| Description |
Background Iron defciency in athletes is initially treated with a nutritional intervention. If negative iron balance persists, oral iron supplementation (OIS) can be used. Despite the recent proposal for a refnement of treatment strategies for irondefcient athletes, there is no general consensus regarding the actual efciency, dosage, or optimal regimen of OIS. Objective The aim of this meta-analysis was to evaluate to what extent OIS afects blood iron parameters and physical performance in healthy adult athletes. Methods PubMed, Web of Science, PEDro, CINAHL, SPORTDiscus, and Cochrane were searched from inception to 2 November 2022. Articles were eligible if they satisfed the following criteria: recruited subjects were healthy, adult and physically active individuals, who used exclusively OIS, irrespective of sex and sports discipline. Exclusion criteria: simultaneous supplementation with iron and any other micronutrient(s), intravenous iron supplementation or recent exposure to altitude acclimatisation. The methodological quality of included studies was assessed with the PEDro scale, the completeness of intervention reporting with the TIDieR scale, while the GRADE scale was used for quality of evidence synthesis. The present study was prospectively registered in PROSPERO online registry (ID: CRD42022330230). Results From 638 articles identifed through the search, 13 studies (n=449) were included in the quantitative synthesis. When compared to the control group, the results demonstrated that OIS increases serum ferritin (standardized mean difference (SMD)=1.27, 95% CI 0.44–2.10, p=0.006), whereas blood haemoglobin (SMD=1.31, 95% CI - 0.29 to 2.93, p=0.099), serum transferrin receptor concentration (SMD=- 0.74, 95% CI - 1.89 to 0.41, p=0.133), and transferrin saturation (SMD=0.69, 95% CI - 0.84 to 2.22, p=0.330) remained unaltered. Following OIS, a trend of small positive efect on VO2max (SMD=0.49, 95% CI - 0.09 to 1.07, p=0.086) was observed in young healthy athletes. The quality of evidence for all outcomes ranged from moderate to low. Conclusions Increase in serum ferritin concentration after OIS was evident in subjects with initial pre-supplementation serum ferritin concentration?12 µg/l, while only minimal, if any efect, was observed in subjects with higher pre-supplementation serum ferritin concentration. The doses of OIS, that induced a benefcial efect on hematological parameters difered from 16 to 100 mg of elementary iron daily, over the period between 6 and 8 weeks. Shorter supplementation protocols have been shown to be inefective.
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