Anemia and Poor Iron Indices Are Associated With Susceptibility to Febrile Seizures in Children: A Systematic Review and Meta-analysis

Vitamin C-rich guava consumed with mungbean dal reduces anemia and increases hemoglobin but not iron stores: a randomized controlled trial of food-to-food fortification in Indian children

BACKGROUND

Adding vitamin C-rich fruit to staples containing iron could be an effective strategy to improve iron bioavailability and thereby reduce iron-deficiency anemia in children.

OBJECTIVE

We aimed to assess the effect of consuming a mungbean-based meal with or without guava fruit on body iron stores, hemoglobin concentration, and anemia of children as part of a school feeding program.

METHODS

We conducted a 7-month randomized, controlled trial with 6 to 10-year-old school children (n=200; 46% anemic, 71% iron-deficient) from a rural community in Haryana, North India. Children were assigned to two treatment groups to daily receive either a meal of mungbean dal only (3.0 mg of iron; vitamin C:iron molar ratio ∼0.5:1), or mungbean dal with fresh guava (3.2 mg of iron; ∼170 mg of vitamin C; molar ratio ∼18:1). Meals were served every school day under supervision. The primary outcome was body iron stores, while concentrations of hemoglobin and other iron indicators were secondary outcomes.

RESULTS

Daily consumption of mungbean dal along with guava did not result in an overall improvement of body iron stores (mean treatment effect: 0.65 mg/kg body weight; 95% CI: -0.34, 1.63; P=0.197). However, compared to children who consumed mungbean dal only, children in the guava group showed a larger increase in hemoglobin concentration (3.7 g/L; 95% CI: 1.6, 5.6; P=0.001), and a larger drop in the prevalence of anemia (-51%; 95% CIs: -74, -10; P= 0.022) and iron-deficiency anemia (-56%, 95% CI: -83, 13; P=0.087). These effects were more pronounced in children who were iron-deficient at study start.

CONCLUSIONS

Addition of guava to a mungbean-based meal containing a moderate amount of iron increased hemoglobin and reduced anemia but did not provide enough additional absorbed iron to also increase body iron stores. Food-to-food fortification by inclusion of vitamin C rich fruits in iron-containing school meals may help alleviate the burden of anemia in children. This trial was registered at https://clinicaltrials.gov/ct2/show/NCT01191463.

Management of Childhood Iron Deficiency Anemia in a Developed Country-A Multi-Center Experience from Croatia

Iron deficiency anemia (IDA) continues to be a global public health concern, mostly in the developing countries. However, precise epidemiological data on childhood IDA in Croatia are lacking. In order to establish its frequency, underlying etiologies, the rationale for tertiary care visits, diagnostic practices, and current treatment regimens of IDA, medical records of children referred to pediatric hematologists for iron deficiency in a five-year period at tertiary institutions (Zagreb, Rijeka, Split, Osijek) throughout Croatia were retrospectively analyzed. Eight hundred and sixty-four children, predominately of preschool age, were referred mainly by the primary care pediatricians, who, in general, performed basic diagnostics but failed to initiate oral iron therapy in half of the patients. Approximately one-third of patients were symptomatic, with inadequate nutrition prevailing as underlying etiology. Dextriferron was the preferred iron formulation among hematologists, with a median dose of 5 mg/kg, with acceptable compliance rates (63.5-93.2%). Hospital admission rates varied among the centers (9.4-35%), and so did transfusion policies (6.4-22.9%). The greatest difference was observed in the frequency of parenteral iron administration (0.3-21.5%). In conclusion, the burden of childhood IDA, even in a high-income country, remains substantial, necessitating consistent implementation of national guidelines and additional education of primary health care providers.