Comparison of Iron alone and Zinc Plus Iron Supplementation Effect on the Clinical and Laboratory Features of Children with Iron Deficiency Anemia

  • Borhan Moradveisi Cancer and Immunology Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
  • Parin Yazdanifard Besat Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
  • Nima Naleini Besat Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
  • Mohsen Sohrabi Besat Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
Keywords: Anemia; Iron-deficiency Anemia; Iron; Zinc


Background: Childhood Iron deficiency anemia is one of the main health problems around the world especially underdeveloped countries. Supplementation with micronutrients specifically iron supplementation can be considered as a therapeutic strategy to prevent and treatment of this type of anemia. The aim of the present study is to compare the therapeutic effects of zinc plus iron and iron alone supplementation on the clinical and laboratory features of children with iron deficiency anemia referred to our Hospital in 2016.

Materials and Methods: 88 patients aged 6 months to 4 years old with iron deficiency anemia and after applying exclusion criteria were enrolled in the study. Patients were randomly divided into two groups to receive zinc plus iron sulfate or iron sulfate alone supplement for one month. After treatment, clinical symptoms and lab test data including CBC, TIBC and serum iron and ferritin levels were again evaluated. Statistical analyses were performed using SPSS15.

Results: After one month of treatment, the clinical symptoms relived significantly in both groups. Also, there was significant changes between the mean value of laboratory parameters before and after treatment within each group (P <0.05). However, after one month of treatment there was no significant difference between the two groups (P> 0.05).

Conclusion: The study revealed both iron alone and zinc plus iron supplementation are effective on the treatment of iron deficiency anemia but there are no significant difference and preference between these two types of treatment.


1-Rush D. Nutrition and maternal mortality in the developing world. The American journal of clinical nutrition. 2000; 72(1):212s-40s.
2-Kliegman RM, Behrman RE, Jenson HB, Stanton BM. Nelson Textbook of Pediatrics E-Book: Elsevier Health Sciences; 2007.
3-Hess SY, Lönnerdal B, Hotz C, Rivera JA, Brown KH. Recent advances in knowledge of zinc nutrition and human health. Food and nutrition bulletin. 2009; 30(1_suppl1):S5-S11.
4-Anderson GJ, Frazer DM, McLaren GD. Iron absorption and metabolism. Current opinion in gastroenterology. 2009; 25(2):129-35.
5-Silva DG, Priore SE, Franceschini SdC. Risk factors for anemia in infants assisted by public health services: the importance of feeding practices and iron supplementation. Jornal de pediatria. 2007; 83(2):149-56.
6-Organization WH. Iron deficiency anemia: assessment, prevention and control: a guide for programme managers. 2001.
7-Sherry B, Mei Z, Yip R. Continuation of the decline in prevalence of anemia in low-income infants and children in five states. Pediatrics. 2001; 107(4):677-82.
8-Shams S, Asheri H, Kianmehr A, Ziaee V, Koochakzadeh L, Monajemzadeh M, et al. The prevalence of iron deficiency anaemia in female medical students in Tehran. Singapore medical journal. 2010; 51(2):116.
9-Derakhshan S, Derakhshan R. The prevalence of Iron deficiency anemia in 4-6 years old children of kindergardens at Rafsanjan City in 2006. 2007.
10-Motlagh ME, Mardani M. Anemia and Iron deficiency anemia in Lorestan province. Feyz Journal of Kashan University of Medical Sciences. 1999;3.
11-Heidarnia A, Jalili Z, Dabiri S, Farahmandinia Z, Mohammad-Alizadeh S. The prevalence of Iron deficiency anemia in 1-5 years old children referring to Kerman medical care and health centers in 1998. Journal of Kerman university of medical sciences. 1999; 6(4):214-21.
12-Poskitt EM. Early history of iron deficiency. British journal of hematology. 2003; 122(4):554-62.
13-Kumar A, Rai AK, Basu S, Dash D, Singh JS. Cord blood and breast milk iron status in maternal anemia. Pediatrics. 2008; 121(3):e673-e7.
14-Subramaniam G, Girish M. Iron deficiency anemia in children. The Indian Journal of Pediatrics. 2015; 82(6):558-64.
15-Dijkhuizen MA, Wieringa FT, West CE, Martuti S. Effects of iron and zinc supplementation in Indonesian infants on micronutrient status and growth. The Journal of nutrition. 2001; 131(11):2860-5.
16-Brunner C, Wuillemin W. Iron deficiency and iron deficiency anemia-symptoms and therapy. Therapeutische Umschau Revue therapeutique. 2010; 67(5):219-23.
17-Oski FA, Honig AS, Helu B, Howanitz P. Effect of iron therapy on behavior performance in nonanemic, iron-deficient infants. Pediatrics. 1983; 71(6):877-80.
18-Akman M, Cebeci D, Okur V, Angin H, Abali O, Akman A. The effects of iron deficiency on infants' developmental test performance. Acta Paediatrica. 2004; 93(10):1391-6.
19-Ekiz C, Agaoglu L, Karakas Z, Gurel N, Yalcin I. The effect of iron deficiency anemia on the function of the immune system. The Hematology Journal. 2005; 5(7):579-83.
20-Gera T, Sachdev H. Effect of iron supplementation on incidence of infectious illness in children: systematic review. Bmj. 2002; 325(7373):1142.
21-Maguire JL, Parkin PC. Association between iron-deficiency anemia and stroke in young children. Pediatrics. 2007; 120(5):1053-7.
22-Lund EK, Wharf SG, Fairweather-Tait SJ, Johnson IT. Oral ferrous sulfate supplements increase the free radical–generating capacity of feces from healthy volunteers. The American journal of clinical nutrition. 1999; 69(2):250-5.
23-Killip S, Bennett JM, Chambers MD. Iron deficiency anemia. American family physician. 2007;75.
24-Khoshfetrat M, Klantari N, Mohammadi Nasrabadi F, Rashidi A, Neyestani T, Abadi A. Effects of Iron Supplementation With or Without Vitamin C on Oxidative Stress and Iron Status in Iron Deficient Female College Students. Iranian Journal of Endocrinology and Metabolism. 2008; 10(1):25-33.
25-Black MM. Zinc deficiency and child development. The American journal of clinical nutrition. 1998; 68(2):464S-9S.
26-Brown KH, Peerson JM, Baker SK, Hess SY. Preventive zinc supplementation among infants, preschoolers, and older prepubertal children. Food and nutrition bulletin. 2009; 30(1_suppl1):S12-S40.
27-Fallahi a, Pouretemad h, Farhadi a. Effect of iron and zinc supplementation on academic performance of primary school children. Journal of Shahrekord University of Medical Sciences. 2009; 10(4):35-42.
28-Gülsan M, Malbora B, Avcı Z, Bayraktar N, Bozkaya İ, Özbek N. Effects of Zinc Sulfate Supplementation in Treatment of Iron Deficiency Anemia. Turkish Journal of Hematology. 2013; 30(2):144.
29-Walker CF, Kordas K, Stoltzfus RJ, Black RE. Interactive effects of iron and zinc on biochemical and functional outcomes in supplementation trials. The American journal of clinical nutrition. 2005; 82(1):5-12.
30-Muñoz EC, Rosado JL, López P, Furr HC, Allen LH. Iron and zinc supplementation improves indicators of vitamin A status of Mexican preschoolers. The American journal of clinical nutrition. 2000; 71(3):789-94.
31-Turgut S, Polat A, Inan M, Turgut G, Emmungil G, Bican M, et al. Interaction between anemia and blood levels of iron, zinc, copper, cadmium and lead in children. Indian journal of pediatrics. 2007; 74(9):827-30.
32-Allen LH, Rosado JL, Casterline JE, López P, Muñoz E, García OP, et al. Lack of hemoglobin response to iron supplementation in anemic Mexican preschoolers with multiple micronutrient deficiencies. The American journal of clinical nutrition. 2000; 71(6):1485-94.
33-Hettiarachchi M, Liyanage C, Wickremasinghe R, Hilmers D, Abrams S. The efficacy of micronutrient supplementation in reducing the prevalence of anemia and deficiencies of zinc and iron among adolescents in Sri Lanka. European journal of clinical nutrition. 2008; 62(7):856-65.
34-Zlotkin S, Arthur P, Schauer C, Antwi KY, Yeung G, and Piekarz A. Home-fortification with iron and zinc sprinkles or iron sprinkles alone successfully treats anemia in infants and young children. The Journal of nutrition. 2003; 133(4):1075-80.
35-Donangelo CM, Woodhouse LR, King SM, Viteri FE, King JC. Supplemental zinc lowers measures of iron status in young women with low iron reserves. The Journal of nutrition. 2002; 132(7):1860-4.
36-Davidson L, Almgren A, Sandström B, Hurrell RF. Zinc absorption in adult humans: the effect of iron fortification. British Journal of Nutrition. 1995; 74(3):417-25.
37-Fairweather-Tait SJ, Wharf SG, Fox TE. Zinc absorption in infants fed iron-fortified weaning food. The American journal of clinical nutrition. 1995; 62(4):785-9.
38-Sözmen EY, Kavakli K, Çetinkaya B, Akçay YD, Yilmaz D, Aydinok Y. Effects of iron (II) salts and iron (III) complexes on trace element status in children with iron-deficiency anemia. Biological trace element research. 2003; 94(1):79-85.
39-Ghosh S, Daga S, Kasthuri D, Misra R, Chuttani H. Gastrointestinal function in iron deficiency states in children. American Journal of Diseases of Children. 1972; 123(1):14-7.
40-Kolsteren P, Rahman S, Hilderbrand K, Diniz A. Treatment for iron deficiency anemia with a combined supplementation of iron, vitamin A and zinc in women of Dinajpur, Bangladesh. European journal of clinical nutrition. 1999; 53(2):102-6.
41-Murdiana A, Azis I, Saidin S, Jahari AB, Karyadi D. Vitamin A-fortified monosodium glutamate and vitamin A status: a controlled field trial. The American journal of clinical nutrition. 1988; 48(5):1265-70.
42-Alarcon K, Kolsteren PW, Prada AM, Chian AM, Velarde RE, Pecho IL, et al. Effects of separate delivery of zinc or zinc and vitamin A on hemoglobin response, growth, and diarrhea in young Peruvian children receiving iron therapy for anemia. The American journal of clinical nutrition. 2004; 80(5):1276-82.
43-Lind T, Lönnerdal B, Stenlund H, Gamayanti IL, Ismail D, Seswandhana R, et al. A community-based randomized controlled trial of iron and zinc supplementation in Indonesian infants: effects on growth and development. The American journal of clinical nutrition. 2004; 80(3):729-36.
How to Cite
Moradveisi B, Yazdanifard P, Naleini N, Sohrabi M. Comparison of Iron alone and Zinc Plus Iron Supplementation Effect on the Clinical and Laboratory Features of Children with Iron Deficiency Anemia. Int J Hematol Oncol Stem Cell Res. 13(4):220-228.
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