Relation between the response to iron supplementation and sickle cell hemoglobin phenotype in preschool children in western Kenya

Terlouw, Anja ORCID: https://orcid.org/0000-0001-5327-8995, Desai, M. R., Wannemuehler, K. A., Kariuki, S. K., Pfeiffer, C. M., Kager, P. A., Shi, Y. P. and terKuile, Feiko ORCID: https://orcid.org/0000-0003-3663-5617 (2004) 'Relation between the response to iron supplementation and sickle cell hemoglobin phenotype in preschool children in western Kenya'. American Journal of Clinical Nutrition, Vol 79, Issue 3, pp. 466-472.

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Abstract

Background: Iron supplementation has been associated with greater susceptibility to malaria and lower hematologic responses in pregnant Gambian women with sickle cell trait (HbAS) than in similar women with the normal (HbAA) phenotype. It is not known whether a similar interaction exists in children.
Objective: Our aim was to determine the influence of the HbAS phenotype on hematologic responses and malaria after iron supplementation in anemic (hemoglobin: 70-109 g/L) children aged 2-35 mo.
Design: We conducted a double-blind, randomized, placebo-controlled trial (HbAS, n = 115; HbAA, n = 408) of intermittent preventive treatment with sulfadoxine pyrimethamine (IPT-SP) at 4 and 8 wk and daily supervised iron for 12 wk.
Results: The mean difference in hemoglobin concentrations at 12 wk between children assigned iron and placebo iron, after adjustment for the effect of IPT-SP, was 9.1 g/L (95% CI: 6.4, 11.8) and 8.2 g/L (4.0, 12.4) in HbAA and HbAS children, respectively (P for interaction = 0.68). Although malaria parasitemia and clinical malaria occurred more often in HbAS children in the iron group than in those in the placebo iron group, this difference was not significant; incidence rate ratios were 1.23 (95% CI: 0.64, 2.34) and 1.41 (0.39, 5.00), respectively. The corresponding incidence rate ratios in HbAA children in the same groups were 1.07 (95% Cl: 0.77, 1.48) and 0.59 (0.35, 1.01), respectively. The corresponding interactions between the effects of iron and hemoglobin phenotype were not significant.
Conclusions: There was no evidence for a clinically relevant modification by the hemoglobin S phenotype of the effects of iron supplementation in the treatment of mild anemia. The benefits of iron supplementation are likely to outweigh possible risks associated with malaria in children with the HbAA or HbAS phenotype.

Item Type:	Article
Uncontrolled Keywords:	iron supplementation; sickle cell hemoglobin; hemoglobin malaria; children; africa; treated bed nets; perennial malaria transmission; longitudinal cohort area; mortality; anemia; morbidity; site; epidemiology; deficiency
Subjects:	QU Biochemistry > Vitamins > QU 145 Nutrition. Nutritional requirements WC Communicable Diseases > Tropical and Parasitic Diseases > WC 765 Prevention and control WH Hemic and Lymphatic Systems > Hematologic Diseases. Immunologic Factors. Blood Banks > WH 170 Hemolytic anemia (e.g., Sickle cell anemia) WS Pediatrics > Diseases of Children and Adolescents > By System > WS 300 Hemic and lymphatic system
Digital Object Identifer (DOI):	https://doi.org/10.1093/ajcn/79.3.466
Depositing User:	Ms Julia Martin
Date Deposited:	12 Dec 2011 15:43
Last Modified:	05 Dec 2024 14:36
URI:	https://archive.lstmed.ac.uk/id/eprint/2106

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