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Compliance compromises an interventional study on iron supplementation in female combatants
  1. Shany Guly Gofrit1,
  2. S Ohayon-Cohen2,
  3. A M Tsur1,
  4. V Rabkin1,
  5. M Michael Shapira1 and
  6. A S Finestone3
  1. 1Israel Defense Forces Ground Command, Medical Division, Israel Defense Forces Medical Corps, Ramat Gan, Israel
  2. 2Department of Internal Medicine J, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  3. 3Department of Orthopaedic Surgery, Assaf Harofeh MC, affiliated to the Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
  1. Correspondence to Dr Shany Guly Gofrit, Israel Defense Forces, Medical Corps, Ramat Gan 02149, Israel; shanygo{at}


Introduction Low iron levels are related to overuse injuries, poor physical performance and cognitive impairments in female recruits. The aim of this study was to evaluate iron supplement compliance in female combatants during basic training, and its effect on haemoglobin (Hgb), ferritin and injuries.

Methods 329 female recruits to light infantry units filled induction questionnaires regarding smoking status, previous overuse injuries and iron deficiency. Blood was drawn for Hgb and ferritin. Subjects with ferritin levels below 20 ng/mL were considered iron depleted and were prescribed a ferrous fumarate supplement. After 4 months of basic training, the subjects completed a follow-up questionnaire regarding overuse injuries, reasons for failure to complete basic training and compliance with iron supplementation. Blood tests were repeated.

Results Mean ferritin levels declined during training (from 18.1±18.2 to 15.3±9.6, p=0.01). Compliance with iron supplementation was observed in 26 (26.3%) of the subjects. In compliant subjects, Hgb levels remained constant and ferritin levels increased by 2.9±5.4 (p=0.07). The main reasons for reported non-compliance were forgetfulness, 26 (35.6%), and gastrointestinal side effects, 17 (23.3%). Injuries during training were not found to be associated with iron status. Smokers had a significantly higher rate of reported injuries prior to training (p<0.01).

Conclusions Ferritin levels decline during training. Compliance with iron supplementation is low. Iron supplementation has a significant effect on ferritin levels, even in the non-compliance group. Injuries were not related to iron status in this group. Further research is needed in order to clarify the most appropriate iron supplementation method.

  • iron deficiency anaemia
  • iron supplement
  • compliance
  • overuse injuries
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  • Contributors SGG: devising the concept of the study, data collection, statistical analysis and writing. SOC, AMT, MMS: reviewing data, proofreading of the manuscript, data collection. VR: statistical analysis and study design. ASF: writing and proofreading, statistical analysis, data reviewing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Israel Defense Forces Institutional Review Board (permit 1822-2017).

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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