Randomized controlled trial assessing the efficacy of a reusable fish-shaped iron ingot to increase hemoglobin concentration in anemic, rural Cambodian women

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dc.contributor.authorRappaport, A.
dc.contributor.authorWhitfield, K.
dc.contributor.authorChapman, G.
dc.contributor.authorYada, R.
dc.contributor.authorKheang, K.
dc.contributor.authorLouise, J.
dc.contributor.authorSummerlee, A.
dc.contributor.authorArmstrong, G.
dc.contributor.authorGreen, T.
dc.date.issued2017
dc.descriptionFirst published online June 14, 2017
dc.description.abstractBackground: Anemia affects 45% of women of childbearing age in Cambodia. Iron supplementation is recommended in populations in which anemia prevalence is high. However, there are issues of cost, distribution, and adherence. A potential alternative is a reusable fish-shaped iron ingot, which, when added to the cooking pot, leaches iron into the fluid in which it is prepared.Objective: We sought to determine whether there was a difference in hemoglobin concentrations in rural Cambodian anemic women (aged 18-49 y) who cooked with the iron ingot or consumed a daily iron supplement compared with a control after 1 y.Design: In Preah Vihear, 340 women with mild or moderate anemia were randomly assigned to 1) an iron-ingot group, 2) an iron-supplement (18 mg/d) group, or 3) a nonplacebo control group. A venous blood sample was taken at baseline and at 6 and 12 mo. Blood was analyzed for hemoglobin, serum ferritin, and serum transferrin receptor. Hemoglobin electrophoresis was used to detect structural hemoglobin variants.Results: Anemia prevalence was 44% with the use of a portable hemoglobinometer during screening. At baseline, prevalence of iron deficiency was 9% on the basis of a low serum ferritin concentration. There was no significant difference in mean hemoglobin concentrations between the iron-ingot group (115 g/L; 95% CI: 113, 118 g/L; P = 0.850) or iron-supplement group (115 g/L; 95% CI: 113, 117 g/L; P = 0.998) compared with the control group (115 g/L; 95% CI: 113, 117 g/L) at 12 mo. Serum ferritin was significantly higher in the iron-supplement group (73 μg/L; 95% CI: 64, 82 μg/L; P = 0.002) than in the control group at 6 mo; however, this significance was not maintained at 12 mo (73 μg/L; 95% CI: 58, 91 μg/L; P = 0.176).Conclusions: Neither the iron ingot nor iron supplements increased hemoglobin concentrations in this population at 6 or 12 mo. We do not recommend the use of the fish-shaped iron ingot in Cambodia or in countries where the prevalence of iron deficiency is low and genetic hemoglobin disorders are high. This trial was registered at clinicaltrials.gov as NCT02341586.
dc.description.statementofresponsibilityAviva I Rappaport, Kyly C Whitfield, Gwen E Chapman, Rickey Y Yada, Khin Meng Kheang, Jennie Louise, Alastair J Summerlee, Gavin R Armstrong, and Timothy J Green
dc.identifier.citationAmerican Journal of Clinical Nutrition, 2017; 106(2):667-674
dc.identifier.doi10.3945/ajcn.117.152785
dc.identifier.issn0002-9165
dc.identifier.issn1938-3207
dc.identifier.orcidLouise, J. [0000-0001-5785-0290]
dc.identifier.orcidGreen, T. [0000-0002-0667-4300]
dc.identifier.urihttp://hdl.handle.net/2440/107072
dc.language.isoen
dc.publisherAmerican Society for Nutrition
dc.rights© 2017 American Society for Nutrition
dc.source.urihttps://doi.org/10.3945/ajcn.117.152785
dc.subjectanemia
dc.subjectCambodia
dc.subjecthemoglobin
dc.subjectinflammation
dc.subjectiron deficiency
dc.subjectiron ingot
dc.subjectLucky Iron Fish
dc.subjectrandomized controlled trial
dc.subjectserum ferritin
dc.subjectwomen of reproductive age
dc.titleRandomized controlled trial assessing the efficacy of a reusable fish-shaped iron ingot to increase hemoglobin concentration in anemic, rural Cambodian women
dc.typeJournal article
pubs.publication-statusPublished

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