Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial

• Published in: BMJ Vol. 326; no. 7399; pp. 1124 - 1126
• Main Authors: Verdon, F, Burnand, B, Stubi, C-L Fallab, Bonard, C, Graff, M, Michaud, A, Bischoff, T, de Vevey, M, Studer, J-P, Herzig, L, Chapuis, C, Tissot, J, Pécoud, A, Favrat, B
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 24.05.2003; British Medical Association; BMJ Publishing Group LTD; BMJ Publishing Group; BMJ Publishing Group Ltd
• Edition: International edition
• Subjects: Adolescent; Adult; Anemia; Anxiety; Biological and medical sciences; Chronic fatigue syndrome; Clinical trials; Confidence intervals; Depressive disorders; Dietary iron; Dietary Supplements; Double-Blind Method; Drug dosages; Fatigue; Fatigue - blood; Fatigue - diet therapy; Female; Ferritins; Ferritins - blood; Ferrous Compounds - administration & dosage; General and cellular metabolism. Vitamins; Hemoglobin; Humans; Iron; Iron - administration & dosage; Iron deficiency anemia; Medical sciences; Metabolic diseases; Middle Aged; Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...); Patients; Pharmacology. Drug treatments; Placebos; Primary Care; Regression Analysis; Treatment Outcome; Women; Womens health; Womens health services; Switzerland; Human; Asthenia; Treatment efficiency; Ferritin; Double blind study; Hemoglobin; Biological marker; Fatigue; Female; Iron; Supplementation
• ISSN: 0959-8138; 0959-8146; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.326.7399.1124

Abstract Objective To determine the subjective response to iron therapy in non-anaemic women with unexplained fatigue. Design Double blind randomised placebo controlled trial. Setting Academic primary care centre and eight general practices in western Switzerland. Participants 144 women aged 18 to 55, assigned to either oral ferrous sulphate (80 mg/day of elemental iron daily; n=75) or placebo (n=69) for four weeks. Main outcome measures Level of fatigue, measured by a 10 point visual analogue scale. Results 136 (94%) women completed the study. Most had a low serum ferritin concentration; ≤ 20 μg/l in 69 (51%) women. Mean age, haemoglobin concentration, serum ferritin concentration, level of fatigue, depression, and anxiety were similar in both groups at baseline. Both groups were also similar for compliance and dropout rates. The level of fatigue after one month decreased by −1.82/6.37 points (29%) in the iron group compared with −0.85/6.46 points (13%) in the placebo group (difference 0.95 points, 95% confidence interval 0.32 to 1.62; P=0.004). Subgroups analysis showed that only women with ferritin concentrations ≤ 50 μg/l improved with oral supplementation. Conclusion Non-anaemic women with unexplained fatigue may benefit from iron supplementation. The effect may be restricted to women with low or borderline serum ferritin concentrations.