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Poventud-Fuentes I, Chong TH, Dowlin M, Devaraj S, Curry CV. Reticulocyte hemoglobin equivalent as a marker to assess iron deficiency: A large pediatric tertiary care hospital study. Int J Lab Hematol 2024; 46:148-155. [PMID: 37850393 DOI: 10.1111/ijlh.14188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Detection of iron deficiency (ID) remains challenging. We aimed to evaluate the performance of reticulocyte hemoglobin equivalent (Ret-He) as a potential diagnostic marker to assess ID and iron deficiency anemia (IDA) in a large pediatric cohort. METHODS A total of 3158 patients (aged 15 days to 19 years with a median age of 8.5 years; 60.2% female) were retrospectively studied. Statistical analysis was performed (a) to evaluate relationship of Ret-He with other relevant complete blood count and iron panel parameters; (b) to compare the levels of Ret-He in ID and IDA groups to a control group; and (c) to assess sensitivity and specificity of Ret-He in ID, IDA, and anemia without ID groups. RESULTS Ret-He values were significantly positively correlated to ferritin and transferrin saturation (TSAT). The median Ret-He was significantly lower in ID. A Ret-He cutoff of ≤30.0 pg distinguished cases of ID from the control group with a sensitivity of 90.2%, specificity of 59.5%, and area under curve (AUC) of 0.88. Ret-He showed better diagnostic performance in the IDA group and acceptable performance for ID without anemia. The sensitivity, specificity, and AUC were 90.1%, 80.9%, and 0.93 for IDA at cutoff value of ≤27.4 pg, and 80.8%, 51.1%, and 0.70 for ID without anemia at cutoff value of ≤30.8 pg, respectively. CONCLUSION Our large pediatric tertiary care hospital study demonstrates that Ret-He is a reliable marker to help confirm IDA in pediatric population. However, further studies are needed for its use to capture the early stages of ID.
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Affiliation(s)
- Izmarie Poventud-Fuentes
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Thomas H Chong
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Michael Dowlin
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Sridevi Devaraj
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Choladda V Curry
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, USA
- Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
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Xi X, Wu Q, Wang X, Sun X, Yu G, Jiang L, Wu H, Zhang L. The association between iron metabolism with the change of blood pressure and risk of hypertension: A large cross-sectional study. J Trace Elem Med Biol 2023; 79:127193. [PMID: 37269648 DOI: 10.1016/j.jtemb.2023.127193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND The relationship between iron metabolism and variations in blood pressure and hypertension risk is still not clear. This study aimed to determine whether iron metabolism is associated with changes in blood pressure and hypertension prevalence in the general United States population. METHODS The National Health and Nutrition Examination Survey (NAHNES) database contains data on 116876 Americans from 1999 to 2020 years. Data from the NHANES database were used to examine the relationships between iron metabolism (serum iron [SI], serum ferritin [SF], and soluble transferrin receptor [sTfR]) and changes in blood pressure and hypertension prevalence. Generalized linear models and restricted cubic spline (RCS) plot curves were used to estimate the relationship between iron metabolism and hypertension. Further, generalized additive models with smooth functions were used to identify the relationship between iron metabolism and blood pressure. Finally, a stratified subgroup analysis was performed. RESULTS A total of 6710 participants were included in our analysis. The RCS plot showed a linear relationship between SI, as well as sTfR, and hypertension prevalence. SF and hypertension prevalence were associated in a J-shape. In addition, the relationship between SI and systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased initially and then increased. A correlation between SF, SBP, and DBP first decreased, then increased, and finally decreased. A positive linear correlation existed between sTfR and SBP, but it increased and then decreased with DBP. CONCLUSION The correlation between SF and hypertension prevalence displayed a J-curve. In contrast, the correlation between SI, as well as sTfR, and hypertension risk was negative and positive, respectively.
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Affiliation(s)
- Xiaolong Xi
- Department of Critical Care Medicine, Shaoxing People's Hospital, No.568 Zhong Xing Road, Shaoxing, Zhejiang, 312000, China
| | - Qiong Wu
- Department of Cardiology, Kunshan Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu, 215300, China
| | - Xiaotong Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, China
| | - Xuedong Sun
- Department of Critical Care Medicine, Shaoxing People's Hospital, No.568 Zhong Xing Road, Shaoxing, Zhejiang, 312000, China
| | - Guofeng Yu
- Department of Critical Care Medicine, Shaoxing People's Hospital, No.568 Zhong Xing Road, Shaoxing, Zhejiang, 312000, China
| | - Lixian Jiang
- Department of Cardiology, Wuxi No.2 People's Hospital, Wuxi Clinical College of Nanjing Medical University, Wuxi, Jiangsu, 214000, China
| | - Hanzhi Wu
- Department of Cardiology, Wuxi No.2 People's Hospital, Wuxi Clinical College of Nanjing Medical University, Wuxi, Jiangsu, 214000, China
| | - Lizhu Zhang
- Department of Cardiology, Jiangnan University Medical Center, No.68 Zhongshan Road, Wuxi, Jiangsu, 214001, China.
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Ceballos-Rasgado M, Lowe NM, Mallard S, Clegg A, Moran VH, Harris C, Montez J, Xipsiti M. Adverse Effects of Excessive Zinc Intake in Infants and Children Aged 0-3 Years: A Systematic Review and Meta-Analysis. Adv Nutr 2022; 13:2488-2518. [PMID: 36055780 PMCID: PMC9776731 DOI: 10.1093/advances/nmac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/18/2022] [Accepted: 08/17/2022] [Indexed: 01/29/2023] Open
Abstract
Zinc supplementation reduces morbidity, but evidence suggests that excessive intakes can have negative health consequences. Current guidelines of upper limits (ULs) of zinc intake for young children are extrapolated from adult data. This systematic review (PROSPERO; registration no. CRD42020215187) aimed to determine the levels of zinc intake at which adverse effects are observed in young children. Studies reporting potential adverse effects of zinc intake in children aged 0-3 y were identified (from inception to August 2020) in MEDLINE, Embase, and the Cochrane Library, with no limits on study design. Adverse clinical and physical effects of zinc intake were synthesized narratively, and meta-analyses of biochemical outcomes were conducted. Random effects models were used to generate forest plots to examine the evidence by age category, dose, dose duration, chemical formula of zinc, and zinc compared with placebo. The Joanna Briggs Institute Critical Appraisal Checklist, Cochrane Risk of Bias 2, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline were employed to assess risk of bias and to appraise the certainty of evidence. Fifty-eight studies assessed possible adverse effects of zinc doses ranging from 3 to 70 mg/d. Data from 39 studies contributed to meta-analyses. Zinc supplementation had an adverse effect on serum ferritin, plasma/serum copper concentration, serum transferrin receptor, hemoglobin, hematocrit, and the odds of anemia in ≥1 of the subgroups investigated. Lactulose:mannitol ratio was improved with zinc supplementation, and no significant effect was observed on C-reactive protein, erythrocyte superoxide dismutase, zinc protoporphyrin, blood cholesterol, and iron deficiency anemia. The certainty of the evidence, as assessed using GRADE, was very low to moderate. Although possible adverse effects of zinc supplementation were observed in some subgroups, it is unclear whether these findings are clinically important. The synthesized data can be used to undertake a dose-response analysis to update current guidelines of ULs of zinc intake for young children.
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Affiliation(s)
- Marena Ceballos-Rasgado
- Centre for Global Development, University of Central Lancashire, Preston, Lancashire, United Kingdom
| | | | | | - Andrew Clegg
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Applied Health Research Hub, University of Central Lancashire, Preston, Lancashire, United Kingdom
| | - Victoria H Moran
- Centre for Global Development, University of Central Lancashire, Preston, Lancashire, United Kingdom
| | - Catherine Harris
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Applied Health Research Hub, University of Central Lancashire, Preston, Lancashire, United Kingdom
| | - Jason Montez
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Maria Xipsiti
- Food and Nutrition Division, Food and Agriculture Organization of the United Nations, Rome, Italy
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Larsson SM, Hillarp A, Karlsland Åkeson P, Hellström‐Westas L, Domellöf M, Askelöf U, Götherström C, Andersson O. Soluble Transferrin Receptor during infancy and reference intervals for the Roche Cobas platform. Int J Lab Hematol 2021; 43:378-386. [PMID: 33217104 PMCID: PMC8246861 DOI: 10.1111/ijlh.13391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 10/07/2020] [Accepted: 10/25/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Infant iron status assessments may be difficult to interpret due to infections. The soluble transferrin receptor (sTfR) has been suggested as a biomarker mainly unaffected by the acute phase response. Reference intervals reflecting dynamics of infant growth first year in life are not well established. METHODS The sTfR and CRP concentrations were measured in samples from 451 term infants with the Roche Cobas platform in umbilical cord, at 48-96 hours, 4 and 12 months. Reference values were constructed as the 2.5th and 97.5th percentiles. The relationship between CRP concentrations >1 mg/L and sTfR was tested by Kendall correlation. RESULTS Reference intervals for girls and boys were 2.4-9.5 mg/L at birth, 2.9-8.4 mg/L at 48-96 hours, 2.6-5.7 mg/L at 4 months and 3.0-6.3 mg/L at 12 months. No differences between sexes were observed except for at 4 months. sTfR did not covariate with CRP concentrations >1 mg/L except in 48-96 hours samples. CONCLUSION This study reports reference intervals for sTfR from birth to 12 months of age in a large group of infants in a low-risk area for iron deficiency. sTfR might add value to infant iron status diagnostics since no covariation with CRP was found at birth, at 4 months or at 12 months.
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Affiliation(s)
- Sara Marie Larsson
- Department of Clinical ChemistryHospital of HallandHalmstadSweden
- Department of Clinical Sciences, Lund, PediatricsLund UniversityLundSweden
| | - Andreas Hillarp
- Department of Clinical ChemistryHospital of HallandHalmstadSweden
| | - Pia Karlsland Åkeson
- Department of Clinical Sciences Malmö, Preventive PediatricsLund UniversityLundSweden
| | | | - Magnus Domellöf
- Department of Clinical Sciences, PediatricsUmeå UniversityUmeåSweden
| | - Ulrica Askelöf
- Division of Obstetrics and GynecologyDepartment of Clinical Science, Intervention and TechnologyKarolinska InstitutetStockholmSweden
| | - Cecilia Götherström
- Division of Obstetrics and GynecologyDepartment of Clinical Science, Intervention and TechnologyKarolinska InstitutetStockholmSweden
| | - Ola Andersson
- Department of Clinical Sciences, Lund, PediatricsLund UniversityLundSweden
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