The Inclusion of Folic Acid in Weekly Iron-Folic Acid Supplements Confers no Additional Benefit on Anemia Reduction in Nonpregnant Women: A Randomized Controlled Trial in Malaysia

Samson KLI; Loh SP; Lee SS; Sulistyoningrum DC; Khor GL; Mohd Shariff ZB; Ismai IZ; Makrides M; Hutcheon JA; Roche ML; Green TJ; Karakochuk CD

doi:10.1093/jn/nxab115

The Inclusion of Folic Acid in Weekly Iron-Folic Acid Supplements Confers no Additional Benefit on Anemia Reduction in Nonpregnant Women: A Randomized Controlled Trial in Malaysia

Samson KLI ¹ , Loh SP ² , Lee SS ² , Sulistyoningrum DC ³ , Khor GL ² , Mohd Shariff ZB ² Show all authors , Ismai IZ ² , Makrides M ³ , Hutcheon JA ⁴ , Roche ML ⁵ , Green TJ ³ , Karakochuk CD ¹

Affiliations

¹ Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada
² Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
³ SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
⁴ BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
⁵ Nutrition International, Ottawa, Ontario, Canada

J Nutr, 2021 Aug 07;151(8):2264-2270.

PMID: 33978167 DOI: 10.1093/jn/nxab115

Abstract

BACKGROUND: Weekly iron-folic acid (IFA) supplements are recommended for all menstruating women in countries where anemia prevalence is ≥20%; however, it is unknown whether the inclusion of folic acid in weekly IFA supplements reduces anemia.

OBJECTIVES: We examined whether the inclusion of folic acid in weekly IFA supplements conferred any benefit on hemoglobin (Hb) concentration, anemia reduction, or iron status [ferritin and soluble transferrin receptor (sTfR)], over iron alone.

METHODS: In this secondary analysis of a randomized controlled trial in Malaysia, n = 311 nonpregnant women (18-45 y old) received 60 mg Fe with either 0, 0.4, or 2.8 mg folic acid once-weekly for 16 wk. Fasting blood was collected at baseline and 16 wk. A generalized linear model (normal distribution with identity link) was used to assess Hb concentration at 16 wk (primary outcome).

RESULTS: At baseline, 84% of women had low folate status (plasma folate 0.05). Baseline plasma folate concentration did not modify the effect of treatment on Hb concentration at 16 wk. Among all women, the risks of anemia [risk ratio (RR): 0.65; 95% CI: 0.45, 0.96; P = 0.03] and iron deficiency based on ferritin (RR: 0.30; 95% CI: 0.20, 0.44; P

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.