Ferrous sulfate and elemental iron
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Comparative Efficacy and Safety of Ferrous Sulfate and Elemental Iron
Introduction to Iron Supplementation
Iron deficiency anemia (IDA) is a prevalent condition worldwide, particularly affecting women and children. Various forms of iron supplements, including ferrous sulfate and elemental iron, are used to address this deficiency. This article synthesizes research findings on the efficacy and safety of these iron supplements.
Efficacy of Ferrous Sulfate in Treating Anemia
Ferrous Sulfate vs. Elemental Iron in Wheat-Based Snacks
A study conducted on Thai women compared the efficacy of wheat-based snacks fortified with ferrous sulfate, electrolytic iron, and hydrogen-reduced iron. The results showed that all three forms significantly improved iron status, with ferrous sulfate being the most effective. The relative efficacy of electrolytic and hydrogen-reduced iron compared to ferrous sulfate was 77% and 49%, respectively.
Single vs. Multiple Daily Doses of Ferrous Sulfate
In a trial involving anemic infants in Ghana, researchers compared the efficacy of single-dose versus three-times-daily ferrous sulfate drops. Both regimens resulted in similar rates of successful anemia treatment, suggesting that a single daily dose could improve adherence without compromising efficacy.
Ferrous Sulfate vs. Ferrous Bisglycinate in Pregnancy
A study on pregnant women found that ferrous bisglycinate (25 mg/day) was as effective as ferrous sulfate (50 mg/day) in preventing iron deficiency and anemia. Additionally, ferrous bisglycinate caused fewer gastrointestinal complaints, indicating it might be a preferable option for pregnant women.
Ferrous Sulfate vs. Iron Polysaccharide Complex in Children
Research comparing ferrous sulfate with iron polysaccharide complex in children with nutritional IDA found that ferrous sulfate led to a greater increase in hemoglobin levels and a higher rate of complete anemia resolution. This suggests that ferrous sulfate is more effective for treating IDA in children.
Safety and Side Effects of Iron Supplements
Gastrointestinal Side Effects
Ferrous sulfate is known to cause gastrointestinal side effects, which can affect adherence to treatment. Studies have shown that ferrous bisglycinate and iron polysaccharide complexes may be better tolerated, with fewer reports of gastrointestinal issues .
Free Radical Generation
A study on healthy volunteers indicated that ferrous sulfate supplementation increased the free radical-generating capacity of feces, which could potentially lead to mucosal cell damage or increased carcinogen production in the colon. This highlights a potential risk associated with ferrous sulfate supplementation.
Iron Absorption in Special Populations
In patients on continuous ambulatory peritoneal dialysis (CAPD), the absorption of both ferrous sulfate and polysaccharide ferric complex was poor, suggesting that alternative iron supplementation strategies might be needed for this population.
Conclusion
Ferrous sulfate remains a highly effective treatment for iron deficiency anemia, particularly in children and pregnant women. However, its gastrointestinal side effects and potential for increasing free radical generation in the colon are notable concerns. Alternatives like ferrous bisglycinate and iron polysaccharide complexes offer similar efficacy with potentially better tolerability. Further research is needed to optimize iron supplementation strategies, particularly for special populations and long-term use.
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