We investigated the effect of oral iron (Fe), with or without multiple micronutrients (MMN), on hemoglobin (Hb) concentration among anemic Cambodian women, which has important policy implications for effective anemia reduction.
In this 2×2 factorial double-blind randomized controlled trial, 809 non-pregnant women (18-45 y) with Hb =117 g/L (HemoCueÂ®) were convenience sampled from 26 villages in Kampong Chhnang province and randomized to receive 12 wk of daily oral Fe (60 mg), MMN (14 nutrients excluding Fe), Fe+MMN, or placebo. Adjusted generalized linear mixed-effects models were used for analyses.
Baseline anemia prevalence (Hb <120 g/L) was 58% (n=468/808) based on a complete blood count. Iron deficiency was 25% and 22% based on sTfR (>8.3 mg/L) and inflammation-adjusted ferritin (<15 µg/L), respectively. Mean adjusted Hb concentration at 12 wk did not significantly differ between Fe and Fe+MMN groups (120.9 vs. 122.9 g/L); and both were higher than MMN and placebo groups (116.3 and 116.2 g/L; P<0.05). Mean (95% CI) adjusted Hb difference between Fe+MMN and Fe groups was not significant (1.7 [-0.3, 3.7] g/L; P=0.09). âAt the marginsâ factorial analysis showed mean (95% CI) adjusted Hb difference at 12 wk was 5.6 (3.8, 7.4) g/L (P<0.001) among all women who received Fe (with or without MMN; n=383) and 1.1 (-0.7, 2.9) g/L (P=0.24) among women who received MMN (with or without Fe; n=382), with no significant interaction between groups (P=0.61).
Daily oral Fe supplementation significantly increased Hb concentrations in non-pregnant Cambodian women after 12 wk; however, inclusion of MMN did not confer additional benefit.