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McClung JP, Gaffney-Stomberg E, Lee JJ. Female athletes: a population at risk of vitamin and mineral deficiencies affecting health and performance. J Trace Elem Med Biol 2014; 28:388-92. [PMID: 25060302 DOI: 10.1016/j.jtemb.2014.06.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Adequate vitamin and mineral status is essential for optimal human health and performance. Female athletes could be at risk for vitamin and mineral insufficiency due to inadequate dietary intake, menstruation, and inflammatory responses to heavy physical activity. Recent studies have documented poor iron status and associated declines in both cognitive and physical performance in female athletes. Similarly, insufficient vitamin D and calcium status have been observed in female athletes, and may be associated with injuries, such as stress fracture, which may limit a female athlete's ability to participate in regular physical activity. This review will focus on recent studies detailing the prevalence of poor vitamin and mineral status in female athletes, using iron, vitamin D, and calcium as examples. Factors affecting the dietary requirement for these vitamins and minerals during physical training will be reviewed. Lastly, countermeasures for the prevention of inadequate vitamin and mineral status will be described.
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Affiliation(s)
- James P McClung
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine (USARIEM), Natick, MA 01760, United States.
| | - Erin Gaffney-Stomberg
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine (USARIEM), Natick, MA 01760, United States
| | - Jane J Lee
- Department of Nutritional Science, University of Texas at Austin, Austin, TX 78712, United States
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102
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Beck KL, Conlon CA, Kruger R, Coad J. Dietary determinants of and possible solutions to iron deficiency for young women living in industrialized countries: a review. Nutrients 2014; 6:3747-76. [PMID: 25244367 PMCID: PMC4179187 DOI: 10.3390/nu6093747] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 08/22/2014] [Accepted: 08/25/2014] [Indexed: 12/21/2022] Open
Abstract
Iron deficiency is a concern in both developing and developed (industrialized) countries; and young women are particularly vulnerable. This review investigates dietary determinants of and possible solutions to iron deficiency in young women living in industrialized countries. Dietary factors including ascorbic acid and an elusive factor in animal protein foods (meat; fish and poultry) enhance iron absorption; while phytic acid; soy protein; calcium and polyphenols inhibit iron absorption. However; the effects of these dietary factors on iron absorption do not necessarily translate into an association with iron status and iron stores (serum ferritin concentration). In cross-sectional studies; only meat intake has consistently (positively) been associated with higher serum ferritin concentrations. The enhancing effects of ascorbic acid and meat on iron absorption may be negated by the simultaneous consumption of foods and nutrients which are inhibitory. Recent cross-sectional studies have considered the combination and timing of foods consumed; with mixed results. Dietary interventions using a range of focused dietary measures to improve iron status appear to be more effective than dietary approaches that focus on single nutrients or foods. Further research is needed to determine optimal dietary recommendations for both the prevention and treatment of iron deficiency.
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Affiliation(s)
- Kathryn L Beck
- Institute of Food Nutrition and Human Health, College of Health, Massey University, Private Bag 102 904, North Shore City 0745, New Zealand.
| | - Cathryn A Conlon
- Institute of Food Nutrition and Human Health, College of Health, Massey University, Private Bag 102 904, North Shore City 0745, New Zealand.
| | - Rozanne Kruger
- Institute of Food Nutrition and Human Health, College of Health, Massey University, Private Bag 102 904, North Shore City 0745, New Zealand.
| | - Jane Coad
- Institute of Food Nutrition and Human Health, College of Health, Massey University, Private Bag 102 904, North Shore City 0745, New Zealand.
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103
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Beguin Y, Jaspers A. Iron sucrose - characteristics, efficacy and regulatory aspects of an established treatment of iron deficiency and iron-deficiency anemia in a broad range of therapeutic areas. Expert Opin Pharmacother 2014; 15:2087-103. [PMID: 25186219 DOI: 10.1517/14656566.2014.953928] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Iron is a key element in the transport and utilization of oxygen and a variety of metabolic pathways. Iron deficiency is a major cause of anemia and can be associated with fatigue, impaired physical function and reduced quality of life. Administration of oral or intravenous (i.v.) iron is the recommended treatment for iron-deficiency anemia (IDA) in different therapeutic areas. AREAS COVERED This article provides an overview of studies that evaluated i.v. iron sucrose for anemia and iron status management, either alone or in combination with erythropoiesis-stimulating agents, across various diseases and conditions. EXPERT OPINION Iron sucrose is an established, effective and well-tolerated treatment of IDA in patients with acute or chronic conditions such as chronic kidney disease, inflammatory bowel disease, pregnancy (second and third trimester), postpartum period, heavy menstrual bleeding and cancer who need rapid iron supply and in whom oral iron preparations are ineffective or not tolerated. Available data on patient blood management warrant further studies on preoperative iron treatment. First experience with iron sucrose follow-on products raises questions about their therapeutic equivalence without comparative clinical data in newly diagnosed patients or patients on existing chronic treatment.
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Affiliation(s)
- Yves Beguin
- University Hospital of Liège , Avenue de l'Hopital1, B-4000 Liège , Belgium +32 43 66 72 01 ; +32 43 66 88 55 ;
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104
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Stack AG, Mohamed W, Elsayed M. Transferrin saturation ratio: a method to estimate risk of cardiovascular mortality in the general population? Biomark Med 2014; 8:913-5. [DOI: 10.2217/bmm.14.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Austin G Stack
- Departments of Nephrology & Internal Medicine, University Hospital Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Ireland
| | - Waleed Mohamed
- Departments of Nephrology & Internal Medicine, University Hospital Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Ireland
| | - Mohamed Elsayed
- Departments of Nephrology & Internal Medicine, University Hospital Limerick, Ireland
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105
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Rineau E, Chaudet A, Carlier L, Bizot P, Lasocki S. Ferric carboxymaltose increases epoetin-α response and prevents iron deficiency before elective orthopaedic surgery. Br J Anaesth 2014; 113:296-298. [DOI: 10.1093/bja/aeu245] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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106
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Stack AG, Mutwali AI, Nguyen HT, Cronin CJ, Casserly LF, Ferguson J. Transferrin saturation ratio and risk of total and cardiovascular mortality in the general population. QJM 2014; 107:623-33. [PMID: 24599805 PMCID: PMC4108849 DOI: 10.1093/qjmed/hcu045] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The transferrin saturation (TSAT) ratio is a commonly used indicator of iron deficiency and iron overload in clinical practice but precise relationships with total and cardiovascular mortality are unclear. PURPOSE To better understand this relationship, we explored the association of TSAT ratio (serum iron/total iron binding capacity) with mortality in the general population. METHODS The relationships of TSAT ratio with total and cardiovascular mortality were explored in 15 823 subjects age 20 and older from the Third National Health and Nutrition Examination Survey (1988-94). All subjects had vital status assessed through to 2006. RESULTS During follow-up, 9.7% died of which 4.4% were from cardiovascular disease. In unadjusted analysis, increasing TSAT ratio was inversely associated with mortality. With adjustment for baseline demographic and clinical characteristics, the TSAT-mortality relationship followed a j-shaped pattern. Compared with the referent group [ratio 23.7-31.3%: hazard ratio (HR) =1.00], subjects in the lowest two quartiles, <17.5 % and 17.5-23.7 %, experienced significantly higher mortality risks of 1.45 (1.19-1.77) and 1.27 (1.06-1.53), respectively, whereas subjects in the highest quartile, >31.3 %, experienced significantly higher mortality risks of 1.23 (1.01-1.49). The pattern of association was more pronounced for cardiovascular mortality with significantly higher mortality risks for the lowest two quartiles [HR = 2.09 (1.43-3.05) and 1.90 (1.33-2.72), respectively] and highest quartile HR = 1.59 (1.05-2.40). CONCLUSIONS Both low and high TSAT ratios are significantly and independently associated with increased total and cardiovascular mortality. The optimal TSAT ratio associated with the greatest survival is between 24% and 40%.
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Affiliation(s)
- A G Stack
- From the Departments of Nephrology and Internal Medicine, University Hospital Limerick, Limerick, Department of Nephrology, Letterkenny General Hospital, Letterkenny, Donegal and Graduate Entry Medical School, University of Limerick, Limerick, IrelandFrom the Departments of Nephrology and Internal Medicine, University Hospital Limerick, Limerick, Department of Nephrology, Letterkenny General Hospital, Letterkenny, Donegal and Graduate Entry Medical School, University of Limerick, Limerick, IrelandFrom the Departments of Nephrology and Internal Medicine, University Hospital Limerick, Limerick, Department of Nephrology, Letterkenny General Hospital, Letterkenny, Donegal and Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - A I Mutwali
- From the Departments of Nephrology and Internal Medicine, University Hospital Limerick, Limerick, Department of Nephrology, Letterkenny General Hospital, Letterkenny, Donegal and Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - H T Nguyen
- From the Departments of Nephrology and Internal Medicine, University Hospital Limerick, Limerick, Department of Nephrology, Letterkenny General Hospital, Letterkenny, Donegal and Graduate Entry Medical School, University of Limerick, Limerick, IrelandFrom the Departments of Nephrology and Internal Medicine, University Hospital Limerick, Limerick, Department of Nephrology, Letterkenny General Hospital, Letterkenny, Donegal and Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - C J Cronin
- From the Departments of Nephrology and Internal Medicine, University Hospital Limerick, Limerick, Department of Nephrology, Letterkenny General Hospital, Letterkenny, Donegal and Graduate Entry Medical School, University of Limerick, Limerick, IrelandFrom the Departments of Nephrology and Internal Medicine, University Hospital Limerick, Limerick, Department of Nephrology, Letterkenny General Hospital, Letterkenny, Donegal and Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - L F Casserly
- From the Departments of Nephrology and Internal Medicine, University Hospital Limerick, Limerick, Department of Nephrology, Letterkenny General Hospital, Letterkenny, Donegal and Graduate Entry Medical School, University of Limerick, Limerick, IrelandFrom the Departments of Nephrology and Internal Medicine, University Hospital Limerick, Limerick, Department of Nephrology, Letterkenny General Hospital, Letterkenny, Donegal and Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - J Ferguson
- From the Departments of Nephrology and Internal Medicine, University Hospital Limerick, Limerick, Department of Nephrology, Letterkenny General Hospital, Letterkenny, Donegal and Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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Cohen-Solal A, Damy T, Terbah M, Kerebel S, Baguet JP, Hanon O, Zannad F, Laperche T, Leclercq C, Concas V, Duvillié L, Darné B, Anker S, Mebazaa A. High prevalence of iron deficiency in patients with acute decompensated heart failure. Eur J Heart Fail 2014; 16:984-91. [PMID: 25065368 DOI: 10.1002/ejhf.139] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/20/2014] [Accepted: 05/23/2014] [Indexed: 12/12/2022] Open
Abstract
AIMS Limited data are available on iron parameters in patients hospitalized for decompensation of chronic heart failure. METHODS AND RESULTS Iron parameters of patients hospitalized for decompensation of chronic heart failure were prospectively assessed during the 72 h after hospital admission. Iron deficiency was defined according to the 2012 European Society of Cardiology Guidelines. Overall, 411 men (75 ± 12 years; 75% NYHA functional classes III/IV) and 421 women (81 ± 11 years; 71% NYHA classes III/IV) were evaluated. The prevalence of iron deficiency was 69% in men and 75% in women (including 41% and 49% with absolute iron deficiency, respectively). The prevalence of anaemia in men (<13 g/dL) was 68% and in women (<12 g/dL) it was 52%. Among non-anaemic patients, the prevalence of iron deficiency was 57% in men and 79% in women. Only 9% of patients received iron supplementation at the time of admission (oral, 9%; intravenous, 0.2%). Multivariate analysis showed that anaemia and antiplatelet treatment in men, and diabetes and low C-reactive protein in women, were independently associated with iron deficiency. CONCLUSIONS Iron deficiency is very common in patients admitted for acute decompensated heart failure, even among non-anaemic patients. Given the benefit of iron therapy in chronic heart failure, our results emphasize the need to assess iron status not only in chronic heart failure patients, but even more so in those admitted for worsening heart failure, regardless of gender, heart failure severity, or haemoglobin level. Initiating iron therapy in hospitalized heart failure patients needs to be investigated.
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Affiliation(s)
- Alain Cohen-Solal
- UMR-S 942, DHU FIRE, Medicine Faculty, Paris Diderot University, Department of Cardiology, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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108
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Vullaganti S, Goldsmith J, Teruya S, Alvarez J, Helmke S, Maurer MS. Cardiovascular effects of hemoglobin response in patients receiving epoetin alfa and oral iron in heart failure with a preserved ejection fraction. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2014; 11:100-5. [PMID: 25009558 PMCID: PMC4076448 DOI: 10.3969/j.issn.1671-5411.2014.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/03/2014] [Accepted: 05/10/2014] [Indexed: 02/06/2023]
Abstract
Background Previous data from a recently conducted prospective, single blind randomized clinical trial among community dwelling older patients with heart failure with a preserved ejection fraction (HFPEF) and anemia randomized to treatment with epoetin alfa (erythropoiesis-stimulating agents, ESA) vs. placebo did not demonstrate significant benefits of therapy regarding left ventricular (LV) structure, functional capacity, or quality of life (QOL). However, several patients randomized to the treatment arm were non-responders with a suboptimal increase in hemoglobin. All patients in the trial also received oral ferrous gluconate, which could have contributed to increases in hemoglobin observed in those receiving placebo. Accordingly, we performed an analysis separating patients into responders vs. non-responders in order to determine if measured improvement in anemia would have any effect on clinical endpoints. Methods A total of 56 patients (age 77 ± 11 years, 68% female) were recruited who had anemia defined as a hemoglobin of ≤ 12 g/dL (average, 10.4 ± 1 g/dL) with HFPEF defined as having NHANES-CHF (National Health And Nutrition Examination Survey: Congestive Heart Failure) criteria score of ≥ 3 and an ejection fraction of > 40% (average EF = 63% ± 15%). Patients were randomly allocated to receive either ESA and ferrous gluconate or ferrous gluconate only. In this analysis, a responder was defined as a patient with an increase of 1 g/dL in the first 4 weeks of the trial. Results Nineteen subjects were classified as responders compared to 33 non-responders. While the average hemoglobin increased significantly at the end of 6 months for responders (1.8 ± 0.3 vs. 0.8 ± 0.2 g/dL, P = 0.004), 50% of the subjects assigned to ESA were non-responders. Left ventricular function including ejection fraction (P = 0.32) and end diastolic volume (P = 0.59) was unchanged in responders compared to non-responders. Responders also showed no significant improvements in New York Heart Association (NYHA) class, Six Minute Walk Test (6 MWT) and peak VO2. Though QOL improved significantly within each group, there was no difference between the two. Conclusions A significant hemoglobin response to anemia treatment with ESA and oral iron does not lead to differences in LV remodeling, functional status, or QOL. Additionally, a significant percent of older adults with HFPEF and anemia do not respond to ESA therapy. Given the results of this small trial, it appears as though using objective improvements in anemia as a marker in older adult subjects with HFPEF does not have significant clinical utility.
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Affiliation(s)
- Sirish Vullaganti
- Clinical Cardiovascular Research Lab for the Elderly, Allen Hospital of New York Presbyterian Hospital, 5141 Broadway, 3 Field West, Room 037, New York, NY 10032, USA
| | - Jeff Goldsmith
- Columbia Mailman School of Public Health, 722 W 168th Street, Rm 630, New York, NY 10032, USA
| | - Sergio Teruya
- Clinical Cardiovascular Research Lab for the Elderly, Allen Hospital of New York Presbyterian Hospital, 5141 Broadway, 3 Field West, Room 037, New York, NY 10032, USA
| | - Julissa Alvarez
- Clinical Cardiovascular Research Lab for the Elderly, Allen Hospital of New York Presbyterian Hospital, 5141 Broadway, 3 Field West, Room 037, New York, NY 10032, USA
| | - Stephen Helmke
- Clinical Cardiovascular Research Lab for the Elderly, Allen Hospital of New York Presbyterian Hospital, 5141 Broadway, 3 Field West, Room 037, New York, NY 10032, USA
| | - Mathew S Maurer
- Clinical Cardiovascular Research Lab for the Elderly, Allen Hospital of New York Presbyterian Hospital, 5141 Broadway, 3 Field West, Room 037, New York, NY 10032, USA
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109
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DELLAVALLE DIANEM, HAAS JERED. Iron Supplementation Improves Energetic Efficiency in Iron-Depleted Female Rowers. Med Sci Sports Exerc 2014; 46:1204-15. [DOI: 10.1249/mss.0000000000000208] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pasricha SR, Low M, Thompson J, Farrell A, De-Regil LM. Iron supplementation benefits physical performance in women of reproductive age: a systematic review and meta-analysis. J Nutr 2014; 144:906-14. [PMID: 24717371 DOI: 10.3945/jn.113.189589] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Animal and human observational studies suggest that iron deficiency impairs physical exercise performance, but findings from randomized trials on the effects of iron are equivocal. Iron deficiency and anemia are especially common in women of reproductive age (WRA). Clear evidence of benefit from iron supplementation would inform clinical and public health guidelines. Therefore, we performed a systematic review and meta-analysis to determine the effect of iron supplementation compared with control on exercise performance in WRA. We searched the Cochrane Central Register of Clinical Trials, MEDLINE, Scopus (comprising Embase and MEDLINE), WHO regional databases, and other sources in July 2013. Randomized controlled trials that measured exercise outcomes in WRA randomized to daily oral iron supplementation vs. control were eligible. Random-effects meta-analysis was used to calculate mean differences (MDs) and standardized MDs (SMDs). Risk of bias was assessed using the Cochrane risk-of-bias tool. Of 6757 titles screened, 24 eligible studies were identified, 22 of which contained extractable data. Only 3 studies were at overall low risk of bias. Iron supplementation improved both maximal exercise performance, demonstrated by an increase in maximal oxygen consumption (VO2 max) [for relative VO2 max, MD: 2.35 mL/(kg ⋅ min); 95% CI: 0.82, 3.88; P = 0.003, 18 studies; for absolute VO2 max, MD: 0.11 L/min; 95% CI: 0.03, 0.20; P = 0.01, 9 studies; for overall VO2 max, SMD: 0.37; 95% CI: 0.11, 0.62; P = 0.005, 20 studies], and submaximal exercise performance, demonstrated by a lower heart rate (MD: -4.05 beats per minute; 95% CI: -7.25, -0.85; P = 0.01, 6 studies) and proportion of VO2 max (MD: -2.68%; 95% CI: -4.94, -0.41; P = 0.02, 6 studies) required to achieve defined workloads. Daily iron supplementation significantly improves maximal and submaximal exercise performance in WRA, providing a rationale to prevent and treat iron deficiency in this group. This trial was registered with PROSPERO (http://www.crd.york.ac.uk/PROSPERO/prospero.asp) as CRD42013005166.
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Affiliation(s)
- Sant-Rayn Pasricha
- Nossal Institute for Global Health, School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia Medical Research Council (MRC) Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Michael Low
- Department of Clinical Haematology and Bone Marrow Transplant, The Alfred Hospital, Melbourne, VIC, Australia
| | - Jane Thompson
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
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111
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Abstract
Iron is a trace mineral that is highly significant to endurance athletes. Iron is critical to optimal athletic performance because of its role in energy metabolism, oxygen transport, and acid-base balance. Endurance athletes are at increased risk for suboptimal iron status, with potential negative consequences on performance, because of the combination of increased iron needs and inadequate dietary intake. This review paper summarizes the role of iron in maximal and submaximal exercise and describes the effects of iron deficiency on exercise performance. Mechanisms that explain the increased risk of iron deficiency in endurance athletes, including exercise-associated inflammation and hepcidin release on iron sequestration, are described. Information on screening athletes for iron deficiency is presented, and suggestions to increase iron intake through diet modification or supplemental iron are provided.
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Affiliation(s)
- Pamela S Hinton
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA
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112
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Favrat B, Balck K, Breymann C, Hedenus M, Keller T, Mezzacasa A, Gasche C. Evaluation of a single dose of ferric carboxymaltose in fatigued, iron-deficient women--PREFER a randomized, placebo-controlled study. PLoS One 2014; 9:e94217. [PMID: 24751822 PMCID: PMC3994001 DOI: 10.1371/journal.pone.0094217] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 03/12/2014] [Indexed: 12/13/2022] Open
Abstract
Background Unexplained fatigue is often left untreated or treated with antidepressants. This randomized, placebo-controlled, single-blinded study evaluated the efficacy and tolerability of single-dose intravenous ferric carboxymaltose (FCM) in iron-deficient, premenopausal women with symptomatic, unexplained fatigue. Methods Fatigued women (Piper Fatigue Scale [PFS] score ≥5) with iron deficiency (ferritin <50 µg/L and transferrin saturation <20%, or ferritin <15 µg/L) and normal or borderline hemoglobin (≥115 g/L) were enrolled in 21 sites in Austria, Germany, Sweden and Switzerland, blinded to the study drug and randomized (computer-generated randomization sequence) to a single FCM (1000 mg iron) or saline (placebo) infusion. Primary endpoint was the proportion of patients with reduced fatigue (≥1 point decrease in PFS score from baseline to Day 56). Results The full analysis included 290 women (FCM 144, placebo 146). Fatigue was reduced in 65.3% (FCM) and 52.7% (placebo) of patients (OR 1.68, 95%CI 1.05–2.70; p = 0.03). A 50% reduction of PFS score was achieved in 33.3% FCM- vs. 16.4% placebo-treated patients (p<0.001). At Day 56, all FCM-treated patients had hemoglobin levels ≥120 g/L (vs. 87% at baseline); with placebo, the proportion decreased from 86% to 81%. Mental quality-of-life (SF-12) and the cognitive function scores improved better with FCM. ‘Power of attention’ improved better in FCM-treated patients with ferritin <15 µg/L. Treatment-emergent adverse events (placebo 114, FCM 209; most frequently headache, nasopharyngitis, pyrexia and nausea) were mainly mild or moderate. Conclusion A single infusion of FCM improved fatigue, mental quality-of-life, cognitive function and erythropoiesis in iron-deficient women with normal or borderline hemoglobin. Although more side effects were reported compared to placebo, FCM can be an effective alternative in patients who cannot tolerate or use oral iron, the common treatment of iron deficiency. Overall, the results support the hypothesis that iron deficiency can affect women’s health, and a normal iron status should be maintained independent of hemoglobin levels. Trial Registration ClinicalTrials.gov NCT01110356
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Affiliation(s)
- Bernard Favrat
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Christian Breymann
- Obstetric Research & Foeto-maternal Haematology Research Group, University Hospital, Zurich, Switzerland
| | - Michael Hedenus
- Department of Internal Medicine, Hematology Section, Sundsvall Hospital, Sundsvall, Sweden
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113
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Salvin HE, Pasricha SR, Marks DC, Speedy J. Iron deficiency in blood donors: a national cross-sectional study. Transfusion 2014; 54:2434-44. [PMID: 24738792 DOI: 10.1111/trf.12647] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 02/03/2014] [Accepted: 02/03/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Iron deficiency (ID) is an important consequence of blood donation. The epidemiology of this problem in the blood donor population was therefore studied to enable appropriate targeting of potential solutions to donor ID. STUDY DESIGN AND METHODS A nationally representative, cluster-based cross-sectional study of Australian blood donors was performed. Donors were eligible for inclusion if they fulfilled criteria for blood donation or were deferred due to low or falling hemoglobin. Ferritin was measured and demographic and donation data were collected. RESULTS A total of 3094 blood donors were recruited, of which samples were collected from 3049 donors; 1873 had exclusively donated whole blood (WB only), 242 had exclusively made apheresis donations, and 530 had not donated ("new" donors) in the previous 24 months. The prevalence of ID in new female donors was 12.0% compared with 1.3% in males. The prevalence of ID in female WB-only donors was 26.4%; it increased with donation frequency and decreased with age. The prevalence in male WB-only donors was 6.3% with no evident change with age or donation frequency. The prevalence of ID in apheresis-only donors (females 6.3%; males 2.2%) did not significantly exceed that of new donors nor did it change with donation frequency. Importantly, the risk of ID could not be satisfactorily predicted in an individual donor by his or her anemia status or with predictive modeling incorporating demographic and donation data. CONCLUSION ID is especially prevalent in female, premenopausal, frequent WB donors. Strategies to combat ID should be implemented, specifically targeting this group.
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Affiliation(s)
- Hannah E Salvin
- Iron Taskforce, The Australian Red Cross Blood Service, Adelaide, SA, Australia
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114
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Abstract
Iron is an important mineral element used by the body in a variety of metabolic and physiologic processes. These processes are highly active when the body is undergoing physical exercises. Prevalence of exercise-induced iron deficiency anemia (also known as sports anemia) is notably high in athletic populations, particularly those with heavy training loads. The pathogenesis of sports anemia is closely related to disorders of iron metabolism, and a more comprehensive understanding of the mechanism of iron metabolism in the course of physical exercises could expand ways of treatment and prevention of sports anemia. In recent years, there have been remarkable research advances regarding the molecular mechanisms underlying changes of iron metabolism in response to physical exercises. This review has covered these advances, including effects of exercise on duodenum iron absorption, serum iron status, iron distribution in organs, erythropoiesis, and hepcidin’s function and its regulation. New methods for the treatment of exercise-induced iron deficiency are also discussed.
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Affiliation(s)
- Wei-Na Kong
- Laboratory of Molecular Iron Metabolism, College of Life Science, Hebei Normal University, Shijiazhuang 050016, Hebei Province, P. R. China ; Bioreactor and Protein Drug Research and Development Center of Hebei Universities, Hebei Chemical & Pharmaceutical College, Shijiazhuang 050026, Hebei Province, P. R. China
| | - Guofen Gao
- Laboratory of Molecular Iron Metabolism, College of Life Science, Hebei Normal University, Shijiazhuang 050016, Hebei Province, P. R. China
| | - Yan-Zhong Chang
- Laboratory of Molecular Iron Metabolism, College of Life Science, Hebei Normal University, Shijiazhuang 050016, Hebei Province, P. R. China
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Enjuanes C, Klip IT, Bruguera J, Cladellas M, Ponikowski P, Banasiak W, van Veldhuisen DJ, van der Meer P, Jankowska EA, Comín-Colet J. Iron deficiency and health-related quality of life in chronic heart failure: results from a multicenter European study. Int J Cardiol 2014; 174:268-75. [PMID: 24768464 DOI: 10.1016/j.ijcard.2014.03.169] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 03/10/2014] [Accepted: 03/26/2014] [Indexed: 01/31/2023]
Abstract
Patients affected by chronic heart failure (CHF) present significant impairment of health-related quality of life (HRQoL). Iron deficiency (ID) is a common comorbidity in CHF with negative impact in prognosis and functional capacity. The role of iron in energy metabolism could be the link between ID and HRQoL. There is little information about the role of ID on HRQoL in patients with CHF. We evaluate the impact of ID on HRQoL and the interaction with the anaemia status, iron status, clinical baseline information and HRQoL, measured with the Minnesota Living with Heart Failure questionnaire (MLHFQ) was obtained at baseline in an international cohort of 1278 patients with CHF. Baseline characteristics were median age 68 ± 12, 882 (69%) were males, ejection fraction was 38% ± 15 and NYHA class was I/II/III/IV (156/247/487/66). ID (defined as ferritin level< 100 µg/L or serum ferritin 100-299 µg/L in combination with a TSAT<20%) was present in 741 patients (58%). 449 (35%) patients were anaemic. Unadjusted global scores of MLHFQ (where higher scores reflect worse HRQoL) were worse in ID and anaemic patients (ID+: 42 ± 25 vs. ID-: 37 ± 25; p-value=0.001 and A+: 46 ± 25 vs. A-: 37 ± 25; p-value<0.001). The combined influence of ID and anaemia was explored with different multivariable regression models, showing that ID but not anaemia was associated with impaired HRQoL. ID has a negative impact on HRQoL in CHF patients, and this is independent of the presence of anaemia.
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Affiliation(s)
- Cristina Enjuanes
- Heart Diseases Biomedical Research Group, Program of Research in Inflammatory and Cardiovascular Disorders, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ijsbrand T Klip
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jordi Bruguera
- Heart Diseases Biomedical Research Group, Program of Research in Inflammatory and Cardiovascular Disorders, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Merce Cladellas
- Heart Diseases Biomedical Research Group, Program of Research in Inflammatory and Cardiovascular Disorders, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Piotr Ponikowski
- Center for Heart Diseases, Military Hospital, Wroclaw, Poland; Department of Heart Diseases, Wroclaw Medical University, Poland
| | | | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ewa A Jankowska
- Center for Heart Diseases, Military Hospital, Wroclaw, Poland; Department of Heart Diseases, Wroclaw Medical University, Poland; Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Josep Comín-Colet
- Heart Diseases Biomedical Research Group, Program of Research in Inflammatory and Cardiovascular Disorders, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Abstract
Anemia and iron deficiency are quite prevalent in patients with heart failure (HF) and may overlap. Both anemia and iron deficiency are associated with worse symptoms and adverse clinical outcomes. In the past few years, there has been an enormous interest in the subject of iron deficiency and its management in patients with HF. In this review, the etiology and relevance of iron deficiency, iron metabolism in the setting of HF, studies on iron supplementation in patients with HF and potential cardiovascular effects of subclinical iron overload are discussed.
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Affiliation(s)
- Natasha P Arora
- Detroit Medical Center, Wayne State University, Detroit, MI, USA
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Hsieh YP, Huang CH, Lee CY, Lin CY, Chang CC. Silencing of hepcidin enforces the apoptosis in iron-induced human cardiomyocytes. J Occup Med Toxicol 2014; 9:11. [PMID: 24641804 PMCID: PMC3995429 DOI: 10.1186/1745-6673-9-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 03/10/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Iron is essential not only for erythropoisis but also for several bioenergetics' processes in myocardium. Hepcidin is a well-known regulator of iron homeostasis. Recently, researchers identified low hepcidin was independently associated with increased 3-year mortality among systolic heart failure patients. In addition, our previous in vivo study revealed that the left ventricular mass index increased in chronic kidney disease patients with lower serum hepcidin. We hypothesize that hepcidin interacts with the apoptotic pathway of cardiomyocytes during oxidative stress conditions. METHODS To test this hypothesis, human cardiomyocytes were cultured and treated with ferrous iron. The possible underlying signaling pathways of cardiotoxicity were examined following knockdown studies using siRNAs of hepcidin (siRNA1 was used as a negative control and siRNA2 was used to silence hepcidin). RESULTS We found that ferrous iron induces apoptosis in human cardiomyocytes in a dose-dependent manner. This iron-induced apoptosis was linked to enhanced caspase 8, reduced Bcl-2, Bcl-xL, phosphorylated Akt and GATA-4. Hepcidin levels increased in human cardiomyocytes pretreated with ferrous iron and returned to non-iron treated levels following siRNA2 transfection. In iron pretreated cardiomyocytes, the siRNA2 transfection further increased caspase 8 expression and decreased the expression of GATA-4, Bcl-2, Bcl-xL and phosphorylated Akt than iron pretreatment alone, but caspase 9 levels remained unchanged. CONCLUSIONS Our findings suggest that hepcidin can rescue human cardiomyocytes from iron-induced apoptosis through the regulation of GATA-4/Bcl-2 and the extrinsic apoptotic pathway.
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Affiliation(s)
- Yao-Peng Hsieh
- Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanhsiao St., Changhua 500, Taiwan.,Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ching-Hui Huang
- Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Chia-Ying Lee
- Division of Pediatric Nephrology, China Medical University Hospital, Changhua, Taiwan
| | - Ching-Yuang Lin
- Clinical Immunological Center, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.,Program for Aging, China Medical University, Taichung, Taiwan
| | - Chia-Chu Chang
- Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanhsiao St., Changhua 500, Taiwan.,Program for Aging, China Medical University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Mast AE. Low hemoglobin deferral in blood donors. Transfus Med Rev 2013; 28:18-22. [PMID: 24332843 DOI: 10.1016/j.tmrv.2013.11.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/04/2013] [Accepted: 11/08/2013] [Indexed: 11/18/2022]
Abstract
Low hemoglobin deferral occurs in about 10% of attempted whole blood donations and commonly is a consequence of iron deficiency anemia. Pre-menopausal women often have iron deficiency anemia caused by menstruation and pregnancy and have low hemoglobin deferral on their first donation attempt. Frequent donors also develop iron deficiency and iron deficiency anemia because blood donation removes a large amount of iron from the donor and the 56-day minimum inter-donation interval for donors in the United States is not sufficient for recovery of hemoglobin and iron stores. Other causes for low hemoglobin deferral range from a medically insignificant deferral of a woman with hemoglobin between 12.0 and 12.4 g/dL, which is within the normal reference range but below the 12.5 g/dL needed to donate blood, to anemia caused by an unrecognized malignancy in a "healthy" individual attempting to donate blood. The diverse causes of anemia in blood donors make it difficult to provide accurate information to donors about the cause of their low hemoglobin deferral and complicate implementation of programs to prevent them by blood collecting agencies. This article reviews how hemoglobin is measured and the demographics and causes of low hemoglobin deferral in blood donors. It provides recommendations for how blood collection agencies can provide donors with accurate information about the cause of their deferral and discusses programs that can be implemented to decrease these deferrals in regular donors.
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Affiliation(s)
- Alan E Mast
- Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI, USA; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA.
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Kiss JE, Steele WR, Wright DJ, Mast AE, Carey PM, Murphy EL, Gottschall JL, Simon TL, Cable RG. Laboratory variables for assessing iron deficiency in REDS-II Iron Status Evaluation (RISE) blood donors. Transfusion 2013; 53:2766-75. [PMID: 23617531 PMCID: PMC3895107 DOI: 10.1111/trf.12209] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 12/21/2012] [Accepted: 12/21/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND Iron deficiency is common in regular blood donors. We evaluated the diagnostic sensitivity and specificity of red blood cell (RBC) hematology analyzer indices to assess iron status as a part of donor management. STUDY DESIGN AND METHODS A total of 1659 male and female donors from the Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study who were either first-time/reactivated (FT/RA; no donations for 2 years) or frequent donors were recruited into a longitudinal study of regular donation of RBCs. Of these, 1002 donors returned 15 to 24 months later for a final assessment. Absent iron stores (AIS) was defined as plasma ferritin level of less than 12 μg/L. Logarithm of the ratio of soluble transferrin receptor to ferritin of at least 2.07 (≥97.5% in FT/RA males) was used to define iron-deficient erythropoiesis (IDE). Receiver operating characteristics analysis was performed to assess selected RBC indices (e.g., percentage of hypochromic mature RBCs, proportion of hypochromic mature RBCs [HYPOm], and hemoglobin [Hb] content of reticulocytes [CHr]) in identifying AIS and IDE. RESULTS HYPOm and CHr detected IDE with comparable sensitivity, 72% versus 69%, but differed in specificity: HYPOm 68% and CHr 53%. For detecting AIS, sensitivity was improved to 85% for HYPOm and 81% for CHr but specificity was reduced for both. Venous Hb had high specificity but poor sensitivity for IDE and AIS. A plasma ferritin level of less than 26.7 μg/L was a good surrogate for assessing IDE. CONCLUSION RBC indices correlate with AIS and IDE and are more informative than Hb measurement, but lack sufficient sensitivity and specificity to be used as diagnostic tools in blood donors at risk for iron deficiency.
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Affiliation(s)
- Joseph E Kiss
- The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania; Westat, Rockville, Maryland; Blood Center of Wisconsin, Milwaukee, Wisconsin; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin; Hoxworth Blood Center, University of Cincinnati Academic Health Center, Cincinnati, Ohio; University of California at San Francisco and Blood Systems Research Institute, San Francisco, California; CSL Plasma, Boca Raton, Florida; New England Region, American Red Cross Blood Services, Farmington, Connecticut
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Bayeva M, Chang HC, Wu R, Ardehali H. When less is more: novel mechanisms of iron conservation. Trends Endocrinol Metab 2013; 24:569-77. [PMID: 23948590 PMCID: PMC4720524 DOI: 10.1016/j.tem.2013.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/15/2013] [Accepted: 07/16/2013] [Indexed: 01/24/2023]
Abstract
Disorders of iron homeostasis are very common, yet the molecular mechanisms of iron regulation remain understudied. Over 20 years have passed since the first characterization of iron-regulatory proteins (IRP) as mediators of cellular iron-deficiency response in mammals through iron acquisition. However, little is known about other mechanisms necessary for adaptation to low-iron states. In this review, we present recent evidence that establishes the existence of a new iron-regulatory pathway aimed at iron conservation and optimization of iron use through suppression of nonessential iron-consuming processes. Moreover, we discuss the possible links between iron homeostasis and energy metabolism uncovered by studies of iron-deficiency response.
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123
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Ruiter G, Lanser IJ, de Man FS, van der Laarse WJ, Wharton J, Wilkins MR, Howard LS, Vonk-Noordegraaf A, Voskuyl AE. Iron deficiency in systemic sclerosis patients with and without pulmonary hypertension. Rheumatology (Oxford) 2013; 53:285-92. [PMID: 24155365 DOI: 10.1093/rheumatology/ket331] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES SSc-associated pulmonary hypertension (SSc-PH) has a worse prognosis compared with SSc without PH (SSc-nonPH). Iron deficiency (ID) was previously associated with worse clinical outcome and survival in other types of PH, but ID effects in SSc-PH are unknown. Therefore we investigated the prevalence and clinical significance of ID in systemic sclerosis patients with and without PH. METHODS Body iron status was determined in SSc-PH (n = 47) and SSc-nonPH patients (n = 122). ID was defined by circulating soluble transferrin receptor (sTfR) levels >28.1 nmol/l. Clinical and exercise parameters were compared between the groups. Four-year survival after iron measurements was determined. RESULTS ID prevalence was 46.1% in SSc-PH compared with 16.4% in SSc-nonPH patients (P < 0.001). Overall hepcidin levels were high compared with reference values and related to sTfR, but not with IL-6 (P = 0.82). Six-minute walking distance and maximal achieved work at ergometry was lower in SSc-PH compared with SSc-nonPH patients (P < 0.001 and P < 0.01, respectively) and was even further reduced in case of ID (P(interaction) < 0.05). In addition, ID SSc-PH patients had a poorer survival compared with non-ID patients [hazard ratio (HR) 0.34, 95% CI 0.14, 0.82, P < 0.05) and a similar trend was observed in SSc-nonPH patients (HR 0.16, 95% CI 0.02, 1.11, P = 0.06). CONCLUSION ID is more prevalent in SSc-PH than in SSc-nonPH patients and is associated with exercise impairment in both SSc-PH and SSc-nonPH. In addition, ID SSc-PH patients have a significantly worse survival compared with non-ID patients.
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Affiliation(s)
- Gerrina Ruiter
- Department of Pulmonology, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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Bertinato J, Aroche C, Plouffe LJ, Lee M, Murtaza Z, Kenney L, Lavergne C, Aziz A. Diet-induced obese rats have higher iron requirements and are more vulnerable to iron deficiency. Eur J Nutr 2013; 53:885-95. [PMID: 24096586 DOI: 10.1007/s00394-013-0592-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 09/24/2013] [Indexed: 01/27/2023]
Abstract
PURPOSE Since obesity is associated with poorer iron status, the effects of diet-induced obesity on iron status and iron-regulatory pathways were examined. METHODS Weanling male diet-induced obese sensitive (n = 12/diet group) and resistant (n = 12/diet group) rats were fed one of four high-fat, high-energy diets supplemented with 5 (5Fe, low), 15 (15Fe, marginal), 35 (35Fe, normal) or 70 (70Fe, high) mg iron/kg diet for 12 weeks. At the end of the study, rats in each diet group were categorised as obese (>19 %) or lean (<17 %) based on percentage body fat. RESULTS Obese rats gained more weight, had larger total lean mass, consumed more food and showed greater feed efficiency compared with lean rats. Obese rats fed the 5Fe and 15Fe diets had poorer iron status than lean rats fed the same diet. Obese 5Fe rats had lower serum iron and more severe iron-deficiency anaemia. Obese 15Fe rats had lower mean corpuscular haemoglobin and liver iron concentrations. Hepcidin mRNA expression in liver and adipose tissue was similar for obese and lean rats. Iron concentration and content of the iron transporters divalent metal transporter 1 and ferroportin 1 in duodenal mucosa were also similar. CONCLUSIONS Obese rats that were larger, regardless of adiposity, had higher iron requirements compared with lean rats that appeared independent of hepcidin, inflammation and intestinal iron absorption. Higher iron requirements may have resulted from larger accretion of body mass and blood volume. Greater food consumption did not compensate for the higher iron needs, indicating increased susceptibility to iron deficiency.
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Affiliation(s)
- Jesse Bertinato
- Nutrition Research Division, Health Products and Food Branch, Health Canada, Sir Frederick G. Banting Research Centre, 251 Sir Frederick Banting Driveway, PL 2203E, Ottawa, ON, K1A 0K9, Canada,
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125
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McClung JP, Murray-Kolb LE. Iron Nutrition and Premenopausal Women: Effects of Poor Iron Status on Physical and Neuropsychological Performance. Annu Rev Nutr 2013; 33:271-88. [DOI: 10.1146/annurev-nutr-071812-161205] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- James P. McClung
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine (USARIEM), Natick, Massachusetts 01760;
| | - Laura E. Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania 16802
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Ludwig H, Müldür E, Endler G, Hübl W. Prevalence of iron deficiency across different tumors and its association with poor performance status, disease status and anemia. Ann Oncol 2013; 24:1886-1892. [PMID: 23567147 PMCID: PMC3690908 DOI: 10.1093/annonc/mdt118] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/07/2013] [Accepted: 02/08/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Only limited data on the prevalence of iron deficiency (ID) and its correlation with clinical parameters are available in cancer. ID frequently contributes to the pathogenesis of anemia in patients with cancer and may lead to several symptoms such as impaired physical function, weakness and fatigue. PATIENTS AND METHODS Parameters of iron status and clinical parameters were evaluated in 1528 patients with cancer who presented consecutively within a four-month period at our center. One thousand fifty-three patients had solid tumors and 475 hematological malignancies. RESULTS ID [transferrin saturation (TSAT) < 20%] was noted in 645 (42.6%) of the 1513 patients with TSAT tests available and 500 (33.0%) were anemic. ID rates were highest in pancreatic (63.2%), colorectal (51.9%) and lung cancers (50.7%). Of the 409 iron-deficient patients in whom serum ferritin levels were available additionally to TSAT, 335 (81.9%) presented with functional ID (FID) (TSAT < 20%, serum ferritin ≥30 ng/ml) and 74 (18.1%) with absolute ID. In patients with solid tumors, prevalence of ID correlated with cancer stage at diagnosis (P = 0.001), disease status (P = 0.001) and ECOG performance status (P = 0.005). CONCLUSIONS ID was frequently noted in cancer and was associated with advanced disease, close proximity to cancer therapy, and poor performance status in patients with solid tumors.
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Affiliation(s)
- H Ludwig
- Department of Medicine I, Center for Oncology, Haematology and Palliative Care, Wilhelminenspital, Vienna.
| | - E Müldür
- Department of Medicine I, Center for Oncology, Haematology and Palliative Care, Wilhelminenspital, Vienna
| | - G Endler
- Central Laboratory, Wilhelminenspital, Vienna, Austria
| | - W Hübl
- Central Laboratory, Wilhelminenspital, Vienna, Austria
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Dopsaj V, Martinovic J, Dopsaj M. Early detection of iron deficiency in elite athletes: could microcytic anemia factor (Maf) be useful? Int J Lab Hematol 2013; 36:37-44. [DOI: 10.1111/ijlh.12115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 04/30/2013] [Indexed: 11/28/2022]
Affiliation(s)
- V. Dopsaj
- Faculty of Pharmacy; Department of Medical Biochemistry; University of Belgrade; Belgrade Serbia
- Center of Medical Biochemistry; Clinical Centre of Serbia; Belgrade Serbia
| | - J. Martinovic
- Health Center Rakovica; Laboratory Department; Belgrade Serbia
| | - M. Dopsaj
- Faculty of Sport and Physical Education; University of Belgrade; Belgrade Serbia
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Comín-Colet J, Enjuanes C, González G, Torrens A, Cladellas M, Meroño O, Ribas N, Ruiz S, Gómez M, Verdú JM, Bruguera J. Iron deficiency is a key determinant of health-related quality of life in patients with chronic heart failure regardless of anaemia status. Eur J Heart Fail 2013; 15:1164-72. [PMID: 23703106 PMCID: PMC3782146 DOI: 10.1093/eurjhf/hft083] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aims To evaluate the effect of iron deficiency (ID) and/or anaemia on health-related quality of life (HRQoL) in patients with chronic heart failure (CHF). Methods and results We undertook a post-hoc analysis of a cohort of CHF patients in a single-centre study evaluating cognitive function. At recruitment, patients provided baseline information and completed the Minnesota Living with Heart Failure questionnaire (MLHFQ) for HRQoL (higher scores reflect worse HRQoL). At the same time, blood samples were taken for serological evaluation. ID was defined as serum ferritin levels <100 ng/mL or serum ferritin <800 ng/mL with transferrin saturation <20%. Anaemia was defined as haemoglobin ≤12 g/dL. A total of 552 CHF patients were eligible for inclusion, with an average age of 72 years and 40% in NYHA class III or IV. The MLHFQ overall summary scores were 41.0 ± 24.7 among those with ID, vs. 34.4 ± 26.4 for non-ID patients (P = 0.003), indicating worse HRQoL. When adjusted for other factors associated with HRQoL, ID was significantly associated with worse MLHFQ overall summary (P = 0.008) and physical dimension scores (P = 0.002), whereas anaemia was not (both P > 0.05). Increased levels of soluble transferrin receptor were also associated with impaired HRQoL (P ≤ 0.001). Adjusting for haemoglobin and C-reactive protein, ID was more pronounced in patients with anaemia compared with those without (P < 0.001). Conclusion In patients with CHF, ID but not anaemia was associated with reduced HRQoL, mostly due to physical factors.
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Affiliation(s)
- Josep Comín-Colet
- Heart Failure Programme, Department of Cardiology, Hospital del Mar, Barcelona, Spain
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Howard LSGE, Watson GMJ, Wharton J, Rhodes CJ, Chan K, Khengar R, Robbins PA, Kiely DG, Condliffe R, Elliott CA, Pepke-Zaba J, Sheares K, Morrell NW, Davies R, Ashby D, Gibbs JSR, Wilkins MR. Supplementation of iron in pulmonary hypertension: Rationale and design of a phase II clinical trial in idiopathic pulmonary arterial hypertension. Pulm Circ 2013; 3:100-7. [PMID: 23662181 PMCID: PMC3641712 DOI: 10.4103/2045-8932.109923] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Our aim is to assess the safety and potential clinical benefit of intravenous iron (Ferinject) infusion in iron deficient patients with idiopathic pulmonary arterial hypertension (IPAH). Iron deficiency in the absence of anemia (1) is common in patients with IPAH; (2) is associated with inappropriately raised levels of hepcidin, the key regulator of iron homeostasis; and (3) correlates with disease severity and worse clinical outcomes. Oral iron absorption may be impeded by reduced absorption due to elevated hepcidin levels. The safety and benefits of parenteral iron replacement in IPAH are unknown. Supplementation of Iron in Pulmonary Hypertension (SIPHON) is a Phase II, multicenter, double-blind, randomized, placebo-controlled, crossover clinical trial of iron in IPAH. At least 60 patients will be randomized to intravenous ferric carboxymaltose (Ferinject) or saline placebo with a crossover point after 12 weeks of treatment. The primary outcome will be the change in resting pulmonary vascular resistance from baseline at 12 weeks, measured by cardiac catheterization. Secondary measures include resting and exercise hemodynamics and exercise performance from serial bicycle incremental and endurance cardiopulmonary exercise tests. Other secondary measurements include serum iron indices, 6-Minute Walk Distance, WHO functional class, quality of life score, N-terminal pro-brain natriuretic peptide (NT-proBNP), and cardiac anatomy and function from cardiac magnetic resonance. We propose that intravenous iron replacement will improve hemodynamics and clinical outcomes in IPAH. If the data supports a potentially useful therapeutic effect and suggest this drug is safe, the study will be used to power a Phase III study to address efficacy.
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Affiliation(s)
- Luke S G E Howard
- Department of Cardiology, National Pulmonary Hypertension Service, Hammersmith Hospital, London, United Kingdom ; National Heart and Lung Institute, London, United Kingdom
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Kien CL, Bunn JY, Poynter ME, Stevens R, Bain J, Ikayeva O, Fukagawa NK, Champagne CM, Crain KI, Koves TR, Muoio DM. A lipidomics analysis of the relationship between dietary fatty acid composition and insulin sensitivity in young adults. Diabetes 2013; 62:1054-63. [PMID: 23238293 PMCID: PMC3609566 DOI: 10.2337/db12-0363] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Relative to diets enriched in palmitic acid (PA), diets rich in oleic acid (OA) are associated with reduced risk of type 2 diabetes. To gain insight into mechanisms underlying these observations, we applied comprehensive lipidomic profiling to specimens collected from healthy adults enrolled in a randomized, crossover trial comparing a high-PA diet to a low-PA/high-OA (HOA) diet. Effects on insulin sensitivity (SI) and disposition index (DI) were assessed by intravenous glucose tolerance testing. In women, but not men, SI and DI were higher during HOA. The effect of HOA on SI correlated positively with physical fitness upon enrollment. Principal components analysis of either fasted or fed-state metabolites identified one factor affected by diet and heavily weighted by the PA/OA ratio of serum and muscle lipids. In women, this factor correlated inversely with SI in the fasted and fed states. Medium-chain acylcarnitines emerged as strong negative correlates of SI, and the HOA diet was accompanied by lower serum and muscle ceramide concentrations and reductions in molecular biomarkers of inflammatory and oxidative stress. This study provides evidence that the dietary PA/OA ratio impacts diabetes risk in women.
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Affiliation(s)
- C Lawrence Kien
- Department of Pediatrics, University of Vermont, Burlington, Vermont, USA.
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Evstatiev R, Alexeeva O, Bokemeyer B, Chopey I, Felder M, Gudehus M, Iqbal T, Khalif I, Marteau P, Stein J, Gasche C. Ferric carboxymaltose prevents recurrence of anemia in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol 2013; 11:269-77. [PMID: 23078888 DOI: 10.1016/j.cgh.2012.10.013] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 10/01/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Iron-deficiency anemia is the most common systemic complication of inflammatory bowel diseases (IBD). Iron-deficiency anemia recurs frequently and rapidly after iron-replacement therapy in patients with IBD. We performed a randomized, placebo-controlled trial to determine if administration of ferric carboxymaltose (FCM) prevents anemia in patients with IBD and low levels of serum ferritin. METHODS We performed a single-blind, multicenter study of nonanemic patients who had completed the FERGIcor study. Serum levels of ferritin were assessed every second month, and patients were given FCM (total iron dose, 1181 ± 662 mg; n = 105) or placebo (n = 99) when levels decreased to less than 100 μg/L. The primary end point was time to recurrence of anemia within 8 months. Secondary end points included changes of quality of life, disease activity, results from laboratory tests, and adverse events. RESULTS Anemia recurred in 26.7% of subjects given FCM and in 39.4% given placebo. The time to anemia recurrence was longer in the FCM group (hazard ratio, 0.62; 95% confidence interval, 0.38-1.00; P = .049). Markers of body levels of iron increased or remained at normal levels in subjects given FCM (ferritin increased by 30.3 μg/L, transferrin saturation increased by 0.6%) but decreased in the group given placebo (ferritin decreased by 36.1 μg/L, transferrin saturation decreased by 4.0%). Changes in quality of life and disease activity were comparable between groups. Adverse events were reported in 59.0% of the FCM group and 50.5% of the placebo group, and serious adverse events were reported in 6.7% and 8.1%, respectively. CONCLUSIONS FCM prevents recurrence of anemia in patients with IBD, compared with placebo. Nevertheless, the high rate of anemia recurrence warrants optimization of the frequency and requirements for FCM treatment.
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Affiliation(s)
- Rayko Evstatiev
- Department of Medicine 3, Division of Gastroenterology and Hepatology and Christian Doppler Laboratory for Molecular Cancer Chemoprevention, Medical University of Vienna, Vienna, Austria
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133
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Steinmetz T, Tschechne B, Harlin O, Klement B, Franzem M, Wamhoff J, Tesch H, Rohrberg R, Marschner N. Clinical experience with ferric carboxymaltose in the treatment of cancer- and chemotherapy-associated anaemia. Ann Oncol 2013; 24:475-482. [PMID: 23071262 PMCID: PMC3551483 DOI: 10.1093/annonc/mds338] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/05/2012] [Accepted: 07/12/2012] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Intravenous (i.v.) iron can improve anaemia of chronic disease and response to erythropoiesis-stimulating agents (ESAs), but data on its use in practice and without ESAs are limited. This study evaluated effectiveness and tolerability of ferric carboxymaltose (FCM) in routine treatment of anaemic cancer patients. PATIENTS AND METHODS Of 639 patients enrolled in 68 haematology/oncology practices in Germany, 619 received FCM at the oncologist's discretion, 420 had eligible baseline haemoglobin (Hb) measurements, and 364 at least one follow-up Hb measurement. Data of transfused patients were censored from analysis before transfusion. RESULTS The median total iron dose was 1000 mg per patient (interquartile range 600-1500 mg). The median Hb increase was comparable in patients receiving FCM alone (1.4 g/dl [0.2-2.3 g/dl; N = 233]) or FCM + ESA (1.6 g/dl [0.7-2.4 g/dl; N = 46]). Patients with baseline Hb up to 11.0 g/dl and serum ferritin up to 500 ng/ml benefited from FCM treatment (stable Hb ≥ 11.0 g/dl). Also patients with ferritin >500 ng/ml but low transferrin saturation benefited from FCM treatment. FCM was well tolerated, 2.3% of patients reported putative drug-related adverse events. CONCLUSIONS The substantial Hb increase and stabilisation at 11-12 g/dl in FCM-treated patients suggest a role for i.v. iron alone in anaemia correction in cancer patients.
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Affiliation(s)
- T Steinmetz
- Outpatient Clinic for Oncology and Haematology, Cologne.
| | - B Tschechne
- Klinikum Neustadt am Rübenberge, Neustadt am Rübenberge
| | | | - B Klement
- Vifor Pharma, Glattbrugg, Switzerland
| | | | | | - H Tesch
- Outpatient Clinic, Im Pruefling, Frankfurt
| | | | - N Marschner
- Practice for Oncology and Hematology, Freiburg, German
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134
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Abstract
OBJECTIVE To determine the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) among a group of female athletes and compare with an age-matched group of female nonathletes. To study lifestyle factors that could play a role in the development of ID and IDA and compare these factors between the groups. DESIGN A controlled clinical trial. SETTING A senior high school for athletes in Gothenburg, Sweden. PARTICIPANTS All female athletes at a senior high school for top-level athletes were offered to take part. Fifty-seven female athletes accepted to participate in the study. The control group consisted of a random sample of 130 age-matched nonathlete students; 92 accepted to participate in the study. INTERVENTION Intervention was not an actual part of this study but those with ID and IDA were treated with iron by the regular school doctor. MAIN OUTCOME MEASURES Iron deficiency anemia and ID were determined by levels of hemoglobin, serum iron, total iron-binding capacity, transferrin saturation, and serum ferritin. RESULTS The main result of the study is the finding that ID and IDA are common among young adolescent female athletes and that there was no difference between female athletes and nonathletes. In the athlete group, 30 of 57 individuals (52%) had ID compared with 43 of 92 individuals (48%) in the nonathlete group (P > 0.3). Comparisons of the 2 groups showed no significant difference in hemoglobin (P > 0.30). In total, we found that 5 of 57 athletes (8.6%) had IDA compared with 3 of 92 nonathletes (3.3%), the difference being not statistically significant (P = 0.24). CONCLUSIONS The main finding of this study is that ID and IDA are common among female adolescents but not more common among athletes than nonathletes. The results are despite factors that should favor a better iron status in the athlete group, such as better iron intake and less menstrual bleeding. Other factors that might have an impact on iron balance, must therefore be considered.
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135
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Bucca C, Culla B, Brussino L, Ricciardolo FL, Cicolin A, Heffler E, Bugiani M, Rolla G. Effect of iron supplementation in women with chronic cough and iron deficiency. Int J Clin Pract 2012; 66:1095-100. [PMID: 23067033 DOI: 10.1111/ijcp.12001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS Chronic cough is more frequent and severe in women than in men. Women often have decreased iron stores, because of menses and pregnancies. We investigated if iron deficiency has a role in chronic cough by increasing airway sensitivity to inhaled irritants. METHODS Twenty-two non-smoking women with chronic unexplained cough and iron deficiency (serum ferritin below 15 ng/ml) were examined in baseline, after 2 months empiric treatment with anti H1-histaminic drug and proton pump inhibitor, and after iron supplementation (330-660 mg iron sulphate tablets daily) for 2 months. Outcome measures were cough visual analogue scale (VAS), and histamine thresholds of the larynx (PC25MIF50, concentration causing 25% in MIF50), bronchi (PC20FEV1) and cough (PC5cough). RESULTS Mean serum ferritin was 9.3 ng/ml (95% CI 7.7-10.9), 13 patients had mild anaemia. All the patients had laryngeal and cough hyperresponsiveness,12 had also bronchial hyperresponsiveness. Empiric treatment produced no significant effect, whereas iron supplementation improved cough VAS from 4.03 (3.6-4.47) to 2.6 (1.9-3.27), p < 0.0001, PC20FEV1 from 10.04 mg/ml (5.37-18.77) to 22.2 (11.7-41.8), p < 0.001, PC25MIF50 from 3.09 mg/ml (1.9-4.9) to 11.9 (7.3-19.4), p < 0.001 and PC5cough from 2.1 mg/ml (1.2-3.6) to 8.8 (5.2-15.1), p < 0.001. CONCLUSION In women with unexplained chronic cough unresponsive to targeted treatment, airway and cough hyperresponsiveness may be sustained by iron deficiency. Healthy women with chronic cough should be checked for iron deficiency as iron repletion may resolve such disturbing symptom.
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Affiliation(s)
- C Bucca
- Department of Clinical Pathophysiology, Respiratory Pathophysiology Unit, University of Turin, Turin, Italy.
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136
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Gaffney-Stomberg E, McClung JP. Inflammation and diminished iron status: mechanisms and functional outcomes. Curr Opin Clin Nutr Metab Care 2012; 15:605-13. [PMID: 23075938 DOI: 10.1097/mco.0b013e328357f63b] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To summarize recent findings regarding the effects of inflammation on iron (Fe) metabolism and to review studies detailing the influence of poor Fe status on physical and cognitive performance. RECENT FINDINGS Hepatic expression and release of hepcidin, a negative regulator of Fe status, is increased by the actions of the inflammatory cytokine interleukin-6. Inflammation associated with chronic disease, obesity, and exercise is associated with elevated interleukin-6 and hepcidin levels, which may result in diminished Fe status. SUMMARY Decrements in Fe status due to insufficient dietary Fe intake and/or the inflammatory response may degrade physical and cognitive performance. Future studies should clarify whether dietary or other therapeutic interventions to mitigate inflammation attenuate hepcidin-mediated declines in Fe status.
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Affiliation(s)
- Erin Gaffney-Stomberg
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts 01760, USA
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137
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Jankowska EA, von Haehling S, Anker SD, Macdougall IC, Ponikowski P. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives. Eur Heart J 2012; 34:816-29. [PMID: 23100285 PMCID: PMC3596759 DOI: 10.1093/eurheartj/ehs224] [Citation(s) in RCA: 270] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Iron is a micronutrient essential for cellular energy and metabolism, necessary for maintaining body homoeostasis. Iron deficiency is an important co-morbidity in patients with heart failure (HF). A major factor in the pathogenesis of anaemia, it is also a separate condition with serious clinical consequences (e.g. impaired exercise capacity) and poor prognosis in HF patients. Experimental evidence suggests that iron therapy in iron-deficient animals may activate molecular pathways that can be cardio-protective. Clinical studies have demonstrated favourable effects of i.v. iron on the functional status, quality of life, and exercise capacity in HF patients. It is hypothesized that i.v. iron supplementation may become a novel therapy in HF patients with iron deficiency.
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Affiliation(s)
- Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University, ul Weigla 5, 50-981 Wroclaw, Poland.
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138
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Casgrain A, Collings R, Harvey LJ, Hooper L, Fairweather-Tait SJ. Effect of iron intake on iron status: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2012; 96:768-80. [PMID: 22932280 DOI: 10.3945/ajcn.112.040626] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The response of status biomarkers to an increase in iron supply depends on several physiologic and environmental factors, which make it difficult to predict the outcome of an intervention. OBJECTIVE We assessed effects of baseline iron status, sex, menopausal status, duration of intervention, iron form, and daily dose on the change in iron status in response to iron supplementation. DESIGN A systematic review of randomized controlled trials (RCTs) of iron-supplementation and -fortification trials that assessed effects on hemoglobin, serum ferritin (SF), soluble transferrin receptor, or body iron was conducted. Subgrouping and straight-line and curved metaregression were used to describe the magnitude and dose-responsiveness of effect modifiers with respect to changes in status. RESULTS Forty-one RCTs were included; none of the RCTs were judged at low risk of bias. Random-effects meta-analyses showed that iron supplementation significantly improved iron status but with high levels of heterogeneity. Metaregression explained approximately one-quarter of between-study variance in effect size. There were clear effects on SF with study duration (increase in SF concentration/wk: 0.51 μg/L; 95% CI: 0.02, 1.00 μg/L; P = 0.04) and dose (increase in SF concentration/g Fe: 0.10 μg/L; 95% CI: 0.01, 0.20 μg/L; P = 0.036) and on hemoglobin concentrations with baseline iron status [-0.08 g/dL (95% CI: 0.15, 0.00 g/dL) per 10-μg/L increase in baseline SF concentration; P = 0.02]. Insufficient data were available to assess effects on body iron, sex, or menopausal status. CONCLUSION Quantitative relations between baseline iron status, study duration, and iron dose on changes in iron-status biomarkers, which were generated from the meta-analyses, can be used to predict effects of trials of iron supplementation and fortification and to design iron-intervention programs.
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Affiliation(s)
- Amelie Casgrain
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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139
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Vaucher P, Druais PL, Waldvogel S, Favrat B. Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. CMAJ 2012; 184:1247-54. [PMID: 22777991 DOI: 10.1503/cmaj.110950] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The true benefit of iron supplementation for nonanemic menstruating women with fatigue is unknown. We studied the effect of oral iron therapy on fatigue and quality of life, as well as on hemoglobin, ferritin and soluble transferrin receptor levels, in nonanemic iron-deficient women with unexplained fatigue. METHODS We performed a multicentre, parallel, randomized controlled, closed-label, observer-blinded trial. We recruited from the practices of 44 primary care physicians in France from March to July 2006. We randomly assigned 198 women aged 18-53 years who complained of fatigue and who had a ferritin level of less than 50 ug/L and hemoglobin greater than 12.0 g/dL to receive either oral ferrous sulfate (80 mg of elemental iron daily; n=102) or placebo (n=96) for 12 weeks. The primary outcome was fatigue as measured on the Current and Past Psychological Scale. Biological markers were measured at 6 and 12 weeks. RESULTS The mean score on the Current and Past Psychological Scale for fatigue decreased by 47.7% in the iron group and by 28.8% in the placebo group (difference -18.9%, 95% CI -34.5 to -3.2; p=0.02), but there were no significant effects on quality of life (p=0.2), depression (p=0.97) or anxiety (p=0.5). Compared with placebo, iron supplementation increased hemoglobin (0.32 g/dL; p=0.002) and ferritin (11.4 μg/L; p<0.001) and decreased soluble transferrin receptor (-0.54 mg/L; p<0.001) at 12 weeks. INTERPRETATION Iron supplementation should be considered for women with unexplained fatigue who have ferritin levels below 50 μg/L. We suggest assessing the efficiency using blood markers after six weeks of treatment. Trial registration no. EudraCT 2006-000478-56.
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Affiliation(s)
- Paul Vaucher
- Department of Community Medicine and Primary Care, University of Geneva, Switzerland
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140
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141
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Steinmetz HT. The role of intravenous iron in the treatment of anemia in cancer patients. Ther Adv Hematol 2012; 3:177-91. [PMID: 23556124 PMCID: PMC3573441 DOI: 10.1177/2040620712440071] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Anemia is a major cause of morbidity in cancer patients resulting in poor physical performance, prognosis and therapy outcome. Initially, erythropoietin-stimulating agents (ESAs) were supposed to be the treatment of choice but about one third of patients turned out to be nonresponders and meta-analyses provided evidence of an increased risk of mortality if used excessively. This along with the successful use of intravenous iron for anemia in patients with chronic kidney disease prompted seven clinical studies evaluating the efficacy of intravenous iron as an adjunct to ESAs and four additional studies using intravenous iron only for anemia in cancer patients. These studies confirmed a superior response if ESAs are combined with intravenous iron and revealed iron only to be a useful option in patients with mild and absolute iron deficiency (AID). Currently, best treatment decisions for anemia in cancer might be based on measurements of serum ferritin (SF), transferrin saturation (TSAT), soluble transferrin receptor (sTfR), ferritin index (FI = sTfR/log SF), hypochromic reticulocytes (CHR) and C-reactive protein (CRP). However, there is still an urgent need for trials investigating diagnostic approaches to optimize therapy of anemia in cancer patients with iron and/or ESAs.
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Affiliation(s)
- H Tilman Steinmetz
- Outpatient Clinic for Hematology and Oncology, Sachsenring 69, 50677 Cologne, Germany
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142
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Crouter SE, DellaValle DM, Haas JD. Relationship between physical activity, physical performance, and iron status in adult women. Appl Physiol Nutr Metab 2012; 37:697-705. [PMID: 22624679 DOI: 10.1139/h2012-044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Iron deficiency affects approximately 16% of US females 18-45 years old. Iron is a key component of heme-containing proteins, which are essential for oxygen transport throughout the body. With low iron levels, performance and intense physical activity may be compromised. Thus, the purpose of this study was to examine the relationship between iron status, physical performance, and physical activity in 18- to 45-year-old females. Participants (N = 109) were screened for iron status using a venous blood sample, had their height and mass measured, and self-reported their physical activity level. The screening was used to match iron-depleted nonanemic females (hemoglobin, Hgb > 120 g·L(-1); serum ferritin, sFer < 20 µg·L(-1)) to females with normal iron levels. After participant matching, they had their body composition measured, performed three cycle ergometer tests (maximal, endurance, and efficiency), and wore an ActiGraph GT1M accelerometer for five consecutive days, except when sleeping or during water activities. The final sample consisted of 25 iron-depleted participants and 24 with normal iron levels. Key findings were as follows: (i) after controlling for fat-free mass and vigorous physical activity, iron-depleted females had a significantly lower [Formula: see text]O(2) at ventilatory threshold compared with those with normal iron levels (P < 0.05); and (ii) after controlling for age, iron-depleted females spent significantly more time in sedentary behaviors and significantly less time in light physical activity than those with normal iron levels (P < 0.05). The increased sedentary time in iron-depleted females may contribute to excess mass gain over time; however, further investigation is needed to confirm these results.
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Affiliation(s)
- Scott E Crouter
- Cornell University, Division of Nutritional Sciences, Ithaca, NY 14853, USA.
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143
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Pasricha SR. Should we screen for iron deficiency anaemia? A review of the evidence and recent recommendations. Pathology 2012; 44:139-47. [PMID: 22198251 DOI: 10.1097/pat.0b013e32834e8291] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Worldwide, over 1.6 billion people are anaemic. The prevalence of anaemia and contribution of iron deficiency to this burden is heterogeneous between different populations. Iron deficiency anaemia (IDA) is associated with impaired development in children, adverse effects on cognitive and physical performance in adults, and poorer maternal and infant outcomes in pregnancy. Causes of anaemia other than iron deficiency are important in developed countries and where malaria, thalassaemia or haemoglobinopathy are prevalent. Haemoglobin is the most commonly used screening test for iron deficiency, but may have inadequate sensitivity and specificity to determine iron status in many settings. Screening for anaemia during pregnancy is widely recommended. In children, studies evaluating screening programs have found problems with implementation, acceptability and follow-up of testing, and most international authorities do not support this practice. Nevertheless, certain groups with a particularly high pre-test probability of IDA may benefit from testing following clinical evaluation. Further research is required to define the role of screening and improve available tests for IDA in both developed and developing settings. In this review, the rationale, evidence, experience and expert guidelines regarding screening for IDA, especially among pregnant and paediatric populations, will be evaluated.
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Affiliation(s)
- Sant-Rayn Pasricha
- Nossal Institute for Global Health, and Department of Medicine, The Royal Melbourne Hospital, Australia.
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144
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Macdougall IC, Canaud B, de Francisco ALM, Filippatos G, Ponikowski P, Silverberg D, van Veldhuisen DJ, Anker SD. Beyond the cardiorenal anaemia syndrome: recognizing the role of iron deficiency. Eur J Heart Fail 2012; 14:882-6. [PMID: 22523375 PMCID: PMC3403475 DOI: 10.1093/eurjhf/hfs056] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Growing awareness that heart failure, renal impairment, and anaemia are frequent co-morbidities which can exacerbate one another in a vicious circle of clinical deterioration has led to the concept of the cardiorenal anaemia syndrome (CRAS). The role of iron deficiency within this complex interplay has been less well examined. Scrutiny of data from the recent FAIR-HF trial raises a new hypothesis: is it time for ‘CRAS’ to be supplemented with new acronyms such as CRIDS (cardiorenal–iron deficiency syndrome) or even CRAIDS (cardiorenal–anaemia–iron deficiency syndrome)? Iron deficiency occurs frequently in heart failure patients with or without anaemia. It not only impairs oxygen transport through reduced erythropoiesis, but adversely affects oxidative metabolism, cellular energetics, and immune mechanisms, and the synthesis and degradation of complex molecules such as DNA. One large observational study in patients with heart failure found iron deficiency to be an independent predictor of death or urgent heart transplantation (hazard ratio 1.58, 95% confidence interval 1.14–2.17, P = 0.005). In the FAIR-HF trial, i.v. iron therapy was associated with significant improvements in physical functioning in iron-deficient patients with heart failure, even in non-anaemic patients in whom haemoglobin levels did not change following i.v. iron administration. Key questions regarding the use of i.v. iron supplementation in the setting of heart failure merit exploration and could readily be answered by appropriately designed clinical trials. It is to be hoped that these important clinical trials are conducted, to permit a more subtle characterization of the patient's pathological condition and interventional requirements.
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Affiliation(s)
- Iain C Macdougall
- Department of Renal Medicine, King's College Hospital, London SE5 9RS, UK.
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145
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Pasricha SRS, De-Regil LM. Daily iron supplementation for improving iron status and health among menstruating women. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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146
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Reinke S, Taylor WR, Duda GN, von Haehling S, Reinke P, Volk HD, Anker SD, Doehner W. Absolute and functional iron deficiency in professional athletes during training and recovery. Int J Cardiol 2012; 156:186-91. [DOI: 10.1016/j.ijcard.2010.10.139] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 09/30/2010] [Accepted: 10/31/2010] [Indexed: 01/01/2023]
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147
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Iron deficiency predicts impaired exercise capacity in patients with systolic chronic heart failure. J Card Fail 2012; 17:899-906. [PMID: 22041326 DOI: 10.1016/j.cardfail.2011.08.003] [Citation(s) in RCA: 204] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 07/30/2011] [Accepted: 08/01/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND Iron is an indispensable element of hemoglobin, myoglobin, and cytochromes, and, beyond erythropoiesis, is involved in oxidative metabolism and cellular energetics. Hence, iron deficiency (ID) is anticipated to limit exercise capacity. We investigated whether ID predicted exercise intolerance in patients with systolic chronic heart failure (CHF). METHODS AND RESULTS We prospectively studied 443 patients with stable systolic CHF (age 54 ± 10 years, males 90%, ejection fraction 26 ± 7%, New York Heart Association Class I/II/III/IV 49/188/180/26). ID was defined as: serum ferritin <100 μg/L or serum ferritin 100-300 μg/L with serum transferrin saturation <20%. Exercise capacity was expressed as peak oxygen consumption (VO(2)) and ventilatory response to exercise (VE-VCO(2) slope). ID was present in 35 ± 4% (±95% confidence interval) of patients with systolic CHF. Those with ID had reduced peak VO(2) and increased VE-VCO(2) slope as compared to subjects without ID (peak VO(2): 13.3 ± 4.0 versus 15.3 ± 4.5 mL•min•kg, VE-VCO(2) slope: 50.9 ± 15.8 versus 43.1 ± 11.1, respectively, both P < .001, P < .05). In multivariable models, the presence of ID was associated with reduced peak VO(2) (β = -0.14, P < .01 P < .05) and higher VE-VCO(2) slope (β = 0.14, P < .01 P < .05), adjusted for demographics and clinical variables. Analogous associations were found between serum ferritin, and both peak VO(2) and VE-VCO(2) slope (P < .05). CONCLUSIONS ID independently predicts exercise intolerance in patients with systolic CHF, but the strength of these associations is relatively weak. Whether iron supplementation would improve exercise capacity in iron-deficient subjects requires further studies.
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148
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Comin-Colet J, Lainscak M, Dickstein K, Filippatos GS, Johnson P, Lüscher TF, Mori C, Willenheimer R, Ponikowski P, Anker SD. The effect of intravenous ferric carboxymaltose on health-related quality of life in patients with chronic heart failure and iron deficiency: a subanalysis of the FAIR-HF study. Eur Heart J 2012; 34:30-8. [PMID: 22297124 PMCID: PMC3533918 DOI: 10.1093/eurheartj/ehr504] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS Patients with chronic heart failure (CHF) show impaired health-related quality of life (HRQoL), an important target for therapeutic intervention. Impaired iron homeostasis may be one mechanism underlying the poor physical condition of CHF patients. This detailed subanalysis of the previously published FAIR-HF study evaluated baseline HRQoL in iron-deficient patients with CHF and the effect of intravenous ferric carboxymaltose (FCM) on HRQoL. METHODS AND RESULTS FAIR-HF randomized 459 patients with reduced left ventricular ejection fraction and iron deficiency, with or without anaemia, to FCM or placebo (2:1). Health-related quality of life was assessed at baseline and after 4, 12, and 24 weeks of therapy using the generic EQ-5D questionnaire and disease-specific Kansas City cardiomyopathy questionnaire (KCCQ). Baseline mean visual analogue scale (VAS) score was 54.3 ± 16.4 and KCCQ overall summary score was 52.4 ± 18.8. Ferric carboxymaltose significantly improved VAS and KCCQ (mean differences from baseline in KCCQ overall, clinical and total symptom scores, P< 0.001 vs. placebo) at all time points. At week 24, significant improvement vs. placebo was observed in four of the five EQ-5D dimensions: mobility (P= 0.004), self-care (P< 0.001), pain/discomfort (P= 0.006), anxiety/depression (P= 0.012), and usual activity (P= 0.035). Ferric carboxymaltose improved all KCCQ domain mean scores from Week 4 onward (P≤ 0.05), except for self-efficacy and social limitation. Effects were present in both anaemic and non-anaemic patients. CONCLUSIONS HRQoL is impaired in iron-deficient patients with CHF. Intravenous FCM significantly improved HRQoL after 4 weeks, and throughout the remaining study period. The positive effects of FCM were independent of anaemia status.
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Affiliation(s)
- Josep Comin-Colet
- Heart Failure Programme, Department of Cardiology, and Research in Inflammatory and Cardiovascular Disorders Programme, IMIM-Hospital del Mar (Parc de Salut Mar), Passeig Maritim, 25-29, 08003, Barcelona, Spain.
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149
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Waldvogel S, Pedrazzini B, Vaucher P, Bize R, Cornuz J, Tissot JD, Favrat B. Clinical evaluation of iron treatment efficiency among non-anemic but iron-deficient female blood donors: a randomized controlled trial. BMC Med 2012; 10:8. [PMID: 22272750 PMCID: PMC3292842 DOI: 10.1186/1741-7015-10-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 01/24/2012] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Iron deficiency without anemia is related to adverse symptoms that can be relieved by supplementation. Since a blood donation can induce such an iron deficiency, we investigated the clinical impact of iron treatment after a blood donation. METHODS One week after donation, we randomly assigned 154 female donors with iron deficiency without anemia, aged below 50 years, to a four-week oral treatment of ferrous sulfate versus a placebo. The main outcome was the change in the level of fatigue before and after the intervention. Aerobic capacity, mood disorder, quality of life, compliance and adverse events were also evaluated. Hemoglobin and ferritin were used as biological markers. RESULTS The effect of the treatment from baseline to four weeks of iron treatment was an increase in hemoglobin and ferritin levels to 5.2 g/L (P < 0.01) and 14.8 ng/mL (P < 0.01), respectively. No significant clinical effect was observed for fatigue (-0.15 points, 95% confidence interval -0.9 points to 0.6 points, P = 0.697) or for other outcomes. Compliance and interruption for side effects was similar in both groups. Additionally, blood donation did not induce overt symptoms of fatigue in spite of the significant biological changes it produces. CONCLUSIONS These data are valuable as they enable us to conclude that donors with iron deficiency without anemia after a blood donation would not clinically benefit from iron supplementation. TRIAL REGISTRATION ClinicalTrials.gov: NCT00981877.
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Affiliation(s)
- Sophie Waldvogel
- Blood Transfusion Service of the Swiss Red Cross, Lausanne, Switzerland.
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150
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Ethical aspects of blood donors and the recipients of their blood. JOURNAL OF BLOOD TRANSFUSION 2011; 2012:606753. [PMID: 24089650 PMCID: PMC3777254 DOI: 10.1155/2012/606753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 12/13/2011] [Accepted: 12/27/2011] [Indexed: 11/29/2022]
Abstract
To date medical care is inextricable based on blood donors and blood products. The continuing increase and intensification of tests and guidelines also results in a change in deferral and abnormal test results. Donors and recipients of their blood are faced with this information and are confronted with a kaleidoscope of thoughts and emotions. The discussion with respect to paid versus nonpaid donation is not new, but other aspects are less often discussed. We describe these other aspects for donors and recipients of their blood and hope to open the ethical discussion; if and to what extent we should have limits?
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