title: Impact of small-quantity lipid-based nutrient supplement on hemoglobin, iron status and biomarkers of inflammation in pregnant Ghanaian women.
abstract: We examined hemoglobin (Hb, g/L), iron status (zinc protoporphyrin, ZPP, µmol/mol heme, and transferrin receptor, TfR, mg/L) and inflammation (C-reactive protein, CRP and alpha-1 glycoprotein, AGP) in pregnant Ghanaian women who participated in a randomized controlled trial. Women (n = 1320) received either 60 mg Fe + 400-µg folic acid (IFA); 18 micronutrients including 20-mg Fe (MMN) or small-quantity lipid-based nutrient supplements (SQ-LNS, 118 kcal/d) with the same micronutrient levels as in MMN, plus four additional minerals (LNS) daily during pregnancy. Intention-to-treat analysis included 349, 354 and 354 women in the IFA, MMN and LNS groups, respectively, with overall baseline mean Hb and anemia (Hb <100) prevalence of 112 and 13.3%, respectively. At 36 gestational weeks, overall Hb was 117, and anemia prevalence was 5.3%. Compared with the IFA group, the LNS and MMN groups had lower mean Hb (120 ± 11 vs. 115 ± 12 and 117 ± 12, respectively; P < 0.001), higher mean ZPP (42 ± 30 vs. 50 ± 29 and 49 ± 30; P = 0.010) and TfR (4.0 ± 1.3 vs. 4.9 ± 1.8 and 4.6 ± 1.7; P < 0.001), and greater prevalence of anemia (2.2% vs. 7.9% and 5.8%; P = 0.019), elevated ZPP (>60) [9.4% vs. 18.6% and 19.2%; P = 0.003] and elevated TfR (>6.0) [9.0% vs. 19.2% and 15.1%; P = 0.004]. CRP and AGP concentrations did not differ among groups. We conclude that among pregnant women in a semi-urban setting in Ghana, supplementation with SQ-LNS or MMN containing 20 mg iron resulted in lower Hb and iron status but had no impact on inflammation, when compared with iron (60 mg) plus folic acid (400 µg). The amount of iron in such supplements that is most effective for improving both maternal Hb/iron status and birth outcomes requires further evaluation. This trial was registered at ClinicalTrials.gov as: NCT00970866.
authors.affiliation: Department of Nutrition and Food Science, University of Ghana, Accra, Ghana.
authors.forename: Seth
authors.initials: S
authors.lastname: Adu-Afarwuah
authors.affiliation: Department of Nutrition and Food Science, University of Ghana, Accra, Ghana.
authors.forename: Anna
authors.initials: A
authors.lastname: Lartey
authors.affiliation: Department of Nutrition and Food Science, University of Ghana, Accra, Ghana.
authors.forename: Harriet
authors.initials: H
authors.lastname: Okronipa
authors.affiliation: Center for Child Health Research and Department of Pediatrics, University of Tampere School of Medicine and Tampere University Hospital, Finland.
authors.forename: Per
authors.initials: P
authors.lastname: Ashorn
authors.affiliation: Nutriset S.A.S., Malaunay, France.
authors.forename: Mamane
authors.initials: M
authors.lastname: Zeilani
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, California, USA.
authors.forename: Lacey M
authors.initials: LM
authors.lastname: Baldiviez
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, California, USA.
authors.forename: Brietta M
authors.initials: BM
authors.lastname: Oaks
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, California, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Vosti
authors.affiliation: Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, California, USA.
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
mesh_terms: D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D005869:Ghana / Q000453:epidemiology; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D007501:Iron / Q000008:administration & dosage / Q000097:blood*; D039382:Maternal Nutritional Physiological Phenomena; D018977:Micronutrients / Q000008:administration & dosage; D009752:Nutritional Status; D011247:Pregnancy; D015995:Prevalence; D011524:Protoporphyrins / Q000097:blood; D011990:Receptors, Transferrin / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D018977:Micronutrients; D011524:Protoporphyrins; D011990:Receptors, Transferrin; C017803:zinc protoporphyrin; D002097:C-Reactive Protein; D005492:Folic Acid; D007501:Iron
keywords: LNS; hemoglobin; inflammation; iron status; lipid-based nutrient supplements; multiple micronutrients; prenatal supplementation