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"Anemia is the main micronutrient deficiency problem among adolescent school girls in Indonesia. Anemia due to iron deficiency often coexists with zine deficiency. Iron and zinc have anlagonistic interaction. Therefore, it was appropriate ratio of iron-zinc supplementation.ObjectiveThe study was aimed to investigate the different ratios of iron-zinc supplementation Fe: Zn = 2: 1 and Fe: Zn = 4: 1 on improving the iron and zinc status and eventually reduction of the morbidity of anemic adolescent school girls compared to iron supplementation alone.MethodologyA randomized, double blind community trial was conducted among anemic adolescent school girls (10-12 years old). Selection of subjects was conduted in two steps. Firstly, 238 girls (out of 1358 girls), with hemoglobin concentration level < 115 g/L using Hemocue were recruited and given antihelminthic drug (500 mg mebendazole as a single dose). Secondly, those who had hemoglobin concentration < 120 g/L using Cell Dyn from venous blood one week after deworming (n+133) were enrolled into the study.The 133 subjects were assigned randomly to one of the three groups for daily iron-zinc supplementation for 12 weeks with: Group 1 (n=45): iron (60 mg/day), Group 2 (n=45): iron and zinc (30 mg and 15 mg/day) or group 3 (n=43): iron and zinc (60 mg and 15 mg/day).Supplement intake was supervised at base line, weight and height were measured and the available iron and zinc intake from diet was estimated using a model modified from WHO/FAO and Murphy, based on the data 24-hour Food Recall and Food Frequency Questionnare. Iron (hemoglobin/Hb, serum ferritin/SF, serum transferrin receptor/TfR, zinc protoporphyrin/ZPP, Mean Corpuscular Volume/MCV, Red-cell Distribution Width/RDW, body iron/BI) and zinc (serum zinc/SZ) status and supplementation. Morbidity status of diarrhea and Acule Respiratory Infection (ARI) were recorded weekly. The phagocytes cell and Cell-Mediated Immunity were measured only for 50% of the subjects.Results and DiscussionBy the end of the supplementation, most indicators of iron status were increased significantly in all subjects both they took iron supplementation with or without zinc, and the proportion of iron deficiency anemia reduced. Iron supplementation alone or iron-zinc improved zinc status. The proportion of zinc deficiency was sinificantly reduced only among subjects who took iron-zinc supplementation with the ratio of Fe: Zn =2: 1. which was significantly lower compared to the other two groups at the end of supplementation. In iron/zinc 2 : 1 group, no subject had iron deficiency anemia and zinc deficiency after 12 weeks of supplementation, which suggested that iron-zinc supplementation with the ration of Fe: Zn = 2 : 1 had reduced both iron deficiency anemia and zinc deficiency.In this study, iron deficiency among anemic school girls was due to insufficiency of iron in red blood cell, and iron or iron-zinc supplementation for 12 weeks had less benefit to increase iron status. The possibility; of hemoglobinopathies such as thalassemia trait affecting adolescent girls in this study should be considered as several studies indicated that the prevalence of tlinlassemia trait among the same population in Indonesia is high.Iron deficiency also occurred at the storage level, which increased and reached the normal value with iron or iron-zinc supplementation. At the end of supplementation, the mean value of most indicators of iron status in all groups did not reach the normal value (such as Hb < 120 g/L, ZPP > 40 umol/mol heme, MCV <2 80 fL, RDW > l4%), perhaps the 12-weeks of iron supplementation was not long enough to fulfill iron for the 120 erythrocyte life cycle.lt seems, that the competition between iron and zinc occurred both at the storage level and the erythrocyte formation, and iron-zinc supplementation with the ratio of Fe: Zn = 2: 1 had minimal interaction as the improvement of both iron and zinc status was higher compared to the other groups. Most anemic adolescent school girls in this study had low available iron and zinc intake from the diet, with low intake of enhancers and high intake of inhibitors, which is not enough to promote either iron or zinc absorption from the supplements.The reduction of the proportion ol' subjects suffering from ARI was the highest among subjects who took either iron alone (3l.1% to 6.7%) compared to those who took iron- zinc supplement with ratio 2: 1 (1 7.3% to l1.l%) or iron-zinc supplement with ratio 4: 1(16.3 % to l4%), indicating that iron alone reduced morbidity status in tenn of Acute Respiratory Infection (ARI). However, adding zinc to iron supplements with ratio 2: 1 scents to improve the specific immune response of anemic adolescent school girls, as shown that the ratio of CD-4/CD-S was slightly increased among subjects who took iron-zinc supplement with the ratio of Fe: Zn= 2: 1.Conclusions and Recommendationslt was concluded, that both iron deficiency anemia (22%) and zinc deficiency (15.8%) were problems in the study area. Iron deficiency and hemoglobinopathies such as that assemia trait might be the causes of anemia among adolescent school girls. A daily 30 mg iron and 15 mg zinc supplementation among anemic adolescent schools girls for 12 weeks improved iron and zinc status and reduced iron deficiency anemia and zinc deficiency. Iron supplementation alone increased iron status, while adding zinc to iron supplementation protected the adverse effect of iron on decreasing zinc status.The competition between iron and zinc might occur in the role of both nutrients for erythrocytes formation as well-as at storage level, and supplementation with the ratio of Fe: Zn = 2: 1 had minimal interaction on improving bot.h iron and zinc status. As most of the anemic adolescent school girls had inadequate iron and zinc intake from the diet, the deficiencies of other micronutrients such as; vitamin A, folic acid and vitamin B12 should also be considered as the causes of anemia.Combined iron-zinc supplementation with the ratio of Fe: Zn = 2: 1 was appropriate on reducing the risk of anemic adolescent school girls suffering from Acute Respiratory Infection, however the mechanism of both iron and zinc on enhancing immune system could not clearly be shown from the results of this study.It is recommended to establish an iron-zinc supplementation program with ratio of 2: 1 through the existing channel of school health program to alleviate iron de iciency anemia and zinc deficiency 'among adolescent girls. Research cum action prioritized is to explain the contribution of bioavailability iron and zinc intake from the diet including increase the enhancers and minimize the inhibitors to the absorption of iron-zinc supplementation with ratio of Fe: Zn = 2: 1. The possibility of hemoglobinopathies such as thalassemia trait, as the cause of anemia needs further investigations."

"Anemia is the main micronutrient deficiency problem among adolescent school girls in Indonesia. Anemia due to iron deficiency often coexists with zine deficiency. Iron and zinc have anlagonistic interaction. Therefore, it was appropriate ratio of iron-zinc supplementation. Objective The study was aimed to investigate the different ratios of iron-zinc supplementation Fe: Zn = 2: 1 and Fe: Zn = 4: 1 on improving the iron and zinc status and eventually reduction of the morbidity of anemic adolescent school girls compared to iron supplementation alone. Methodology randomized, double blind community trial was conducted among anemic adolescent school girls (10-12 years old). Selection of subjects was conduted in two steps. Firstly, 238 girls (out of 1358 girls), with hemoglobin concentration level < 115 g/L using Hemocue were recruited and given antihelminthic drug (500 mg mebendazole as a single dose). Secondly, those who had hemoglobin concentration < 120 g/L using Cell Dyn from venous blood one week after deworming (n+133) were enrolled into the study. The 133 subjects were assigned randomly to one of the three groups for daily iron-zinc supplementation for 12 weeks with: Group 1 (n=45): iron (60 mg/day), Group 2 (n=45): iron and zinc (30 mg and 15 mg/day) or group 3 (n=43): iron and zinc (60 mg and 15 mg/day).Supplement intake was supervised at base line, weight and height were measured and the available iron and zinc intake from diet was estimated using a model modified from WHO/FAO and Murphy, based on the data 24-hour Food Recall and Food Frequency Questionnare. Iron (hemoglobin/Hb, serum ferritin/SF, serum transferrin receptor/TfR, zinc protoporphyrin/ZPP, Mean Corpuscular Volume/MCV, Red-cell Distribution Width/RDW, body iron/BI) and zinc (serum zinc/SZ) status and supplementation. Morbidity status of diarrhea and Acule Respiratory Infection (ARI) were recorded weekly. The phagocytes cell and Cell-Mediated Immunity were measured only for 50% of the subjects. Results and Discussion By the end of the supplementation, most indicators of iron status were increased significantly in all subjects both they took iron supplementation with or without zinc, and the proportion of iron deficiency anemia reduced. Iron supplementation alone or iron-zinc improved zinc status. The proportion of zinc deficiency was sinificantly reduced only among subjects who took iron-zinc supplementation with the ratio of Fe: Zn =2: 1. which was significantly lower compared to the other two groups at the end of supplementation. In iron/zinc 2 : 1 group, no subject had iron deficiency anemia and zinc deficiency after 12 weeks of supplementation, which suggested that iron-zinc supplementation with the ration of Fe: Zn = 2 : 1 had reduced both iron deficiency anemia and zinc deficiency. In this study, iron deficiency among anemic school girls was due to insufficiency of iron in red blood cell, and iron or iron-zinc supplementation for 12 weeks had less benefit to increase iron status. The possibility; of hemoglobinopathies such as thalassemia trait affecting adolescent girls in this study should be considered as several studies indicated that the prevalence of tlinlassemia trait among the same population in Indonesia is high. Iron deficiency also occurred at the storage level, which increased and reached the normal value with iron or iron-zinc supplementation. At the end of supplementation, the mean value of most indicators of iron status in all groups did not reach the normal value (such as Hb < 120 g/L, ZPP > 40 umol/mol heme, MCV <2 80 fL, RDW > l4%), perhaps the 12-weeks of iron supplementation was not long enough to fulfill iron for the 120 erythrocyte life cycle. lt seems, that the competition between iron and zinc occurred both at the storage level and the erythrocyte formation, and iron-zinc supplementation with the ratio of Fe: Zn = 2: 1 had minimal interaction as the improvement of both iron and zinc status was higher compared to the other groups. Most anemic adolescent school girls in this study had low available iron and zinc intake from the diet, with low intake of enhancers and high intake of inhibitors, which is not enough to promote either iron or zinc absorption from the supplements. The reduction of the proportion ol' subjects suffering from ARI was the highest among subjects who took either iron alone (3l.1% to 6.7%) compared to those who took iron- zinc supplement with ratio 2: 1 (1 7.3% to l1.l%) or iron-zinc supplement with ratio 4: 1(16.3 % to l4%), indicating that iron alone reduced morbidity status in tenn of Acute Respiratory Infection (ARI). However, adding zinc to iron supplements with ratio 2: 1 scents to improve the specific immune response of anemic adolescent school girls, as shown that the ratio of CD-4/CD-S was slightly increased among subjects who took iron- zinc supplement with the ratio of Fe: Zn= 2: 1 Conclusions and Recommendations lt was concluded, that both iron deficiency anemia (22%) and zinc deficiency (15.8%) were problems in the study area. Iron deficiency and hemoglobinopathies such as that assemia trait might be the causes of anemia among adolescent school girls. A daily 30 mg iron and 15 mg zinc supplementation among anemic adolescent schools girls for 12 weeks improved iron and zinc status and reduced iron deficiency anemia and zinc deficiency. Iron supplementation alone increased iron status, while adding zinc to iron supplementation protected the adverse effect of iron on decreasing zinc status. The competition between iron and zinc might occur in the role of both nutrients for erythrocytes formation as well-as at storage level, and supplementation with the ratio of Fe: Zn = 2: 1 had minimal interaction on improving bot.h iron and zinc status. As most of the anemic adolescent school girls had inadequate iron and zinc intake from the diet, the deficiencies of other micronutrients such as; vitamin A, folic acid and vitamin B12 should also be considered as the causes of anemia. Combined iron-zinc supplementation with the ratio of Fe: Zn = 2: 1 was appropriate on reducing the risk of anemic adolescent school girls suffering from Acute Respiratory Infection, however the mechanism of both iron and zinc on enhancing immune system could not clearly be shown from the results of this study. It is recommended to establish an iron-zinc supplementation program with ratio of 2: 1 through the existing channel of school health program to alleviate iron de iciency anemia and zinc deficiency 'among adolescent girls. Research cum action prioritized is to explain the contribution of bioavailability iron and zinc intake from the diet including increase the enhancers and minimize the inhibitors to the absorption of iron-zinc supplementation with ratio of Fe: Zn = 2: 1. The possibility of hemoglobinopathies such as thalassemia trait, as the cause of anemia needs further investigations."

"Seventy six PEM (-2SD WFA) anemic (Hb 8 <10g0d1) children aged 2 - < 5 years were randomly divided into a treatment group and a control group. For two months, the treatment group received Fe + Yrt C (30 mg el. iron + 20 mg Vit C) while the control group received Vit C (20 mg) atone. Neither the subject nor the distributor could distinguish between the two types of supplements. Anthropometrics, hematological, and dietary evaluations were conducted before and after the study. Corrections were made for parasitic infestations before the intervention phase.

Fe + Vd C has showed significant effects on Improving the nutritional status of subjects in terms of hematological (Hb , serum ferritin, and MCV) and anthropometrics indices (weight, and height). It was also found out that it has significant effect on HAZ of subjects as compared with the effect of Vit C. Vit C has showed significant effects on weight and height but not on hematological status.

It was concluded in this study that Fe has significant effect on increasing linear growth since no significant change was found in energy intake."

"ABSTRACTAn experimental community trial study was conducted to observe the influence of communication program on weekly iron supplementation in Tanzanian adolescent school girls. A sample of 237 school-going adolescent girls aged 14 -17 years was randomly recruited from 5 schools in Darus-Salaam and placed into 3 groups. One group received 65 mg elementary iron with 0.25 mg folic acid on a weekly dose along with communication sessions. The second group received the same dose of iron tablets and no communication sessions. No intervention was made to the control group. A VENN Diagram to assess the most closer person whom the girls would listen to was drawn prior to study. Three Focus Group Discussions at different stages with the adolescents and teachers were conducted. Anthropometrics in-dices were done once at baseline. Supplementation and communication strategies lasted for 8 weeks. Measurements of Hemoglobin levels to obtain a general picture about the nutritional status of the participants were carried out before and after the intervention. Hemoglobin increased in school 1&2, (iron supplementation plus communication schools), (p<0.001); and anemia dropped significantly (p<0.001). School 3 (iron without communication) had zero anemia decrease; while school 4 (control); had anemia rates unchanged. To the contrary; anemia levels increased significantly in control school 5; (p>0.05). Knowledge test was carried out before and after intervention; and an in-crease in test scores of school 1&2 was observed (p<0.001). Compliance was checked through stool examination (observed compliance) and iron pill distribution record (reported compliance). The results as indicated by two positive stool tests, were 94% and 75% in school 1 and 2 respectively; in school 3 (iron supplementation only) it was 50%. Reported compliance was 89% for school I&2 each, and 48% for school 3.It was concluded that, carefully planned communication strategies can influence ingestion of iron supplementation; and, as anemia in adolescents in Tanzania is high, therefore a National Iron Supplementation Program was recommended."

"Tujuan mengevaluasi efek suplementasi susu yang diperkaya dengan zat besi dan zink terhadap indikator pertumbuhan, kapasitas fisik dan kecepatan berpikir anak sekolah yang kurang berat (underweight). Metode Eksperimen pada dua kelompok paralel tersamar ganda dilaksanakan di beberapa sekolah dasar di Jakarta dan Surakarta, Indonesia. Sejumlah 245 anak sekolah usia 7-9 tahun yang underweight di daerah miskin perkotaan Jakarta and Solo dialokasikan secara acak menerima dua gelas susu yang diperkaya zat besi dan zink (n = 121) atau susu biasa (n= 124) setiap hari selama enam bulan. Indikator biokimia, antropometri, kapasitas fisik dan fungsi kognisi diukur saat awal, bulan ke-3 dan ke-6. Hasil Antara kelompok susu diperkaya dibandingkan dengan kelompok susu biasa, peningkatan kadar hemoglobin (berturut-turut 0,01 + 0,96 mg/dL dan 0.17 + 0.81 mg/dL) dan serum feritin (berturut-turut 12,77 + 25,50 mcg/dL dan 14,99 + 29,56 mcg/dL) tidak berbeda bermakna antara kedua kelompok. Selanjutnya, terjadi penurunan kadar serum zink (berturut-turut 3,01 + 3,24 mMol/dL dan 3,12 + 3,71mMol/dL) yang tidak bermakna antara kedua kelompok. Penambahan berat badan pada kelompok susu diperkaya (1,31 + 0,69 kg) berbeda secara bermakna (P=0.045) dibandingkan dengan kelompok susu biasa (1,13 + 0,69 kg), sejalan dengan peningkatan indikator underweight (WAZ) pada kelompok susu diperkaya (1.47 + 0.50) yang lebih besar secara bermakna (P=0.025) dibandingkan dengan peningkatannya pada kelompok susu biasa (1,33 + 0,47). Terdapat perbaikan skor kecepatan berpikir yang bermakna (P=0.001) pada kelompok susu diperkaya (12,74 + 11,76) dibandingkan dengan kelompok susu biasa (8.31 + 9,60), namun tidak ada perbedaan yang bermakna untuk perbaikan skor kapasitas fisik antara kedua kelompok (berturut-turut 10323,77 + 9253,83 dan 8435,94 + 8824,55). Kesimpulan pada anak sekolah usia 7-9 tahun yang underweight, suplementasi susu yang diperkaya dengan zat besi dan zink akan lebih mendukung pertumbuhan dan kecepatan berpikir.

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AbstractAim to evaluated the effect of milk supplementation enriched with iron and zinc on indicators of growth, physical capacity and cognitive performance in underweight school-children. Method Two-armed, randomized controlled double-blind trial was performed in several primary schools in Jakarta and Surakarta, Indonesia. A total of 245 underweight schoolchildren aged 7-9 years living in urban poor areas of Jakarta and Solo were randomly allocated to receive two cups of iron-zinc fortified-milk (n = 121) or non-iron-zinc fortified milk (n= 124) supplementation daily for six months. Biochemical indicators, anthropometric indices, physical capacity and cognitive performance were measured at before and after the supplementation. Results The study shows that between the fortified and non-fortified milk group, there was no significant different in haemoglobin increase (0.01 + 0.96 mg/dL versus 0.17 + 0.81 mg/dL) nor serum ferritin increase (12.77 + 25.50 mcg/dL versus 14.99 + 29.56 mcg/dL). Unexpectedly, decreased in serum zinc was found in both groups (3.01 + 3.24 mMol/dL and 3.12 + 3.71 mMol/dL). There was significant higher increment (P=0.045) in body weight among the fortified milk group (1.31 + 0.69 kg) as compared to the non-fortified group (1.13 + 0.69 kg). Consistently, there was significant increase (P=0.025) in the indicator of underweight (WAZ) among the fortified milk group (1.47 + 0.50) as compared to the non-fortified group (1.33 + 0.47). There was significant improvement (P=0.001) of cognitive performance, i.e. coding test-score among the fortified group (12.74 + 11.76) as compared to the non-fortified group (8.31 + 9.60), but there was no significant difference found in the improvement of physical capacity score in both groups (10323.77 + 9253.83 versus 8435.94 + 8824.55). Conclusion Among underweight schoolchildren aged 7-9 y, supplementation of milk fortified with iron and zinc can provide better growth, and better speed processing of learning ability. "

"Anemia has long been recognized as a serious public health problem in many developing countries. WHO reported at an INACG meeting and estimated that 2 billion people were anemic. Based on the public health viewpoint, most cases of anemia are nutritional anemia and defined in the year 1968 WHO technical report as a condition in which the hemoglobin content of the blood is lower than normal as a result of a deficiency of one or more essential nutrients, regardless ofthe cause of such deficiency.The causal relationship between iron deficiency and physical work capacity is evaluated through a systematic review of research literature, including animal and human studies. The presumed mechanism for this effect is the reduced oxygen transport associated with anemia; tissue iron deficiency may also play a role through reduced cellular oxidative capacity.The effects of anemia on physical activities and work performance have been studied in several countries such as Indonesia and China. A study in Indonesia found a significantly lower output of anemic Indonesian rubber plantation workers than the non-anemic workers. The Vietnam national survey in anemia l995 revealed that the prevalence of anemia was 40.2 % among non-pregnant women; it was also high among males around 20 %), whereas the prevalence of iron deficiency among non pregnant women was not very high (33.3 %). Therefore, multivitamin supplementation may reduce the anemia prevalence among Vietnamese non pregnant workers. Some main problems of an anemia control program (in scale of 113 districts of Vietnam) were side effects and the unpleasant taste of iron tablets; it caused the low compliance of iron tablet consumption. On the other hand, multi vitamin tablets have no side effect and have a palatable taste, thus it may be well accepted."

"ABSTRACTThe overall objectives of this study were to determine and compare the efficacy of daily vs weekly supplementation with iron, vitamin A, and zinc in children. Furthermore, the impact of supplementation on disease incidence (Diarrhea, Acute Respiratory Infection) and growth performance was investigated Subjects was children aged 6-24 months from rural households in Chi Lang Bac commune of Thanh Mien district, Hai Duong province, Vietnam.The research was designed as a randomized double-blind placebo-control trial. A total of 168 children were divided into 3 groups: daily, weekly, and placebo treatment lasted 12 weeks. Data on biochemical were collected at start and the end of supplementation. Data on growth were collected at start, end, and 3 months after the supplementation ended Supplements contained 333 lug retinol (1100 IU), 8 mg el. iron, 5 mg el. zinc for the daily dose (DD); 1700 pg retinol (5600 IU), 20 mg el. iron, 17.4 mg el. Zinc for the weekly dose (WLD); and the last group was the placebo (PL).After 12-week supplementation, increase for Hb, retinol, and zinc concentrations in the supplemented DD and WLD were similar (P>0.05) and significant higher (P<0.01) from those in the PL. The improvement of all anthropometric indices were similar between supplemented DD, and WLD with PL at the end, and at 3 months after the supplementation (P>0.05). In stunted children at baseline, changes for HAZ in the supplemented DD and WLD were similar (P>0.05) and significant higher (P<0.05) from those in the PL at 3 months after the supplementation. Incidence of Diarrhea and ARI in supplemented DD and WLD groups were similar (P> 0.05) and significant lower (P<0.01) compared with those in the PL at the end of 12-week supplementation.The WLD multi-nutrient supplementation for 12 weeks can be a possible preventive strategy to improve the iron, vitamin A, and zinc status of children aged 6-24 months."

"Kelainan metabolisme besi dapat terjadi akibat gangguan sintesis heme dan globin. Gangguan sintesis heme dijumpai pada defisiensi besi, anemia penyakit menahun dan anemia sideroblastik. Gangguan sintesis rantai globin dikenal sebagai hemoglobinopati terdiri dari thalassemia dan hemoglobin varian. Defisiensi besi dibedakan menjadi defisiensi besi tahap I, ii, Ilia dan l1ib. Pada defisiensi besi tahap I dan 11 belum dijumpai anemia, sedangkan tahap III a dan b telah dijumpai anemia. Diagnosis kelainan metabolisme besi dilakukan dengan perneriksaan hematologi, status besi tubuh, analisis hemoglobin dan menemukan ringed sideroblast di sum-sum tulang. Pada kasus campuran thalassemia E3 heterozigot dengan anemia defisiensi besi, anaiisis hemoglobin dilakukan setelah perbaikan status besi tubuh untuk mencegah rendah palsu kadar Hb A2 dan F. Besi berperan panting di Susunan Saraf Pusat (SSP) diantaranya untuk mileinisasi saraf, neurotransmiter dan metabolisme katekolamin. Pada penelitian ini dari 150 subyek diperoleh proporsi kelainan metabolisme besi sebesar 94'%. Kelainan metabolisme besi yang diperoleh terdiri dari defisiensi besi tahap I, II, Isla dan IIIb, anemia penyakit menahun, thalassemia 8 heterozigot, kemungkinan thalassemia a 1 atau 2 gen delesi, penyakit Hb H, HPF thalassemia heterozigot ganda serta campuran kelainan tersebut. Kelainan metabolisme besi dibedakan menjadi kelainan metabolisme besi disertai anemia (80.14%) dan tanpa anemia (19.85%). Proporsi hemoglobinopati (39.71%) dan campuran hemoglobinopati dengan defisiensi besi (39%) merupakan kelainan metabolisme besi terbanyak dibandingkan defisiensi besi (19.85%). Pada penelitian ini diperoleh prestasi belajar buruk secara bermakna pada kasus defisiensi besi (p<0.05) dibandingkan dengan kasus bukan defisiensi besi, tErutama pada mata pelajaran matematika dan bahasa Indonesia. Oleh karena proporsi hemoglobinopati yang lebih tinggi dibandingkan defisiensi besi, disarankan untuk diadakan tindak lanjut oleh dinas kesehatan setempat untuk mencegah peningkatan kasus hemoglobinopati homozigot atau heterozigot ganda. Untuk kasus defisiensi besi dilakukan pemeriksaan lanjutan guna mencari penyebab.

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Iron metabolism disorder may caused by defects of heme or globin synthesis. Defect of heme synthesis includes iron deficiency, anemia of chronic disease and siderobistic anemia. Defect of giobin synthesis are called hemoglobinopathies. Hemoglobinopathies may include either thalassemias or hemoglobin variants. Iron deficiency is classified into stage I, stage II, stage ill a and Ilib. Anemia is found in iron deficiency stage llla and 111b_ Diagnosis of iron metabolism disorder were done by hematology examination, iron status, hemoglobin analysis and bone marrow ringed sideroblast. In thalassemia R heterozygote patients with Iron deficiency anemia before hemoglobin analysis, iron status must be corrected to prevent falsey low Hb A2 and F levels. In the central nervous system iron are utilized in myelinisation, neurotransmitter and catecolamine metabolism. In this study on 150 subjects, proportion of iron metabolism disorder was 94%. Iron metabolism disorder were classified into iron deficiency stage I, II, Illa and illb, anemia of chronic disease, thalassemia 13 heterozygote, suspected of thalassemia a 1 or 2 gene deletion and mixed case between iron metabolism disorder. iron metabolism disorder was divided into anemia (80.14%) and non anemia (19.85%). Hemoglobinopathies (39.71%), mixed case between hemoglobinopathies and iron deficiency (39%) comprises biggest proportion compared with iron deficiency (19.85%).This study also found that iron deficiency subjects had significantly worse academic achievement (p<0.05) compared with non iron deficiency subjects especially in math and. bahasa Indonesia. As the proportion of hemoglobinopathies was higher than iron deficiency, we suggest that the district heatlh department to take action to prevent the increase in the prevalence of homozygous or compound heterozygous hemoglobinopathies. For iron deficiency cases, further investigation is needed to find causes of iron deficiency."

"Masalah gizi terbagi menjadi masalah gizi makro dan mikro. Masalah gizi makro adalah masalah gizi yang disebabkan karena kekurangan atau ketidakseimbangan asupan energi dan protein. Bila terjadi pada anak balita maka akan mengakibatkan marasmus, kwashiorkor atau marasmik-kwashiorkor dan selanjutnya akan terjadi gangguan pertumbuhan pada anak usia sekolah. Anak usia sekolah yang menderita kekurangan gizi juga memiliki kekurangan gizi mikro (micronutrient) zat besi dan seng (zinc), hal tersebut sangat berpengaruh terhadap pertumbuhan fisik dan perkembangan potensi intelektualnya. Penelitian ini menggunakan data sekunder yang dikumpulkan oleh Departemen Gizi Fakultas Kedokteran UI tahun 2008 pada penelitian 'Micronutrient Status After Milk Supplementation in Urban-Poor Schoolchildren in Jakarta and Solo' dan penelitian oleh Yuniarty (2008) 'Status Gizi Anak Sekolah Usia 7 -9 tahun di Daerah Miskin Perkotaan Jakarta Setelah Penghentian Susu Fortifikasi' yang dilaksanakan pada bulan agustus 2007 sampai dengan bulan Mei 2008. Data tersebut dianalisis dengan menggunakan uji regresi generalized estimating equation (GEE). Hasil penelitian menunjukkan bahwa terjadi peningkatan berat badan dan tinggi badan anak pada anak yang diberi intervensi, tidak ada perbedaan status gizi antara anak yang diberi susu fortifikasi dengan anak yang diberi susu tanpa fortifikasi, dan status gizi pada anak yang diberi susu fortifikasi dan susu tanpa fortifikasi tidak dipengaruhi oleh asupan makanan, penghasilan orang tua, jumlah anak dalam keluarga, pendidikan ibu dan kebiasaan minum susu. Disarankan, untuk mengetahui efek pemberian susu fortifikasi zat besi dan seng terhadap status gizi diperlukan waktu penelitian yang lebih lama dan menggunakan sampel anak yang mempunyai gizi baik maupun buruk.

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Nutrient problem comprises of macronutrient and micronutrient. Macronutrient problem is caused by lack of or imbalance between energy and protein. When it happens to children it will cause marasmus, kwashiorkor or marasmic-kwashiorkor and result in growth interference. Children in the school period who suffer from lack of nutrient will also suffer from lack of micronutrient iron and zinc, which would influence their physical and intellectual potential growth.

This research utilizes secondary data which collected by Nutrient Department of Medical Faculty of UI year 2008 on the research of 'Micronutrient Status After Milk Supplementation in Urban-Poor Schoolchildren in Jakarta and Solo' and research by Yuniarty(2008) 'Nutrient Status for Schoolchildren Ages 7-9 years old in Urban-Poor Jakarta after the Discontinuance of Fortified Milk' (Status Gizi Anak Sekolah Usia 7-9 tahun di Daerah Miskin Perkotaan Jakarta Setelah Penghentian Susu Fortifikasi) which carried out on August 2007 until May 2008. The data was analyzed using regression test 'Generalized Estimating Equation' (GEE).

Result of those studies show that the weight and height of the children who were given intervention were increasing, with no nutrient status differences between the children who were given fortified milk and the children who were given unfortified milk. The nutrient status is not influenced by food, parenting income, total children in family, mother education or milk drinking habit. It is suggested though, that a longer and more extensive research using a wider sample of children with good and bad nutrient status is needed to find out how iron and zinc in fortified milk would affect the nutrient status in children."