Do ponto de vista nutricional, quando a maternidade ocorre na adolescência, soma-se à já elevada demanda de ferro decorrente do crescimento de um organismo jovem, aquela relacionada ao processo gestacional, fatores que combinados aumentam de forma substancial o risco da instalação de um quadro de deficiência de ferro e anemia. Considerando os escassos trabalhos realizados nessa área e as conseqüências danosas do desenvolvimento de um quadro de anemia durante a gestação, planejou-se este estudo com o objetivo de caracterizar o estado nutricional referente ao ferro, no decorrer do processo gestacional de adolescentes, analisando a interferência da idade (16anos) no estado nutricional relativo ao ferro. Estudou-se uma amostra de 155 adolescentes que se encontravam em diferentes semanas gestacionais, atendidas no serviço de assistência pré-natal do Amparo Maternal Sociedade Civil Beneficiente. A população foi caracterizada em relação à situação sócio-econômica, à vida sexual e reprodutiva e ao estado nutricional. Determinou-se a concentração de ferritina sérica (FS), saturação de transferrina (ST), zinco protoporfirina (ZPP) e hemoglobina (Hb) para avaliar a ocorrência de ferro-depleção, ferro-deficiência e anemia. Verificou-se que as gestantes pertenciam, em sua maioria, a famílias de baixa renda, eram solteiras, não tinham o primeiro grau completo e já não freqüentavam mais a escola. Tinham iniciado a vida sexual, em média aos 15 anos, a maioria era primigesta, não utilizava método anticoncepcional e havia procurado assistência pré-natal no segundo ou terceiro trimestre. Apenas um terço das adolescentes com mais de 20 semanas de gestação referiram ingestão de sulfato ferroso. O peso pré-gestacional referido revelou que cerca de 15 por cento delas havia iniciado a gravidez desnutridas e a mesma proporção foi verificada no momento da entrevista. O consumo médio de ferro foi de 18,4mg (61 por cento de adequação), sendo que mais da metade das adolescentes sequer havia consumido 60 por cento da recomendação, mas apresentava consumo sistemático de feijão e carne. Verificou-se diminuição importante nas reservas de ferro, a partir da 21 a semana de gestação, identificada pela concentração de FS, semana a partir da qual cerca de 60 por cento das gestantes apresentaram-se ferro-depletadas (FS<l2,0ug/L). Cerca de 50 por cento das adolescentes estudadas eram ferro-deficientes, de acordo com os dois indicadores determinados (ST e ZPP), situação que se mostrou mais severa no final do processo gravídico, quando mais de dois terços das gestantes encontravam-se nessa condição. A anemia, diagnosticada pela concentração de hemoglobina (Hb<11,0g/dl) foi detectada em 14,2 por cento da população estudada, variando de zero nas primeiras 12 semanas de gestação, a 22,2 por cento no período de 33 a 36 semanas. Mesmo não se verificando diferença estatisticamente significante entre os dois grupos etários estudados, os dados evidenciam que as adolescentes com idade <16 anos apresentaram um padrão distinto de demanda de ferro durante o processo gestacional, mostrando uma necessidade maior do primeiro para o segundo trimestre, o que tendeu a ocorrer do segundo para o terceiro trimestre no grupo de mais idade. Esses dados sugerem que nas mais jovens, a demanda gestacional é somada àquela própria do organismo em crescimento. Os resultados obtidos ressaltam a importância de uma assistência pré-natal de boa qualidade, que além da suplementação de ferro deve envolver um programa de educação para a saúde que conscientize a população sobre a necessidade do uso do suplemento e saliente os riscos decorrentes da deficiência de ferro. Mais do que isso, enfatiza a importância da assistência integral à saúde do adolescente, uma vez que o estado nutricional pré-gestacional mostrou ser fundamental na ocorrência da deficiência de ferro e da anemia. / From a nutritional perspective, teenage pregnancy represents an increase to the already great need of iron due to the growing process of an young body. These two factors substantially increase the risks of iron defficiency and anemia. The lack of studies in this field and the important consequences of the anemia during the pregnancy motivated the present study. Its objective is to verify the nutritional status, conceming the iron, during the pregnancy o f teenagers, correlating age (16 years old) and nutritional status. A sample of 155 teenagers of different gestational ages attending to a health care center was studied. Their social status, their sexual behaviour, their reproductive story and their nutritional status were characterized. Their serical ferritine (SF), tranferrine saturation (TS), zinc protoporphyrin (ZPP) and hemoglobin (Hb) were analysed to verify the presence of iron depletion, defficiency or anemia. The results showed the majority of these teenagers were single, belonged to low-income families, had less than eight years o f school and no longer attended the school. They had their first sexual intercourse near the age of 15, without using contraceptive method. That was their first pregnancy and they look for prenatal care when they were in the second or third trimester of pregnancy. Only 1/3 of those who had more of 20 weeks of pregnancy took ferrous sulfate. About 15 per cent of then began the pregnancy undemourished and the same amount of undemutrition was found at the moment of the interview. Their medium consumption ofiron was 18,4mg (61 per cent ofthe recommended). More than 50 per cent ofthem had a consumption of less than 60 per cent the recommended, although they declared to eat meat and beans regularly. The SF behaviour resulted in an intense mobilization of the iron resources during the second half of pregnancy, period wich approximately 60 per cent of the pregnants presented absense of iron stores. Iron deficiency determined by indicators (TS and ZPP) affecting 50 per cent of the pregnant teenagers and this situation got worse during the pregnancy, affecting 2/3 of them in the last month (36 weeks). Anemia was detected by the Hb concentration in 14,2 per cent of the teenagers. It was found a variation of this value between O - 22,2 per cent in the first twelve weeks until 33 to 36 weeks of the pregnance, respectivelly. Although there wasn\'t a significative difference between the two groups studied, data revealed that those teenagers <16 years old showed a distinct pattern of iron need during the pregnancy, with a greater need of iron during the transition from the first to the second trimester. On the other hand, those over 16 exhibit this greater need in the second to third trimester. This data suggest that in the young adolescents the mineral was used to face the needs of a still immature body. The results point out the important of a good prenatal care, able to offer iron supplementation and, moreover, to develop an educational program to promote the subjects\' understanding about the need of supplementation and the risks of iron deficiency. More than this, this study emphasizes the importance o f the global assistance of the adolescent\'s health, once pre-conceptional nutritional status showed to be of great importance in the prevalence of the iron deficiency and anemia.

A anemia ferropriva é o problema nutricional de maior prevalência atualmente no mundo. Sua ocorrência é considerada maior nos países em desenvolvimento, onde 36 por cento da população apresenta essa patologia. No Brasil uma parcela considerável da população está afetada. Em São Paulo o quadro não é diferente: 35 por cento das crianças de seis a sessenta meses do município de São Paulo apresentavam anemia por carência de ferro na década de oitenta. Em Osasco, município da área metropolitana de São Paulo, 51 por cento dos escolares de sete a oito anos são anêmicos. Com o objetivo de verificar o papel da alimentação como um dos determinantes da anemia prevalente entre adolescentes do município de Osasco - São Paulo (Brasil), foram estudados 509 escolares das quintas e oitavas séries de escolas da Rede Pública de Ensino de Osasco. A prevalência de anemia, identificada através da determinação da concentração de hemoglobina do sangue em amostras colhidas por punção digital, pelo método da cianometahemoglobina, foi baixa (5,3 por cento ), não havendo diferença entre os sexos. O perfil nutricional, identificado através de medidas antropométricas, revelou que 17,3 por cento dos adolescentes se localizaram abaixo do percentil 10 para peso/idade e 4,7 por cento abaixo do percentil 3. A proporção de desnutridos foi maior entre os alunos das quintas séries. Os homens apresentaram-se em piores condições nutricionais do que as mulheres. A prática alimentar, conhecida através do registro dos alimentos consumidos pelos alunos em três dia alternados, mostrou-se semelhante àquela encontrada em São Paulo em 1974/75. Foi observado pequeno consumo de alimentos fonte de vitamina C (elemento importante na absorção de ferro) e a tendência da substituição do jantar tradicional por um lanche. A maior parte dos adolescentes tem consumo energético adequado e de ferro, inadequado. A dieta consumida pelos adolescentes pode ser considerada de boa qualidade, justificando a baixa prevalência de anemia encontrada, embora a pequena densidade do ferro e do ferro biodisponível da dieta seja um indicador da provável existência de indivíduos deficientes em ferro em proporção apreciável na população. / Iron deficiency anemia is currently the most prevalent nutritional problem in the world. Its incidence is more significant in developing countries, where 36 per cent of the population develops this pathology. A substancial part of Brazilian population is affected by it. Even in the State of São Paulo the situation is the same: 35 per cent o f the children aged six to sixty months had iron deficiency anemia in the 80\'s in the city of São Paulo; and in Osasco, a town in the metropolitan area of São Paulo, 51 per cent of the school children aged 7-8 are anemic. Aiming at assessing the role of the diet as one of the determining causes for the anemia which is prevalent among teenagers in the town of Osasco, State of São Paulo, Brazil, a study was carried out with 509 students from 5th and 8th grade in the public school network in Osasco. The prevelence of anemia was checked through blood hemoglobin sampling, using digital puncture and the cyanomethahemoglobin method. The results have shown a discrete 5,3 per cent , regardless the sex o f the students. The nutritional profile, identified through anthropometric measurement, indicated that 17,3 per cent of the teenagers were under percentil 10 for weight/age and 4,7 per cent under percentile 3. The proportion of undernourished youngsters was higher among students in 5th grade. Boys showed worse nourishment conditions than girls. The nutritional practice, known through the records of the teenagers\' food intake during three alternating days, proved similar to that of 1974/75, in São Paulo. It was noted that the intake of foods containing Vitamin C is low - Viatmin C being an important element for the absortion of iron - and there is a trend of replacing the traditional dinner by a light meal. Most teenagers\' energy intake is adequa te whereas iron\'s is inadequate. The teenagers\' diet may be considered good, thus explaining the discrete prevalence of anemia among this group. Nevertheless, the low density of iron and bioavaiable iron in the diet are indications of the probable substantial proportion of iron deficient teenagers among the population.

Background and Objectives: It is estimated that over 40% of children in Ecuador are anemic. Anemia in children can influence physical and cognitive development and have lasting effects on adulthood productivity and quality of life. The objectives of this study were to: (1) evaluate the relationship of anemia and cognitive function, and (2) determine the influence of demographic factors on cognitive function. Population and Setting: The sample consisted of 175 school-aged children between 5 to 11 years old attending a school in a poverty stricken area of Guayaquil, Ecuador. Methods: A descriptive correlational cross sectional design was used to study the relationship between the level of anemia and the level of cognitive function. Other demographic factors were evaluated to determine their influence on cognitive function. Data were collected at the school using the Raven's Coloured Progressive Matrices to measure cognitive function and the STAT-Site MHgb Meter to measure hemoglobin levels. Results: No significant correlation was found between the level of anemia and cognitive function. Multiple regression analysis of demographic variables and cognitive function found age (Beta=0.56, t=8.6, p=0.000) and income (Beta=0.16, t=2.5, p=0.01) to be significant predictors of cognitive function. Interpretation and Conclusion: Many factors influence cognitive function and development. Additional research is needed to determine the effect of income level and related factors, such as parental time spent with the child doing homework, value placed on education in the home, education level of the parents, and quality of nutrition. Interventions to improve socioeconomic level, enhance parenting styles that foster cognitive development, and improve nutrition should be implemented.

Adequate nutrition is fundamental to optimal physical and cognitive growth in the second year of life. Toddlers, however, are particularly vulnerable to poor nutrition due to their high nutrient needs in relation to their body size and energy intakes. Nutrient-dense diets are therefore essential during this period. However, no practical quantitative food-based dietary guidelines directed at this age group are available to help caregivers choose nutrient-rich foods for their toddler. Such guidelines are needed not only to ensure adequate intakes of all nutrients during the period of dietary transition from infant to family foods, but also to emphasise intakes of nutrients for which toddlers are at particular risk of deficiency. Biochemical evidence suggests that iron nutrition requires special attention in New Zealand toddlers. The overall aim of this thesis was to design and assess the efficacy of practical food-based strategies for toddlers to ensure optimal nutritional status of 12-24 month old New Zealand children, with a specific focus on iron nutrition. To achieve these overall aims, the research was carried out in three stages. In the first stage, secondary data analysis of food intake data for New Zealand toddlers identified the foods commonly consumed by New Zealand toddlers, the serving sizes and frequency of consumption of these foods, and the nutrients that New Zealand toddlers are at risk of consuming in suboptimal amounts. The food intake data were obtained from 3-day weighed food intakes that had been collected on non-consecutive days in an earlier community-based cross-sectional survey of 188 randomly selected non-breastfeeding 12-24 month old urban South Island New Zealand children. In addition to describing the food consumption patterns of New Zealand toddlers, the secondary data analysis also identified that nearly 40% of New Zealand toddlers were at risk of suboptimal iron intakes. The results of these analyses were used in the second stage of the thesis to develop three food-based strategies. To do this a 4-phase approach based on linear and goal programming was used to design and hypothetically evaluate three sets of food-based strategies for 12-24 month old non-breastfeeding New Zealand children, and to identify the key problem nutrients for each set of strategies. The three sets of strategies were based on: (1) all foods consumed by toddlers including iron-fortified infant and toddler foods, (2) family foods only, or (3) family foods that are not fortified with iron. The mathematical modelling confirmed that iron was the key problem nutrient in the diets of New Zealand toddlers. The analysis showed that only food-based strategies that included a recommendation for the replacement of non-fortified cow�s milk with an iron-fortified toddler milk (500 mL), i.e. strategy set 1, achieved the Australian-New Zealand Recommended Dietary Intakes for all nutrients, including iron. In fact, inclusion of a recommendation for a substantially increased consumption of flesh foods was identified as the only possible alternative to the iron-fortified toddler milk recommendation for improving iron nutrition in New Zealand toddlers. Although the set of strategies including this flesh food recommendation did not provide as much total iron as those including the iron-fortified toddler milk recommendation, the bioavailability of the iron is likely to be greater because flesh foods provide highly bioavailable haem iron (red meat being a particularly rich source) and have an enhancing effect on the absorption of non-haem iron. The two key recommendations for achieving New Zealand toddlers� iron needs were, therefore, a recommendation to consume an iron-fortified toddler milk and a recommendation to consume substantial amounts of red meat. In the third stage, the efficacy of an increased intake of red meat or the use of an iron-fortified milk for improving biochemical iron status in healthy non-anaemic 12-20 month old New Zealand children was investigated in a 20-week partial double-blind randomised placebo-controlled intervention trial. The study also examined the effect of these two interventions on dietary iron intakes and growth, and investigated the association between the amount of meat consumed and biochemical iron parameters. Participants (n=225) were assigned to one of three groups: Meat Group (n=90), Fortified Milk Group (n=45), or Placebo Group (n=90). Children in the Meat Group were encouraged to consume two red meat dishes per day (~ 2.6 mg of iron). In the Fortified Milk Group and Placebo Group, the children�s regular milk was replaced with iron-fortified cow�s milk (1.5 mg of iron per 100 g of prepared milk), or non-fortified cow�s milk (< 0.1 mg of iron per 100 g of prepared milk), respectively. Geometric mean dietary iron intakes (95% CI) increased from 4.7 (4.1, 5.3) to 5.3 (4.7, 6.0) mg per day in the Meat Group (P=0.007), and from 4.3 (3.7, 5.0) to 10.4 (9.0, 12.2) mg per day in the Fortified Milk Group (P<0.001). These increased iron intakes differed significantly from the Placebo Group (both P<0.001), which declined from 5.1 (4.5, 5.7) to 4.6 (4.1, 5.2) mg per day during the intervention (P=0.047). Over 20 weeks, adjusted geometric mean serum ferritin concentration increased by 44% (95% CI: 14%, 82%) in the Fortified Milk Group (P=0.002), tended to decrease in the Placebo Group (14% decrease (95% CI: -27%, 1%; P=0.063)), and did not significantly change in the Meat Group (10% increase (95% CI: -7%, 30%; P=0.241)). However, because iron status declined in the Placebo Group, both groups fared significantly better than the Placebo Group: serum ferritin concentration at 20 weeks was 68% (95% CI: 27%, 124%; P<0.001) greater in the Fortified Milk Group than in the Placebo Group, and 29% (95% CI: 2%, 63%; P=0.033) greater in the Meat Group than in the Placebo Group. There were no intervention effects on haemoglobin or serum transferrin receptor concentration. The cross-sectional analysis showed that a daily intake of 1 g of red meat was associated with 0.65% (95% CI: 0.18%, 1.11%; P=0.007) higher serum ferritin concentration. No adverse effects of the interventions on the toddlers� growth were detected. In conclusion, this thesis shows that food-based strategies can be designed that, if adhered to, should ensure adequate iron status in New Zealand toddlers. Although both the iron-fortified milk recommendation and the increased red meat recommendation are likely to prevent the decline in body iron stores that can occur during the second year of life, only consumption of iron-fortified milk can successfully increase iron stores. Therefore, food-based strategies for New Zealand toddlers will need to include a recommendation that encourages the consumption of foods developed specifically for toddlers that are fortified with iron.

<p>The overall aims of the study were to determine the prevalence of anaemia in women of reproductive age and to investigate the underlying causes, as well as assess the effectiveness of antenatal care (ANC) interventions for anaemia prevention. Consecutive pregnant women booking for ANC (n=2235) were screened for anaemia, followed up and screened again late in pregnancy. Basic ANC interventions included iron and folate supplementation, malaria chemoprophylaxis and referral of severe anaemia cases, and in addition staff training and education for the women and the community at the study clinic. Non-pregnant women (n=504), adolescents: pregnant (n=76), non-pregnant (n=130), and boys (n=101) were also screened for anaemia. Haematological and biochemical investigations were made on anaemic cases.</p><p>The prevalences of anaemia and severe anaemia in pregnant women were 60% and 3.8%, respectively. The adolescent pregnant women were more anaemic, with an overall prevalence of anaemia of 76%. In the non-pregnant women the prevalence was 49%. Anaemia was more prevalent in adolescent girls than in boys, and iron deficiency was the main underlying cause in all groups. In the anaemic pregnant women, malaria and other infections were more common, and Serum ferritin therefore underestimates iron deficiency.</p><p>ANC interventions achieved a significant reduction in the prevalence of severe and moderate anaemia but only a moderate reduction in overall prevalence of anaemia. Time for treatment of anaemia during pregnancy is inadequate to correct pre-existing nutritional deficiencies, and all the underlying factors are not addressed. Anaemia control must include all women of reproductive age, starting with adolescents to build up their iron stores before pregnancy. ANC supplementation should include other nutrients, and there is also a need to identify and treat infections during pregnancy. Training of ANC providers and supervision as well as improvement in the logistics and supply supplements to the clinics needs reinforcement.</p>

The overall aims of the study were to determine the prevalence of anaemia in women of reproductive age and to investigate the underlying causes, as well as assess the effectiveness of antenatal care (ANC) interventions for anaemia prevention. Consecutive pregnant women booking for ANC (n=2235) were screened for anaemia, followed up and screened again late in pregnancy. Basic ANC interventions included iron and folate supplementation, malaria chemoprophylaxis and referral of severe anaemia cases, and in addition staff training and education for the women and the community at the study clinic. Non-pregnant women (n=504), adolescents: pregnant (n=76), non-pregnant (n=130), and boys (n=101) were also screened for anaemia. Haematological and biochemical investigations were made on anaemic cases. The prevalences of anaemia and severe anaemia in pregnant women were 60% and 3.8%, respectively. The adolescent pregnant women were more anaemic, with an overall prevalence of anaemia of 76%. In the non-pregnant women the prevalence was 49%. Anaemia was more prevalent in adolescent girls than in boys, and iron deficiency was the main underlying cause in all groups. In the anaemic pregnant women, malaria and other infections were more common, and Serum ferritin therefore underestimates iron deficiency. ANC interventions achieved a significant reduction in the prevalence of severe and moderate anaemia but only a moderate reduction in overall prevalence of anaemia. Time for treatment of anaemia during pregnancy is inadequate to correct pre-existing nutritional deficiencies, and all the underlying factors are not addressed. Anaemia control must include all women of reproductive age, starting with adolescents to build up their iron stores before pregnancy. ANC supplementation should include other nutrients, and there is also a need to identify and treat infections during pregnancy. Training of ANC providers and supervision as well as improvement in the logistics and supply supplements to the clinics needs reinforcement.

Soils in many agricultural areas have high pH, resulting in low availability of zinc and iron. Plants grown on such soils suffer from either Zn or Fe deficiency or both. The efficient plant genotypes grown normally in calcerous soils were found to evolve some strategies to acquire the iron which is in insoluble form. Iron efficient graminaceous monocots release iron chelating substances, mugineic acid family phytosiderophores (MAs), in response to iron deficiency stress. Several researchers have suggested that phytosiderophores also can play role in grass Zn nutrition and thus it may be possible that it is the uptake mechanism for Zn efficiency. Several possible genes that take role in phytosiderophore synthesis or found to be induced under iron deficient conditions were identified in several organisms but not on wheat. In this study, the efficient barley cultivar Tokak-157, efficient wheat cultivar Kira&ccedil / -66 and relatively less efficient wheat cultivar BDMM-19 were grown in normal growth conditions for 1 week and transfered to zinc deficient, iron deficient and both zinc and iron deficient nutrient solutions. After growing 1 week on these conditions, plants grown on both zinc and iron deficient nutrient solutions were retransfered to zinc and iron sufficient conditions. Degenerate primers were designed for the conserved regions of previously identified genes that take role in phytosiderophore synthesis or induced under iron deficient conditions and RT-PCRs were performed. The complete open reading frame of IDI-1(Iron deficiency induced-1) gene and the putative gene fragment for SAM-s (S-adenosylmethionine synthetase) were identified.

The most common form of nutritional deficiency worldwide is iron deficiency, which is associated with sup optimal early brain development. Literature indicates that children with a poor nutritional status during early development of the brain showed poorer cognitive functioning, deficient growth and muscle function. The first purpose of this study was to determine if iron status plays a role in motor competency. A second purpose was to determine if iron status shows an association with motor competency, behavioural characteristics and scholastic success, while a third purpose was to determine if the consumption of different teas will improve iron intake positively and consequently will improve motor development and behaviour. A test- retest research design was used in a randomised parallel study, with one group of children drinking tea and a control group drinking 'rooibos' tea. The Movement Assessment Battery for Children (MABC) (Henderson & Sugden, 1992) was used to determine the DCD (Developmental co-ordination disorder) status in the group (N = 76). In this group, 45 children were classified as children with DCD. Blood samples were taken to determine the haemoglobin, ferritin and transferrin saturation levels while a 24hr recall dietary questionnaire was used to determine nutritional intakes. Descriptive statistics, t-testing, effect sizes and analysis of co-variance were used to analyse the data. With regards to the first aim of the study, the results which were analysed by means of t-testing, effect sizes and co-variance of analysis indicated that iron deficiency showed significant relationships with Developmental Coordination Disorder (DCD). When corrected for influences other than haemoglobin on gross motor competency manual dexterity, and especially ball skills, showed significant relationships with iron deficiency. These results demonstrate the importance of proper nutrition on motor and cognitive development. With reference to the second aim of the study the assessment of children with DCD by the teachers with regard to their manual dexterity and behavioural characteristics, indicated poorer manual dexterity and more behavioural problems compared to children without DCD. The children in the DCD group was also divided into a group where the MABC-total showed improvement and their haemoglobin levels increased (n=19). This group was then compared with a group of DCD children of which the MABC total decreased and a decrease in haemoglobin was found (n=6). Although the groups were small, the results indicate that manual dexterity skills and mathematics, reading and writing was poorer in the DCD-children whose iron status decreased. No definite association between the different teas and improvement of motor development and behaviour were indicated by the results. Overall, the conclusion can be made that a relationship between iron status and Developmental Coordination Disorder (DCD) among 9-12 year old children exist. However, it is recommended that more studies of this nature should be done on school age children to substantiate the findings of this study. Intervention studies should also be implemented where the children with depleted iron anaemia status should receive iron supplementation. / Thesis (M.Sc. (Human Movement Science))--North-West University, Potchefstroom Campus, 2005.

Iron deficiency anemia (IDA) and calcium deficiency affect millions of children globally. Sprinkles is a multi-micronutrient powder (MNP) that has successfully treated anemic infants and can be modified to include additional micronutrients. The efficacy for treating IDA and preventing calcium deficiency requires evaluation due to potential nutrient interactions. We assessed the efficacy of Sprinkles MNP including iron with and without calcium on hemoglobin (Hb) response in 100 anemic rural Bangladeshi infants for 2 months. Sprinkles MNP with and without calcium resulted in a significantly higher Hb concentrations in both groups (P<0.0001 and P<0.0001). However, infants who received Sprinkles MNP without calcium had a significantly higher change in Hb concentration (P=0.024) and rate of recovery from anemia (P=0.008). No differences in socio-demographic or dietary characteristics were documented between groups. Although both groups had an improvement in Hb status, the antagonistic interaction between iron and calcium requires further study.

Iron deficiency anemia (IDA) and calcium deficiency affect millions of children globally. Sprinkles is a multi-micronutrient powder (MNP) that has successfully treated anemic infants and can be modified to include additional micronutrients. The efficacy for treating IDA and preventing calcium deficiency requires evaluation due to potential nutrient interactions. We assessed the efficacy of Sprinkles MNP including iron with and without calcium on hemoglobin (Hb) response in 100 anemic rural Bangladeshi infants for 2 months. Sprinkles MNP with and without calcium resulted in a significantly higher Hb concentrations in both groups (P<0.0001 and P<0.0001). However, infants who received Sprinkles MNP without calcium had a significantly higher change in Hb concentration (P=0.024) and rate of recovery from anemia (P=0.008). No differences in socio-demographic or dietary characteristics were documented between groups. Although both groups had an improvement in Hb status, the antagonistic interaction between iron and calcium requires further study.