BMJ 2002;325:1142 ( 16 November )

Papers

Effect of iron supplementation on incidence of infectious illness in children: systematic review

Tarun Gera, senior resident,  H P S Sachdev, professor. 

Division of Clinical Epidemiology, Department of Paediatrics, Maulana Azad Medical College, New Delhi 110002, India

Correspondence to: H P S Sachdev E-6/12, Vasant Vihar, New Dehli 110057, India hpssachdev{at}hotmail.com

Objective: To evaluate the effect of iron supplementation on the incidence of infections in children.
Design: Systematic review of randomised controlled trials.
Data sources: 28 randomised controlled trials (six unpublished and 22 published) on 7892 children.
Interventions: Oral or parenteral iron supplementation or fortified formula milk or cereals.
Outcomes: Incidence of all recorded infectious illnesses, and individual illnesses, including respiratory tract infection, diarrhoea, malaria, other infections, and prevalence of positive smear results for malaria.
Results: The pooled estimate (random effects model) of the incidence rate ratio (iron v placebo) was 1.02 (95% confidence interval 0.96 to 1.08, P=0.54; P<0.0001 for heterogeneity). The incidence rate difference (iron minus placebo) for all recorded illnesses was 0.06 episodes/child year (0.06 to 0.18, P=0.34; P<0.0001 for heterogeneity). However, there was an increase in the risk of developing diarrhoea (incidence rate ratio 1.11, 1.01 to 1.23, P=0.04), but this would not have an overall important on public health (incidence rate difference 0.05 episodes/child year, -0.03 to 0.13; P=0.21). The occurrence of other illnesses and positive results on malaria smears (adjusted for positive smears at baseline) were not significantly affected by iron administration. On meta-regression, the statistical heterogeneity could not be explained by the variables studied.
Conclusion: Iron supplementation has no apparent harmful effect on the overall incidence of infectious illnesses in children, though it slightly increases the risk of developing diarrhoea.

What is already known on this topic Iron supplementation is recommended to prevent iron deficiency, which is a major health problem, especially in the developing countries Conflicting data exist regarding the possibility of an increase in the incidence of infections with iron supplementation, resulting in concern about the safety of this intervention What this study adds Iron supplementation has no apparent harmful effect on the overall incidence of infectious illnesses in children Iron administration increases the risk of developing diarrhoea Fortification of foods may be the safest and most beneficial mode of supplementation in relation to infectious illnesses

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Iron supplementation and infection: another important issue remains to be answered

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What about parenteral iron in Neonates?

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Analysis failed to take account of clustering

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Reply to Two Rapid Responses

tarun gera, et al.
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Re: Analysis failed to take account of clustering

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bmj.com, 20 Dec 2002 [Full text]

Iron supplementation - weigh the balance!

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