Public Health Nutrition: 13(3), 418–423 doi:10.1017/S1368980009991224 Leaf concentrate as an alternative to iron and folic acid supplements for anaemic adolescent girls: a randomised controlled trial in India Swati Vyas 1 , Simon M Collin 2, *, Eric Bertin 3 , Glyn J Davys 4 and Beena Mathur 5 1 Department of Foods and Nutrition, International College for Girls, Jaipur, India: 2 Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK: 3 Department of Nutrition, Universite ´ de Reims Champagne-Ardenne, Reims, France: 4 Association pour la Promotion des Extraits Foliaires en Nutrition (APEF), Nozet, Connantre, France: 5 Postgraduate Department of Home Science, University of Rajasthan, Jaipur, India Submitted 13 January 2009: Accepted 14 July 2009: First published online 26 August 2009 Abstract Objective: Despite public health campaigns based on Fe and folic acid supple- ments, Fe-deficiency anaemia remains highly prevalent among women in India. We investigated leaf concentrate as an alternative to Fe and folic acid supplements for treating anaemia in adolescent girls. Design: Randomised controlled two-arm trial over 3 months: one group received daily Fe and folic acid (IFA; 60 mg Fe, 500 mg folic acid); the other daily leaf concentrate (LC; 5 mg Fe, 13 mg folic acid). Hb concentration, mean cell volume, serum Fe, serum ferritin and total Fe-binding capacity were measured pre- and post-intervention. Setting: Jaipur, India. Subjects: One hundred and two adolescent girls aged 14–18 years. Results: Of the 102 girls randomized to the two arms of the trial, four (3?9 %) were severely anaemic (Hb , 7 g/dl), twenty-eight (27?5 %) were moderately anaemic (Hb $ 7 g/dl, ,10 g/dl) and seventy (68?6 %) were mildly anaemic (Hb $ 10 g/dl, ,12 g/dl). In the IFA group, eleven girls (20?4 %) withdrew due to side-effects, compared with one girl (2?1 %) in the LC group (P 5 0?005). Total losses to follow- up were 14/54 in the IFA group and 2/48 in the LC group. At the end of the trial, none of the eighty-six remaining girls were severely anaemic, nine (10?5 %) were moderately anaemic and twenty-six (30?2 %) were mildly anaemic; fifty-one (59?3 %) had normal Hb levels ($12 g/dl). After adjustment for baseline values, LC was as effective as IFA in improving serum Fe parameters and treating anaemia. Conclusions: Leaf concentrate is an effective, and more palatable, alternative to Fe and folic acid supplements for treating anaemia in adolescent girls. Keywords Leaf concentrate Iron Folic acid Anaemia Adolescent girls India Fe requirements in girls increase dramatically during adolescence, from a pre-adolescent requirement of approximately 0?8 mg/d to as much as 2?2 mg/d, due to increases in blood volume and lean body mass, and the onset of menses (1) . Pregnancy increases Fe requirements even further, to 7?5 mg/d in the third trimester (2) . Adoles- cent girls are at increased risk of adverse pregnancy out- comes associated with anaemia (3,4) . Where Fe-deficiency anaemia is highly prevalent and childbearing at young ages is common, there is an urgent public health need to prevent anaemia among adolescent girls (5,6) . The prevalence of anaemia among girls aged 15–19 years in India is 56 % (7) . Girls in this age group account for 17 % of total fertility in India; 3 % of girls aged 15 years and 36 % of girls aged 19 years will have begun child- bearing (7) . The provision of Fe and folic acid supplements to pregnant women is an integral part of the Reproductive and Child Health Programme in India. The programme recommends that women consume 100 daily doses of Fe (100 mg) and folic acid (400 mg) during pregnancy. In practice, although 65 % of mothers receive Fe and folic acid supplements, only 23 % of women consume these supplements for at least 90 d (7) . This low level of adher- ence may be partly due to the frequent gastrointestinal side-effects of Fe supplements (8) . In the context of low-income countries, there is a need to develop low-cost, locally produced micronutrient supplements to ensure the sustainability of anaemia pre- vention campaigns. Such supplements must be palatable and culturally acceptable. In the present study we *Corresponding author: Email simon.collin@bristol.ac.uk r The Authors 2009 Downloaded from https://www.cambridge.org/core. 15 Dec 2021 at 10:59:54, subject to the Cambridge Core terms of use.