Iron supplements of no benefit to infants for their development, NEJM study
Australia: Three months of daily supplementation with iron syrup or multiple micronutrient powders did not affect child development or other functional outcomes, according to findings from a randomized, placebo-controlled trial. The findings of the study, published in the New England Journal of Medicine, involved infants in Bangladesh.
The World Health Organization (WHO) recommends the universal provision of iron supplements (drops or syrup) or multiple micronutrient powders to young children in low-to-middle-income countries where anemia is prevalent. However, there is no clarity on the functional benefits and safety of these interventions. To get some clarity on its benefits, Sant-Rayn Pasricha, the Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, and colleagues conducted a three-group, double-blind, double-dummy, individually randomized, placebo-controlled trial.
The researchers assessed the immediate and medium-term benefits and risks of 3 months of daily supplementation with iron syrup or iron-containing multiple micronutrient powders, as compared with placebo, in 8-month-old children in rural Bangladesh. 3300 infants were randomized to receive iron syrup (1101 infants), multiple micronutrient powders (1099), or placebo (1100) daily.
The primary outcome, cognitive development, was assessed by the cognitive composite score on the Bayley Scales of Infant and Toddler Development, third edition, immediately after completion of the assigned 3-month regimen; scores range from 55 to 145, with higher scores indicating better cognitive performance.
Key findings of the study include:
- After completion of the assigned 3-month regimen, no apparent effect on the cognitive composite score was observed with iron syrup as compared with placebo or with multiple micronutrient powders as compared with placebo.
- No apparent effect on any other developmental or growth outcome was observed immediately after completion of the assigned regimen or at 9 months after completion.
- At 9 months after completion of the assigned regimen, the prevalences of anemia, iron deficiency, and iron deficiency anemia increased in all three trial groups but remained lower among the children who received iron syrup or multiple micronutrient powders than among those who received placebo.
- The risk of serious adverse events and incidence of symptoms of infection were similar in the three trial groups.
The researchers concluded, "in this trial involving infants in Bangladesh, 3 months of daily supplementation with iron syrup or multiple micronutrient powders did not appear to have an effect on child development or other functional outcomes as compared with placebo."
Reference:
The study titled, "Benefits and Risks of Iron Interventions in Infants in Rural Bangladesh," is published in the New England Journal of Medicine.
DOI: https://www.nejm.org/doi/full/10.1056/NEJMoa2034187
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