Study On Effect Of Iron Supplementation To Improve Anemia Population In Shanghai

Iron deficiency anemia is one of the most common nutritional deficiency diseases worldwide, especially developing countries. World Health Organization in 2001 reports that there are about 40 billion to 50 billion people (66% to 80% of the world's population) in iron deficiency, and 20 million people with anemia (more than 30% of the world's population) are mainly due to iron deficiency, of which 90% live in developing countries. Iron deficiency anemia is especially prevalent in children, women of childbearing age and elderly. National Nutrition and Health Survey in 2002 shows that prevalence of anemia among Chinese is 20.1%(male 15.8% and female 23.3%; urban residents 18.2% and rural residents 20.8%), the prevalence of anemia in the elderly upward trend with increasing age. Iron deficiency anemia can lead to decrease physical activity, memory loss, learning efficiency low, decreased immunity and low levels of population health.【Objective】This study was designed to find out the effect of iron supplementation to improve iron deficiency anemia in children and adolescents, women of childbearing age and the elderly in Shanghai and their dietary characteristics through added iron supplementation and dietary survey, find out the total iron intake to maintain normal iron status and the effect of different dietary factors on iron deficiency anemia and analysis dietary factors which can Promote or inhibit the absorption and utilization of iron, in order to improve the health of high risk of iron deficiency anemia and provide the basis and methods for developing interventions. To prevent and reduce the incidence of iron deficiency anemia, adjusting the diet to correct irrational eating behavior, increasing iron intake and improving the bioavailability of iron can be used.【Methods】Children and adolescents group:146 subjects aged from 6 to 10 years (75 intervention group,71 control group) which were from two primary schools in Minhang District and met the requirements were recruited and were randomly divided into intervention and control groups by school units. Survey was performed with the general survey, dietary survey for three consecutive days 24 hours and physical tests. Intake of dietary energy and mainly nutrient were analyzed and evaluated by the Chinese Dietary Reference Intakes in 2000.Women of childbearing age group:74 subjects aged from 21 to 45 years which met the requirements were recruited and were randomly divided into intervention and control groups by hemoglobin. Survey was performed with the general survey, food frequency questionnaire survey and 24-hour dietary recalls. The dietary pattern was analyzed and evaluated by Dietary Guidelines for Chinese residents in 2007. Intake of dietary energy and mainly nutrient were analyzed and evaluated by the Chinese Dietary Reference Intakes in 2000.The elderly group:76 subjects aged from 60 to 79 years (25 male,51 female) which met the requirements were recruited and were intervention group. Survey was performed with the general survey, food frequency questionnaire survey and 24-hour dietary recalls. The dietary pattern was analyzed and evaluated by Dietary Guidelines for the elder in 2010. Intake of dietary energy and mainly nutrient were analyzed and evaluated by the Chinese Dietary Reference Intakes in 2000.Intervention and control groups respectively ate a pack of iron nutrition package daily (Main ingredients are iron pyrophosphate and ferrous fumarate, including elemental iron 8mg) and placebo. Both groups were intervened continuously six months to observe effect.All subjects were tested iron deficiency anemia related indicators such as hemoglobin, serum ferritin and C-reactive protein and made survey at the baseline, mid-time and final survey.【Results】Children and adolescents group:After six months, mean hemoglobin of the intervention group was from 107.0g/L significantly (P<0.01) up to 121.8 g/L, the control group from 107.8g/L significantly (P<0.01) up to 120.2g/L, no statistically difference between groups. The number of hemoglobin≥115g/L, no anemia, in intervention group and control group was respectively 57 (81.4%) and 58 (82.3%) and significantly higher than the baseline survey (P<0.01), no statistically difference between groups. After intervention, geometric mean serum ferritin of the intervention group was from 16.9ug/L significantly (P<0.01) up to 42.2g/L, the control group from 22.4ug/L significantly (P <0.01) up to 35.2g/L, no statistically difference between groups. But the rise rate of intervention group was 149.7% significantly (P<0.01) higher than control group 57.1%. The number of serum ferritin>15ug/L,adequate iron storage, in intervention group and control group was respectively 69 (98.6%) and60 (86.8%), no statistically difference between groups. More than 80% anemia students whose the average intake of calcium, zinc, VA were less than 60% of recommended intake, while many students whose energy, VB2, VC intake were less than 80%. The intake of dietary iron in intervention and control group was respectively 10.3mg/d and 11.5mg/d, the control group was significantly (P<0.01) higher than the intervention group, of which 74.8% of the iron from plant foods. Total iron intake (dietary iron plus iron supplement) showed positive correlation with hemoglobin (r=0.36, P<0.01). If children and adolescents can intake of 13.0mg iron daily, they would be able to make hemoglobin≥115g/L.Physical measurements and physical indicators of both groups were significantly increased, the increase in the intervention group was steeper. More intake of iron, VC and meat were the protective factors in children and adolescents with iron deficiency anemia (P<0.05).Women of childbearing age group:After six months, mean hemoglobin of the intervention group was from 104.9g/L significantly (P<0.01) up to 116.8g/L, the control group from 104.4g/L to 104.5g/L Final survey, the intervention were significantly (P<0.01) higher than the control. The number of hemoglobin≥120g/L, no anemia, in intervention group was 15 (44.1%) also significantly (P<0.01) higher than 5 (14.3%) of the control. The possibility of intervention group hemoglobin standard was 4.7 times the control group (95%CI:1.5-15.2). In addition, anemia-related index in the intervention group, such as HCT, MCV, MCH, and MCHC, showed an upward trend (P<0.05) and were significantly higher than the control at the final survey (P<0.01,0.01,0.01,0.01, 0.05). After six months, geometric mean of serum ferritin in the intervention group was from the 4.7ug/L significantly (P<0.01) up to 14.6ug/L, Final survey, the intervention were significantly (P<0.01) higher than the control. The number of serum ferritin>15ug/L, adequate iron storage, in intervention group was11 (35.5%) and also significantly higher than the control 4 (12.1%). The possibility of serum ferritin>15ug/L in the intervention was 4.0 times of the control group (95%CI:1.1～14.3). The average intake of energy, calcium, iron, zinc, VA, VB2, and VC in women of childbearing age with anemia was less than 80% of recommended nutrient intake. The intake of dietary iron was 14.0g/L, and significantly (P<0.05) lower than Dietary Reference Intakes. The dietary iron was mainly from plant foods. Total iron intake (dietary iron and iron supplement) showed positive correlation with hemoglobin (r= 0.57, P<0.01). If women of childbearing age can intake of 23.2mg iron daily, they would be able to make hemoglobin≥120g/L. More iron intake was the protective factors, and more menstrual blood volume and intake of dietary fiber are the risk factors of Iron deficiency anemia (P<0.05).The elderly group:The compliance of older women was better than older men. After six months, mean hemoglobin of older men was from 115.4g/L to 114.4 g/L, older women from 111.4g/L to 114.4g/L, total from 112.5g/L to 114.4g/L. There was no statistically difference. The number of hemoglobin≥120g/L or 130g/L, no anemia, was 20(32.3%), including 16(34.8%) older women. The geometric mean of serum ferritin at mid-time and final survey was respectively 55.1ug/L and 40.1ug/L and was both significantly (P<0.01) higher than the baseline survey 9.1ug/L. The number of serum ferritin>15ug/Lwas50 (80.1%), including 40(87.0%) women and 10(62.5%) men. The possibility of serum ferritin>15ug/L in older women was 4.0 times of older men (95%CI:1.1～15.1). The average intake of fruit and milk was only 67.3g and 100.3g, severely lower than recommended intake. The average intake of protein, zinc and VC were less than 80% of dietary reference intakes, while intake of VA and VB2 were generally less than 80%.74.4% of the iron was from plant foods. The total iron intake (dietary iron and iron supplement) showed positive correlation with hemoglobin (r= 0.70, P<0.01). Intake of 26.2mg iron daily, older men would be able to make hemoglobin≥130g/L and 22.3mg iron older women can keep hemoglobin≥120g/ L. More iron intake, high BMI and high intake of VC and meat were the protective factors in the elderly with iron deficiency anemia and drinking coffee and egg intake were risk factors (P<0.05).【Conclusion】Children and adolescents group:8mg of iron supplement daily for consecutive six months can improve iron deficiency anemia in children and adolescents. Intake 13.0mg iron daily can meet the need of children and adolescents.Women of childbearing age group:8mg of iron supplement daily for consecutive six months can improve iron deficiency anemia in women of childbearing age. Intake 23.2mg iron daily can meet the need of women of childbearing age.The elderly group:8mg of iron supplement daily for consecutive six months can improve iron deficiency anemia in elderly. Older men intake 26.2mg iron daily and older women intake 22.3mg iron daily can meet the need.