Is untargeted iron supplementation harmful when iron deficiency is not the major cause of anaemia? Study protocol for a double-blind, randomised controlled trial among non-pregnant Cambodian women.
Study Goal
The researchers aimed to determine if untargeted iron supplementation poses potential harm and to compare the effects of two forms of iron (ferrous sulfate and ferrous bisglycinate) versus placebo.
Results Summary
The abstract does not provide results; it describes the study design and planned measurements, including ferritin concentrations and markers of potential harm in blood and stool.
Population
Non-pregnant women aged 18-45 years in Cambodia.
Effective Dosage
60 mg elemental iron as ferrous sulfate or 18 mg ferrous bisglycinate, administered daily.
Duration
12 weeks
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
daily oral iron supplementation for 12 weeks | neutral | anaemia prevalence | women and adolescents where anaemia prevalence is greater than 40% | - | recommends | #1 |
untargeted iron supplementation | neutral | - | where iron deficiency is not a major cause of anaemia | - | is a waste of resources; at worst, it could cause harm | #2 |
different forms of iron with varying bioavailability | neutral | - | - | - | may present greater risks of harm | #3 |
untargeted iron supplementation | neutral | - | non-pregnant women (ages 18-45 years) | - | determine if there is potential harm associated with | #4 |
60 mg elemental iron as ferrous sulfate | neutral | - | non-pregnant women (ages 18-45 years) | - | receive | #5 |
18 mg ferrous bisglycinate | neutral | - | non-pregnant women (ages 18-45 years) | - | receive | #6 |
placebo | neutral | - | non-pregnant women (ages 18-45 years) | - | receive | #7 |
iron | neutral | ferritin concentration | - | - | assess the effect of | #8 |
iron | neutral | markers of potential harm | - | - | assess the effect of | #9 |
INTRODUCTION: The WHO recommends daily oral iron supplementation for 12 weeks in women and adolescents where anaemia prevalence is greater than 40%. However, if iron deficiency is not a major cause of anaemia, then, at best, untargeted iron supplementation is a waste of resources; at worst, it could cause harm. Further, different forms of iron with varying bioavailability may present greater risks of harm. METHODS AND ANALYSIS: A 12-week three-arm, double-blind, randomised controlled supplementation trial was conducted in Cambodia to determine if there is potential harm associated with untargeted iron supplementation. We will recruit and randomise 480 non-pregnant women (ages 18-45 years) to receive one of three interventions: 60 mg elemental iron as ferrous sulfate (the standard, commonly used form), 18 mg ferrous bisglycinate (a highly bioavailable iron amino acid chelate) or placebo. We will measure ferritin concentrations (to evaluate non-inferiority between the two forms of iron), as well as markers of potential harm in blood and stool (faecal calprotectin, gut pathogen abundance and DNA damage) at baseline and 12 weeks. Mixed-effects generalised linear models will be used to assess the effect of iron on ferritin concentration and markers of potential harm at 12 weeks. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of British Columbia Clinical Research Ethics Board (H18-02610), the Children's and Women's Health Centre of British Columbia Research Ethics Board (H18-02610) and the National Ethics Committee for Health Research in Cambodia (273-NECHR). Findings will be published in peer-reviewed journals, presented to stakeholders and policymakers globally and shared within participants' communities. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT04017598).