Iron deficiency anaemia

Maternal hemoglobin and iron status in early pregnancy and childhood cardiac outcomes

BACKGROUND & AIMS

Dysregulation of iron homeostasis is associated with cardiac alterations in a sex-dependent manner in adults. It is unknown whether iron status during pregnancy has long-term impact on cardiovascular health, and if this association is influenced by sex. Therefore, this study aimed to evaluate sex-specific association between maternal iron status during early pregnancy and cardiac outcomes in children aged 10 years.

METHODS

In a population-based cohort study among 1972 mother-child pairs, hemoglobin and ferritin were measured in early pregnancy (<18 weeks) and categorized into anemia (hemoglobin<11 g/dL), elevated hemoglobin (hemoglobin≥13.2 g/dL), iron deficiency (ferritin<15 μg/L), and iron overload (ferritin>150 μg/L). At 10 years of age, cardiac MRI was performed to measure right and left cardiac outcomes of function (ventricular end-diastolic volume (RVEDV and LVEDV) and ejection fraction (RVEF and LVEF)), and structure (left ventricular mass (LVM), and left ventricular mass-to-volume ratio (LMVR)). Results are presented for boys and girls separately and models were adjusted for confounders and multiple testing.

RESULTS

In boys, one standard deviation score (SDS) increase in maternal hemoglobin was associated with lower RVEDV and LVEDV (difference (95%CI) -0.10 (-0.17, -0.03) SDS and -0.09 (-0.16, -0.03) SDS, respectively). In boys, maternal anemia, as compared to normal hemoglobin levels, was associated with higher LVEDV (difference 0.34 (0.10, 0.59) SDS). No associations were observed for other cardiac outcomes and for ferritin in boys. No associations were observed in girls.

CONCLUSION

In boys, dysregulated iron status during early pregnancy might permanently alter cardiovascular RVEDV and LVEDV function. Underlying mechanisms need further study.

In-situ speciation and estimation of iron(II) and iron(III) contents in anisotropic polysaccharide-based hydrogel by 1H low-field nuclear magnetic resonance

This article aims to quantify and differentiate in-situ iron(II) and/or iron(III) in heterogeneous polygalacturonate hydrogels using the 1H-NMR relaxometry technique. This holds significant importance, for example, in addressing iron-deficiency anemia through the oral administration of iron(II) supplements. The NMR dispersion profiles of the gels exhibited markedly distinct relaxation behaviors corresponding to the different iron oxidation states. At 20 MHz, two primary relaxation mechanisms must be considered: relaxation arising from water molecules confined within the polygalacturonate fiber mesh and paramagnetic relaxation due to iron cations. When iron(III) serves as the cross-linking agent, paramagnetic interaction dominates the relaxation, while with iron(II) as the cross-linker, both mechanisms have to be considered. To distinguish labile from structuring iron, we monitored the evolution of iron concentrations within the gels during successive washes using NMR and atomic absorption spectroscopy. Eventually, a gel containing both iron(II) and iron(III) was analyzed, and successful differentiation between the two cations was achieved. NMR relaxometry demonstrates powerful capabilities in terms of in-situ experiments, rapid results, speciation (iron(II)/iron(III)), and quantification (labile/ bridging iron).

Fortifying jelly foods with microencapsulated anti-anaemic compounds, ferrous gluconate, ascorbic acid and folic acid

Low ferrous iron bioavailability presents a challenge for food fortification programmes. In this study, jelly foods were fortified with spray-dried chitosan microparticles that had been loaded with ferrous gluconate (FeG) and folic acid (FA) to alleviate iron deficiency anaemia and FA deficiency anaemia, respectively. The presence of FA and ascorbic acid (AA) increased the in vitro iron bioavailability of the FeG-AA-FA microparticles up to sixfold. Furthermore, the iron bioavailability of the fortified jelly foods increased more than 5 folds compared to that of the FeG-AA-FA microparticles. The use of lower temperature during the preparation of fortified jelly foods is recommended to avoid the microparticles' decomposition and a Maillard browning reaction. These findings can help food technologists and product developers select formulations with higher ferrous bioavailability to reduce the prevalence of anaemia.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13197-022-05599-7.

Iron Absorption: Factors, Limitations, and Improvement Methods

Iron is an essential element for human life since it participates in many functions in the human body, including oxygen transport, immunity, cell division and differentiation, and energy metabolism. Iron homeostasis is mainly controlled by intestinal absorption because iron does not have active excretory mechanisms for humans. Thus, efficient intestinal iron bioavailability is essential to reduce the risk of iron deficiency anemia. There are two forms of iron, heme and nonheme, found in foods. The average daily dietary iron intake is 10 to 15 mg in humans since only 1 to 2 mg is absorbed through the intestinal system. Nutrient-nutrient interactions may play a role in dietary intestinal iron absorption. Dietary inhibitors such as calcium, phytates, polyphenols and enhancers such as ascorbic acid and proteins mainly influence iron bioavailability. Numerous studies have been carried out for years to enhance iron bioavailability and combat iron deficiency. In addition to traditional methods, innovative techniques are being developed day by day to enhance iron bioavailability. This review will provide information about iron bioavailability, factors affecting absorption, iron deficiency, and recent studies on improving iron bioavailability.

Transcriptome and morphological analysis in Caligus rogercresseyi uncover the effects of Atlantic salmon vaccination with IPath®

It is known that iron transporter proteins and their regulation can modulate the fish's immune system, suggesting these proteins as a potential candidate for fish vaccines. Previous studies have evidenced the effects of Atlantic salmon immunized with the chimeric iron-related protein named IPath® against bacterial and ectoparasitic infections. The present study aimed to explore the transcriptome modulation and the morphology of the sea louse Caligus rogercresseyi in response to Atlantic salmon injected with IPath®. Herein, Atlantic salmon were injected with IPath® and challenged to sea lice in controlled laboratory conditions. Then, female adults were collected after 25 days post-infection for molecular and morphological evaluation. Transcriptome analysis conducted in lice collected from immunized fish revealed high modulation of transcripts compared with the control groups. Notably, the low number of up/downregulated transcripts was mainly found in lice exposed to the IPath® fish group. Among the top-25 differentially expressed genes, Vitellogenin, Cytochrome oxidases, and proteases genes were strongly downregulated, suggesting that IPath® can alter lipid transport, hydrogen ion transmembrane transport, and proteolysis. The morphological analysis in lice collected from IPath® fish revealed abnormal embryogenesis and inflammatory processes of the genital segment. Furthermore, head kidney, spleen, and skin were also analyzed in immunized fish to evaluate the transcription expression of immune and iron homeostasis-related genes. The results showed downregulation of TLR22, MCHII, IL-1β, ALAs, HO, BLVr, GSHPx, and Ferritin genes in head kidney and skin tissues; meanwhile, those genes did not show significant differences in spleen tissue. Overall, our findings suggest that IPath® can be used to enhance the fish immune response, showing a promissory commercial application against lice infections.

Anaemia among mother-father-child pairs in India: examining co-existence of triple burden of anaemia in a family

BACKGROUND

Anaemia is a global health concern and is also a common comorbidity in multiple medical conditions. Very limited research is available examining anaemia among family members in India and across various countries. The present study aimed to examine the co-existence of the triple burden of anaemia among mother-father-child pairs in a family.

METHODS

The data utilized was from the National Family Health Survey conducted in 2015-16. The effective sample size for the study was 26,910 couples, along with children aged 6-59 months. The bivariate and binary logistic regression analysis were applied to assess the factors associated with family-level anaemia. In bivariate analysis, a chi-square test was performed to determine the association of socio-demographic factors with anaemic family.

RESULTS

More than half of the mothers (57.5%) and their children (58%), along with 10% of fathers, were found to be anaemic; however, the co-existence of triple burden of anaemia among mother-father-child pairs was 4.7% in the study. The likelihood of family-level anaemia was low when both the parents were educated [OR: 0.69, CI: 0.58-0.81], and it was high when both the parents were employed [OR: 1.40 CI: 1.10-1.80]. Families from the Scheduled Tribe had a 62% higher likelihood to suffer from anaemia [OR: 1.62, CI: 1.33-1.97].

CONCLUSIONS

The suggested interventions include early diagnosis, effective management, and treatment of anaemia. Moreover, adequate complementary feeding practices for children shall also be promoted. Parental education on nutrition is also required, and community interventions are needed to improve parental education on nutrition. At last, there is a need for greater policy and program attention to improving nutritional knowledge among mothers so as to tackle the triple burden of anaemia among mother-father-child pairs.

Chimeric Protein IPath® with Chelating Activity Improves Atlantic Salmon's Immunity against Infectious Diseases

Infection processes displayed by pathogens require the acquisition of essential inorganic nutrients and trace elements from the host to survive and proliferate. Without a doubt, iron is a crucial trace metal for all living organisms and also a pivotal component in the host–parasite interactions. In particular, the host reduces the iron available to face the infectious disease, increasing iron transport proteins’ expression and activating the heme synthesis and degradation pathways. Moreover, recent findings have suggested that iron metabolism modulation in fish promotes the immune response by reducing cellular iron toxicity. We hypothesized that recombinant proteins related to iron metabolism could modulate the fish’s immune system through iron metabolism and iron-responsive genes. Here a chimeric iron transport protein (IPath^®) was bioinformatically designed and then expressed in a recombinant bacterial system. The IPath^® protein showed a significant chelating activity under in vitro conditions and biological activity. Taking this evidence, a vaccine candidate based on IPath^® was evaluated in Atlantic salmon challenged with three different fish pathogens. Experimental trials were conducted using two fish groups: one immunized with IPath^® and another injected with adjutant as the control group. After 400 accumulated thermal units (ATUs), two different infection trials were performed. In the first one, fish were infected with the bacterium Aeromonas salmonicida, and in a second trial, fish were exposed to the ectoparasite Caligus rogercresseyi and subsequently infected with the intracellular bacterium Piscirickettsia salmonis. Fish immunized with IPath^® showed a significant delay in the mortality curve in response to A. salmonicida and P. salmonis infections. However, no significant differences between infected and control fish groups were observed at the end of the experiment. Notably, sea lice burden reduction was observed in vaccinated Atlantic salmon. Transcriptional analysis evidenced a high modulation of iron-homeostasis-related genes in fish vaccinated with IPath^® compared to the control group during the infection. Moreover, increasing expression of Atlantic salmon IgT was associated with IPath^® immunization. This study provides evidence that the IPath^® protein could be used as an antigen or booster in commercial fish vaccines, improving the immune response against relevant pathogens for salmon aquaculture.

Clinical thresholds for diagnosing iron deficiency: comparison of functional assessment of serum ferritin to population based centiles

Low serum ferritin is diagnostic of iron deficiency, yet its published lower cut-off values are highly variable, particularly for pediatric populations. Lower cut-off values are commonly reported as 2.5th percentiles, and is based on the variation of ferritin values in the population. Our objective was to determine whether a functional approach based on iron deficient erythropoiesis could provide a better alternative. Utilizing 64,443 ferritin test results from pediatric electronic health records, we conducted various statistical techniques to derive 2.5th percentiles, and also derived functional reference limits through the association between ferritin and erythrocyte parameters: hemoglobin, mean corpuscular volume, mean cell hemoglobin concentration, and red cell distribution width. We find that lower limits of reference intervals derived as centiles are too low for clinical interpretation. Functional limits indicate iron deficiency anemia starts to occur when ferritin levels reach 10 µg/L, and are largely similar between genders and age groups. In comparison, centiles (2.5%) presented with lower limits overall, with varying levels depending on age and gender. Functionally-derived limits better reflects the underlying physiology of a patient, and may provide a basis for deriving a threshold related to treatment of iron deficiency and any other biomarker with functional outcomes.

Qualitative in vitro study on the degradation of mineral complexes in vegetables

Mechanisms of degradation and absorption of mineral complexes by the human digestive system are complex and still under investigation. The elaborate matrix of vegetables, and the presence of phytates and other inhibitors make study of these mechanisms difficult. In this qualitative study, extracts from freeze-dried savoy cabbage, broccoli, kale and spinach were subjected to digestion in vitro at pH 2.0 and pH 7.5 and analysed using SEC-ICP-MS. The results suggest that low molecular weight species (peak 6), related to the iron and zinc fractions, which appeared after acidic digestion in all vegetables, except in kale, were considerably reduced after digestion at pH 7.5. Low molecular weight species (peak 9), related to the phosphorus fraction, were present in all vegetables, except in kale, after alkaline digestion. While cabbage, broccoli and spinach showed similar degradation patterns, kale showed a different degradation behaviour.

Cyclic Voltammetry and Oxidation Rate Studies of Ferrous Gluconate Complex Solutions for Preparation of Chitosan-Tripolyphosphate Microparticles

A proper understanding of the properties of iron could increase the effectiveness of programmes for alleviating iron deficiency. Recently, encapsulation has been considered an appropriate method for protecting iron from injurious reactions. However, several events may occur during encapsulation processes, including changes in the iron’s oxidation state. Oxidation of ferrous iron is not desirable since the intestines can only absorb iron in the ferrous form. In this study, a cyclic voltammetry method was applied to investigate the likelihood of ferrous gluconate oxidation for the preparation of chitosan-tripolyphosphate microparticles. Then, the electrochemical properties of ferrous gluconate were confirmed experimentally. The oxidation rate of ferrous gluconate is also discussed in this paper. All the experimental solutions were formulated in detail to produce conditions similar to those of microparticle production. Cyclic voltammetry analysis was conducted using a configuration of three electrodes connected to an electrochemical analyser. Graphite, platinum wire, and Ag/AgCl were employed as the auxiliary, working, and reference electrodes, respectively. The cyclic voltammetry results show that the observed potential for each anodic peak shifted negatively in the presence of chitosan and sodium tripolyphosphate. Moreover, the rate of ferrous oxidation tended to increase during 75 min of experiments due to the presence of chitosan and sodium tripolyphosphate. These behaviours indicate the transformation of ferrous iron to ferric iron during iron microparticle preparation. Furthermore, these findings suggest that spray drying is a preferable method to minimise the oxidation reaction.