Skip to main content
×
Home

The effect of iron fortification and de-worming on anaemia and iron status of Vietnamese schoolchildren

  • Huong Thi Le (a1), Inge D. Brouwer (a2), Khan Cong Nguyen (a3), Jan Burema (a2) and Frans J. Kok (a2)...
Abstract

Previous data from Vietnam show that anaemia is highly prevalent among schoolchildren, who are considered not to be iron deficient. Trichuris infection doubled the risk of anaemia. The present study aimed to evaluate the hypothesis that de-worming is more effective than iron fortification in an anaemic, infection-prone population. In a trial with a 2 × 2 factorial design, 425 anaemic children aged 6–8 years were randomly assigned to receive either iron-fortified noodles or placebo, and mebendazole or placebo. Outcomes considered were change in haematological indicators of iron status (Hb, serum ferritin (SF), serum transferrin receptor (TfR) and haemoglobinopathies analysis); inflammations (C-reactive protein (CRP)); parasite infection status (hookworm, Trichuris and Ascaris infection); and IgE. ANOVA and logistic regression were used to assess the effects of iron fortification and de-worming on Hb, SF, TfR, body iron and anaemia. Hb improved in all groups after 6 months of intervention. Iron fortification significantly improved Hb, SF and body iron (2·6 g/l, 16·3 μg/l and 1 mg/kg, respectively). Prevalence of elevated IgE was very high at baseline (99 %) and significantly reduced to about 75 % in all groups after intervention. De-worming unexpectedly showed no effect on Hb, iron status and IgE level. It is concluded that iron fortification slightly improved anaemia and iron status in anaemic schoolchildren in rural Vietnam that were not considered iron deficient. Chronic infection or other unidentified factors may play an important role in the seasonal reduction of anaemia seen in all treatment groups.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The effect of iron fortification and de-worming on anaemia and iron status of Vietnamese schoolchildren
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      The effect of iron fortification and de-worming on anaemia and iron status of Vietnamese schoolchildren
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      The effect of iron fortification and de-worming on anaemia and iron status of Vietnamese schoolchildren
      Available formats
      ×
Copyright
Corresponding author
*Corresponding author: Mrs Huong Thi Le, No. 41 Lane 101, Pham Ngoc Thach Str., Dongda, Hanoi, Vietnam, fax +84 4 7337955, email huong.lethi@wur.nl or email donghuong@fpt.vn
References
Hide All
Anonymous (2000) Iron Deficiency Anaemia: Assessment, Prevention and Control. Geneva: World Health Organization.
Asobayire FS, Adou P, Davidsson L, Cook JD & Hurrell RF (2001) Prevalence of iron deficiency with and without concurrent anaemia in population groups with high prevalences of malaria and other infections: a study in Côte d'Ivoire. Am J Clin Nutr 74, 776782.
Baggett HC, Parkinson AJ, Muth PT, Gold BD & Gessner BD (2006) Endemic iron deficiency associated with Helicobacter pylori infection among school-aged children in Alaska. Pediatrics 117, e396e404.
Broek N van den & Letsky E (2000) Etiology of anemia in pregnancy in south Malawi. Am J Clin Nutr 72, 247S256S.
Cardoso M, Ferreira M, Camargo L & Szarfarc S (1994) Anaemia, iron deficiency and malaria in a rural community in Brazilian Amazon. Eur J Clin Nutr 48, 326332.
Cook JD, Flowers CH & Skikne BS (2003) The quantitative assessment of body iron. Blood 101, 33593364.
Dean AG, Dean JA, Coulombier D, et al. (1995) Epi Info Version 6: A Word-processing, Database and Statistics Program for Public Health on IBM-compatible Microcomputer. Atlanta, GA: Center for Disease Control and Prevention.
Dugdale M (2001) Anemia. Obstet Gynecol Clin North Am 28, 363381.
Field A (2005) Discovering Statistics Using SPSS for Windows, 2nd ed., London: Sage Publications.
Fleming A (1981) Haematologic manifestations of malaria and other parasitic diseases. Clin Haematol 10, 9831011.
Food and Agriculture Organization & World Health Organization (1998) Requirement of Vitamin A, Iron, Folate and Vitamin B12. FAO Food and Nutrition Series no. 32. Rome: FAO.
Gamble M, Palafox N, Dancheck B, Ricks M, Briand K & Semba R (2004) Relationship of vitamin A deficiency, iron deficiency, and inflammation to anemia among preschool children in the Republic of the Marshall Islands. Eur J Clin Nutr 58, 13961401.
Gibson RS (2005) Principles of Nutrition Assessment, 2nd ed., Oxford: Oxford University Press.
Heil W, Koberstein R & Zawta B (2000) Reference Ranges for Adults and Children: Pre-Analytical Considerations no. 133. Mannheim: Roche Diagnostics.
Hoa DT (2002) Effect of fortified biscuit with vitamin A and iron on vitamin A status and anemia in primary school children in sub-urban Vietnam. PhD Thesis, : Hanoi Medical University.
Hodge LM, Mrinaro M, Jones HP, McGhee JR, Kiyono H & Simecka JW (2001) Immunoglobulin A (IgA) responses and IgE-associated inflammation along the respiratory tract after mucosal but not systemic immunization. Infect Immun 69, 23282338.
Hoffbrand A & Pettit J (1993) Essential Haematology. Oxford: Blackwell Scientific Publications.
Hurrell R (1997) Preventing iron deficiency through food fortification. Nutr Rev 55, 210222.
INACG (2002) Anemia, Iron Deficiency and Iron Deficiency Anemia. Washington, DC: ILSI Research Foundation.
JECFA (1974) Toxicological Evaluation of Some Food Additives Including Anticaking agents, Antimicrobials, Antioxidants, Emulsifiers and Thickening Agents. Joint FAO/WHO Expert Committee on Food Additives. WHO Technical Report Series no. 539. Geneva: World Health Organization.
Kling P, Roberts R & Widness J (1998) Plasma transferrin receptor levels and indices of erythropoiesis and iron status in healthy term infants. J Pediatr Hematol Oncol 20, 309314.
Layrisse M, Aparcedo L, Martinez C & Roche M (1967) Blood loss due to infection with Trichuris trichiura. Am J Trop Med Hyg 16, 613619.
Le HT (1999) Nutritional status and related factors of primary school children in Hanoi and sub urban Hanoi. Masters Thesis, Hanoi Medical University.
Le HT (2006) Anemia among schoolchildren in Vietnam: the efficacy of iron fortification. PhD Thesis, Wageningen University.
Le HT, Brouwer ID, Verhoef H, Khan NC & Kok FJ (2005) Determinants of anaemia in infection-prone school children in rural Vietnam. S Afr J Clin Nutr 49, 140.
Looker A, Dallman P, Carroll M, Gunter E & Johnson C (1997) Prevalence of iron deficiency in the United States. JAMA 277, 973976.
Malope BI, MacPhail AP, Alberts M & Hiss DC (2001) The ratio of serum transferrin receptor and serum ferritin in the diagnosis of iron status. Br J Haematol 115, 84–89.
Means RJ (2000) The anaemia of infection. Baillieres Best Pract Res Clin Haematol 13, 151162.
Ninh NX, Khan NC & Khoi HH (2001) Micronutrient deficiencies and strategies for their control in Vietnam. In 20 Years of Prevention and Control of Micronutrient Deficiency in Vietnam, pp. 24–33 [NX Ninh, NC Khan, HH Khoi and NT Lam, editors]. Hanoi: Medical Publishing House.
Olsen A, Nawiri J & Friis H (2000) The impact of iron supplementation on reinfection with intestinal helminths and Schistosoma mansoni in western Kenya. Trans R Soc Trop Med Hyg 94, 493499.
Osório MM (2002) Determinant factors of anemia in children. J Pediatr 78, 269–278.
Pedersen S, Saeed I, Friis H & Michaelsen KF (2001) Effect of iron deficiency on Trichuris suis and Ascaris suum infections in pigs. Parasitology 122, 589598.
Phillips R & Pasvol G (1992) Anaemia of Plasmodium falciparum malaria. Baillieres Best Pract Res Clin Haematol 5, 315–330.
Ritchie B, McNeil Y & Brewster D (2004) Soluble transferrin receptor in Aboriginal children with a high prevalence of iron deficiency and infection. Trop Med Int Health 9, 96–105.
Sheppard L & Henion J (1997) Quantitative capillary electrophoresis/ion spray tandem mass spectrometry determination of EDTA in human plasma and urine. Analyt Chem 69, 29012907.
Skikne B, Flowers C & Cook JD (1990) Serum transferrin receptor: a quantitative measure of tissue iron deficiency. Blood 75, 1870–1876.
Stephenson LS (1987) The Impact of Helminth Infection on Human Nutrition. London: Taylor & Francis.
Stephenson LS, Holland CV & Cooper ES (2000) The public health significance of Trichuris trichiura. Parasitology 121, S73–S95.
Stoltzfus R, Chwaya H, Montresor A, Albonico M, Savioli L & Tielsch J (2000) Malaria, hookworms and recent fever related to anemia and iron status indicators in 0- to 5-y Zanzibari children and these relationships change with age. J Nutr 130, 17241733.
Stoltzfus R, Chwaya H, Tielsch J, Schulze K, Albonco M & Savioli L (1997) Epidemiology of iron deficiency anemia in Zanzibari school children: the importance of hookworms. Am J Clin Nutr 65, 153–159.
Thurlow RA, Winichagoon P, Green T, Wasantwisut E, Pongcharoen T, Bailey KB & Gibson RS (2005) Only a small proportion of anemia in northeast Thai schoolchildren is associated with iron deficiency. Am J Clin Nutr 82, 380387.
Tomkins A (2005) Environment, Season and Infection. Cambridge: Cambridge University Press.
World Health Organization (1987) Prevention and Control Intestinal Parasitic Infections. Report of a WHO Expert Committee. Technical Report Series no. 749. Geneva: WHO.
World Health Organization (1991) Basic Laboratory Methods in Medical Parasitology. Geneva: WHO.
World Health Organization (1995) Physical Status, the Use and Interpretation of Anthropometry. WHO Technical Report Series no. 854. Geneva: WHO.
World Health Organization (2000) Iron Deficiency Anaemia: Assessment, Prevention and Control. Geneva: WHO.
Yip R & Dallman PR (1988) The roles of inflammation and iron deficiency as causes of anemia. Am J Clin Nutr 48, 12951300.
Zimmermann MB, Molinari L, Staubli-Asobayire F, Hess SY, Chaouki N, Adou P & Hurrell RF (2005) Serum transferrin receptor and zinc protoporphyrin as indicators of iron status in African children. Am J Clin Nutr 81, 615–623.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Full text views

Total number of HTML views: 7
Total number of PDF views: 98 *
Loading metrics...

Abstract views

Total abstract views: 173 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 18th November 2017. This data will be updated every 24 hours.