Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990-2021: findings from the Global Burden of Disease Study 2021

Global, regional, and national progress towards the 2030 global nutrition targets and forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

The six global nutrition targets (GNTs) related to low birthweight, exclusive breastfeeding, child growth (ie, wasting, stunting, and overweight), and anaemia among females of reproductive age were chosen by the World Health Assembly in 2012 as key indicators of maternal and child health, but there has yet to be a comprehensive report on progress for the period 2012 to 2021. We aimed to evaluate levels, trends, and observed-to-expected progress in prevalence and attributable burden from 2012 to 2021, with prevalence projections to 2050, in 204 countries and territories.

METHODS

The prevalence and attributable burden of each target indicator were estimated by age group, sex, and year in 204 countries and territories from 2012 to 2021 in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, the most comprehensive assessment of causes of death, disability, and risk factors to date. Country-specific relative performance to date was evaluated with a Bayesian meta-regression model that compares prevalence to expected values based on Socio-demographic Index (SDI), a composite indicator of societal development status. Target progress was forecasted from 2021 up to 2050 by modelling past trends with meta-regression using a combination of key quantities and then extrapolating future projections of those quantities.

FINDINGS

In 2021, a few countries had already met some of the GNTs: five for exclusive breastfeeding, four for stunting, 96 for child wasting, and three for child overweight, and none met the target for low birthweight or anaemia in females of reproductive age. Since 2012, the annualised rates of change (ARC) in the prevalence of child overweight increased in 201 countries and territories and ARC in the prevalence of anaemia in females of reproductive age decreased considerably in 26 countries. Between 2012 and 2021, SDI was strongly associated with indicator prevalence, apart from exclusive breastfeeding (|r-|=0·46-0·86). Many countries in sub-Saharan Africa had a decrease in the prevalence of multiple indicators that was more rapid than expected on the basis of SDI (the differences between observed and expected ARCs for child stunting and wasting were -0·5% and -1·3%, respectively). The ARC in the attributable burden of low birthweight, child stunting, and child wasting decreased faster than the ARC of the prevalence for each in most low-income and middle-income countries. In 2030, we project that 94 countries will meet one of the six targets, 21 countries will meet two targets, and 89 countries will not meet any targets. We project that seven countries will meet the target for exclusive breastfeeding, 28 for child stunting, and 101 for child wasting, and no countries will meet the targets for low birthweight, child overweight, and anaemia. In 2050, we project that seven additional countries will meet the target for exclusive breastfeeding, five for low birthweight, 96 for child stunting, nine for child wasting, and one for child overweight, and no countries are projected to meet the anaemia target.

INTERPRETATION

Based on current levels and past trends, few GNTs will be met by 2030. Major reductions in attributable burden for exclusive breastfeeding and anthropometric indicators should be recognised as huge scientific and policy successes, but the comparative lack of progress in reducing the prevalence of each, along with stagnant anaemia in women of reproductive age and widespread increases in child overweight, suggests a tenuous status quo. Continued investment in preventive and treatment efforts for acute childhood illness is crucial to prevent backsliding. Parallel development of effective treatments, along with commitment to multisectoral, long-term policies to address the determinants and causes of suboptimal nutrition, are sorely needed to gain ground.

FUNDING

Bill & Melinda Gates Foundation.

The Effect of Maternal Haemoglobinopathies and Iron Deficiency Anaemia on Foetal Growth Restriction: A Systematic Review and Meta-Analysis

Maternal anaemia is a significant global health issue that adversely affects both maternal and foetal outcomes, particularly, intrauterine growth restriction (IUGR). This systematic review and meta-analysis aimed to consolidate existing evidence on the impact of maternal anaemia on the risk of IUGR. We conducted a comprehensive search across PubMed, Embase, Cochrane and Web of Science until 28 February 2024. Eligible studies included observational designs that reported maternal anaemia and its association with IUGR or small for gestational age (SGA) outcomes. The pooled odds ratios (ORs) were calculated using a random-effects model and heterogeneity was assessed with the I² statistic. The R software (version 4.3) was used for statistical analyses. A total of 38 studies involving 3,871,849 anaemic and 27,978,450 non-anaemic pregnant women were included. The pooled analysis demonstrated that anaemia in pregnancy is associated with a significantly increased risk of IUGR (OR = 1.30, 95% CI: 1.05-1.62, I² = 97%). Subgroup analyses by anaemia severity showed non-significant associations for mild (OR = 0.84, 95% CI: 0.58-1.23) and moderate anaemia (OR = 0.98, 95% CI: 0.48-1.98), while severe anaemia indicated a higher, though non-significant, risk of IUGR (OR = 1.42, 95% CI: 0.69-2.93). Maternal anaemia is associated with a heightened risk of IUGR, highlighting the critical need for effective management and early intervention strategies within prenatal care settings. Future research should focus on elucidating the effects of different severities of anaemia on birth outcomes, including IUGR and long-term effects later in life.

Predictors of Anaemia Among Young Children Receiving Daily Micronutrient Powders (MNPs) for 24 Weeks in Bangladesh: A Secondary Analysis of the Zinc in Powders Trial

In Bangladesh, anaemia is estimated to affect 52% of children 6-59 months, with the youngest children (6-23 months) experiencing the highest levels of anaemia (71%). Micronutrient powders (MNPs) are designed to increase micronutrient intake in young children; however, in some settings, the prevalence of anaemia may remain elevated despite the high coverage of MNPs. In a secondary analysis of the Zinc in Powders trial (ZiPT), we identified risk factors that were associated with anaemia among Bangladeshi children 9-11 months of age who received standard 15-component MNPs, including 10 mg of iron, daily for 24 weeks. At enrolment, socio-demographic characteristics were collected. Morbidity symptoms were assessed on a semi-weekly basis. Haemoglobin (measured via single-drop capillary blood using Hemocue 301+) and child anthropometry were assessed at enrolment and endline (24 weeks). Risk factors for anaemia at endline (24 weeks) were identified using minimally adjusted (age and sex) logistic regression models. Multivariate models were subsequently constructed, controlling for age, sex and significant risk factors. Of the 481 children randomized to the MNP arm, 442 completed the trial and had haemoglobin data available at endline. Anaemia (haemoglobin < 10.5 g/dL) prevalence declined from 54.1% at baseline to 32.6% at endline. In minimally adjusted models, season of enrolment, underweight at enrolment, asset score, hygiene score and frequent morbidity symptoms were associated with the odds of anaemia at endline. However, some factors lost statistical significance in multivariate models. MNPs are an important tool for anaemia prevention; however, they should be part of an integrated approach for anaemia control.

Leveraging artificial intelligence chatbots for anemia prevention: A comparative study of ChatGPT-3.5, copilot, and Gemini outputs against Google Search results

Aim

This study evaluated the understandability, actionability, and readability of text on anemia generated by artificial intelligence (AI) chatbots.

Methods

This cross-sectional study compared texts generated by ChatGPT-3.5, Microsoft Copilot, and Google Gemini at three levels: "normal," "6th grade," and "PEMAT-P version." Additionally, texts retrieved from the top eight Google Search results for relevant keywords were included for comparison. All texts were written in Japanese. The Japanese version of the PEMAT-P was used to assess understandability and actionability, while jReadability was used for readability. A systematic comparison was conducted to identify the strengths and weaknesses of each source.

Results

Texts generated by Gemini at the 6th-grade level (n = 26, 86.7 %) and PEMAT-P version (n = 27, 90.0 %), as well as ChatGPT-3.5 at the normal level (n = 21, 80.8 %), achieved significantly higher scores (≥70 %) for understandability and actionability compared to Google Search results (n = 17, 25.4 %, p < 0.001). For readability, Copilot and Gemini texts demonstrated significantly higher percentages of "very readable" to "somewhat difficult" levels than texts retrieved from Google Search (p = 0.000-0.007).

Innovation

This study is the first to objectively and quantitatively evaluate the understandability and actionability of educational materials on anemia prevention. By utilizing PEMAT-P and jReadability, the study demonstrated the superiority of Gemini in terms of understandability and readability through measurable data. This innovative approach highlights the potential of AI chatbots as a novel method for providing public health information and addressing health disparities.

Conclusion

AI-generated texts on anemia were found to be more readable and easier to understand than traditional web-based texts, with Gemini demonstrating the highest level of understandability. Moving forward, improvements in prompts will be necessary to enhance the integration of visual elements that encourage actionable responses in AI chatbots.

Moderate-to-Severe Preoperative Anemia is Associated with Increased Postoperative Myocardial Infarction and Mortality in Patients Undergoing Transcarotid Artery Revascularization

BACKGROUND

While preoperative anemia is prevalent among surgical patients, its impact on patients undergoing transcarotid artery revascularization (TCAR) remains poorly understood. This study aims to assess the relationship between the severity of preoperative anemia and outcomes following TCAR.

METHODS

A retrospective analysis of the Vascular Quality Initiative database (2016-2021) was performed to identify patients who underwent TCAR for carotid stenosis. Anemia was defined according to World Health Organization guidelines as a hemoglobin (Hb) level <12 g/dL in females and <13 g/dL in males. The severity of anemia was further classified as mild (Hb: 10-11.9 g/dL in females and 11-12.9 g/dL in males) or moderate to severe (Hb < 10 g/dL in females and <11 g/dL in males). Patients were stratified into three cohorts as follows, based on the presence and severity of preoperative anemia: no anemia, mild anemia, and moderate-to-severe anemia. The primary outcome was 30-day mortality. Secondary outcomes included in-hospital stroke, in-hospital death, myocardial infarction (MI), and prolonged postoperative hospitalization (>1 day). Univariable and multivariable logistic regression analyses were conducted to evaluate the association between the severity of preoperative anemia and clinical outcomes.

RESULTS

Among 21,648 patients who underwent TCAR, 4,240 (19.8%) had mild anemia, and 3,401 (15.8%) had moderate-to-severe anemia preoperatively. After adjusting for relevant clinical factors and confounders, moderate-to-severe preoperative anemia was associated with significantly increased odds of in-hospital MI (adjusted odds ratio [aOR], 2.39; 95% confidence interval [CI]: 1.53-3.74; P < 0.001), in-hospital death (aOR, 2.65; 95% CI: 1.62-4.34; P < 0.001), and 30-day mortality (aOR, 1.89; 95% CI: 1.32-2.72; P < 0.001) compared to nonanemic patients. Among patients with moderate-to-severe anemia, factors such as a history of chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF), urgent or emergent procedures, and symptomatic carotid stenosis were the strongest predictors of 30-day mortality. In contrast, mild anemia was not associated with increased odds of adverse postoperative outcomes compared to the nonanemic cohort. Preoperative anemia, regardless of severity, was not associated with an increased risk of postoperative stroke following TCAR. However, the severity of preoperative anemia was associated with a stepwise increase in the adjusted odds of prolonged hospitalization (aOR, 1.19 [mild anemia] and 1.57 [moderate-to-severe anemia]).

CONCLUSION

In this multi-institutional retrospective study of patients undergoing TCAR, moderate-to-severe preoperative anemia was independently associated with higher adjusted odds of in-hospital MI, in-hospital death, and 30-day mortality, without an increased risk of postoperative stroke. These findings highlight moderate-to-severe preoperative anemia as a potential independent prognostic marker for identifying high-risk patients. Furthermore, incorporating the severity of anemia into preoperative risk stratification may aid in tailoring perioperative cardiac assessment and optimization strategies, potentially mitigating the risk of adverse outcomes following TCAR.

Global Burden of Anaemia Among Women of Childbearing Age: Temporal Trends, Inequalities and Projections Using the Global Burden of Disease 2021

OBJECTIVE

To analyse temporal trends, inequalities and projections in anaemia burden among women of childbearing age (WCBA).

DESIGN

Population-based study.

SETTING

Data from the Global burden of Disease (GBD) Study.

POPULATION

WCBA (ages 15-49) diagnosed with anaemia.

METHODS

According to the GBD study, original data sources, including population-based surveys, scientific studies and government reports, were synthesised to estimate WCBA anaemia prevalence and years lived with disability (YLD). We extracted annual estimates with 95% uncertainty intervals (UIs) from 1990 to 2021 and assessed relative prevalence risks by age, period and cohort. Inequality was evaluated via sociodemographic index (SDI). The Bayesian age-period-cohort model was used to predict progress toward the 2030 prevalence halving target.

MAIN OUTCOMES MEASURES

The burden of WCBA anaemia.

RESULTS

Despite population growth increasing total case numbers, the global age-standardised prevalence rate of WCBA anaemia declined from 35.64% (95% UI: 34.16 to 37.37) in 1990 to 33.77% (32.10-35.55) in 2021. Socioeconomic disparities persisted, with a stable concentration index around -0.21 over time, indicating sustained inequality disadvantaging lower-SDI countries, especially in Western and Central Sub-Saharan Africa and South Asia. Despite reductions in period/cohort prevalence risks, projections indicated insufficient progress toward the 2030 target.

CONCLUSION

The persistent global burden, inequalities and insufficient progress in addressing WCBA anaemia continue to call for improving anaemia management, contextually tailored, multisectoral nutritional and non-nutritional interventions to achieve the 2030 target.

Efficacy, Safety, and Tolerability of Ferric Carboxymaltose and Iron Sucrose in Iron-Deficiency Anemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective

This study comprehensively compares the efficacy, safety, and tolerability of two commonly used intravenous iron preparations, ferric carboxymaltose (FCM) and iron sucrose (IS), in adult patients with iron-deficiency anemia (IDA).

Materials and Methods

A systematic literature search was conducted across the PubMed, Ovid MEDLINE, Web of Science, and Cochrane Library databases up to January 1, 2024, to identify randomized controlled trials directly comparing FCM and IS treatments in adult patients with IDA. The primary outcome of interest was change in hemoglobin (Hb) levels during follow-up. Meta-analyses were conducted with inverse variance random effects models.

Results

Fourteen trials were included in the study, with a total of 4757 patients. FCM resulted in a non-significant increase in Hb levels (mean difference [MD]: 0.45 g/dL, 95% confidence interval [CI]: 0.08 to 0.83, p=0.02) and ferritin levels (MD: 37.32 ng/mL, 95% CI: 18.98 to 55.65, p<0.01) compared to IS. FCM was associated with a higher risk of hypersensitivity reactions compared to IS (relative risk [RR]: 2.97, 95% CI: 1.35 to 6.52, p<0.01) but showed no significant difference in severe adverse events (RR: 1.03, 95% CI: 0.88 to 1.21, p=0.70) and had a non-significant increased risk of hypophosphatemia (RR: 2.84, 95% CI: 0.89 to 9.06, p=0.08).

Conclusion

Ten studies showed some concerns of risk of bias (RoB) and four studies had a high RoB for the change in Hb levels during follow-up. The lack of standardized definitions for hypersensitivity reactions and variability in dosing protocols and follow-up durations across studies may affect the generalizability of our safety findings.

Severe Thrombocytopenia Secondary to Severe Iron Deficiency Anemia due to Menorrhagia

Thrombocytosis is commonly seen in patients with iron deficiency anemia and often normalizes following iron supplementation. Thrombocytopenia with iron deficiency anemia is a less common occurrence that can be seen in severe cases. This phenomenon is well documented in the pediatric population secondary to nutritional deficiency but is underreported in the adult population. Similarly, thrombocytopenia resolves following iron supplementation but the mechanism behind this and why select patients are affected is not well understood. This case report describes a young woman with menorrhagia who was found to have iron deficiency anemia and severe thrombocytopenia with resolution following intravenous iron.

Machine learning approach for differentiating iron deficiency anemia and thalassemia using random forest and gradient boosting algorithms

Formulas based on red blood cell indices have been used to differentiate between iron deficiency anemia (IDA) and thalassemia (Thal). However, they exhibit varying efficiencies. In this study, we aimed to develop a tool for discriminating between IDA and Thal by using the random forest (RF) and gradient boosting (GB) algorithms. Complete blood count data from 1143 patients with anemia and low mean corpuscular volume were collected (382 patients with IDA, 635 with Thal, and 126 with IDA and Thal). The data were randomly divided into the training and testing datasets in a ratio of 80:20. The RF and GB models had good diagnostic performances for predicting IDA and Thal in the training and testing datasets. In the testing dataset for predicting binary outcomes, GB and RF both had an accuracy of 90.7%, and an area under the receiver operating characteristic curve (AUC-ROC) of 0.953. A lower diagnostic performance was observed when patients with IDA and Thal were included. GB and RF showed accuracies of 80.4% and 82.2%, respectively, and AUC-ROC values of 0.910 and 0.899, respectively. In conclusion, we developed a machine learning approach using GB algorithm. This tool is potentially useful in Thal- and IDA-endemic regions.

Association between Neutrophil Percentage-to-Albumin ratio and anemia risk: a population-based study

Anemia remains a significant global health challenge, driven by complex inflammatory mechanisms. This study investigated the association between neutrophil percentage-to-albumin ratio (NPAR) and anemia risk, utilizing data from 24,938 participants in the National Health and Nutrition Examination Survey (2005-2018). Multivariable logistic regression analysis revealed a significant association between NPAR and anemia risk (OR = 1.16; 95% CI 1.13-1.18, p < 0.0001). Two-piecewise regression analysis identified a nonlinear relationship with a threshold at NPAR 11.96: below this threshold, an inverse association was observed (OR = 0.88; 95% CI 0.79-0.98, p = 0.0249), while above it, a positive association was evident (OR = 1.21; 95% CI 1.18-1.25, p < 0.0001). Subgroup analyses demonstrated stronger associations in males, non-Hispanic Whites, diabetic patients, and individuals who were married or living with a partner. These findings highlight the potential of NPAR as a novel biomarker for assessing anemia risk in clinical practice.

Perceptions and Acceptability of a Low Phytate: Iron Molar Ratio Biofortified Bean and Sweet Potato Dish Among Pregnant Women in Rural Uganda

Background: Iron deficiency anemia (IDA) disproportionately affects pregnant women who reside in low-income countries because they predominantly consume staple legumes and tubers such as conventional common beans (CCBs) and white-fleshed sweet potatoes (WFSPs). Such staples are either low in iron or rich in iron absorption inhibitors such as phytates. To fight IDA, a high-iron-biofortified common bean (IBCB) was introduced in Uganda. However, there is limited knowledge about its acceptability among pregnant women. This experimental crossover study determined the sensory acceptability of a low phytate:iron molar ratio dish, WFSP + IBCB (test food), against a high phytate:iron molar ratio dish, WFSP + CCB (control food), among pregnant women in rural Uganda. Their perceptions of consuming the test food during pregnancy were also explored. Methods: A total of 104 pregnant women participated in this study. The sensory attributes (taste, color, aroma, texture, and general acceptability) of the test and control foods were rated using a five-point facial hedonic scale ranging from "dislike very much", "dislike", "neutral", "like", to "like very much". An attribute was acceptable if the participant scored either "like" or "like very much". Focus group discussions (FGDs) were conducted to explore participant perceptions about the factors that may influence them to eat WFSP + IBCB during pregnancy. The chi-square test was used to detect the proportion difference for each sensory attribute within participants between test and control foods, while FGD data were analyzed by thematic analysis. Results: All the sensory attributes were acceptable to the participants and not significantly different between control and test foods (p > 0.05). Participants were willing to consume IBCB if it was affordable, sustainably available, and provided healthy pregnancy outcomes. Conclusions: The sensory attributes of the test food were equally accepted as the control food, suggesting that the consumption of WFSP + IBCB has the potential to replace WFSP + CCB among the study participants. The study participants showed positive perceptions of consuming IBCB if it was accessible, sustainable, affordable, and provided healthy pregnancy outcomes.

Machine learning of blood haemoglobin and haematocrit levels via smartphone conjunctiva photography in Kenyan pregnant women: a clinical study protocol

INTRODUCTION

Anaemia during pregnancy is a widespread health burden globally, especially in low- and middle-income countries, posing a serious risk to both maternal and neonatal health. The primary challenge is that anaemia is frequently undetected or is detected too late, worsening pregnancy complications. The gold standard for diagnosing anaemia is a clinical laboratory blood haemoglobin (Hgb) or haematocrit (Hct) test involving a venous blood draw. However, this approach presents several challenges in resource-limited settings regarding accessibility and feasibility. Although non-invasive blood Hgb testing technologies are gaining attention, they remain limited in availability, affordability and practicality. This study aims to develop and validate a mobile health (mHealth) machine learning model to reliably predict blood Hgb and Hct levels in Black African pregnant women using smartphone photos of the conjunctiva.

METHODS AND ANALYSIS

This is a single-centre, cross-sectional and observational study, leveraging existing antenatal care services for pregnant women aged 15 to 49 years in Kenya. The study involves collecting smartphone photos of the conjunctiva alongside conventional blood Hgb tests. Relevant clinical data related to each participant's anaemia status will also be collected. The photo acquisition protocol will incorporate diverse scenarios to reflect real-world variability. A clinical training dataset will be used to refine a machine learning model designed to predict blood Hgb and Hct levels from smartphone images of the conjunctiva. Using a separate testing dataset, comprehensive analyses will assess its performance by comparing predicted blood Hgb and Hct levels with clinical laboratory and/or finger-prick readings.

ETHICS AND DISSEMINATION

This study is approved by the Moi University Institutional Research and Ethics Committee (Reference: IREC/585/2023 and Approval Number: 004514), Kenya's National Commission for Science, Technology, and Innovation (NACOSTI Reference: 491921) and Purdue University's Institutional Review Board (Protocol Number: IRB-2023-1235). Participants will include emancipated or mature minors. In Kenya, pregnant women aged 15 to 18 years are recognised as emancipated or mature minors, allowing them to provide informed consent independently. The study poses minimal risk to participants. Findings and results will be disseminated through submissions to peer-reviewed journals and presentations at the participating institutions, including Moi Teaching and Referral Hospital and Kenya's Ministry of Health. On completion of data collection and modelling, this study will demonstrate how machine learning-driven mHealth technologies can reduce reliance on clinical laboratories and complex equipment, offering accessible and scalable solutions for resource-limited and at-home settings.

Deferrals for Low Haemoglobin and Anaemia Among First-Time Prospective Blood Donors in Southern Ghana: Results From the BLOODSAFE Ghana-Iron and Nutritional Counselling Strategy Pilot (BLIS) Study

In Ghana, prevalence of anaemia is higher than the worldwide average and contributes to deferral of blood donors. A cross-sectional study was carried out as part of a pilot study aimed at improving haemoglobin levels and promoting repeat donations to retain donors who were deferred due to low haemoglobin. The copper sulphate test was used to determine low haemoglobin and anaemia assessed by the World Health Organization (WHO) gender-specific criteria. Over sixteen months, 1213 donors were eligible, of which 826 (68%) were male and 78 (6.4%) were deferred for low haemoglobin. Among these 78 deferrals, 71 (91%) were female, 77 (99%) were first-time donors and 77 (99%) were voluntary nonremunerated blood donors (VNRBDs). A total of 337 donors consented to provide a blood specimen out of which 325 donors met eligibility criteria and had complete FBC results. Of those, 189 (N = 39 males; N = 150 females), or 58%, were classified as anaemic. Model-based estimates which correct for selection bias in the enrolment process found that 61.6% of female donors (95% credible interval: [53.4%, 70.8%]) and 19.7% of male donors (95% credible interval: [11.5%, 33.8%]) were anaemic by WHO criteria. Among the 252 consenting donors with completed blood specimen analyses and haemoglobin levels meeting the threshold for blood donation, 118 (47%) were classified as anaemic according to WHO criteria. Population-level estimates of anaemia using WHO criteria suggest anaemia is highly prevalent and the results generally matched donor deferral using the copper sulphate test among women blood donors. Trial Registration: ClinicalTrials.gov identifier: NCT04949165.

Global, regional and national epidemiology of anemia attributable to chronic kidney disease, 1990-2021

Background

Chronic kidney disease (CKD) presents a significant global health challenge, with anemia frequently manifesting in the more advanced stages. This study aimed to evaluate the global burden and cross-country inequality of CKD-related anemia from 1990 to 2021.

Methods

Data on CKD-related anemia were extracted from the Global Burden of Disease 2021 study. Trends in prevalence, years lived with disability (YLDs) and corresponding estimated annual percentage changes (EAPCs) from 1990 to 2021 were analyzed at global, regional and national levels. Health inequity analysis methodologies were employed to evaluate cross-country inequality based on sociodemographic index.

Results

In 2021, global CKD-related anemia cases reached 63 751 624 [95% uncertainty interval (UI), 59 045 051-68 372 650], representing a 96.24% increase from 1990 (32 486 224; 95% UI 30 356 876-35 047 084). Notwithstanding this increase, global prevalence [EAPC -0.27; 95% confidence interval (CI) -0.34 to -0.21] and YLDs rates (EAPC -0.66; 95% CI -0.70 to -0.62) generally declined. Females were disproportionately affected, comprising 55.75% of prevalence cases and 65.87% of YLDs numbers in 2021. From 1990 to 2021, the burden increased in individuals with CKD-related anemia associated with type 1 diabetes. Significant cross-country inequalities in prevalence were observed and persisted [slope index of inequality: 255.04 (389.56-120.51) in 1990 to 423.30 (572.78-273.81) in 2021; health concentration index: -0.09 (-0.12 to -0.07) in 1990 to -0.14 (-0.17 to -0.11) in 2021].

Conclusions

Despite the global decline in prevalence and YLDs rates of CKD-related anemia, the number of cases continued to increase, and the burden disproportionately concentrated in less developed countries and territories. This investigation also revealed a gender disparity and the influence of specific causes.

Parvovirus B19-associated pure red cell aplasia in the setting of HIV and competing health risks

An HIV positive, early adolescent girl from rural Southern Africa required multiple hospital admissions for severe normocytic anaemia. As she was virologically suppressed on antiretrovirals, the initial anaemia workup focused on nutritional deficiencies and excluding chronic haemolysis. A lack of readily available expertise and resources contributed to a delay in investigations, during which she was treated symptomatically with blood transfusions. She was later transferred to a tertiary hospital where she was diagnosed with parvovirus B19 (B19V) associated pure red cell aplasia. Intravenous immunoglobulin was administered with a good clinical response. The delayed diagnosis and treatment had a significant impact on her and her family and placed further strain on limited available transfusion resources. This case emphasises that B19V infection should not be overlooked as a cause of anaemia in people living with HIV, irrespective of virological and immunological HIV control. Environmental and age-group-specific risk factors should be considered.

Prevalence and sociodemographic determinants of anemia among ever-married women of reproductive age in Jordan: insights from the 2023 Jordan population and family health survey

BACKGROUND

Anemia, characterized by low haemoglobin levels, remains a critical public health issue, particularly among women of reproductive age. Despite global advancements in addressing anemia, it continues to be a widespread concern in Jordan. This study aims to examine the prevalence of anemia and the sociodemographic factors associated with it among ever-married women aged 15-49 in Jordan, utilizing data from the 2023 Jordan Population and Family Health Survey (JPFHS).

METHODS

This is a secondary analysis was conducted using data from the 2023 JPFHS. The survey employed a two-stage stratified cluster sampling method to collect comprehensive information on haemoglobin levels, sociodemographic characteristics, and various health-related factors. Anemia was classified into mild, moderate, and severe categories based on WHO guidelines, using hemoglobin levels obtained from capillary blood samples analyzed with portable HemoCue photometers. Multivariate logistic regression analysis was then performed to identify the independent predictors of anemia.

RESULTS

Among the 6,249 participants, the prevalence of anemia was 35.33%, with 1,089 cases of mild anemia, 1,022 moderate cases, and 96 severe cases. The highest incidence of severe and mild anemia was observed in the 45-49 age group (41.1% and 20.2%, respectively). Moderate anemia was most prevalent among women aged 35-39 (21.5%), while the highest proportion of non-anemic participants was found in the 30-34 age group (19.7%). Multivariable analysis showed that women living in northern regions had higher odds of anemia (P < 0.0001). Conversely, overweight (P = 0.03), obesity (P = 0.04), and daily smoking (P = 0.002) were associated with lower odds of anemia.

CONCLUSION

Anemia remains a moderate yet concerning public health issue in Jordan, particularly among underweight women and those in northern regions. The findings emphasize the need for targeted nutritional interventions and region-specific healthcare strategies to address anemia risk. Public health programs should focus on improving dietary intake, especially among underweight women, to mitigate anemia and enhance overall women's health outcomes.

The cost-effectiveness of interventions used for the screening, diagnosis and management of anaemia in pregnancy: A systematic review

An estimated 40% of pregnant women worldwide are anaemic, of which 80% live in low- and middle-income countries (LMICs). The reality of finite health budgets, particularly in low-resource settings, means that interventions used for screening, diagnosing, and treating anaemia in pregnancy need to be informed by cost-effectiveness evidence. We conducted a systematic review to identify all studies evaluating the cost-effectiveness of managing anaemia in pregnancy. We searched two health economics (NHS EED and EconLit) and four medical (MEDLINE, Embase, CINAHL Plus and CENTRAL) databases for relevant studies published up to the 9th of August 2024. Studies were eligible if they conducted an economic evaluation of any intervention used in the management of anaemia in pregnancy regardless of aetiology, provided that anaemia was a specified outcome. Data were extracted and study quality assessed by two independent reviewers using the extended CHEC-E tool. Due to significant heterogeneity, data were analysed narratively. 19 eligible cost-effectiveness studies were identified. Nine studies related to iron deficiency anaemia, finding that intravenous rather than oral iron supplements were cost-effective in most instances. Multiple micronutrient supplements were also found to be cost-effective compared to iron and folic acid supplements. Ten studies related to malaria-related anaemia, identifying several cost-effective antimalarial regimens; both preventative and therapeutic. Cost-effective delivery channels of antimalarials as well as non-pharmacological interventions were also identified. This review identifies several avenues through which the management of anaemia in pregnancy can be optimised from an economic perspective. Despite this, there is a significant deficit of cost-effectiveness evidence relating to this condition, which limited the deduction of cost-effectiveness for many of the interventions assessed.

Maternal Anaemia and Congenital Heart Disease in Offspring: A Case-Control Study Using Linked Electronic Health Records in the United Kingdom

OBJECTIVE

Assessment of whether maternal anaemia in early pregnancy is associated with offspring congenital heart disease (CHD).

DESIGN

Matched case-control study.

SETTING

January 1998-October 2020, United Kingdom.

POPULATION

Women with a haemoglobin measurement in the first 100 days of pregnancy and a CHD-diagnosed child.

METHODS

Data were extracted from the United Kingdom Clinical Practice Research Datalink GOLD database of electronic health records. Cases were 2,776 women with a CHD-diagnosed child. These were compared to 13 880 matched controls, women without a CHD-diagnosed child. Anaemia was classified as < 110 g/L haemoglobin following the WHO definition. A conditional logistic regression analysis was conducted, adjusted for potential maternal demographic and health-related confounders.

MAIN OUTCOME MEASURES

Offspring CHD diagnosed within 5 years of birth.

RESULTS

123 (4.4%) cases and 390 (2.8%) controls had anaemia. After adjusting for potential confounders, the odds of giving birth to a CHD-diagnosed child were 47% higher among anaemic mothers (adjusted OR 1.47, 95% CI 1.18,1.83, p < 0.001).

CONCLUSIONS

The observed association between maternal anaemia in early pregnancy and increased risk of offspring CHD supports our recent evidence in mice. Approximately two-thirds of anaemia cases globally are due to iron deficiency. A clinical trial of periconceptional iron supplementation might be a minimally invasive and low-cost intervention for the prevention of some CHD if iron deficiency anaemia is proven to be a cause.

Global, regional and national burden of dietary iron deficiency from 1990 to 2021: a Global Burden of Disease study

Although iron deficiency is well documented, less is known about dietary involvement in symptomatic iron deficiency manifesting in medical conditions. In this study, we quantified the global burden of dietary iron deficiency, focusing on where inadequate dietary iron intake leads to clinical manifestations such as anemia. We analyzed data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to estimate dietary iron deficiency prevalence and disability-adjusted life years (DALYs), stratified by age, sex, geography and socio-demographic index (SDI) across 204 countries. In 2021, global age-standardized prevalence and DALY rates were 16,434.4 (95% uncertainty interval (UI), 16,186.2-16,689.0) and 423.7 (285.3-610.8) per 100,000 population, with rates decreasing by 9.8% (8.1-11.3) and 18.2% (15.4-21.1) from 1990 to 2021. A higher burden was observed in female individual (age-standardized prevalence, 21,334.8 (95% UI, 20,984.8-21,697.4); DALYs, 598.0 (402.6-854.4)) than in male individual ((age-standardized prevalence, 11,684.7 (11,374.6-12,008.8); DALYs, 253.0 (167.3-371.0)). High-SDI countries presented greater improvement, with a 25.7% reduction compared to 11.5% in low-SDI countries. Despite global improvements, dietary iron deficiency remains a major health concern with a global prevalence of 16.7%, particularly affecting female individuals, children and residents in low-SDI countries. Urgent interventions through supplementation, food security measures and fortification initiatives are essential.

Exposure to Endotoxin Oxidized by Atmospheric Ozone Greatly Enhances Anemia

Endotoxin (lipopolysaccharide, LPS), widely distributed in the atmospheric environment with strong immunogenicity, is an important biological component of ambient particulate matter. However, whether LPS participates in atmospheric chemistry and how its biological health impacts change with the relevant processes are poorly understood. In this study, we employed the rat model to investigate the impact of ozone oxidation on the biological toxicity of LPS and used Fourier transform infrared spectroscopy and high-resolution electrospray mass spectrometry to study the underlying reaction mechanisms. The results show that the LPS can be oxidized by ozone and the resulting reactant greatly enhanced inflammatory anemia with a 177% capacity increase despite a minor influence on its immunogenicity. In contrast to the control, rats exposed to oxidized LPS were observed to release characteristic exhaled biomarkers, indicating that the formed reactant indeed altered the biological effects of LPS. Mechanistic investigation reveals that ozone oxidation of the hydroxyl group in the key toxic part of LPS, kdo2-lipid A, can cause dysregulation of iron homeostasis in rats, which is the mechanism of oxidized LPS-enhanced anemia. Unfortunately, these chemical structure changes and the resulting health impacts cannot be detected by the conventional LPS analysis method. This study highlights the changes in the toxicity of LPS and its health impacts when oxidized by ozone and the need to broadly consider the involvement of bioaerosol in atmospheric chemistry.

Associations of metals with hemoglobin and anemia in a Chinese early adolescent cohort

BACKGROUND

The relationship between exposure to metals with hemoglobin levels and anemia in children and adolescents has shown inconsistency. This study aimed to evaluate the associations of individual metals and metal mixtures with hemoglobin levels and anemia risk, as well as potential sex differences, in a Chinese early adolescent cohort.

METHODS

Data was obtained from a Chinese early adolescent cohort with two-year follow-up periods. Serum concentrations of 12 metals were measured using inductively coupled plasma mass spectrometry (ICP-MS). To examine the individual associations of metals with hemoglobin levels and anemia risk, a series of single-metal and multi-metal adjusted generalized linear mixed models (GLMMs) were applied. Additionally, quantile g-computation (qgcomp) and Bayesian kernel machine regression (BKMR) were used to analyze the effects of metal mixture. Furthermore, all analyses were stratified by sex.

RESULTS

The multi-metal adjusted GLMMs identified significant associations of As (β=2.31; 95 % CI: 0.15, 4.47), Cd (β=-2.11; 95 % CI: -4.11, -0.11), Cr (β=-10.19; 95 % CI: -19.09, -1.30), Cu (β=-7.27; 95 % CI: -14.27, 0.26), Fe (β=13.71; 95 % CI: 10.03, 17.38), Pb (β=7.87; 95 % CI: 4.21, 11.5), V(β=-13.60; 95 % CI: -21.32, -5.88), and Zn (β=14.77; 95 % CI: 4.38, 25.15) with hemoglobin concentration, as well as As (OR=0.26; 95 % CI: 0.11, 0.60), Co(OR=4.27; 95 % CI: 1.25, 14.6), Cr (OR=10.49; 95 % CI: 1.61, 68.39), Fe (OR=0.03; 95 % CI: 0.01, 0.12) and Pb (OR=0.18; 95 % CI: 0.04, 0.80) with anemia risk. Moreover, the qgcomp revealed no association of metal mixture with hemoglobin concentration (β=0.94; 95 % CI=-0.45, 2.33) or anemia risk (OR=0.81; 95 % CI: 0.51, 1.27). After stratification by sex, the qgcomp demonstrated no significant overall effect of the metal mixture on hemoglobin concentration or anemia risk in either boys (β=0.93; 95 % CI: -0.84, 2.71 for hemoglobin, and OR=0.64; 95 % CI: 0.27, 1.52 for anemia) or girls (β=0.93, 95 % CI: -1.16, 3.01 for hemoglobin, and OR=0.72; 95 % CI: 0.40, 1.32 for anemia). Similarly, sex-stratified BKMR models also revealed no significant association between the metal mixture and hemoglobin concentration or anemia risk in either boys or girls.

CONCLUSIONS

This study highlights the individual and collective impacts of 12 metals on hemoglobin and anemia during early adolescence, underscoring the need for experimental and larger cohort studies to further corroborate these findings.

Impact of inflammation on anemia in children: a cross-sectional study

INTRODUCTION

The association of inflammation and iron deficiency could be related to up to 40% of anemia in young children.

OBJECTIVE

To describe the anemia and iron deficiency in children and verify possible associations with dietary practices, nutritional status and inflammatory markers.

METHODS

This cross-sectional study was conducted with one hundred and twelve children aged between 6 months and 3 years in Early Childhood Education Centers in Minas Gerais, Brazil. Nutritional status regarding iron and inflammatory markers was assessed using the reference values proposed by the World Health Organization.

RESULTS

Anemia and iron deficiency were observed in 58 (51.8%) and 89 (79.5%), respectively, of children evaluated. Hemoglobin values were directly associated with the z-score of height for age after adjusting for high-sensitivity C-reactive protein values (β-adjusted = 0.375; 95% CI 0.088 to 0.662; p = 0.011). The values of high-sensitivity C-reactive protein correlated directly with RDW (r = 0.202; p = 0.033), ferritin (r = 0.425; p < 0.001) and soluble transferrin receptor (r = 0.446; p < 0.001), and inversely with hemoglobin (r = -0.287; p = 0.002), serum iron (r = -0.580; p < 0.001) and transferrin saturation index (r = -0.528; p < 0.001). The ROC curve shows that RDW (AUC = 0.708; CI 95% 0.612 to 0.803) and soluble transferrin receptor (AUC = 0.588; 95% CI 0.481 to 0.694) were the variables that showed the better level of discrimination of anemia.

CONCLUSIONS

The prevalence of anemia was higher than in national studies, and there was a correlation between inflammatory markers and biomarkers of iron nutritional status.

The prevalence of anemia, iron deficiency, and iron deficiency anemia in adult migrants in Nigde, Turkey

OBJECTIVES

Anemia is a significant public health concern, particularly among migrants. The aim of this study was to evaluate the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) among adult migrants in Nigde.

METHODS

This retrospective study included a total of 2378 adult migrants who were admitted to Nigde Omer Halisdemir University Training and Research Hospital. The complete blood count, serum iron, unsaturated iron-binding capacity, transferrin saturation, and serum ferritin levels of all migrants were analyzed. The status and severity of anemia and ID were determined according to the definitions of the World Health Organization.

RESULTS

Out of the migrants, 77.2% were female. The migrants originated from 40 different countries, with the majority of them coming from Syria (41.4%), followed by Afghanistan (27.3%), Iraq (9.1%), Iran (9.1%), and other countries (13.1%). The prevalence of anemia, ID, and IDA among adult migrants was 20.8%, 23.8%, and 14%, respectively. In females, the prevalence of anemia, ID, and IDA in 25.5%, 29.9%, and 17.7%, respectively. In males, the prevalence of anemia, ID, and IDA was 4.8%, 3.1%, and 1.6%, respectively. 57.5% of the anemia cases were mild anemia and 57.9% were microcytic anemia. IDA accounted for 67.6% of total cases of anemia, 69.4% of females with anemia, and 34.6% of males with anemia. Serum iron, ferritin, and mean corpuscular volume (MCV) levels in Syrians were significantly lower than those in all other countries.

CONCLUSION

Anemia among adult migrants was a moderate public health concern. IDA is the most common cause of anemia in females, but not in males. The prevalence of anemia, ID and IDA varied significantly by geography and gender. Public awareness, screening and prevention programs on iron supplementation and food fortification should be implemented to reduce the prevalence of anemia in at-risk populations.

Disease Burden, Temporal Trends, and Cross-Country Inequality Associated with Sociodemographic Indicators in Alzheimer's Disease and Other Dementias

INTRODUCTION

The purpose of this article is to describe the global burden and temporal trends of Alzheimer's disease and other dementias from 1990 to 2021 and explore cross-country inequality associated with sociodemographic development-related factors.

METHODS

The disability-adjusted life years of Alzheimer's disease and other dementias and sociodemographic index were extracted from the Global Burden of Disease 2021 study, and other sociodemographic development-related factors, including government expenditure on education (% of GDP), net national income per capita, health expenditure per capita, and fertility rate, were sourced from World Bank Data. Disability-adjusted life years of Alzheimer's disease and other dementias across 204 countries/territories and global age-sex distribution in 2021 were illustrated. The Joinpoint regression model was used to analyze the temporal trends of disease burden, and the slope index of inequality and concentration index were calculated to quantify cross-country inequalities. Analyses were conducted in 2024.

RESULTS

Significant disparities were observed in the numbers, rates, and age-standardized rates of disability-adjusted life years across 204 countries/territories. Females demonstrated higher disability-adjusted life year numbers (rates) for all age groups. Age-standardized disability-adjusted life year rate increased worldwide and was high in high-middle and middle sociodemographic index regions but increased faster in low (average annual percentage change=0.227%) and low-middle (average annual percentage change=0.244%) sociodemographic index regions. Cross-country inequality analyses indicated that disability-adjusted life years of Alzheimer's disease and other dementias were skewed and higher in countries with higher sociodemographic development, and the inequality increased with time except for education expenditure-related inequality.

CONCLUSIONS

The burden of Alzheimer's disease and other dementias has risen globally over the past 3 decades, accompanied by increasing cross-country inequalities, which disproportionately affects countries with high sociodemographic development. Boosting expenditure on education may narrow this inequality.

Papilledema

OBJECTIVE

This article describes the recognition, investigation, and management of papilledema.

LATEST DEVELOPMENTS

Papilledema describes optic disc swelling (usually bilateral) arising from raised intracranial pressure. Due to the serious nature of papilledema, there is a fear of underdiagnosis and hence one of the major stumbling points is the correct identification of papilledema. While there has been a stepwise increase in the incidence and prevalence of idiopathic intracranial hypertension due to the worldwide epidemic of people living with obesity, secondary causes such as cerebral venous sinus thrombosis, intracranial masses, and infections must not be missed. Our ability to image the optic nerve has been greatly enhanced by the directed use of optical coherence tomography, with recent studies observing novel imaging findings that can help distinguish pseudopapilledema from papilledema. The structured investigation of papilledema is now routine and research into the management of CSF disorders is finding new avenues for targeted treatments.

ESSENTIAL POINTS

Confirmation of papilledema typically requires a thorough ocular examination including visual field testing. Ocular imaging such as color fundus photographs and optical coherence tomography are useful. Joint care between ophthalmologists and neurologists is key to treating the underlying condition and managing any visual dysfunction and headache.

What works for anemia reduction among women of reproductive age? Synthesized findings from the exemplars in anemia project

BACKGROUND

Few countries have succeeded to decrease the prevalence of anemia in women of reproductive age (WRA), and where improvements have been observed, contributing factors are not well understood.

OBJECTIVES

To synthesize cross-cutting findings from specific exemplar studies in Uganda, Senegal, the Philippines, and Pakistan by reviewing anemia trends, policies, and programs, comparing drivers of change, and proposing strategies to achieve further reductions in WRA anemia.

METHODS

A mixed-methods approach was used for exemplar case studies: 1) descriptive analyses of Demographic and Health Surveys and national survey data; 2) review of relevant policies/programs; 3) stakeholder in-depth interviews and focus group discussions with WRA and community members; and 4) Oaxaca-Blinder decomposition to identify determinants of hemoglobin change over time. This cross-country analysis performs triangulation of qualitative and quantitative analyses.

RESULTS

Compound annual change rates for anemia from the ∼2005-2018 period were -0.7% in Senegal, -2.4% in Uganda, -3.4% in Pakistan, and -6.2% in the Philippines. Despite these reductions, WRA anemia burden in Senegal and Pakistan continues to be a severe public health problem. Direct and indirect health sector strategies, such as iron-folic acid supplementation in pregnancy, vitamin A supplementation during lactation, malaria control (Uganda and Senegal), investments in family planning, and better access to health services through community-based approaches, contributed to a median of 36.5% (range: 30%-66%) change in hemoglobin. Nonhealth sector strategies, including social protection and poverty alleviation schemes, empowering of girls and women, and improving household conditions, contributed to a 21% (18%-58%) change in hemoglobin. Large-scale food fortification (for example, wheat flour with iron) could have also contributed to improved micronutrient intakes and reduction in iron deficiency anemia.

CONCLUSIONS

A context-specific, multisectoral approach is needed to decrease WRA anemia, incorporating direct nutritional interventions and indirect strategies within the health and nonhealth sectors. Lessons from the successes and challenges from exemplar countries could help accelerate global anemia reduction.

Prevalence and patterns of testing for anaemia in primary care in England: a cohort study using an electronic health records database

BACKGROUND

Despite epidemiological data on anaemia being available on a global scale, the prevalence of anaemia in the UK is not well described.

AIM

To describe anaemia prevalence and testing patterns for haemoglobin and other blood parameters.

DESIGN AND SETTING

This study was a descriptive population-based cohort study using data drawn from the Clinical Practice Research Datalink Aurum database in 2019.

METHOD

Demographic data were extracted for each person who was registered at their current practice during 2019, including linked data on Index of Multiple Deprivation. Anaemia prevalence in 2019 was calculated based on World Health Organization-specified age and gender thresholds for haemoglobin. Anaemia was classified based on mean corpuscular volume and ferritin. People with anaemia were followed up for up to 1 year to investigate longitudinal testing patterns for haemoglobin.

RESULTS

The cohort contained 14 million people. Anaemia prevalence in England in 2019 was 4.1% (583 847/14 207 841) (5.1% [363 438/7 121 614] females and 3.1% [220 409/7 086 227] males). Prevalence was higher in people aged >65 years, people of Black and Asian ethnicities, and people living in areas with higher social deprivation. Only half of people with anaemia and a mean corpuscular volume of ≤100 fL had an accompanying ferritin value recorded. About half of people with anaemia had a follow-up haemoglobin test within 1 year, most of which still indicated anaemia.

CONCLUSION

Anaemia is prevalent in the UK with large disparities between levels of demographic variables. Investigation and follow-up of anaemia is suboptimal in many patients. Health interventions aimed at improving anaemia investigation and treatment are needed, particularly in the most at-risk groups.

Global, regional and national temporal trends in Parkinson's disease incidence, disability-adjusted life year rates in middle-aged and older adults: a cross-national inequality analysis and Bayesian age-period-cohort analysis based on the global burden of disease 2021

BACKGROUND

Parkinson's disease (PD) ranks as the second most prevalent neurodegenerative disorder; however, its epidemiological characteristics among middle-aged and older adults at global, regional, and national levels remain inadequately documented.

METHODS

This study assessed temporal trends in PD among middle-aged and older adults by extracting incidence rates, disability-adjusted life year (DALY) rates, and corresponding age-specific rates (ASRs) from the Global Burden of Disease (GBD) database spanning 1990 to 2021. Estimated annual percentage change (EAPC) was employed to analyze trends over the past 30 years. The slope index of inequality (SII) and concentration index (CI) were utilized to evaluate disparities in the burden of PD across various countries. Additionally, Bayesian age-period-cohort (BAPC) modeling was applied to project DALY figures for the next 15 years.

RESULTS

In 2021, the global incidence and DALY rates for middle-aged and older adults with PD stood at 79.68 and 477.50 cases per 100,000 population, respectively. Both incidence and DALY rates have exhibited an upward trajectory over the past 32 years, with EAPCs of 1.2 (95% UI: 1.1-1.3) and 0.6 (95% UI: 0.5-0.7), respectively. Among the five sociodemographic index (SDI) regions, the high-middle SDI region reported the highest incidence and DALY rates for PD in 2021, at 93.93 and 512.29 cases per 100,000 population, respectively. A positive correlation was observed between the SDI and age-specific incidence rate (ASIR) as well as age-specific DALY rate (ASDR). Disparities in the burden of PD among middle-aged and older adults, associated with SDI, are on the rise and are primarily concentrated in high SDI countries. It is projected that the global incidence and DALY rates for middle-aged and older adults with PD will experience significant increases over the next 15 years.

CONCLUSIONS

The global burden of PD among middle-aged and older adults has markedly escalated over the past 32 years, particularly in high-middle SDI regions. These findings underscore the necessity for the development of effective interventions and public health policies, contributing to the attainment of the sustainable development goals established by the World Health Organization (WHO).

A metal-polyphenol network-based iron supplement with improved stability and reduced gastrointestinal toxicity for iron deficiency anemia therapy

Iron deficiency anemia (IDA) is a global health concern, particularly affecting women and children of reproductive age. Although oral iron supplements are the standard treatment for IDA, their bioavailability is often compromised by food interactions, and they are associated with significant gastrointestinal side effects. To overcome these limitations, we developed a novel iron nano-supplement, TA-Fe NPs, based on metal-polyphenol networks (MPNs) formed through the coordination of tannic acid (TA) and Fe3+. These uniform nanoparticles (∼190 nm) offer enhanced chemical stability and reduced food interference compared to traditional iron supplements. The polyphenolic TA component provides antioxidant properties, effectively mitigating oxidative stress and inflammation induced by free iron ions. To further improve stability and intestinal absorption, TA-Fe NPs were encapsulated in an enteric coating (TA-Fe@L100) to protect against acidic conditions in the stomach. In a mouse model of IDA, TA-Fe@L100 demonstrated superior therapeutic efficacy compared to FeSO4, including improvements in hematological parameters, organ iron storage, and gut microbiota balance. Importantly, TA-Fe@L100 alleviated common gastrointestinal side effects associated with iron supplementation, presenting a promising alternative for IDA treatment. Our findings suggest that TA-Fe@L100 is a cost-effective and biocompatible oral iron supplement with minimal side effects, offering significant potential for broader clinical application in the management of IDA.

Anemia in Asian children: trends in the prevalence, etiology and analysis of geographic inequalities

BACKGROUND

Pediatric anemia is a pervasive public health issue in Asia, significantly impairing children's growth, cognitive development, and future potential. This study evaluates trends, prevalence, and socio-economic disparities of pediatric anemia across Asia from 1990 to 2021, leveraging data from the Global Burden of Disease Study (GBD) 2021 study.

METHODS

Using estimated annual percentage change (EAPC) and Pearson's correlation coefficient, geographic variations and temporal trends were analysed alongside associations between prevalence, years lived with disability (YLDs), and Socio-demographic index (SDI).

RESULTS

The study reveals a modest overall decline in anemia prevalence by 11.9%, from 464.53 million cases in 1990 to 409.07 million in 2021. High-SDI regions such as East Asia achieved significant reductions (- 71.36%), with countries like Singapore, the Republic of Korea, Seychelles, Qatar, and the United Arab Emirates (UAE) showing substantial progress. In stark contrast, low-SDI countries, including Yemen (108.34%) and Afghanistan (130.28%), along with Cambodia, India, and Pakistan, experienced alarming increases. Dietary iron deficiency was the dominant cause, followed by hemoglobinopathies and neglected tropical diseases. Females, particularly adolescents, and children under five faced disproportionate burdens, with prevalence rates in low-SDI regions exceeding 47,000 per 100,000 compared to < 10,000 per 100,000 in high-SDI areas.

CONCLUSIONS

These findings emphasize profound regional and socio-economic inequalities in anemia burden. Urgent, evidence-based interventions are imperative, focusing on enhancing nutrition, expanding healthcare access, and integrating sex-sensitive strategies to address this multifaceted issue. Strengthened policies and targeted actions are critical to mitigating the burden and fostering health equity, particularly in vulnerable low-SDI regions.

Factors that influence anemia prevalence: a comparative study of datasets from Russia and South Africa

BACKGROUND

The prevalence of anemia is heterogeneous: different countries and population groups face varying risks of the disease. By identifying social, demographic, and economic factors, policymakers can define risk groups based on lifestyle and tailor measures to address the disease. This study examines and compares socioeconomic factors associated with anemia using data from two national surveys. The Russian survey relied solely on questionnaires, while the South African survey included medical examinations to confirm anemia cases.

METHODS

Multinomial regression was employed to estimate the risks of anemia using a combination of socioeconomic factors.

RESULTS

An inverse relationship was observed between bad habits and the risk of anemia in both samples. Education, income, and regular food consumption were found to be insignificant variables in both samples. However, household property ownership emerged as a significant factor. In South Africa, an inverse relationship with anemia risk was identified for households owning electric/gas ovens (OR = 0.769, 95% CI: 0.613-0.967, p ≤ 0.05) and washing machine (OR = 0.699, 95% CI: 0.564-0.866, p ≤ 0.01. Increased efforts for housekeeping also manifest themselves as increased risk to be anemic if an individual grows vegetables and fruits (OR = 1.333, 95% CI: 1.063-1.671, p ≤ 0.05). In Russia, factors associated with a higher socioeconomic status-such as owning a computer (OR = 0.754, 95% CI: 0.629-0.905, p ≤ 0.01), car (OR = 0.757, 95% CI: 0.610-0.938, p ≤ 0.05), or DVD player (OR = 0.819, 95% CI: 0.684-0.981, p ≤ 0.05) - were linked to a lower risk of anemia. Additionally, the habit of seeking medical help rather than self-medicating was negatively associated with anemia in the Russian sample (OR = 0.774, 95% CI: 0.704-0.850, p ≤ 0.01).

CONCLUSIONS

The comparison of socio-economic factors influencing the prevalence of anemia between Russian and South African samples has validated self-assessments as a reliable proxy for health status in the context of Russia. This methodological advancement underpins current and future research based on the extensive database of the Russia Longitudinal Monitoring Survey, encompassing approximately 2,500 indicators, to investigate disease prevalence.

Association between dietary patterns and anemia in older adults: the 2015 China adults chronic diseases and nutrition surveillance

BACKGROUND

Anemia is a condition that has been affected 1.92 billion people worldwide in 2021, leading physical decline, functional limitation and cognitive impairment. However, there are currently fewer studies focusing on the relationship between anemia and dietary patterns in older adults. This study aimed to analysis the dietary patterns in older adults aged 60 and above in China and their association with anemia.

METHODS

The data was obtained from the 2015 Chinese Adults Chronic Diseases and Nutrition Surveillance (2015 CACDNS), dietary information was collected using the food frequency method within the past year, exploratory factor analysis was used to extract dietary patterns, and logistic regression was used to analyze the relationship between dietary patterns and anemia.

RESULTS

A total of 48,955 elderly people were included, and the number of anemia patients was 4,417 (9.02%). Four dietary patterns were categorized by the exploratory factor analysis, two dietary patterns have been found to have a statistically significant relationship with the prevalence of anemia. Compared to the first quintile, the fifth quintile of dietary pattern 2 (DP2), characterized by high intake of rice and flour, fresh vegetables, livestock and poultry meat, aquatic products, was associated with higher prevalence of anemia in older adults (OR = 1.412, 95%CI: 1.273-1.567, P < 0.0001), and the trend test results showed that score of this dietary pattern was associated with higher prevalence of anemia (p for trend < 0.0001). Compared to the first quintile, Dietary Pattern 4 (DP4), rich in fungi and algae, fried dough products, other grains, various beans, and rice and flour, was linked to lower prevalence of anemia of the fifth quintile (OR = 0.768, 95% CI: 0.674-0.874, P < 0.0001). And DP4 score was associated with lower prevalence of anemia (P for trend < 0.0001).

CONCLUSIONS

There were differences in dietary patterns among elderly people over 60 in China, and the prevalence of anemia in older adults was related to DP2, and DP4.

A global analysis of the burden of ischemic heart disease attributable to diet low in ω-3 fatty acids between 1990 and 2021

AIM

Ischemic heart disease (IHD) is a major contributor to global mortality and disability, imposing a significant health and economic burden on patients and society. Despite existing treatment options including medications and surgeries, their effectiveness remains limited, with issues such as suboptimal treatment outcomes and high recurrence rates. This study aims to investigate the relationship between low dietary intake of ω-3 fatty acids and the burden of IHD, hoping to provide new insights into the prevention and treatment of IHD.

METHOD

Using the Global Burden of Disease (GBD) 2021 dataset, we examined the impact of low ω-3 dietary intake on the burden of ischemic heart disease (IHD) between 1990 and 2021globally, regionally, temporally. The Joinpoint regression model was applied to analyze the trend of IHD burden attributed to low ω-3 dietary intake over time.

RESULTS

In 2021, the global IHD-related Disability-Adjusted Life Years (DALYs) and deaths caused by a low ω-3 diet was 15,511,020(95% UI: 3,098,820 to 25,946,110) and 627,340 (95% UI: 119,540 to 1,082,740), accounting for 8.23% (95% UI: 1.64-13.52%) of all IHD-related DALYs and 6.97% (95% UI: 1.33-11.76%) of all IHD deaths, respectively. From 1990 to 2021, there was a significant upward trend in DALYs and deaths, but age-standardized DALYs and death rates showed a declining trend. Regional analysis indicated that the burden of IHD was highest in South Asia and lowest in High-Income Asia Pacific regions. At the national level, India, China, the United States, and Pakistan had a higher burden of IHD. Furthermore, as the Socio-Demographic Index (SDI) increased, the burden of IHD caused by a low ω-3 diet gradually decreased.

CONCLUSION

This study untangles a significant association between a low ω-3 diet and the burden of IHD, emphasizing the importance of promoting healthy eating habits globally. Future research should further explore the impact of dietary changes on the burden of IHD and develop targeted public health policies to reduce the burden of IHD.

Preoperative Anemia and Iron Deficiency in Elective Gastrointestinal Cancer Surgery Patients

BACKGROUND AND OBJECTIVES

Preoperative anemia can impact postoperative outcomes, but its importance in gastrointestinal cancer patients, and significance of anemia etiology remains unclear. We aimed to characterize the frequency and impact of preoperative anemia, and iron-deficiency anemia (IDA), on perioperative outcomes.

METHODS

We performed a retrospective cohort study of adult patients undergoing elective gastrointestinal cancer surgery. The primary outcome was the incidence of perioperative RBC transfusion. Secondary outcomes included 90-day postoperative major morbidity, ICU admission, and 90-day hospital readmission. Multivariable analyses were performed to assess the association between preoperative anemia and IDA and outcomes.

RESULTS

Preoperative anemia was present in 55.5% of patients (n = 15 414), and 58.3% of anemic patients were iron deficient. Preoperative anemia was independently associated with increased risk of RBC transfusion (RR 2.88, 95% CI 2.60-3.20), and secondary outcomes. For every preoperative hemoglobin decrease of 1 g/dL, the adjusted risk of perioperative RBC transfusion increased by 40% (RR 1.39, 95% CI 1.37-1.42).

CONCLUSION

Preoperative anemia is prevalent, and an independent risk factor for adverse postoperative outcomes. Decreases in preoperative hemoglobin levels elevate the risk of transfusion and adverse outcomes, supporting further study to optimize management of treatable causes of preoperative anemia including IDA.

Food Insecurity, Anemia and Vitamin A Deficiency in Brazilian Children Aged between 6 and 59 Months of Age: Brazilian National Survey on Child Nutrition (ENANI-2019)

Background

Anemia and vitamin A deficiency (VAD) can be related to poverty and food insecurity (FI), which can increase risk of stunting and delayed child development.

Objectives

This study aims to assess the association between FI and the occurrence of anemia and VAD in Brazilian children aged 6-59 months.

Methods

Data from 6020 children from the Brazilian National Survey on Child Nutrition (2019) were used. FI was assessed using the Brazilian Food Insecurity Scale, classifying households into food security (FS) and FI levels. The outcomes were anemia [hemoglobin <10.5 g/dL (6-23 months) and hemoglobin <11 g/dL (24-59 months)] and VAD (retinol corrected by C-reactive protein <0.7 μmol/L). FI frequencies, anemia, and VAD prevalences were calculated according to FI levels, 95% confidence intervals (CIs), and P-trend. The adjusted prevalence ratio (PR) was estimated using quasi-Poisson regression.

Results

The prevalence of mild, moderate, and severe FI was 37.7% (95% CI: 32.0%, 43.4%), 6.2% (95% CI: 4.8%, 7.6%), and 4.2% (95% CI: 3.1%, 5.3%), respectively. The prevalence of anemia was 7.1% (95% CI: 5.9%, 8.3%), and VAD was 3.0% (95% CI: 2.5%, 3.6%). A significant linear trend (P-trend < 0.001) was observed in the prevalence of anemia according to the degree of FI: severe (15.5%; 95% CI: 8.1%, 22.9%), moderate (10.0%; 95% CI: 5.4%, 14.6%), mild (6.6%; 95% CI: 4.9%, 8.3%), and FS (6.4%; 95% CI: 4.7%, 8.1%). Children living in households with severe FI had an 82% higher prevalence of anemia (PR: 1.82; 95% CI: 1.40, 4.17) than those living in FS. A significant linear trend (P-trend < 0.001) was observed in the prevalence of VAD according to the degree of FI: severe (3.3%; 95% CI: 0.0%, 6.7%), moderate (5.8%; 95% CI: 2.3%, 9.2%), FI (2.8%; 95% CI: 1.9%, 3.7%), and FS (2.9%; 95% CI: 2.1%, 3.7%). No association was observed between FI and VAD.

Conclusions

Severe FI was associated with anemia among Brazilian children aged 6-59 months.

Maternal Anemia as a Predictor of Childhood Anemia: Evidence from Gambian Health Data

BACKGROUND

Iron deficiency anemia (IDA) is a significant global health problem affecting close to 2 billion people worldwide. The prevalence of IDA is higher among children younger than five years and women of reproductive age, indicating an intergenerational correlation between maternal and child anemia. This study aims to analyze the association between maternal and child anemia in The Gambia.

METHODS

A nationally representative dataset comprising 3249 children under the age of five, obtained from The Gambia Demographic and Health Survey (2019-2020), was utilized for empirical analyses. Multivariate linear regression models were employed to assess the association between maternal and child anemia. The multivariate models were adjusted for various confounding variables, including birth order, age, and the gender of the child, as well as maternal education, religion, wealth quintiles, rural residence, and region-fixed effects.

RESULTS

Fifty-three percent of children and 52% of mothers are anemic. Children from poorer households show a higher rate of anemia compared to those from wealthier households. Maternal anemia was significantly associated with the anemia status of the children. Children born to anemic mothers were 13.5% more likely to be also anemic (p < 0.001). The correlation coefficient between mother and child hemoglobin levels is 0.165 (p < 0.001). The correlation coefficient between maternal and child anemia is higher among the bottom three wealth quintiles than the top two wealth quintiles.

CONCLUSIONS

The significant intergenerational association between maternal and child anemia status highlights the need for targeted, multi-pronged strategies to combat the adverse impacts of anemia. Maternal anemia, in general, appears to influence childhood anemia beyond just the pregnancy period. Shared socioeconomic environment, dietary patterns, and exposure to infections likely contribute to this intergenerational association.

Systematic Review and Meta-Analysis: Iron Deficiency and Iron Deficiency Anemia Among Military Recruits Undergoing Basic Combat Training

INTRODUCTION

The first period of military service consists of a physically and mentally challenging basic combat training (BCT) program. Factors like demanding physical exercise, limited recovery time, and restricted diet choice and food intake may challenge iron intake and homeostasis in recruits undergoing BCT. Iron-deficient individuals may experience reduced work capacity, fatigue, weakness, frequent infections, and increased injury risk. Limited knowledge is available on the extent of this potential health risk among military recruits. The aim of the present study was to systematically review published studies on the prevalence and change in prevalence of anemia, iron deficiency (ID), and ID anemia (IDA) among recruits undergoing BCT.

MATERIALS AND METHODS

Electronic searches were conducted in the databases Medline (Ovid), Embase (Embase.com), and Web of Science (Clarivate Analytics) from database inception up until April 16, 2024. Inclusion criteria were observational studies with both cross-sectional and observational longitudinal designs that examined the effects of BCT (intervention) on iron status (outcome) in military recruits (population). Extracted data were the number of participants (n), age, sex, country/population, BCT duration, and relevant measures of prevalence and changes in prevalence of anemia, ID, and IDA (primary outcome) and physical performance, mood state, stress fractures, attrition rate, and nutritional supplements (secondary outcomes). The study quality and risk of bias were assessed using the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data and The National Institutes of Health Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group. Meta-analyses were performed using restricted maximum-likelihood models, and the effect size was calculated as Cohen's h with 95% CI.

RESULTS

Twenty-two articles were systematically reviewed (n = 111,764 men and 12,650 women), and six of these papers (n = 388 men and 773 women) were included in the meta-analysis. There was a varying prevalence of anemia, ID, and IDA among military recruits at the start of BCT. Results from meta-analyses showed negligible and nonsignificant effects of BCT on the prevalence of anemia, ID, and IDA. The quality of the included cross-sectional studies ranging from fair to good, whereas a large proportion of the included longitudinal studies were classified as poor. No sign of publication bias was found.

CONCLUSIONS

The prevalence of anemia, ID, and IDA in military recruits seems not to be affected by the completion of BCT shorter than 16 weeks, whereas the effects of longer BCT durations remain unclear. Even though body iron homeostasis seems unaffected, adequate energy and nutritional intake should remain a priority. Future research could focus on dietary interventions to determine the optimal diet among female recruits in specifically exposed populations.

Prevalence, sub-types, and associated factors of anemia among inpatients at a tertiary psychiatric hospital in Tanzania: a cross-sectional study

BACKGROUND

Anemia has been linked to psychiatric disorders including depression, bipolar disorder, and schizophrenia. Studies have demonstrated an association between anemia and worsening clinical presentation and treatment outcomes of these disorders. This study aimed to assess the prevalence and factors associated with anemia among adult patients admitted at Mirembe National Mental Health Hospital (MNMH) in Dodoma, Tanzania.

METHODS

A cross-sectional analytical study was conducted at MNMH among 265 adults admitted at the hospital. Socio-demographic and clinical variables were collected using a closed-ended questionnaire, and anemia and other hematological indices were assessed via complete blood count (CBC). Data were entered into an Open Data Kit (ODK) app and analyzed using SAS version 9.4. Chi-squared test was used initially to assess association between individual exposures and the outcome, anemia. Variables with a p-value < 0.20 from the chi squared analysis were fitted into a logistic regression model to determine their odds of association with anemia. Odds ratios from adjusted regression analysis were used to identify factors independently associated with anemia. Significance level was set at p value < 0.05.

RESULTS

The prevalence of anemia among adult patients admitted at MNMH was 44% (CI 38.08, 50.36). The majority of participants had mild anemia (74.36%). Microcytic hypochromic and normocytic normochromic were the common types of anemia (47% and 46% respectively). Being male, institutionalization, and using Olanzapine was associated with anemia among participants at bivariate analysis, however, only institutionalization remained as a statistically significant factor associated with anemia at multivariable analysis (AOR:5.742, 95% CI 2.048, 16.105).

CONCLUSIONS

Comprehensive care strategies addressing anemia among psychiatric inpatients are crucial, extending beyond psychiatric symptoms to address factors related to prolonged admission, such as nutritional considerations. It is recommended that regular screening for anemia be implemented among psychiatric inpatients and efforts should be made to investigate and address the underlying causes of anemia among this population.

Preoperative Anemia as a Predictor of Periprosthetic Joint Infection Following Total Knee Arthroplasty: A Continuous Variable Analysis

BACKGROUND

Preoperative anemia, defined by the World Health Organization as hemoglobin levels below 12.0 g/dL in women and below 13.0 g/dL in men, has been associated with postoperative complications following total knee arthroplasty (TKA). This study sought to utilize preoperative hemoglobin levels to assess the risk of early postoperative adverse events following elective TKA.

METHODS

An inpatient and outpatient encounters database was utilized to identify all primary TKA patients between 2016 and 2021 who had a preoperative hemoglobin value within 28 days of surgery. Restricted cubic splines were generated utilizing multivariable logistic regression models to assess the relationship between hemoglobin, as a continuous variable, and the 90-day risk of periprosthetic joint infection (PJI), aggregate medical complications, and aggregate surgical complications. Hemoglobin changepoints were identified beyond which the risk of PJI significantly increased. In total, 61,857 TKA patients (women: 37,800 [61.1%]; men: 24,057 [38.9%]) were identified with preoperative hemoglobin values, of which 367 (0.60%) developed a PJI.

RESULTS

The risk of PJI, aggregate medical complications, and aggregate surgical complications was found to significantly increase for patients who had a hemoglobin < 13.0 g/dL (men < 13.0 g/dL; women < 12.7 g/dL). Patients who had a hemoglobin of 10 g/dL had a 1.86-fold (95% confidence interval [CI]: 1.44 to 2.41) increased risk of PJI, a 2.72 (CI: 2.56 to 2.90) times increased risk of medical complications, and a 2.16-fold (CI: 1.82 to 2.57) increased risk of aggregate surgical complications. No increased risk of adverse events was found for hemoglobin values > 13.0 g/dL.

CONCLUSIONS

Preoperative anemia is associated with early postoperative adverse outcomes, including PJI, following elective TKA. Further study is necessary to determine if correction of low preoperative hemoglobin decreases is associated with decreased complication rates or if low hemoglobin values are a surrogate for chronic diseases that increase the postoperative risk of complications.

Prevalence of suspected anemia in Japanese young children determined using noninvasive hemoglobin measurements: an observational study

Recently, noninvasive spot hemoglobin measurement (SpHb) using Pulse CO-Oximeter Rad-67™ Spot-check (Rad-67) has been validated, although anemia diagnosis typically relies on blood hemoglobin concentration measurement. In this large-scale survey of Japanese children aged 1-5 years, we evaluated SpHb distribution to understand the prevalence of suspected anemia, and further examined the relationship between SpHb and background factors. Children were recruited from large retail stores in Japan between November 2022 and August 2023. SpHb was measured by nutritionists or registered dietitians using Rad-67. Four thousand one hundred thirty-three participants were included and stratified by age and sex. The prevalence of children below the World Health Organization threshold value for anemia was found to be 5.2% in total (ranging between 2.6% and 7.8% in subgroups). Mean SpHb values increased with age, and were higher in boys. Age and sex were independently related to SpHb. Overall, this study shows that approximately 3%-8% of young children in Japan are suspected to be anemic.

The association of metabolic disorders and prognosis in cancer patients

OBJECTIVE

Metabolic disorders are common in cancer patients. This study aimed to classify the metabolic disorder status of cancer patients using hematological indicators and to examine the association between disorder types and prognosis.

METHODS

A cohort of 6307 patients from INSCOC was classified into three clusters via K-means clustering based on hematological indicators. Logistic regression and Cox models assessed each cluster's impact on adverse outcomes.

RESULTS

A total of 6,307 participants were included in the study, K-means clustering divided the population into three groups, Cluster 1 (Normal Group, NG), Cluster 2 (Mild Disorder Group, MDG) and Cluster 3 (Severe Disorder Group, SDG). Compared to NG, MDG (OR = 2.268; 95% CI: 1.967-2.616) and SDG (OR = 4.317; 95% CI: 2.441-7.634) had significantly higher risks of sarcopenia. MDG (OR = 1.943; 95% CI: 1.717-2.198) was associated with a higher risk of moderate malnutrition, and both MDG (OR = 3.786; 95% CI: 3.282-4.368) and SDG (OR = 14.501; 95% CI: 6.847-30.709) were identified as risk factors for severe malnutrition (p < 0.05). Cox regression analysis indicated that MDG and SDG were independent risk factors for all-cause mortality (MDG: HR = 1.460, 95% CI: 1.341-1.590; SDG: HR = 2.257, 95% CI: 1.622-3.140) and cancer-specific mortality (MDG: HR = 1.192, 95% CI: 1.039-1.367; SDG: HR = 2.068, 95% CI: 1.825-2.343) (p < 0.05).

CONCLUSION

K-means clustering effectively categorized metabolic disorder subgroups, supporting targeted interventions and demonstrating a significant link between disorder severity and adverse outcomes.

The utility of inpatient work-up of incidental anemia during hospitalization for an acute medical condition: A retrospective cohort study

INTRODUCTION

The best timing for evaluation of anemia is not well defined and the clinical yield of performing workup during non-anemia-related hospitalization is unclear. We aimed to evaluate the prognostic value of inpatient laboratory anemia evaluation.

METHODS

This was a retrospective propensity-matched cohort study between the years 2013-2022 in Rabin Medical Center Israel. We included all patients admitted for non-anemia-related reasons and were found to be anemic. Patients were divided into groups based on basic laboratory anemia evaluation. Outcomes were cancer diagnosis, colonoscopy rate, duration of admission, and all-cause mortality. Multivariable analysis with competing risk of death was performed and a p-value of 5 % was considered significant.

RESULTS

Following matching, 4,238 patients were included in the evaluation group compared to 7,680 in the no-evaluation group. In-patient laboratory anemia evaluation was associated with gastrointestinal cancer and any cancer diagnosis - HR of 1.53 (95 % CI, 1.15- 2.05) and HR of 1.23 (95 % CI, 1.11-1.37) respectively. The rate of colonoscopy was higher, and anemia prevalence was lower in the evaluation group after 1-year follow-up. Intravenous iron treatment was more prevalent in the evaluation group. The laboratory anemia evaluation prolonged the admission (5 vs 4 days). There was no difference in the all-cause mortality across the 10-year follow-up.

CONCLUSION

Inpatient anemia evaluation with basic laboratory tests was found to be associated with an increase in outpatient gastrointestinal cancer diagnosis and showed clinical and diagnostic advantages. For patients who can benefit from early gastrointestinal cancer diagnosis, admission holds a valid opportunity to initiate the evaluation.

Optimal dose and duration of iron supplementation for treating iron deficiency anaemia in children and adolescents: A systematic review and meta-analysis

INTRODUCTION

Iron deficiency anaemia (IDA) accounts for nearly two-thirds of all anaemia cases globally. Despite the widespread use of iron supplementation, the optimal dose and duration for treating IDA remain unclear. In this study, we aimed to determine the most effective dose and duration of iron supplementation for improving haemoglobin (Hb) levels in children and adolescents (≤19 years) with IDA.

METHODS

A systematic review and meta-analysis were conducted. We searched MEDLINE, Embase, CINAHL, and the Cochrane Library for peer-reviewed studies published between 2013 and 2024. The interventions included iron supplementation with a defined dose and duration of at least 30 days. Comparators were placebo, no treatment, or alternative regimens. The outcome was the change in Hb levels. Eligible studies included IDA cases diagnosed through ferritin level measurements in healthy individuals. Studies involving pregnant women or children with underlying conditions were excluded. A meta-analysis was performed using standardized mean differences to pool effect sizes for Hb improvement with 95% confidence intervals (CIs). Subgroup analyses were performed for different treatment durations (<3 months, 3-6 months, >6 months) and dosage categories (<5 mg/kg/day, 5-10 mg/kg/day, >10 mg/kg/day). A random-effects meta-regression model was used to determine the optimal dose and duration, accounting for known covariates affecting Hb improvement.

RESULTS

A total of 28 studies with 8,829 participants from 16 countries were included. The pooled effect size for Hb improvement was 2.01 gm/dL (95% CI: 1.48-2.54, p < 0.001). Iron supplementation for less than 3 months showed the highest significant effect size (2.39 gm/dL, 95% CI: 0.72-4.07), followed by treatments exceeding 6 months (1.93 gm/dL, 95% CI: 0.09-3.77). The lowest effect size was observed in treatments lasting 3-6 months (1.58 gm/dL, 95% CI: 0.93-2.23). Low-dose iron supplementation (<5 mg/kg/day) demonstrated favourable trends in Hb improvement, particularly in individuals with lower baseline Hb levels. Oral ferrous sulphate had a significant effect (2.03 gm/dL, 95% CI: 1.24-2.82), while parenteral ferric Carboxymaltose showed consistent efficacy.

CONCLUSION

Low-dose iron supplementation (<5 mg/kg/day) combined with treatment durations of either less than 3 months or more than 6 months, is optimal for improving Hb levels in children and adolescents with IDA. Tailoring treatment based on baseline Hb levels and anaemia severity is essential. These findings provide evidence to support updated guidelines on iron supplementation in paediatric and adolescent populations and inform national anaemia management programmes.

TRIAL REGISTRATION

Prospero registration number: This study was registered with PROSPERO (CRD42024541773).

Prevalence and determinants of anaemia in South Asian diaspora women residing in Hong Kong: An exploratory cross-sectional study

Background

Anaemia has been a significant public health challenge for the South Asian community, in particular women and migrant populations. Despite abundant research in developed Western settings, evidence in urbanized Asian settings is extremely scarce for comparisons. This study aims to assess the prevalence and social determinants of anaemia in South Asian women residing in Hong Kong, an advanced economy in Asia.

Methods

Between June 2022 and December 2023, 675 non-pregnant South Asian adult women were recruited through territory-wide outreach health assessments for anthropometric and biomedical measurements, in addition to a survey on self-reported sociodemographic, lifestyle, and health factors. Multivariable ordinal logistic regression was employed to identify the predictors of anaemia severity.

Results

The observed prevalence of mild and moderate/severe anaemia (haemoglobin level <12 g/dL) were 26.8 % and 31.4 %, respectively. Findings supported the independent protective role of better diet quality against anaemia severity (aOR=0.40 [95 % CI = 0.22, 0.73] for high diet quality compared to poor diet quality), and that women of reproductive age (aOR=2.36 [1.03, 5.44] for the 35-44 age group compared to the youngest group), having a larger household size (aOR=1.11 [1.01,1.21] per person increase), and staying for a longer period in Hong Kong (aOR=1.83 [1.07, 3.13] for > 7 years compared to < 3 years) were associated with more severe anaemia.

Conclusion

The high prevalence of anaemia in our sampled South Asian women in Hong Kong, especially those of reproductive age, was partly attributable to nutrition, acculturation, and cultural preference on larger family size, beyond potential genetic predisposition.

Effect of probiotic and prebiotics supplementation on hemoglobin levels and iron absorption among women of reproductive age and children: a systematic review and meta-analysis

BACKGROUND

This review aims to assess the effect of oral administration of probiotics and/or prebiotics in children and women of reproductive age (WRA) to improve intestinal iron absorption, hemoglobin, and ferritin levels.

METHODS

Randomized controlled trials from published literature on probiotics and or prebiotics for prevention or treatment of anemia as a supplement or fortification in children or WRA till Jan 31, 2023, were included. Studies on probiotics and prebiotics in patients with anemia due to other causes were excluded. Screening and data extraction was done using Distiller SR and meta-analysis was performed using Revman 5.4.1.

RESULTS

A total of 1925 records were identified from Pubmed, Embase, and Cochrane, of which 29 were included in the systematic review (14 supplementation and 15 fortification studies; 15 studies in children and 14 studies in WRA). The major interventions included galacto-oligosaccharide, inulin, heat-killed H61, Lactobacillus plantarum 299v, Lactobacillus reuteri, Lactobacillus acidophilus. Meta-analysis of 5 studies in WRA showed that the use of prebiotics and/or probiotics with or without iron was associated with little or no effect on hemoglobin. However, there is low certainty of evidence that the intervention led to improvement in fractional absorption of iron as compared to placebo or iron [8 studies, n = 335, mean increase 0.74%, 95%CI-0.11-1.38, p = 0.02]. Meta-analysis of 6 studies in WRA using prebiotics and/or probiotics with or without iron led to a significant increase in ferritin levels in WRA (mean increase 2.45 ng/ml, 95% CI 0.61-4.3, p = 0.009, n = 320) [Moderate certainty of evidence]. In children, meta-analysis of up to 8 studies did not result in any significant change in hemoglobin, ferritin and fractional iron absorption [low or very low certainty of evidence].

CONCLUSION

There is some evidence to show that the use of prebiotics or probiotics (especially Lp299v and GOS) with or without oral iron can improve iron absorption in women and lead to improvement in ferritin levels in women. However, the current evidence does not conclusively show the benefit of these interventions in improving hemoglobin levels in women and children.

Association between serum hemoglobin level and bone mineral density in adults: Iranian multi-center osteoporosis study (IMOS)

The associations between serum hemoglobin (Hb) levels and bone mineral density (BMD) were investigated in population of the 4th Iranian Multicenter Osteoporosis Study (IMOS). A positive relationship between Hb levels and BMD at hip and femoral neck were detected only in men.

PURPOSE

Previous studies have investigated the relationship between hemoglobin (Hb) levels and bone mineral density (BMD) with controversial findings. This study aimed to evaluate this association using data from the 4th Iranian Multicenter Osteoporosis Study (IMOS), a population-based national survey, including a population sample aged 50 years and older.

METHODS

The present study was conducted as a cross-sectional data analysis derived from the fourth round of the IMOS. Demographic information, Hb levels, and BMD measurements were collected. BMD was measured with dual-energy X-ray absorptiometry (DXA). Low BMD (osteopenia/osteoporosis) and osteoporosis were defined as a T-score less than -1 and less than -2.5 at each site including hip, femoral neck, or lumbar spine, respectively. Multiple linear regression analysis was used to assess the relationship between Hb levels and BMD.

RESULTS

This study included 1,426 participants (54.2% female) with the mean age of 62.6 ± 8.0 years. The mean Hb levels among patients with or without osteoporosis were 12.9 ± 2.0 mg/dl and 13.1 ± 1.9 mg/dl, respectively (p-value = 0.08). It was demonstrated a positive relationship between Hb levels and BMD at hip (β = 0.0079, 95% CI: 0.002- 0.0135, p-value = 0.006) and femoral neck (β = 0.0064, 95% CI: 0.0015- 0.0113, p-value = 0.01) in only men. However, there was no significant correlation between Hb levels with low BMD and osteoporosis in either gender.

CONCLUSION

Our findings showed a favorable relationship between Hb levels and BMD at the hip and femoral neck, particularly in men. This highlights gender and site-specific distinctions between hematological and skeletal health..Future studies should unravel these possible associations and investigate the underlying mechanisms.

An approach to Hemequity: Identifying the barriers and facilitators of iron deficiency reduction strategies in low- to middle-income countries

Approximately 1.92 billion people worldwide are anaemic, and iron deficiency is the most common cause. Iron deficiency anaemia (IDA) disproportionately affects women of reproductive age and remains under-addressed in low- to middle-income countries (LMICs). The primary objective of our scoping review is to evaluate the barriers and facilitators to IDA management in LMICs by using an intersectionality-enhanced implementation science lens adapted from the consolidated framework for implementation research and the theoretical domains framework. A total of 53 studies were identified. Contextual barriers included the deprioritization of IDA risk, unequal gender norms and stigma from the HIV/AIDS epidemic. Regional poverty, conflict and natural disasters led to supply chain barriers. Individual-level facilitators included partner support and antenatal care access while barriers included forgetfulness and having medical comorbidities. Successful interventions also utilized education initiatives to empower women in community decision-making. Moreover, community mobilization and the degree of community ownership determined the sustainability of IDA reduction strategies. IDA is not only a medical problem, but one that is rooted in the sociocultural and political context. Future approaches must recognize the resilience of LMIC communities and acknowledge the importance of knowledge translation rooted in community ownership and empowerment.