Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
BMJ Glob Health. 2023 Feb;8(2). doi: 10.1136/bmjgh-2022-010745.
WHO guidelines on iron supplementation among children call for further research to identify the optimal schedule, duration, dose and cosupplementation regimen.
A systematic review and meta-analysis of randomised controlled trials was undertaken. Randomised controlled trials providing ≥30 days of oral iron supplementation versus placebo or control to children and adolescents aged <20 years were eligible. Random-effects meta-analysis was used to summarise the potential benefits and harms of iron supplementation. Meta-regression was used to estimate iron effect heterogeneity.
129 trials with 201 intervention arms randomised 34 564 children. Frequent (3-7/week) and intermittent (1-2/week) iron regimens were similarly effective at decreasing anaemia, iron deficiency and iron deficiency anaemia (p heterogeneity >0.05), although serum ferritin levels and (after adjustment for baseline anaemia) haemoglobin levels increased more with frequent supplementation. Shorter (1-3 months) versus longer (7+ months) durations of supplementation generally showed similar benefits after controlling for baseline anaemia status, except for ferritin which increased more with longer duration of supplementation (p=0.04). Moderate-dose and high-dose supplements were more effective than low-dose supplements at improving haemoglobin (p=0.004), ferritin (p=0.008) and iron deficiency anaemia (p=0.02), but had similar effects to low-dose supplements for overall anaemia. Iron supplementation provided similar benefits when administered alone or in combination with zinc or vitamin A, except for an attenuated effect on overall anaemia when iron was cosupplemented with zinc (p=0.048).
Weekly and shorter duration iron supplementation at moderate or high doses might be optimal approaches for children and adolescents at risk of deficiency.
CRD42016039948.
世界卫生组织（WHO）关于儿童铁补充剂的指南呼吁进一步研究，以确定最佳方案、持续时间、剂量和联合补充方案。
对随机对照试验进行了系统回顾和荟萃分析。合格的试验为向年龄<20 岁的儿童和青少年提供至少 30 天的口服铁补充剂与安慰剂或对照相比。使用随机效应荟萃分析总结铁补充剂的潜在益处和危害。使用元回归估计铁效应异质性。
129 项试验有 201 个干预组，共纳入 34564 名儿童。频繁（每周 3-7 次）和间歇（每周 1-2 次）补铁方案在降低贫血、缺铁和缺铁性贫血方面同样有效（p 异质性>0.05），尽管血清铁蛋白水平和（在调整基线贫血后）血红蛋白水平在频繁补充时增加更多。在控制基线贫血状态后，较短（1-3 个月）与较长（7+个月）的补充持续时间通常显示出相似的益处，除了铁蛋白，补充持续时间较长时增加更多（p=0.04）。与低剂量补充剂相比，中剂量和高剂量补充剂在改善血红蛋白（p=0.004）、铁蛋白（p=0.008）和缺铁性贫血（p=0.02）方面更有效，但对总体贫血的作用与低剂量补充剂相似。铁补充剂单独或与锌或维生素 A 联合使用时具有相似的益处，除了与锌联合使用时对总体贫血的作用减弱（p=0.048）。
对于有缺乏风险的儿童和青少年，每周和较短时间内给予中或高剂量的铁补充剂可能是最佳方法。
CRD42016039948。
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