This document discusses iron (Fe) supplementation for pregnant mothers and children. It describes therapeutic feeding as giving food or supplements to treat diseases or poor health conditions. Both vitamin A and iron are important micronutrients. Iron deficiency is common and can impact cognitive and motor development in children. Studies in China and other countries found that iron and folic acid supplementation in pregnancy reduced anemia and improved live birth rates. A 10-year follow up study found benefits of prenatal multiple micronutrient supplements on children's development. While iron treatment can be beneficial, excess iron poses oxidative stress risks, so the appropriate dose for children requires more research. Novel delivery methods like iron fish show promise but need more evidence, especially for impacts on

1. Nutritional Intervention at a critical
condition: Iron (Fe)
Supplementation for Pregnant
Mothers and Children
Poltekkes Kemenkes Mataram
Mataram, March 8th, 2018
Emmy Kardinasari, S.Si., M.Sc.

2. What is Therapeutic Feeding?
• Therapeutic feeding is the act of giving a food or
supplementation which purpose is for healing
certain disease or poor health condition.
• This type of food is designed for a specific
purpose, containing or rich in certain nutrients
which help to improve the patients condition.
• This treatments have been applied for many
cases of malnutrition, many studies conducted
mainly in Africa, South and South East Asia.

3. Therapeutic feeding

4. Vitamin A and Iron
• Both vitamin A and iron (Fe) are
micronutrients, needed in a small amount yet
a deficiency might cause massive destruction
in the body.
• Obtained through a healthy diet.
• Essential for growth, immune system, and
managing body homeostasis.

5. Why Vitamin A?
• Vitamin A is essential for the functioning of the
immune system and the healthy growth and
development of children, and is usually acquired
through a healthy diet.
• Role of vitamin A in the body:
– Boost immune system
– Support growth, bone development
– Support vision
– Reproduction
– Cell differentiation
• Intervention in Indonesia: vitamin A supplementation
twice a year (February and August for children under 5
year-old.

6. Vitamin A rich foods

7. Vitamin A Intervention
• Supplementation for mothers susceptible to
anaemia and infectious diseases: increase
haemoglobin level and reduce risk of anaemia
(Prado et al., 2012).
• In some studies in Sub-Saharan countries: vitamin
A supplementation help to reduce risk of
morbidity and mortality (
• In Indonesia vitamin A supplementation must be
given for pregnant mothers to improve fetal
growth and immune system.

8. Why iron (Fe)?
• Iron is essential mineral, could only be obtained
through diet
• Iron has vital roles for the body
• Sufficient iron in daily diet is important to maintain
body’s homeostasis
• The iron status would affect the body’s health in
long-term

9. The Role of Iron in the Body
• Fe is the main mineral in haemoglobin, haemoglobin
binds oxygen and circulate it through the body.
About 70% of total iron in the body can be found in
blood (heme iron).

10. The Role of Iron in the Body (2)
• Iron affect the progression of central nervous
system development at gestational age
• Iron deficiency in animal models shows
alteration in the capability of producing
dopamine and norephinephrine (Beard JL,
2008)
• Iron support a proper growth, especially at
early ages.

11. Iron rich foods

12. Iron Deficiency and Development
Alteration
• It is the most common nutritional
deficiency as it affect 20-50% of
world population (Belmont MD,
2001) .
• It has been known that brain growth
spurt begins in the last trimester of
pregnancy up to 2 years of life.
• Many studies shows poor cognitive
and motor development among
children who have iron deficiency
anaemia in infancy.
• The group at risk of iron deficiency
are children at young age and women
at reproductive ages.

13. Trial of Iron Deficiency Anaemia (IDA) in pregnancy,
with follow up study in Rural China (Chang et al.,
2013)

14. • Double blind RCT
• Involved 5828 participant.
• Treatments and results:
– Folic acid (97% live births)
– Iron & folic acid (97% live births)
– Multimicronutrient (MMN) (96% live births)
• Key factors:
– Increase in nutritional, health, and sanitary
awareness
– Health promotion

15. S10Y: SUMMIT 10 Years follow-up study (Prado et al.,
2017)
• Double blind RCT
• Treatments:
– Iron and folic acid (IFA)
– MMN
• Participants
– IFA (1413 children were tested)
– MMN (1466 children were tested)
• Compliance of IFA and MMN consumption: with
intensive and proactive support from community
facilitator

16. Results

17. Intervention in Children and Novel Treatment?
• Not so much
• No convincing evidence yet
• Only one novel treatment that is promoted up till
now: https://luckyironfish.com/
• A novel treatment initiated by Gavin Armstrong in
Cambodia.
• Produces fish-shaped iron stone.
• Promising impact only studied in women, reduction
of anaemia in general (Armstrong G, 2017).
• Still not convincing for impact in children.

18. Lucky Iron Fish ($ 25 at Amazon, produced in
Cambodia and Canada)

19. The issue with iron treatment
• Iron overload has shown in many study to trigger oxidative
stress.
• In chronic disease, iron overload reported to cause more
damage for the patients.
• Treatment in children at a very young age might be useful but
not convincing as there are a lot of confounding factors such
as: chronic energy malnutrition, communicable disease
(diarrhoea, pneumonia, and TB).
• Possible negative impact of oxidative stress induced disease
due to long-term retention.

20. Exploration: Future Nutritionists, are
y’all ready?
• Treatment for children at young age
• Safe dose for iron supplementation in children
• A fun and acceptable form of treatment (gummy
bear, candies, or fruity tablets)
• Long-term follow-up studies post-treatment
• Dietary promotion intervention
• == Space left for suggestion from audiences ;) ==

21. Any question?

22. ”Someone who can't see
the the obstacle right in
front of them, can't defeat
the obstacle that lies
beyond!” – Furudate
Haruichi, Haikyuu.