Crystal D Karakochuk1,2, Mikaela K Barker1,2, Kyly C Whitfield1, Susan I Barr1, Suzanne M Vercauteren2,3, Angela M Devlin4,2, Jennifer A Hutcheon5,2, Lisa A Houghton6, Sophonneary Prak7, Kroeun Hou8, Tze Lin Chai8, Ame Stormer8, Sokhoing Ly8, Robyn Devenish9, Christian Oberkanins10, Helene Pühringer10, Kimberly B Harding11, Luz M De-Regil11, Klaus Kraemer12,13, Tim J Green14,15. 1. Food, Nutrition, and Health and Departments of. 2. British Columbia Children's Hospital Research Institute, Vancouver, Canada. 3. Division of Hematopathology, Children's and Women's Health Centre of British Columbia, Vancouver, Canada. 4. Pediatrics and. 5. Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada. 6. Department of Human Nutrition, University of Otago, Dunedin, New Zealand. 7. National Maternal and Child Health Center, Cambodian Ministry of Health, Phnom Penh, Cambodia. 8. Helen Keller International, Phnom Penh, Cambodia. 9. Laboratory Department, National Pediatric Hospital, Phnom Penh, Cambodia. 10. ViennaLab Diagnostics GmbH, Vienna, Austria. 11. Micronutrient Initiative, Ottawa, Canada. 12. Sight and Life Foundation, Basel, Switzerland. 13. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 14. Discipline of Paediatrics, University of Adelaide, Adelaide, Australia; and tim.green@sahmri.com. 15. Healthy Mothers, Babies, and Children's Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.
Abstract
Background: Despite a high prevalence of anemia among nonpregnant Cambodian women, current reports suggest that iron deficiency (ID) prevalence is low. If true, iron supplementation will not be an effective anemia reduction strategy.Objective: We measured the effect of daily oral iron with or without multiple micronutrients (MMNs) on hemoglobin concentration in nonpregnant Cambodian women screened as anemic.Design: In this 2 × 2 factorial, double-blind, randomized trial, nonpregnant women (aged 18-45 y) with hemoglobin concentrations ≤117 g/L (capillary blood) were recruited from 26 villages in Kampong Chhnang province and randomly assigned to receive 12 wk of iron (60 mg; Fe group), MMNs (14 other micronutrients; MMN group), iron plus MMNs (Fe+MMN group), or placebo capsules. A 2 × 2 factorial intention-to-treat analysis with the use of a generalized mixed-effects model was used to assess the effects of iron and MMNs and the interaction between these factors. Results:In July 2015, 809 women were recruited and 760 (94%) completed the trial. Baseline anemia prevalence was 58% (venous blood). Mean (95% CI) hemoglobin concentrations at 12 wk in the Fe, MMN, Fe+MMN, and placebo groups were 121 (120, 121), 116 (116, 117), 123 (122, 123), and 116 (116, 117) g/L, with no iron × MMN interaction (P = 0.66). Mean (95% CI) increases in hemoglobin were 5.6 g/L (3.8, 7.4 g/L) (P < 0.001) among women who received iron (n = 407) and 1.2 g/L (-0.6, 3.0 g/L) (P = 0.18) among women who received MMNs (n = 407). The predicted proportions (95% CIs) of women with a hemoglobin response (≥10 g/L at 12 wk) were 19% (14%, 24%), 9% (5%, 12%), 30% (24%, 35%), and 5% (2%, 9%) in the Fe, MMN, Fe+MMN, and placebo groups, respectively.Conclusions: Daily iron supplementation for 12 wk increased hemoglobin in nonpregnant Cambodian women; however, MMNs did not confer additional significant benefit. Overall, ∼24% of women who received iron responded after 12 wk; even fewer would be likely to respond in the wider population. This trial was registered at clinicaltrials.gov as NCT02481375.
RCT Entities:
Background: Despite a high prevalence of anemia among nonpregnant Cambodian women, current reports suggest that iron deficiency (ID) prevalence is low. If true, iron supplementation will not be an effective anemia reduction strategy.Objective: We measured the effect of daily oral iron with or without multiple micronutrients (MMNs) on hemoglobin concentration in nonpregnant Cambodian women screened as anemic.Design: In this 2 × 2 factorial, double-blind, randomized trial, nonpregnant women (aged 18-45 y) with hemoglobin concentrations ≤117 g/L (capillary blood) were recruited from 26 villages in Kampong Chhnang province and randomly assigned to receive 12 wk of iron (60 mg; Fe group), MMNs (14 other micronutrients; MMN group), iron plus MMNs (Fe+MMN group), or placebo capsules. A 2 × 2 factorial intention-to-treat analysis with the use of a generalized mixed-effects model was used to assess the effects of iron and MMNs and the interaction between these factors. Results: In July 2015, 809 women were recruited and 760 (94%) completed the trial. Baseline anemia prevalence was 58% (venous blood). Mean (95% CI) hemoglobin concentrations at 12 wk in the Fe, MMN, Fe+MMN, and placebo groups were 121 (120, 121), 116 (116, 117), 123 (122, 123), and 116 (116, 117) g/L, with no iron × MMN interaction (P = 0.66). Mean (95% CI) increases in hemoglobin were 5.6 g/L (3.8, 7.4 g/L) (P < 0.001) among women who received iron (n = 407) and 1.2 g/L (-0.6, 3.0 g/L) (P = 0.18) among women who received MMNs (n = 407). The predicted proportions (95% CIs) of women with a hemoglobin response (≥10 g/L at 12 wk) were 19% (14%, 24%), 9% (5%, 12%), 30% (24%, 35%), and 5% (2%, 9%) in the Fe, MMN, Fe+MMN, and placebo groups, respectively.Conclusions: Daily iron supplementation for 12 wk increased hemoglobin in nonpregnant Cambodian women; however, MMNs did not confer additional significant benefit. Overall, ∼24% of women who received iron responded after 12 wk; even fewer would be likely to respond in the wider population. This trial was registered at clinicaltrials.gov as NCT02481375.
Authors: Brock A Williams; Kelsey M Cochrane; Jordie A J Fischer; Abeer M Aljaadi; Liadhan McAnena; Mary Ward; Helene McNulty; Hou Kroeun; Tim J Green; Kyly C Whitfield; Crystal D Karakochuk Journal: J Nutr Date: 2020-07-01 Impact factor: 4.798
Authors: Kelsey M Cochrane; Brock A Williams; Jordie A J Fischer; Kaitlyn L I Samson; Lulu X Pei; Crystal D Karakochuk Journal: Curr Dev Nutr Date: 2020-09-24
Authors: Lulu X Pei; Hou Kroeun; Suzanne M Vercauteren; Susan I Barr; Tim J Green; Arianne Y Albert; Crystal D Karakochuk Journal: J Nutr Date: 2021-08-07 Impact factor: 4.798
Authors: Kristina D Michaux; Kroeun Hou; Crystal D Karakochuk; Kyly C Whitfield; Sokhoing Ly; Vashti Verbowski; Ame Stormer; Keith Porter; Kathy H Li; Lisa A Houghton; Larry D Lynd; Aminuzzaman Talukder; Judy McLean; Timothy J Green Journal: Matern Child Nutr Date: 2019-05 Impact factor: 3.092
Authors: Lulu X Pei; Tebogo T Leepile; Kelsey M Cochrane; Kaitlyn L I Samson; Jordie A J Fischer; Brock A Williams; Hou Kroeun; Lizl Bonifacio; Crystal D Karakochuk Journal: Diagnostics (Basel) Date: 2021-02-03
Authors: Shannon L Steele; Anthony Y Y Hsieh; Izabella Gadawski; Hou Kroeun; Susan I Barr; Angela M Devlin; Hélène C F Côté; Crystal D Karakochuk Journal: Nutrients Date: 2021-05-31 Impact factor: 5.717
Authors: Jordie Aj Fischer; Lulu X Pei; David M Goldfarb; Arianne Albert; Rajavel Elango; Hou Kroeun; Crystal D Karakochuk Journal: BMJ Open Date: 2020-08-16 Impact factor: 2.692