1
|
Lee NH. Iron deficiency in children with a focus on inflammatory conditions. Clin Exp Pediatr 2024; 67:283-293. [PMID: 38772411 DOI: 10.3345/cep.2023.00521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/03/2023] [Indexed: 05/23/2024] Open
Abstract
Iron deficiency (ID) tends to be overlooked compared with anemia. However, its prevalence is estimated to be twice as high as that of ID anemia, and ID without anemia can be accompanied by clinical and functional impairments. The symptoms of ID are nonspecific, such as fatigue and lethargy, but can lead to neurodevelopmental disorders in children, restless legs syndrome, and recurrent infections due to immune system dysregulation. In particular, the risk of ID is high in the context of chronic inflammatory diseases (CIDs) due to the reaction of various cytokines and the resulting increase in hepcidin levels; ID further exacerbates these diseases and increases mortality. Therefore, the diagnosis of ID should not be overlooked through ID screening especially in high-risk groups. Ferritin and transferrin saturation levels are the primary laboratory parameters used to diagnose ID. However, as ferritin levels respond to inflammation, the diagnostic criteria differ among guidelines. Therefore, new tools and criteria for accurately diagnosing ID should be developed. Treatment can be initiated only with an accurate diagnosis. Oral iron is typically the first-line treatment for ID; however, the efficacy and safety of intravenous iron have recently been recognized. Symptoms improve quickly after treatment, and the prognosis of accompanying diseases can also be improved. This review highlights the need to improve global awareness of ID diagnosis and treatment, even in the absence of anemia, to improve the quality of life of affected children, especially those with CIDs.
Collapse
Affiliation(s)
- Na Hee Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| |
Collapse
|
2
|
Mohus RM, Flatby H, Liyanarachi KV, DeWan AT, Solligård E, Damås JK, Åsvold BO, Gustad LT, Rogne T. Iron status and the risk of sepsis and severe COVID-19: a two-sample Mendelian randomization study. Sci Rep 2022; 12:16157. [PMID: 36171422 PMCID: PMC9516524 DOI: 10.1038/s41598-022-20679-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/16/2022] [Indexed: 01/15/2023] Open
Abstract
Observational studies have indicated an association between iron status and risk of sepsis and COVID-19. We estimated the effect of genetically-predicted iron biomarkers on risk of sepsis and risk of being hospitalized with COVID-19, performing a two-sample Mendelian randomization study. For risk of sepsis, one standard deviation increase in genetically-predicted serum iron was associated with odds ratio (OR) of 1.14 (95% confidence interval [CI] 1.01-1.29, P = 0.031). The findings were supported in the analyses for transferrin saturation and total iron binding capacity, while the estimate for ferritin was inconclusive. We found a tendency of higher risk of hospitalization with COVID-19 for serum iron; OR 1.29 (CI 0.97-1.72, P = 0.08), whereas sex-stratified analyses showed OR 1.63 (CI 0.94-2.86, P = 0.09) for women and OR 1.21 (CI 0.92-1.62, P = 0.17) for men. Sensitivity analyses supported the main findings and did not suggest bias due to pleiotropy. Our findings suggest a causal effect of genetically-predicted higher iron status and risk of hospitalization due to sepsis and indications of an increased risk of being hospitalized with COVID-19. These findings warrant further studies to assess iron status in relation to severe infections, including the potential of improved management.
Collapse
Affiliation(s)
- Randi Marie Mohus
- grid.5947.f0000 0001 1516 2393Gemini Center for Sepsis Research, Institute of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Clinic of Anesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Postboks 3250 Torgarden, 7006 Trondheim, Norway
| | - Helene Flatby
- grid.5947.f0000 0001 1516 2393Gemini Center for Sepsis Research, Institute of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristin V. Liyanarachi
- grid.5947.f0000 0001 1516 2393Gemini Center for Sepsis Research, Institute of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Infectious Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Andrew T. DeWan
- grid.5947.f0000 0001 1516 2393Gemini Center for Sepsis Research, Institute of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway ,grid.47100.320000000419368710Department of Chronic Disease Epidemiology and Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT USA
| | - Erik Solligård
- grid.5947.f0000 0001 1516 2393Gemini Center for Sepsis Research, Institute of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jan Kristian Damås
- grid.5947.f0000 0001 1516 2393Gemini Center for Sepsis Research, Institute of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Infectious Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Centre of Molecular Inflammation Research, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjørn Olav Åsvold
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, HUNT Research Centre, NTNU, Norwegian University of Science and Technology, Levanger, Norway
| | - Lise T. Gustad
- grid.5947.f0000 0001 1516 2393Gemini Center for Sepsis Research, Institute of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway ,Nord-Trøndelag Hospital Trust, Levanger, Norway ,grid.465487.cFaculty of Health Sciences, Nord University, Levanger, Norway
| | - Tormod Rogne
- grid.5947.f0000 0001 1516 2393Gemini Center for Sepsis Research, Institute of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway ,grid.47100.320000000419368710Department of Chronic Disease Epidemiology and Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT USA ,grid.418193.60000 0001 1541 4204Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
3
|
Serial T-SPOT.TB responses in Tanzanian adolescents: Transient, persistent and irregular conversions. PLoS One 2022; 17:e0268685. [PMID: 35749397 PMCID: PMC9231806 DOI: 10.1371/journal.pone.0268685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background Prospective studies of interferon-gamma release assays (IGRA) on healthy subjects in tuberculosis-endemic regions have not examined the long-term variability of serial assays. This issue is relevant to the interpretation of tuberculosis (TB) vaccine trials based on prevention of infection. Methods T-SPOT.TB assays were performed manually on healthy adolescents during a tuberculosis vaccine trial in Tanzania at 5 intervals over 3 years. Assay results were defined as negative, positive, borderline or invalid. Subsequently, microtiter plates were analyzed by an automated reader to obtain quantitative counts of spot forming cells (SFCs) for the present analysis. Results 3387 T-SPOT.TB samples were analyzed from 928 adolescents; manual and automated assay results were 97% concordant. Based on the quantitative results 143 (15%) participants were prevalent IGRA-positives at baseline, were ineligible for further study. Among the remaining IGRA-negative participants, the annual rate of IGRA conversion was 2·9%. Among 43 IGRA converters with repeat assays 12 (28%) were persistent converters, 16 (37%) were transient converters, and 15 (35%) comprised a new category defined as irregular converters (≥2 different subsequent results). ESAT-6 and CFP-10 responses were higher in prevalent than incident positives: 53 vs 36 for CFP-10 (p < 0·007); 44 vs 34 for ESAT-6 (p = 0·12). Conclusions Definitions of IGRA conversion, reversion, and persistence depend critically on the frequency of testing. Multiple shifts in categories among adolescents in a TB-endemic country may represent multiple infections, variable host responses in subclinical infection, or assay variation. These findings should to be considered in the design and interpretation of TB vaccine trials based on prevention of infection. Household contact studies could determine whether even transient IGRA conversion might represent exposure to an active case of M. tuberculosis disease.
Collapse
|
4
|
The Association between Iron-Deficiency Anemia (IDA) and Septic Arthritis (SA): The Real-World Data. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58050617. [PMID: 35630034 PMCID: PMC9145831 DOI: 10.3390/medicina58050617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Iron-deficiency anemia (IDA) could predispose the afflicted individuals to various infections and musculoskeletal disorders. This study attempted to investigate the association between IDA and septic arthritis (SA), a musculoskeletal disease. Materials and Methods: We investigated all the eligible subjects in the Taiwanese longitudinal health insurance database (LHID) between 2000 and 2012. Subjects with the diagnosis of IDA (International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM): 280) were allocated to the IDA cohort. The control subjects were randomly matched to every subject with IDA coding by age and sex at the 1:4 ratio. All of the recruited subjects were followed since the index date to the onset of SA (ICD-9-CM: 711.0), withdrawal from the insurance (including death), or 31 December 2013. Results: The cumulative incidence of SA was assessed. We showed that the cumulative incidence of SA was higher in the IDA cohort than in the control cohort (p-value < 0.0001). After adjustment of the comorbidities, the IDA patients had a 2.53-fold risk of SA compared to control subjects (aHR = 2.53, 95% CI = 1.89−3.38). Conclusions: IDA was associated with an increased risk of SA.
Collapse
|
5
|
Polymicrobial bacteremia due to Lactobacillus jensenii and Veillonella montpellierensis in a pregnant patient; case report and review of literature. Anaerobe 2022; 75:102576. [PMID: 35489617 DOI: 10.1016/j.anaerobe.2022.102576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/21/2022]
Abstract
Prompt and accurate diagnosis of polymicrobial bacteremia, which causes the difficulty in anti-infective treatments, poor treatment outcome and high mortality, is essential for initiating effective antimicrobial therapy. Here we present a case of bacteremia caused by two types of uncommon bacteria, Lactobacillus jenseniand and Veillonella montpellierensis in a 29-year-old pregnant woman at 33 weeks of gestation with anemia due to iron deficiency. She had no comorbidity or other chronic illnesses and was successfully treated with appropriate antibiotic use.
Collapse
|
6
|
Dong Z, Zhang D, Wu X, Yin Y, Wan D. Ferrous Bisglycinate Supplementation Modulates Intestinal Antioxidant Capacity via the AMPK/FOXO Pathway and Reconstitutes Gut Microbiota and Bile Acid Profiles in Pigs. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2022; 70:4942-4951. [PMID: 35420025 DOI: 10.1021/acs.jafc.2c00138] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Multi-omics were applied to compare the risks and benefits of ferrous sulfate (FeSO4) and ferrous bisglycinate (FebisGly) in pigs in the current study. The FebisGly group showed reduced triglyceride (TG) and triglyceride/total cholesterol (TG/CHOL) values in the serum and reduced malondialdehyde (MDA) and increased glutathione (GSH) levels in the duodenum. Transcriptome analysis revealed that differentially expressed genes in the duodenum were enriched in oxidative phosphorylation, AMPK, and FOXO signaling pathways between FeSO4 and FebisGly groups. AMPK phosphorylation and FOXO3 protein expressions were significantly increased in the FebisGly group. Bacterial 16S rRNA gene sequence analysis revealed significantly reduced alpha diversity in the FeSO4 group and increased Firmicutes, reduced Bacteroidetes, and Proteobacteria abundances in the FebisGly group. Targeted metabolome revealed notably increased lithocholic acid (LCA), glycolithocholic acid (GLCA), hyodeoxycholic acid (HDCA), ursodeoxycholic acid (UDCA), and glycoursodeoxycholic acid (GUDCA) in the FebisGly group. RDA analysis indicated that Fusobacteria was positively correlated with TG and TG/high-density lipoprotein in the FeSO4 group while Christensenellaceae_R-7_group, Ruminococcaceae_UCG-002, and Ruminococcaceae_UCG-005 were positively correlated with UDCA and GLCA in the FebisGly group. According to the current study, FebisGly improves serum lipid metabolism, modulates intestinal antioxidant capacity via the AMPK/FOXO pathway, and reconstitutes gut microbiota and bile acid profiles in pigs.
Collapse
Affiliation(s)
- Zhenglin Dong
- Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Research Center of Livestock & Poultry Sciences, South-Central Experimental Station of Animal Nutrition and Feed Science in Ministry of Agriculture, Institute of Subtropical Agriculture, The Chinese Academy of Sciences, Changsha, Hunan 410125, China
| | - Dongming Zhang
- Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Research Center of Livestock & Poultry Sciences, South-Central Experimental Station of Animal Nutrition and Feed Science in Ministry of Agriculture, Institute of Subtropical Agriculture, The Chinese Academy of Sciences, Changsha, Hunan 410125, China
| | - Xin Wu
- Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Research Center of Livestock & Poultry Sciences, South-Central Experimental Station of Animal Nutrition and Feed Science in Ministry of Agriculture, Institute of Subtropical Agriculture, The Chinese Academy of Sciences, Changsha, Hunan 410125, China
| | - Yulong Yin
- Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Research Center of Livestock & Poultry Sciences, South-Central Experimental Station of Animal Nutrition and Feed Science in Ministry of Agriculture, Institute of Subtropical Agriculture, The Chinese Academy of Sciences, Changsha, Hunan 410125, China
| | - Dan Wan
- Key Laboratory of Agro-Ecological Processes in Subtropical Region, Hunan Research Center of Livestock & Poultry Sciences, South-Central Experimental Station of Animal Nutrition and Feed Science in Ministry of Agriculture, Institute of Subtropical Agriculture, The Chinese Academy of Sciences, Changsha, Hunan 410125, China
| |
Collapse
|
7
|
Association of Abnormal Iron Status with the Occurrence and Prognosis of Peritoneal Dialysis-Related Peritonitis: A Longitudinal Data-Based 10-Year Retrospective Study. Nutrients 2022; 14:nu14081613. [PMID: 35458175 PMCID: PMC9027868 DOI: 10.3390/nu14081613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 01/27/2023] Open
Abstract
This retrospective study investigated the effect of iron status on peritonitis by analyzing longitudinal iron parameters in peritoneal dialysis (PD) patients. Patients who received PD at our center from 1 January 2006 to 31 December 2015 were included and followed up until 31 December 2017. According to the joint quartiles of baseline transferrin saturation and ferritin, iron status was categorized as reference iron status (RIS), absolute iron deficiency (AID), functional iron deficiency (FID), and high iron status (HIS). Generalized estimating equations and Cox regression models with time-dependent covariates were used. A total of 1258 PD patients were included; 752 (59.8%) were male, with a mean (±standard deviation) age of 47.4 (±14.9) years. During a median follow-up period of 35.5 (interquartile range, 18.4–60.0) months, 450 (34.3%) patients had 650 episodes of peritonitis. By analyzing longitudinal data, patients with AID were independently positively associated with the occurrence (adjusted odds ratio (AOR) = 1.45) and treatment failure of peritonitis (adjusted hazard ratio (AHR) = 1.85). Patients with HIS were positively associated with the treatment failure of peritonitis (AHR = 2.70). Longitudinal AID and HIS were associated with the episodes and poor prognosis of peritonitis. Active clinical monitoring and correction of iron imbalance in patients with PD are needed.
Collapse
|
8
|
Malnutrition and Dietary Habits Alter the Immune System Which May Consequently Influence SARS-CoV-2 Virulence: A Review. Int J Mol Sci 2022; 23:ijms23052654. [PMID: 35269795 PMCID: PMC8910702 DOI: 10.3390/ijms23052654] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
COVID-19, resulting from the SARS-CoV-2 virus, is a major pandemic that the world is fighting. SARS-CoV-2 primarily causes lung infection by attaching to the ACE2 receptor on the alveolar epithelial cells. However, the ACE2 receptor is also present in intestinal epithelial cells, suggesting a link between nutrition, virulence and clinical outcomes of COVID-19. Respiratory viral infections perturb the gut microbiota. The gut microbiota is shaped by our diet; therefore, a healthy gut is important for optimal metabolism, immunology and protection of the host. Malnutrition causes diverse changes in the immune system by repressing immune responses and enhancing viral vulnerability. Thus, improving gut health with a high-quality, nutrient-filled diet will improve immunity against infections and diseases. This review emphasizes the significance of dietary choices and its subsequent effects on the immune system, which may potentially impact SARS-CoV-2 vulnerability.
Collapse
|
9
|
Lanz P, Wieczorek M, Sadlon A, de Godoi Rezende Costa Molino C, Abderhalden LA, Schaer DJ, Spahn DR, Freystätter G, Orav EJ, Egli A, Bischoff-Ferrari HA. Iron Deficiency and Incident Infections among Community-Dwelling Adults Age 70 Years and Older: Results from the DO-HEALTH Study. J Nutr Health Aging 2022; 26:864-871. [PMID: 36156678 DOI: 10.1007/s12603-022-1836-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVES To assess if baseline iron deficiency, with or without anemia, is associated with incident infections over 3 years among community-dwelling older adults. DESIGN Prospective secondary analysis of DO-HEALTH, a 3-year randomized, double-blind controlled trial. SETTING AND PARTICIPANTS 2157 community-dwelling adults age 70+ from 5 European countries with good cognitive function and mobility and no major health events in the 5 years prior to enrollment Measurements: Incident infections, their severity and type were recorded every 3 months throughout the 3-year follow-up. Iron deficiency was defined as soluble transferrin receptor (sTfR) levels > 28.1 nmol/l and anemia as hemoglobin levels < 120 g/l for women and 130 g/l for men. We applied negative binomial mixed effects regression models with random effects for countries, and controlling for treatment allocation, age, sex, body mass index, polypharmacy, number of comorbidities, smoking status, living situation, alcohol intake, frailty status, and physical activity levels. A pre-defined stratified analysis was performed to explore if the associations between iron deficiency and infections were consistent by baseline anemia status. RESULTS In total, 2141 participants were included in the analyses (mean age 74.9 years, 61.5% of women, 26.8% with iron deficiency). Across all participants, baseline iron deficiency was not associated with incident overall infections, but was associated with a 63% greater rate of incident severe infections requiring hospitalization (incidence rate ratio [IRR] 1.63, 95% Confidence Interval [CI] 1.11-2.41, p=0.01). This association was more pronounced among the 2000 participants who did not have anemia at baseline (IRR=1.80, 95% CI 1.20-2.69, p=0.005). CONCLUSION Based on this prospective study among generally healthy European community-dwelling older adults, iron deficiency was not associated with the incidence rate of overall infections but may increase the incidence of severe infections. Intervention studies are needed to prove the causality of this observation.
Collapse
Affiliation(s)
- P Lanz
- Heike A. Bischoff-Ferrari, University Hospital Zurich, Department of Aging Medicine and Aging Research, Raemistrasse 101, 8091 Zurich, Switzerland, ORCID 0000-0002-4554-658X, Phone: +41-44-255-2757,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Nogueira-de-Almeida CA, Ued FDV, Del Ciampo LA, Martinez EZ, Ferraz IS, Contini AA, Cruz FCSD, Silva RFB, Nogueira-de-Almeida ME, Lamounier JA. Prevalence of childhood anaemia in Brazil: still a serious health problem: a systematic review and meta-analysis. Public Health Nutr 2021; 24:6450-6465. [PMID: 34212834 PMCID: PMC11148596 DOI: 10.1017/s136898002100286x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To estimate the prevalence of anaemia in Brazilian children up to 83·9 months old. DESIGN Systematic review and meta-analysis, using databases PubMed, Scopus, SciELO, Lilacs, Google Scholar, Periódicos Capes, Arca, Biblioteca Virtual em Saúde, Microsoft Academic Search and Cochrane Library using search terms: anaemia, prevalence, child and Brazil. PROSPERO Registration number: CRD42020208818. SETTING Cross-sectional, cohort, case-control and intervention studies published between 2007 and 2020 were searched, excluding those who assessed children with an illness or chronic condition. The main outcome was anaemia prevalence. Random effects models based on the inverse variance method were used to estimate pooled prevalence measures. Sensitivity analyses removed studies with high contribution to overall heterogeneity. PARTICIPANTS From 6790 first screened, 134 eligible studies were included, totalling 46 978 children aged zero to 83·9 months analysed, with adequate regions representativeness. RESULTS Pooled prevalence of anaemia was 33 % (95 % CI 30, 35). Sensitivity analyses showed that withdrawal of studies that contributed to high heterogeneity did not influence national average prevalence. CONCLUSIONS Childhood anaemia is still a serious public health problem in Brazil, exposing 33 % of Brazilian children to the anaemia repercussions. The main limitation of the study is the estimation of national prevalence based on local surveys, but a large number of studies were included, with representation in all regions of the country, giving strength to the results. In Brazil, more public policies are needed to promote supplementation, fortification and access to healthy eating to reduce the high level of anaemia among children.
Collapse
Affiliation(s)
- Carlos Alberto Nogueira-de-Almeida
- Medical Department, Federal University of São Carlos, Brazil - DMED UFSCAR, Rod. Washington Luiz, km 235, São Carlos, SP13565-905, Brazil
| | - Fábio da Veiga Ued
- Nutrition School, University of São Paulo, Brazil - FMRP-USP, Ribeirao Preto, Brazil
| | | | | | - Ivan Savioli Ferraz
- Nutrition School, University of São Paulo, Brazil - FMRP-USP, Ribeirao Preto, Brazil
| | - Andrea Aparecida Contini
- Medical Department, Federal University of São Carlos, Brazil - DMED UFSCAR, Rod. Washington Luiz, km 235, São Carlos, SP13565-905, Brazil
| | | | | | | | - Joel Alves Lamounier
- Medical School, Federal University of Sao Joao Del Rei, Brazil - DMED UFSJ, Sao Joao Del Rei, Brazil
| |
Collapse
|
11
|
Das K, Das S, Mohapatra S, Swain A, Mohakud NK. Risk and Adverse Outcome Factors of Severe Acute Malnutrition in Children: A Hospital-Based Study in Odisha. Cureus 2021; 13:e18364. [PMID: 34737917 PMCID: PMC8557996 DOI: 10.7759/cureus.18364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/05/2022] Open
Abstract
Background Malnutrition is prevalent in 41% of children less than five years old in developing countries. Objective To determine the clinical spectrum, identify the risk factors, and find out the factors responsible for the adverse outcomes of severe acute malnutrition (SAM) in children. Methods In this prospective cohort, children aged one month to five years with SAM from October 2016 to September 2018 were enrolled. Clinical profile, contributing factors, treatment, and outcome of cases (n=198) were noted. Results SAM was diagnosed in 323 (1.6%) of admitted cases. The unimmunized children were 123 (62.1%). Common co-morbidities were acute gastroenteritis (n=89, 44.9%), respiratory tract infection (n=88, 44.4%), and septicemia (n=54, 26.7%). Children not on exclusive breastfeeding (n=157, 79.1%), early complementary feeding (<6 months) (n=157, 88.2%), bottle-feeding (n=138, 77.55%), low birth weight (157, 79.1%), living in kutcha houses (115, 58.2%), and unavailability of safe drinking water (131, 66.4%) were the significant risk factors. Pneumonia, diarrhea, nutritional edema, hypothermia, and circulatory shock at the time of admission were responsible for adverse outcomes. One hundred and eighty-three (92.4%) children were cured and discharged and 15 (7.6%) children died. Conclusions Wrong feeding practices and unavailability of safe drinking water have an important bearing on the development of SAM children. Pneumonia, diarrhea, nutritional edema, hypothermia, and circulatory shock at the time of admission were responsible for adverse outcomes.
Collapse
Affiliation(s)
- Kedarnath Das
- Paediatrics, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, IND
| | - Swarnalata Das
- Paediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | | | - Arakhita Swain
- Paediatrics, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, IND
| | - Nirmal K Mohakud
- Paediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| |
Collapse
|
12
|
Morais AHDA, Aquino JDS, da Silva-Maia JK, Vale SHDL, Maciel BLL, Passos TS. Nutritional status, diet and viral respiratory infections: perspectives for severe acute respiratory syndrome coronavirus 2. Br J Nutr 2021; 125:851-862. [PMID: 32843118 PMCID: PMC7542326 DOI: 10.1017/s0007114520003311] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 12/21/2022]
Abstract
COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was recognised by the WHO as a pandemic in 2020. Host preparation to combat the virus is an important strategy to avoid COVID-19 severity. Thus, the relationship between eating habits, nutritional status and their effects on the immune response and further implications in viral respiratory infections is an important topic discussed in this review. Malnutrition causes the most diverse alterations in the immune system, suppressing of the immune response and increasing the susceptibility to infections such as SARS-CoV-2. On the other hand, obesity induces low-grade chronic inflammation caused by excess adiposity, which increases angiotensin-converting enzyme 2. It decreases the immune response favouring SARS-CoV-2 virulence and promoting respiratory distress syndrome. The present review highlights the importance of food choices considering their inflammatory effects, consequently increasing the viral susceptibility observed in malnutrition and obesity. Healthy eating habits, micronutrients, bioactive compounds and probiotics are strategies for COVID-19 prevention. Therefore, a diversified and balanced diet can contribute to the improvement of the immune response to viral infections such as COVID-19.
Collapse
Affiliation(s)
- Ana Heloneida de Araújo Morais
- Nutrition Postgraduate Program, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN59078-970, Brazil
- Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN59078-970, Brazil
| | - Jailane de Souza Aquino
- Nutrition Postgraduate Program, Center for Health Sciences, Federal University of Paraíba, João Pessoa, PB58050-085, Brazil
| | - Juliana Kelly da Silva-Maia
- Nutrition Postgraduate Program, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN59078-970, Brazil
- Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN59078-970, Brazil
| | - Sancha Helena de Lima Vale
- Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN59078-970, Brazil
| | - Bruna Leal Lima Maciel
- Nutrition Postgraduate Program, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN59078-970, Brazil
- Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN59078-970, Brazil
| | - Thaís Sousa Passos
- Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, RN59078-970, Brazil
| |
Collapse
|
13
|
Chang R, Chu KA, Lin MC, Chu YH, Hung YM, Wei JCC. Newly diagnosed iron deficiency anemia and subsequent autoimmune disease: a matched cohort study in Taiwan. Curr Med Res Opin 2020; 36:985-992. [PMID: 32223346 DOI: 10.1080/03007995.2020.1748585] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To explore whether newly diagnosed iron deficiency anemia (IDA) is associated with subsequent systemic autoimmune disease onset.Methods: The study identified 22,440 patients who received a diagnosis of IDA between 2000 and 2012 from a random sample of 1 million people from Taiwan's National Health Insurance Research Database. The patients with IDA were randomly matched with 89,528 patients with no IDA by age, gender, and index year. We followed the 2 groups until systemic autoimmune disease onset. Cox proportional hazards analysis was used to determine autoimmune disease risk by age, gender, and comorbidities, in terms of hazard ratios (HRs) and 95% confidence intervals (CIs).Results: Adjusted HR (95% CI) of autoimmune disease in the IDA group was 2.37 (1.92-2.92) compared with the non-IDA group. The subgroup analysis indicated that a patient with IDA had a significantly greater risk of autoimmune disease if they were female or had the comorbidities of hypertension, hyperlipidemia, cancer, allergic rhinitis, urticaria, chronic obstructive pulmonary disease, or chronic liver disease. The autoimmune disease was significantly more likely to occur within 2 years after a new diagnosis of IDA.Conclusions: IDA significantly increases autoimmune disease risk, particularly in female patients and patients with certain comorbidities. Clinicians should conduct further clinical evaluations and laboratory tests of autoimmune disease in patients with IDA.
Collapse
Affiliation(s)
- Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Recreation Sports Management, Tajen University, Pingtung, Taiwan
| | - Kuo-An Chu
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
- Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, Medical University Hospital, Taichung, Taiwan
| | - Yi-Hsin Chu
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yao-Min Hung
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan
- Yuhing Junior College of Health Care and Management, Kaohsiung, Taiwan
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
14
|
Fallet E, Rayar M, Landrieux A, Camus C, Houssel-Debry P, Jezequel C, Legros L, Uguen T, Ropert-Bouchet M, Boudjema K, Guyader D, Bardou-Jacquet E. Iron metabolism imbalance at the time of listing increases overall and infectious mortality after liver transplantation. World J Gastroenterol 2020; 26:1938-1949. [PMID: 32390704 PMCID: PMC7201152 DOI: 10.3748/wjg.v26.i16.1938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/30/2020] [Accepted: 04/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver transplantation (LT) is the best treatment for patients with liver cancer or end stage cirrhosis, but it is still associated with a significant mortality. Therefore identifying factors associated with mortality could help improve patient management. The impact of iron metabolism, which could be a relevant therapeutic target, yield discrepant results in this setting. Previous studies suggest that increased serum ferritin is associated with higher mortality. Surprisingly iron deficiency which is a well described risk factor in critically ill patients has not been considered.
AIM To assess the impact of pre-transplant iron metabolism parameters on post-transplant survival.
METHODS From 2001 to 2011, 553 patients who underwent LT with iron metabolism parameters available at LT evaluation were included. Data were prospectively recorded at the time of evaluation and at the time of LT regarding donor and recipient. Serum ferritin (SF) and transferrin saturation (TS) were studied as continuous and categorical variable. Cox regression analysis was used to determine mortality risks factors. Follow-up data were obtained from the local and national database regarding causes of death.
RESULTS At the end of a 95-mo median follow-up, 196 patients were dead, 38 of them because of infections. In multivariate analysis, overall mortality was significantly associated with TS > 75% [HR: 1.73 (1.14; 2.63)], SF < 100 µg/L [HR: 1.62 (1.12; 2.35)], hepatocellular carcinoma [HR: 1.58 (1.15; 2.26)], estimated glomerular filtration rate (CKD EPI Cystatin C) [HR: 0.99 (0.98; 0.99)], and packed red blood cell transfusion [HR: 1.05 (1.03; 1.08)]. Kaplan Meier curves show that patients with low SF (< 100 µg/L) or high SF (> 400 µg/L) have lower survival rates at 36 mo than patients with normal SF (P = 0.008 and P = 0.016 respectively). Patients with TS higher than 75% had higher mortality at 12 mo (91.4% ± 1.4% vs 84.6% ± 3.1%, P = 0.039). TS > 75% was significantly associated with infection related death [HR: 3.06 (1.13; 8.23)].
CONCLUSION Our results show that iron metabolism imbalance (either deficiency or overload) is associated with post-transplant overall and infectious mortality. Impact of iron supplementation or depletion should be assessed in prospective study.
Collapse
Affiliation(s)
- Elodie Fallet
- Service des Maladies du Foie, CHU Rennes, University Rennes, Rennes 35033, France
| | - Michel Rayar
- Service de Chirurgie Hepatobilaire, CHU Rennes, University Rennes, Rennes 35033, France
| | - Amandine Landrieux
- Service des Maladies du Foie, CHU Rennes, University Rennes, Rennes 35033, France
| | - Christophe Camus
- Service de Réanimation médicale, CHU Rennes, University Rennes, Rennes 35033, France
| | - Pauline Houssel-Debry
- Service des Maladies du Foie, CHU Rennes, University Rennes, Rennes 35033, France
- Service de Chirurgie Hepatobilaire, CHU Rennes, University Rennes, Rennes 35033, France
| | - Caroline Jezequel
- Service des Maladies du Foie, CHU Rennes, University Rennes, Rennes 35033, France
| | - Ludivine Legros
- Service des Maladies du Foie, CHU Rennes, University Rennes, Rennes 35033, France
| | - Thomas Uguen
- Service des Maladies du Foie, CHU Rennes, University Rennes, Rennes 35033, France
| | | | - Karim Boudjema
- Service de Chirurgie Hepatobilaire, CHU Rennes, University Rennes, Rennes 35033, France
| | - Dominique Guyader
- Service des Maladies du Foie, CHU Rennes, University Rennes, Rennes 35033, France
| | | |
Collapse
|
15
|
Mattiello V, Schmugge M, Hengartner H, von der Weid N, Renella R. Diagnosis and management of iron deficiency in children with or without anemia: consensus recommendations of the SPOG Pediatric Hematology Working Group. Eur J Pediatr 2020; 179:527-545. [PMID: 32020331 DOI: 10.1007/s00431-020-03597-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 11/26/2022]
Abstract
Iron deficiency is the most prevalent nutritional deficiency affecting children and adolescents worldwide. A consistent body of epidemiological data demonstrates an increased incidence of iron deficiency at three timepoints: in the neonatal period, in preschool children, and in adolescents, where it particularly affects females.Conclusion: This narrative review focuses on the most suggestive symptoms of iron deficiency in childhood, describes the diagnostic procedures in situations with or without anemia, and provides Swiss expert-based management recommendations for the pediatric context.What is Known:• Iron deficiency (ID) is one of the most common challenges faced by pediatricians.• Significant progress in the diagnosis and therapy of ID has been made over the last decade.What is New:• Our expert panel provides ID management recommendations based on the best available evidence.• They include strategies for ID diagnosis and therapy, both oral and intravenous.
Collapse
Affiliation(s)
- Veneranda Mattiello
- Department "Woman-Mother-Child and Adolescent", Pediatric Hematology-Oncology Unit, Division of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - Markus Schmugge
- Division of Pediatric Hematology, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Heinz Hengartner
- Pediatric Hematology-Oncology Unit, Children's Hospital of Sankt Gallen, Sankt Gallen, Switzerland
| | - Nicolas von der Weid
- Pediatric Hematology-Oncology Department, University Children's Hospital and University of Basel, Basel, Switzerland
| | - Raffaele Renella
- Department "Woman-Mother-Child", Pediatric Hematology-Oncology Unit, Division of Pediatrics, Lausanne University Hospital and University of Lausanne, Vaudois, BH11, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| |
Collapse
|
16
|
Ganz T, Aronoff GR, Gaillard CAJM, Goodnough LT, Macdougall IC, Mayer G, Porto G, Winkelmayer WC, Wish JB. Iron Administration, Infection, and Anemia Management in CKD: Untangling the Effects of Intravenous Iron Therapy on Immunity and Infection Risk. Kidney Med 2020; 2:341-353. [PMID: 32734254 PMCID: PMC7380433 DOI: 10.1016/j.xkme.2020.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Patients with chronic kidney disease (CKD) are at increased risk for infection, attributable to immune dysfunction, increased exposure to infectious agents, loss of cutaneous barriers, comorbid conditions, and treatment-related factors (eg, hemodialysis and immunosuppressant therapy). Because iron plays a vital role in pathogen reproduction and host immunity, it is biologically plausible that intravenous iron therapy and/or iron deficiency influence infection risk in CKD. Available data from preclinical experiments, observational studies, and randomized controlled trials are summarized to explore the interplay between intravenous iron and infection risk among patients with CKD, particularly those receiving maintenance hemodialysis. The current evidence base, including data from a recent randomized controlled trial, suggests that proactive judicious use of intravenous iron (in a manner that minimizes the accumulation of non-transferrin-bound iron) beneficially replaces iron stores while avoiding a clinically relevant effect on infection risk. In the absence of an urgent clinical need, intravenous iron therapy should be avoided in patients with active infection. Although serum ferritin concentration and transferrin saturation can help guide clinical decision making about intravenous iron therapy, definition of an optimal iron status and its precise determination in individual patients remain clinically challenging in CKD and warrant additional study.
Collapse
Affiliation(s)
- Tomas Ganz
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | | | | | - Lawrence T Goodnough
- Department of Pathology, Stanford University, Stanford, CA.,Department of Medicine (Hematology), Stanford University, Stanford, CA
| | - Iain C Macdougall
- Department of Renal Medicine, King's College Hospital, London, United Kingdom
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Graça Porto
- Pathology and Molecular Immunology Department, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.,i3S, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Wolfgang C Winkelmayer
- Section of Nephrology and Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX
| | - Jay B Wish
- Division of Nephrology, Indiana University Health, Indianapolis, IN
| |
Collapse
|
17
|
Abstract
Intestinal iron homeostasis is like the Zhong-Yong in traditional Chinese culture, which is a dynamic balance between Yin and Yang.
Collapse
Affiliation(s)
- Haoxuan Ding
- College of Animal Science
- Zhejiang University
- Key Laboratory of animal feed and nutrition of Zhejiang Province
- Hangzhou
- China
| | - Xiaonan Yu
- College of Animal Science
- Zhejiang University
- Key Laboratory of animal feed and nutrition of Zhejiang Province
- Hangzhou
- China
| | - Jie Feng
- College of Animal Science
- Zhejiang University
- Key Laboratory of animal feed and nutrition of Zhejiang Province
- Hangzhou
- China
| |
Collapse
|
18
|
Page MGP. The Role of Iron and Siderophores in Infection, and the Development of Siderophore Antibiotics. Clin Infect Dis 2019; 69:S529-S537. [PMID: 31724044 PMCID: PMC6853763 DOI: 10.1093/cid/ciz825] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Iron is an essential nutrient for bacterial growth, replication, and metabolism. Humans store iron bound to various proteins such as hemoglobin, haptoglobin, transferrin, ferritin, and lactoferrin, limiting the availability of free iron for pathogenic bacteria. However, bacteria have developed various mechanisms to sequester or scavenge iron from the host environment. Iron can be taken up by means of active transport systems that consist of bacterial small molecule siderophores, outer membrane siderophore receptors, the TonB-ExbBD energy-transducing proteins coupling the outer and the inner membranes, and inner membrane transporters. Some bacteria also express outer membrane receptors for iron-binding proteins of the host and extract iron directly from these for uptake. Ultimately, iron is acquired and transported into the bacterial cytoplasm. The siderophores are small molecules produced and released by nearly all bacterial species and are classified according to the chemical nature of their iron-chelating group (ie, catechol, hydroxamate, α-hydroxyl-carboxylate, or mixed types). Siderophore-conjugated antibiotics that exploit such iron-transport systems are under development for the treatment of infections caused by gram-negative bacteria. Despite demonstrating high in vitro potency against pathogenic multidrug-resistant bacteria, further development of several candidates had stopped due to apparent adaptive resistance during exposure, lack of consistent in vivo efficacy, or emergence of side effects in the host. However, cefiderocol, with an optimized structure, has advanced and has been investigated in phase 1 to 3 clinical trials. This article discusses the mechanisms implicated in iron uptake and the challenges associated with the design and utilization of siderophore-mimicking antibiotics.
Collapse
Affiliation(s)
- Malcom G P Page
- Life Sciences and Chemistry, Jacobs University, Bremen gGmbh, Bremen, Germany
| |
Collapse
|
19
|
Chu KA, Hsu CH, Lin MC, Chu YH, Hung YM, Wei JCC. Association of iron deficiency anemia with tuberculosis in Taiwan: A nationwide population-based study. PLoS One 2019; 14:e0221908. [PMID: 31469869 PMCID: PMC6716659 DOI: 10.1371/journal.pone.0221908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/16/2019] [Indexed: 11/24/2022] Open
Abstract
Background Iron deficiency is associated with decreased cellular immunity, which may predispose patients with iron deficiency anemia (IDA) to increased risk of developing tuberculosis (TB). This study investigated the relationship between newly diagnosed IDA and TB infection in Taiwan. Methods The study included data on 21,946 patients with incident IDA and 87,555 non-IDA controls from a national database covering the period 2000–2012. IDA and non-IDA subjects were matched 1:4 on age, gender, and index year. The follow-up period was defined as the time from the initial IDA diagnosis to the date of developing TB or 31 December 2013. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals, with the control group as the reference. Results The adjusted hazard ratio of TB for the IDA group was 1.99 (95% confidence interval, 1.77–2.25) compared with the control group. The subgroup analysis showed that for both genders, all age groups, and patients with diabetes mellitus, hyperlipidemia, hypertension, cancer, chronic obstructive pulmonary disease, and hepatitis B virus infection, the IDA group had significantly higher TB incidence. The association was significantly stronger within the 5 years after new IDA diagnosis for both genders and all age groups. Conclusions Higher TB incidence was discovered in the IDA group, especially for patients with comorbidities.
Collapse
Affiliation(s)
- Kuo-An Chu
- Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chun-Hsiang Hsu
- Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Hsin Chu
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yao-Min Hung
- School of Medicine, National Yang Ming University, Taipei, Taiwan
- Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Yuhing Junior College of Health Care and Management, Kaohsiung, Taiwan
- * E-mail: (YMH); (JCCW)
| | - James Cheng-Chung Wei
- Department of Rheumatology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, China
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- * E-mail: (YMH); (JCCW)
| |
Collapse
|
20
|
Association of iron status with the risk of bloodstream infections: results from the prospective population-based HUNT Study in Norway. Intensive Care Med 2018; 44:1276-1283. [PMID: 30039264 DOI: 10.1007/s00134-018-5320-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/12/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE As iron is essential for both immune function and microbial growth, alterations in iron status could influence the risk of infections. We assessed the associations of iron status with risk of bloodstream infections (BSIs) and BSI mortality. METHODS We measured serum iron, transferrin saturation (Tsat) and total iron-binding capacity (TIBC) in 61,852 participants in the population-based HUNT2 study (1995-97). Incident BSIs (1995-2011) were identified through linkage with the Mid-Norway Sepsis Register, which includes prospectively registered information on BSI from local and regional hospitals. We assessed the risk of a first-time BSI and BSI mortality with the iron indices using Cox proportional hazards regression analysis. RESULTS During a median follow-up of 14.8 years, 1738 individuals experienced at least one episode of BSI, and 370 died within 30 days after a BSI. In age- and sex-adjusted analyses, BSI risk was increased among participants with indices of iron deficiency, serum iron ≤ 2.5th percentile (HR 1.72, 95% CI 1.34-2.21), Tsat ≤ 2.5th percentile (HR 1.48, 95% CI 1.12-1.96) or TIBC ≥ 97.5th percentile (HR 1.46, 95% CI 1.06-2.01). The associations remained similar after adjusting for comorbidities and exclusion of BSI related to cancer, rheumatic illnesses and inflammatory bowel disease. BSI mortality showed similar associations. CONCLUSION Indices of severe iron deficiency are associated with an increased risk of a future BSI.
Collapse
|
21
|
Abstract
OBJECTIVE To consider the key implications of iron deficiency for biochemical and physiological functions beyond erythropoiesis. METHODS PubMed was searched for relevant journal articles published up to August 2017. RESULTS Anemia is the most well-recognized consequence of persisting iron deficiency, but various other unfavorable consequences can develop either before or concurrently with anemia. Mitochondrial function can be profoundly disturbed since iron is a cofactor for heme-containing enzymes and non-heme iron-containing enzymes in the mitochondrial electron transport chain. Biosynthesis of heme and iron-sulfur clusters in the mitochondria is inhibited, disrupting synthesis of compounds such as hemoglobin, myoglobin, cytochromes and nitric oxide synthase. The physiological consequences include fatigue, lethargy, and dyspnea; conversely, iron repletion in iron-deficient individuals has been shown to improve exercise capacity. The myocardium, with its high energy demands, is particularly at risk from the effects of iron deficiency. Randomized trials have found striking improvements in disease severity in anemic but also non-anemic chronic heart failure patients with iron deficiency after iron therapy. In vitro and pre-clinical studies have demonstrated that iron is required by numerous enzymes involved in DNA replication and repair, and for normal cell cycle regulation. Iron is also critical for immune cell growth, proliferation, and differentiation, and for specific cell-mediated effector pathways. Observational studies have shown that iron-deficient individuals have defective immune function, particularly T-cell immunity, but more evidence is required. Pre-clinical models have demonstrated abnormal myelogenesis, brain cell metabolism, neurotransmission, and hippocampal formation in iron-deficient neonates and young animals. In humans, iron deficiency anemia is associated with poorer cognitive and motor skills. However, the impact of iron deficiency without anemia is less clear. CONCLUSION The widespread cellular and physiological effects of iron deficiency highlight the need for early detection and treatment of iron deficiency, both to ameliorate these non-erythropoietic effects, and to avoid progression to iron deficiency anemia.
Collapse
Affiliation(s)
| | - Ali T Taher
- b American University of Beirut Medical Center , Beirut , Lebanon
| |
Collapse
|
22
|
Wander K, Shell-Duncan B, Brindle E. Lower incidence of respiratory infections among iron-deficient children in Kilimanjaro, Tanzania. EVOLUTION MEDICINE AND PUBLIC HEALTH 2017; 2017:109-119. [PMID: 28852503 PMCID: PMC5570096 DOI: 10.1093/emph/eox010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 06/15/2017] [Indexed: 02/07/2023]
Abstract
Objective: We posited a trade-off in iron nutrition, with iron deficiency decreasing risk for infection by depriving infectious agents of iron while increasing risk for infection by compromising immune protection. We described associations between iron deficiency and prevalent and incident infectious disease episodes and cell-mediated immunity (CMI) among 283 children in Kilimanjaro, Tanzania. Methodology: Whole blood specimens were evaluated for hemoglobin and dried blood spots (DBS) were evaluated for biomarkers of iron deficiency (transferrin receptor) and inflammation (C-reactive protein and α1-acid glycoprotein). Prevalent and incident infectious disease episodes were identified by physician’s diagnosis. CMI was evaluated as delayed-type hypersensitivity to Candida albicans (DTH-Candida). Associations between iron status and elevated inflammation, prevalent infectious disease episodes and DTH-Candida were described with logistic regression models; associations between iron status and incident infectious disease episodes were described with Cox proportional hazards models. Results: Elevated inflammation and diagnosed infectious diseases were more common among children with iron-deficiency anemia (IDA, severe iron deficiency), but not significantly so. The incidence of infectious disease was lowest among children with moderate iron deficiency (iron-deficient erythropoiesis, IDE); this pattern was most apparent for respiratory infections (aHR: 0.24; p: 0.030). DTH-Candida was not compromised among children with any degree of iron deficiency. Conclusions and implications: We observed no adverse effect of iron deficiency on CMI, but did observe patterns consistent with the hypothesis that moderate iron deficiency protects against respiratory infections and may represent a nutritional adaptation to infectious disease. This suggests that interventions targeting iron deficiency should be coupled with effective infectious disease control measures.
Collapse
Affiliation(s)
- Katherine Wander
- Department of Anthropology, Binghamton University (SUNY), Binghamton, NY, USA
| | - Bettina Shell-Duncan
- Department of Anthropology, University of Washington, Seattle, WA, USA.,Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
| | - Eleanor Brindle
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
| |
Collapse
|
23
|
Dietary Composition Influences Incidence of Helicobacter pylori-Induced Iron Deficiency Anemia and Gastric Ulceration. Infect Immun 2016; 84:3338-3349. [PMID: 27620719 DOI: 10.1128/iai.00479-16] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/02/2016] [Indexed: 12/17/2022] Open
Abstract
Epidemiologic studies have provided conflicting data regarding an association between Helicobacter pylori infection and iron deficiency anemia (IDA) in humans. Here, a Mongolian gerbil model was used to investigate a potential role of H. pylori infection, as well as a possible role of diet, in H. pylori-associated IDA. Mongolian gerbils (either H. pylori infected or uninfected) received a normal diet or one of three diets associated with increased H. pylori virulence: high-salt, low-iron, or a combination of a high-salt and low-iron diet. In an analysis of all infected animals compared to uninfected animals (independent of diet), H. pylori-infected gerbils had significantly lower hemoglobin values than their uninfected counterparts at 16 weeks postinfection (P < 0.0001). The mean corpuscular volume (MCV) and serum ferritin values were significantly lower in H. pylori-infected gerbils than in uninfected gerbils, consistent with IDA. Leukocytosis and thrombocytosis were also detected in infected gerbils, indicating the presence of a systemic inflammatory response. In comparison to uninfected gerbils, H. pylori-infected gerbils had a higher gastric pH, a higher incidence of gastric ulcers, and a higher incidence of fecal occult blood loss. Anemia was associated with the presence of gastric ulceration but not gastric cancer. Infected gerbils consuming diets with a high salt content developed gastric ulcers significantly more frequently than gerbils consuming a normal-salt diet, and the lowest hemoglobin levels were in infected gerbils consuming a high-salt/low-iron diet. These data indicate that H. pylori infection can cause IDA and that the composition of the diet influences the incidence and severity of H. pylori-induced IDA.
Collapse
|
24
|
Myhre KE, Webber BJ, Cropper TL, Tchandja JN, Ahrendt DM, Dillon CA, Haas RW, Guy SL, Pawlak MT, Federinko SP. Prevalence and Impact of Anemia on Basic Trainees in the US Air Force. SPORTS MEDICINE-OPEN 2016; 2:23. [PMID: 27239430 PMCID: PMC4863912 DOI: 10.1186/s40798-016-0047-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 04/27/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Anemia has been implicated in adverse health outcomes of athletes and military trainees, ranging from overuse injuries to degraded physical and cognitive performance. The purpose of this study was to investigate prevalence of anemia among US Air Force (USAF) basic trainees, to compare physical performance and discharge rates between anemic and non-anemic trainees, and to determine the risks and relative risks of being discharged for anemic versus non-anemic women and men. METHODS All USAF basic trainees were screened for anemia between July 2013 and January 2014, during an 8-week basic training course at Joint Base San Antonio-Lackland, TX. Age, sex, screening hemoglobin, anthropometric measurements, initial/final physical fitness assessment scores, and discharge data were collected from trainees. Those identified as anemic (hemoglobin <13.5 g/dL for males and <12.0 g/dL for females) received additional labwork, nutritional counseling, and oral iron-replacement, if indicated. Mean percent improvement was calculated for all performance parameters from beginning to end of training. Anemic trainees were compared to non-anemic trainees by t test with Welch modification. Results were stratified by sex and anemia severity with post-hoc Bonferroni correction. RESULTS Prevalence of anemia was 12.6 % (N = 18,827). Respective prevalence of borderline, moderate, and severe anemia was 12.6, 10.9, and 1.9 % for females and 4.8, 3.8, and 0.3 % for males. Mean 1.5-mile run-time, push-up and sit-up counts improved from beginning to end of training for both anemic and non-anemic trainees (p < 0.001 both). Non-anemic trainees had slightly greater run-time improvements than borderline and moderate anemics (female: 17.7 vs. 15.2, and 15.1 % improvement, p < 0.05 both; male: 14.9 vs. 13.2, and 13.5 % improvement, p < 0.05 both). One-way ANOVA demonstrated statistically significant differences between initial and final fitness data for all measures and both genders (p < 0.001) with the exception of final sit-up counts for male trainees (p = 0.082). Discharge rate for anemic trainees was 9.0 % (20 % for severely anemic trainees) as compared to 5.7 % for non-anemics. CONCLUSIONS Anemia was prevalent among USAF basic trainees. Identification and treatment of anemia may optimize physical performance and decrease the rate of medical discharge.
Collapse
Affiliation(s)
- Kathryn E Myhre
- Joint Base San Antonio, Adolescent and Young Adult Medicine Service, Fort Sam Houston, San Antonio, TX USA ; University of Texas School of Public Health, San Antonio, USA
| | | | | | | | - Dale M Ahrendt
- Joint Base San Antonio, Adolescent and Young Adult Medicine Service, Fort Sam Houston, San Antonio, TX USA
| | - Christopher A Dillon
- Joint Base San Antonio, Adolescent and Young Adult Medicine Service, Fort Sam Houston, San Antonio, TX USA
| | - Roy W Haas
- Joint Base San Antonio, Lackland, San Antonio, TX USA
| | | | - Mary T Pawlak
- Joint Base San Antonio, Lackland, San Antonio, TX USA
| | | |
Collapse
|
25
|
Somuk BT, Sapmaz E, Soyalıç H, Yamanoğlu M, Mendil D, Arici A, Gurbuzler L. Evaluation of iron and zinc levels in recurrent tonsillitis and tonsillar hypertrophy. Am J Otolaryngol 2016; 37:116-9. [PMID: 26954864 DOI: 10.1016/j.amjoto.2015.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/03/2015] [Accepted: 11/11/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study is to look into the roles of iron and zinc metals in etiopathogenesis of recurrent tonsillitis and tonsillar hypertrophy by evaluating the levels of iron and zinc elements in the palatine tonsillar tissue. METHODS In total, 40 patients who underwent a tonsillectomy to treat recurrent tonsillitis and tonsillar hypertrophy were included in the study. Patients were classified into two groups, recurrent tonsillitis and tonsillar hypertrophy, determined by the results of clinical and histopathological examination. The levels of iron and zinc elements were determined for each tonsillar tissue sample. RESULTS There was a significant difference in the iron and zinc concentrations (p<0.001) between the tonsillar hypertrophy and recurrent tonsillitis groups. The levels of iron and zinc were significantly lower in the recurrent tonsillitis group. CONCLUSIONS This study suggests that low tissue concentrations of iron and zinc may lead to recurrent tonsillitis.
Collapse
Affiliation(s)
- Battal Tahsin Somuk
- Department of Otorhinolaryngology, Gaziosmanpasa University School of Medicine, Tokat, Turkey.
| | - Emrah Sapmaz
- Department of Otorhinolaryngology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Harun Soyalıç
- Department of Otorhinolaryngology, Ahi Evran University School of Medicine, Kırşehir, Turkey
| | - Murat Yamanoğlu
- Department of Otorhinolaryngology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Durali Mendil
- Faculty of Science and Arts of Chemistry, Gaziosmanpasa University, Tokat, Turkey
| | - Akgül Arici
- Department of Pathology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Levent Gurbuzler
- Department of Otorhinolaryngology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| |
Collapse
|
26
|
Malan L, Baumgartner J, Calder PC, Zimmermann MB, Smuts CM. n-3 Long-chain PUFAs reduce respiratory morbidity caused by iron supplementation in iron-deficient South African schoolchildren: a randomized, double-blind, placebo-controlled intervention. Am J Clin Nutr 2015; 101:668-79. [PMID: 25733652 DOI: 10.3945/ajcn.113.081208] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Although iron supplementation in malaria-free areas mostly reduces infectious morbidity, it can sometimes increase morbidity from infections as a result of the dependence of pathogenic microorganisms on iron. Supplementation with n-3 (ω-3) long-chain polyunsaturated fatty acids (LCPUFAs) improved morbidity in several human studies. However, information on the combined effect of iron and n-3 LCPUFA supplementation on infectious morbidity is limited. OBJECTIVE We determined whether n-3 LCPUFAs and iron supplementation, alone or in combination, affected absenteeism and illness in iron-deficient schoolchildren with low fish intake. DESIGN A total of 321 South African children (aged 6-11 y) with iron deficiency (ID) were randomly divided into 4 groups to receive 1) iron plus placebo, 2) a mixture of docosahexaenoic acid and eicosapentaenoic acid (DHA/EPA) plus placebo, 3) iron plus DHA/EPA, or 4) placebo plus placebo as oral supplements 4 times/wk for 8.5 mo. Morbidity was recorded, and iron-status indexes were measured. The total phospholipid fatty acid composition of peripheral blood mononuclear cell membranes was analyzed in a subsample (n = 130). RESULTS Iron supplementation increased the number of days with illness when all symptoms were considered (B: 0.87; 95% CI: 0.71, 1.03) as well as illness that was specifically caused by respiratory symptoms (B: 1.45; 95% CI: 1.21, 1.70), whereas DHA/EPA reduced the number of days with illness at school (B: -0.96; 95% CI: -1.33, -0.59). The increases caused by iron were reduced to the levels seen in the placebo plus placebo group when iron was provided in combination with DHA/EPA as indicated by significant iron × DHA/EPA interactions (both P < 0.001). CONCLUSION Iron supplementation increased morbidity (mostly respiratory) in iron-deficient South African schoolchildren with low DHA/EPA intake, but when iron was given in combination with DHA/EPA, this effect was prevented.
Collapse
Affiliation(s)
- Linda Malan
- From the Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa (LM, CMS, and JB); the Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (PCC), the National Institute for Health Research Biomedical Research Centre in Nutrition, Southampton University Hospital National Health Service Foundation Trust and University of Southampton, Southampton, United Kingdom (PCC); the Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia (PCC); and the Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Eidgenössische Technische Hochschule Zürich, Switzerland (MBZ)
| | - Jeannine Baumgartner
- From the Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa (LM, CMS, and JB); the Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (PCC), the National Institute for Health Research Biomedical Research Centre in Nutrition, Southampton University Hospital National Health Service Foundation Trust and University of Southampton, Southampton, United Kingdom (PCC); the Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia (PCC); and the Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Eidgenössische Technische Hochschule Zürich, Switzerland (MBZ)
| | - Philip C Calder
- From the Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa (LM, CMS, and JB); the Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (PCC), the National Institute for Health Research Biomedical Research Centre in Nutrition, Southampton University Hospital National Health Service Foundation Trust and University of Southampton, Southampton, United Kingdom (PCC); the Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia (PCC); and the Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Eidgenössische Technische Hochschule Zürich, Switzerland (MBZ)
| | - Michael B Zimmermann
- From the Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa (LM, CMS, and JB); the Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (PCC), the National Institute for Health Research Biomedical Research Centre in Nutrition, Southampton University Hospital National Health Service Foundation Trust and University of Southampton, Southampton, United Kingdom (PCC); the Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia (PCC); and the Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Eidgenössische Technische Hochschule Zürich, Switzerland (MBZ)
| | - Cornelius M Smuts
- From the Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa (LM, CMS, and JB); the Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (PCC), the National Institute for Health Research Biomedical Research Centre in Nutrition, Southampton University Hospital National Health Service Foundation Trust and University of Southampton, Southampton, United Kingdom (PCC); the Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia (PCC); and the Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Eidgenössische Technische Hochschule Zürich, Switzerland (MBZ)
| |
Collapse
|
27
|
Cuttitta F, Torres D, Vogiatzis D, Buttà C, Bellanca M, Gueli D, Lupo U, Schimmenti C, Virzì G, Petrantoni R, Balistreri F, Paterna S, Parrinello G. Obesity and iron deficiency anemia as risk factors for asymptomatic bacteriuria. Eur J Intern Med 2014; 25:292-5. [PMID: 24529889 DOI: 10.1016/j.ejim.2014.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/11/2014] [Accepted: 01/23/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Few studies examined the risk factors of asymptomatic bacteriuria, showing contradictory results. Our study aimed to examine the association between different clinical and laboratory parameters and asymptomatic bacteriuria in internal medicine patients. MATERIALS AND METHODS 330 consecutive hospitalized subjects, asymptomatic for urinary tract infections (UTIs), underwent to microscopic examination of urine specimens. 100 subjects were positive for microscopic bacteriuria and were recruited into the study. At the quantitative urine culture 31 subjects of study population were positive while 69 subjects were negative for bacteriuria. RESULTS The analysis of clinical characteristics showed that the two groups of subjects (positive and negative urine culture for bacteriuria) were significant different (p<0.05) about obesity (76.7% vs 42% respectively), metabolic syndrome (80.6% vs 44,9%), cholelithiasis (35.5% vs 13,2%) and iron deficiency anemia (80.6% vs 53,6%). The univariate analysis showed that only obesity, cholelithiasis and iron deficiency anemia were positively associated with positive urine culture for bacteriuria (Odds Ratios [OR]=3.79, p=0.0003; OR=2,65, p=0.0091; OR=2.63, p=0.0097; respectively). However, the multivariate analysis by logistic regression showed that only obesity and iron deficiency anemia, independently associated with positive urine culture for bacteriuria (OR=3.9695, p=0.0075; OR=3.1569, p=0.03420 respectively). CONCLUSIONS This study shows that obesity and iron deficiency anemia are independent risk factors for asymptomatic bacteriuria.
Collapse
Affiliation(s)
- F Cuttitta
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy.
| | - D Torres
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - D Vogiatzis
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - C Buttà
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - M Bellanca
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - D Gueli
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - U Lupo
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - C Schimmenti
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - G Virzì
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - R Petrantoni
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - F Balistreri
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - S Paterna
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - G Parrinello
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| |
Collapse
|