Prevalence of iron deficiency with and without anemia in recreationally active men and women

Hematological and iron status in aerobic vs. anaerobic female athletes: an observational study

Introduction

Physical training induces iron status impairment in athletic females in the short term and over prolonged periods. Nevertheless, the existing literature lacks a comprehensive evaluation of the differential impacts of aerobic vs. anaerobic training on hematological indices and iron status among adolescent female athletes. The aim of this study was to assess the hematological factors and iron status in aerobic vs. anaerobic training in athletic females.

Methods

This observational, cross-sectional study recruited twenty-five adolescent athletic females; thirteen of them participated in an aerobic sport (long-distance running), while twelve of them participated in an anaerobic sport (broad jumping). Hematological factors were assessed by analyzing blood concentrations of hemoglobin (Hb), hematocrit (Hct), red blood cell (RBC) count, mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC), while the iron status assessment was conducted through evaluating levels of serum transferrin and serum ferritin.

Results

Athletic females who participated in the aerobic sport showed significantly lower Hb (MD -0.84; 95% CI -1.63: -0.04; p = 0.041), Hct (MD -5.49; 95% CI -7.86: -3.12; p = 0.0001), RBC count (MD -0.37; 95% CI -0.57: -0.17; p = 0.001), and MCV (MD -5.15; 95% CI -9.41: -0.89; p = 0.020), as well as significantly higher MCHC (MD 2.99; 95% CI 2.18: 3.79; p = 0.0001) and serum transferrin (MD 46.77; 95% CI 10.95: 82.59; p = 0.013) than athletic females who participated in the anaerobic sport. However, there was an insignificant difference in serum ferritin levels (MD -3.18; 95% CI -11.49: 5.13; p = 0.437) between both groups.

Conclusion

Except for the ferritin level that exhibited an insignificant difference between aerobic and anaerobic training, aerobic training was associated with a worse impact on the hematological factors and iron status than anaerobic training in adolescent athletic females.

Diagnosis and Treatment of Iron Deficiency and Iron Deficiency Anemia in Children and Adolescents: Recommendations of the Polish Pediatric Society, the Polish Society of Pediatric Oncology and Hematology, the Polish Society of Neonatology, and the Polish Society of Family Medicine

Background/Objectives. Iron deficiency is one of the most common nutritional deficiencies worldwide and is the leading cause of anemia in the pediatric population (microcytic, hypochromic anemia due to iron deficiency). Moreover, untreated iron deficiency can lead to various systemic consequences and can disrupt the child's development. Methods/Results. Therefore, a team of experts from the Polish Pediatric Society, the Polish Society of Pediatric Oncology and Hematology, the Polish Neonatology Society, and the Polish Society of Family Medicine, based on a review of the current literature, their own clinical experience, and critical discussion, has developed updated guidelines for the diagnosis, prevention, and treatment of iron deficiency in children from birth to 18 years of age. These recommendations apply to the general population and do not take into account the specifics of individual conditions and diseases.

Pre-exercise supplementation with curcuma xanthorrhiza roxb has minimal impact on red blood cell parameters but reduces oxidative stress: a preliminary study in rats

PURPOSE

This study examined the effects of longterm pre-exercise Curcuma xanthorriza Roxb supplementation on red blood cell indices along with circulating malondialdehyde (MDA) and superoxide dismutase (SOD) levels in response to endurance exercise to address previously inconsistent findings.

METHODS

Male Wistar rats (Rattus norvegicus; n = 20, aged 12-16 weeks) were divided equally into an exercise-only group (C) and three groups supplemented with Curcuma extract at dosages of 6.75 (T1), 13.50 (T2), and 20.25 mg (T3). Curcuma extract supplementation was administered for 28 d immediately prior to exercise.

RESULTS

Following 28 d of exhaustive swimming, the hematocrit and erythrocyte count increased by 15% (p = 0.06). Pre-exercise Curcuma supplementation did not significantly affect mean corpuscular volume or mean corpuscular hemoglobin concentration. Longterm exercise intervention resulted in elevated MDA levels by 41% (p <0.001), while Curcuma supplementation (13.50 mg) attenuated this increase by 16.6% (p = 0.09). Additionally, Curcuma supplementation resulted in a dose-dependent increase in SOD levels, with an 82.6% increase observed at 20.25 mg (p = 0.028).

CONCLUSION

Our preliminary findings indicated that pre-exercise supplementation with Curcuma extract had a negligible effect on changes in red blood cell markers, but it mitigated the increase in oxidative stress induced by exercise training. Our future research direction will involve applying the findings to humans.

Prevalence of anemia and iron deficiency and its association with body mass index in elite Japanese high school long-distance runners

OBJECTIVES

Anemia is a common condition in long-distance runners (LDRs). Recently, not only iron deficiency (ID) but also energy deficiency has been considered as a risk factor for anemia in athletes but no evidence has yet been established. The aim of this study was to investigate the prevalence of anemia and ID and the influence of body mass index (BMI) on anemia in high-school LDRs.

METHODS

The participants were 406 male and 235 female elite Japanese LDRs who competed in the All-Japan High-School Ekiden Championship 2019. They submitted their anthropometric data and results of a blood test within five days after the competition. The prevalence of anemia and ID and the influence of BMI on anemia were assessed retrospectively.

RESULTS

Mean hemoglobin concentrations (Hb) were 14.8 ± 0.9 g/dl in males and 13.2 ± 0.9 g/dl in females. The prevalence of anemia (Hb < 14 g/dl in males and < 12 g/dl in females) was significantly higher in males (16.3%) than females (6.4%), but males also showed higher prevalence of non-iron deficiency anemia (NIDA) than females (11.6% and 3.0%, respectively). No significant gender difference was found in the prevalence of iron deficiency anemia (IDA) (4.7% in males and 3.4% in females). ID (serum ferritin level < 25 ng/ml) was significantly more prevalent in females (37.4%) than males (18.5%). A binary logistic regression analysis revealed that low BMI was a contributor to anemia in females (odds ratios: 0.577 (95% CI: 0.369-0.901), p = 0.012).

CONCLUSION

In Japanese high-school LDRs, one in six males was anemic, but most males did not have ID. Conversely, one-third of females were diagnosed with ID. Lower BMI was identified as a risk for anemia in females, suggesting that leanness may also lead to anemia in females.

Continuous training in young athletes decreases hepcidin secretion and is positively correlated with serum 25(OH)D and ferritin

Background

Iron deficiency is known to impair muscle function and reduce athletic performance, while vitamin D has been reported to induce iron deficiency. However, the mechanism underlying exercise-induced changes in iron metabolism and the involvement of vitamins in this mechanism are unclear. The present study examined changes in biological iron metabolism induced by continuous training and the effects of vitamin D on these changes.

Methods

Diet, physical characteristics, and blood test data were collected from 23 female high school students in a dance club on the last day of each of a 2-month continuous training period and a 2-week complete rest periods.

Results

Serum hepcidin-25 levels were significantly lower during the training period than the rest period (p = 0.013), as were the red blood cell count, hemoglobin, and hematocrit (all p < 0.001). Serum erythropoietin was significantly higher (p = 0.001) during the training period. Significant positive correlations were observed between 25(OH)D levels and serum iron, serum ferritin, and transferrin saturation during the training period. Multiple regression analysis with serum 25(OH)D level as the dependent variable and serum ferritin and iron levels as independent variables during the training period revealed a significant association with serum ferritin.

Conclusion

Continuous training may promote hemolysis and erythropoiesis, contributing to the suppression of hepcidin expression. The relationship between serum 25(OH)D and iron in vivo may be closely related to metabolic changes induced by the exercise load.

Comparison of Nutrition among Female Floorball Players of Extra-Class Teams from Poland and the Czech Republic during the Preparation Period for the League Season

The study aimed to assess the frequency of food intake and to compare the consumption of female extramural players training floorball in Poland and the Czech Republic during the preparation period for the league season. In total, 43 players training floorball in senior clubs participated in the study, including 21 from the Polish and 22 from the Czech clubs. The research tool was based on the standardised questionnaire for the Examination of Eating Behaviours and Opinions on Food and Nutrition (QEB). The study also analysed body composition using the Bioelectrical Impedance Analysis (BIA) method, and the research tool was a TANITA MC-780 S MA body composition analyser (Tanita Corporation, Tokyo, Japan). The Polish women's floorball players had lower results in body fat percentage (FM) and muscle mass (MM) than the Czech team. The mean FM in the players of the Polish team was 18.6% ± 5.4, and the mean MM was 45.8 kg ± 4.2. In the Czech team players, these figures were 19.8% ± 5.4 and 47.8 kg ± 4.2. Despite the similar value of mean BMI in both teams, the highest BMI in the case of female athletes from Poland (17.7), indicating underweight, and the highest BMI in female athletes from the Czech Republic (26.9), indicating overweight, were significant. The study showed differences in both body composition analysis and dietary patterns of the Czech and Polish players. The Czech women's floorball players had a higher muscle mass and body fat percentage than Polish floorball players. Furthermore, differences in diet were observed among the players of the Czech team compared to the players of the Polish team. The Czech women's floorball players consumed a slightly higher amount of healthier products, such as whole-grain products. The Polish players took in more meat, processed products and fruit juices. This study is one of the first to assess the nutrition of those involved in floorball. There is a need for further research that focuses on the specifics of the discipline, the exercise capacity of the players and points during the season that require nutritional support. This knowledge would help develop effective nutritional strategies and plan and implement appropriate nutrition education for this group of athletes.

Assessing the occurrence and severity of pre- and postendodontic pain in anemic and healthy female patients

OBJECTIVES

The objective of this current survey was to assess both the occurrence and severity of pre- and post-endodontic pain among female individuals, distinguishing between those with anemia and those without.

MATERIALS AND METHODS

In the current study, we included a total of 60 women with anemia (hemoglobin < 11) and those without anemia (hemoglobin > 13). We recorded the occurrence and severity of pain before and at 24, 48, and 72 h following root canal treatment using a visual analog scale (VAS) ranging from 0 to 10. Additionally, we collected data on patient age, tooth type, as well as pulpal and periapical conditions. Statistical analysis was carried out using two-way ANOVA, pairedt-tests, and Pearson correlation coefficient. The significance level for statistical tests was set at p ≤ .05.

RESULTS

The incidence of preoperative pain in both anemic and non-anemic patients was 80%. The total incidence of post-operative pain was recorded as 71.7% (82.2% in anemic and 61.1% in non-anemic women). Compared with the pretreatment pain incidence and intensity, the values increased in 24 h but declined in 48 h and 72 h after treatment. Considering the posttreatment pain intensity, the mean values were higher in the three time intervals (24, 48, and 72 h) in anemic patients. Pulpal and periapical status, in contrast to age and tooth type, significantly contributed to the intensity of posttreatment pain.

CONCLUSION

Regarding the importance of pain phenomenon in human life, it is recommended to consider anemia as an important risk factor for post-endodontic pain. Early diagnosis and analgesic treatment interventions in anemic females, alongside the pain control during root canal treatment, could promote the patient's satisfaction and quality of care.

The IRONy in Athletic Performance

Iron is an essential micronutrient for athletes, intricately linked to their performance, by regulating cellular respiration and metabolism. Impaired iron levels in the body can significantly hinder athletic performance. The increased demand for iron due to exercise, coupled with potential dietary iron insufficiencies, particularly among endurance athletes, amplifies the risk of iron deficiency. Moreover, prolonged exercise can impact iron absorption, utilization, storage, and overall iron concentrations in an athlete. On the contrary, iron overload may initially lead to enhanced performance; however, chronic excess iron intake or underlying genetic conditions can lead to detrimental health consequences and may negatively impact athletic performance. Excess iron induces oxidative damage, not only compromising muscle function and recovery, but also affecting various tissues and organs in the body. This narrative review delineates the complex relationship between exercise and iron metabolism, and its profound effects on athletic performance. The article also provides guidance on managing iron intake through dietary adjustments, oral iron supplementation for performance enhancement in cases of deficiency, and strategies for addressing iron overload in athletes. Current research is focused on augmenting iron absorption by standardizing the route of administration while minimizing side effects. Additionally, there is ongoing work to identify inhibitors and activators that affect iron absorption, aiming to optimize the body's iron levels from dietary sources, supplements, and chelators. In summary, by refining the athletic diet, considering the timing and dosage of iron supplements for deficiency, and implementing chelation therapies for iron overload, we can effectively enhance athletic performance and overall well-being.

The Perceived Impact of Iron Deficiency and Iron Therapy Preference in Exercising Females of Reproductive Age: A Cross-Sectional Survey Study

Background

Patient perceptions of iron deficiency and efficacy of iron therapy may differ from the interpretations of doctors. Qualitative investigation at an individual level related may help define patient expectations and therapeutic targets. Therefore, we aimed to explore this concept in exercising females of reproductive age.

Methods

Exercising females (n = 403) who either (a) were currently experiencing iron deficiency, or (b) have experienced iron deficiency in the past were included. A survey comprising open-ended text response questions explored three 'domains': (1) the impact of iron deficiency, (2) the impact of iron tablet supplementation (where applicable), and (3) the impact of iron infusion treatment (where applicable). Questions were asked about training, performance, and recovery from exercise. Survey responses were coded according to their content, and sentiment analysis was conducted to assess responses as positive, negative, or neutral.

Results

Exercising females showed negative sentiment toward iron deficiency symptoms (mean range = -0.94 to -0.81), with perception that fatigue significantly impacts performance and recovery. Iron therapies were perceived to improve energy, performance, and recovery time. Participants displayed a strong positive sentiment (mean range = 0.74 to 0.79) toward iron infusion compared to a moderately positive sentiment toward oral iron supplementation (mean range = 0.44 to 0.47), with many participants perceiving that oral iron supplementation had no effect.

Conclusion

In Australia, women prefer an iron infusion in treatment of iron deficiency compared to oral iron.

The impact of iron and heme availability on the healthy human gut microbiome in vivo and in vitro

Responses of the indigenous human gut commensal microbiota to iron are poorly understood because of an emphasis on in vitro studies of pathogen iron sensitivity. In a study of iron supplementation in healthy humans, we identified gradual microbiota shifts in some participants correlated with bacterial iron internalization. To identify direct effects due to taxon-specific iron sensitivity, we used participant stool samples to derive diverse in vitro communities. Iron supplementation of these communities caused small compositional shifts, mimicking those in vivo, whereas iron deprivation dramatically inhibited growth with irreversible, cumulative reduction in diversity and replacement of dominant species. Sensitivity of individual species to iron deprivation in axenic culture generally predicted iron dependency in a community. Finally, exogenous heme acted as a source of inorganic iron to prevent depletion of some species. Our results highlight the complementarity of in vivo and in vitro studies in understanding how environmental factors affect gut microbiotas.

Evaluation of the Response to Pulpal Sensibility Tests (Cold, EPT) in Anemic and Healthy Women

Introduction

The prevalence of anemia has been reported high in the female population in Iran. Anemia can be asymptomatic or can present in a variety of symptoms, especially when serum Hb values decrease. The present study would assess dental pulp response to cold and EPT sensibility tests in anemic and healthy women.

Materials and Methods

One hundred twenty maxillary central incisors belonging to participants aged 18–58 years were included in this survey. 60 patients had anemia (Hb ≤ 12.5) with/without medication (30 in each group) and 60 women as controls had no anemia (Hb > 12.5) with/without medication (30 in each group). Electric and cold pulpal sensibility tests were performed for all teeth. Statistical analysis was performed with t-student, Chi-square test, and two-way ANOVA. The significance level was set as p < 0.05.

Results

According to the results of this study, the mean value of hemoglobin in anemic and healthy women was 11.5 and 14.08 g/dl, respectively. The mean value of response to EPT in anemic women with and without medication was 3.21 and 3.14, respectively. The mean value of response to EPT in healthy women with and without medication was 3.81 and 3.58 g/dl, respectively. The mean value of time delay response to cold test was 3.03 and 2.82 s in anemic patients with/without medication. Also, the mean value of time delay response to cold test was 2.80 and 2.93 s in healthy women with/without medication. The pulpal responses to EPT tests had significant differences between anemic and healthy women (p=0.043). There were no significant differences between anemic and healthy women considering time delay response to the cold test (p=0.077).

Conclusion

Based on the results of the present study, tooth response to the EPT  sensibility test may alter in anemic patients despite medication. The evidence from this preliminary study suggests that peripheral neuropathy in anemic patients could affect pulpal sensibility tests.

Nutritional optimization for female elite football players-topical review

Women's football is an intermittent sport characterized by frequent intense actions throughout the match. The high number of matches with limited recovery time played across a long competitive season underlines the importance of nutritional strategies to meet these large physical demands. In order to maximize sport performance and maintain good health, energy intake must be optimal. However, a considerable proportion of female elite football players does not have sufficient energy intake to match the energy expenditure, resulting in low energy availability that might have detrimental physiologic consequences and impair performance. Carbohydrates appear to be the primary fuel covering the total energy supply during match-play, and female elite football players should aim to consume sufficient carbohydrates to meet the requirements of their training program and to optimize the replenishment of muscle glycogen stores between training bouts and matches. However, several macro- and micronutrients are important for ensuring sufficient energy and nutrients for performance optimization and for overall health status in female elite football players. The inadequacy of macro-and micronutrients in the diet of these athletes may impair performance and training adaptations, and increase the risk of health disorders, compromising the player's professional career. In this topical review, we present knowledge and relevant nutritional recommendations for elite female football players for the benefit of sports nutritionists, dietitians, sports scientists, healthcare specialists, and applied researchers. We focus on dietary intake and cover the most pertinent topics in sports nutrition for the relevant physical demands in female elite football players as follows: energy intake, macronutrient and micronutrient requirements and optimal composition of the everyday diet, nutritional and hydration strategies to optimize performance and recovery, potential ergogenic effects of authorized relevant supplements, and future research considerations.

HFE Genotype and Endurance Performance in Competitive Male Athletes

INTRODUCTION

Hereditary hemochromatosis can cause individuals to absorb too much iron from their diet. Higher tissue iron content, below the threshold of toxicity, may enhance oxygen carrying capacity and offer a competitive advantage. Single nucleotide polymorphisms (SNP) in the homeostatic iron regulator (HFE) gene have been shown to modify iron metabolism and can be used to predict an individual's risk of hemochromatosis. Several studies have shown that HFE genotypes are associated with elite endurance athlete status; however, no studies have examined whether HFE genotypes are associated with endurance performance.

PURPOSE

The objectives of this study were to determine whether there was an association between HFE risk genotypes (rs1800562 and rs1799945) and endurance performance in a 10-km cycling time trial as well as maximal oxygen uptake (V˙O2peak), an indicator of aerobic capacity.

METHODS

Competitive male athletes (n = 100; age = 25 ± 4 yr) completed a 10-km cycling time trial. DNA was isolated from saliva and genotyped for the rs1800562 (C282Y) and rs1799945 (H63D) SNP in HFE. Athletes were classified as low risk (n = 88) or medium/high risk (n = 11) based on their HFE genotype for both SNP using an algorithm. ANCOVA was conducted to compare outcome variables between both groups.

RESULTS

Individuals with the medium- or high-risk genotype were ~8% (1.3 min) faster than those with the low-risk genotype (17.0 ± 0.8 vs 18.3 ± 0.3 min, P = 0.05). V˙O2peak was ~17% (7.9 mL·kg-1⋅min-1) higher in individuals with the medium- or high-risk genotype compared with those with the low-risk genotype (54.6 ± 3.2 vs 46.7 ± 1.0 mL·kg-1⋅min-1, P = 0.003).

CONCLUSION

Our findings show that HFE risk genotypes are associated with improved endurance performance and increased V˙O2peak in male athletes.

Analysis of the consumption of sports supplements in elite fencers according to sex and competitive level

Background

The aim of this study was to analyze the consumption of sports supplements (SS) in competitive level fencers and compare differences based on sex and competitive level (international and national).

Methods

A total of 49 fencers (18 men and 31 women) of national (n = 16) and international (n = 33) level completed a questionnaire with questions about SS consumption and the possible repercussions on health and / or sports performance. The results were analyzed based on the different categorizations established by the Australian Institute of Sport (AIS), as well as by sex and level of competence to which the participants belonged to.

Results

46.9% of fencers have consumed SS with the main motivation being performance improvement (34.2%). Medical doctors were the individuals who were more likely to advise men to consume SS (50.0% vs 5.6%; OR = 3.29 [1.50–7.20]). Friends were most likely to advise women (38.9% vs 8.3%; OR = 1.75 [1.05–2.93]). The most consumed SS were sport drinks (44.9%), vitamin C (43.4%), sport bars (38.8%), and caffeine (28.6%). In regards to the SS categories, it was observed differences in the interaction level·sex in medical supplements (p = 0.017). In addition, there was a higher prevalence of whey protein consumption in women (25.8% vs 0%; p = 0.020) and iron consumption in men (33% vs 6.5%; p = 0.039).

Conclusions

The prevalence of SS use in fencers is within the values previously reported in athletes of the same competitive level. There were no differences by sex and competitive level in the total consumption of SS, nor in each of the groups of level of evidence, being sport drinks, bars and caffeine the most consumed SS.

How Does the Dietary Intake of Female Field-Based Team Sport Athletes Compare to Dietary Recommendations for Health and Performance? A Systematic Literature Review

Field-based team sports present large energetic demands given their intermittent high-intensity nature. Current evidence suggests that the dietary intake of female athletes may be insufficient to meet such demands, resulting in negative consequences for athletic performance and health. The primary aim of this review was to therefore assess the adequacy of dietary intake of female field-based team sport athletes when compared to dietary recommendations. A systematic search of databases, including PubMed, Web of Science, SPORTDiscus, and OpenGrey, was performed from the earliest record available until July 2020, obtaining an initial total of 2588 articles. To be included within the final review, articles were required to provide a quantitative assessment of baseline dietary intake specific to the target population. A total of 20 studies (n = 462) met the full eligibility criteria. A majority reported that the dietary intake of female field-based team sport athletes was insufficient in overall energy (2064 ± 309 kcal·day^-1), carbohydrate (4.3 ± 1.2 g·kg·day^-1), and iron intake (13.6 ± 6.2 mg·day^-1) when compared to recommendations. Future research is required to establish why female team sport athletes consistently demonstrate deficient dietary practices, and to explore the potential negative consequences of this.

Iron status in athletic females, a shift in perspective on an old paradigm

Iron deficiency is a common nutrient deficiency within athletes, with sport scientists and medical professionals recognizing that athletes require regular monitoring of their iron status during intense training periods. Revised considerations for athlete iron screening and monitoring have suggested that males get screened biannually during heavy training periods and females require screening biannually or quarterly, depending on their previous history of iron deficiency. The prevalence of iron deficiency in female athletes is higher than their male counterparts and is often cited as being a result of the presence of a menstrual cycle in the premenopausal years. This review has sought to revise our current understanding of female physiology and the interaction between primary reproductive hormones (oestrogen and progesterone) and iron homoeostasis in females. The review highlights an apparent symbiotic relationship between iron metabolism and the menstrual cycle that requires additional research as well as identifying areas of the menstrual cycle that may be primed for nutritional iron supplementation.

Cancer Related Anemia: An Integrated Multitarget Approach and Lifestyle Interventions

Cancer is often accompanied by worsening of the patient's iron profile, and the resulting anemia could be a factor that negatively impacts antineoplastic treatment efficacy and patient survival. The first line of therapy is usually based on oral or intravenous iron supplementation; however, many patients remain anemic and do not respond. The key might lie in the pathogenesis of the anemia itself. Cancer-related anemia (CRA) is characterized by a decreased circulating serum iron concentration and transferrin saturation despite ample iron stores, pointing to a more complex problem related to iron homeostatic regulation and additional factors such as chronic inflammatory status. This review explores our current understanding of iron homeostasis in cancer, shedding light on the modulatory role of hepcidin in intestinal iron absorption, iron recycling, mobilization from liver deposits, and inducible regulators by infections and inflammation. The underlying relationship between CRA and systemic low-grade inflammation will be discussed, and an integrated multitarget approach based on nutrition and exercise to improve iron utilization by reducing low-grade inflammation, modulating the immune response, and supporting antioxidant mechanisms will also be proposed. Indeed, a Mediterranean-based diet, nutritional supplements and exercise are suggested as potential individualized strategies and as a complementary approach to conventional CRA therapy.

Iron Deficiency and Iron Deficiency Anemia Are Common Epidemiological Conditions in Saudi Arabia: Report of the National Epidemiological Survey

Iron deficiency is the most prevalent nutritional deficiency worldwide. According to an estimate by the World Health Organization, up to 27% of the world's population experience iron deficiency anemia (IDA). Studies conducted in the Middle East, including Saudi Arabia, have suggested that IDA is the most common cause of anemia, especially among females. This study aimed to determine the prevalence of IDA and iron deficiency (ID) among apparently healthy young university students from four regions in Saudi Arabia. Students were asked to complete a simple survey questionnaire; blood samples were then collected and analyzed after obtaining informed consent. A total of 981 students completed the survey, with 11% of the participants reporting symptoms of anemia; 34% of participants were diagnosed with IDA and 6% reported a diagnosis of hemoglobinopathy. Blood analysis confirmed the prevalence of ID and IDA in 28.6% and 10.7% of the participants, respectively; those with ID and IDA were mostly females (88.5% and 94%, resp.). Thalassemia trait and sickle cell trait were detected in 1.3% and 7% of participants, respectively. Our findings from a national survey among young university in Saudi Arabia indicate a high prevalence of ID and IDA.

Ferritin readings in young adult, female university student recreational runners

BACKGROUND

Elite female athletes have shown vulnerability to various degrees of iron deficiency. Less is known about recreational fitness exercisers. A study was done to examine plasma ferritin, an assessor of iron status, in young adult, university student fitness runners.

METHODS

The present study examined serum ferritin concentrations, an indicator of iron status, in 39 female university students (age 18-25) who ran for fitness, but ran less than competition runners. Selected subjects all reported themselves as not anemic.

RESULTS

Mean + SD for 3 mile run time was 26.25 + 3.0 min. The mean ferritin reading was low: 12.4 + 12.3 ng/mL (+ SD). Out of the 39 women, 29 had readings that fell below 15 ng/mL, which some consider the cutoff for iron deficiency. In addition, all but 2 subjects had values below 35, which has been proposed as Stage 1 iron deficiency for athletes. Ferritin levels did not correlate with 3 mile run times (Pearson correlation coefficient, P > 0.05). A 1 mo intervention with 3 minerals that included iron (36 mg/day) significantly raised ferritin values when the iron was bisglycinate (p < 0.05), but not when it was ferrous sulfate (p > 0.05).

CONCLUSION

In this study, a degree of iron deficiency was seen in most of a group of female fitness runners (each of whom had self reported as not being anemic).

No effect of supplemented heat stress during an acute endurance exercise session in hypoxia on hepcidin regulation

Hepcidin is a novel factor for iron deficiency in athletes, which is suggested to be regulated by interleukin-6 (IL-6) or erythropoietin (EPO).

PURPOSE

The purpose of the present study was to compare endurance exercise-induced hepcidin elevation among "normoxia", "hypoxia" and "combined heat and hypoxia".

METHODS

Twelve males (21.5 ± 0.3 years, 168.1 ± 1.2 cm, 63.6 ± 2.0 kg) participated in the present study. They performed 60 min of cycling at 60% of [Formula: see text] in either "heat and hypoxia" (HHYP; F_iO₂ 14.5%, 32 °C), "hypoxia" (HYP; F_iO₂ 14.5%, 23 °C) or "normoxia" (NOR; F_iO₂ 20.9%, 23 °C). After completing the exercise, participants remained in the prescribed conditions for 3 h post-exercise. Blood samples were collected before, immediately and 3 h after exercise.

RESULTS

Plasma IL-6 level significantly increased immediately after exercise (P < 0.05), with no significant difference among the trials. A significant elevation in serum EPO was observed 3 h after exercise in hypoxic trials (HHYP and HYP, P < 0.05), with no significant difference between HHYP and HYP. Serum hepcidin level increased 3 h after exercise in all trials (NOR, before 18.3 ± 3.9 and post180 31.2 ± 6.3 ng/mL; HYP, before 13.5 ± 2.5 and post180 23.3 ± 3.6 ng/mL, HHYP; before 15.8 ± 3.3 and post180 31.4 ± 5.3 ng/mL, P < 0.05). However, there was no significant difference among the trials during post-exercise.

CONCLUSION

Endurance exercise in "combined heat and hypoxia" did not exacerbate exercise-induced hepcidin elevation compared with the same exercise in "hypoxia" or "normoxia".

Diagnosis and management of iron deficiency in children with or without anemia: consensus recommendations of the SPOG Pediatric Hematology Working Group

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.

The association of HFE gene H63D polymorphism with endurance athlete status and aerobic capacity: novel findings and a meta-analysis

PURPOSE

Iron is an important component of the oxygen-binding proteins and may be critical to optimal athletic performance. Previous studies have suggested that the G allele of C/G rare variant (rs1799945), which causes H63D amino acid replacement, in the HFE is associated with elevated iron indexes and may give some advantage in endurance-oriented sports. The aim of the present study was to investigate the association between the HFE H63D polymorphism and elite endurance athlete status in Japanese and Russian populations, aerobic capacity and to perform a meta-analysis using current findings and three previous studies.

METHODS

The study involved 315 international-level endurance athletes (255 Russian and 60 Japanese) and 809 healthy controls (405 Russian and 404 Japanese). Genotyping was performed using micro-array analysis or by PCR. VO2max in 46 male Russian endurance athletes was determined using gas analysis system.

RESULTS

The frequency of the iron-increasing CG/GG genotypes was significantly higher in Russian (38.0 vs 24.9%; OR 1.85, P = 0.0003) and Japanese (13.3 vs 5.0%; OR 2.95, P = 0.011) endurance athletes compared to ethnically matched controls. The meta-analysis using five cohorts (two French, Japanese, Spanish, and Russian; 586 athletes and 1416 controls) showed significant prevalence of the CG/GG genotypes in endurance athletes compared to controls (OR 1.96, 95% CI 1.58-2.45; P = 1.7 × 10-9). Furthermore, the HFE G allele was associated with high V̇O2max in male athletes [CC: 61.8 (6.1), CG/GG: 66.3 (7.8) ml/min/kg; P = 0.036].

CONCLUSIONS

We have shown that the HFE H63D polymorphism is strongly associated with elite endurance athlete status, regardless ethnicities and aerobic capacity in Russian athletes.

Nutrition for Female Soccer Players-Recommendations

Soccer is one of the most popular sports in the world. As its number of players is increasing, the number of female players is also on the rise. However, there are limited data about how the diets of female soccer players should be designed. Thus, the aim of our work is to deliver concise nutritional recommendations for women practicing this sport. Based on a literature review, we emphasize that individual adjustment of the energy value of the diet is the key factor for the physical performance of female soccer players. Appropriate macronutrient intake makes it possible to achieve the proper energy value of the diet (5-10 g/kg body mass/day carbohydrates; 1.2-1.7 g/kg body mass/day proteins; <30% fats from energy). The micronutrients should be consumed in amounts corresponding to individual values recommended in national standards. Soccer players should pay special attention to the proper consumption of such micronutrients, as well as vitamins such as iron, calcium, and vitamin D. The right amount of fluid intake, consistent with the player's needs, is crucial in maximizing exercise performance. The diet of a female practicing soccer is usually characterized with low energy values, which increases the risk of various health consequences related to low energy availability. Monitoring the diets of female soccer players is, therefore, necessary.

Professional Female Athletes Are at a Heightened Risk of Iron-Deficient Erythropoiesis Compared With Nonathletes

This study primarily aimed to quantify and compare iron status in professional female athletes and nonathletes. Furthermore, this study also aimed to identify differences in iron status according to sporting discipline and explore the relationship between ferritin concentration and weekly training volume in professional athletes. A total of 152 participants were included in this study, including 85 athletes who were members of senior teams (handball, n = 24; volleyball, n = 36; soccer, n = 19; and judo, n = 6) involved at the highest level of competition and 67 nonathletes. A significantly greater proportion (p = .05) of athletes (27%) demonstrated iron-deficient erythropoiesis (IDE) compared with nonathletes (13%). There were nonsignificant differences (p > .05) in the prevalence of iron deficiency (ID; 49% vs. 46%) and iron deficiency anemia (IDA; 2% vs. 4%) between athletes and nonathletes. Similarly, the prevalence of ID, IDE, and IDA was not significantly different between sports (p > .05). Furthermore, training volume was negatively correlated with ferritin concentration in athletes (r: −.464, moderate, p < .001). Professional female athletes are at a heightened risk of IDE compared with nonathletes; therefore, they should be periodically screened for ID to reduce the deleterious effects on training and performance. The similar prevalence of ID, IDE, and IDA found across athletes competing in different sports suggests that overlaps exist between handball, volleyball, soccer, and judo athletes regarding risk of disturbance in iron metabolism.

Utility of Novel Hypochromia and Microcythemia Markers in Classifying Hematological and Iron Status in Male Athletes

In athletes, no reliable indices exist for an unambiguous evaluation of hematological and iron status. Therefore, the utility of some new red blood cell (RBC) parameters was explored in 931 elite male athletes aged 13–35 years. To diagnose iron status, the values of ferritin and soluble transferrin receptor (sTfR), total iron binding capacity (TIBC), and basic blood morphology were determined in blood. The new hematological markers included among others: mean cellular hemoglobin content in reticulocytes (CHr), percentage of erythrocytes (HYPOm) and reticulocytes (HYPOr) with decreased cellular hemoglobin concentration, percentage of erythrocytes (LowCHm) and reticulocytes (LowCHr) with decreased cellular hemoglobin content, mean volume of reticulocytes (MCVr), and percentage of erythrocytes with decreased volume (MICROm). Despite adverse changes in reticulocyte hypochromia indices (CHr, LowCHr, HYPOr; p < 0.001) in the iron depletion state, the area under the receiver operating characteristic curve (AUC-ROC) values calculated for them were relatively low (0.539–0.722). In iron-deficient erythropoiesis (IDE), unfavorable changes additionally concern microcythemia indices in both reticulocytes and erythrocytes (MCVr, MCV, MICROm, and red cell volume distribution width—RDW), with especially high values of AUC-ROC (0.947–0.970) for LowCHm, LowCHr, and CHr. Dilutional sports anemia was observed in 6.1% of athletes. In this subgroup, only hemoglobin concentration (Hb), hematocrit (Hct), and RBC (all dependent on blood volume) were significantly lower than in the normal group. In conclusion, the diagnostic utility of the new hematology indices was not satisfactory for the detection of an iron depletion state in athletes. However, these new indices present high accuracy in the detection of IDE and sports anemia conditions.

Iron Deficiency as a Therapeutic Target in Cardiovascular Disease

Iron deficiency is the most common nutritional disorder in the world. It is prevalent amongst patients with cardiovascular disease, in whom it is associated with worse clinical outcomes. The benefits of iron supplementation have been established in chronic heart failure, but data on their effectiveness in other cardiovascular diseases are lacking or conflicting. Realising the potential of iron therapies in cardiovascular disease requires understanding of the mechanisms through which iron deficiency affects cardiovascular function, and the cell types in which such mechanisms operate. That understanding has been enhanced by recent insights into the roles of hepcidin and iron regulatory proteins (IRPs) in cellular iron homeostasis within cardiovascular cells. These studies identify intracellular iron deficiency within the cardiovascular tissue as an important contributor to the disease process, and present novel therapeutic strategies based on targeting the machinery of cellular iron homeostasis rather than direct iron supplementation. This review discusses these new insights and their wider implications for the treatment of cardiovascular diseases, focusing on two disease conditions: chronic heart failure and pulmonary arterial hypertension.

Iron considerations for the athlete: a narrative review

Iron plays a significant role in the body, and is specifically important to athletes, since it is a dominant feature in processes such as oxygen transport and energy metabolism. Despite its importance, athlete populations, especially females and endurance athletes, are commonly diagnosed with iron deficiency, suggesting an association between sport performance and iron regulation. Although iron deficiency is most common in female athletes (~ 15-35% athlete cohorts deficient), approximately 5-11% of male athlete cohorts also present with this issue. Furthermore, interest has grown in the mechanisms that influence iron absorption in athletes over the last decade, with the link between iron regulation and exercise becoming a research focus. Specifically, exercise-induced increases in the master iron regulatory hormone, hepcidin, has been highlighted as a contributing factor towards altered iron metabolism in athletes. To date, a plethora of research has been conducted, including investigation into the impact that sex hormones, diet (e.g. macronutrient manipulation), training and environmental stress (e.g. hypoxia due to altitude training) have on an athlete's iron status, with numerous recommendations proposed for consideration. This review summarises the current state of research with respect to the aforementioned factors, drawing conclusions and recommendations for future work.

Is Endurance Exercise Safe? The Myth of Pheidippides

With the increase in participation in endurance events in the general population, patient concern may arise as to whether endurance exercise is safe. Acute but not chronic increases in blood urea nitrogen, creatinine, and urine albumin occur in endurance exercise. Iron-deficiency anemia may be observed in female athletes. Upper respiratory illness is increased in elite athletes but decreased in intense recreational athletes. No convincing evidence of developing osteoarthritis exists. Common gastrointestinal symptoms occur and isolated reports of gastrointestinal bleeding exist. Nevi are increased and the minimal erythematous dose is decreased. Exercising in the presence of air pollution has negative pulmonary effects, but overall, benefit exists. Numerous reports pertain to the cardiovascular system. The risk of cardiac arrest increases during exercise, troponin is elevated after exercise, and a predisposition for atrial fibrillation exists. Ventricular myocardial scar formation as assessed by gadolinium enhancement on magnetic resonance imaging is inconsistently observed, and increased coronary plaque of a more stable variety is reported. Left ventricular compliance is chronically increased and no decrease in longevity is found. Although some concerns exist, endurance exercise is safe.

Iron status and associations with physical performance during basic combat training in female New Zealand Army recruits

Decreases in Fe status have been reported in military women during initial training periods of 8-10 weeks. The present study aimed to characterise Fe status and associations with physical performance in female New Zealand Army recruits during a 16-week basic combat training (BCT) course. Fe status indicators - Hb, serum ferritin (sFer), soluble transferrin receptor (sTfR), transferrin saturation (TS) and erythrocyte distribution width (RDW) - were assessed at the beginning (baseline) and end of BCT in seventy-six volunteers without Fe-deficiency non-anaemia (sFer 10 mg/l at baseline or end. A timed 2·4 km run followed by maximum press-ups were performed at baseline and midpoint (week 8) to assess physical performance. Changes in Fe status were investigated using paired t tests and associations between Fe status and physical performance evaluated using Pearson correlation coefficients. sFer (56·6 (sd 33·7) v. 38·4 (sd 23·8) µg/l) and TS (38·8 (sd 13·9) v. 34·4 (sd 11·5) %) decreased (P&lt;0·001 and P=0·014, respectively), while sTfR (1·21 (sd 0·27) v. 1·39 (sd 0·35) mg/l) and RDW (12·8 (sd 0·6) v. 13·2 (sd 0·7) %) increased (P&lt;0·001) from baseline to end. Hb (140·6 (sd 7·5) v. 142·9 (sd 7·9) g/l) increased (P=0·009) during BCT. At end, sTfR was positively (r 0·29, P=0·012) and TS inversely associated (r -0·32, P=0·005) with midpoint run time. There were no significant correlations between Fe status and press-ups. Storage and functional Fe parameters indicated a decline in Fe status in female recruits during BCT. Correlations between tissue-Fe indicators and run times suggest impaired aerobic fitness. Optimal Fe status appears paramount for enabling success in female recruits during military training.

Mechanisms of cardiac iron homeostasis and their importance to heart function

Heart disease is a common manifestation in conditions of iron imbalance. Normal heart function requires coupling of iron supply for oxidative phosphorylation and redox signalling with tight control of intracellular iron to below levels at which excessive ROS are generated. Iron supply to the heart is dependent on systemic iron availability which is controlled by the systemic hepcidin/ferroportin axis. Intracellular iron in cardiomyocytes is controlled in part by the iron regulatory proteins IRP1/2. This mini-review summarises current understanding of how cardiac cells regulate intracellular iron levels, and of the mechanisms linking cardiac dysfunction with iron imbalance. It also highlights a newly-recognised mechanism of intracellular iron homeostasis in cardiomyocytes, based on a cell-autonomous cardiac hepcidin/ferroportin axis. This new understanding raises pertinent questions on the interplay between systemic and local iron control in the context of heart disease, and the effects on heart function of therapies targeting the systemic hepcidin/ferroportin axis.

Effects of diet before endurance exercise on hepcidin response in young untrained females

[Purpose]

We examined the effects of diet before endurance exercise on hepcidin response in young untrained females.

[Methods]

Ten young untrained females [age: 20.6 ± 0.8 y, height: 157.5 ± 1.0 cm, weight: 54.4 ± 1.5 kg, and maximal oxygen uptake (VO_2max): 35.9 ± 1.1 mL/kg/min] were involved in two experimental conditions with a crossover design. The two conditions were separated by approximately 1 month, and each condition was performed during the follicular phase. Subjects completed 60 min of pedaling at 65% of VO_2max after consuming a meal (FED) or not consuming a meal (CON). Blood samples were collected before, immediately after, and 3 h after exercise.

[Results]

Serum ferritin levels before exercise did not differ between the two conditions (P > 0.05). Blood glucose and lactate levels were significantly elevated immediately after exercise only under the FED condition (P < 0.05). Serum iron levels were significantly elevated after exercise under both conditions. However, the plasma interleukin-6 and serum hepcidin levels were not significantly different 3 h after exercise under either condition (P > 0.05).

[Conclusion]

Consuming a meal before endurance exercise at moderate intensity did not affect exercise-induced hepcidin elevation in young untrained females.

Repressed Exercise-Induced Hepcidin Levels after Danggui Buxue Tang Supplementation in Male Recreational Runners

This study was to investigate the protective and recovery effects of Danggui Buxue Tang (DBT) supplementation on exercise performance, hepcidin, iron status, and other related biochemical parameters after being challenged by a single bout of intense aerobic exercise. A total of 36 recreationally active males were pair-matched and randomly assigned to receive DBT or a placebo for 11 days, while using clusters based on their aerobic capacities. On the eighth day of the supplementation, the participants performed a 13-km run with maximal effort. Blood and urine samples were collected and analysed before treatment (Pre-Tre) and immediately after (Post-Ex), 24 h after (24-h Rec), and 72 h after (72-h Rec) the run. DBT supplementation dramatically shortened the finish times by 14.0% (12.3 min) when compared with that in the placebo group. Significant group × time effects were observed in serum hepcidin and iron levels. DBT supplementation repressed hepcidin levels at Post-Ex and 24-h Rec, thereby causing a significant increase in iron levels by 63.3% and 31.4% at Post-Ex and 72-h Rec, respectively. However, DBT supplementation had no significant anti-inflammatory or haemolysis-preventative effects. Short-term DBT supplementation shortened the running time and repressed exercise-induced hepcidin levels, thereby boosting iron levels and accelerating iron homeostasis during recovery.

Iron deficiency without anemia - a clinical challenge

One should always consider iron deficiency (without anemia) as the cause of persisting, unexplained unspecific, often severe, symptoms, regardless of the primary underlying disease. The symptoms of iron deficiency may arise from the metabolic systems where many proteins are iron containing. Long-standing iron deficiency may be challenging to treat.

Does Iron Supplementation Improve Performance in Iron-Deficient Nonanemic Athletes?

CONTEXT

Supplementing iron-deficient nonanemic (IDNA) athletes with iron to improve performance is a trend in endurance sports.

OBJECTIVES

To investigate the benefits of iron on performance, identify a ferritin level cutoff in IDNA athletes, and determine which iron supplementation regimens are most effective.

DATA SOURCES

A search of the PubMed, CINAHL, Embase, ERIC, and Cochrane databases was performed in 2014 including all articles. Citations of pertinent review articles were also searched. In 2017, the search was repeated.

STUDY SELECTION

Inclusion criteria comprised studies of level 1 to 3 evidence, written in the English language, that researched iron supplementation in nonanemic athletes and reported performance outcomes.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

The search terms used included athletic performance, resistance training, athletes, physical endurance, iron, iron deficiency, supplement, non-anemic, low ferritin, ferritin, ferritin blood level, athletes, and sports.

RESULTS

A total of 1884 studies were identified through the initial database search, and 13 were identified through searching references of relevant review articles. A subsequent database search identified 46 studies. Following exclusions, 12 studies with a total of 283 participants were included. Supplementing IDNA athletes with iron improved performance in 6 studies (146 participants) and did not improve performance in the other 6 studies (137 participants). In the 6 studies that showed improved performance with iron supplementation, all used a ferritin level cutoff of ≤20 μg/L for treatment. Additionally, all studies that showed improved performance used oral iron as a supplement.

CONCLUSION

The evidence is equivocal as to whether iron supplementation in IDNA athletes improves athletic performance. Supplementing athletes with ferritin levels <20 μg/L may be more beneficial than supplementing athletes with higher baseline ferritin levels.

Medical assessment in athletes

Practicing sports at a professional level requires the body to be in good health. The fact of carrying out a continuous and high intensity physical activity in the presence of pathological conditions and/or a maladaptation of the body can be detrimental to the athletes' health and, therefore, to their performance. Many of the problems that arise in the sports field could be prevented with a periodic and well-structured medical assessment. In this review, we describe the protocol of the medical service of a high-level sports club for the assessment of its professional athletes.

Biomarkers in Sports and Exercise: Tracking Health, Performance, and Recovery in Athletes

Lee, EC, Fragala, MS, Kavouras, SA, Queen, RM, Pryor, JL, and Casa, DJ. Biomarkers in sports and exercise: tracking health, performance, and recovery in athletes. J Strength Cond Res 31(10): 2920–2937, 2017—Biomarker discovery and validation is a critical aim of the medical and scientific community. Research into exercise and diet-related biomarkers aims to improve health, performance, and recovery in military personnel, athletes, and lay persons. Exercise physiology research has identified individual biomarkers for assessing health, performance, and recovery during exercise training. However, there are few recommendations for biomarker panels for tracking changes in individuals participating in physical activity and exercise training programs. Our approach was to review the current literature and recommend a collection of validated biomarkers in key categories of health, performance, and recovery that could be used for this purpose. We determined that a comprehensive performance set of biomarkers should include key markers of (a) nutrition and metabolic health, (b) hydration status, (c) muscle status, (d) endurance performance, (e) injury status and risk, and (f) inflammation. Our review will help coaches, clinical sport professionals, researchers, and athletes better understand how to comprehensively monitor physiologic changes, as they design training cycles that elicit maximal improvements in performance while minimizing overtraining and injury risk.

Effects of an Acute Exercise Bout on Serum Hepcidin Levels

Iron deficiency is a frequent and multifactorial disorder in the career of athletes, particularly in females. Exercise-induced disturbances in iron homeostasis produce deleterious effects on performance and adaptation to training; thus, the identification of strategies that restore or maintain iron homeostasis in athletes is required. Hepcidin is a liver-derived hormone that degrades the ferroportin transport channel, thus reducing the ability of macrophages to recycle damaged iron, and decreasing iron availability. Although it has been suggested that the circulating fraction of hepcidin increases during early post-exercise recovery (~3 h), it remains unknown how an acute exercise bout may modify the circulating expression of hepcidin. Therefore, the current review aims to determine the post-exercise expression of serum hepcidin in response to a single session of exercise. The review was carried out in the Dialnet, Elsevier, Medline, Pubmed, Scielo and SPORTDiscus databases, using hepcidin (and “exercise” or “sport” or “physical activity”) as a strategy of search. A total of 19 articles were included in the review after the application of the inclusion/exclusion criteria. This search found that a single session of endurance exercise (intervallic or continuous) at moderate or vigorous intensity (60–90% VO_2peak) stimulates an increase in the circulating levels of hepcidin between 0 h and 6 h after the end of the exercise bout, peaking at ~3 h post-exercise. The magnitude of the response of hepcidin to exercise seems to be dependent on the pre-exercise status of iron (ferritin) and inflammation (IL-6). Moreover, oxygen disturbances and the activation of a hypoxia-induced factor during or after exercise may stimulate a reduction of hepcidin expression. Meanwhile, cranberry flavonoids supplementation promotes an anti-oxidant effect that may facilitate the post-exercise expression of hepcidin. Further studies are required to explore the effect of resistance exercise on hepcidin expression.

The Association between Iron and Vitamin D Status in Female Elite Athletes

Vitamin D may influence iron metabolism and erythropoiesis, whereas iron is essential for vitamin D synthesis. We examined whether vitamin D deficiencies (VDD) are associated with reduced iron status and whether progressive iron deficiency (ID) is accompanied by inferior vitamin D status. The study included 219 healthy female (14–34 years old) athletes. VDD was defined as a 25(OH)D concentration < 75 nmol/L. ID was classified based on ferritin, soluble transferrin receptor (sTfR), total iron binding capacity (TIBC) and blood morphology indices. The percentage of ID subjects was higher (32%) in the VDD group than in the 25(OH)D sufficient group (11%) (χ² = 10.6; p = 0.001). The percentage of VDD subjects was higher (75%) in the ID than in the normal iron status group (48%) (χ² = 15.6; p = 0.001). The odds ratios (ORs) for VDD increased from 1.75 (95% CI 1.02–2.99; p = 0.040) to 4.6 (95% CI 1.81–11.65; p = 0.001) with progressing iron deficiency. ID was dependent on VDD in both VDD groups (25(OH)D < 75 and < 50 nmol/L). The ID group had a lower 25(OH)D concentration (p = 0.000). The VDD group had lower ferritin (p = 0.043) and iron (p = 0.004) concentrations and higher values of TIBC (p = 0.016) and sTfR (p = 0.001). The current results confirm the association between vitamin D and iron status in female athletes, although it is difficult to assess exactly which of these nutrients exerts a stronger influence over the other.

Novel Iron-Whey Protein Microspheres Protect Gut Epithelial Cells from Iron-Related Oxidative Stress and Damage and Improve Iron Absorption in Fasting Adults

BACKGROUND

Iron food fortification and oral iron formulations are frequently limited by poor absorption, resulting in the widespread use of high-dose oral iron, which is poorly tolerated.

METHODS

We evaluated novel iron-denatured whey protein (Iron-WP) microspheres on reactive oxygen species (ROS) and viability in gut epithelial (HT29) cells. We compared iron absorption from Iron-WP versus equimolar-dose (25 mg elemental iron) ferrous sulphate (FeSO4) in a prospective, randomised, cross-over study in fasting volunteers (n = 21 per group) dependent on relative iron depletion (a ferritin level ≤/>30 ng/mL).

RESULTS

Iron-WP caused less ROS generation and better HT29 cell viability than equimolar FeSO4. Iron-WP also showed better absorption with a maximal 149 ± 39% increase in serum iron compared to 65 ± 14% for FeSO4 (p = 0.01). The response to both treatments was dependent on relative iron depletion, and multi-variable analysis showed that better absorption with Iron-WP was independent of baseline serum iron, ferritin, transferrin saturation, and haemoglobin in the overall group and in the sub-cohort with relative iron depletion at baseline (p < 0.01).

CONCLUSIONS

Novel Iron-WP microspheres may protect gut epithelial cells and improve the absorption of iron versus FeSO4. Further evaluation of this approach to food fortification and supplementation with iron is warranted.

Incidence of Iron Deficiency and Iron Deficient Anemia in Elite Runners and Triathletes

OBJECTIVE

To assess the incidence of iron deficiency (ID), and iron deficient anemia (IDA) within a cohort of highly trained runners and triathletes, and to examine the association of oral iron supplementation history with serum ferritin (sFe) and hemoglobin (Hb) concentrations.

METHODS

A retrospective analysis of routine blood test data taken from 2009 to 2015 from (n = 38) elite level runners and triathletes between the ages of 21 to 36 years. Oral iron supplement intake was assessed through a questionnaire.

RESULTS

Triathletes (female, FT; male, MT) and runners (female, FR; male, MR) had higher incidence of at least 1 episode of ID (FT 60.0%, MT 37.5%, FR 55.6%, MR 31.3%) compared with values reported in the literature for endurance athletes (20%-50% females, 0%-17% males). Male triathletes and runners had a higher incidence of IDA than their female teammates (25% MT, 20% FT, 6.3% for MR, 0% FR), a finding which has previously not been reported. Hemoglobin concentrations were low, with incidence of Hb <140 g/L in men occurring at least once in 87.5% of triathletes, and 31.3% of runners, and Hb <120 g/L in women occurring at least once in 20% of triathletes, but 0% of runners. Although the athletes were appropriately treated with oral iron (mean 94 ± 115 mg/d), there was no observed correlation between iron intake and sFe or Hb.

CONCLUSIONS

Even with monitoring and treatment in place, ID and IDA are significant concerns for the health and performance of elite runners and triathletes, and this issue affects males and females.

Reticulocyte hemoglobin content (MCHr) in the detection of iron deficiency

BACKGROUND

Blood hemoglobin (Hb) concentration within the reference interval does not exclude iron deficiency (ID): individuals with normal stores lose iron during a long period before their Hb falls below of the level that is defined as anemia. The process entails a decrease of storage iron, shown by serum ferritin below reference range, followed by iron depletion, eventually leading to iron restricted erythropoiesis; consequence of an imbalance between erythropoietic iron requirements and too low supply is a reduction of Hb synthesis in reticulocytes.

OBJECTIVE

We study the potential utility of mean reticulocyte hemoglobin content (MCHr), reported by CELL-DYN Sapphire (Abbott Diagnostics) analyzer, in the detection of ID in non-anemic adults.

METHODS

207 patients with Hb within the reference range were enrolled. ID was defined as Hb>120g/L (women), >130g/L (men) and serum ferritin <30μg/L. Student's t-test was applied to detect deviations between groups, statistical significance P<0.05. The performance of MCHr in detecting ID was evaluated applying Receiver Operating Characteristic (ROC) curve analysis. Kappa test was applied to verify concordance between ferritin and MCHr.

RESULTS

68 patients (33%) suffered ID, median MCHr in this group was 26.9 pg, statistically different from the normal group, MCHr 30.9pg (P<0.0001). ROC ANALYSIS (GOLD STANDARD FERRITIN <30μG/L): Area under curve AUC 0.851 (95% CI 0.770-0.912) at cut off 30.0 pg, with sensitivity 84.1% and specificity 71.1%. Kappa 0.667 (95% CI 0.527-0.858).

CONCLUSION

Due to their short lifespan reticulocytes and derived parameters reflect current erythropoiesis status, before Hb and erythrocyte indices drop. MCHr had the best AUC and diagnostic value compared to erythrocyte indices. MCHr is a reliable test for the investigation of ID and could improve the detection of iron deficient adults.

Peripapillary retinal nerve fiber layer thickness in patients with iron deficiency anemia

Purpose:

To evaluate the effect of iron deficiency anemia (IDA) on peripapillary retinal nerve fiber layer (RNFL) thickness with optical coherence tomography (OCT).

Materials and Methods:

102 female patients who had IDA (hemoglobin <12 g/dl, serum transferrin saturation <15%, serum iron <50 μg/dl, and serum ferritin <15 μg/dl) were enrolled in the study. Optic disc and RNFL parameters obtained by Cirrus high-definition OCT 4000 were compared with those of 49 age and sex-matched nonanemic individuals. The time between blood analysis and OCT measurements was 3.14 ± 5.6 (range, 0–28) days in the anemia group, and 3.5 ± 6.7 (range, 0–27) days in the control group (P = 0.76).

Results:

Average ages of 102 patients and 49 control subjects were 35.76 ± 10.112 (range, 18–66) years, and 36.08 ± 8.416 (range, 19–57) years (P = 0.850), respectively. The average RNFL thickness was 94.67 ± 9.380 in the anemia group, and 100.22 ± 9.12 in the control group (P = 0.001). Temporal, nasal, and lower quadrant average RNFL thicknesses of IDA group were thinner than the control group (P = 0.001, P = 0.013, P = 0.008). Upper quadrant RNFL thicknesses in IDA and control groups were similar. Correlation analysis revealed positive correlation between mean RNFL thickness and hemoglobin (r = 0.273), iron (r = 0.177), ferritin (r = 0.163), and transferrin saturations (r = 0.185), while a negative correlation was found between total iron binding capacity (r = −0.199) and mean RNFL thickness.

Conclusions:

Peripapillary RNFL thickness measured by OCT is thinner in adult female patients with IDA. It may have a significant influence on the management of many disorders such as glaucoma and neuro-ophthalmological diseases.