title: School-administered weekly iron-folate supplements improve hemoglobin and ferritin concentrations in Malaysian adolescent girls.
abstract: BACKGROUND
  Iron deficiency and its consequent anemia constitute the commonest micronutrient deficiency in the world.
  
  
  OBJECTIVE
  We investigated whether long-term, weekly iron-folate supplements administered at school would improve hemoglobin and ferritin concentrations in adolescent girls, including those with mild-to-moderate anemia and hemoglobin concentrations indicating borderline anemia.
  
  
  METHODS
  Subjects were 266 girls with hemoglobin concentrations of 80-119.9 g/L (group A) and 358 girls with hemoglobin concentrations of 120-130 g/L (group B) who were otherwise healthy. Two hundred sixty-six girls in group A and 268 girls in group B were randomly assigned to receive either 60 or 120 mg Fe plus 3.5 mg folic acid weekly for 22 wk. Ninety of the girls in group B were randomly assigned to receive only 5 mg folic acid weekly. Capillary hemoglobin and plasma ferritin were measured at baseline and after 12 and 22 wk of supplementation.
  
  
  RESULTS
  By the end of the study, 2% of the girls had dropped out and > 96% had taken > or = 20 of the 22 tablets; side effects were minimal. Mean plasma ferritin increased significantly in all iron-supplemented groups, independently of initial hemoglobin values and iron doses. Ferritin concentrations decreased in the girls supplemented with folic acid only. As expected, hemoglobin responses to iron were higher in group A than in group B and increases were positively correlated with initial plasma ferritin. Hemoglobin failed to respond to folate supplementation if initial plasma ferritin concentrations were low. Mean hemoglobin increased significantly and consistently in relation to the length of treatment.
  
  
  CONCLUSIONS
  Long-term, weekly iron-folate supplementation was found to be a practical, safe, effective, and inexpensive method for improving iron nutrition in adolescent schoolgirls.
authors.affiliation: Division of Human Nutrition, Institute for Medical Research, Ministry of Health, Kuala Lumpur, Malaysia.
authors.forename: E S
authors.initials: ES
authors.lastname: Tee
authors.forename: M
authors.initials: M
authors.lastname: Kandiah
authors.forename: N
authors.initials: N
authors.lastname: Awin
authors.forename: S M
authors.initials: SM
authors.lastname: Chong
authors.forename: N
authors.initials: N
authors.lastname: Satgunasingam
authors.forename: L
authors.initials: L
authors.lastname: Kamarudin
authors.forename: S
authors.initials: S
authors.lastname: Milani
authors.forename: A E
authors.initials: AE
authors.lastname: Dugdale
authors.forename: F E
authors.initials: FE
authors.lastname: Viteri
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000145:classification / Q000188:drug therapy*; D002196:Capillaries; D004338:Drug Combinations; D005260:Female; D005293:Ferritins / Q000097:blood*; D005492:Folic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D006397:Hematinics / Q000008:administration & dosage / Q000627:therapeutic use*; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000627:therapeutic use*; D008296:Malaysia; D010349:Patient Compliance; D012574:Schools
chemical_list: D004338:Drug Combinations; D006397:Hematinics; D006454:Hemoglobins; D005293:Ferritins; D005492:Folic Acid; D007501:Iron