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The role of sub-clinical inflammation on the haemoglobin response, iron and vitamin A status of Anaemic Myanmar adolescent school girls during iron and vitamin A supplementation = Peranan inflamasi sub-klinik terhadap respon hemoglobin, status zat besi dan vitamin A pada remaja perempuan usia sekolah selama pemberian suplementasi zat besi dan vitamin A.

Introduction Anaemia is one of the major nutritional problems in Myanmar. Nutritional status assessments were influenced by sub-clinical inflammation (SCI).However; there is lack of information on the role of SCI on the effect of iron supplementation. Objective The purpose of the study is to identify the role of sub-clinical inflammation on iron status during iron and vitamin A supplementation. Methodology A randomized, double-blinded, placebo-controlled experimental study was conducted. Post-menarcheal, anaemic adolescent girls (Hb < 120 g/L) were recruited from 6 schools after screening among 1269 subjects. Subjects with haemoglobinopathies were excluded and 402 subjects were recruited. Deworming was done with a single dose of 400 mg Albendazole. Subjects were assigned into one of four groups: FA group (2.5 mg of folate), Vitamin A group (15,000 IU of vitamin A and folate), IFA group (60 mg elemental iron and folate) and IFA+Vitamin A group (iron, vitamin A and folate) and treated for 12 weeks. Three blood collections were done at the baseline, middle and endline. Anthropometry and dietary assessment were also done. Results Anaemia was major public health problem. Iron deficiency and iron deficiency anaemia were prevalent. By the end of intervention, the prevalence of A, ID and IDA reduced significantly in IFA+Vitamin A group. The prevalence of SCI was low in the population yet able to show its influence on iron supplementation. When stratified by SCI, negative effect of SCI was seen on changes in Hb, SF and body iron store. Vitamin A has significant interaction effect with SCI and has contributed to iron supplementation. Conclusion Weekly iron supplementation combined with vitamin A for 12 week significantly reduced the prevalence of anaemia. SCI has negative influence on iron supplementation. Vitamin A positively contributes to iron supplementation when there is SCI. Recommendation SCI should be taken into account in assessing the effectiveness of any micronutrient supplementation. Vitamin A should be added to iron supplementation. The role of other micronutrient such as folic acid should not be ignored in tackling anaemia.
Key Words: Anaemia, Adolescent, Sub-clinical inflammation, Iron supplementation



Latar belakang Anemia adalah salah satu masalah gizi utama di Myanmar. Pengkajian status gizi dapat dipengaruhi oleh inflamasi sub-klinik (ISK). Tetapi informasi tentang peranan ISK terhadap dampak suplementasi zat besi masih terbatas. Tujuan Tujuan studi ini adalah mengidentifikasi peranan ISK terhadap status gizi zat besi selama pemberian suplementasi zat besi dan vitamin A. Metode Studi ini menggunakan randomisasi, tersamar ganda, plasebo-kontrol eksperimental desain. Remaja perempuan yang telah menstruasi dan anemia (Hb < 120 g/L) sebanyak 1269 anak berhasil disaring dari 6 sekolah. Setelah dikurangi dengan anak yang memiliki masalah haemoglobinopathies, total subyek menjadi 402 anak. Mereka kemudian diberi tablet kecacingan albendazole dengan dosis 400 mg sebanyak 1 kali. Selama 12 minggu subyek dibagi menjadi 4 kelompok yang masing-masing kelompok (100 anak) menerima perlakuan berbeda, yaitu kelompok FA (2.5 mg folat), kelompok Vitamin A (15,000 IU vitamin A dan folat), kelompok IFA (60 mg zat besi elemen + folat) dan kelompok IFA+Vitamin A (zat besi, vitamin A dan folat). Pengambilan darah dilakukan sebelum, pada saat dan akhir intervensi. Pengkajian terhadap antropometri dan asupan makanan juga dilakukan terhadap subyek. Hasil Anemia adalah masalah kesehatan utama di masyarakat. Masalah kekurangan zat besi dan zat besi anemia sering ditemui di masyarakat. Pada akhir intervensi, prevalensi kekurangan vitamin A, zat besi dan anemia zat besi berkurang secara nyata pada kelompok IFA+Vitamin A. Karena rendahnya tingkat prevalensi ISK pada populasi sehingga studi ini tidak dapat menunjukkan seberapa besar pengaruh ISK terhadap suplementasi zat besi. Setelah distratifikasi dengan ISK, terlihat adanya pengaruh negatif ISK terhadap perubahan Hb, serum Feritin dan simpanan zat besi tubuh. Vitamin A mempunyai pengaruh interaksi yang nyata dengan ISK, dan vitamin A mempunyai kontribusi terhadap suplementsi zat besi. Kesimpulan Suplementasi mingguan zat besi dikombinasikan dengan vitamin A selama 12 minggu mengurangi secara nyata prevalensi anemia. ISK mempunyai pengaruh negatif pada suplementasi zat besi. Vitamin A mempunyai kontribusi positif terhadap suplementsi zat besi bila terjadi ISK. Saran Kehadiran ISK harus dipertimbangkan ketika mengkaji suatu suplementasi zat gizi mikro. VitA harus ditambahkan pada suplementasi zat besi. Peranan zat gizi mikro lain seperti asam folat tidak dapat dihiraukan ketika menangani masalah anemia.
Kata kunci : anemia, remaja, inflamasi sub-klinis, suplementasi zat besi.