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Zheng Z, Pan J, Liu M, Chen Z, Zhang L, Gao J, Gao P, Zhang X. Anemia and testosterone deficiency risk: insights from NHANES data analysis and a Mendelian randomization analysis. Aging Male 2024; 27:2346312. [PMID: 38685728 DOI: 10.1080/13685538.2024.2346312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/17/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Previous research has shown that testosterone deficiency (TD) increases the risk of anemia, but it is unclear whether anemia affects testosterone levels. This study investigated the influence of anemia on testosterone levels. METHODS Utilizing data from six NHANES cycles, including demographic, testosterone levels, and hemoglobin concentrations, we employed multivariable-adjusted logistic regression to investigate the relationship between anemia and testosterone levels. Moreover, a two-sample Mendelian randomization (MR) study employing genome-wide association study (GWAS) data examined the causal relationship. Kaplan-Meier survival estimation was used to compared the overall survival (OS) of anemic and nonanemic patients with low testosterone and normal testosterone levels. RESULTS The inclusion of 21,786 participants (2318 with anemia and19,468 without anemia) revealed that nonanemic patients exhibited higher testosterone levels than did anemic patients (β = 22.616, 95% CI: 3.873-41.359, p = 0.01807). MR analysis confirmed anemia as a cause of TD (OR = 1.045, 95% CI: 1.020-1.071, p < 0.001). Anemic males with low testosterone had reduced OS compared to those with normal levels (p < 0.001). CONCLUSIONS Anemia emerged as a potential risk factor for TD, highlighting a bidirectional relationship between these conditions. Additional prospective investigations are essential for the validation and reinforcement of our findings.
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Affiliation(s)
- Zhenming Zheng
- Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, PR China
- Institute of Urology, Anhui Medical University, Hefei, PR China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, PR China
| | - Jiashan Pan
- Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, PR China
- Institute of Urology, Anhui Medical University, Hefei, PR China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, PR China
| | - Ming Liu
- Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, PR China
- Institute of Urology, Anhui Medical University, Hefei, PR China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, PR China
| | - Zhimin Chen
- Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, PR China
- Institute of Urology, Anhui Medical University, Hefei, PR China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, PR China
| | - Lvwen Zhang
- Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, PR China
- Institute of Urology, Anhui Medical University, Hefei, PR China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, PR China
| | - Jingjing Gao
- Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, PR China
- Institute of Urology, Anhui Medical University, Hefei, PR China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, PR China
| | - Pan Gao
- Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, PR China
- Institute of Urology, Anhui Medical University, Hefei, PR China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, PR China
| | - Xiansheng Zhang
- Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, PR China
- Institute of Urology, Anhui Medical University, Hefei, PR China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, PR China
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Arai H, Nozoe M, Kamiya K, Matsumoto S, Morimoto T. Anemia and Rehabilitation Outcomes in Patients Undergoing Convalescent Rehabilitation. Arch Phys Med Rehabil 2024; 105:539-545. [PMID: 37981255 DOI: 10.1016/j.apmr.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Assessment of the association between anemia and recovery of physical disability in patients with functional impairment. DESIGN A retrospective cohort study. SETTING A convalescent rehabilitation ward. PARTICIPANTS The subjects were patients undergoing convalescent rehabilitation due to neurologic disease, musculoskeletal disorders, or hospital-associated deconditioning. Patients were classified into 3 groups (no anemia; mild anemia [men: hemoglobin of 11.0-12.9 g/dL; women: hemoglobin of 11.0-11.9 g/dL]; and moderate/severe anemia [hemoglobin < 11.0 g/dL]) based on hemoglobin levels. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The study outcomes were functional independence measures for motor function (FIM-M) score at discharge, changes in the FIM-M score between hospital admission and discharge, length of stay, and FIM-M efficiency score (change in FIM-M score divided by length of stay). A linear regression model was constructed to explore the association of anemia with the FIM-M efficiency score. As a subgroup analysis, we constructed a linear regression model to explore the association of anemia with the FIM-M efficiency score in patients with or without stroke. RESULTS Of 376 consecutive patients with a mean age of 80 years, 258 (69%) had mild or moderate/severe anemia. There were no significant differences between the 3 groups in the FIM-M score at discharge, changes in the FIM-M score, length of stay, and FIM-M efficiency score. A multiple linear regression model showed that the FIM-M efficiency score was not associated with anemia (mild anemia group: β=-0.02, P=.8; moderate/severe anemia group: β=-0.005, P=.9). In the subgroup analysis of patients with or without stroke, the multiple regression model also showed no significant association between anemia and FIM-M efficiency score in each group. CONCLUSIONS Anemia on admission was common among patients in a convalescent rehabilitation ward but was not associated with improvement of FIM-M after rehabilitation.
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Affiliation(s)
- Hideki Arai
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan; Toyonaka Heisei Hospital, Toyonaka, Japan.
| | - Masafumi Nozoe
- Department of Physical Therapy, Faculty of Rehabilitation, Kansai Medical University, Hirakata, Japan
| | - Kuniyasu Kamiya
- Department of Basic Medical Sciences Region, Kobe City College of Nursing, Kobe, Japan
| | | | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
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Abstract
Metabolic syndrome (MS), a conglomeration of several conditions including obesity, type 2 diabetes mellitus (T2DM), insulin resistance, elevated blood pressure, and dyslipidemia is reaching epidemic proportions. Anemia is caused by iron deficiency or dysregulation of iron homeostasis, leading to tissue hypoxia. Coexistence of anemia and MS or its components has been reported in the literature. The term "rubrometabolic syndrome" acts as a unifying entity linking the importance of blood in health and anemia in MS; it justifies two principles - redness of blood and low-grade inflammation. Chronic low-grade inflammation in MS affects iron metabolism leading to anemia. Tissue hypoxia that results from the anemic condition seems to be a major causative factor for the exacerbation of several microvascular and macrovascular components of T2DM, which include diabetic neuropathy, nephropathy, retinopathy, and cardiovascular complications. In obesity, anemia leads to malabsorption of micronutrients and can complicate the management of the condition by bariatric surgery. Anemia interferes with the diagnosis and management of T2DM, obesity, dyslipidemia, or hypertension due to its effect on pathological tests as well as medications. Since anemia in MS is multifaceted, the management of anemia is challenging as overcorrection of anemia with erythropoietin-stimulating agents can cause detrimental effects. These limitations necessitate availability of an effective and safe therapy that can maintain and elevate the hemoglobin levels along with maintaining the physiological balance of other systems. This review discusses the physiological links between anemia and MS along with diagnosis and management strategies in patients with coexistence of anemia and MS.
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Affiliation(s)
| | - Ankia Coetzee
- Division of Endocrinology, Stellenbosch University & Tygerberg Hospital, Cape Town, South Africa
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Joel R Saldaña
- Resultados Medicos, Desarrollo e Investigación, SC, Boulevard Valle de San Javier, Pachuca Hidalgo, Mexico City, Mexico
| | - Gary Kilov
- University of Melbourne, Launceston, Australia
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Salis F, Locci G, Mura B, Mandas A. Anemia in Elderly Patients-The Impact of Hemoglobin Cut-Off Levels on Geriatric Domains. Diagnostics (Basel) 2023; 13:diagnostics13020191. [PMID: 36673001 PMCID: PMC9857598 DOI: 10.3390/diagnostics13020191] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 12/28/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023] Open
Abstract
Background: The primary aim of this study was to evaluate the impact of anemia—according to the WHO criteria—on cognitive performances, mood, functional and nutritional status, and comorbidities in a population of subjects aged 65 years or older. The secondary aim of this study was to understand if different hemoglobin cut-off levels are associated with a variation of the mentioned domains’ impairment. Methods: We designed a cross-sectional study, including subjects aged 65 or more consecutively evaluated in an outpatient setting from July 2013 to December 2019. A sum of 1698 subjects met the inclusion criteria. They were evaluated with: MMSE and CDT (cognitive assessment), GDS (mood), BADL, IADL, PPT, and POMA (autonomies), MNA (nutritional status), and CIRS (comorbidities). Results: According to the WHO criteria, non-anemic patients reported significantly better performances than the anemics in BADL (p < 0.0001), IADL (p = 0.0007), PPT (p = 0.0278), POMA (p = 0.0235), MNA, CIRS TOT, CIRS ICC, and CIRS ISC (p < 0.0001). The same tendency has been found by considering the 12 g/dL- and the 13 g/dL-cut-off level in the whole population. The multivariate analysis showed that, considering the 12 g/dL-cut-off level, age (OR: 1.03, p = 0.0072), CIRS (OR: 1.08, p < 0.0001), and gender (OR: 0.57, p = 0.0007) were significant regressors of anemia, while considering the 13 g/dL-cut-off level, age (OR: 1.04, p = 0.0001), POMA (OR: 1.03, p = 0.0172), MNA (OR = 0.95, p = 0.0036), CIRS (OR: 1.17, p < 0.0001), ICC (OR = 0.83, p = 0.018), and gender (OR = 0.48, p < 0.0001) were significant regressors of anemia, while the other CGA variables were excluded by the model (p > 0.01). Conclusions: Our study showed that anemia negatively impact on geriatric people’s general status, regardless of which hemoglobin cut-off level is considered. It also highlighted that hemoglobin concentrations < 13 g/dL, regardless of gender, have an association with the impairment of the affective-functional-nutritional state as well as an increase in comorbidities; therefore, it should be pursuable to consider the elderly person “anemic” if Hb < 13 g/dL regardless of gender.
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Affiliation(s)
- Francesco Salis
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy
- Correspondence: ; Tel.: +39-070-675-4190; Fax: +39-070-675-3122
| | - Giambeppe Locci
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy
| | - Barbara Mura
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy
| | - Antonella Mandas
- Department of Medical Sciences and Public Health, University of Cagliari, 09127 Cagliari, Italy
- University Hospital “Azienda Ospedaliero-Universitaria” of Cagliari, 09127 Cagliari, Italy
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Clinical Implication of the Acumen Hypotension Prediction Index for Reducing Intraoperative Haemorrhage in Patients Undergoing Lumbar Spinal Fusion Surgery: A Prospective Randomised Controlled Single-Blinded Trial. J Clin Med 2022; 11:jcm11164646. [PMID: 36012890 PMCID: PMC9410436 DOI: 10.3390/jcm11164646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 12/15/2022] Open
Abstract
We investigated the clinical implication of the Hypotension Prediction Index (HPI) in decreasing amount of surgical haemorrhage and requirements of blood transfusion compared to the conventional method (with vs. without HPI monitoring). A prospective, randomised controlled-trial of 19- to 73-year-old patients (n = 76) undergoing elective lumbar spinal fusion surgery was performed. According to the exclusion criteria, the patients were divided into the non-HPI (n = 33) and HPI (n = 35) groups. The targeted-induced hypotension systolic blood pressure was 80−100 mmHg (in both groups), with HPI > 85 (in the HPI group). Intraoperative bleeding was lower in the HPI group (299.3 ± 219.8 mL) than in the non-HPI group (532 ± 232.68 mL) (p = 0.001). The non-HPI group had a lower level of haemoglobin at the end of the surgery with a larger decline in levels. The incidence of postoperative transfusion of red blood cells was higher in the non-HPI group than in the HPI group (9 (27.3%) vs. 1 (2.9%)). The use of HPI monitoring may play a role in providing timely haemodynamic information that leads to improving the quality of induced hypotension care and to ameliorate intraoperative surgical blood loss and postoperative demand for blood transfusion in patients undergoing lumbar fusion surgery.
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Gadó K, Khodier M, Virág A, Domján G, Dörnyei G. Anemia of geriatric patients. Physiol Int 2022; 109:119-134. [DOI: 10.1556/2060.2022.00218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/14/2022] [Accepted: 02/22/2022] [Indexed: 11/19/2022]
Abstract
Abstract
Anemia is a common finding in the elderly. Approximately 10 percent of the elderly suffers from anemia. Anemia per se is an independent factor of mortality in older patients regardless its cause. Frailty is also frequent in geriatric patients. That means that there is a decreased reserve capacity to react to different stress factors including anemia. The frequent presence of heart failure and also impaired cerebrovascular circulation makes more difficult to tolerate anemia in older age.
Anemia is a symptom, finding and treating the underlying cause is also important.
Treatment always depends on clinical findings: the more severe the symptoms, the more important to treat them. Severity of anemia depends not only the underlying cause, degree of anemia, co-morbidities and frailty of the patients, but also the speed of its development. Sudden blood loss due to an accident is less well tolerated than the same degree of anemia due to B12 deficiency.
Main causes of anemia in the elderly include nutritional deficiencies, chronic diseases, tumors, and certain hematological malignancies such as chronic lymphocytic leukemia, multiple myeloma, myelodysplastic syndrome.
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Affiliation(s)
- Klara Gadó
- Department of Clinical Studies, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
- Department of Geriatrics and Center of Nursing Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Malaz Khodier
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Andrea Virág
- Department of Geriatrics and Center of Nursing Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Gyula Domján
- Department of Clinical Studies, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Gabriella Dörnyei
- Department of Morphology and Physiotherapy, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
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Galbussera AA, Mandelli S, Rosso S, Zanetti R, Rossi M, Giacomin A, Detoma P, Riva E, Tettamanti M, Porta MGD, Lucca U. Mild anemia and 11- to 15-year mortality risk in young-old and old-old: Results from two population-based cohort studies. PLoS One 2021; 16:e0261899. [PMID: 34972180 PMCID: PMC8719676 DOI: 10.1371/journal.pone.0261899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/13/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mild anemia is a frequent although often overlooked finding in old age. Nevertheless, in recent years anemia has been linked to several adverse outcomes in the elderly population. Objective of the study was to investigate the association of mild anemia (hemoglobin concentrations: 10.0-11.9/12.9 g/dL in women/men) with all-cause mortality over 11-15 years and the effect of change in anemia status on mortality in young-old (65-84 years) and old-old (80+ years). METHODS The Health and Anemia and Monzino 80-plus are two door-to-door, prospective population-based studies that included residents aged 65-plus years in Biella municipality and 80-plus years in Varese province, Italy. No exclusion criteria were used. RESULTS Among 4,494 young-old and 1,842 old-old, mortality risk over 15/11 years was significantly higher in individuals with mild anemia compared with those without (young-old: fully-adjusted HR: 1.35, 95%CI, 1.15-1.58; old-old: fully-adjusted HR: 1.28, 95%CI, 1.14-1.44). Results were similar in the disease-free subpopulation (age, sex, education, smoking history, and alcohol consumption adjusted HR: 1.54, 95%CI, 1.02-2.34). Both age groups showed a dose-response relationship between anemia severity and mortality (P for trend <0.0001). Mortality risk was significantly associated with chronic disease and chronic kidney disease mild anemia in both age groups, and with vitamin B12/folate deficiency and unexplained mild anemia in young-old. In participants with two hemoglobin determinations, seven-year mortality risk was significantly higher in incident and persistent anemic cases compared to constant non-anemic individuals in both age groups. In participants without anemia at baseline also hemoglobin decline was significantly associated with an increased mortality risk over seven years in both young-old and old-old. Limited to the Monzino 80-plus study, the association remained significant also when the risk was further adjusted also for time-varying covariates and time-varying anemia status over time. CONCLUSIONS Findings from these two large prospective population-based studies consistently suggest an independent, long-term impact of mild anemia on survival at older ages.
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Affiliation(s)
- Alessia A. Galbussera
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Sara Mandelli
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Stefano Rosso
- Piedmont Cancer Registry, Centre for Epidemiology and Prevention in Oncology in Piedmont, Turin, Italy
| | - Roberto Zanetti
- Piedmont Cancer Registry, Centre for Epidemiology and Prevention in Oncology in Piedmont, Turin, Italy
| | - Marianna Rossi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Paolo Detoma
- Laboratory of Analysis, Ospedale degli Infermi, Biella, Italy
| | - Emma Riva
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Mauro Tettamanti
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Matteo G. Della Porta
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ugo Lucca
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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Wangping J, Ke H, Shengshu W, Yang S, Shanshan Y, Wenzhe C, Yao H, Miao L. Associations Between Anemia, Cognitive Impairment, and All-Cause Mortality in Oldest-Old Adults: A Prospective Population-Based Cohort Study. Front Med (Lausanne) 2021; 8:613426. [PMID: 33644094 PMCID: PMC7902775 DOI: 10.3389/fmed.2021.613426] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/18/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: To evaluate the combined effects of anemia and cognitive function on the risk of all-cause mortality in oldest-old individuals. Design: Prospective population-based cohort study. Setting and Participants: We included 1,212 oldest-old individuals (men, 416; mean age, 93.3 years). Methods: Blood tests, physical examinations, and health questionnaire surveys were conducted in 2012 were used for baseline data. Mortality was assessed in the subsequent 2014 and 2018 survey waves. Cox proportional hazards models were used to evaluate anemia, cognitive impairment, and mortality risk. We used restricted cubic splines to analyze and visualize the association between hemoglobin (Hb) levels and mortality risk. Results: A total of 801 (66.1%) deaths were identified during the 6-year follow-up. We noted a significant association between anemia and mortality (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14-1.54) after adjusting for confounding variables. We also observed a dose-response relationship between the severity of anemia and mortality (P < 0.001). In the restricted cubic spline models, Hb levels had a reverse J-shaped association with mortality risk (HR 0.88, 95% CI 0.84-0.93 per 10 g/L-increase in Hb levels below 130 g/L). The reverse J-shaped association persisted in individuals without cognitive impairment (HR 0.88, 95% CI 0.79-0.98 per 10 g/L-increase in Hb levels below 110 g/L). For people with cognitive impairment, Hb levels were inversely associated with mortality risk (HR 0.83, 95% CI 0.78-0.89 per 10 g/L-increase in Hb levels below 150 g/L). People with anemia and cognitive impairment had the highest risk of mortality (HR 2.60, 95% CI 2.06-3.27). Conclusion: Our results indicate that anemia is associated with an increased risk of mortality in oldest-old people. Cognitive impairment modifies the association between Hb levels and mortality.
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Affiliation(s)
- Jia Wangping
- Graduate School, Chinese People's Liberation Army General Hospital, Beijing, China
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
- Department of Military Medical Technology Support, School of Non-commissioned Officer, Army Medical University, Shijiazhuang, China
| | - Han Ke
- Graduate School, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Wang Shengshu
- Graduate School, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Song Yang
- Graduate School, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yang Shanshan
- Department of Disease Prevention and Control, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Cao Wenzhe
- Graduate School, Chinese People's Liberation Army General Hospital, Beijing, China
| | - He Yao
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Liu Miao
- Graduate School, Chinese People's Liberation Army General Hospital, Beijing, China
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Erythrocyte Characteristics and the Risk of Depression in Late Life: A Population-Based Prospective Study. J Am Med Dir Assoc 2020; 21:1677-1683. [PMID: 32651133 DOI: 10.1016/j.jamda.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/12/2020] [Accepted: 05/09/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Inflammation and vascular dysregulation may contribute to the development of depression and impose a burden on erythropoiesis. This study aimed to identify the association of erythrocyte indices with the severity of depressive symptoms and risk of developing depressive disorders in the older people. DESIGN A prospective cohort study on a randomly sampled Korean older population; the baseline assessment from 2010 to 2012, the first follow-up assessment from 2012 to 2014, and the second follow-up assessment from 2014 to 2016 (mean follow-up duration = 3.4 years). SETTING A nationwide and community-based cohort. PARTICIPANTS A total of 4451 Koreans aged 60 years or older. METHODS We examined the associations of the values and changes in mean corpuscular volume, mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) with the risk of prevalent and incident depression using logistic regression analyses. RESULTS High MCH and MCHC in female participants and high MCHC in male participants were associated with high geriatric depression scale scores and risk of prevalent depression. In female participants, high- and middle-MCH tertile groups showed a 2.68- and 2.34-fold higher risk of incident depression than did the low tertile group. In male participants, the high-MCH tertile group showed a 1.79-fold higher risk of incident depression than did the low tertile group. In both sexes, the participants whose MCV changed to the high or middle tertile or remained in the high or middle tertile during the follow-up period, and whose MCH increased to the high tertile or remained in the high tertile, were at a higher risk of incident depression. CONCLUSIONS AND IMPLICATIONS Changes in erythrocyte may be associated with the risk of depression in older adults. This prospective study proposes a new perspective of the old hematologic parameters for understanding the pathophysiology of late-life depression.
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Retnakumar C, Chacko M, Ramakrishnan D, George LS, Krishnapillai V. Prevalence of anemia and its association with dietary pattern among elderly population of urban slums in Kochi. J Family Med Prim Care 2020; 9:1533-1537. [PMID: 32509645 PMCID: PMC7266240 DOI: 10.4103/jfmpc.jfmpc_1113_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/12/2020] [Accepted: 02/20/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Anemia is common among the elderly and it is the reason behind their poor survival. Anemia among the elderly is consistently disregarded, which can even incite cardiovascular complexities. The risk of physical decline for the elderly with iron insufficiency is twofold than that of others in the same age. The elderly populace dwelling in urban slums is progressively influenced. Hence, the objective was to study the prevalence of anemia among elderly dwelling in urban slums of Kochi corporation and its association with the dietary pattern. Methodology: A cross-sectional study was carried out among 165 elderly (60 years of age and above), residing in urban slums of Kochi corporation. The hemoglobin level was measured using Heamocue and the dietary pattern was assessed by a structured pretested questionnaire eliciting a 7-day dietary recall. Results: The prevalence of anemia among the elderly was observed to be 60.6%, out of which 66% were females and 49% were males. The elderly females were found to be more vulnerable to anemia. Conclusion: Anemia was found to be significantly high among the elderly population in urban slums of Kochi. Regular screening and management of anemia along with dietary awareness have become the need of the hour.
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Affiliation(s)
- Charutha Retnakumar
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, Kerala, India
| | - Maya Chacko
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, Kerala, India
| | - Devraj Ramakrishnan
- Department of Community Medicine, Government Medical College, Idukki, Kerala, India
| | - Leyanna S George
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, Kerala, India
| | - Vijayakumar Krishnapillai
- Department of Community Medicine and Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, Kerala, India
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11
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Hong CT, Hsieh YC, Liu HY, Chiou HY, Chien LN. Association Between Anemia and Dementia: A Nationwide, Populationbased Cohort Study in Taiwan. Curr Alzheimer Res 2020; 17:196-204. [DOI: 10.2174/1567205017666200317101516] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/06/2020] [Accepted: 01/29/2020] [Indexed: 11/22/2022]
Abstract
Background:
In addition to the traditional risk predictors, whether anemia is an early biomarker
of dementia, needs to be confirmed.
Objective:
This population-based cohort study aimed to investigate the dementia risk in patients with
newly diagnosed anemia using data from the Taiwan National Health Insurance Research Database.
Methods:
All newly diagnosed anemia patients (n = 26,343) with no history of stroke hospitalization,
central nervous disease other than dementia, psychiatric disorders, traumatic brain injury, major operations,
or blood loss diseases, were enrolled. A group of non-anemic controls, 1:4 matched with anemic
patients on the basis of demographics and comorbidities, was also included. A competing risk analysis
was used to evaluate the dementia risk in anemic patients compared to that of their matched controls.
Results:
The adjusted subdistribution hazard ratio (SHR) of dementia risk in anemic patients was 1.14
(95% confidence interval [CI]: 1.08~1.21, p<0.001). Patients with iron supplements tended to exhibit a
lower dementia risk (adjusted SHR: 0.84; 95% CI: 0.75~0.94, p=0.002) compared to patients without
iron supplement. A subgroup analysis showed that a positive association between dementia and anemia
existed in females, those aged 70 years and older, and patients without hypertension, diabetes, or hyperlipidemia.
Conclusion:
The present population-based cohort study identified that newly diagnosed anemia is a risk
factor for dementia and also that iron supplementation was able to reduce the risk of dementia in people
with iron deficiency anemia.
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Affiliation(s)
- Chien-Tai Hong
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yi-Chen Hsieh
- College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Hung-Yi Liu
- Health and Clinical Research Data Center, School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Hung-Yi Chiou
- Department of Applied Molecular Epidemiology, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
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12
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Rivilla Marugán L, Lorente Aznar T, Molinero Rodriguez M, García-Erce JA. [Anaemia and the elderly: Critical review of its definition and prevalence]. Rev Esp Geriatr Gerontol 2019; 54:189-194. [PMID: 31164237 DOI: 10.1016/j.regg.2019.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVES The prevalence of anaemia is an important health indicator, although there is little rigorous information gathered on the elderly population, particularly in those over 80 years old. The same criteria that are used in the general population are often used to define anaemia in the elderly. The epidemiological data collected by the WHO in 1968 (that have been used to generalise this criteria), did not include the population over 65 years-old. Two objectives are established, which includes a critical review of the available evidence on whether the criteria used to define anaemia in the adult population can be extrapolated to the elderly, and a review of publications on the prevalence of anaemia in the elderly over 80 years-old. MATERIAL AND METHODS A systematic bibliographic search was performed on the established objectives. RESULTS Although the WHO criteria, based on data from 1968, are widely used, other possible cut-off points have been proposed for elderly people. A total of 20 studies were found that were conducted in North America and Europe, with only 70,000 patients, and different age criteria. The prevalence of anaemia ranges between 3% and 63%, depending on the diagnostic criteria, age, and whether they were institutionalised or not. CONCLUSIONS Anaemia is a very prevalent disease in elderly patients. The collection of large databases is necessary to determine more adequate diagnostic criteria.
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Affiliation(s)
- Laura Rivilla Marugán
- Medicina Familiar y Comunitaria, Centro de Salud de Sabiñánigo, Servicio Aragonés de Salud, Huesca, España
| | - Teófilo Lorente Aznar
- Medicina Familiar y Comunitaria, Centro de Salud de Sabiñánigo, Servicio Aragonés de Salud, Huesca, España
| | - Mónica Molinero Rodriguez
- Medicina Familiar y Comunitaria, Centro de Salud de Sabiñánigo, Servicio Aragonés de Salud, Huesca, España
| | - José Antonio García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, España; Grupo de Trabajo de la Sociedad Española de Transfusión Sanguínea «Hemoterapia basada en sentido común».
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13
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Valent P, Büsche G, Theurl I, Uras IZ, Germing U, Stauder R, Sotlar K, Füreder W, Bettelheim P, Pfeilstöcker M, Oberbauer R, Sperr WR, Geissler K, Schwaller J, Moriggl R, Béné MC, Jäger U, Horny HP, Hermine O. Normal and pathological erythropoiesis in adults: from gene regulation to targeted treatment concepts. Haematologica 2018; 103:1593-1603. [PMID: 30076180 PMCID: PMC6165792 DOI: 10.3324/haematol.2018.192518] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/30/2018] [Indexed: 12/12/2022] Open
Abstract
Pathological erythropoiesis with consequent anemia is a leading cause of symptomatic morbidity in internal medicine. The etiologies of anemia are complex and include reactive as well as neoplastic conditions. Clonal expansion of erythroid cells in the bone marrow may result in peripheral erythrocytosis and polycythemia but can also result in anemia when clonal cells are dysplastic and have a maturation arrest that leads to apoptosis and hinders migration, a constellation typically seen in the myelodysplastic syndromes. Rarely, clonal expansion of immature erythroid blasts results in a clinical picture resembling erythroid leukemia. Although several mechanisms underlying normal and abnormal erythropoiesis and the pathogenesis of related disorders have been deciphered in recent years, little is known about specific markers and targets through which prognosis and therapy could be improved in anemic or polycythemic patients. In order to discuss new markers, targets and novel therapeutic approaches in erythroid disorders and the related pathologies, a workshop was organized in Vienna in April 2017. The outcomes of this workshop are summarized in this review, which includes a discussion of new diagnostic and prognostic markers, the updated WHO classification, and an overview of new drugs used to stimulate or to interfere with erythropoiesis in various neoplastic and reactive conditions. The use and usefulness of established and novel erythropoiesis-stimulating agents for various indications, including myelodysplastic syndromes and other neoplasms, are also discussed.
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Affiliation(s)
- Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria .,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Austria
| | - Guntram Büsche
- Institute of Pathology, Medizinische Hochschule Hannover, Germany
| | - Igor Theurl
- Department of Internal Medicine II, Medical University Innsbruck, Austria
| | - Iris Z Uras
- Institute of Pharmacology and Toxicology, University of Veterinary Medicine, Vienna, Austria
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - Reinhard Stauder
- Department of Internal Medicine V, Medical University Innsbruck, Austria
| | - Karl Sotlar
- Institute of Pathology, Paracelsus Medical University Salzburg, Austria
| | - Wolfgang Füreder
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria
| | - Peter Bettelheim
- First Department of Internal Medicine, Elisabethinen Hospital, Linz, Austria
| | - Michael Pfeilstöcker
- Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Austria.,3Medical Department, Hanusch Hospital, Vienna, Austria
| | - Rainer Oberbauer
- Department of Nephrology and Dialysis, Medical University of Vienna, Austria
| | - Wolfgang R Sperr
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Austria
| | - Klaus Geissler
- 5Medical Department for Hematology and Oncology, Hospital Hietzing, Vienna, Austria
| | - Jürg Schwaller
- Department of Biomedicine, University Children's Hospital Basel, Switzerland
| | - Richard Moriggl
- Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria.,Department of Biomedical Science, Institute of Animal Breeding and Genetics, University of Veterinary Medicine, Vienna, Austria
| | - Marie C Béné
- Hematology Biology, University Hospital, Nantes, France
| | - Ulrich Jäger
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Austria.,Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Austria
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilian University, Munich, Germany
| | - Olivier Hermine
- Imagine Institute, INSERM U 1163, CNRS 8654, Université Paris Descartes, Sorbonne, Paris Cité, France
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14
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Nakayama S, Matsuda M, Adachi T, Sueda S, Ohashi Y, Awaji S, Hashimoto S, Matsumura I. Novel prognostic index based on hemoglobin level and platelet count for diffuse large B-cell lymphoma, not otherwise specified in the R-CHOP era. Platelets 2018; 30:637-645. [DOI: 10.1080/09537104.2018.1499889] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Shoko Nakayama
- Department of Hematology, PL General Hospital, Tondabayashi City, Osaka, Japan
- Division of Hematology and Rheumatology, Kinki University Faculty of Medicine, Osakasayama City, Osaka, Japan
| | - Mitsuhiro Matsuda
- Department of Hematology, PL General Hospital, Tondabayashi City, Osaka, Japan
| | - Tatsuya Adachi
- Department of Hematology, PL General Hospital, Tondabayashi City, Osaka, Japan
| | - Sanae Sueda
- Department of Hematology, PL General Hospital, Tondabayashi City, Osaka, Japan
| | - Yuka Ohashi
- Department of Pathology, PL General Hospital, Tondabayashi City, Osaka, Japan
| | - Sumie Awaji
- Department of Pathology, PL General Hospital, Tondabayashi City, Osaka, Japan
| | - Shigeo Hashimoto
- Department of Pathology, PL General Hospital, Tondabayashi City, Osaka, Japan
| | - Itaru Matsumura
- Division of Hematology and Rheumatology, Kinki University Faculty of Medicine, Osakasayama City, Osaka, Japan
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15
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Ekregbesi P, Shankar-Hari M, Bottomley C, Riley EM, Mooney JP. Relationship between Anaemia, Haemolysis, Inflammation and Haem Oxygenase-1 at Admission with Sepsis: a pilot study. Sci Rep 2018; 8:11198. [PMID: 30046137 PMCID: PMC6060141 DOI: 10.1038/s41598-018-29558-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/06/2018] [Indexed: 12/12/2022] Open
Abstract
Upregulation of haem oxygenase-1 (HO-1), due to haemolysis and/or inflammation, can lead to impaired immune function. Anaemia is common among sepsis patients, but the consequences of sepsis-associated anaemia are poorly understood. Here, our objective was to determine the prevalence and extent of anaemia, haemolysis, inflammation, and HO-1 induction after early hospital admission. We hypothesised that inflammation- or infection-induced haemolysis contributes to sepsis-associated anaemia and that this will lead to expression of HO-1. In this study, plasma obtained from seventy adult patients within 12 hours of admission to intensive care due to sepsis were analysed for anaemia, haemolysis and inflammatory markers by ELISA and microbead array. The majority (82.6%) of patients were anaemic with evidence of haemolysis (raised haem, haptoglobin, haemopexin, and HO-1 concentrations). Interestingly, concentrations of both haemoglobin and IL-10 were moderately positively correlated with HO-1 concentration (Hb: r = 0.32, p = 0.007; IL-10 r = 0.39, p = 0.0008) whereas HO-1 concentration was weakly negatively correlated with haemopexin (r = −0.23, p = 0.055). Anaemia, while common, was not associated with HO-1 concentration. After adjusting for confounding, HO-1 induction appears to be associated primarily with IL-10 concentration rather than haemolysis. Disease severity at diagnosis was correlated with early plasma IL-10 (r = 0.35, p = 0.003) and HO-1 (r = 0.24, p = 0.048) concentrations. Notably, admission levels of haem, HO-1, and IL-10 were indicators of survival.
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Affiliation(s)
- Phebe Ekregbesi
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Manu Shankar-Hari
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Christian Bottomley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eleanor M Riley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Division of Infection and Immunity, The Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jason P Mooney
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom. .,Division of Infection and Immunity, The Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom.
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16
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Bosman GJCGM. Disturbed Red Blood Cell Structure and Function: An Exploration of the Role of Red Blood Cells in Neurodegeneration. Front Med (Lausanne) 2018; 5:198. [PMID: 30062097 PMCID: PMC6054991 DOI: 10.3389/fmed.2018.00198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/15/2018] [Indexed: 01/19/2023] Open
Abstract
The structure of red blood cells is affected by many inborn and acquired factors, but in most cases this does not seem to affect their function or survival in physiological conditions. Often, functional deficits become apparent only when they are subjected to biochemical or mechanical stress in vitro, or to pathological conditions in vivo. Our data on the misshapen red blood cells of patients with neuroacanthocytosis illustrate this general mechanism: an abnormal morphology is associated with an increase in the susceptibility of red blood cells to osmotic and mechanical stress, and alters their rheological properties. The underlying mutations may not only affect red cell function, but also render neurons in specific brain areas more susceptible to a concomitant reduction in oxygen supply. Through this mechanism, an increased susceptibility of already compromised red blood cells to physiological stress conditions may constitute an additional risk factor in vulnerable individuals. Also, susceptibility may be induced or enhanced by systemic pathological conditions such as inflammation. An exploration of the literature suggests that disturbed red blood cell function may play a role in the pathophysiology of various neurodegenerative diseases. Therefore, interventions that reduce the susceptibility of red blood cells to physiological and pathological stress may reduce the extent or progress of neurodegeneration.
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Affiliation(s)
- Giel J C G M Bosman
- Department of Biochemistry, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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17
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Gasmi M, Sellami M, Denham J, Padulo J, Kuvacic G, Selmi W, Khalifa R. Time-restricted feeding influences immune responses without compromising muscle performance in older men. Nutrition 2018; 51-52:29-37. [PMID: 29571007 DOI: 10.1016/j.nut.2017.12.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/20/2017] [Accepted: 12/04/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study examined the effect of 12 wk of time-restricted feeding (TRF) on complete blood cell counts, natural killer cells, and muscle performance in 20- and 50-year-old men. METHODS Forty active and healthy participants were randomly divided into young experimental, young control, aged experimental, and aged control group. Experimental groups participated in TRF. Before (P1) and after (P2) TRF, participants performed a maximal exercise test to quantify muscle power. Resting venous blood samples were collected for blood count calculation. RESULTS No changes were identified in muscle power in all groups after TRF (P > 0.05). At P1, red cells, hemoglobin, and hematocrit were significantly higher in young participants compared with elderly participants (P < 0.05). At P2, this age effect was not found in red cells between the young experimental group and the aged experimental group (P > 0.05). At P1, white blood cells and neutrophils were significantly higher in young participants compared with elderly participants (P < 0.05). At P2, only neutrophils decreased significantly (P < 0.05) in experimental groups without significant (P > 0.05) difference among them. Lymphocytes decreased significantly in the aged experimental group at P2 (P < 0.05), whereas NKCD16+ and NKCD56+ decreased significantly in experimental groups at P2 (P < 0.05). TRF had no effect on CD3, CD4+, and CD8+ levels (P > 0.05). CONCLUSION TRF decreases hematocrit, total white blood cells, lymphocytes, and neutrophils in young and older men. TRF may be effective in preventing inflammation by decreasing natural killer cells. As such, TRF could be a lifestyle strategy to reduce systemic low-grade inflammation and age-related chronic diseases linked to immunosenescence, without compromising physical performance.
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Affiliation(s)
- Maha Gasmi
- Higher Institute of Sport and Physical Education of Ksar said, Tunis, Tunisia
| | - Maha Sellami
- University of Split, Faculty of Kinesiology, Split, Croatia; Tunisian Research Laboratory Sport Performance Optimization, National Center of Medicine and Science in Sports, Tunis, Tunisia.
| | - Joshua Denham
- School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Johnny Padulo
- University of Split, Faculty of Kinesiology, Split, Croatia; Tunisian Research Laboratory Sport Performance Optimization, National Center of Medicine and Science in Sports, Tunis, Tunisia; University e-campus, Novedrate, Italy
| | - Goran Kuvacic
- University of Split, Faculty of Kinesiology, Split, Croatia
| | - Walid Selmi
- Higher Institute of Sport and Physical Education of Ksar said, Tunis, Tunisia
| | - Riadh Khalifa
- Higher Institute of Sport and Physical Education of Ksar said, Tunis, Tunisia
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18
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Kip MM, Schop A, Stouten K, Dekker S, Dinant GJ, Koffijberg H, Bindels PJ, IJzerman MJ, Levin MD, Kusters R. Assessing the cost-effectiveness of a routine versus an extensive laboratory work-up in the diagnosis of anaemia in Dutch general practice. Ann Clin Biochem 2018; 55:630-638. [PMID: 29199442 PMCID: PMC6196589 DOI: 10.1177/0004563217748984] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Establishing the underlying cause of anaemia in general practice is a diagnostic challenge. Currently, general practitioners individually determine which laboratory tests to request (routine work-up) in order to diagnose the underlying cause. However, an extensive work-up (consisting of 14 tests) increases the proportion of patients correctly diagnosed. This study investigates the cost-effectiveness of this extensive work-up. Methods A decision-analytic model was developed, incorporating all societal costs from the moment a patient presents to a general practitioner with symptoms suggestive of anaemia (aged ≥ 50 years), until the patient was (correctly) diagnosed and treated in primary care, or referred to (and diagnosed in) secondary care. Model inputs were derived from an online survey among general practitioners, expert estimates and published data. The primary outcome measure was expressed as incremental cost per additional patient diagnosed with the correct underlying cause of anaemia in either work-up. Results The probability of general practitioners diagnosing the correct underlying cause increased from 49.6% (95% CI: 44.8% to 54.5%) in the routine work-up to 56.0% (95% CI: 51.2% to 60.8%) in the extensive work-up (i.e. +6.4% [95% CI: -0.6% to 13.1%]). Costs are expected to increase slightly from €842/patient (95% CI: €704 to €994) to €845/patient (95% CI: €711 to €994), i.e. +€3/patient (95% CI: €-35 to €40) in the extensive work-up, indicating incremental costs of €43 per additional patient correctly diagnosed. Conclusions The extensive laboratory work-up is more effective for diagnosing the underlying cause of anaemia by general practitioners, at a minimal increase in costs. As accompanying benefits in terms of quality of life and reduced productivity losses could not be captured in this analysis, the extensive work-up is likely cost-effective.
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Affiliation(s)
- Michelle Ma Kip
- 1 Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Annemarie Schop
- 2 Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Karlijn Stouten
- 3 Department of Clinical Chemistry, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Soraya Dekker
- 1 Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Geert-Jan Dinant
- 4 Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Hendrik Koffijberg
- 1 Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Patrick Je Bindels
- 5 Department of General Practice, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Maarten J IJzerman
- 1 Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Mark-David Levin
- 2 Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Ron Kusters
- 1 Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands.,6 Department of Clinical Chemistry and Hematology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
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19
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Green R, Allen LH, Bjørke-Monsen AL, Brito A, Guéant JL, Miller JW, Molloy AM, Nexo E, Stabler S, Toh BH, Ueland PM, Yajnik C. Vitamin B 12 deficiency. Nat Rev Dis Primers 2017; 3:17040. [PMID: 28660890 DOI: 10.1038/nrdp.2017.40] [Citation(s) in RCA: 465] [Impact Index Per Article: 66.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Vitamin B12 (B12; also known as cobalamin) is a B vitamin that has an important role in cellular metabolism, especially in DNA synthesis, methylation and mitochondrial metabolism. Clinical B12 deficiency with classic haematological and neurological manifestations is relatively uncommon. However, subclinical deficiency affects between 2.5% and 26% of the general population depending on the definition used, although the clinical relevance is unclear. B12 deficiency can affect individuals at all ages, but most particularly elderly individuals. Infants, children, adolescents and women of reproductive age are also at high risk of deficiency in populations where dietary intake of B12-containing animal-derived foods is restricted. Deficiency is caused by either inadequate intake, inadequate bioavailability or malabsorption. Disruption of B12 transport in the blood, or impaired cellular uptake or metabolism causes an intracellular deficiency. Diagnostic biomarkers for B12 status include decreased levels of circulating total B12 and transcobalamin-bound B12, and abnormally increased levels of homocysteine and methylmalonic acid. However, the exact cut-offs to classify clinical and subclinical deficiency remain debated. Management depends on B12 supplementation, either via high-dose oral routes or via parenteral administration. This Primer describes the current knowledge surrounding B12 deficiency, and highlights improvements in diagnostic methods as well as shifting concepts about the prevalence, causes and manifestations of B12 deficiency.
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Affiliation(s)
- Ralph Green
- Department of Pathology and Laboratory Medicine, University of California Davis, 4400 V Street, PATH Building, Davis, California 95817, USA
| | - Lindsay H Allen
- USDA, ARS Western Human Nutrition Research Center, University of California Davis, Davis, California, USA
| | | | - Alex Brito
- USDA, ARS Western Human Nutrition Research Center, University of California Davis, Davis, California, USA
| | - Jean-Louis Guéant
- Inserm UMRS 954 N-GERE (Nutrition Génétique et Exposition aux Risques Environnementaux), University of Lorraine and INSERM, Nancy, France
| | - Joshua W Miller
- School of Environmental and Biological Sciences, Rutgers University, New Brunswick, New Jersey, USA
| | - Anne M Molloy
- School of Medicine and School of Biochemistry and Immunology, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Ebba Nexo
- Department of Clinical Medicine, Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Sally Stabler
- Department of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Ban-Hock Toh
- Centre for Inflammatory Diseases, Monash Institute of Medical Research, Clayton, Victoria, Australia
| | - Per Magne Ueland
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway.,Section for Pharmacology, Department of Clinical Science, University of Bergen, Bergen, Norway
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20
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Vegetarian Nutrition for the Older Adult: Vitamin B12, Iron, and Zinc. Curr Nutr Rep 2017. [DOI: 10.1007/s13668-017-0194-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Robalo Nunes A, Fonseca C, Marques F, Belo A, Brilhante D, Cortez J. Prevalence of anemia and iron deficiency in older Portuguese adults: An EMPIRE substudy. Geriatr Gerontol Int 2017; 17:1814-1822. [PMID: 28188967 DOI: 10.1111/ggi.12966] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/22/2016] [Accepted: 10/12/2016] [Indexed: 11/29/2022]
Affiliation(s)
- António Robalo Nunes
- Anemia Working Group - Portugal; Lisbon Portugal
- Geriatric University Unit; Lisbon University Medical School; Lisbon Portugal
- Northern Lisbon Hospital Center; Lisbon Portugal
| | - Cândida Fonseca
- Anemia Working Group - Portugal; Lisbon Portugal
- West Lisbon Hospital Center; Lisbon Portugal
- NOVA Medical School; Nova University of Lisbon; Lisbon Portugal
| | - Filipa Marques
- Anemia Working Group - Portugal; Lisbon Portugal
- West Lisbon Hospital Center; Lisbon Portugal
- NOVA Medical School; Nova University of Lisbon; Lisbon Portugal
| | - Aurora Belo
- Anemia Working Group - Portugal; Lisbon Portugal
| | - Dialina Brilhante
- Anemia Working Group - Portugal; Lisbon Portugal
- Francisco Gentil Portuguese Institute of Oncology, Lisbon Center; Lisbon Portugal
| | - José Cortez
- Anemia Working Group - Portugal; Lisbon Portugal
- NOVA Medical School; Nova University of Lisbon; Lisbon Portugal
- Francisco Gentil Portuguese Institute of Oncology, Lisbon Center; Lisbon Portugal
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22
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Kohno K, Narimatsu H, Shiono Y, Suzuki I, Kato Y, Sho R, Otani K, Ishizawa K, Yamashita H, Kubota I, Ueno Y, Kato T, Fukao A, Kayama T. High Serum Adiponectin Level Is a Risk Factor for Anemia in Japanese Men: A Prospective Observational Study of 1,029 Japanese Subjects. PLoS One 2016; 11:e0165511. [PMID: 27918575 PMCID: PMC5137881 DOI: 10.1371/journal.pone.0165511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/13/2016] [Indexed: 12/19/2022] Open
Abstract
Erythroid abnormalities including anemia and polycythemia are often observed in the general clinical setting. Because recent studies reported that adiponectin negatively affects hematopoiesis, we performed a prospective observational study to assess the relationship between anemia and adiponectin, as well as other parameters, in 1029 Japanese subjects (477 men and 552 women) 40 years of age and older. Body measurements, blood tests, and nutrition intake studies were performed at baseline, and 5 to 7 years later (follow-up). Hemoglobin (Hb) and hematocrit (Hct) levels in men with high serum adiponectin levels were lower at follow-up than at baseline. Multiple regression analysis showed that age, body mass index, adiponectin, and glutamic-pyruvic transaminase were significantly associated with erythroid-related variables (red blood cells, Hb, and Hct) in both men and women (P <0.05). In a logistic regression analysis, adiponectin, fasting blood glucose, and β-natriuretic peptide were significant risk factors for anemia in men, and blood urea nitrogen and amylase were significant risk factors in women. Physical features and nutrient intake were not risk factors for anemia. Our study demonstrates, both clinically and epidemiologically, that a high serum adiponectin level decreases the amounts of erythroid-related variables and is a risk factor for anemia in Japanese men.
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Affiliation(s)
- Kei Kohno
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan
- * E-mail: (KK); (HN)
| | - Hiroto Narimatsu
- Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute, Yokohama City, Kanagawa, Japan
- * E-mail: (KK); (HN)
| | - Yosuke Shiono
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan
| | - Ikuko Suzuki
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan
| | - Yuichi Kato
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan
| | - Ri Sho
- Department of Public Health, Yamagata University Graduate School of Medicine, Yamagata City, Yamagata, Japan
| | - Katsumi Otani
- Department of Public Health, Yamagata University Graduate School of Medicine, Yamagata City, Yamagata, Japan
| | - Kenichi Ishizawa
- Department of Hematology and Cell Therapy, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan
| | - Hidetoshi Yamashita
- Department of Ophthalmology and Visual Sciences, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan
| | - Isao Kubota
- First Department of Internal Medicine, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan
| | - Yoshiyuki Ueno
- Second Department of Internal Medicine, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan
| | - Takeo Kato
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan
| | - Akira Fukao
- Department of Public Health, Yamagata University Graduate School of Medicine, Yamagata City, Yamagata, Japan
| | - Takamasa Kayama
- Department of Neurosurgery, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan
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Nielson C, Wingett D. Intensive care and invasive ventilation in the elderly patient, implications of chronic lung disease and comorbidities. Chron Respir Dis 2016; 1:43-54. [PMID: 16281668 DOI: 10.1191/1479972304cd012rs] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims: Elderly patients have an increasing prevalence of illness that requires consideration of critical care and invasive ventilatory support. Although critical care of even the very elderly can provide value, with increasing age the potential risks of treatment and diminishing returns with respect to quality and quantity of life result in a need for careful evaluation. Variable combinations of impaired organ function, active disease and residual pathology from past disease and injury all affect critical care, with the consequence that the elderly are a very heterogeneous population. Recognizing that critical care is a limited resource, it is important to identify patients who may be at increased risk or least likely to benefit from treatment. Patients with functional impairments, nutritional deficiencies and multiple comorbidities may be at highest risk of poor outcomes. Those with very severe disease, extreme age and requirements for prolonged ventilatory support have high in-hospital mortality. Functional impairments, comorbidities and severity of illness are usually more important considerations than chronologic age. The objective of this review is to identify how common problems of the elderly affect critical care and decisions concerning use of invasive ventilatory support.
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Milagres CS, Moraes KBDD, Franceschini SCC, Sant’Ana LFR, Lima LM, Ribeiro AQ. Prevalência e fatores associados à presença de anemia em idosos do município de Viçosa (MG), Brasil. CIENCIA & SAUDE COLETIVA 2015; 20:3733-41. [DOI: 10.1590/1413-812320152012.20752014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 03/20/2015] [Indexed: 11/22/2022] Open
Abstract
Resumo A anemia é o problema hematológico mais comum encontrado na população idosa. Com objetivo de avaliar a prevalência e os fatores associados à anemia em idosos no município de Viçosa (MG), foi realizado um estudo transversal, de base populacional. Os dados foram coletados de junho a dezembro de 2009, mediante inquérito domiciliar e realização de exames bioquímicos em 349 idosos. A prevalência de anemia foi de 11,7% (IC95% 8,3%-15,1%) e mostrou-se mais elevada entre os homens (15,4%), entre idosos com 80 anos e mais (30,0%) e naqueles que praticavam polifarmácia (16,8%). Os resultados evidenciaram determinantes de anemia semelhantes ao observado em países desenvolvidos. A real necessidade da polifarmácia deve ser avaliada na atenção à saúde dos idosos, com vistas a prevenir iatrogenias, dentre as quais a anemia está incluída.
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25
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Lee J, McGovern ME, Bloom DE, Arokiasamy P, Risbud A, O'Brien J, Kale V, Hu P. Education, gender, and state-level disparities in the health of older Indians: Evidence from biomarker data. ECONOMICS AND HUMAN BIOLOGY 2015; 19:145-156. [PMID: 26398850 PMCID: PMC4658270 DOI: 10.1016/j.ehb.2015.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 08/07/2015] [Accepted: 09/03/2015] [Indexed: 06/05/2023]
Abstract
Using new biomarker data from the 2010 pilot round of the Longitudinal Aging Study in India (LASI), we investigate education, gender, and state-level disparities in health. We find that hemoglobin level, a marker for anemia, is lower for respondents with no schooling (0.7g/dL less in the adjusted model) compared to those with some formal education and is also lower for females than for males (2.0g/dL less in the adjusted model). In addition, we find that about one third of respondents in our sample aged 45 or older have high C-reaction protein (CRP) levels (>3mg/L), an indicator of inflammation and a risk factor for cardiovascular disease. We find no evidence of educational or gender differences in CRP, but there are significant state-level disparities, with Kerala residents exhibiting the lowest CRP levels (a mean of 1.96mg/L compared to 3.28mg/L in Rajasthan, the state with the highest CRP). We use the Blinder-Oaxaca decomposition approach to explain group-level differences, and find that state-level disparities in CRP are mainly due to heterogeneity in the association of the observed characteristics of respondents with CRP, rather than differences in the distribution of endowments across the sampled state populations.
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Affiliation(s)
- Jinkook Lee
- Dornsife Center for Economic and Social Research, University of Southern California, 638 Downey Way, Los Angeles, CA 90089, USA; RAND Corporation, Santa Monica, CA, USA.
| | - Mark E McGovern
- Queen's University Belfast, Belfast, United Kingdom; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - P Arokiasamy
- International Institute for Population Sciences, Mumbai, India
| | - Arun Risbud
- National AIDS Research Institute, Pune, Maharashtra, India
| | - Jennifer O'Brien
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Varsha Kale
- National AIDS Research Institute, Pune, Maharashtra, India
| | - Peifeng Hu
- University of California, Los Angeles, CA, USA
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Cappellini MD, Motta I. Anemia in Clinical Practice-Definition and Classification: Does Hemoglobin Change With Aging? Semin Hematol 2015; 52:261-9. [PMID: 26404438 DOI: 10.1053/j.seminhematol.2015.07.006] [Citation(s) in RCA: 208] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Anemia is a global public health problem affecting both developing and developed countries at all ages. According to the World Health Organization (WHO), anemia is defined as hemoglobin (Hb) levels <12.0 g/dL in women and <13.0 g/dL in men. However, normal Hb distribution varies not only with sex but also with ethnicity and physiological status. New lower limits of normal Hb values have been proposed, according to ethnicity, gender, and age. Anemia is often multifactorial and is not an independent phenomenon. For the classification and diagnosis the hematologic parameters, the underlying pathological mechanism and patient history should be taken into account. The aging of population, especially in Western countries, causes an increase of anemia in elderly people. In this population, anemia, recently defined by levels of Hb <12 g/dL in both sexes, is mostly of mild degree (10-12 g/dL). Understanding the pathophysiology of anemia in this population is important because it contributes to morbidity and mortality. In one third of the patients, anemia is due to nutritional deficiency, including iron, folate, or vitamin B12 deficiency; moreover, anemia of chronic disease accounts for about another third of the cases. However, in one third of patients anemia cannot be explained by an underlying disease or by a specific pathological process, and for this reason it is defined "unexplained anemia". Unexplained anemia might be due to the progressive resistance of bone marrow erythroid progenitors to erythropoietin, and a chronic subclinical pro-inflammatory state.
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Affiliation(s)
- M Domenica Cappellini
- Department of Medicine, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Science and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - Irene Motta
- Department of Medicine, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Science and Community Health, Università degli Studi di Milano, Milan, Italy
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Lewerin C, Johansson H, Lerner UH, Karlsson MK, Lorentzon M, Barrett-Connor E, Smith U, Ohlsson C, Mellström D. High serum adiponectin is associated with low blood haemoglobin in elderly men: the Swedish MrOS study. J Intern Med 2015; 278:68-76. [PMID: 25491722 DOI: 10.1111/joim.12340] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Blood haemoglobin (Hb) concentration declines in elderly men, whilst the level of the adipocyte-derived protein adiponectin increases with age. The association between erythropoiesis and adiponectin in elderly men is unclear. The aim of this study was to determine whether adipokines such as adiponectin and leptin are associated with anaemia and Hb concentration in elderly community-dwelling men. DESIGN AND SETTING The Gothenburg part of the population-based Swedish Osteoporotic Fractures in Men (MrOS) cohort (n = 1010; median age 75.3 years, range 69-81). MAIN OUTCOME MEASURES We investigated the associations between levels of adiponectin and Hb before and after adjusting for potential confounders [i.e. age, body composition, erythropoietin (EPO), total oestradiol, leptin, cystatin C and iron and B vitamin status]. RESULTS In these elderly men, age was negatively associated with Hb (r = -0.12, P < 0.001) and positively associated with adiponectin level (r = 0.13, P < 0.001). In age-adjusted partial correlations, Hb and adiponectin levels were negatively correlated (r = -0.20, P < 0.001); this association remained significant after multivariable adjustment for age, body composition, EPO, fasting insulin, sex hormones, leptin and ferritin. Age-adjusted mean adiponectin concentrations were significantly higher in anaemic men (66/1005; Hb <130 g L(-1) ) compared to nonanaemic men (14.0 vs. 11.7 μg mL(-1) , P < 0.05). In multivariate analysis, adiponectin together with EPO, total oestradiol, insulin, albumin, transferrin saturation, HDL cholesterol, cystatin C, total body fat mass and free thyroxine, but not leptin, explained 35% of the variation in Hb level. These results remained essentially unchanged after exclusion of men with diabetes. CONCLUSIONS Serum adiponectin, but not leptin, was negatively and independently associated with Hb. This finding suggests a possible role of adiponectin in the age-related decline in Hb level observed in apparently healthy elderly men.
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Affiliation(s)
- C Lewerin
- Section of Haematology and Coagulation, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - H Johansson
- Center for Bone and Arthritis Research (CBAR) and Geriatric Medicine, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - U H Lerner
- Center for Bone and Arthritis Research (CBAR) and Geriatric Medicine, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Molecular Peridontology, Umeå University, Umeå, Sweden
| | - M K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopaedics, Lund University, Malmö, Sweden
| | - M Lorentzon
- Center for Bone and Arthritis Research (CBAR) and Geriatric Medicine, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - E Barrett-Connor
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - U Smith
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - C Ohlsson
- Department of Internal Medicine and Clinical Nutrition, Center for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - D Mellström
- Center for Bone and Arthritis Research (CBAR) and Geriatric Medicine, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Uscinska E, Sobkowicz B, Sawicki R, Kiluk I, Baranicz M, Stepek T, Dabrowska M, Szmitkowski M, Musial WJ, Tycinska AM. Parameters influencing in-hospital mortality in patients hospitalized in intensive cardiac care unit: is there an influence of anemia and iron deficiency? Intern Emerg Med 2015; 10:337-44. [PMID: 25502592 DOI: 10.1007/s11739-014-1170-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 11/28/2014] [Indexed: 02/07/2023]
Abstract
We investigated the incidence and prognostic value of anemia as well as of the iron status in non-selected patients admitted to an intensive cardiac care unit (ICCU). 392 patients (mean age 70 ± 13.8 years, 43% women), 168 with acute coronary syndromes (ACS), 122 with acute decompensated heart failure, and 102 with other acute cardiac disorders were consecutively, prospectively assessed. The biomarkers of iron status-serum iron concentration (SIC), total iron binding capacity (TIBC), and transferrin saturation (TSAT) together with standard clinical, biochemical and echocardiographic variables-were analyzed. In-hospital mortality was 3.8% (15 patients). The prevalences of anemia (according to WHO criteria), and iron deficiency (ID) were 64 and 63%, respectively. The level of biomarkers of iron status, but not anemia, was lower in patients who died (p < 0.05). Anemia was less frequent in patients with ACS as compared to the remaining ICCU population (p = 0.019). The analysis by logistic regression indicated the highest risk of death for age [odds ratio (OD) 1.38, 95% CI 1.27-1.55], SIC (OR 0.85, 95% CI 0.78-0.94), TIBC (OR 0.95, 95% CI 0.91-0.98), left ventricle ejection fraction (OR 0.85, 95% CI 0.77-0.93), as well as hospitalization for non-ACS (OR 0.25, 95% CI 0.14-0.46), (p < 0.05). The risk of death during hospitalization tended to increase with decreasing levels of TIBC (p = 0.49), as well as with the absence of ACS (p = 0.54). The incidence of anemia and ID in heterogeneous ICCU patients is high. Parameters of the iron status, but not anemia per se, independently influence in-hospital mortality. The prevalence of anemia is higher in non-ACS patients, and tends to worsen the prognosis.
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Affiliation(s)
- Ewa Uscinska
- Department of Cardiology, Medical University of Bialystok, ul. Sklodowskiej-Curie 24a, 15-276, Bialystok, Poland
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29
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Agreement between fecal occult blood test and virtual colonoscopy in the diagnostic procedure of anemia in elderly patients. Eur Geriatr Med 2014. [DOI: 10.1016/j.eurger.2014.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Callera F, Callera AF, da Silva AM, Rosa ES. Prevalence of anemia in a sample of elderly southeastern Brazilians. Rev Bras Hematol Hemoter 2014; 37:43-7. [PMID: 25638767 PMCID: PMC4318851 DOI: 10.1016/j.bjhh.2014.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/23/2014] [Indexed: 11/29/2022] Open
Abstract
Objective To demonstrate the proportion of anemia and its association with demographic and clinical characteristics in a representative sample of elderly people from São José dos Campos, São Paulo. Methods Demographic data and blood samples were collected from 398 over 65-year-old male and female individuals. Anemia was defined as hemoglobin concentration <12 g/dL in women and <13 g/dL in men. Anemic and non-anemic groups were compared using the chi-squared test and a multiple logistic regression model. Results The prevalence of anemia was 18.6% (20.8% in men and 17.6% in women). The percentages of anemia rose significantly across the age groups >75–80, >85–90 and >90–95 years (p-value = 0.0251). There were no significant differences in gender, ethnic background, place of residence, years of schooling, income, comorbidities and use of medications. According to gender, the mean hemoglobin concentration and mean corpuscular volume were 11.5 g/dL (range: 8.4–11.9 g/dL) and 90.7 fL (range: 63.0–111.7 fL) for women and 11.9 g/dL (range: 8.6–12.8 g/dL) and 92.1 fL (range: 59.8–100.1 fL) for men. The great majority of anemia cases were mild with less than 6% having hemoglobin concentrations below 10.9 g/dL. Mean corpuscular volume was lower than 80 fL in six cases (8%), between 80 and 100 fL in 65 cases (88%) and higher than 100 fL in three cases (4%). Conclusion A total of 18.6% of elderly people from São José dos Campos had mild anemia with the majority being normocytic. The percentages of anemia rose as the age increased demonstrating an association between age and anemia.
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Lewerin C, Nilsson-Ehle H, Jacobsson S, Johansson H, Sundh V, Karlsson MK, Lorentzon M, Barrett-Connor E, Vandenput L, Ohlsson C, Mellström D. Serum estradiol associates with blood hemoglobin in elderly men: the MrOS Sweden study. J Clin Endocrinol Metab 2014; 99:2549-56. [PMID: 24731011 DOI: 10.1210/jc.2013-4111] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Blood hemoglobin (Hb) declines with age in healthy elderly men, in whom decreasing T has been regarded as part of normal aging. However, the association between Hb and serum estradiol is incompletely known. OBJECTIVE To determine whether estradiol is associated with anemia/Hb and established determinants of Hb in elderly men without prostate cancer. DESIGN, SETTING, AND PARTICIPANTS The MrOS (Osteoporotic Fractures in Men) is a population-based study (n = 918; median age, 75.3 y; range, 70-81 y). MAIN OUTCOME MEASURES We evaluated total estradiol in relation to Hb and adjusted for potential confounders (ie, age, body mass index [BMI], erythropoietin [EPO], total T, cystatin C, and iron and B-vitamin status). RESULTS Estradiol correlated negatively with age (r = -0.14; P < .001). Hb correlated (age adjusted) positively with estradiol (r = 0.21; P < .001) and T (r = 0.10; P < .01). Independent predictors for Hb in multivariate analyses were estradiol, EPO, BMI, transferrin saturation, cystatin C, and free T4, but not T. After exclusion of subjects with Hb <130 g/L and/or T < 8 nmol/L (n = 99), the correlation between Hb and T was no longer significant, whereas the associations between Hb and estradiol remained. After adjusting for age, BMI, and EPO, men with lower estradiol levels were more likely to have Hb in the lowest quartile of values (odds ratio per SD decrease in estradiol = 1.61 [95% confidence interval, 1.34-1.93]). Anemic subjects (Hb < 130 g/L) had lower mean estradiol than nonanemic subjects (67.4 vs 79.4 pmol/L; P < .001). CONCLUSIONS Estradiol correlated positively and independently with Hb. Decreased estradiol might partly explain the age-related Hb decline observed in healthy elderly men.
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Affiliation(s)
- Catharina Lewerin
- Section of Hematology and Coagulation, Department of Internal Medicine, Institute of Medicine (C.L., H.N.-E.), Department of Clinical Chemistry and Transfusion Medicine (S.J.), and Center for Bone and Arthritis Research (CBAR), Geriatric Medicine at the Institute of Medicine (H.J., V.S., M.L., D.M.), Sahlgrenska Academy at the University of Gothenburg, 413 45 Gothenburg, Sweden; Clinical and Molecular Osteoporosis Research Unit (M.K.K.), Department of Clinical Sciences and Orthopaedics, Lund University, SE-20502 Malmö, Sweden; Department of Family and Preventative Medicine (E.B.-C.), University of California, San Diego, California 92093; and CBAR (L.V., C.O.), Department of Internal Medicine and Clinical Nutrition, at the Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, SE-411 45 Gothenburg, Sweden
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Duh MS, Latypova A, Greenberg P. Impact and treatment of anemia in the elderly: clinical, epidemiological and economic perspectives. Expert Rev Pharmacoecon Outcomes Res 2014; 6:577-90. [DOI: 10.1586/14737167.6.5.577] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Beyer I, Compté N, Busuioc A, Cappelle S, Lanoy C, Cytryn E. Anemia and transfusions in geriatric patients: a time for evaluation. Hematology 2013; 15:116-21. [DOI: 10.1179/102453310x12583347010052] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- I. Beyer
- Geriatric DepartmentUniversitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels B-1090, Belgium
| | - N. Compté
- Geriatric DepartmentHôpital Académique Erasme, Brussels, Belgium
| | - A. Busuioc
- Geriatric Department, Centre Hospitalier Universitaire Brugmann, Free University of Brussels (VUB/ULB), Brussels, Belgium
| | - S. Cappelle
- Geriatric DepartmentHôpital Académique Erasme, Brussels, Belgium
| | - C. Lanoy
- Geriatric Department, Centre Hospitalier Universitaire Brugmann, Free University of Brussels (VUB/ULB), Brussels, Belgium
| | - E. Cytryn
- Geriatric Department, Centre Hospitalier Universitaire Brugmann, Free University of Brussels (VUB/ULB), Brussels, Belgium
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Sgnaolin V, Engroff P, Ely LS, Schneider RH, Schwanke CHA, Gomes I, Morrone FB, de Carli GA. Hematological parameters and prevalence of anemia among free-living elderly in south Brazil. Rev Bras Hematol Hemoter 2013; 35:115-8. [PMID: 23741189 PMCID: PMC3672121 DOI: 10.5581/1516-8484.20130032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/31/2012] [Indexed: 10/29/2022] Open
Abstract
OBJECTIVE The aims of this study were to analyze the hematological parameters, the prevalence of anemia and the association between anemia and socioeconomic conditions in an elderly community-based population. METHODS A population-based study was performed as part of the Multidimensional Study of the Elderly in Porto Alegre, Brazil (EMIPOA). An initial total of 1058 community residents aged 60 years and older were interviewed. Of these, 392 agreed to have a physical evaluation and a blood sample was taken from each. The hematological parameters analyzed in the blood samples included the hemoglobin concentration, mean cell volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and red cell distribution width (RDW). The association between the variables and the diagnosis of anemia was assessed using the chi-squared test and a multiple logistic regression model. RESULTS The overall prevalence of anemia was 12.8%. Anemia was present in 13.7% of women and in 10.4% of men. Normocytic normochromic anemia without anisocytosis was the most common type of anemia (46%). The assessment of erythrocyte morphology showed significant differences between anemic and non-anemic individuals (microcytosis = 12% vs. 1.5%, hypochromia = 40% vs. 8.8%, and anisocytosis = 26% vs. 7%). In the analysis of socioeconomic conditions, significant differences were found in respect to age and race. CONCLUSION The prevalence of anemia increases with age and is associated with race, microcytosis, hypochromia and anisocytosis. Anemia is not a condition that should be associated only with the aging process, as it may be due to pathological conditions that occur most frequently in this age group. As a result, a diagnosis of anemia warrants adequate clinical attention.
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Affiliation(s)
- Vanessa Sgnaolin
- Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS, Porto Alegre, RS, Brazil
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Partridge J, Harari D, Gossage J, Dhesi J. Anaemia in the older surgical patient: a review of prevalence, causes, implications and management. J R Soc Med 2013; 106:269-77. [PMID: 23759887 DOI: 10.1177/0141076813479580] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This review provides the clinician with a summary of the causes, implications and potential treatments for the management of anaemia in the older surgical patient. The prevalence of anaemia increases with age and is frequently identified in older surgical patients. Anaemia is associated with increased postoperative morbidity and mortality. Allogenic blood transfusion is commonly used to treat anaemia but involves inherent risks and may worsen outcomes. Various strategies for the correction of pre- and postoperative anaemia have evolved. These include correction of nutritional deficiencies and the use of intravenous iron and erythropoesis stimulating therapy. Clear differences exist between the elective and emergency surgical populations and the translation of research findings into these individual clinical settings requires more work. This should lead to a standardized approach to the management of this frequently encountered clinical scenario.
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Hsu HS, Li CI, Liu CS, Lin CC, Huang KC, Li TC, Huang HY, Lin WY. Iron deficiency is associated with increased risk for cardiovascular disease and all-cause mortality in the elderly living in long-term care facilities. Nutrition 2013; 29:737-43. [DOI: 10.1016/j.nut.2012.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 10/26/2012] [Accepted: 10/28/2012] [Indexed: 01/13/2023]
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Barbosa FPT, Luna RCP, Monteiro MGCA, Asciutti LSR, de Oliveira RSS, Diniz ADS, Lima RT, Benigna MJCDN, de Moraes RM, Costa MJC, Gonçalves MDCR. Relationship between hemoglobin, serum retinol and habitual meat consumption in the elderly: a population-based study. Arch Gerontol Geriatr 2013; 57:60-5. [PMID: 23427795 DOI: 10.1016/j.archger.2013.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/17/2013] [Accepted: 01/23/2013] [Indexed: 01/12/2023]
Abstract
Considering the scarcity of data on the relationship between hemoglobin, serum retinol and habitual meat consumption in the elderly, a cross-sectional population-based study was performed, which was representative of the population of a state capital in Northeastern Brazil, including 176 elderly aged between 60 and 90 years, who responded to questionnaires about habitual food consumption and socioeconomic aspects. Blood counts and serum retinol analyses were carried out. The prevalence of anemia was 9.58%, and 96% of elderly showing adequate serum retinol levels. The consumption of vitamin A and iron was adequate in 93.75% and 85%, respectively. There was no correlation between serum retinol and hemoglobin values (p=0.56), and as expected, there was a positive association between meat consumption and hemoglobin (p=0.02). Based on results obtained in this study, it was concluded that the maintenance of adequate vitamin A and meat intake in this population should be encouraged, which appears to be an effective intervention strategy to achieve appropriate serum retinol and hemoglobin values, and hence lower iron deficiency anemia rates.
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Affiliation(s)
- Fernanda P T Barbosa
- Postgraduate Program in Nutritional Sciences, Center for Health Sciences, Department of Nutrition, Federal University of Paraíba, Castelo Branco, João Pessoa, PB 58059-900, Brazil
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Andrès E, Serraj K, Federici L, Vogel T, Kaltenbach G. Anemia in elderly patients: New insight into an old disorder. Geriatr Gerontol Int 2012; 13:519-27. [DOI: 10.1111/ggi.12017] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 12/21/2022]
Affiliation(s)
| | - Khalid Serraj
- Department of Internal Medicine, Diabetes and Metabolic Disorders; University Hospital of Strasbourg; Strasbourg; France
| | - Laure Federici
- Department of Internal Medicine; University Hospital of Oujda; Oujda; Morocco
| | - Thomas Vogel
- Department of Geriatrics and Internal Medicine; University Hospital of Strasbourg; Strasbourg; France
| | - Georges Kaltenbach
- Department of Geriatrics and Internal Medicine; University Hospital of Strasbourg; Strasbourg; France
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Chalmers KA, Knuiman MW, Divitini ML, Bruce DG, Olynyk JK, Milward EA. Long-term mortality risks associated with mild anaemia in older persons: the Busselton Health Study. Age Ageing 2012; 41:759-64. [PMID: 23019140 DOI: 10.1093/ageing/afs150] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND up to 25% of older people in the USA and other Western countries are anaemic by World Health Organization (WHO) criteria. The objective of this study was to examine the long-term relationships of haemoglobin concentration with all-cause and cause-specific mortality in a community-based sample of Australian adults surveyed in 1978. METHODS a community survey of 2,194 adults aged 40+ years in Busselton, Western Australia in 1978 with mortality follow-up to 2001. Cox regression models were used to investigate the relationships of haemoglobin as a continuous measure and anaemia by WHO criteria (women <12 g/dl (7.5 mmol/l); men <13 g/dl (8.1 mmol/l)) with all-cause, cardiovascular and cancer mortality. RESULTS anaemia was predominantly mild (>10 g/dl) and normocytic. There was an increased risk of death from all causes and from cancer for men with low haemoglobin. Cancers were predominantly of the prostate and genito-urinary organs, and to a lesser extent the gastrointestinal tract. There was no increased risk of all cause or cancer death in women. CONCLUSION mild, normocytic anaemia is associated with survival reductions in middle-aged and older men, where it often occurs with prostate, gastrointestinal and other cancers, and should be investigated to exclude treatable causes.
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Affiliation(s)
- Kerry A Chalmers
- School of Psychology, The University of Newcastle and Hunter Medical Research Institute, Callaghan, New South Wales, Australia
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de Castro CCM, Gondim Gomes CB, Martins MRA, de Sousa JC, Magalhaes SMM, Pinheiro RF. Tissue doppler echocardiography detects preclinical markers of cardiac lesion in MDS patients. J Hematol Oncol 2012; 5:30. [PMID: 22709732 PMCID: PMC3418154 DOI: 10.1186/1756-8722-5-30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 06/07/2012] [Indexed: 11/27/2022] Open
Abstract
Myelodysplastic syndrome (MDS) is a clonal hematopoietic stem cell disorder of elderly people. Cardiac dysfunction is a marker of grim prognosis in MDS. We evaluated cardiac dysfunction of MDS patients with or without transfusion dependency by tissue doppler echocardiography. We found the average values of ventricular end-systolic and end-diastolic volumes in transfusion dependency MDS group higher than others. These results were strongly correlated to hemoglobin levels. Tissue Doppler Echocardiography should be routinely performed in MDS patients to detect preclinical cardiac alterations and prevent more heart insults in this group of chronic anemic aged patients.
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Santos IS, Scazufca M, Lotufo PA, Menezes PR, Benseñor IM. Causes of recurrent or persistent anemia in older people from the results of the São Paulo Ageing & Health Study. Geriatr Gerontol Int 2012; 13:204-8. [DOI: 10.1111/j.1447-0594.2012.00888.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Micronutrient (Zn, Cu, Fe)-gene interactions in ageing and inflammatory age-related diseases: implications for treatments. Ageing Res Rev 2012; 11:297-319. [PMID: 22322094 DOI: 10.1016/j.arr.2012.01.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 01/20/2012] [Accepted: 01/23/2012] [Indexed: 02/07/2023]
Abstract
In ageing, alterations in inflammatory/immune response and antioxidant capacity lead to increased susceptibility to diseases and loss of mobility and agility. Various essential micronutrients in the diet are involved in age-altered biological functions. Micronutrients (zinc, copper, iron) play a pivotal role either in maintaining and reinforcing the immune and antioxidant performances or in affecting the complex network of genes (nutrigenomic approach) involved in encoding proteins for a correct inflammatory/immune response. By the other side, the genetic inter-individual variability may affect the absorption and uptake of the micronutrients (nutrigenetic approach) with subsequent altered effects on inflammatory/immune response and antioxidant activity. Therefore, the individual micronutrient-gene interactions are fundamental to achieve healthy ageing. In this review, we report and discuss the role of micronutrients (Zn, Cu, Fe)-gene interactions in relation to the inflammatory status and the possibility of a supplement in the event of a micronutrient deficiency or chelation in presence of micronutrient overload in relation to specific polymorphisms of inflammatory proteins or proteins related of the delivery of the micronutriemts to various organs and tissues. In this last context, we report the protein-metal speciation analysis in order to have, coupled with micronutrient-gene interactions, a more complete picture of the individual need in micronutrient supplementation or chelation to achieve healthy ageing and longevity.
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Anemia and mortality in older persons: does the type of anemia affect survival? Int J Hematol 2012; 95:248-56. [PMID: 22351246 DOI: 10.1007/s12185-012-1007-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 01/05/2012] [Accepted: 01/10/2012] [Indexed: 10/28/2022]
Abstract
Anemia is a common condition among community-dwelling older adults. The present study investigates the effect of type of anemia on subsequent mortality. We analyzed data from participants of the Third National Health and Nutrition Survey who were aged ≥50 and had valid hemoglobin levels determined by laboratory measurement. Anemia was defined by World Health Organization criteria. 7,171 subjects met our inclusion criterion. Of those with anemia (n = 862, deaths = 491), 24% had nutritional anemia, 11% had anemia of chronic renal disease, 26% had anemia of chronic inflammation, and 39% had unexplained anemia. We found an overall relative risk (RR) for mortality of 1.8 (p < 0.001) comparing those with anemia to those without, after adjusting for age, sex, and race. After we controlled for a number of chronic medical conditions, the overall RR was 1.6. Compared to persons without anemia, we found the following RRs for the type of anemia: nutritional (2.34, p < 0.0001), chronic renal disease (1.70, p < 0.0001), chronic inflammation (1.48, p < 0.0001), and unexplained (1.26, p < 0.01). Anemia is common although not severe in older non-institutionalized adults. When compared with non-anemic older adults, those with nutritional anemia or anemia due to chronic renal disease have the highest mortality risk.
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Possibility of myelodysplastic syndromes screening using a complete blood automated cell count. Leuk Res 2011; 35:1623-7. [DOI: 10.1016/j.leukres.2011.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 06/07/2011] [Accepted: 06/14/2011] [Indexed: 11/19/2022]
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Bhasin A, Rao MY. Characteristics of anemia in elderly: a hospital based study in South India. Indian J Hematol Blood Transfus 2011; 27:26-32. [PMID: 22379291 DOI: 10.1007/s12288-011-0056-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 01/25/2011] [Indexed: 11/27/2022] Open
Abstract
Anemia is a common concern in older people and can have significant morbidity and mortality. Because anemia is a sign, not a diagnosis, an evaluation is almost always warranted to identify the underlying cause. The purpose of this study was to study the clinical profile of elderly patients with anemia and to study characteristics of hematological types of anemia in such patients as well as the closest possible etiological profile. Hundred patients above the age of 60 years were included in the study. Clinical profile with laboratory studies of Hemoglobin and diagnostic tests to fix the etiology. Majority of patients had normocytic blood picture. Renal failure was the most common underlying chronic disease. Significant number of patients were on non steroidal anti-inflammatory drugs which could contribute to the anaemia. 14% of the patients had an underlying malignancy. 73.3% of the patients in the microcytic group had an underlying GI lesion on endoscopy. Identifying anemia as an important aspect of a comprehensive geriatric assessment is absolutely essential further to clinical detection. Confirming the type of anemia is critical to direct the investigation for profiling the etiology since it is well known that the treatment of anemia goes a long way in improving the overall outcome and quality of life.
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Affiliation(s)
- Amit Bhasin
- Department of Medicine, M.S. Ramaiah Medical College and Hospital, Bangalore, India
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Wong J, Abrishami A, El Beheiry H, Mahomed NN, Roderick Davey J, Gandhi R, Syed KA, Muhammad Ovais Hasan S, De Silva Y, Chung F. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. J Bone Joint Surg Am 2010; 92:2503-13. [PMID: 21048170 DOI: 10.2106/jbjs.i.01518] [Citation(s) in RCA: 365] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Topical application of tranexamic acid to bleeding wound surfaces reduces blood loss in patients undergoing some major surgeries, without systemic complications. The objective of the present trial was to assess the efficacy and safety of the topical application of tranexamic acid on postoperative blood loss in patients undergoing primary unilateral total knee arthroplasty with cement. METHODS In a prospective, double-blind, placebo-controlled trial, 124 patients were randomized to receive 1.5 or 3.0 g of tranexamic acid in 100 mL of normal saline solution or an equivalent volume of placebo (normal saline solution) applied into the joint for five minutes at the end of surgery. The primary outcome was blood loss calculated from the difference between the preoperative hemoglobin level and the corresponding lowest postoperative value or hemoglobin level prior to transfusion. The safety outcomes included Doppler ultrasound in all patients and measurement of plasma levels of tranexamic acid one hour after release of the tourniquet. RESULTS Twenty-five patients were withdrawn for various reasons; therefore, ninety-nine patients were included in the intention-to-treat analysis. The postoperative blood loss was reduced in the 1.5 and 3-g tranexamic acid groups (1295 mL [95% confidence interval, 1167 to 1422 mL] and 1208 mL [95% confidence interval, 1078 to 1339 mL], respectively) in comparison with the placebo group (1610 mL [95% confidence interval, 1480 to 1738 mL]) (p < 0.017). The postoperative hemoglobin levels were higher in the 1.5 and 3.0-g tranexamic acid groups (10.0 g/dL [95% confidence interval, 9.5 to 10.4 g/dL] and 10.1 g/dL [95% confidence interval, 9.8 to 10.5 g/dL], respectively) in comparison with the placebo group (8.6 g/dL [95% confidence interval, 8.2 to 9 g/dL]) (p < 0.017). With the numbers studied, there was no difference in the rates of deep-vein thrombosis or pulmonary embolism between the three groups. Minimal systemic absorption of tranexamic acid was observed. CONCLUSIONS At the conclusion of a total knee arthroplasty with cement, topical application of tranexamic acid directly into the surgical wound reduced postoperative bleeding by 20% to 25%, or 300 to 400 mL, resulting in 16% to 17% higher postoperative hemoglobin levels compared with placebo, with no clinically important increase in complications being identified in the treatment groups.
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Affiliation(s)
- Jean Wong
- Department of Anesthesia, Toronto Western Hospital, University of Toronto, 2MC-434, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada.
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Tettamanti M, Lucca U, Gandini F, Recchia A, Mosconi P, Apolone G, Nobili A, Tallone MV, Detoma P, Giacomin A, Clerico M, Tempia P, Savoia L, Fasolo G, Ponchio L, Della Porta MG, Riva E. Prevalence, incidence and types of mild anemia in the elderly: the "Health and Anemia" population-based study. Haematologica 2010; 95:1849-56. [PMID: 20534701 PMCID: PMC2966906 DOI: 10.3324/haematol.2010.023101] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 05/28/2010] [Accepted: 05/31/2010] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hemoglobin concentrations slightly below the lower limit of normal are a common laboratory finding in the elderly, but scant evidence is available on the actual occurrence of mild anemia despite its potential effect on health. The objectives of this study were to estimate the prevalence and incidence of mild grade anemia and to assess the frequency of anemia types in the elderly. DESIGN AND METHODS This was a prospective, population-based study in all residents 65 years or older in Biella, Italy. RESULTS Blood test results were available for analysis from 8,744 elderly. Hemoglobin concentration decreased and mild anemia increased steadily with increasing age. Mild anemia (defined as a hemoglobin concentration of 10.0-11.9 g/dL in women and 10.0-12.9 g/dL in men) affected 11.8% of the elderly included in the analysis, while the estimated prevalence in the entire population was 11.1%. Before hemoglobin determination, most mildly anemic individuals perceived themselves as non-anemic. Chronic disease anemia, thalassemia trait, and renal insufficiency were the most frequent types of mild anemia. The underlying cause of mild anemia remained unexplained in 26.4% of the cases, almost one third of which might be accounted for by myelodysplastic syndromes. In a random sample of non-anemic elderly at baseline (n=529), after about 2 years, the annual incidence rate of mild anemia was 22.5 per 1000 person-years and increased with increasing age. CONCLUSIONS The prevalence and incidence of mild anemia increase with age and mild anemia affects more than one out of ten elderly individuals. Unexplained anemia is common and may be due to myelodysplastic syndromes in some cases.
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Affiliation(s)
- Mauro Tettamanti
- Laboratory of Geriatric Neuropsychiatry, Istituto di Ricerche Farmacologiche “Mario Negri”, Milan
| | - Ugo Lucca
- Laboratory of Geriatric Neuropsychiatry, Istituto di Ricerche Farmacologiche “Mario Negri”, Milan
| | - Francesca Gandini
- Laboratory of Geriatric Neuropsychiatry, Istituto di Ricerche Farmacologiche “Mario Negri”, Milan
| | - Angela Recchia
- Laboratory of Geriatric Neuropsychiatry, Istituto di Ricerche Farmacologiche “Mario Negri”, Milan
| | - Paola Mosconi
- Laboratory for Medical Research & Consumer Involvement, Istituto di Ricerche Farmacologiche “Mario Negri”, Milan
| | - Giovanni Apolone
- Laboratory of Translational and Outcome Research in Oncology, Istituto di Ricerche Farmacologiche “Mario Negri”, Milan
| | - Alessandro Nobili
- Laboratory of Quality Assessment of Geriatric Therapies and Services, and Drug Information Services for the Elderly, Istituto di Ricerche Farmacologiche “Mario Negri”, Milan
| | | | - Paolo Detoma
- Laboratory of Analysis, Ospedale degli Infermi, Biella
| | | | - Mario Clerico
- Department of Oncology, Ospedale degli Infermi, Biella
| | | | - Luigi Savoia
- Community Medicine, Local Health Authority ASL BI, Biella
| | | | - Luisa Ponchio
- U.O. Oncologia Medica, IRCCS Fondazione Salvatore Maugeri, Pavia and
| | - Matteo G. Della Porta
- Division of Hematology, University of Pavia & Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emma Riva
- Laboratory of Geriatric Neuropsychiatry, Istituto di Ricerche Farmacologiche “Mario Negri”, Milan
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JOHNSON M, HAUSMAN D, DAVEY A, POON L, ALLEN R, STABLER S. Vitamin B12 deficiency in African American and white octogenarians and centenarians in Georgia. J Nutr Health Aging 2010; 14:339-45. [PMID: 20424799 PMCID: PMC2978918 DOI: 10.1007/s12603-010-0077-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Test the hypotheses that vitamin B12 deficiency would be prevalent in octogenarians and centenarians and associated with age, gender, race/ethnicity, living arrangements (community or skilled nursing facility), animal food intake, B-vitamin supplement use, atrophic gastritis, folate status, and hematological indicators. DESIGN Population-based multi-ethnic sample of adults aged 80 to 89 and 98 and above. SETTING Northern Georgia in the United States. PARTICIPANTS Men and women aged 80 to 89 (octogenarians, n = 80) and 98 and older (centenarians, n = 231). MEASUREMENTS Wilcoxon signed-rank tests, Fisher's exact tests, and logistic regression analysis was used to examine the associations of vitamin B12 status with the variables of interest. RESULTS After excluding participants receiving vitamin B12 injections (n = 17), the prevalence of vitamin B12 deficiency was higher in centenarians than in octogenarians (35.3% vs. 22.8%, p < 0.05, defined as plasma vitamin B12 < 258 pmol/L and serum methylmalonic acid > 271 nmol/L and methylmalonic acid > serum 2-methylcitrate) and in both age groups was correlated with significantly higher homocysteine (p < 0.05) and lower plasma and red cell folate (p < 0.01), but was not related to hemoglobin, anemia, mean cell volume, or macrocytosis. In logistic regression analysis, the probability of being vitamin B12-deficient was significantly increased by being a centenarian vs. octogenarian (p < 0.03), by being white vs. African American (p < 0.02), by increasing severity of atrophic gastritis (p < 0.001), and by not taking oral B-vitamin supplements (p < 0.01), but was not related to gender, living arrangements, or animal food intake. CONCLUSIONS Centenarians and octogenarians are at high risk for vitamin B12 deficiency for many of the same reasons identified in other older adult populations. Given the numerous potential adverse consequences of poor vitamin B12 status, efforts are needed to ensure vitamin B12 adequacy in these older adults.
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Affiliation(s)
- M.A. JOHNSON
- Department of Foods and Nutrition, University of Georgia, Athens, GA, USA
| | - D.B. HAUSMAN
- Department of Foods and Nutrition, University of Georgia, Athens, GA, USA
| | - A. DAVEY
- College of Health Professions, Temple University, Philadelphia, PA, USA
| | - L.W. POON
- Institute of Gerontology, University of Georgia, Athens, GA, USA
| | - R.H. ALLEN
- University of Colorado Denver Health Sciences Center, Aurora, CO, USA
| | - S.P. STABLER
- University of Colorado Denver Health Sciences Center, Aurora, CO, USA
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Abstract
Nutritional anemias are important because they are easily reversed and because their underlying causes, most often unrelated to dietary intake, require individualized assessment. Iron-deficiency anemia (IDA) usually results from iron losses accompanying chronic bleeding, including loss to intestinal parasites, or from gastric disorders or malabsorption in the elderly. Cobalamin-deficiency anemia, the only nutritional anemia with predilection for the elderly, nearly always stems from failure of intrinsic factor (IF)-related absorption. Folate-deficiency anemia, the only nutritional anemia usually caused by poor intake, has nearly disappeared in countries that fortify food with folic acid. Copper-deficiency anemia, which usually results from malabsorptive disorders or from medical or nutritional interventions that provide inadequate copper or excess zinc, is uncommon but increasingly recognized. The prevalences of nutritional anemias, which are not always distinguished from non-anemic deficiency, are uncertain. The mean corpuscular volume (MCV) provides an essential diagnostic tool leading to judicious matching of relevant biochemical changes with relevant anemia. Nutritional anemias usually feature abnormal MCV, whereas the predominant anemias in the aged, especially the anemias of chronic disease/chronic inflammation (ACD/ACI), of renal failure, and of unknown causes, are typically normocytic.
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Affiliation(s)
- Ralph Carmel
- Departments of Medicine, New York Methodist Hospital, 506 Sixth Street, Brooklyn, NY 11215, USA.
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Riva E, Tettamanti M, Mosconi P, Apolone G, Gandini F, Nobili A, Tallone MV, Detoma P, Giacomin A, Clerico M, Tempia P, Guala A, Fasolo G, Lucca U. Association of mild anemia with hospitalization and mortality in the elderly: the Health and Anemia population-based study. Haematologica 2008; 94:22-8. [PMID: 19001283 DOI: 10.3324/haematol.13449] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Mild anemia is a frequent laboratory finding in the elderly usually disregarded in everyday practice as an innocent bystander. The aim of the present population-based study was to prospectively investigate the association of mild grade anemia with hospitalization and mortality. DESIGN AND METHODS A prospective population-based study of all 65 to 84 year old residents in Biella, Italy was performed between 2003 and 2007. Data from a total of 7,536 elderly with blood tests were available to estimate mortality; full health information available to evaluate health-related outcomes was available for 4,501 of these elderly subjects. Mild grade anemia was defined as a hemoglobin concentration between 10.0 and 11.9 g/dL in women and between 10.0 and 12.9 g/dL in men. RESULTS The risk of hospitalization in the 3 years following recruitment was higher among the mildly anemic elderly subjects than among subjects who were not anemic (adjusted hazard ratio: 1.32; 95% confidence interval: 1.09-1.60). Mortality risk in the following 3.5 years was also higher among the mildly anemic elderly (adjusted hazard ratio: 1.86; 95% confidence interval: 1.34-2.53). Similar results were found when slightly elevating the lower limit of normal hemoglobin concentration to 12.2 g/dL in women and to 13.2 g/dL in men. The risk of mortality was significantly increased in mild anemia of chronic disease but not in that due to beta-thalassemia minor. CONCLUSIONS After controlling for many potential confounders, mild grade anemia was found to be prospectively associated with clinically relevant outcomes such as increased risk of hospitalization and all-cause mortality. Whether raising hemoglobin concentrations can reduce the risks associated with mild anemia should be tested in controlled clinical trials.
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Affiliation(s)
- Emma Riva
- Laboratory of Geriatric Neuropsychiatry, Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
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