Iron Folate Supplementation is Necessary but not Sufficient to Reduce Anemia in Myanmar Adolescent Girls
Min Kyaw Htet *
South East Asian Ministers of Education Organization (SEAMEO), Regional Center for Food and Nutrition (RECFON), Jakarta, Indonesia and Department of Health, Ministry of Health, Nyi Pyi Taw, Myanmar.
Umi Fahmida
South East Asian Ministers of Education Organization (SEAMEO), Regional Center for Food and Nutrition (RECFON), Jakarta, Indonesia.
Drupadi Dillon
South East Asian Ministers of Education Organization (SEAMEO), Regional Center for Food and Nutrition (RECFON), Jakarta, Indonesia and Center of Community Health and Population Studies, The Research Institute, Trisakti University, Jakarta, Indonesia.
Arwin Ali Purbaya Akib
Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
Budi Utomo
Faculty of Public Health, University of Indonesia, Depok, Indonesia.
David I Thurnham
Northern Ireland Centre for Food and Health, School of Biomedical Science, University of Ulster, Coleraine, UK.
*Author to whom correspondence should be addressed.
Abstract
Objectives: Anaemia is a major nutritional problem in Myanmar and it is important to improve the preconceptional iron status of young women. In this study we assessed the beneficial effect of iron, folate and vitamin A supplementation on anaemia of adolescent girls.
Methods: A randomized, double-blinded, placebo-controlled study (NCT: 01198574) was conducted among anaemic adolescent schoolgirls (n=402) in Ayeyarwady region, Myanmar. The schoolgirls were recruited from 6 schools after screening for anemia (Hb<120g/L) among 1269 subjects. They were assigned into one of four groups: all groups received folate (F, 2.5 mg of folate), other groups received Vitamin A (FVA, 15,000 IU), Iron (IF, 60 mg elemental iron and folate) and IF+Vitamin A (IFVA). Supplementation was done once a week for 12 weeks. Iron, vitamin A, folate and inflammation status were measured. Serum ferritin (SF) and retinol (SR) were corrected for inflammation.
Results: The prevalence of iron deficiency (ID) (SF<15µg/L), low vitamin A status (SR<1.05µmol/L) and folate deficiency (serum folate<6.6nmol/L) were ~20%, 30% and 52% respectively at baseline. Compared with folate, ID was reduced significantly by IF (OR 0.24; 95%CI 0.06, 0.92) and IFA (OR 0.15; 95%CI 0.04, 0.57) respectively. Although Hb significantly increased in all groups, risk of anaemia did not differ between groups that received iron and those who received folate alone or folate plus vitamin A.
Conclusions: Multiple micronutrient deficiencies coexist among adolescent girls. Weekly iron supplementation combined with folate and vitamin A alleviated only some of the anaemia and should be implemented but other causes also need to be urgently investigated.