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Iron is involved in the transport of oxygen and cellular respiration as a component of hemoglobin, myoglobin and the enzymes: cytochrome oxidase, peroxidase and catalase.

Physiology

In the gut, ferric iron is converted to ferrous iron (the soluble form) in the presence of the acidic pH of the stomach. Luminal iron-binding proteins facilitate the absorption of iron across the intestinal mucosa. Iron is stored in the body as ferritin and hemosiderin in the liver, bone marrow and spleen. A significant portion of iron in the body is a component of hemoglobin and myoglobin. The remainder is bound to iron transport proteins and enzymes.

Food Sources

Heme iron is best absorbed and is found in red meats and liver, heart and kidney. Less bioavailable sources of iron include green leafy vegetables and whole grain cereals.

Deficiency

A deficiency of iron may lead to anemia with physical signs including weakness, fatigue, poor …

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Articles:

2) Presented at the FASB Experimental Biology conference in Orlando, Florida, 2001:

PART 1. RANDOMIZED PROSPECTIVE CONTROLLED TRIAL OF FERROUS SULFATE DROPS VERSUS MICRONENCAPSULATED FERROUS FUMARATE ‘SPRINKLES’ FOR TREATMENT OF ANEMIA IN GHANAIAN INFANTS AND YOUNG CHILDREN. Stanley Zlotkin, Paul Arthur, Kojo Yeboah Antwi, George Yeung. Dept of Paediatrics and Nutr Sci, Hosp For Sick Children, U of Toronto, Toronto, Canada M5R1L9, London School of Hygiene & Trop Med, London, UK, Kintampo Health Res. Centre, Min. of Health, Ghana.>> Background: The standard therapy for anemia in infants is ferrous sulfate drops (DROPS) administered 3-times daily. Unfortunately, adherence to treatment is often poor in both developed and developing countries. One reason for the lack of success is the unpleasant side-effects associated with the use of this form of iron. AIM: In this study we evaluated the use of a new form of iron,
dosing schedule and delivery system to treat …

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Function

Folate is involved in DNA synthesis. It is involved in cell division and replication. The active form in the body is tetrahydrofolic acid (THFA), which is involved in certain biological reactions including amino acid conversions.

Physiology

Folic acid is synthesized by intestinal microflora of the colon. It is stored in the liver and other body tissues. Excretion occurs through feces and urine.

Food Sources

Sources of folate include liver, organ meats, yeast, dark green leafy vegetables, legumes, nuts, whole grain cereals, eggs and fruit.

Deficiency

Deficiencies result in fatigue, insomnia, and anemia. Folate deficiency is particularly high in developing countries such as India, especially in pregnant and lactating women. Deficiency results in anemia (megaloblastic neurocytic), glossitis (inflammation of the tongue), gastrointestinal disturbances, diarrhea, malabsorption and mood changes. Deficiency during pregnancy may result in neurotube defects in newborns.…

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Effectiveness Study:

A study looking at the operational feasibility of an intervention under normal or field conditions.

Efficacy Study:

A study looking at the technical feasibility, where a meaningful response to treatment or intervention is sought under closely supervised conditions.

Dissolution Studies:

Laboratory based studies looking at the solubility of pharmaceutical compounds.

Bitot’s Spots:

Superficial foamy patches forming on the eye. These resemble small dark spots on the whites of the eyes.

Xerophthalmia:

Dryness resulting from inadequate function of the lacrimal glands, which supply water to produce tears.

Bioavailability

The amount of a compound absorbed into the body.…

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Study 1: Efficacy of Sprinkles to treat anemia (Completed)

A clinical trial testing the efficacy of Sprinkles in treating iron deficiency anemia (IDA) was conducted in Ghana where more than 80% of children are anemic. This trial was performed in the field study area of the Kintampo Health Research Centre, located in the Kintampo district of Ghana, West Africa.

557 infants, 6-18 months of age with hemoglobin levels between 70-99 g/L, were randomized to receive either iron Sprinkles plus ascorbic acid (80 mg elemental iron) once per day or ferrous sulphate drops (40 mg elemental iron) 3 times per day for a total of 2 months. Hemoglobin and serum ferritin concentrations were assessed at baseline and after two months of treatment.

At the end of the treatment period, it was found that iron Sprinkles were as efficacious as ferrous sulphate drops, the gold standard, in treating IDA. Successful treatment of …

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For the past 150 years or more, oral ferrous sulphate drops or syrup has been the primary source of iron for the treatment (and prevention) of iron deficiency anemia. When a soluble form or iron (such as ferrous sulphate) is ingested in the proper dose, this intervention is effective. However, adherence to long-term ingestion of oral drops is often poor because of the unpleasant metallic taste of drops; drops can stain a baby’s teeth unless wiped off immediately after use; and if the dose is high, the infant may complain of abdominal discomfort.

Supplefer Sprinkles was specifically developed to improve adherence (ie. acceptance and use). Compared to drops or syrup,
Sprinkles are easier to use. The table below exemplifies this point. Sprinkles may provide a possible
solution to the problem of adherence and a valuable supplementation method (Taken from Zlotkin, 2002-Editorial).

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Mathematical Modeling

Once efficacy is demonstrated by conducting numerous studies in different geographical areas, program planning and implementation must be examined. Owing to the high prevalence of anemia in most developing countries, such a program must be targeted to all children less than three years of age. For large scale community based intervention, individualized screening procedure for IDA is not possible because: (a) there is no single marker for IDA; and (b) multiple marker studies will be very expensive. Therefore all children will receive iron intervention and a single safe dose is desired that is effective for all ‘at risk’ children under the age of 3 years. Such an ideal dose is challenging to compute, particularly because of the unique and complex metabolism of iron, and the changing needs of iron in rapidly growing children.

While dosing and frequency issues remain unresolved, the conventional approach to these challenges has been …

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Articles:

1) Zlotkin S, Arthur P, Antwi KY, Yeung G. Treatment of anemia with microencapsulated ferrous fumarate plus ascorbic acid supplied as sprinkles to complementary (weaning) foods. Am J Clin Nutr. 2001 Dec;74(6):791-5.

2) Zlotkin S, Arthur P, Antwi KY, Yeung G. Randomized, controlled trial of single versus 3-times-daily ferrous sulfate drops for treatment of anemia. Pediatrics. 2001 Sep;108(3):
613-6.

3) Zlotkin S, Arthur P, Schauer C, Antwi K, Yeung G, Piekarz A. Home-Fortification with Iron and Zinc Sprinkles Alone Successfully treats anemia in infants and young children. Journal of Nutrition. January 2003, 133: 1075-1080.

4) Zlotkin S. (editorial) Current issues for the prevention and treatment of iron deficiency anemia. Indian Pediatrics. February 2002; 39:125-129.
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5) Zlotkin S. Clinical Nutrition: 8. The role of nutrition in the prevention of iron deficiency anemia in infants, children and adolescents. Canadian Medical Association Journal. January 2003; 168(1):59-63.
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6) Zlotkin …

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Benin and Vietnam (Contact: Claudia Schauer; Planning Stage)

In developing countries of Asia and Africa prevalence of anemia ranges from 45 to 76% and weaning infants, adolescent girls and women of reproductive age (WRA) are at particular risk. The etiology of anemia in both Benin and Vietnam is multifactorial thereby, necessitating interventions to address multiple causes of anemia to achieve the desired results.

We are evaluating a combination of interventions to reduce iron deficiency and anemia in Benin and Vietnam. In each country we will test iron cooking pots as well as one dietary intervention, (Sprinkles) and one public health intervention (anti-helminth).

Phase I: Field-based qualitative research will be carried out to determine which interventions are most acceptable and affordable. In addition, a lab-based study will be conducted to determine the increase in iron content and to estimate bioavailability of iron from typical weaning foods and traditional family foods cooked …

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