnancy weekly IFA or multiple micronutrient ( MM ) supplementation will improve birth outcomes and maternal and infant iron status compared to the current practice of prenatal IFA supplementation only . This paper provides an overview of study design , methodology and sample characteristics from baseline survey data and key lessons learned . Methods / design We have recruited 5011 WRA in a double-blind stratified r and omized controlled trial in rural Vietnam and r and omly assigned them to receive weekly supplements containing either : 1 ) 2800 μg folic acid 2 ) 60 mg iron and 2800 μg folic acid or 3 ) MM . Women who become pregnant receive daily IFA , and are being followed through pregnancy , delivery , and up to three months post-partum . Study outcomes include birth outcomes and maternal and infant iron status . Data are being collected on household characteristics , maternal diet and mental health , anthropometry , infant feeding practice s , morbidity and compliance . Discussion The study is timely and responds to the WHO Global Expert Consultation which identified the need to evaluate the long term benefits of weekly IFA and MM supplementation in WRA . Findings will generate new information to help guide policy and programs design ed to reduce the burden of anemia in women and children and improve maternal and child health outcomes in re source poor setting s . Trial registration
Daily iron supplementation significantly improves maximal and submaximal exercise performance in WRA , providing a rationale to prevent and treat iron deficiency in this group .
Animal and human observational studies suggest that iron deficiency impairs physical exercise performance , but findings from r and omized 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 .