The effect of iron versus iron plus zinc supplementation in children with malaria
Keywords:
iron, zinc, Plasmodium falciparum, hemoglobin, serum ferritin
Abstract
Introduction Little is known about the potential interaction of ironand zinc given to increase hemoglobin and serum ferritin in chil-
dren with malaria.
Objective To study the effect of iron compared with a combination of
iron and zinc supplementation on children with falciparum malaria.
Method Children with positive Plasmodium falciparum (n=86) were
randomly assigned to a daily supplementation of 6 mg iron/kg per
day plus placebo or plus 10 mg zinc per day for 30 days. All children
were treated with the same regimen for the treatment of P. falciparum.
Venous blood samples were collected at the start and end of the
study. After 30 days of supplementation, the baseline and follow-up
blood samples were analyzed.
Results The increase of hemoglobin concentration in the iron
plus placebo group was 0.58 g/dl, while in the iron plus zinc group
was 0.09 g/dl (P<0.05). Serum ferritin concentration was high in
both groups before trial, yet there was no significant difference
after iron supplementation.
Conclusions Iron supplementation showed significant increase
in hemoglobin concentration in children with positive P. falciparum
treated with the same regimen of treatment. Supplementation of
iron alone as well as iron plus zinc had been proven ineffective to
iincrease serum ferritin in children with malaria.
References
1. Iyer JK, Shi L, Shankar AH, Sullivan DJ Jr. Zinc pro-
toporphyrin IX binds heme crystal to inhibit the pro-
cess of crystallization in Plasmodium falciparum. Mol
Med 2003;9:175-82.
2. Zinc Against Plasmodium Study Group. Effect of zinc
on the treatment of Plasmodium falciparum malaria in
children: A randomized controlled trial. Am J Clin Nutr
2002;76:805-12.
3. Hastka J, Lasserre JJ, Schwarzbeck A, Hehlmann R.
Central role of zinc protoporphyrin in staging iron de-
ficiency. Clin Chem 1994;40:768-73.
4. Brabin BJ. The role of malaria in nutritional anemias.
In: Fomon SJ, Zlotkins S, editors. Nutritional Anemias.
New York: Nestec/Raven Press; 1992. p. 65-80.
5. Fomon SJ. Iron. In: Fomon SJ, editor. Infant Nutrition.
2nd ed. Philadelphia: Saunders, 1974. p. 299-317.
6. Rettmer RL, Carlson TH, Origenes ML, Jack RM, Labb
RF. Zinc protoporphyrin/heme ratio for diagnosis of
preanemic iron deficiency. Pediatrics 1999;104:37-41.
7. Will AM. Iron metabolism, sideroblastic anemia and
iron overload. In: Lilleyman JS, Hann IM, Blanchette
VS, editors. Pediatric Hematology. 2nd ed. London:
Churchill Livingstone; 2000. p. 105-26.
8. Verhoef H, West CE, Nzyuko SM, de Vogel S, van der
Valk R, Wanga MA, et al. Intermittent administration
of iron and sulfadoxine-pyrimethamine to control
anaemia in Kenyan children: A randomized controlled
trial. Lancet 2002;360:908-14.
9. Lind T, Lonnerdal B, Stenlund H, Ismail D, Seswandhana
R, Ekstrom EC, et al. A community-based randomized
controlled trial of iron and zinc supplementation in In-
donesian infants: Interactions between iron and zinc.
Am J Clin Nutr 2003;77:883-90.
10. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn
LM, Flegal KM, Mei Z, et al. 2000 CDC growth charts
for the United States: Methods and development. Vi-
tal Health Stat 2002;246:1-90.
11. Verhoef H. Iron deficiency and malaria as determinants
of anaemia in African children [thesis]. Wageningen:
Wageningen Univ.; 2001.
12. Shankar AH. Nutritional modulation of malaria mor-
bidity and mortality. J Infect Dis 2000;182(Suppl1):
S37-53.
13. Oski FA. Nutritional anemias. In: Walker WA, Watkins
JB, editors. Nutrition in pediatrics basic science and clini-
cal application. 1st ed. Toronto: Little Brown. p. 107-26.
14. Dallman PR, Yip R, Oski FA. Iron deficiency and re-
lated nutritional anemias. In: Nathan DG, Oski FA,
editors. Hematology of infancy and childhood. 4th ed.
Philadelphia: Saunders; 1993. p. 413-46.
15. Gibson RS. Principles of nutritional assesment. New
York: Oxford University Press; 1990. p. 349-76.
16. Stoltzfus RJ, Chwaya HM, Albonico M. Serum
feritin, erythrocyte protoporphyrin and hemoglobin
are valid indicators of iron status of school children
in a malaria-holoendemic population. J Nutr
1997;127:293-8.
17. O’Brien RT. Hematologic manifestation of chronic sys-
temic disease. In: Miller DR, Baehner RL, editors.
Blood diseases of infancy and childhood. 7th ed. St
Louis: Mosby; 1995. p. 539-41.
18. Labbe RF, Vreman HJ, Vreman, Stevenson DK. Zinc
protoporphyrin: A metabolite with a mission. Clin
Chem 1999;12:2060-72.
19. INACG Expert Panel. Safety of iron supplementation
programs in malaria-endemic regions. INACG consen-
sus statement. Washington: International Nutritional
Anaemia Consultative Group, 1999.
20. Yulizar. Manfaat suplementasi besi pada penderita
malaria falciparum yang mendapat pengobatan anti
malaria dengan parameter gambaran hemogram [the-
sis]. Medan: North Sumatera Univ.; 2003.
toporphyrin IX binds heme crystal to inhibit the pro-
cess of crystallization in Plasmodium falciparum. Mol
Med 2003;9:175-82.
2. Zinc Against Plasmodium Study Group. Effect of zinc
on the treatment of Plasmodium falciparum malaria in
children: A randomized controlled trial. Am J Clin Nutr
2002;76:805-12.
3. Hastka J, Lasserre JJ, Schwarzbeck A, Hehlmann R.
Central role of zinc protoporphyrin in staging iron de-
ficiency. Clin Chem 1994;40:768-73.
4. Brabin BJ. The role of malaria in nutritional anemias.
In: Fomon SJ, Zlotkins S, editors. Nutritional Anemias.
New York: Nestec/Raven Press; 1992. p. 65-80.
5. Fomon SJ. Iron. In: Fomon SJ, editor. Infant Nutrition.
2nd ed. Philadelphia: Saunders, 1974. p. 299-317.
6. Rettmer RL, Carlson TH, Origenes ML, Jack RM, Labb
RF. Zinc protoporphyrin/heme ratio for diagnosis of
preanemic iron deficiency. Pediatrics 1999;104:37-41.
7. Will AM. Iron metabolism, sideroblastic anemia and
iron overload. In: Lilleyman JS, Hann IM, Blanchette
VS, editors. Pediatric Hematology. 2nd ed. London:
Churchill Livingstone; 2000. p. 105-26.
8. Verhoef H, West CE, Nzyuko SM, de Vogel S, van der
Valk R, Wanga MA, et al. Intermittent administration
of iron and sulfadoxine-pyrimethamine to control
anaemia in Kenyan children: A randomized controlled
trial. Lancet 2002;360:908-14.
9. Lind T, Lonnerdal B, Stenlund H, Ismail D, Seswandhana
R, Ekstrom EC, et al. A community-based randomized
controlled trial of iron and zinc supplementation in In-
donesian infants: Interactions between iron and zinc.
Am J Clin Nutr 2003;77:883-90.
10. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn
LM, Flegal KM, Mei Z, et al. 2000 CDC growth charts
for the United States: Methods and development. Vi-
tal Health Stat 2002;246:1-90.
11. Verhoef H. Iron deficiency and malaria as determinants
of anaemia in African children [thesis]. Wageningen:
Wageningen Univ.; 2001.
12. Shankar AH. Nutritional modulation of malaria mor-
bidity and mortality. J Infect Dis 2000;182(Suppl1):
S37-53.
13. Oski FA. Nutritional anemias. In: Walker WA, Watkins
JB, editors. Nutrition in pediatrics basic science and clini-
cal application. 1st ed. Toronto: Little Brown. p. 107-26.
14. Dallman PR, Yip R, Oski FA. Iron deficiency and re-
lated nutritional anemias. In: Nathan DG, Oski FA,
editors. Hematology of infancy and childhood. 4th ed.
Philadelphia: Saunders; 1993. p. 413-46.
15. Gibson RS. Principles of nutritional assesment. New
York: Oxford University Press; 1990. p. 349-76.
16. Stoltzfus RJ, Chwaya HM, Albonico M. Serum
feritin, erythrocyte protoporphyrin and hemoglobin
are valid indicators of iron status of school children
in a malaria-holoendemic population. J Nutr
1997;127:293-8.
17. O’Brien RT. Hematologic manifestation of chronic sys-
temic disease. In: Miller DR, Baehner RL, editors.
Blood diseases of infancy and childhood. 7th ed. St
Louis: Mosby; 1995. p. 539-41.
18. Labbe RF, Vreman HJ, Vreman, Stevenson DK. Zinc
protoporphyrin: A metabolite with a mission. Clin
Chem 1999;12:2060-72.
19. INACG Expert Panel. Safety of iron supplementation
programs in malaria-endemic regions. INACG consen-
sus statement. Washington: International Nutritional
Anaemia Consultative Group, 1999.
20. Yulizar. Manfaat suplementasi besi pada penderita
malaria falciparum yang mendapat pengobatan anti
malaria dengan parameter gambaran hemogram [the-
sis]. Medan: North Sumatera Univ.; 2003.
Published
2016-10-18
How to Cite
1.
Lubis B, Dasraf D, Rosdiana N, Lubis B, Lubis M, Pasaribu S, Lubis C. The effect of iron versus iron plus zinc supplementation in children with malaria. PI [Internet]. 18Oct.2016 [cited 25Nov.2024];46(1):7-2. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/847
Section
Articles
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Received 2016-10-10
Accepted 2016-10-10
Published 2016-10-18
Accepted 2016-10-10
Published 2016-10-18
