AnaemiA | Figure 1
Case Report: Anaemia
56 yo female with severe iron deficiency anaemia - Hb 60. No symptoms or signs of bleeding. Normal scopes and Pill cam. Received iron infusion but now becoming iron deficient again. History of rheumatoid arthritis - on methotrexate and plaquenil.
Any suggestions on next step? Renal imaging? Referral to hematology? Pan scan? Thanks.
Review of Multiple Micronutrient Fortification
Review question
Does multiple micronutrient fortification improve health?
Background
Vitamins and minerals are essential for growth and body functioning. Micronutrient deficiencies are prevalent in many populations, and food fortification is one of the interventions to mitigate the impact of these deficiencies and enhance health. Food fortification involves adding micronutrients to processed foods. Studies have examined various forms of micronutrient fortification, including single, dual, and multiple micronutrient fortification, involving zinc, iron, selenium, vitamin A, vitamin B complexes, vitamin C, and vitamin E.
Study Characteristics
We included 43 studies (48 papers) involving 19,585 participants (17,878 children) in this review. The evidence is current as of August 2018. Most studies assessed the effects of food fortification with micronutrients compared to a placebo or no intervention; some compared it with iodised salt or calcium-only fortification.
Key Results
- MMN fortification may reduce overall anaemia by 32% and iron deficiency anaemia by 72%.
- Notable reductions in micronutrient deficiencies include:
- Iron deficiency by 56%
- Vitamin A deficiency by 58%
- Vitamin B2 deficiency by 64%
- Vitamin B6 deficiency by 91%
- Vitamin B12 deficiency by 58%.
- Positive effects on child growth were observed.
However, the effect of MMN on zinc deficiency and child growth based on height is uncertain.
Quality of the Evidence
The evidence quality was assessed as low to very low due to methodological limitations, potential biases, high heterogeneity, and small sample sizes. While some positive effects were noted for MMN fortification, lack of information on side effects and potential factors affecting efficacy complicate the results. Further subgroup analyses could not be performed adequately due to limited studies in certain areas, leaving results uncertain due to low evidence quality.