Role of Oral Vitamin C Supplementation with Iron-Folic Acid in Treating Anemia among School-Going Adolescent Girls: A Non-Randomized Interventional Study from Central India
DOI:
https://doi.org/10.55489/njcm.170420266042Keywords:
Adolescent, Anemia, Ascorbic Acid, Iron, HemoglobinAbstract
Background: Anemia affects 59.1% of Indian adolescent girls aged 15–19 years. Vitamin C may enhance non-heme iron absorption when added to iron-folic acid (IFA) supplementation.
Objective: To evaluate whether adding oral Vitamin C to IFA supplementation improves hemoglobin levels in school-going adolescent girls with mild-to-moderate anemia.
Methods: A non-randomized quasi-experimental study enrolled 211 adolescent girls (10-19 years) across four schools in central India. Two schools received IFA plus 500 mg Vitamin C daily (n=106); two received IFA alone (n=105) for 90 days.
Results: Mean hemoglobin increased by 1.10 ± 0.62 g/dl in the intervention group versus 0.64 ± 0.58 g/dl in controls (adjusted mean difference: 0.45 g/dl; 95% CI: 0.29-0.61; p<0.001). Normal hemoglobin was achieved in 38.68% versus 19.05% of participants, respectively. Side effects were comparable between groups.
Conclusions: Adding Vitamin C to IFA supplementation significantly improves hemoglobin levels in adolescent girls. Integration into national anemia programs warrants consideration, pending randomized controlled trial confirmation.
Trial Registration: CTRI/2023/08/056557
References
World Health Organization. Adolescent health [Internet]. Geneva: World Health Organization; [cited 2024 Aug 28]. Available from: https://www.who.int/health-topics/adolescent-health#tab=tab_1
Bej P. Adolescent health problems in India: A review from 2001 to 2015. Indian journal of community health. 2015;27(4):418-428. Available from: https://iapsmupuk.org/journal/index.php/IJCH/article/view/597
Arnett JJ. Emerging adulthood: What is it, and what is it good for?. Child development perspectives. 2007 Dec;1(2):68-73. DOI: https://doi.org/10.1111/j.1750-8606.2007.00016.x
Sawyer SM, Afifi RA, Bearinger LH, Blakemore SJ, Dick B, Ezeh AC, Patton GC. Adolescence: a foundation for future health. The lancet. 2012 Apr 28;379(9826):1630-1640. DOI: https://doi.org/10.1016/S0140-6736(12)60072-5 PMid:22538178
Povey J, Plage S, Huang Y, Gramotnev A, Cook S, Austerberry S, Western M. Adolescence: a period of vulnerability and risk for adverse outcomes across the life course: the role of parent engagement in learning. In: Baxter J, Lam J, Povey J, Lee R, Zubrick SR, editors. Family dynamics over the life course. Life Course Research and Social Policies, vol 15. Cham: Springer; 2022. p. 97-131. DOI: https://doi.org/10.1007/978-3-031-12224-8_6
United Nations Children’s Fund (UNICEF). Adolescent development and participation [Internet]. New York: UNICEF; [cited 2026 Feb 2]. Available from: https://www.unicef.org/india/what-we-do/adolescent-development-participation
World Health Organization & United Nations Population Fund. The reproductive health of adolescents: a strategy for action / a joint WHO/UNFPA/UNICEF statement. World Health Organization; 1989. Available from- https://iris.who.int/handle/10665/39306
Rose-Clarke K, Pradhan H, Rath S, Rath S, Samal S, Gagrai S, Nair N, Tripathy P, Prost A. Adolescent girls' health, nutrition and wellbeing in rural eastern India: a descriptive, cross-sectional community-based study. BMC Public Health. 2019 May 31;19(1):673. DOI: https://doi.org/10.1186/s12889-019-7053-1 PMid:31151394 PMCid:PMC6544920
Chokhandre PK, Vatavati SR, Pundappanavar BI, Hallad JS. Menstrual disorder and its treatment seeking among adolescent girls in India: evidence from nationwide survey. Int J Adolesc Med Health. 2024 Dec 10;36(6):595-603. DOI: https://doi.org/10.1515/ijamh-2024-0101 PMid:39648892
World Health Organization. Anaemia in women and children [Internet]. Geneva: WHO; [cited 2026 January 13]. Available from: https://www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children
Kaur S, Sangha JK. Effect of Iron Supplementation Along with Vitamin C and Nutrition Counselling on the Anaemic Status of Adolescent Girls. Int J Health Sci. 2016;6(5):279-287.
National Family Health Survey (NFHS-5), 2019-21: Compendium of fact sheets Key Indicators: India and 14 states/UTs (Phase-II). Ministry of Health and Family welfare, Government of India. Available from: https://www.mohfw.gov.in/sites/default/files/NFHS-5_Phase-II_0.pdf
Mehnaz S, Afzal S, Khalil S, Khan Z. Impact of Iron, Folate & Vitamin C Supplementation on The Prevalence of Iron Deficiency Anemia in Non-pregnant Females of Peri Urban Areas of Aligarh. Indian Journal of Community Medicine. 2006 Jul 1;31(3):201.
Nair KM, Iyengar V. Iron content, bioavailability & factors affecting iron status of Indians. Indian Journal of Medical Research. 2009 Nov 1;130(5):634-645.
Nair KM, Brahmam GN, Radhika MS, Dripta RC, Ravinder P, Balakrishna N, et al. Inclusion of guava enhances non-heme iron bioavailability but not fractional zinc absorption from a rice-based meal in adolescents. J nutr. 2013 Jun 1;143(6):852-858. DOI: https://doi.org/10.3945/jn.112.171702 PMid:23596161 PMCid:PMC3652882
Resmi S, Latheef F, Vijayaraghavan R. Correlation of level of haemoglobin with iron and vitamin c among adolescent girls with iron deficiency anemia undergoing nutritional support therapy. International Journal of Research in Ayurveda & Pharmacy. 2017;8(4):77-81. DOI: https://doi.org/10.7897/2277-4343.084219
Tesfaye M, Yemane T, Adisu W, Asres Y, Gedefaw L. Anemia and iron deficiency among school adolescents: burden, severity, and determinant factors in southwest Ethiopia. Adolesc Health Med Ther. 2015 Dec 15;6:189-196. DOI: https://doi.org/10.2147/AHMT.S94865 PMid:26719736 PMCid:PMC4687608
World Health Organization. Anaemia - fact sheet [Internet]. Geneva: World Health Organization; 2025 [cited 2026 Feb 2]. Available from: https://www.who.int/news‑room/fact‑sheets/detail/anaemia
Killip S, Bennett JM, Chambers MD. Iron deficiency anemia. Am Fam Physician. 2007;75(5):671-678. Available from: https://www.aafp.org/pubs/afp/issues/2007/0301/p671.html
Patel RR, Sachdeva PD. A Systematic Review of Anemia among Adolescents Girls. Natl J Med Res. 2021 Jul 1;11(3):109-113. Available from: https://njmr.in/index.php/file/article/view/32
Deng J, Ramelli L, Li PY, Eshaghpour A, Li A, Schuenemann G, Crowther MA. Efficacy of vitamin C with Fe supplementation in patients with iron deficiency anemia: a systematic review and meta-analysis. Blood Vessel Thromb Hemost. 2024 Aug 2;1(4):100023. DOI: https://doi.org/10.1016/j.bvth.2024.100023 PMid:40765927 PMCid:PMC12320449
Cook JD, Reddy MB. Effect of ascorbic acid intake on nonheme-iron absorption from a complete diet. Am J Clin Nutr. 2001 Jan 1;73(1):93-98. DOI: https://doi.org/10.1093/ajcn/73.1.93 PMid:11124756
Astuti ND, Wirjatmadi B, Adriani M. The role of addition of vitamin C in iron supplementation on ferritin serum levels in anemia adolescent females. Health Notions. 2018 Mar 31;2(3):332-338. Available from: https://www.heanoti.com/index.php/hn/article/view/147
Patil P, Geevarghese P, Khaire P, Joshi T, Suryawanshi A, Mundada S, Pawar S, Farookh A. Comparison of therapeutic efficacy of ferrous ascorbate and iron polymaltose complex in iron deficiency anemia in children: a randomized controlled trial. Indian J Pediatr. 2019 Dec;86(12):1112-1117. DOI: https://doi.org/10.1007/s12098-019-03068-2 PMid:31520309
Sethi V, Yadav S, Agrawal S, Sareen N, Kathuria N, Mishra P, Kapoor J, Dureja S. Incidence of side-effects after weekly iron and folic acid consumption among school-going Indian adolescents. Indian Pediatrics. 2019 Jan;56(1):33-36. DOI: https://doi.org/10.1007/s13312-019-1463-0 PMid:30806358
Aguayo VM, Paintal K, Singh G. The Adolescent Girls' Anaemia Control Programme: a decade of programming experience to break the inter-generational cycle of malnutrition in India. Public health nutrition. 2013 Sep;16(9):1667-1676. DOI: https://doi.org/10.1017/S1368980012005587 PMid:23343620 PMCid:PMC10271399
Sridharan V, Manoharan A, Rajasekar VD, Devanbu VG, Maruthappapandian J, Surya BN. Contributing Factors of Anaemia Among Women in The Reproductive Age Group (15 to 49 Years) in Rural Chengalpattu District: A Cross-Sectional Study. Indian Journal of Community Medicine. 2026;51(1):75-82. DOI: https://doi.org/10.4103/ijcm.ijcm_538_24
Mechenro JP, Kumar BM, John KR, Balakrishnan D. Nutritional anemia in a rural community in Tamil Nadu. Gastroenterology, Hepatology and Endoscopy Practice. 2022 Jan 1;2(1):15-19. DOI: https://doi.org/10.4103/ghep.ghep_37_21
Kapil U, Kapil R, Gupta A. National Iron Plus Initiative: current status & future strategy. Indian Journal of Medical Research. 2019 Sep 1;150(3):239-247. DOI: https://doi.org/10.4103/ijmr.IJMR_1782_18 PMid:31719294 PMCid:PMC6886130
Lynch SR, Cook JD. Interaction of vitamin C and iron. Ann NY Acad Sci. 1980 Dec 1;355(1):32-44. DOI: https://doi.org/10.1111/j.1749-6632.1980.tb21325.x PMid:6940487
Siegenberg D, Baynes RD, Bothwell TH, Macfarlane BJ, Lamparelli RD, Car NG, MacPhail P, Schmidt U, Tal A, Mayet F. Ascorbic acid prevents the dose-dependent inhibitory effects of polyphenols and phytates on nonheme-iron absorption. The American journal of clinical nutrition. 1991 Feb 1;53(2):537-541. DOI: https://doi.org/10.1093/ajcn/53.2.537 PMid:1989423
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