TY - JOUR
T1 - The Inclusion of Folic Acid in Weekly Iron-Folic Acid Supplements Confers no Additional Benefit on Anemia Reduction in Nonpregnant Women
T2 - A Randomized Controlled Trial in Malaysia
AU - Li Samson, Kaitlyn
AU - Loh, Su Peng
AU - Lee, Siew Siew
AU - Sulistyoningrum, Dian C.
AU - Khor, Geok Lin
AU - Shariff, Zalilah Binti Mohd
AU - Ismai, Irmi Zarina
AU - Makrides, Maria
AU - Hutcheon, Jennifer A.
AU - Roche, Marion L.
AU - Green, Timothy J.
AU - Karakochuk, Crystal D.
N1 - Publisher Copyright:
© 2021 The Author(s). Published by Oxford University Press on behalf of the American Society for Nutrition.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - Background: Weekly iron.folic acid (IFA) supplements are recommended for all menstruating women in countries where anemia prevalence is .20%; however, it is unknown whether the inclusion of folic acid inweekly IFA supplements reduces anemia. Objectives: We examined whether the inclusion of folic acid in weekly IFA supplements conferred any benefit on hemoglobin (Hb) concentration, anemia reduction, or iron status [ferritin and soluble transferrin receptor (sTfR)], over iron alone. Methods: In this secondary analysis of a randomized controlled trial in Malaysia, n = 311 nonpregnant women (18. 45 y old) received 60 mg Fe with either 0, 0.4, or 2.8 mg folic acid once-weekly for 16 wk. Fasting blood was collected at baseline and 16 wk. A generalized linear model (normal distribution with identity link) was used to assess Hb concentration at 16 wk (primary outcome). Results: At baseline, 84% of women had low folate status (plasma folate < 14 nmol/L). At 16 wk, marginal mean (95% CI) Hb was 131 (130, 133), 131 (129, 132), and 132 (130, 133) g/L; ferritin was 58.2 (53.9, 62.5), 56.5 (52.2, 60.9), and 58.0 (53.7, 62.3) μg/L; and sTfR was 5.8 (5.5, 6.1), 5.8 (5.5, 6.1), and 5.9 (5.6, 6.2) mg/L in the 0, 0.4, and 2.8 mg/wk groups, respectively, with no differences between groups (P > 0.05). Baseline plasma folate concentration did not modify the effect of treatment on Hb concentration at 16 wk. Among all women, the risks of anemia [risk ratio (RR): 0.65; 95% CI: 0.45, 0.96; P = 0.03] and iron deficiency based on ferritin (RR: 0.30; 95% CI: 0.20, 0.44; P < 0.001) were lower at 16 wk than at baseline. Conclusions: Despite the low folate status among these nonpregnant Malaysian women, the inclusion of folic acid in weekly IFA supplements did not reduce anemia or improve iron status, over iron alone. However, the benefits of folic acid for neural tube defect prevention still warrant its retention in weekly IFA supplements.
AB - Background: Weekly iron.folic acid (IFA) supplements are recommended for all menstruating women in countries where anemia prevalence is .20%; however, it is unknown whether the inclusion of folic acid inweekly IFA supplements reduces anemia. Objectives: We examined whether the inclusion of folic acid in weekly IFA supplements conferred any benefit on hemoglobin (Hb) concentration, anemia reduction, or iron status [ferritin and soluble transferrin receptor (sTfR)], over iron alone. Methods: In this secondary analysis of a randomized controlled trial in Malaysia, n = 311 nonpregnant women (18. 45 y old) received 60 mg Fe with either 0, 0.4, or 2.8 mg folic acid once-weekly for 16 wk. Fasting blood was collected at baseline and 16 wk. A generalized linear model (normal distribution with identity link) was used to assess Hb concentration at 16 wk (primary outcome). Results: At baseline, 84% of women had low folate status (plasma folate < 14 nmol/L). At 16 wk, marginal mean (95% CI) Hb was 131 (130, 133), 131 (129, 132), and 132 (130, 133) g/L; ferritin was 58.2 (53.9, 62.5), 56.5 (52.2, 60.9), and 58.0 (53.7, 62.3) μg/L; and sTfR was 5.8 (5.5, 6.1), 5.8 (5.5, 6.1), and 5.9 (5.6, 6.2) mg/L in the 0, 0.4, and 2.8 mg/wk groups, respectively, with no differences between groups (P > 0.05). Baseline plasma folate concentration did not modify the effect of treatment on Hb concentration at 16 wk. Among all women, the risks of anemia [risk ratio (RR): 0.65; 95% CI: 0.45, 0.96; P = 0.03] and iron deficiency based on ferritin (RR: 0.30; 95% CI: 0.20, 0.44; P < 0.001) were lower at 16 wk than at baseline. Conclusions: Despite the low folate status among these nonpregnant Malaysian women, the inclusion of folic acid in weekly IFA supplements did not reduce anemia or improve iron status, over iron alone. However, the benefits of folic acid for neural tube defect prevention still warrant its retention in weekly IFA supplements.
KW - anemia
KW - folic acid
KW - iron deficiency
KW - iron-folic acid
KW - public health
KW - supplementation
KW - women's health
UR - http://www.scopus.com/inward/record.url?scp=85114069208&partnerID=8YFLogxK
U2 - 10.1093/jn/nxab115
DO - 10.1093/jn/nxab115
M3 - Article
C2 - 33978167
AN - SCOPUS:85114069208
SN - 0022-3166
VL - 151
SP - 2264
EP - 2270
JO - Journal of Nutrition
JF - Journal of Nutrition
IS - 8
ER -