Ferrous sulfate 150mg / Folic acid 500microgram modified-release capsules

Nutritional deficiencies are prevalent in populations across the world. Fortification of staple foods has been used as an alternative to supplementation to address many deficiencies. One such staple is salt, which has long been fortified with iodine, but more recently with iron, folate, and other micronutrients. Our objective was to determine the effects of fortified salt on nutritional and health outcomes among children, adolescents, and adults. We conducted a systematic review of published and unpublished literature using a pre-defined search strategy. Abstracts and full texts were screened for randomized trials, quasi-randomized trials, and pre-post-designs of double or multiple fortified salt. We calculated the weighted pooled effect sizes for the effects of fortified salt on nutritional and health outcomes. Of the 395 studies identified, 33 (including 37 intervention-control comparisons) fit our inclusion criteria. Of these comparisons, 26 studied the effects of salt fortified with iron and iodine [double fortified salt (DFS)], 2 studied the effects of salt fortified with folic acid and iodine, 1 studied the effect of triple fortified salt, 1 studied the effect of quadruple fortified salt, and 7 studied the effects of multiple micronutrient fortified salt (MMFS; fortified with ≥5 nutrients). Pooled effect sizes indicated positive effects from all iron-containing fortified salt on hemoglobin concentration [standardized mean difference (95% confidence interval): DFS 0.36 (0.22, 0.50), n comparisons = 26; triple fortified salt 1.56 (1.42, 1.70), n comparisons = 1; quadruple fortified salt 0.33 (0.02, 0.63), n comparisons = 1; MMFS 0.23 (0.03, 0.43), n comparisons = 6]. DFS and MMFS reduced the odds of anemia and iron deficiency (ID) anemia. MMFS improved serum folate and reduced the odds of ID. Pooled effects on biomarkers of vitamin B12, vitamin A, and zinc status varied by type of salt, but were largely not significant. Fortification of salt with iodine and iron, with and without other nutrients, is effective in increasing hemoglobin and reducing the odds of anemia and ID in population-based studies.

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This systematic review, conducted under the COST Action CA20218 "Promoting Innovation of fermented foods" (PIMENTO), aimed to evaluate whether sourdough- and regular-bread fermentation improve iron bioavailability, absorption, and status in humans. Screening of PubMed, Scopus, and Cochrane Library (January 1970-December 2024) identified 8 human intervention studies, in healthy or iron-deficient participants, that met inclusion criteria. EFSA's scientific guidance for health claim applications, which integrates product characteristics and mechanisms of action to the human studies, was followed, and the extracted data were narratively presented. Results were inconclusive as acute postprandial studies increased non-haem iron bioavailability (especially in low-phytate breads); for example, low-phytate white bread produced a greater 2 h increase in serum iron than high-phytate wholemeal bread (59 vs. 30 μg Fe/100 mL), while exogenous phytase increased iron absorption by 50% for ferrous sulfate and 61% for iron bis-glycine chelate. However, long-term trials did not improve, and in one case even decreased, ferritin and total body iron; specifically, in the low-phytate sourdough rye bread group, ferritin declined from 32 ± 7 to 27 ± 6 μg/L and total body iron from 6.9 ± 1.4 to 5.4 ± 1.1 mg/kg over 12 weeks. On the other hand, phytate reduction combined with iron fortification showed positive effects on haemoglobin or prevented iron depletion; in anaemic children, fermented amaranth bread increased haemoglobin [adjusted β = 8.9 g/L (95% CI: 3.5-14.3)] and reduced anaemia prevalence (32% vs. 56%) compared to control bread. Despite convincing mechanistic evidence that the sourdough-fermentation process in bread fabrication improves iron bioavailability, through reduction of phytate, no human studies address this research question with the appropriate control and study quality.Systematic review registrationosf.io/gzt8m.

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BACKGROUND: Iron-Folic Acid (IFA) supplementation during pregnancy is widely recommended to prevent maternal anemia and improve birth outcomes. However, the optimal formulation, dose, and frequency of IFA supplementation remain uncertain. This systematic review and meta-analysis aimed to evaluate the effect of different IFA formulations, doses, and frequencies on pregnancy and neonatal outcomes compared to Multiple Micronutrients (MMN) among pregnant women. METHODS: A comprehensive literature search was conducted across PubMed, Google Scholar, Cochrane Library, Scopus, and TRIP databases to identify pertinent studies published up to December 31st, 2023. Outcome measures includes preterm birth (PTB), stillbirths, low birth weight (LBW), small for gestational age (SGA), miscarriage rate (MR), neonatal mortality, and perinatal mortality. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated, and the quality of evidence was assessed using GRADEpro. RESULTS: Among 20 studies comparing IFA to MMN, our analysis showed a significant increased risk with LBW (RR: 1.07, 95% CI: 1.01 to 1.13, p = 0.02, I2 = 24%) associated with IFA and MMN and elevated risk of stillbirth (RR: 1.08, 95% CI: 1.00 to 1.17, p = 0.05, I2 = 19%), SGA (RR: 1.03, 95% CI: 0.99 to 1.06) compared to IFA with MMN. However, non-significant risk of PTB (RR: 0.84, 95% CI: 0.38 to 1.84) and MR (RR: 1.04, 95% CI: 0.92 to 1.16, p = 0.54) was observed with IFA as compared to MMN. Neonatal mortality and perinatal mortality also did not significantly differ between the two groups. Certain formulations and doses showed trend of risk, particularly in relation to stillbirth and SGA. CONCLUSIONS: Our findings emphasize the importance of carefully considering the potential risks and benefits of IFA supplementation in pregnancy, and suggest the need for further research to elucidate the underlying mechanisms driving these associations and to optimize supplementation strategies for maternal and neonatal health.

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Background Iron and folic acid (IFA) are essential nutrients, with deficiencies associated not only with anemia but also with other significant health consequences, including impaired cognitive development, increased susceptibility to infections, and adverse pregnancy outcomes. Despite the widespread use of IFA for management, a notable percentage of individuals failed to respond resulting in persistent anemia. This systematic review investigates the management of non-responders to oral iron and folic acid (IFA) treatment, among children under five. Non-responders are anemic individuals who do not recover after the standard IFA treatment. A comprehensive search was conducted across multiple databases including Medline, Cochrane, Embase, and Google Scholar, covering the period from January 1, 2000, to May 31, 2024. From the initial search of 14,242 studies, we conducted title and abstract screening, and 27 articles were selected for full text screening. After further exclusion, a total of 8 studies were identified, including randomized controlled trials, cohort studies, and case series. The review found that intravenous management, particularly ferric carboxymaltose, was found to be effective in cases of iron non-responsiveness. However, the causes of poor/non-responders to oral iron are less explored, indicating a need for further research. The review also identified a lack of high-quality studies on this topic. The review highlights the limited evidence on managing anemia unresponsive to oral iron, especially in low- and middle-income countries. While intravenous iron shows promise, more data is required to draw solid conclusions. Developing personalized treatment strategies is crucial to improving outcomes and addressing the global burden of anemia.

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ObjectiveTo estimate the prevalence and associated factors of anemia after Roux-en-Y gastric bypass (RYGB).MethodsA comprehensive literature search was conducted across PubMed, EMBASE, and CENTRAL from inception through 18 January 2025, utilizing search terms including anemia, anaemia, hemoglobin, haemoglobin, Hb, gastric bypass, and RYGB. Eligible studies reported anemia prevalence post-RYGB with data on either follow-up duration or Roux limb length.ResultsFrom 2787 screened records, 74 studies involving 12,262 patients met inclusion criteria. Pooled analysis revealed a 26% overall postoperative anemia prevalence. Temporal stratification revealed a progressive increase in prevalence: 15% at ≤1 year, 27% at >1-5 years, and 35% at >5 years post-surgery. Meta-regression confirmed a significant positive correlation between anemia prevalence and follow-up duration. Studies with inadequate supplementation of iron, vitamin B12, and folic acid reported higher anemia rates compared to those with adequate supplementation. Etiological analyses identified strong associations of anemia with vitamin B12 and iron deficiencies, but not with folic acid deficiency. Demographic risk factors included preoperative anemia, female sex, and baseline BMI >45 kg/m 2 . RYGB with longer Roux limbs showed a trend toward higher anemia risk.ConclusionThis study quantifies a substantial burden of anemia following RYGB, demonstrating its temporal progression. The findings underscore the necessity for protocolized long-term hematologic surveillance, optimized nutrient repletion strategies targeting iron and vitamin B12, and personalized risk mitigation approaches for high-risk cohorts, particularly women and those with long Roux limbs, preoperative anemia, or severe obesity.

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An estimated 40% of pregnant women worldwide are anaemic, of which 80% live in low- and middle-income countries (LMICs). The reality of finite health budgets, particularly in low-resource settings, means that interventions used for screening, diagnosing, and treating anaemia in pregnancy need to be informed by cost-effectiveness evidence. We conducted a systematic review to identify all studies evaluating the cost-effectiveness of managing anaemia in pregnancy. We searched two health economics (NHS EED and EconLit) and four medical (MEDLINE, Embase, CINAHL Plus and CENTRAL) databases for relevant studies published up to the 9th of August 2024. Studies were eligible if they conducted an economic evaluation of any intervention used in the management of anaemia in pregnancy regardless of aetiology, provided that anaemia was a specified outcome. Data were extracted and study quality assessed by two independent reviewers using the extended CHEC-E tool. Due to significant heterogeneity, data were analysed narratively. 19 eligible cost-effectiveness studies were identified. Nine studies related to iron deficiency anaemia, finding that intravenous rather than oral iron supplements were cost-effective in most instances. Multiple micronutrient supplements were also found to be cost-effective compared to iron and folic acid supplements. Ten studies related to malaria-related anaemia, identifying several cost-effective antimalarial regimens; both preventative and therapeutic. Cost-effective delivery channels of antimalarials as well as non-pharmacological interventions were also identified. This review identifies several avenues through which the management of anaemia in pregnancy can be optimised from an economic perspective. Despite this, there is a significant deficit of cost-effectiveness evidence relating to this condition, which limited the deduction of cost-effectiveness for many of the interventions assessed.

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Anemia prevalence in Indian pregnant women remains at 52.2% (The National Family Health Survey-5), necessitating rigorous comparison of standard versus newer iron formulations to optimize treatment in India. To evaluate the comparative effectiveness of oral and parenteral iron preparations in Indian pregnant women, focusing on hemoglobin and serum ferritin improvement. We searched PubMed, Embase, Cochrane Library, and Google Scholar for Randomized Controlled Trials (RCTs) published up to 2024. Only RCTs from India were included. Data from 17 trials (N = 2,228) were synthesized using network meta-analysis to estimate mean differences (MDs) in hemoglobin and serum ferritin levels. Within oral formulations, newer salts significantly outperformed the standard of care; specifically, ferrous asparto glycinate demonstrated the highest hemoglobin improvement (MD: 1.21 g/dL; 95% confidence interval [CI] 0.04-2.38) (hypothesis-generating; small sample), followed by ferrous bisglycinate and iron polymaltose complex, compared to ferrous sulfate. Among parenteral formulations, iron sucrose emerged as the superior agent (MD: 0.76 g/dL; 95% CI 0.52-1.00) for hemoglobin recovery. While the comparison between modes confirmed the known superiority of parenteral over oral iron (MD: 0.88 g/dL at 4 weeks), the network ranking highlights that newer oral molecules offer significantly better efficacy than the current standard, ferrous sulfate. Iron sucrose shows the highest efficacy for rapid hemoglobin correction. Among oral options, ferrous asparto glycinate, ferrous bisglycinate, and iron polymaltose complex provide better hemoglobin improvement than ferrous sulfate. These findings support a review of iron-molecule choices within the Anemia Mukt Bharat strategy. PROSPERO Registration Number: CRD42024570537.

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Ferric carboxymaltose (FCM) is widely used to correct anemia and replenish iron stores rapidly, particularly in Western populations. However, lower doses of FCM are typically used in East Asia, with limited research on their effectiveness, especially in postpartum women. This randomized controlled trial aimed to assess the efficacy of low-dose FCM compared with oral ferrous sulfate in increasing postpartum hemoglobin (Hb) levels and replenishing iron stores in East Asian women. Sixty postpartum women with Hb levels < 10 g/dL and serum ferritin ≤ 30 ng/mL were randomized to receive either intravenous FCM (500 mg at baseline and 2 weeks) or oral ferrous sulfate (210 mg daily for 4 weeks). The primary outcome was the increase in Hb levels at 2 weeks post-enrollment. Secondary outcomes included serum ferritin, transferrin saturation, the Edinburgh Postnatal Depression Scale (EPDS) score, and adverse events at 4 weeks. The FCM group demonstrated a significantly greater increase in Hb levels at 2 weeks (mean difference 0.42 g/dL; 95% CI: 0.12-0.72; P =  0.006), with markedly higher ferritin (adjusted mean difference 356.0 ng/mL; 95% CI: 321.0-403.0; P <  0.001) and transferrin saturation (adjusted mean difference 10.76%; 95% CI: 4.20-17.31; P =  0.002) at 4 weeks. Although there was no significant difference in final Hb levels at 4 weeks (mean difference 0.36 g/dL; 95% CI: -0.01-0.72; P =  0.055), the FCM group had a lower median EPDS score (median difference -3.0; 95% CI: -5.0 to -1.0; P =  0.002) and fewer gastrointestinal side effects, including constipation and nausea. Hypophosphatemia occurred asymptomatically in three patients in the FCM group. These findings suggest that low-dose FCM infusion is highly effective in increasing Hb levels at 2 weeks post-enrollment, with fewer gastrointestinal side effects and higher ferritin levels observed at 4 weeks post-enrollment compared with oral ferrous sulfate. This study was registered at the UMIN Clinical Trials Registry, which meets the requirements of the ICMJE, on December 1, 2021 (ID: UMIN000046049).

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