Skip to main content Accessibility help

Vitamin D3 supplementation for 8 weeks leads to improved haematological status following the consumption of an iron-fortified breakfast cereal: a double-blind randomised controlled trial in iron-deficient women

  • Salma F. Ahmad Fuzi (a1) (a2) and Sohail Mushtaq (a1)


The effect of 38 µg (1500 IU) daily vitamin D3 supplementation, consumed with an Fe-fortified breakfast cereal for 8 weeks, on haematological indicators in Fe-deficient female subjects was investigated. Fifty Fe-deficient subjects (plasma ferritin concentration <20 µg/l; mean age: 27·4 (sd 9·4) years) were randomised to consume an Fe-fortified breakfast cereal containing 9 mg of Fe daily, with either a vitamin D3 supplement or placebo. Blood samples were collected at baseline, interim (4 weeks) and post-intervention (8 weeks) for measurement of Fe and vitamin D status biomarkers. The effect of intervention was analysed using mixed-model repeated-measures ANOVA. Significant increases were observed in two main haematological indices: Hb concentration and haematocrit level from baseline to post-intervention in the vitamin D group but not in the placebo group. The increase from baseline to post-intervention in Hb concentration in the vitamin D group (135 (sd 11) to 138 (sd 10) g/l) was significantly higher compared with the placebo group (131 (sd 15) to 128 (sd 13) g/l) (P=0·037). The increase in haematocrit level from baseline to post-intervention was also significantly higher in the vitamin D group (42·0 (sd 3·0) to 43·8 (sd 3·4) %) compared with the placebo group (41·2 (sd 4·3) to 40·7 (sd 3·6) %) (P=0·032). Despite the non-significant changes in plasma ferritin concentration, this study demonstrates that 38 µg supplemental vitamin D, consumed daily, with Fe-fortified breakfast cereal led to improvement in Hb concentration and haematocrit levels in women with low Fe stores. These findings may have therapeutic implications in the recovery of Fe status in Fe-deficient populations at a healthcare level.


Corresponding author

*Corresponding author: Associate Professor S. Mushtaq, fax +44 124511310, email


Hide All
1. World Health Organization (2008) Introduction. In Worldwide Prevalence of Anemia 1993–2005: WHO Database on Anemia, p. 1 [B de Benoist, I Egli and M Cogswell, editors]. Geneva: WHO Press, World Health Organization.
2. Pasricha, S-R, Drakesmith, H, Black, J, et al. (2013) Control of iron deficiency anemia in low- and middle-income countries. Blood 121, 26072617.
3. Souza, AI, Batista Filho, M, Bresani, CC, et al. (2009) Adherence and side effects of three ferrous sulfate treatment regimens on anemic pregnant women in clinical trials. Cad Saude Publica 25, 12251233.
4. Scientific Advisory Committee on Nutrition (2010) Iron and Health. London: TSO.
5. Lopez, A, Cacoub, P, Macdougall, IC, et al. (2016) Iron deficiency anaemia. Lancet 387, 907916.
6. World Health Organization/Centers for Disease Control and Prevention (2004) Assesing the Iron Status of Populations: Including Literature Reviews: Report of a Joint World Health Organization/Centers for Disease Control and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level, 2nd ed. Geneva: World Health Organization/Centers for Disease Control and Prevention.
7. Andrews, NC & Schmidt, PJ (2007) Iron homeostasis. Annu Rev Physiol 69, 6985.
8. Holick, MF, Binkley, NC, Bischoff-Ferrari, HA, et al. (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96, 19111930.
9. Yoon, JW, Kim, SW, Yoo, EG, et al. (2012) Prevalence and risk factors for vitamin D deficiency in children with iron deficiency anemia. Korean J Pediatr 55, 206211.
10. Bacchetta, J, Zaritsky, JJ, Sea, JL, et al. (2013) Suppression of iron-regulatory hepcidin by vitamin D. J Am Soc Nephrol 25, 564572.
11. Zughaier, SM, Alvarez, JA, Sloan, JH, et al. (2014) The role of vitamin D in regulating the iron-hepcidin-ferroportin axis in monocytes. J Clin Transl Endocrinol 1, e19e25.
12. Han, SS, Kim, M, Kim, H, et al. (2013) Non-linear relationship between serum 25-hydroxyvitamin D and hemoglobin in Korean females: the Korean National Health and Nutrition Examination Survey 2010–2011. PLOS ONE 8, e72605.
13. Sim, JJ, Lac, PT, Liu, ILA, et al. (2010) Vitamin D deficiency and anemia: a cross-sectional study. Ann Hematol 89, 447452.
14. Smith, EM, Alvarez, JA, Kearns, MD, et al. (2017) High-dose vitamin D3 reduces circulating hepcidin concentrations: a pilot, randomized, double-blind, placebo-controlled trial in healthy adults. Clin Nutr 36, 980985.
15. Madar, AA, Stene, LC, Meyer, HE, et al. (2016) Effect of vitamin D3 supplementation on iron status: a randomized, double-blind, placebo-controlled trial among ethnic minorities living in Norway. Nutr J 15, 7483.
16. Ernst, JB, Tomaschitz, A, Grübler, MR, et al. (2016) Vitamin D supplementation and hemoglobin levels in hypertensive patients: a randomized controlled trial. Int J Endocrinol 2016, 6836402.
17. Scholz-Ahrens, KE, Schaafsma, G, Kip, P, et al. (2004) Iron-fortified milk can improve iron status in young women with low iron stores. Milchwissenschaft 59, 253257.
18. Department of Health (1991) Dietary Reference Values for Food Energy and Nutrients for the United Kingdom: Report of the Panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy, vol. 41. London: HMSO.
19. Food Standards Agency (2002) McCance and Widdowson’s The Composition of Foods, 6th summary ed. Cambridge: Royal Society of Chemistry.
20. Scientific Advisory Committee on Nutrition (2015) Carbohydrates and Health. London: TSO.
21. World Health Organization/The United Nations International Children’s Emergency Fund/United Nations University (2001) Iron Deficiency Anemia: Assessment, Prevention and Control. A Guide for Programme Managers. Geneva: World Health Organization.
22. Ross, AC, Taylor, CL, Yaktine, AL, et al. (2011) Dietary Reference Intakes for Calcium and Vitamin D: Food and Nutrition Board. Washington, DC: Institute of Medicine of the National Academies Press.
23. George-Gay, B & Parker, K (2003) Understanding the complete blood count with differential. J Perianesth Nurs 18, 96117.
24. Sooragonda, B, Bhadada, SK, Shah, VN, et al. (2014) Effect of vitamin D replacement on hemoglobin concentration in subjects with concurrent iron-deficiency anemia and vitamin D deficiency: a randomized, single-blinded, placebo-controlled trial. Acta Haematol 133, 3135.
25. Toxqui, L, Pérez-Granados, AM, Blanco-Rojo, R, et al. (2013) Effects of an iron or iron and vitamin D–fortified flavoured skimmed milk on iron metabolism: a randomized controlled double-blind trial in iron-deficient women. J Am Coll Nutr 32, 312320.
26. Hennigar, SR, Gaffney-Stomberg, E, Lutz, LJ, et al. (2016) Consumption of a calcium and vitamin D-fortified food product does not affect iron status during initial military training: a randomised, double-blind, placebo-controlled trial. Br J Nutr 115, 637643.
27. Casgrain, A, Collings, R, Harvey, LJ, et al. (2012) Effect of iron intake on iron status: a systematic review and meta-analysis of randomised controlled trials. Am J Clin Nutr 96, 768780.
28. Shin, JY & Shim, JY (2013) Low vitamin D levels increase anemia risk in Korean women. Clin Chim Acta 421, 177180.
29. Dastani, Z, Berger, C, Langsetmo, L, et al. (2014) In healthy adults, biological activity of vitamin D, as assessed by serum PTH, is largely independent of DBP concentrations. J Bone Miner Res 29, 494499.
30. Bates, B, Lennox, A, Prentice, A, et al. (2014) The National Diet and Nutrition Survey. Results from Years 1, 2, 3 and 4 (Combined) of the Rolling Programme (2008/2009–2011/2012). London: TSO.
31. Quintero-Gutiérrez, AG, González-Rosendo, G, Pozo, JP, et al. (2016) Haem iron concentrate and iron sulfate added to chocolate biscuits: effects on haematological indices of Mexican school children. J Am Coll Nutr 35, 544551.
32. Bal, D, Nagesh, K, Surendra, H, et al. (2015) Effect of supplementation with iron fortified biscuits on the haemoglobin status of children in rural areas of Shimoga, Karnataka. Indian J Pediatr 82, 253259.
33. Barbosa, TNN, Taddei, JAdAC, Palma, D, et al. (2012) Double-blind randomized controlled trial of rolls fortified with microencapsulated iron. Rev Assoc Med Bras 58, 118124.
34. Karl, JP, Lieberman, HR, Cable, SJ, et al. (2010) Randomised, double-blind, placebo-controlled trial of an iron-fortified food product in female soldiers during military training: relations between iron status, serum hepcidin, and inflammation. Am J Clin Nutr 92, 93100.


Type Description Title
Supplementary materials

Ahmad Fuzi et al. supplementary material
Ahmad Fuzi et al. supplementary material 1

 Word (20 KB)
20 KB

Vitamin D3 supplementation for 8 weeks leads to improved haematological status following the consumption of an iron-fortified breakfast cereal: a double-blind randomised controlled trial in iron-deficient women

  • Salma F. Ahmad Fuzi (a1) (a2) and Sohail Mushtaq (a1)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed