Battling iron deficiency: RCT data suggests ferrous sulfate is more effective in children

By Nathan Gray contact

- Last updated on GMT

Iron-deficient children supplemented with a daily low-dose of ferrous sulfate may see better results than those given iron polysaccharide complex, according to a new RCT.

The trial data, published in JAMA, suggests that infants and children suffering from iron-deficiency anaemia would be better to receive supplementation with ferrous sulfate, despite previous suggestions that iron polysaccharide complex may be better as it is more tolerable and better tasting.

Iron-deficiency anaemia (IDA) is a global problem. In 2010 it was estimated that more than 1 billion people around the world were affected by iron-deficiency anaemia (IDA).

Led by Dr Jacquelyn Powers of the Baylor College of Medicine, the team compared supplementation of two key forms of iron that are regularly used in children suffering from IDA in a randomised trial of 80 infants and children.

The team noted that while ferrous sulfate is the most commonly used oral iron supplement, there have been suggestions that iron polysaccharide complex may be a better option in children due to it possibly being better tolerated and tasting better.

“Children supplemented with a daily low-dose of ferrous sulfate saw better results than those given iron polysaccharide complex, according to the RCT data,”​ said the team – who suggested that as such a low-dose daily supplementation of ferrous sulfate “should be considered for children with nutritional iron-deficiency anaemia.”

RCT data

Powers and her colleagues performed a double-blind, superiority randomised clinical trial of infants and children nutritional IDA (assessed by history and laboratory criteria), in which iron was supplemented for 12 weeks.

Each of the 80 children – all aged 9 months to 4 years – were randomly assigned to receive three mg per kg of elemental iron once daily – as either ferrous sulfate drops or iron polysaccharide complex drops.

“Among infants and children aged 9 to 48 months with nutritional iron-deficiency anaemia, ferrous sulfate compared with iron polysaccharide complex resulted in a greater increase in haemoglobin concentration at 12 weeks,”​ said Powers and her team.

They reported that from baseline to 12 weeks, mean haemoglobin increased from 7.9 to 11.9 g/dL for the ferrous sulfate group and 7.7 to 11.1 g/dL for iron complex group. On average, children supplemented with ferrous sulfate saw a greater difference of 1.0 g/dL, the study found.

The team added that previous studies of neurocognitive outcomes in children with IDA have shown the clinical importance that a difference of 1 g/dL – such as that found in this trial – can have.

Furthermore, they said that the proportion of infants and children with a complete resolution of IDA was higher in the ferrous sulfate group (29% vs 6%).

Despite suggestions that iron polysaccharide complex is better tolerated than ferrous sulfate, the team reported that there were significantly more reports of diarrhoea in the iron complex group (58%) than in the ferrous sulfate group (35%), Powers and colleagues added.

Source: JAMA
Published online, Open Access, doi: 10.1001/jama.2017.6846
“Effect of Low-Dose Ferrous Sulfate vs Iron Polysaccharide Complex on Hemoglobin Concentration in Young Children With Nutritional Iron-Deficiency Anemia: A Randomized Clinical Trial”
Authors: Jacquelyn M. Powers, et al

Related topics: Research

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