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Role of Oxidative Stress and Antioxidants in Children with IDA

Background: Increased oxidative stress with free radical generation in iron deficiency anemia (IDA), its aggravation at therapeutic doses of iron and reduction of oxidative stress by antioxidant supplementation are well studied in adults. Studies in this regard are scanty in children.

Objective: The co-prescription of antioxidants with iron supplementation in IDA to counter the oxidative stress is a well studied and established fact in adults .Though iron supplementation is a common clinical practice in children it is not conventional to coprescribe anti-oxidants in children. Therefore a study was undertaken to evaluate the oxidative stress in IDA in children and the effect of antioxidants during iron supplementation and to evolve an optimal suitable therapeutic strategy to minimize oxidative stress and there by adverse clinical effects.

Methods: All the children attending the pediatrics OPD in IRT PMCH during JULY/AUGUST 2008 were randomly screened for anemia by clinical and hemoglobin evaluation. 21 children whose parents gave consent for participation in the study were included for evaluation. They were in the age group of ten months to sixteen years. Nutritional status of the study population was recorded by a twenty four hour recall survey method. After deworming, children were started with oral iron supplementation in three different groups; group I – oral iron only, group II – oral iron with vitamin C, group III – oraliron with vitamin E. Lipid peroxides and Lipid hydroperoxides were measured as the indices of oxidative stress before initiation, tenth day (I follow up), thirtieth day (II follow up) after oral iron therapy. Serum iron profile was also studied for evaluation.

Results: There was no significant difference in serum iron profile response to oral iron therapy between the groups. Oxidative stress indices showed a decreasing trend in all the groups with no significant difference among the groups. There were no clinical adverse effects of oral iron supplementation in all the groups.

Conclusion: Unlike in adults, oxidative stress in iron deficiency anemia is not aggravated by oral iron supplementation in children. There was no significant difference between oral iron alone and oral iron with antioxidants in terms of clinical and biochemical response. Lipid hydroperoxides seems to be an early indicator of oxidative stress.

Author(s): Parasuram Melarcode Krishnamoorthy,Natesh Prabu R, Mohan D.M, Sabitha N, Janakarajan V.N, Balasubramanian Natesan

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