Table 1 Characteristics of included trials
RT | Country | Sample | LF intervention group | Comparison group | Main findings |
|---|---|---|---|---|---|
Darwish et al. (2018) [23] | Egypt | 93 pregnant women, with IDA, > 18 years, gestational age between 14–28 weeks | 60 participants LF oral sachets 200 mg per day | 33 participants Τotal dose infusion of low molecular weight iron dextran (Iron (III)-hydroxide dextran complex) The dose for each participant was calculated according to the Ganzoni formula according to weight and iron stores | Both the iron and the LF therapy showed a rise in Hb concentration levels in participants. LF oral sachets can be used as an alternative to total dose infusion iron dextran supplementation |
El-Asheer et al. (2021) [24] | Egypt | 96 children, with IDA between 2–15 years old | 32 participants 100 mg per day | 32 participants Ferrous sulfate 6 mg/kg/day elemental iron administered orally once daily | There was a statistically significant difference in the increase of Hb concentration levels favouring LF treatment. Oral bovine LF was a more effective and safer alternative to oral ferrous sulfate. It has a better patient compliance and fewer side effects |
El-Hawy, Abd Al-Salam and Bahbah. (2021) [30] | Egypt | 120 children, with IDA, between 1–18 years old | 30 participants 100 mg per day for children < 3 years old 200 mg per day for children > 3 years old | 30 participants Iron bisglycinate chelate (FeBC) taken at a dose of 0.75 mg/kg/d 30 participants Iron polymaltose complex (IPC) (50mg/5 ml) at a dose of 6 mg/kg/d | The administration of LF with iron was more effective for increasing Hb concentration levels than the administration of iron alone |
El-Nasr et al. (2021) [34] | Egypt | 300 pregnant women, with IDA, second trimester (12 weeks of gestation onwards), with single fetus | 150 participants combined intake of 200 mg of LF and 30 mg of iron per day | 150 participants Dried ferrous sulfate 150 mg per day | Combined LF with ferrous sulfate was a more effective treatment, with a statistically significant difference, in increasing Hb concentration levels in pregnant women, than iron alone |
Kamal, Rezk and Hafez. (2021) [31] | Egypt | 150 children, with IDA, > 2 years of age | 50 participants 200 mg per day | 50 participants Ferric hydroxide polymaltose 6mg/kg/day 3X per day | There was a significant increase in Hb concentration levels in all three intervention groups. However, there was a significant difference favouring the LF and ferrous gluconate compound group. Therefore, LF with iron may be a more effective, alternative, treatment for increasing Hb concentration levels than the traditionally used iron alone |
Macciò et al. (2010) [20] | Italy | 148 cancer patients undergoing chemotherapy, ≥ 18 years old, histological diagnosis of a solid tumor at an advanced disease stage (stage III–IV) | 75 participants s.c. rHuEPO-β, 30,000 UI once weekly and LF 200 mg/day | 73 participants s.c. rHuEPO-β, 30,000 UI once weekly and ferric gluconate (125 mg i.v. weekly) | There was no significant difference in the mean Hb increase between the LF arm and the intravenous iron group. LF and i.v iron exhibited similar efficacy for increasing Hb concentration levels, in cancer patients undergoing chemotherapy |
Nappi et al. (2009) [21] | Italy | 97 pregnant women, with IDA, gestational age > 12 weeks and < 36 weeks, singleton pregnancy | 49 participants 200 mg per day | 48 participants Ferrous sulfate 100 mg of iron at the daily oral dose of one tablet of 520 m | Both the LF and the iron groups showed a significant increase in Hb concentration levels. However, there were no statistically significant differences between both treatments. Bovine LF had the same efficacy as ferrous sulfate |
Omar et al. (2021) [32] | Egypt | 66 children, with Cerebral Palsy and who met the WHO diagnostic criteria of IDA, aged between 1–10 years | 34 participants oral bLF (30% iron-saturated) 200 mg per day | 32 participants Iron Polymaltose complex at a dose of 6 mg/kg/day of elemental iron in 2 divided doses | Both the LF and the iron groups showed a statistically significant increase in Hb concentration levels. Bovine LF was effective and superior to the effect of iron hydroxide polymaltose complex, with fewer side effects, for children with cerebral palsy, suffering with IDA |
Paesano et al. (2006) [22] | Italy | 205 pregnant women, suffering from ID and IDA, in different stages of pregnancy | 107 participants 200 mg per day | 98 participants Ferrous sulfate 520 mg tablet dose containing 156 mg of elemental iron per day | Hb concentration levels showed a significant increase in all groups of women. However, in women receiving bovine LF treatment the mean values of Hb were higher than those in the ferrous sulfate group |
Paesano et al. (2010) [19] | Italy | 60 pregnant women, with mild IDA, third trimester of gestation | 30 participants oral bLF (30% iron saturated) 200 mg per day | 30 participants Ferrous sulfate 520 mg tablet dose containing 156 mg of elemental iron per day | Women treated with bovine LF showed a statistically significant increase in Hb concentration levels. Women treated with ferrous sulfate showed an increase in Hb concentration levels, but values did not reach statistical significance |
Paesano et al. (2010) [19] | Italy | 166 non-pregnant women of childbearing age, aged between 19–45 years old, with mild IDA | 90 participants oral bLF (30% iron saturated) 200 mg per day | 76 participants Ferrous sulfate 520 mg tablet dose containing 156 mg of elemental iron per day | Women treated with bovine LF showed a statistically significant increase in Hb concentration levels, in contrast to women treated with ferrous sulfate |
Rezk et al. (2016) [33] | Egypt | 200 pregnant women, with IDA, second trimester of gestation, single fetus | 100 participants 250 mg per day | 100 participants Dried ferrous sulfate capsules 150 mg per day | The total increase in Hb concentration levels in the LF group was higher than that compared to the ferrous sulfate group. Bovine LF was more effective than ferrous sulfate, with fewer gastrointestinal side effects and better patient compliance to treatment |
Hemeda et al. (2018) [35] | Egypt | 146 pregnant women, with IDA, gestational age > 14 weeks | 73 participants 200 mg per day | 73 participants Ferrous fumarate 350 mg iron (115 mg elemental iron) per day | The increase in Hb concentration levels was statistically significantly higher in the LF group in comparison to the iron fumarate group. Bovine LF was more efficacious than ferrous fumarate in the treatment of patients with a low Hb concentration profile. It is safer and has a better patient compliance to treatment |
El-Khawaga and Abdelmaksoud (2019) [36] | Egypt | 85 primary school children, with IDA, primary school age, between 6–12 years | 43 participants 200 mg per day | 42 participants Elemental iron 6 mg/kg/day | There was a statistically significant increase in Hb concentration levels in the LF group of patients compared to the elemental iron group. LF was a more effective and a safer alternative for treating patients with a low Hb concentration profile than elemental iron |
Atia et al. (2021) [37] | Egypt | 40 obese children and adolescents, with IDA, aged between 6–18 years | 20 participants 100 mg per day | 20 participants Ferric hydroxide polymaltose 6 mg/kg/day | There was significant elevation in the mean value of Hb concentration after therapy with bovine LF compared to the mean value after oral iron therapy. Bovine LF was superior to ferric hydroxide polymaltose for the treatment of Hb concentration levels, in obese children, with less gastrointestinal side effects |
Fawzy Mohamed, Soliman Taha and Farrag Ismaeil Farag. (2020) [25] | Egypt | 200 pregnant women, with IDA, gestational age 24–32 weeks, singleton pregnancy | 100 participants LF plus folic acid 100 mg per day | 100 participants Dried ferrous sulfate 150 mg per day | Hb concentration levels significantly increased in both the LF and iron groups, but the increase was statistically significantly higher in the LF group. Bovine LF was more efficacious in improving Hb concentration levels and better tolerated, with better patient compliance to treatment |
Bayoumy, Ragab and Elghareeb. (2021) [26] | Egypt | 140 pregnant women, with IDA, gestational age < 28 weeks, singleton pregnancy | 70 participants 200 mg per day | 70 participants Ferrous sulfate 200 mg per day | The increase of Hb concentration levels was significantly higher in the LF group compared to the ferrous sulfate group. Bovine LF was more effective than ferrous sulfate in improving Hb concentration levels and more tolerable |
Ali et al. (2015) [29] | Egypt | 600 pregnant women, Hb concentration level ≥ 10.5, gestational age 20–32 weeks, singleton pregnancy | 200 participants 250 mg per day | 200 participants Ferrous sulfate 150 mg per day 200 participants Amino acid chelated iron 15 mg per day | Hb concentration levels showed an increase in all groups after treatment. The difference in the mean Hb values among groups were statistically insignificant. LF was equally effective in improving Hb concentration levels as the other two trialled oral iron preparations |
El Amrousy et al. (2022) [27] | Egypt | 80 children with inflammatory bowel disease, suffering with IDA, aged between 5–18 years | 40 participants 100 mg per day | 40 participants Ferrous sulfate 6mg/kg/day | Hb concentration levels were significantly increased in both groups. However, the LF group had a significantly higher mean Hb value than the ferrous sulfate group. LF was an effective alternative to iron treatment with fewer side effects, in children with inflammatory bowel disease |