School-administered weekly iron-folate supplements improve hemoglobin and ferritin concentrations in Malaysian adolescent girls

Background: Iron deficiency and its consequent anemia constitute the common est micronutrient deficiency in the world. Objective: We investigated whether long-term, weekly iron-folate supplement s administered at school would improve hemoglobin and ferritin concentratio ns in adolescent girls, including those with mild-to-moderate anemia and he moglobin concentrations indicating borderline anemia. Design: 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 12 0 mg Fe plus 3.5 mg folic acid weekly for 22 wk. Ninety of the girls in gro up B wi:re randomly assigned to receive only 5 mg folic acid weekly. Capill ary hemoglobin and plasma ferritin were measured at baseline and after 12 a nd 22 wk of supplementation. Results: By the end of the study, 2% of the girls had dropped out and >96% hart taken greater than or equal to 20 of the 22 tablets; side effects were minimal. Mean plasma ferritin increased significantly in all iron-suppleme nted groups, independently of initial hemoglobin values and iron doses. Fer ritin concentrations decreased in the girls supplemented with folic acid on ly. As expected, hemoglobin responses to iron were higher in group A than i n group B and increases were positively correlated with initial plasma ferr itin. Hemoglobin failed to respond to folate supplementation if initial pla sma ferritin concentrations were low. Mean hemoglobin increased significant ly and consistently in relation to the length of treatment. Conclusion: Long-term, weekly iron-folate supplementation was found to be a practical, safe, effective, and inexpensive method for improving iron nutr ition in adolescent schoolgirls.