Serum lipid profiles of young Japanese women with iron deficiency without anemia

PURPOSE

We aimed to evaluate the association between iron deficiency without anemia (IDNA) and serum lipid profiles in young women of around 20 years of age.

METHODS

This study included non-anemic (hemoglobin ≥ 12 g/dL) female volunteers aged 18 to 22 years who were not taking mineral/vitamin supplements and living in the metropolitan area of Tokyo, Japan. These volunteers were classified into two groups based on their sFer (serum ferritin) levels: normal group (sFer ≥ 20 ng/mL, n = 36) and IDNA group (sFer < 20 ng/mL, n = 29). Venous blood samples were obtained from the antecubital veins of these volunteers after 10-12-h fasting to measure the hematological and biochemical parameters, including lipid levels and iron status. The results of each group were compared using Student's t-test or the Mann-Whitney U test (for inhomogeneous variance).

RESULTS

The serum cholesterol levels varied depending on the iron status in the women. Serum high-density lipoprotein cholesterol (HDL-C) levels in the IDNA group were significantly higher (P = 0.006) than that in the normal group. However, the levels of total cholesterol (T-CHO), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) were not significantly different between the groups. Serum LDL-C levels were positively and significantly correlated with sFer levels in the IDNA group (Kendall's rank correlation 0.264, P = 0.044), but not in the normal group. The sFer level was not correlated with serum HDL-C in both groups. The reason for the high serum HDL-C levels in young women with IDNA is not yet clear. Compared to the normal group, the frequency of eating bread containing bran was significantly higher (P = 0.031) and that for yogurt was significantly lower (P = 0.040) in the IDNA group. The proportion of the women who were susceptible to infection, which was measured using the Cornell Medical Index, was significantly higher in the IDNA group than in the normal group. Among those susceptible to infection, the serum HDL-C level of the volunteers in the IDNA group was significantly higher than that of the volunteers in the normal group (P = 0.024).

CONCLUSIONS

Our findings suggest that lipid parameters may be associated with IDNA and susceptibility to infection. Further research is needed to elucidate the mechanisms underlying the changes in the serum cholesterol levels in individuals with IDNA and the clinical significance of these findings.

Iron deficiency without anaemia is a potential cause of fatigue: meta-analyses of randomised controlled trials and cross-sectional studies

Fe deficiency is a prevalent nutritional disease, and fatigue is a common complaint in the general and patient population. The association between Fe deficiency without anaemia (IDNA) and fatigue is unclear. Here, we performed a meta-analysis to evaluate the therapeutic effect of Fe on fatigue in patients with IDNA and the association between IDNA and fatigue in the population. Articles from the PubMed database up to 19 January 2016 were systematically searched. A total of six relevant randomised controlled trials (RCT) and six relevant cross-sectional studies were identified. All outcomes were converted into effect sizes. In the meta-analysis of the six RCT, we identified a significant therapeutic effect of Fe in fatigue patients with IDNA (pooled effect size 0·33; 95 % CI 0·17, 0·48; I 2=0·0 %; P<0·0001). A sensitivity analysis found that the overall results (i.e. significant association) were robust. In the meta-analysis of the six cross-sectional studies, the association between IDNA and fatigue was not significant (pooled effect size 0·10; 95 % CI -0·11, 0·31; I 2=57·4 %; P=0·362). A sensitivity analysis found that the overall results (i.e. no significant association) were not robust; removal of one study made the outcomes significant. These meta-analyses suggest that improving Fe status may decrease fatigue. Further research is necessary to identify diagnostic criteria for selecting fatigue patients who might benefit from Fe therapy and to assess the prevalence of IDNA with fatigue in the general population.

Is iron deficiency in the absence of anemia associated with fatigue in inflammatory bowel disease?

OBJECTIVES

We explored whether iron deficiency in the absence of anemia is associated with fatigue in inflammatory bowel disease (IBD).

METHODS

We assessed iron deficiency and anemia in 280 participants from the population-based Manitoba IBD Cohort Study.

RESULTS

Iron deficiency was identified in 20% with Crohn's disease and 27% with ulcerative colitis. Anemia was identified overall in 50 (18%), with 230 who were nonanemic. In the nonanemic subgroup, there were no significant differences between iron-deficient and -sufficient groups in mean fatigue levels or proportions with problematic fatigue. There was no unique contribution of iron deficiency to problematic fatigue after adjustment for active disease and anemia.

CONCLUSIONS

There was no evidence of an association between iron deficiency and fatigue in the absence of anemia, suggesting that iron deficiency is not a clinically relevant contributor to fatigue in IBD.

Dietary and supplement treatment of iron deficiency results in improvements in general health and fatigue in Australian women of childbearing age

OBJECTIVE

To examine the effects of iron deficiency and its treatment by iron supplementation or a high iron diet on fatigue and general health measures in women of childbearing age.

DESIGN

Randomised controlled trial to compare supplement and dietary treatment of iron deficiency.

SUBJECTS

44 iron deficient (serum ferritin < 15 microg/L or serum ferritin 15-20 microg/L, plus two of the following: serum iron < 10 micromol/L, total iron binding capacity > 68 micromol/L or transferrin saturation < 15%) and 22 iron replete (hemoglobin > or = 10 g/L and serum ferritin > 20 microg/L) women 18 to 50 years of age were matched for age and parity.

INTERVENTIONS

Iron deficient women were randomly allocated to either iron supplementation or a high iron diet for 12 weeks.

MEASURES OF OUTCOME

Iron deficient and iron replete participants had iron studies performed and completed the Piper Fatigue Scale (PFS) and the SF-36 general health and well-being questionnaire at baseline (T0), following the 12 week intervention (T1) and again after a six-month non-intervention phase (T2). The SF-36 includes measures of physical (PCS) and mental (MCS) health and vitality (VT).

RESULTS

MCS and VT scores were lower and PFS scores were higher for iron deficient women (diet and supplement groups) than iron replete women at baseline. Both intervention groups showed similar improvements in MCS, VT and PFS scores during the intervention phase, but mean increases in serum ferritin were greater in the supplement than the diet group. PCS scores were not related to iron status.

CONCLUSIONS

Treatment of iron deficiency with either supplementation or a high iron diet results in improved mental health and decreased fatigue among women of childbearing age.

Iron status and non-specific symptoms of female students

OBJECTIVE

To examine the relationship between iron status and non-specific symptoms among female students.

DESIGN

Cross-sectional study.

SUBJECTS AND SETTING

Data were collected from 255 female students, aged 15 to 30 years, attending Curtin University of Technology, Perth or secondary schools in the Perth metropolitan area.

MAIN OUTCOME MEASURES

Frequency of non-specific symptoms, psychological distress based on the General Health Questionnaire (GHQ), and iron status measured by standard hematological and biochemical tests including serum transferrin receptor.

RESULTS

Anemic subjects (hemoglobin < 12.0 g/dL) scored significantly higher on the GHQ than non-anemic subjects (p < 0.05). Using univariate analysis, iron deficiency (serum ferritin < or = 12 micrograms/L) was not associated with non-specific symptoms or psychological distress. Among iron-deficient subjects, those using the oral contraceptive pill reported significantly more symptoms (depression, irritability, difficulty concentrating) than non-users.

CONCLUSIONS

The evidence of an association between iron status and non-specific symptoms was weak with the exception of iron-deficient women using the oral contraceptive pill. Further studies are warranted to determine the role of the oral contraceptive pill in the etiology of depression and other symptoms among iron deficient women.