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Cabalar I, Le TH, Silber A, O'Hara M, Abdallah B, Parikh M, Busch R. The role of blood testing in prevention, diagnosis, and management of chronic diseases: A review. Am J Med Sci 2024; 368:274-286. [PMID: 38636653 DOI: 10.1016/j.amjms.2024.04.009] [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: 09/26/2023] [Revised: 02/06/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
Blood tests are vital to prevention, diagnosis, and management of chronic diseases. Despite this, it can be challenging to construct a comprehensive view of the clinical importance of blood testing because relevant literature is typically fragmented across different disease areas and patient populations. This lack of collated evidence can also make it difficult for primary care providers to adhere to best practices for blood testing across different diseases and guidelines. Thus, this review article synthesizes the recommendations for, and importance of, blood testing across several common chronic conditions encountered in primary care and internal medicine, including cardiovascular diseases, diabetes mellitus, chronic kidney disease, vitamin D deficiency, iron deficiency, and rheumatoid arthritis. Future research is needed to continue improving chronic disease management through clearer dissemination and awareness of clinical guidelines among providers, and better access to blood testing for patients (e.g., via pre-visit laboratory testing).
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Affiliation(s)
- Imelda Cabalar
- Division of Rheumatology, Department of Medicine, Adventist HealthCare Fort Washington Medical Center, Fort Washington, MD, USA
| | - Thu H Le
- Division of Nephrology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | | | | | | | | | - Robert Busch
- Division of Community Endocrinology, Department of Medicine, Albany Medical Center, Albany, NY, USA.
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2
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Keller K, Friedrich O, Treiber J, Quermann A, Friedmann-Bette B. Iron deficiency in athletes: Prevalence and impact on VO 2 peak. Nutrition 2024; 126:112516. [PMID: 39002373 DOI: 10.1016/j.nut.2024.112516] [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: 02/12/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Iron is an important micronutrient in pathways of energy production, adequate nutrient intake and its balance is essential for optimal athletic performance. However, large studies elucidating the impact of iron deficiency on athletes' performance are sparse. METHODS Competitive athletes of any age who presented for preparticipation screening 04/2020-10/2021 were included in this study and stratified for iron deficiency (defined as ferritin level <20 µg/l with and without mild anemia [hemoglobin levels ≥11 g/dl]). Athletes with and without iron deficiency were compared and the impact of iron deficiency on athletic performance was investigated. RESULTS Overall, 1190 athletes (mean age 21.9 ± 11.6 years; 34.2% females) were included in this study. Among these, 19.7% had iron deficiency. Patients with iron deficiency were younger (18.1 ± 8.4 vs. 22.8 ± 12.1 years, P < 0.001), more often females (64.5% vs. 26.8%, P < 0.001), had lower VO2 peak value (43.4 [38.5/47.5] vs. 45.6 [39.1/50.6]ml/min/kg, P = 0.022) and lower proportion of athletes reaching VO2 peak of >50 ml/min/kg (8.5% vs. 16.1%, P = 0.003). Female sex (OR 4.35 [95% CI 3.13-5.88], P > 0.001) was independently associated with increased risk for iron deficiency. In contrast, the risk for iron deficiency decreased by every life year (OR 0.97 [95% CI 0.95-0.99], P = 0.003). Iron deficiency was independently associated with reduced VO2 peak (OR 0.94 [0.91-0.97], P < 0.001) and lower probability to reach VO2 peak >50 ml/min/kg (OR 0.42 [95% CI 0.25-0.69], P = 0.001). CONCLUSIONS Iron deficiency is common in athletes (predominantly in female and in young athletes). Iron deficiency was independently associated with reduced VO2 peak during exercise testing and lower probability to reach a VO2 peak >50 ml/min/kg.
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Affiliation(s)
- Karsten Keller
- Department of Sports Medicine, Medical Clinic VII, University Hospital Heidelberg, Heidelberg, Germany; Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Oliver Friedrich
- Department of Sports Medicine, Medical Clinic VII, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Treiber
- Department of Sports Medicine, Medical Clinic VII, University Hospital Heidelberg, Heidelberg, Germany
| | - Anne Quermann
- Department of Sports Medicine, Medical Clinic VII, University Hospital Heidelberg, Heidelberg, Germany
| | - Birgit Friedmann-Bette
- Department of Sports Medicine, Medical Clinic VII, University Hospital Heidelberg, Heidelberg, Germany
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Passarelli S, Free CM, Shepon A, Beal T, Batis C, Golden CD. Global estimation of dietary micronutrient inadequacies: a modelling analysis. Lancet Glob Health 2024; 12:e1590-e1599. [PMID: 39218000 PMCID: PMC11426101 DOI: 10.1016/s2214-109x(24)00276-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/12/2024] [Accepted: 06/20/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Inadequate micronutrient intakes and related deficiencies are a major challenge to global public health. Analyses over the past 10 years have assessed global micronutrient deficiencies and inadequate nutrient supplies, but there have been no global estimates of inadequate micronutrient intakes. We aimed to estimate the global prevalence of inadequate micronutrient intakes for 15 essential micronutrients and to identify dietary nutrient gaps in specific demographic groups and countries. METHODS In this modelling analysis, we adopted a novel approach to estimating micronutrient intake, which accounts for the shape of a population's nutrient intake distribution and is based on dietary intake data from 31 countries. Using a globally harmonised set of age-specific and sex-specific nutrient requirements, we then applied these distributions to publicly available data from the Global Dietary Database on modelled median intakes of 15 micronutrients for 34 age-sex groups from 185 countries, to estimate the prevalence of inadequate nutrient intakes for 99·3% of the global population. FINDINGS On the basis of estimates of nutrient intake from food (excluding fortification and supplementation), more than 5 billion people do not consume enough iodine (68% of the global population), vitamin E (67%), and calcium (66%). More than 4 billion people do not consume enough iron (65%), riboflavin (55%), folate (54%), and vitamin C (53%). Within the same country and age groups, estimated inadequate intakes were higher for women than for men for iodine, vitamin B12, iron, and selenium and higher for men than for women for magnesium, vitamin B6, zinc, vitamin C, vitamin A, thiamin, and niacin. INTERPRETATION To our knowledge, this analysis provides the first global estimates of inadequate micronutrient intakes using dietary intake data, highlighting highly prevalent gaps across nutrients and variability by sex. These results can be used by public health practitioners to target populations in need of intervention. FUNDING The National Institutes of Health and the Dutch Ministry of Foreign Affairs.
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Affiliation(s)
- Simone Passarelli
- Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA; Office of Global Food Security, US Department of State, Washington, DC, USA.
| | - Christopher M Free
- Marine Science Institute, University of California, Santa Barbara, Santa Barbara, CA, USA; Bren School of Environmental Science and Management, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Alon Shepon
- Department of Environmental Studies, The Porter School of the Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ty Beal
- Institute for Social, Behavioral and Economic Research, University of California, Santa Barbara, Santa Barbara, CA, USA; Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Carolina Batis
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Christopher D Golden
- Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
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Kumar M, Hepner DL, Grawe ES, Keshock M, Khambaty M, Patel MS, Sweitzer B. Diagnosis and Treatment of Perioperative Anemia: A Society for Perioperative Assessment and Quality Improvement Collaborative Review. Anesthesiology 2024:141986. [PMID: 39264293 DOI: 10.1097/aln.0000000000005111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Anemia is common in presurgical patients and is associated with poor clinical outcomes, even without erythrocyte transfusion. Structured preoperative programs for anemia management are associated with fewer blood transfusions, increased hemoglobin concentrations, and improved outcomes.
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Affiliation(s)
- Mandeep Kumar
- Division of Perioperative Medicine, Hartford Healthcare, Hartford, Connecticut, and University of Connecticut, Farmington, Connecticut
| | - David L Hepner
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erin S Grawe
- Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Maureen Keshock
- Department of Anesthesiology, Cleveland Clinic Foundation, Medina, Ohio
| | - Maleka Khambaty
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Manish S Patel
- Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - BobbieJean Sweitzer
- Department of Anesthesiology and Surgical Services, Inova Health Foundation, Falls Church, Virginia; and Department of Medical Education, University of Virginia, Charlottesville, Virginia
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Carolin A, Frazer D, Yan K, Bishop CR, Tang B, Nguyen W, Helman SL, Horvat J, Larcher T, Rawle DJ, Suhrbier A. The effects of iron deficient and high iron diets on SARS-CoV-2 lung infection and disease. Front Microbiol 2024; 15:1441495. [PMID: 39296289 PMCID: PMC11408339 DOI: 10.3389/fmicb.2024.1441495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 08/22/2024] [Indexed: 09/21/2024] Open
Abstract
Introduction The severity of Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is often dictated by a range of comorbidities. A considerable literature suggests iron deficiency and iron overload may contribute to increased infection, inflammation and disease severity, although direct causal relationships have been difficult to establish. Methods Here we generate iron deficient and iron loaded C57BL/6 J mice by feeding standard low and high iron diets, with mice on a normal iron diet representing controls. All mice were infected with a primary SARS-CoV-2 omicron XBB isolate and lung inflammatory responses were analyzed by histology, immunohistochemistry and RNA-Seq. Results Compared with controls, iron deficient mice showed no significant changes in lung viral loads or histopathology, whereas, iron loaded mice showed slightly, but significantly, reduced lung viral loads and histopathology. Transcriptional changes were modest, but illustrated widespread dysregulation of inflammation signatures for both iron deficient vs. controls, and iron loaded vs. controls. Some of these changes could be associated with detrimental outcomes, whereas others would be viewed as beneficial. Discussion Diet-associated iron deficiency or overload thus induced modest modulations of inflammatory signatures, but no significant histopathologically detectable disease exacerbations.
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Affiliation(s)
- Agnes Carolin
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - David Frazer
- Molecular Nutrition, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Kexin Yan
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Cameron R Bishop
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Bing Tang
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Wilson Nguyen
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Sheridan L Helman
- Molecular Nutrition, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Jay Horvat
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW, Australia
| | | | - Daniel J Rawle
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Andreas Suhrbier
- Inflammation Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- GVN Centre of Excellence, Australian Infectious Disease Research Centre, Brisbane, QLD, Australia
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Pham J, Laven-Law G, Symonds EL, Wassie MM, Cock C, Winter JM. Faecal immunochemical tests can improve colonoscopy triage in patients with iron deficiency: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2024; 201:104439. [PMID: 38977142 DOI: 10.1016/j.critrevonc.2024.104439] [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: 05/09/2024] [Revised: 06/30/2024] [Accepted: 07/03/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Use of the faecal immunochemical test (FIT) to triage patients with iron deficiency (ID) for colonoscopy due to suspected colorectal cancer (CRC) may improve distribution of colonoscopic resources. We reviewed the diagnostic performance of FIT for detecting advanced colorectal neoplasia, including CRC and advanced pre-cancerous neoplasia (APCN), in patients with ID, with or without anaemia. METHODS We performed a systematic review of three databases for studies comprising of patients with ID, with or without anaemia, completing a quantitative FIT within six months prior to colonoscopy, where test performance was compared against the reference standard colonoscopy. Random effects meta-analyses determined the diagnostic performance of FIT for advanced colorectal neoplasia. RESULTS Nine studies were included on a total of n=1761 patients with ID, reporting FIT positivity thresholds between 4-150 µg haemoglobin/g faeces. Only one study included a non-anaemic ID (NAID) cohort. FIT detected CRC and APCN in ID patients with 90.7 % and 49.3 % sensitivity, and 81.0 % and 82.4 % specificity, respectively. FIT was 88.0 % sensitive and 83.4 % specific for CRC in patients with ID anaemia at a FIT positivity threshold of 10 µg haemoglobin/g faeces. CONCLUSIONS FIT shows high sensitivity for advanced colorectal neoplasia and may be used to triage those with ID anaemia where colonoscopic resources are limited, enabling those at higher risk of CRC to be prioritised for colonoscopy. There is a need for further research investigating the diagnostic performance of FIT in NAID patients.
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Affiliation(s)
- Jennifer Pham
- Department of Medicine, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Geraldine Laven-Law
- Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, SA 5042, Australia.
| | - Erin L Symonds
- Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, SA 5042, Australia; Department of Gastroenterology and Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Molla M Wassie
- Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, SA 5042, Australia
| | - Charles Cock
- Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, SA 5042, Australia; Department of Gastroenterology and Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Jean M Winter
- Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, SA 5042, Australia
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Horwood CGA, Patel ND, Walker JD, Evans CR. Nonanemic Iron Deficiency in Cardiac Surgery: A Retrospective Observational Study. J Cardiothorac Vasc Anesth 2024; 38:1899-1906. [PMID: 38942683 DOI: 10.1053/j.jvca.2024.05.039] [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: 01/26/2024] [Revised: 05/09/2024] [Accepted: 05/29/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVES Anemia and iron deficiency in patients having cardiac surgery increases their perioperative risk. Nonanemic iron deficiency (NAID) in this group is less well-described. We aimed to investigate the incidence and outcomes of patients with NAID undergoing cardiac surgery. DESIGN Retrospective observational study. SETTING A single, tertiary referral center. PARTICIPANTS Adult patients who were preassessed and underwent cardiac surgery during the study period had data collected. We enrolled 537 patients enrolled and divided them into 4 groups according to hemoglobin and ferritin: NAID, nonanemic iron replete, iron-deficiency anemia (IDA), and non-iron-deficiency anemia. INTERVENTIONS This study was not interventional, but assessed the impact of anemia and iron deficiency on patient outcomes. MEASUREMENTS AND MAIN RESULTS The primary outcome was the incidence of NAID. Secondary outcomes included the number of patients who became anemic awaiting surgery, allogeneic transfusion burden, length of stay, postoperative complications, and death. 179 of 537 patients (33.3%) had NAID. Seventeen patients (9.5%) became anemic in the NAID group compared with 7 (3.3%) in the nonanemic iron replete group while awaiting for surgery (p = 0.02). Patients with NAID were more likely to receive allogeneic transfusions (33% vs 23%; p = 0.04) and had poorer recovery of hemoglobin at follow-up (13.2 ± 1.46 g/dL vs 13.9 ± 1.46 g/dL; p < 0.001). CONCLUSIONS NAID is common and can lead to progression to anemia and increased transfusion. Iron replacement should be considered in patients with NAID in the preoperative setting. A prospective interventional trial is required to demonstrate the benefit of being iron replete.
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Affiliation(s)
- Charles G A Horwood
- University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, Wales, UK.
| | - Nirav D Patel
- University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | - Jason D Walker
- Ysbyty Gwynedd, Betsi Cadwalader University Health Board, Bangor, Wales, UK
| | - Caroline R Evans
- University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, Wales, UK
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Dimas-Benedicto C, Albasanz JL, Bermejo LM, Castro-Vázquez L, Sánchez-Melgar A, Martín M, Martínez-García RM. Impact of Iron Intake and Reserves on Cognitive Function in Young University Students. Nutrients 2024; 16:2808. [PMID: 39203944 PMCID: PMC11356983 DOI: 10.3390/nu16162808] [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: 07/31/2024] [Revised: 08/19/2024] [Accepted: 08/20/2024] [Indexed: 09/03/2024] Open
Abstract
Iron is a key nutrient for cognitive function. During periods of high academic demand, brain and cognitive activity increase, potentially affecting iron intake and reserves. The present study aimed to investigate the impact of iron levels on cognitive function in a university sample, considering the influence of gender. A cross-sectional study was conducted with 132 university students (18-29 years) from the University of Castilla-La Mancha (Spain). A dietary record was formed through a questionnaire to analyze iron consumption, and blood and anthropometric parameters were measured. The Wechsler Adult Intelligence Scale-IV was used to determine the Intelligence Quotient (IQ), as well as the Verbal Comprehension Index (VCI), Working Memory Index (WMI), Processing Speed Index (PSI), and Perceptual Reasoning Index (PRI), to assess cognitive abilities. Among women, the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) was 21% and 4.2%, respectively. No ID or IDA was found in men. The impact of iron intake on IQ and cognitive abilities was mainly associated with the female population, where a positive association between iron intake, serum ferritin, and total IQ was revealed. In conclusion, low iron intake is related to poorer intellectual ability, suggesting that an iron-rich diet is necessary to maintain the academic level of university students.
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Affiliation(s)
- Carmen Dimas-Benedicto
- NUTRI-SAF Research Group, Departamento de Enfermería, Fisioterapia y Terapia Ocupacional, Facultad de Enfermería, University of Castilla-La Mancha, 16071 Cuenca, Spain; (C.D.-B.); (R.M.M.-G.)
| | - José Luis Albasanz
- GNCR Research Group, Departamento de Química Inorgánica, Orgánica y Bioquímica, Facultad de Medicina de Ciudad Real, Instituto de Biomedicina de la UCLM, IDISCAM, University of Castilla-La Mancha, 13071 Ciudad Real, Spain;
| | - Laura M. Bermejo
- VALORNUT Research Group, Departamento de Nutrición y Ciencias de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain;
- San Carlos Health Research Institute (IdISSC), 28040 Madrid, Spain
| | - Lucía Castro-Vázquez
- NUTRI-SAF Research Group, Departamento de Química Analítica y Tecnología de los Alimentos, Facultad de Farmacia, University of Castilla-La Mancha, 02071 Albacete, Spain;
| | - Alejandro Sánchez-Melgar
- GNCR Research Group, Departamento de Química Inorgánica, Orgánica y Bioquímica, Facultad de Enfermeria de Ciudad Real, Instituto de Biomedicina de la UCLM, IDISCAM, University of Castilla-La Mancha, 13071 Ciudad Real, Spain;
| | - Mairena Martín
- GNCR Research Group, Departamento de Química Inorgánica, Orgánica y Bioquímica, Facultad de Medicina de Ciudad Real, Instituto de Biomedicina de la UCLM, IDISCAM, University of Castilla-La Mancha, 13071 Ciudad Real, Spain;
- GNCR Research Group, Departamento de Química Inorgánica, Orgánica y Bioquímica, Facultad de Enfermeria de Ciudad Real, Instituto de Biomedicina de la UCLM, IDISCAM, University of Castilla-La Mancha, 13071 Ciudad Real, Spain;
| | - Rosa M. Martínez-García
- NUTRI-SAF Research Group, Departamento de Enfermería, Fisioterapia y Terapia Ocupacional, Facultad de Enfermería, University of Castilla-La Mancha, 16071 Cuenca, Spain; (C.D.-B.); (R.M.M.-G.)
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Raut RK, Bhattacharyya G, Behera RK. Gastric stability of bare and chitosan-fabricated ferritin and its bio-mineral: implication for potential dietary iron supplements. Dalton Trans 2024; 53:13815-13830. [PMID: 39109655 DOI: 10.1039/d4dt01839g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
Iron deficiency anaemia (IDA), the most widespread nutritional disorder, is a persistent global health issue affecting millions, especially in resource-limited geographies. Oral iron supplementation is usually the first choice for exogenous iron administration owing to its convenience, effectiveness and low cost. However, commercially available iron supplementations are often associated with oxidative stress, gastrointestinal side effects, infections and solubility issues. Herein, we aim to address these limitations by employing ferritin proteins-self-assembled nanocaged architectures functioning as a soluble cellular iron repository-as a non-toxic and biocompatible alternative. Our in vitro studies based on PAGE and TEM indicate that bare ferritin proteins are resistant to gastric conditions but their cage integrity is compromised under longer incubation periods and at higher concentrations of pepsin, which is a critical component of gastric juice. To ensure the safe delivery of encapsulated iron cargo, with minimal cage disintegration/degradation and iron leakage along the gastrointestinal tract, we fabricated the surface of ferritin with chitosan. Further, the stoichiometry and absorptivity of iron-chelator complexes at both gastric and circumneutral pH were estimated using Job's plot. Unlike bipyridyl, deferiprone exhibited pH dependency. In vitro kinetics was studied to evaluate iron release from bare and chitosan-fabricated ferritins employing both reductive (in the presence of ascorbate and bipyridyl) and non-reductive (direct chelation by deferiprone) pathways to determine their bio-mineral stabilities. Chitosan-decorated ferritin displayed superior cage integrity and iron retention capability over bare ferritin in simulated gastric fluid. The ability of ferritins to naturally facilitate controlled iron release in conjugation with enteric coating provided by chitosan may mitigate the aforementioned side effects and enhance iron absorption in the intestine. The results of the current study could pave the way for the development of an oral formulation based on ferritin-caged iron bio-mineral that can be a promising alternative for the treatment of IDA, offering better therapeutic outcomes.
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Affiliation(s)
- Rohit Kumar Raut
- Department of Chemistry, National Institute of Technology, Rourkela - 769008, Odisha, India.
| | - Gargee Bhattacharyya
- Department of Chemistry, National Institute of Technology, Rourkela - 769008, Odisha, India.
| | - Rabindra K Behera
- Department of Chemistry, National Institute of Technology, Rourkela - 769008, Odisha, India.
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Vassilopoulou E, Venter C, Roth-Walter F. Malnutrition and Allergies: Tipping the Immune Balance towards Health. J Clin Med 2024; 13:4713. [PMID: 39200855 PMCID: PMC11355500 DOI: 10.3390/jcm13164713] [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: 07/22/2024] [Revised: 08/04/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
Malnutrition, which includes macro- and micronutrient deficiencies, is common in individuals with allergic dermatitis, food allergies, rhinitis, and asthma. Prolonged deficiencies of proteins, minerals, and vitamins promote Th2 inflammation, setting the stage for allergic sensitization. Consequently, malnutrition, which includes micronutrient deficiencies, fosters the development of allergies, while an adequate supply of micronutrients promotes immune cells with regulatory and tolerogenic phenotypes. As protein and micronutrient deficiencies mimic an infection, the body's innate response limits access to these nutrients by reducing their dietary absorption. This review highlights our current understanding of the physiological functions of allergenic proteins, iron, and vitamin A, particularly regarding their reduced bioavailability under inflamed conditions, necessitating different dietary approaches to improve their absorption. Additionally, the role of most allergens as nutrient binders and their involvement in nutritional immunity will be briefly summarized. Their ability to bind nutrients and their close association with immune cells can trigger exaggerated immune responses and allergies in individuals with deficiencies. However, in nutrient-rich conditions, these allergens can also provide nutrients to immune cells and promote health.
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Affiliation(s)
- Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
- Department of Clinical Sciences and Community Health, Univertià degli Studi die Milano, 20122 Milan, Italy
| | - Carina Venter
- Pediatrics, Section of Allergy & Immunology, University of Colorado Denver School of Medicine, Children’s Hospital Colorado, Box B518, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Franziska Roth-Walter
- Messerli Research Institute, Department of Interdisciplinary Life Sciences, University of Veterinary Medicine Vienna, Medical University of Vienna and University of Vienna, 1210 Vienna, Austria
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, 1090 Vienna, Austria
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11
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Campbell RK, Dewage BG, Cordero C, Maldonado LE, Sotres-Alvarez D, Daviglus ML, Argos M. Prevalence and Risk Factors of Iron Deficiency and Anemia in Women of Reproductive Age in the Hispanic Community Health Study/Study of Latinos. Curr Dev Nutr 2024; 8:104419. [PMID: 39224140 PMCID: PMC11367547 DOI: 10.1016/j.cdnut.2024.104419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/10/2024] [Accepted: 07/14/2024] [Indexed: 09/04/2024] Open
Abstract
Background Women of reproductive age are at elevated risk of iron deficiency (ID) and anemia; in the United States, those of Hispanic/Latino background are at especially high risk. Causes of ID and anemia and variations in risk within Hispanic/Latino women of reproductive age are not well described. Objectives To characterize ID and anemia and their risk factors/markers in Hispanic/Latina women. Methods Data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were used. HCHS/SOL enrolled participants in 2008-2011 at 4 sites: Bronx, Chicago, Miami, and San Diego; 5386 were non-pregnant women ages 18-49 y. Primary outcomes were ID (ferritin <30 μg/L) and anemia (hemoglobin <12 g/dL). Predictors were background/heritage, Short Acculturation Scale for Hispanics scores, years lived in the United States, and interview language, diet summarized in the Alternate Healthy Eating Index 2010, sociodemographic covariates, and study site. Main analyses used survey log binomial regressions adjusted for age, site, and smoking. Results Almost half (42%) of participants were of Mexican background, 15% of Cuban background, and <15% each were of Puerto Rican, Dominican, Central American, or South American background. ID prevalence was 34.4% overall but differed by site-background pairings. The lowest and highest prevalence were 26% and 42% among women of Cuban background in Miami and women of Mexican background in Chicago, respectively. Anemia prevalence was 16% and ranged from 8.9% (Central American background/Miami) to 22% (Dominican background/Bronx). Acculturation, sociodemographic, and diet variables examined did not explain observed prevalence differences by site/background. Conclusions Prevalence of ID and anemia were high among HCHS/SOL women and differed by field center and background. These differences highlight the importance of characterizing nutritional risk by background within Hispanic/Latino women.
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Affiliation(s)
- Rebecca K Campbell
- Division of Epidemiology and Biostatistics, University of Illinois Chicago School of Public Health, Chicago, IL, United States
| | - Bhagya Galkissa Dewage
- Division of Environmental and Occupational Health Sciences, University of Illinois Chicago School of Public Health, Chicago, IL, United States
| | - Christina Cordero
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Luis E Maldonado
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, United States
| | - Martha L Daviglus
- University of Illinois College of Medicine, Chicago, IL, United States
| | - Maria Argos
- Division of Epidemiology and Biostatistics, University of Illinois Chicago School of Public Health, Chicago, IL, United States
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12
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Xue D, Jiang S, He H, Lametsch R, Zhang M, Li C. Hemoglobin Hydrolyzate Promotes Iron Absorption in the Small Intestine through Iron Binding Peptides. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2024; 72:15237-15247. [PMID: 38935870 DOI: 10.1021/acs.jafc.4c00364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Hemoglobin is an excellent source of iron supplements, and its hydrolyzate spontaneously binds iron during digestion and promotes iron absorption in vivo. However, the underlying mechanisms of what peptides bind and how they bind iron ions remain unclear. This study prepared the porcine hemoglobin hydrolyzate through enzymatic hydrolysis and acid treatment and investigated the mechanisms of hemoglobin hydrolyzate on iron absorption through the determination of iron levels in dietary intervention mice, iron binding site analyses, peptide digestion analyses, molecular simulation docking, and INT407 cell validation. The results showed that ingestion of the hemoglobin hydrolyzate diets increased iron levels in the blood of mice, accompanied by the upregulation of duodenal iron circulation-related genes such as ferritin, PCBP1, and HP. Carboxyl, imidazole groups, and aromatic amino acid residues were iron binding sites of hemoglobin hydrolyzate during digestion. VDEVGGEA and VDEVGGE were found to involve the spontaneous and efficient binding of hemoglobin hydrolyzate to iron ions in the intestinal cavity. In particular, the DEVGGE peptide was the typical sequence for hemoglobin hydrolytic peptides to exert iron binding activity.
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Affiliation(s)
- Dejiang Xue
- State Key Laboratory of Meat Quality Control and Cultured Meat Development, MOST; Key Laboratory of Meat Processing, MARA; Jiangsu Collaborative Innovation Center of Meat Production, Processing and Quality Control; College of Food Science and Technology, Nanjing Agricultural University, Weigang 1#, Nanjing 210095, PR China
| | - Shuai Jiang
- College of Food Science and Light Industry, Nanjing Tech University, Nanjing 211816, China
| | - Hui He
- State Key Laboratory of Meat Quality Control and Cultured Meat Development, MOST; Key Laboratory of Meat Processing, MARA; Jiangsu Collaborative Innovation Center of Meat Production, Processing and Quality Control; College of Food Science and Technology, Nanjing Agricultural University, Weigang 1#, Nanjing 210095, PR China
| | - René Lametsch
- Department of Food Science, Faculty of Science, University of Copenhagen, Rolighedsvej 26, Frederiksberg 1958, Denmark
| | - Miao Zhang
- State Key Laboratory of Meat Quality Control and Cultured Meat Development, MOST; Key Laboratory of Meat Processing, MARA; Jiangsu Collaborative Innovation Center of Meat Production, Processing and Quality Control; College of Food Science and Technology, Nanjing Agricultural University, Weigang 1#, Nanjing 210095, PR China
| | - Chunbao Li
- State Key Laboratory of Meat Quality Control and Cultured Meat Development, MOST; Key Laboratory of Meat Processing, MARA; Jiangsu Collaborative Innovation Center of Meat Production, Processing and Quality Control; College of Food Science and Technology, Nanjing Agricultural University, Weigang 1#, Nanjing 210095, PR China
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13
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Weichhart T. Transferrin: the iron transporter takes control. Blood 2024; 144:9-10. [PMID: 38963665 DOI: 10.1182/blood.2024024731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
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14
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Seck M, Manal B, Touré SA, Keita M, Diallo AB, Faye BF, Guèye SM, Dieng F, Sall A, Touré AO, Diop S. Challenges in the management of iron-deficiency anemia in Senegal, West Africa. Ann Hematol 2024; 103:2565-2567. [PMID: 38308021 DOI: 10.1007/s00277-024-05626-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/15/2022] [Indexed: 02/04/2024]
Affiliation(s)
- Moussa Seck
- Hematology department, Cheikh Anta Diop University, Dakar, Senegal.
- Clinical Hematology Department, Dakar, Senegal.
| | | | | | | | | | - Blaise Félix Faye
- Hematology department, Cheikh Anta Diop University, Dakar, Senegal
- Clinical Hematology Department, Dakar, Senegal
| | | | - Fatma Dieng
- Clinical Hematology Department, Dakar, Senegal
| | - Abibatou Sall
- Hematology department, Cheikh Anta Diop University, Dakar, Senegal
| | - Awa Oumar Touré
- Hematology department, Cheikh Anta Diop University, Dakar, Senegal
| | - Saliou Diop
- Hematology department, Cheikh Anta Diop University, Dakar, Senegal
- Clinical Hematology Department, Dakar, Senegal
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15
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Truong J, Naveed K, Beriault D, Lightfoot D, Fralick M, Sholzberg M. The origin of ferritin reference intervals: a systematic review. Lancet Haematol 2024; 11:e530-e539. [PMID: 38937026 DOI: 10.1016/s2352-3026(24)00103-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 06/29/2024]
Abstract
Iron deficiency is a highly prevalent condition, which contributes to unnecessary morbidity, mortality, and health inequity. A serum ferritin concentration of less than 30 μg/L has a high specificity and sensitivity for diagnosing iron deficiency in adults, but the laboratory reported lower limit of normal (LLN) is typically lower. These LLNs might not be rooted in rigorous scientific evidence and might be contributing to structural underdiagnosis of iron deficiency. A systematic review was done per systematic reviews and meta-analysis guidelines with the use of medical literature databases from inception of each database to Nov 30, 2021, to identify studies that determined ferritin reference intervals in healthy adults and grey literature search for the five most common ferritin assays (registration number CRD42022268844). The objectives were to systematically summarise the ferritin reference intervals and to do a methodological quality assessment of the included studies. 2306 studies were screened and 61 full texts were included. 37 studies were eligible for analysis of the ferritin LLN in the general population. The population the sample was comprised of was a total of 21 882 females and 23 650 males participants. The ferritin LLN was a median of 8 μg/L (IQR 5-15) and mean of 9 μg/L (SD 11) in females and a median of 25 μg/L (IQR 16-44) and mean of 25 μg/L (SD 29) in males. 30 (49%) of 61 studies did not explicitly screen for patients at risk of iron deficiency, and 32 (52%) did not refer to a reference interval establishment guideline (eg, guideline recommended by Clinical and Laboratory Standards Institute). The five most used commercial ferritin laboratory assays reported reference intervals with a median LLN of 11 (IQR 9-12) and mean of 9 μg/L (SD 4) for females and median of 22 (IQR 22-24) and mean of 23 μg/L (SD 4) for males. In the literature, serum ferritin reference intervals in healthy adults consistently report a LLN of less than 30 μg/L. Data driving these ferritin reference intervals are at high risk of bias, given no exclusion of individuals at risk for iron deficiency in the presumed normal population sample and no adherence to reference interval establishment standards. We suggest the use of evidence-based laboratory clinical decision limits to diagnose iron deficiency.
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Affiliation(s)
- Judy Truong
- Department of Medicine Canada, University of Toronto, Ontario, Canada.
| | - Kanza Naveed
- Department of Medicine Canada, University of Toronto, Ontario, Canada
| | - Daniel Beriault
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada; St Michael's Hospital, Toronto, ON, Canada
| | | | - Michael Fralick
- Sinai Health System, Division of General Internal Medicine, Toronto, ON, Canada
| | - Michelle Sholzberg
- Department of Medicine Canada, University of Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada; St Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, ON, Canada
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16
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Vavallo M, Cingolani S, Cozza G, Schiavone FP, Dottori L, Palumbo C, Lahner E. Autoimmune Gastritis and Hypochlorhydria: Known Concepts from a New Perspective. Int J Mol Sci 2024; 25:6818. [PMID: 38999928 PMCID: PMC11241626 DOI: 10.3390/ijms25136818] [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: 05/12/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Autoimmune atrophic gastritis is an immune-mediated disease resulting in autoimmune destruction of the specialized acid-producing gastric parietal cells. As a consequence, in autoimmune atrophic gastritis, gastric acid secretion is irreversibly impaired, and the resulting hypochlorhydria leads to the main clinical manifestations and is linked, directly or indirectly, to the long-term neoplastic complications of this disease. In the last few years, autoimmune atrophic gastritis has gained growing interest leading to the acquisition of new knowledge on different aspects of this disorder. Although reliable serological biomarkers are available and gastrointestinal endoscopy techniques have substantially evolved, the diagnosis of autoimmune atrophic gastritis is still affected by a considerable delay and relies on histopathological assessment of gastric biopsies. One of the reasons for the diagnostic delay is that the clinical presentations of autoimmune atrophic gastritis giving rise to clinical suspicion are very different, ranging from hematological to neurological-psychiatric up to gastrointestinal and less commonly to gynecological-obstetric symptoms or signs. Therefore, patients with autoimmune atrophic gastritis often seek advice from physicians of other medical specialties than gastroenterologists, thus underlining the need for increased awareness of this disease in a broad medical and scientific community.
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Affiliation(s)
| | | | | | | | | | | | - Edith Lahner
- Gastroenterology Unit, Sant’Andrea University Hospital, Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy (G.C.); (F.P.S.)
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17
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Chen Y, Li X, Wang Z, Yuan S, Shen X, Xie X, Xing K, Zhu Q. Iron deficiency affects oxygen transport and activates HIF1 signaling pathway to regulate phenotypic transformation of VSMC in aortic dissection. Mol Med 2024; 30:90. [PMID: 38886644 PMCID: PMC11184844 DOI: 10.1186/s10020-024-00859-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/08/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Aortic dissection (AD) is a macrovascular disease which is pathologically characterized by aortic media degeneration.This experiment aims to explore how iron deficiency (ID) affects the function of vascular smooth muscle cell (VSMC) and participates in the occurrence and development of AD by regulating gene expression. METHODS The relationship between iron and AD was proved by Western-blot (WB) and immunostaining experiments in human and animals. Transcriptomic sequencing explored the transcription factors that were altered downstream. WB, flow cytometry and immunofluorescence were used to demonstrate whether ID affected HIF1 expression through oxygen transport. HIF1 signaling pathway and phenotypic transformation indexes were detected in cell experiments. The use of the specific HIF1 inhibitor PX478 further demonstrated that ID worked by regulating HIF1. RESULTS The survival period of ID mice was significantly shortened and the pathological staining results were the worst. Transcriptomic sequencing indicated that HIF1 was closely related to ID and the experimental results indicated that ID might regulate HIF1 expression by affecting oxygen balance. HIF1 activation regulates the phenotypic transformation of VSMC and participates in the occurrence and development of AD in vivo and in vitro.PX478, the inhibition of HIF1, can improve ID-induced AD exacerbation.
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Affiliation(s)
- Yuanyang Chen
- Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
- Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, No. 9 Zhangzhidong Road, Wuhan, 430000, Hubei, People's Republic of China
| | - Xu Li
- Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
- Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, No. 9 Zhangzhidong Road, Wuhan, 430000, Hubei, People's Republic of China
| | - Zhiwei Wang
- Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China.
- Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, No. 9 Zhangzhidong Road, Wuhan, 430000, Hubei, People's Republic of China.
| | - Shun Yuan
- Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
- Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, No. 9 Zhangzhidong Road, Wuhan, 430000, Hubei, People's Republic of China
| | - Xiaoyan Shen
- Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
- Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, No. 9 Zhangzhidong Road, Wuhan, 430000, Hubei, People's Republic of China
| | - Xiaoping Xie
- Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
- Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, No. 9 Zhangzhidong Road, Wuhan, 430000, Hubei, People's Republic of China
| | - Kai Xing
- Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
- Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, No. 9 Zhangzhidong Road, Wuhan, 430000, Hubei, People's Republic of China
| | - Qingyi Zhu
- Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
- Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, No. 9 Zhangzhidong Road, Wuhan, 430000, Hubei, People's Republic of China
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18
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Barton JC, Wiener HW, Barton JC, Acton RT. Prevalence of Iron Deficiency Using 3 Definitions Among Women in the US and Canada. JAMA Netw Open 2024; 7:e2413967. [PMID: 38848068 PMCID: PMC11161847 DOI: 10.1001/jamanetworkopen.2024.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/26/2024] [Indexed: 06/10/2024] Open
Abstract
Importance The prevalence of iron deficiency varies widely according to how it is defined. Objective To compare the prevalence of iron deficiency among women using 3 different definitions. Design, Setting, and Participants The cross-sectional Hemochromatosis and Iron Overload Screening Study (HEIRS; 2000-2006) evaluated the prevalence, determinants, and outcomes of hemochromatosis and other iron-related disorders. Multiethnic, primary care-based screening (2001-2003) was performed at 5 field centers (4 in the US and 1 in Canada). Volunteer women aged 25 years and older were recruited at primary care venues associated with the field centers. Data were analyzed from June to December 2023. Main Outcomes and Measures Measures included transferrin saturation, serum ferritin level, and self-reported age, pregnancy, and race and ethnicity. Three iron deficiency definitions were studied: (1) combined transferrin saturation less than 10% and serum ferritin less than 15 ng/mL (HEIRS), (2) serum ferritin less than 15 ng/mL (World Health Organization [WHO]), and (3) serum ferritin less than 25 ng/mL (a threshold for iron-deficient erythropoiesis [IDE]). Results Among 62 685 women (mean [SD] age, 49.58 [14.27] years), 1957 women (3.12%) had iron deficiency according to the HEIRS definition, 4659 women (7.43%) had iron deficiency according to the WHO definition, and 9611 women (15.33%) had iron deficiency according to the IDE definition. Among 40 381 women aged 25 to 54 years, 1801 women (4.46%) had iron deficiency according to HEIRS, 4267 women (10.57%) had iron deficiency according to WHO, and 8573 women (21.23%) had iron deficiency according to IDE. Prevalence rates of iron deficiency among 2039 women aged 25 to 44 years who reported pregnancy were 5.44% (111 women) according to HEIRS, 18.05% (368 women) according to WHO, and 36.10% (736 women) according to IDE. Iron deficiency prevalence by the 3 respective definitions increased significantly in each racial and ethnic group and was significantly higher among Black and Hispanic participants than Asian and White participants. The relative iron deficiency prevalence among the 62 685 women increased 2.4-fold (95% CI, 2.3-2.5; P < .001) using the WHO definition and increased 4.9-fold (95% CI, 4.7-5.2; P < .001) using the IDE definition. Conclusions and Relevance Three definitions of iron deficiency were associated with significantly different prevalence of iron deficiency in women, regardless of self-reported age, pregnancy, or race and ethnicity. Using higher serum ferritin thresholds to define iron deficiency could lead to diagnosis and treatment of more women with iron deficiency and greater reduction of related morbidity.
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Affiliation(s)
- James C. Barton
- Department of Medicine, The University of Alabama at Birmingham, Birmingham
- Southern Iron Disorders Center, Birmingham, Alabama
| | - Howard W. Wiener
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham
| | | | - Ronald T. Acton
- Southern Iron Disorders Center, Birmingham, Alabama
- Department of Microbiology, The University of Alabama at Birmingham, Birmingham
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19
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Lee NH. Iron deficiency in children with a focus on inflammatory conditions. Clin Exp Pediatr 2024; 67:283-293. [PMID: 38772411 DOI: 10.3345/cep.2023.00521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/03/2023] [Indexed: 05/23/2024] Open
Abstract
Iron deficiency (ID) tends to be overlooked compared with anemia. However, its prevalence is estimated to be twice as high as that of ID anemia, and ID without anemia can be accompanied by clinical and functional impairments. The symptoms of ID are nonspecific, such as fatigue and lethargy, but can lead to neurodevelopmental disorders in children, restless legs syndrome, and recurrent infections due to immune system dysregulation. In particular, the risk of ID is high in the context of chronic inflammatory diseases (CIDs) due to the reaction of various cytokines and the resulting increase in hepcidin levels; ID further exacerbates these diseases and increases mortality. Therefore, the diagnosis of ID should not be overlooked through ID screening especially in high-risk groups. Ferritin and transferrin saturation levels are the primary laboratory parameters used to diagnose ID. However, as ferritin levels respond to inflammation, the diagnostic criteria differ among guidelines. Therefore, new tools and criteria for accurately diagnosing ID should be developed. Treatment can be initiated only with an accurate diagnosis. Oral iron is typically the first-line treatment for ID; however, the efficacy and safety of intravenous iron have recently been recognized. Symptoms improve quickly after treatment, and the prognosis of accompanying diseases can also be improved. This review highlights the need to improve global awareness of ID diagnosis and treatment, even in the absence of anemia, to improve the quality of life of affected children, especially those with CIDs.
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Affiliation(s)
- Na Hee Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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20
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Al Amri T, Al Mamari I, AlSawafi AS, Al Moosawi M, Al-Battashi A. Reversible Pancytopenia Due to Severe Iron Deficiency Anemia in a 12-Year-Old Girl. Cureus 2024; 16:e62175. [PMID: 38993399 PMCID: PMC11238895 DOI: 10.7759/cureus.62175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open
Abstract
Iron deficiency anemia remains a global health challenge among young children starting from birth. Pancytopenia is a rare presentation of iron deficiency in children, being highly reversible with a simple treatment strategy including diet modification and iron supplementation. A 12-year-old Omani girl presented with a four-week history of fatigue, dizziness, and palpitations. Investigations revealed hemoglobin of 3.3 g/dL (11-14.5 g/dL), platelet of 47×109/L (150-450×109/L), white cell count of 3.9×109/L (2.4-9.5×109/L), and absolute neutrophil count of 0.5×109/L (1-4.8×109/L). Her red blood cell distribution width was high (34.1%; 11.5-16.5%), and her reticulocytes were normal (2.1%; 0.2-2%) with a mild elevation in the immature reticulocytes. Moreover, the ferritin level was profoundly low with a result of 1 ug/L only. Her peripheral blood smear showed pancytopenia in a background of microcytic and hypochromic red cells. After appropriate supplementation with oral ferrous sulfate in combination with an iron-rich diet, she showed complete recovery after six months from the initiation of management. This case report highlights that iron deficiency can be a cause of severe pancytopenia in children.
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Affiliation(s)
| | - Issa Al Mamari
- Medicine, Sultan Qaboos University Hospital, Muscat, OMN
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21
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İpek Aytok G, Akkaya Fırat A, Mungan Akın İ, Özel A. How does maternal anemia affect the levels of umbilical cord brain-derived neurotrophic factor? Eur J Obstet Gynecol Reprod Biol 2024; 297:182-186. [PMID: 38677095 DOI: 10.1016/j.ejogrb.2024.04.016] [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: 02/26/2024] [Revised: 04/04/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE In this study, we aimed to evaluate the effect of maternal iron deficiency anemia on the umbilical cord level of brain-derived neurotrophic factor (BDNF), which plays a very important role in the central nervous system. METHODS Our research was planned as a quantitative, prospective, and analytical type of study. A total of 90 volunteers, term, singleton pregnant hospitalized in the Health Sciences University Ümraniye Training and Research Hospital Gynecology and Obstetrics Clinic between September 2021 and August 2022 were included in this study. While 45 of these pregnants were pregnant women with iron deficiency anemia (hemoglobin ≤ 110 g/L and serum ferritin level ≤ 12 μg/L), 45 cases were in the control group without iron deficiency anemia (hemoglobin > 110 g/L, serum ferritin > 12 μg/L). When pregnant were admitted to the hospital, blood samples were taken to analyze hemoglobin, mean cell volume (MCV), iron, unsaturated iron binding capacity, total iron binding capacity, serum ferritin, transferrin, and CRP levels. Also, we noted the maternal age, gravida, parity, birth weight, head circumference, type of birth, 1. minute Apgar score, and 5. minute Apgar score. During the delivery; after the umbilical cord had been clamped and cut, we took 5 cc of umbilical cord blood. Then, we put it in the serum-separating laboratory tubes. After we centrifuged these blood samples, we put the serum parts in the Eppendorf tubes to be stored at -80 degrees Celsius. At the end of the study, we calculated the level of BDNF using special human brain-derived neurotrophic factor ELISA kits. The umbilical cord BDNF levels of the maternal iron deficiency anemia group and the control group were compared statistically. RESULTS When we evaluated the fetal umbilical cord BDNF values of 90 participants, the median value BDNF in the babies of 45 anemic mothers was 3.16 (IQR 0.73), and the median BDNF value of the babies of 45 healthy mothers was 5.37 (IQR 1.02). We found a statistical difference between BDNF and hemoglobin, hematocrit, MCV, and iron values between these two groups. CONCLUSION In conclusion, the BDNF value of the babies of healthy individuals is higher than that of anemic individuals. Our study showed that the amount of BDNF in the umbilical cord blood was significantly affected by maternal iron deficiency anemia.
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Affiliation(s)
- Gökçe İpek Aytok
- Health Sciences University Ümraniye Training and Research Hospital, Department of Gynecology and Obstetrics Ümraniye Istanbul, Turkey
| | - Asuman Akkaya Fırat
- Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, Medical Biochemistry Laboratory, Ataşehir Istanbul, Turkey.
| | - İlke Mungan Akın
- Health Sciences University Ümraniye Training and Research Hospital, Department of Pediatric Istanbul, Turkey
| | - Ayşegül Özel
- Health Sciences University Ümraniye Training and Research Hospital, Department of Gynecology and Obstetrics Ümraniye Istanbul, Turkey
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22
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Neef V, Choorapoikayil S, Hof L, Meybohm P, Zacharowski K. Current concepts in postpartum anemia management. Curr Opin Anaesthesiol 2024; 37:234-238. [PMID: 38390913 PMCID: PMC11062600 DOI: 10.1097/aco.0000000000001338] [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] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW Postpartum anemia (PPA) is common in women after childbirth and affects about 50-80% of all women worldwide. Iron deficiency (ID) is the main cause for anemia and constitutes a potentially preventable condition with great impact on the mother's physical and mental condition after delivery. In most cases, PPA is associated with antenatal ID and peripartum blood losses. Numerous published studies confirmed the positive effect of PPA diagnosis and treatment. RECENT FINDINGS Iron deficiency as well as iron deficiency anemia (IDA) are common in the postpartum period and represent significant health problems in women of reproductive age. SUMMARY Important movements towards early detection and therapy of postpartum anemia have been observed. However, postpartum anemia management is not implemented on a large scale as many healthcare professionals are not aware of the most recent findings in the field. Diagnosis and therapy of PPA, particularly iron supplementation in ID and IDA, has proven to be highly effective with a tremendous effect on women's wellbeing and outcome.
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Affiliation(s)
- Vanessa Neef
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Germany
| | - Suma Choorapoikayil
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Germany
| | - Lotta Hof
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Germany
| | - Patrick Meybohm
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany
| | - Kai Zacharowski
- Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Germany
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Tosyalı M, Demirçelik Y, Bağ Ö, Karaarslan U, Gökçe Ş, Koç F. Use of Different Iron Preparations for Prophylaxis and Effects on Iron Status in Infancy. Healthcare (Basel) 2024; 12:1043. [PMID: 38786453 PMCID: PMC11121401 DOI: 10.3390/healthcare12101043] [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: 03/26/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Aim: To evaluate using different iron preparations for iron deficiency and/or iron deficiency anemia prophylaxis in infants and their iron status. Methods: In this study, we retrospectively evaluated the electronic patient records of 651 healthy children aged 9 to 13 months who met the inclusion criteria and who were followed up in pediatric follow-up outpatient clinics between January 2023 and June 2023. Results: A total of 651 children with a mean age of 11.2 ± 1.4 months, 54.7% of whom were boys, who met the inclusion criteria were included in the study; 56.5% of the children were using Fe + 3 salt and the others were using Fe + 2 salt, microencapsulated iron, or sucrosomial iron drops. After the fifth month of prophylaxis, when the effects of the iron preparations used on the mean laboratory values were evaluated, it was found that hemoglobin, serum iron, and ferritin levels were lower in sucrosomial iron and microencapsulated iron users compared to other preparations (p = 0.001). When statistically pairwise comparisons were made between the groups, hemoglobin and serum iron values were found to be lower in the group using sucrosomial iron compared to the groups using Fe + 2 and Fe + 3 salts (p < 0.0001). Hemoglobin and ferritin levels were higher in the group using Fe + 2 salt compared to both sucrosomial iron and microencapsulated iron groups (p < 0.0001). When the infants were evaluated according to iron status, it was found that 208 (31.9%) had iron deficiency. Iron deficiency was found to be less in infants of families who defined their economic status as rich and in infants who used iron regularly (p-values 0.044 and 0.001, respectively). Iron deficiency/iron deficiency anemia was observed at a higher rate in the group using sucrosomial iron and microencapsulated iron prophylaxis (p = 0.001). Conclusions: To prevent iron deficiency, it is very important to use appropriate iron preparations for prophylaxis and to feed foods with high iron content. Although we found that families were willing to use different iron preparations other than iron salts for their infants, the results presented herein indicate that the rate of iron deficiency was lower in patients using iron salts. However, randomized controlled studies are needed to determine whether these preparations are effective in iron prophylaxis in infants.
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Affiliation(s)
- Merve Tosyalı
- Department of Pediatrics, Faculty of Medicine, Ege University, Children’s Hospital, 35100 Izmir, Turkey; (Ş.G.); (F.K.)
| | - Yavuz Demirçelik
- Department of Pediatrics, Izmir City Hospital, 35180 Izmir, Turkey;
| | - Özlem Bağ
- Department of Pediatrics, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, 35210 Izmir, Turkey; (Ö.B.); (U.K.)
| | - Utku Karaarslan
- Department of Pediatrics, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, 35210 Izmir, Turkey; (Ö.B.); (U.K.)
| | - Şule Gökçe
- Department of Pediatrics, Faculty of Medicine, Ege University, Children’s Hospital, 35100 Izmir, Turkey; (Ş.G.); (F.K.)
| | - Feyza Koç
- Department of Pediatrics, Faculty of Medicine, Ege University, Children’s Hospital, 35100 Izmir, Turkey; (Ş.G.); (F.K.)
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24
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Lanser L, Poelzl G, Messner M, Ungericht M, Zaruba M, Hirsch J, Hechenberger S, Obersteiner S, Koller B, Ulmer H, Weiss G. Imbalance of Iron Availability and Demand in Patients With Acute and Chronic Heart Failure. J Am Heart Assoc 2024; 13:e032540. [PMID: 38639356 PMCID: PMC11179892 DOI: 10.1161/jaha.123.032540] [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: 09/06/2023] [Accepted: 02/06/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Iron deficiency (ID) is a frequent comorbidity in patients with acute (AHF) and chronic heart failure (CHF) associated with morbidity and death. We aimed to better characterize iron homeostasis in patients with heart failure applying different biomarkers and to evaluate the accuracy of current ID definition by the European Society of Cardiology/American College of Cardiology/American Heart Association to indicate tissue iron availability and demand. METHODS AND RESULTS We performed a retrospective cohort study investigating 277 patients with AHF and 476 patients with CHF between February 2021 and May 2022. Patients with AHF had more advanced ID than patients with CHF, reflected by increased soluble transferrin receptor and soluble transferrin receptor-ferritin index, and lower ferritin, serum iron, transferrin saturation, hepcidin, and reticulocyte hemoglobin. Decreased iron availability or increased tissue iron demand, reflected by increased soluble transferrin receptor-ferritin index and decreased reticulocyte hemoglobin, was found in 84.1% (AHF) and 28.0% (CHF) with absolute ID and in 50.0% (AHF) and 10.5% (CHF) with combined ID according to the current European Society of Cardiology/American College of Cardiology/American Heart Association-based ID definition. Low hepcidin expression as an indicator of systemic ID was found in 91.1% (AHF) and 80.4% (CHF) of patients with absolute ID and in 32.3% (AHF) and 18.8% (CHF) of patients with combined ID. ID definitions with higher specificity reduce the need for iron supplementation by 25.5% in patients with AHF and by 65.6% in patients with CHF. CONCLUSIONS Our results suggest that the current European Society of Cardiology/American College of Cardiology/American Heart Association-based ID definition might overestimate true ID, particularly in CHF. More stringent thresholds for ID could more accurately identify patients with heart failure with reduced tissue iron availability who benefit from intravenous iron supplementation.
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Affiliation(s)
- Lukas Lanser
- Department of Internal Medicine IIMedical University of InnsbruckInnsbruckAustria
| | - Gerhard Poelzl
- Department of Internal Medicine IIIMedical University of InnsbruckInnsbruckAustria
| | - Moritz Messner
- Department of Internal Medicine IIIMedical University of InnsbruckInnsbruckAustria
| | - Maria Ungericht
- Department of Internal Medicine IIIMedical University of InnsbruckInnsbruckAustria
| | - Marc‐Michael Zaruba
- Department of Internal Medicine IIIMedical University of InnsbruckInnsbruckAustria
| | - Jakob Hirsch
- Department of Internal Medicine IIIMedical University of InnsbruckInnsbruckAustria
| | - Stefan Hechenberger
- Department of Internal Medicine IIIMedical University of InnsbruckInnsbruckAustria
| | - Stefan Obersteiner
- Department of Internal Medicine IIIMedical University of InnsbruckInnsbruckAustria
| | - Bernhard Koller
- Department of Internal Medicine IIIMedical University of InnsbruckInnsbruckAustria
| | - Hanno Ulmer
- Institute of Medical Statistics and InformaticsMedical University of InnsbruckInnsbruckAustria
| | - Guenter Weiss
- Department of Internal Medicine IIMedical University of InnsbruckInnsbruckAustria
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25
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Clark P. Iron Deficiency Related to Obesity. JOURNAL OF INFUSION NURSING 2024; 47:163-174. [PMID: 38744241 DOI: 10.1097/nan.0000000000000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
There is a direct correlation between being overweight and iron deficiency. Physiological changes occur in obese adipose cells that contribute to the development of iron deficiency (ID) and iron deficiency anemia (IDA). These changes disrupt the normal iron metabolic checks and balances. Furthermore, bariatric surgery can lead to long-term ID and IDA. Oral iron supplementation may not be effective for many of these patients. Intravenous iron infusions can significantly increase the quality of life for individuals experiencing this condition but are also associated with potentially serious complications. Adequate knowledge about intravenous (IV) iron administration can greatly increase the safety of this beneficial therapy. This review article explains the relationship between obesity, ID/IDA, bariatric surgery and the safe administration of IV iron.
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Affiliation(s)
- Pamela Clark
- Author Affiliations: Houston Methodist Sugar Land Hospital, Outpatient IV Therapy Clinic, Sugar Land, Texas (Clark)
- Pamela Clark, RN, BSN, CRNI, has been a registered nurse for 47 years, practicing exclusively in infusion nursing for 40 of those years. She has worked in multiple practice settings, including home health, skilled nursing facilities, free-standing infusion centers, physician office-based infusion centers, and hospital-based infusion centers. Pamela has presented at Infusion Nurses Society conferences on various topics related to infusion nursing and is president of the Greater Houston Area Chapter of the Infusion Nurses Society
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26
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Yunus FM, Jalal C, Das A, Afsana K, Podder R, Vandenberg A, DellaValle DM. Consumption of Iron-Fortified Lentils Is Protective against Declining Iron Status among Adolescent Girls in Bangladesh: Evidence from a Community-Based Double-Blind, Cluster-Randomized Controlled Trial. J Nutr 2024; 154:1686-1698. [PMID: 38458577 DOI: 10.1016/j.tjnut.2024.03.005] [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: 10/18/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND In many low-income countries, iron deficiency (ID) and its anemia (IDA) pose significant health challenges, particularly among females and girls. Finding sustainable and effective solutions to address this issue is critical. OBJECTIVES This study aimed to evaluate the efficacy of incorporating iron-fortified lentils (IFLs) into the diets of rural Bangladeshi adolescent girls on their body iron (Fe) status. METHODS A community-based, double-blind, cluster-randomized controlled trial involved n = 1195 girls aged 10-17 y. A total of 48 adolescent clubs (n = ∼27 girls each) were randomized into 3 groups: 1) 200 g cooked IFLs, 2) 200 g cooked noniron-fortified lentils (NIFLs), and 3) a control group with no lentils (usual dietary intake). The intervention, administered 5 days a week for 85 feeding days, provided ∼8.625 mg Fe from each serving of IFLs and 2.625 mg from NIFLs. Blood samples collected at baseline, midpoint (42 feeding days), and endpoint (85 feeding days) assessed key Fe and inflammation biomarkers. Statistical analyses were filtered for inflammation. RESULTS Although all groups experienced a decline in Fe status over time, the IFL group exhibited a significantly reduced decline in serum ferritin (sFer -7.2 μg/L), and total body iron (TBI -0.48 mg/kg) level compared with NIFL (sFer -14.3 μg/L and TBI -1.36 mg/kg) and usual intake group (sFer -12.8 μg/L and TBI -1.33 mg/kg). Additionally, those in the IFL group had a 57% reduced risk of developing clinical ID (sFer <15 μg/L) compared with the usual intake group. CONCLUSIONS Our findings suggest that incorporating IFLs into the diet can help mitigate a decline in sFer, indicating a positive impact on the body Fe status of adolescent girls. This research underscores the potential role of fortified foods in addressing ID and IDA in vulnerable populations, emphasizing the significance of food-based interventions in public health. TRIAL REGISTRATION NUMBER This trial was registered at the clinicaltrials.gov on May 24, 2018 (https://clinicaltrials.gov/study/NCT03516734?locStr=Bangladesh&country=Bangladesh&distance=50&cond=Anemia&intr=Iron%20fortified%20lentils&rank=1) as NCT03516734.
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Affiliation(s)
- Fakir Md Yunus
- College of Pharmacy and Nutrition, The University of Saskatchewan, Saskatoon, SK, Canada; Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Chowdhury Jalal
- Evaluation and Strategic Research, Nutrition International, Ottawa, ON, Canada
| | - Anupom Das
- Civil Surgeon Office, Ministry of Health and Family Welfare, Jashore, Bangladesh
| | - Kaosar Afsana
- James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Rajib Podder
- College of Agriculture and Bio-resources, The University of Saskatchewan, Saskatoon, SK, Canada
| | - Albert Vandenberg
- College of Agriculture and Bio-resources, The University of Saskatchewan, Saskatoon, SK, Canada
| | - Diane M DellaValle
- Department of Health and Human Performance, King's College, Wilkes-Barre, PA, United States.
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27
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Si G, Du Y, Tang P, Ma G, Jia Z, Zhou X, Mu D, Shen Y, Lu Y, Mao Y, Chen C, Li Y, Gu N. Unveiling the next generation of MRI contrast agents: current insights and perspectives on ferumoxytol-enhanced MRI. Natl Sci Rev 2024; 11:nwae057. [PMID: 38577664 PMCID: PMC10989670 DOI: 10.1093/nsr/nwae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/23/2024] [Accepted: 02/05/2024] [Indexed: 04/06/2024] Open
Abstract
Contrast-enhanced magnetic resonance imaging (CE-MRI) is a pivotal tool for global disease diagnosis and management. Since its clinical availability in 2009, the off-label use of ferumoxytol for ferumoxytol-enhanced MRI (FE-MRI) has significantly reshaped CE-MRI practices. Unlike MRI that is enhanced by gadolinium-based contrast agents, FE-MRI offers advantages such as reduced contrast agent dosage, extended imaging windows, no nephrotoxicity, higher MRI time efficiency and the capability for molecular imaging. As a leading superparamagnetic iron oxide contrast agent, ferumoxytol is heralded as the next generation of contrast agents. This review delineates the pivotal clinical applications and inherent technical superiority of FE-MRI, providing an avant-garde medical-engineering interdisciplinary lens, thus bridging the gap between clinical demands and engineering innovations. Concurrently, we spotlight the emerging imaging themes and new technical breakthroughs. Lastly, we share our own insights on the potential trajectory of FE-MRI, shedding light on its future within the medical imaging realm.
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Affiliation(s)
- Guangxiang Si
- Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210009, China
| | - Yue Du
- Key Laboratory for Bio-Electromagnetic Environment and Advanced Medical Theranostics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 210029, China
| | - Peng Tang
- Key Laboratory for Bio-Electromagnetic Environment and Advanced Medical Theranostics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 210029, China
| | - Gao Ma
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhaochen Jia
- Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210009, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai 200126, China
| | - Dan Mu
- Department of Radiology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Yan Shen
- Key Laboratory for Bio-Electromagnetic Environment and Advanced Medical Theranostics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 210029, China
| | - Yi Lu
- School of Mathematical Sciences, Capital Normal University, Beijing 100048, China
| | - Yu Mao
- Nanjing Key Laboratory for Cardiovascular Information and Health Engineering Medicine, Institute of Clinical Medicine, Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing 210093, China
| | - Chuan Chen
- Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210009, China
| | - Yan Li
- Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210009, China
| | - Ning Gu
- Nanjing Key Laboratory for Cardiovascular Information and Health Engineering Medicine, Institute of Clinical Medicine, Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing 210093, China
- Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210009, China
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28
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Torabinia N, Asadi S, Tarrahi MJ. The Relationship Between Iron and Zinc Deficiency and Aphthous Stomatitis: A Systematic Review and Meta-Analysis. Adv Biomed Res 2024; 13:31. [PMID: 39234428 PMCID: PMC11373730 DOI: 10.4103/abr.abr_41_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/20/2022] [Accepted: 05/02/2022] [Indexed: 09/06/2024] Open
Abstract
Background Recurrent aphthous stomatitis (RAS) is known as the most common ulcerative lesion in the oral mucosa. Aphthous has an unknown etiology and is considered a multifactorial disease. This study was conducted to investigate the relationship between iron and zinc deficiency and the occurrence of RAS. Materials and Methods This systematic review and metaanalysis was performed according to the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guidelines. Data were obtained through an electronic search in international databases, including PubMed, Medline, Embase, ISI Web of Science, Scopus, Springer, ProQuest, ScienceDirect, Clinical Key, and Google Scholar, and domestic Persian databases, including SID, Magiran, and Iran Medex, until April 2021. New-castle Ottawa Scale (NOS) was used to determine the eligibility of studies by evaluating the title and summary of the articles and a partial evaluation of the full text. Comprehensive Metaanalysis (CMA) software was used for data analysis. Results Initially, a total of 1383 articles were retrieved, of which 941 were duplicate studies. Further, 384 studies were excluded after evaluation of the title and abstract, and 36 studies were excluded after considering the inclusion and exclusion criteria. Finally, 22 articles were included in the metaanalysis. The standardized mean difference value was -0.421 (-0.623--0.20) for iron factor, -0.309 (-0.463--0.154) for iron factor in men, -0.483 (-0.375--0373) for iron factor in women, and -0.955 (-0.282--1.628) for the zinc factor. Conclusion In general, the serum iron level (in general, in male and female patients separately) and the zinc serum level in patients with RAS were significantly lower than those of healthy people.
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Affiliation(s)
- Nakisa Torabinia
- Department of Oral and Maxillofacial Pathology, Dental Materials Research Center, Dental Research Institute, School of Dentistry Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saba Asadi
- Dental Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad J Tarrahi
- Department of Epidemiology and Biostatistics, School of Health, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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29
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Kaur T, Upadhyay J, Nandave M, Alsayari A, Alshehri SA, Pukale S, Wahab S, Ahmad W, Rashid S, Ansari MN. Exploring progress in iron supplement formulation approaches for treating iron deficiency anemia through bibliometric and thematic analysis. Heliyon 2024; 10:e29058. [PMID: 38623202 PMCID: PMC11016621 DOI: 10.1016/j.heliyon.2024.e29058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/04/2024] [Accepted: 03/28/2024] [Indexed: 04/17/2024] Open
Abstract
Anemia is a severe health issue that affects around one-third of the global population. Therefore, the present study aims to conduct a bibliometric analysis to investigate the research trends regarding advancements on iron formulations in treating iron deficiency anemia via oral or parenteral route. This study adopts thematic and bibliometric methods on existing research on novel iron formulations. It also provides perspective into the existing understanding on treatment strategies for iron deficiency anemia. This study is conducted on 543 papers on various ferrous and ferric formulations used in the treatment of iron deficiency anemia. The study period is from 1977 to 2022, and the papers are identified from the Scopus database. The bibliometric analysis was carried out using the R tool's Bibliometrix package. The study discusses performance analysis, including annual publications, geographic analysis, relevant affiliations, journal analysis, and citation analysis. In addition, the conceptual structure, including the co-occurrence network, thematic map, thematic evolution, intellectual structure highlighting co-citation analysis, and social structure depicting the collaboration network and collaboration world map, are presented. The results showed increased research on formulation strategies for the treatment of iron deficiency anemia from 2010 onwards. The top 5 contributing countries are the USA, Italy, India, Germany, and the UK, and peer-reviewed journals from the area of nutrition. The most trending areas of study are iron deficiency anemia in pregnancy, chronic kidney diseases, inflammatory bowel diseases, and various intravenous formulations used in its treatment. The authors from Europe collaborate the most with authors from other countries. The study concludes that a safer and more effective iron formulation is needed to reduce the prevalence of anemia. The findings of the study are helpful in advancing research on innovative formulations for treating iron deficiency anemia. The insights from the study are helpful to policymakers in designing specific health policies and investing more in research and development of novel formulations for the treatment of iron deficiency anemia.
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Affiliation(s)
- Tarnjot Kaur
- Department of Pharmaceutical Sciences, School of Health Sciences and Technology, UPES, Bidholi Campus, Dehradun 248007, Uttarakhand, India
| | - Jyoti Upadhyay
- Department of Pharmaceutical Sciences, School of Health Sciences and Technology, UPES, Bidholi Campus, Dehradun 248007, Uttarakhand, India
| | - Mukesh Nandave
- Department of Pharmacology, Delhi Pharmaceutical Sciences and Research University New Delhi, 110017, India
| | - Abdulrhman Alsayari
- Department of Pharmacognosy, College of Pharmacy, King Khalid University, Abha 62529, Saudi Arabia
| | - Saad Ali Alshehri
- Department of Pharmacognosy, College of Pharmacy, King Khalid University, Abha 62529, Saudi Arabia
| | - Sudeep Pukale
- Lupin Research Park, Nande, Maharashtra 412115, India
| | - Shadma Wahab
- Department of Pharmacognosy, College of Pharmacy, King Khalid University, Abha 62529, Saudi Arabia
| | - Wasim Ahmad
- Department of Pharmacy, Mohammed Al-Mana College for Medical Sciences, Dammam 34222, Saudi Arabia
| | - Summya Rashid
- Department of Pharmacology & Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
| | - Mohd Nazam Ansari
- Department of Pharmacology & Toxicology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia
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30
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Tan X, Tan PY, Gong YY, Moore JB. Overnutrition is a risk factor for iron, but not for zinc or vitamin A deficiency in children and young people: a systematic review and meta-analysis. BMJ Glob Health 2024; 9:e015135. [PMID: 38599666 PMCID: PMC11015307 DOI: 10.1136/bmjgh-2024-015135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION Traditionally associated with undernutrition, increasing evidence suggests micronutrient deficiencies can coexist with overnutrition. Therefore, this work aimed to systematically review the associations between iron, zinc and vitamin A (VA) status and weight status (both underweight and overweight) in children and young people. METHODS Ovid Medline, Ovid Embase, Scopus and Cochrane databases were systematically searched for observational studies assessing micronutrient status (blood, serum or plasma levels of iron, zinc or VA biomarkers) and weight status (body mass index or other anthropometric measurement) in humans under 25 years of any ethnicity and gender. Risk of bias assessment was conducted using the American Dietetic Association Quality Criteria Checklist. Where possible, random effects restricted maximum likelihood meta-analyses were performed. RESULTS After screening, 83 observational studies involving 190 443 participants from 44 countries were identified, with many studies having reported on more than one micronutrient and/or weight status indicator. Iron was the most investigated micronutrient, with 46, 28 and 27 studies reporting data for iron, zinc and VA status, respectively. Synthesising 16 records of OR from seven eligible studies, overnutrition (overweight and obesity) increased odds of iron deficiency (ID) (OR (95% CI): 1.51 (1.20 to 1.82), p<0.0001, I2=40.7%). Odds appeared to be higher for children living with obesity (1.88 (1.33 to 2.43), p<0.0001, I2=20.6%) in comparison to those with overweight (1.31 (0.98 to 1.64), p<0.0001, I2=40.5%), although between group differences were not significant (p=0.08). CONCLUSIONS Overnutrition is associated with increased risk of ID, but not zinc or VA deficiencies, with an inverted U-shaped relationship observed between iron status and bodyweight. Our results highlight significant heterogeneity in the reporting of micronutrient biomarkers and how deficiencies were defined. Inflammation status was rarely adequately accounted for, and the burden of ID may well be under-recognised, particularly in children and young people living with overnutrition. PROSPERO REGISTRATION NUMBER CRD42020221523.
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Affiliation(s)
- Xiaomian Tan
- School of Food Science and Nutrition, University of Leeds, Leeds, West Yorkshire, UK
| | - Pui Yee Tan
- School of Food Science and Nutrition, University of Leeds, Leeds, West Yorkshire, UK
| | - Yun Yun Gong
- School of Food Science and Nutrition, University of Leeds, Leeds, West Yorkshire, UK
| | - J Bernadette Moore
- School of Food Science and Nutrition, University of Leeds, Leeds, West Yorkshire, UK
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31
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Muñoz MPS, Ramirez ZPB, Rodriguez ELM, Blandón JDR, Aguiñaga SA, Orozco CAO, Yáñez ARE. Transferrin Saturation, Serum Ferritin, and C-Reactive Protein vs. Serum Ferritin for an optimal Iron Deficiency Diagnosis in Candidates for Bariatric Surgery. Obes Surg 2024; 34:1174-1184. [PMID: 38367125 DOI: 10.1007/s11695-024-07081-z] [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: 10/01/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION Iron has different physiological processes and is regulated by hepcidin that is also an acute phase reactant, which increases with inflammation. Obesity produces a pro-inflammatory state, affecting directly the normal regulation of iron, causing ferritin (FER) deficiency. FER is used as the only indicator of the status of iron in patients with obesity, so the majority of them would be underdiagnosed, leading to a high prevalence of iron deficiency (ID) and anemia. The aim of this study is to evaluate the diagnostic tests: transferrin saturation (TS), FER, and C-reactive protein (CRP) vs. FER with the objective of analyzing the most accurate variable for the diagnosis of ID. MATERIALS AND METHODS We present a cross-sectional, analytical, and retrospective study, evaluating the diagnostic tests in 96 patients, to whom two methods were applied for the diagnosis of ID: method 1 (FER < 30 ng/mL) and method 2 divided into 2A (FER < 30 ng/mL), 2B (FER 30-100 ng/mL + CRP ≥ 5 mg/L), 2C (FER 100-300 ng/mL + CRP ≥ 5 mg/L + TS < 20%), and 2D (TS < 20%). RESULTS The prevalence of ID obtained using method 1 was 30.2% while 69.8% presented ID using total method 2, confirming an underdiagnosis of 39.6%. CONCLUSION The inflammatory state in patients with obesity must be considered in the diagnosis of ID. The use of TS, FER, and CRP has greater validity than the use of serum FER for the diagnosis of ID in patients with obesity.
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Affiliation(s)
- M Patricia Sánchez Muñoz
- Bariatric and Metabolic Surgery Clinic, The Civil Hospital of Guadalajara "Dr Juan I. Menchaca", Salvador Quevedo and Zubieta 750, Eastern Independence, C.P: 44340, Guadalajara, Jalisco, Mexico
| | - Zuleyma P Bello Ramirez
- Bariatric and Metabolic Surgery Clinic, The Civil Hospital of Guadalajara "Dr Juan I. Menchaca", Salvador Quevedo and Zubieta 750, Eastern Independence, C.P: 44340, Guadalajara, Jalisco, Mexico.
| | - Eduardo L Martínez Rodriguez
- Bariatric and Metabolic Surgery Clinic, The Civil Hospital of Guadalajara "Dr Juan I. Menchaca", Salvador Quevedo and Zubieta 750, Eastern Independence, C.P: 44340, Guadalajara, Jalisco, Mexico
| | - José D Reyes Blandón
- Bariatric and Metabolic Surgery Clinic, The Civil Hospital of Guadalajara "Dr Juan I. Menchaca", Salvador Quevedo and Zubieta 750, Eastern Independence, C.P: 44340, Guadalajara, Jalisco, Mexico
| | - Soledad Aldana Aguiñaga
- Bariatric and Metabolic Surgery Clinic, The Civil Hospital of Guadalajara "Dr Juan I. Menchaca", Salvador Quevedo and Zubieta 750, Eastern Independence, C.P: 44340, Guadalajara, Jalisco, Mexico
| | - César A Ortiz Orozco
- General Surgery Department, The Civil Hospital of Guadalajara "Dr Juan I. Menchaca", Salvador Quevedo and Zubieta 750, Eastern Independence, C.P: 44340, Guadalajara, Jalisco, Mexico
| | - Allison R Esparza Yáñez
- University Center for Biological and Agricultural Sciences, University of Guadalajara, Ramón Padilla Sanchez 2100, The Needles, C.P: 44600, Zapopan, Jalisco, Mexico
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Yang L, Chen Y, He S, Yu D. The crucial role of NRF2 in erythropoiesis and anemia: Mechanisms and therapeutic opportunities. Arch Biochem Biophys 2024; 754:109948. [PMID: 38452967 DOI: 10.1016/j.abb.2024.109948] [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: 01/04/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
The nuclear factor erythroid 2-related factor 2 (NRF2) is a transcription factor crucial in cellular defense against oxidative and electrophilic stresses. Recent research has highlighted the significance of NRF2 in normal erythropoiesis and anemia. NRF2 regulates genes involved in vital aspects of erythroid development, including hemoglobin catabolism, inflammation, and iron homeostasis in erythrocytes. Disrupted NRF2 activity has been implicated in various pathologies involving abnormal erythropoiesis. In this review, we summarize the progress made in understanding the mechanisms of NRF2 activation in erythropoiesis and explore the roles of NRF2 in various types of anemia. This review also discusses the potential of targeting NRF2 as a new therapeutic approach to treat anemia.
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Affiliation(s)
- Lei Yang
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, 225009, China
| | - Yong Chen
- Department of Oncology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, 225003, China
| | - Sheng He
- Guangxi Key Laboratory of Birth Defects Research and Prevention, Guangxi Key Laboratory of Reproductive Health and Birth Defects Prevention, Guangxi Zhuang Autonomous Region Women and Children Care Hospital, Nanning, Guangxi, 530000, China
| | - Duonan Yu
- Department of Hematology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, 610000, China; Jiangsu Key Laboratory of Experimental & Translational Non-coding RNA Research, Yangzhou University, Yangzhou, 225009, China; Guangxi Key Laboratory of Birth Defects Research and Prevention, Guangxi Key Laboratory of Reproductive Health and Birth Defects Prevention, Guangxi Zhuang Autonomous Region Women and Children Care Hospital, Nanning, Guangxi, 530000, China.
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Aboujabal K, Sadek K, Obaid K, Sawaf B, Habas E, Habib MB. Iron deficiency-induced thrombocytosis presenting with blue toe syndrome. Clin Case Rep 2024; 12:e8596. [PMID: 38571904 PMCID: PMC10988659 DOI: 10.1002/ccr3.8596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/10/2024] [Accepted: 02/22/2024] [Indexed: 04/05/2024] Open
Abstract
Although the etiology of blue toe syndrome is varied, the association between blue toe syndrome and iron deficiency-induced thrombocytosis (IDIT) has not been well established. We report the case of a 38-year-old Saudi male who presented with blue toe syndrome and laboratory investigations revealed severe thrombocytosis secondary to iron deficiency. The patient was managed with analgesics, antiplatelets, anticoagulation, intravenous fluids, and iron supplementation. Subsequently, his symptoms resolved within a few days. IDIT is crucial to consider as a possible cause of microvascular thrombosis disorders, especially in patients with severe thrombocytosis.
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Affiliation(s)
- Khaled Aboujabal
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Khaled Sadek
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Koutaibah Obaid
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Bisher Sawaf
- Department of Internal MedicineHamad Medical CorporationDohaQatar
| | - Elmukhtar Habas
- Department of Internal MedicineHamad Medical CorporationDohaQatar
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Sardo U, Perrier P, Cormier K, Sotin M, Personnaz J, Medjbeur T, Desquesnes A, Cannizzo L, Ruiz-Martinez M, Thevenin J, Billoré B, Jung G, Abboud E, Peyssonnaux C, Nemeth E, Ginzburg YZ, Ganz T, Kautz L. The hepatokine FGL1 regulates hepcidin and iron metabolism during anemia in mice by antagonizing BMP signaling. Blood 2024; 143:1282-1292. [PMID: 38232308 PMCID: PMC11103088 DOI: 10.1182/blood.2023022724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/20/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024] Open
Abstract
ABSTRACT As a functional component of erythrocyte hemoglobin, iron is essential for oxygen delivery to all tissues in the body. The liver-derived peptide hepcidin is the master regulator of iron homeostasis. During anemia, the erythroid hormone erythroferrone regulates hepcidin synthesis to ensure the adequate supply of iron to the bone marrow for red blood cell production. However, mounting evidence suggested that another factor may exert a similar function. We identified the hepatokine fibrinogen-like 1 (FGL1) as a previously undescribed suppressor of hepcidin that is induced in the liver in response to hypoxia during the recovery from anemia, and in thalassemic mice. We demonstrated that FGL1 is a potent suppressor of hepcidin in vitro and in vivo. Deletion of Fgl1 in mice results in higher hepcidin levels at baseline and after bleeding. FGL1 exerts its activity by directly binding to bone morphogenetic protein 6 (BMP6), thereby inhibiting the canonical BMP-SMAD signaling cascade that controls hepcidin transcription.
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Affiliation(s)
- Ugo Sardo
- Institut de Recherche en Santé Digestive, Université de Toulouse, INSERM, INRAE, ENVT, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Prunelle Perrier
- Institut de Recherche en Santé Digestive, Université de Toulouse, INSERM, INRAE, ENVT, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Kevin Cormier
- Institut de Recherche en Santé Digestive, Université de Toulouse, INSERM, INRAE, ENVT, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Manon Sotin
- Institut de Recherche en Santé Digestive, Université de Toulouse, INSERM, INRAE, ENVT, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Jean Personnaz
- Institut de Recherche en Santé Digestive, Université de Toulouse, INSERM, INRAE, ENVT, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Thanina Medjbeur
- Institut de Recherche en Santé Digestive, Université de Toulouse, INSERM, INRAE, ENVT, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Aurore Desquesnes
- Institut de Recherche en Santé Digestive, Université de Toulouse, INSERM, INRAE, ENVT, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Lisa Cannizzo
- Institut de Recherche en Santé Digestive, Université de Toulouse, INSERM, INRAE, ENVT, Université Toulouse III Paul Sabatier, Toulouse, France
| | | | - Julie Thevenin
- Institut de Recherche en Santé Digestive, Université de Toulouse, INSERM, INRAE, ENVT, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Benjamin Billoré
- Institut de Recherche en Santé Digestive, Université de Toulouse, INSERM, INRAE, ENVT, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Grace Jung
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Elise Abboud
- Institut Cochin, INSERM, Centre National de la Recherche Scientifique, Université de Paris, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Carole Peyssonnaux
- Institut Cochin, INSERM, Centre National de la Recherche Scientifique, Université de Paris, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Elizabeta Nemeth
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Tomas Ganz
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Léon Kautz
- Institut de Recherche en Santé Digestive, Université de Toulouse, INSERM, INRAE, ENVT, Université Toulouse III Paul Sabatier, Toulouse, France
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Bakkannavar S, Faheem Y, Jaiswal A, Shergill K, Boppana K, Almansouri NE, Hamid P. Associative Patterns Between Iron Deficiency Anemia and Febrile Seizures in the Five to 60 Months Age Group: A Comprehensive Systematic Review. Cureus 2024; 16:e56470. [PMID: 38638769 PMCID: PMC11024880 DOI: 10.7759/cureus.56470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Febrile seizures (FS) are commonly seen in younger age groups. The cause of seizures is multifactorial, including viral illnesses, certain vaccines such as MMR (measles, mumps, rubella), family history of FS, and certain mineral deficiencies like zinc. Iron deficiency anemia (IDA) is the most common cause of anemia in children of the same age group. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. This review aimed to investigate the correlation between IDA and fever convulsions. A systematic literature search was conducted using PubMed and Google Scholar databases for studies published between January 2013 and September 2023. The following keywords were used to search the articles: "children", "febrile seizures", and "iron deficiency anemia", using all possible combinations and using the word "and" between them. Following the inclusion and exclusion criteria application, we included 23 case-control studies written in the English language in this study. Quality assessment of studies was done using the Newcastle Ottawa Scale.
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Affiliation(s)
- Saloni Bakkannavar
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Medicine, Jagadguru Jayadeva Murugarajendra Medical College, Davanagere, IND
| | - Youmna Faheem
- Medicine, Ras Al Khaimah Medical & Health Sciences University, Ras Al Khaimah, ARE
- Medicine, New Medical Center Royal Hospital, Abu Dhabi, ARE
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Amisha Jaiswal
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Kainaat Shergill
- Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Medicine, Maharishi Markandeshwar Institute of Medical Sciences & Research, Ambala, IND
| | - Kusalik Boppana
- Gastroenterology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Naiela E Almansouri
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, University of Tripoli, Tripoli, LBY
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Ebea PO, Vidyasagar S, Connor JR, Frazer DM, Knutson MD, Collins JF. Oral iron therapy: Current concepts and future prospects for improving efficacy and outcomes. Br J Haematol 2024; 204:759-773. [PMID: 38253961 PMCID: PMC10939879 DOI: 10.1111/bjh.19268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/01/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024]
Abstract
Iron deficiency (ID) and iron-deficiency anaemia (IDA) are global public health concerns, most commonly afflicting children, pregnant women and women of childbearing age. Pathological outcomes of ID include delayed cognitive development in children, adverse pregnancy outcomes and decreased work capacity in adults. IDA is usually treated by oral iron supplementation, typically using iron salts (e.g. FeSO4 ); however, dosing at several-fold above the RDA may be required due to less efficient absorption. Excess enteral iron causes adverse gastrointestinal side effects, thus reducing compliance, and negatively impacts the gut microbiome. Recent research has sought to identify new iron formulations with better absorption so that lower effective dosing can be utilized. This article outlines emerging research on oral iron supplementation and focuses on molecular mechanisms by which different supplemental forms of iron are transported across the intestinal epithelium and whether these transport pathways are subject to regulation by the iron-regulatory hormone hepcidin.
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Affiliation(s)
- Pearl O. Ebea
- Food Science & Human Nutrition Department, University of Florida, Gainesville, FL, USA
| | | | - James R. Connor
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - David M. Frazer
- Molecular Nutrition Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Mitchell D. Knutson
- Food Science & Human Nutrition Department, University of Florida, Gainesville, FL, USA
| | - James F. Collins
- Food Science & Human Nutrition Department, University of Florida, Gainesville, FL, USA
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VanderMeulen H, Tang GH, Sholzberg M. Tranexamic acid for management of heavy vaginal bleeding: barriers to access and myths surrounding its use. Res Pract Thromb Haemost 2024; 8:102389. [PMID: 38623473 PMCID: PMC11017359 DOI: 10.1016/j.rpth.2024.102389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 04/17/2024] Open
Abstract
Tranexamic acid is safe and effective for the treatment of heavy vaginal bleeding during menstruation and childbirth. It improves the quality of life, facilitates participation in school and work, and reduces the risk of death from postpartum hemorrhage. Despite its well-established benefits, individual- and structural-level barriers preclude its widespread utilization, hindering effective patient care and perpetuating health inequities in women's health. We first describe the evidence for the use of tranexamic acid in treating heavy menstrual bleeding and postpartum hemorrhage. Barriers to tranexamic acid use, including structural sexism, period poverty, misinformation in product monograph labeling, stigmatization of vaginal blood loss, and drug access, are then discussed. Finally, we summarize relevant data presented during the 2023 International Society on Thrombosis and Haemostasis Congress.
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Affiliation(s)
- Heather VanderMeulen
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Grace H. Tang
- Department of Hematology, Hematology-Oncology Clinical Research Group, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle Sholzberg
- Department of Medicine and Laboratory Medicine & Pathobiology, St. Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
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Jiang W, Li X, Wang R, Du Y, Zhou W. Cross-country health inequalities of four common nutritional deficiencies among children, 1990 to 2019: data from the Global Burden of Disease Study 2019. BMC Public Health 2024; 24:486. [PMID: 38360585 PMCID: PMC10870451 DOI: 10.1186/s12889-024-17942-y] [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: 10/23/2023] [Accepted: 01/31/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Nutritional deficiencies remain serious medical and public health issues worldwide, especially in children. This study aims to analyze cross-country inequality in four common nutritional deficiencies (protein-energy malnutrition, dietary iron deficiency, vitamin A deficiency and iodine deficiency) among children from 1990 to 2019 based on Global Burden of Disease (GBD) 2019 data. METHODS Prevalence and disability-adjusted life years (DALYs) data as measures of four nutritional deficiency burdens in people aged 0 to 14 years were extracted from the GBD Results Tool. We analyzed temporal trends in prevalence by calculating the average annual percent change (AAPC) and quantified cross-country inequalities in disease burden using the slope index. RESULTS Globally, the age-standardized prevalence rates of dietary iron deficiency, vitamin A deficiency and iodine deficiency decreased, with AAPCs of -0.14 (-0.15 to -0.12), -2.77 (-2.96 to -2.58), and -2.17 (-2.3 to -2.03) from 1999 to 2019, respectively. Significant reductions in socio-demographic index (SDI)-related inequality occurred in protein-energy malnutrition and vitamin A deficiency, while the health inequality for dietary iron deficiency and iodine deficiency remained basically unchanged. The age-standardized prevalence and DALY rates of the four nutritional deficiencies decreased as the SDI and healthcare access and quality index increased. CONCLUSIONS The global burden of nutritional deficiency has decreased since 1990, but cross-country health inequalities still exist. More efficient public health measures are needed to reduce disease burdens, particularly in low-SDI countries/territories.
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Affiliation(s)
- Wenkai Jiang
- The Second Clinical Medical College, Lanzhou University, No. 222 Tianshui Road (South), Cheng-Guan District, 730030, Lanzhou City, Gansu Province, China
| | - Xiao Li
- The Second Clinical Medical College, Lanzhou University, No. 222 Tianshui Road (South), Cheng-Guan District, 730030, Lanzhou City, Gansu Province, China
| | - Ruiying Wang
- The First Clinical Medical College, Lanzhou University, 730030, Lanzhou, China
| | - Yan Du
- The Second Clinical Medical College, Lanzhou University, No. 222 Tianshui Road (South), Cheng-Guan District, 730030, Lanzhou City, Gansu Province, China
| | - Wence Zhou
- The Second Clinical Medical College, Lanzhou University, No. 222 Tianshui Road (South), Cheng-Guan District, 730030, Lanzhou City, Gansu Province, China.
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Lemaire B, Frias MA, Golaz O, Magnin JL, Viette V, Vuilleumier N, Waldvogel Abramowski S. Ferritin: A Biomarker Requiring Caution in Clinical Decision. Diagnostics (Basel) 2024; 14:386. [PMID: 38396425 PMCID: PMC10887646 DOI: 10.3390/diagnostics14040386] [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: 01/08/2024] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES To determine the ferritin inter-assay differences between three "Conformité Européenne" (CE) marked tests, the impact on reference intervals (RI), and the proportion of individuals with iron deficiency (ID), we used plasma and serum from healthy blood donors (HBD) recruited in three different Switzerland regions. DESIGN AND METHODS Heparinized plasma and serum from HBD were obtained from three different transfusion centers in Switzerland (Fribourg, Geneva, and Neuchatel). One hundred forty samples were recruited per center and per matrix, with a gender ratio of 50%, for a total of 420 HBD samples available per matrix. On both matrices, ferritin concentrations were quantified by three different laboratories using electrochemiluminescence (ECL), latex immunoturbidimetric assay (LIA), and luminescent oxygen channeling immunoassay (LOCI) assays, respectively. The degree of agreement between matrices and between the three sites/methods was assessed by Passing-Bablok and we evaluated the proportion of individuals deemed to have ID per method. RESULTS Overall, no difference between serum and heparinized plasma ferritin values was observed according to Passing-Bablok analyses (proportional bias range: 1.0-3.0%; maximum constant bias: 1.84 µg/L). Significant median ferritin differences (p < 0.001 according to Kruskal-Wallis test) were observed between the three methods (i.e., 83.6 µg/L, 103.5 µg/L, and 62.1 µg/L for ECL, LIA, and LOCI in heparinized plasma, respectively), with proportional bias varying significantly between ±16% and ±32% on serum and from ±14% to ±35% on plasma with no sign of gender-related differences. Affecting the lower end of RI, the proportion of ID per method substantially varied between 4.76% (20/420) for ECL, 2.86% (12/420) for LIA, and 9.05% (38/420) for LOCI. CONCLUSIONS Serum and heparinized plasma are exchangeable for ferritin assessment. However, the order of magnitude of ferritin differences across methods and HBD recruitment sites could lead to diagnostic errors if uniform RI were considered. Challenging the recently proposed use of uniform ferritin thresholds, our results highlight the importance of method- and region-specific RI for ferritin due to insufficient inter-assay harmonization. Failing to do so significantly impacts ID diagnosis.
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Affiliation(s)
- Baptiste Lemaire
- Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
- Medicine Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Miguel A. Frias
- Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Olivier Golaz
- Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Jean-Luc Magnin
- Central Laboratory, HFR-Fribourg, 1700 Fribourg, Switzerland
| | | | - Nicolas Vuilleumier
- Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Sophie Waldvogel Abramowski
- Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
- Medicine Department, Geneva University Hospitals, 1205 Geneva, Switzerland
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Urbanski G, Chabrun F, Lavigne C, Lacout C, Delattre E, Reynier P, Requin J. Serum ferritin/C-reactive protein ratio is a simple and effective biomarker for diagnosing iron deficiency in the context of systemic inflammation. QJM 2024; 117:9-15. [PMID: 37758245 DOI: 10.1093/qjmed/hcad218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/15/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Diagnosing iron deficiency is challenging in the presence of systemic inflammation. AIM To investigate the relationship between plasma C-reactive protein (CRP), serum ferritin (SF) and transferrin saturation (TS), with the objective of establishing a straightforward ratio applicable in the presence of inflammatory syndrome. DESIGN Test prospective cohort and validation retrospective cohort. METHODS A prospective cohort of inpatients (n = 140) assessed the correlation between CRP and SF/TS levels. The diagnostic performance of a determined ratio was evaluated for identifying iron deficiency (ID) using different definitions and in the presence of inflammation and/or chronic heart and/or kidney failure. A large validation cohort (n = 795) further assessed the predictive power of this ratio. RESULTS In a training cohort (median age 76 years [57-84]), a linear relation was observed between SF (µg/l) and CRP (mg/l), unlike with TS. The SF/CRP ratio accurately predicted ID, with receiver operating characteristic-area under the curve (ROC-AUC) values ranging from 0.85 to 0.92 for different ID definitions. A threshold of ≤6 demonstrated the highest Youden index (0.61). In the validation cohort (age 72 years [57-84]), the SF/CRP ratio exhibited an ROC-AUC of 0.88 [95% CI: 0.85-0.90], with an odds ratio of 37.9 [95% CI: 20.3-68.9] for the threshold of ≤6. CONCLUSION In this study, we demonstrated that the SF/CRP ratio, with a threshold of ≤6, is a simple and effective biomarker for ID, even in the presence of systemic inflammation or comorbidities. This ratio could potentially replace the complex set of criteria currently recommended by learned societies.
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Affiliation(s)
- G Urbanski
- Department of Orofacial Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France
- MitoLab, Unité MITOVASC, UMR CNRS 6015, INSERM U1083, SFR ICAT, University of Angers, Angers, France
| | - F Chabrun
- MitoLab, Unité MITOVASC, UMR CNRS 6015, INSERM U1083, SFR ICAT, University of Angers, Angers, France
- Department of Biochemistry and Molecular Biology, University Hospital, Angers, France
| | - C Lavigne
- Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France
| | - C Lacout
- Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France
| | - E Delattre
- Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France
| | - P Reynier
- MitoLab, Unité MITOVASC, UMR CNRS 6015, INSERM U1083, SFR ICAT, University of Angers, Angers, France
- Department of Biochemistry and Molecular Biology, University Hospital, Angers, France
| | - J Requin
- Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France
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MokhtarKalimi E, Loripoor M, Rezaeian M, Gholamrezapour M. The effect of iron supplementation on menstrual bleeding volume and hemoglobin level during menstrual bleeding : A randomized clinical trial. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:19. [PMID: 38532920 PMCID: PMC10965019 DOI: 10.4103/jehp.jehp_1871_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/22/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Many women around the world avoid taking iron supplements during their menstrual bleeding, thinking that menstrual bleeding will increase after taking these supplements. Due to the lack of relevant scientific evidence in this regard, this study was performed to determine the effect of iron supplementation on menstrual blood volume and hemoglobin level during menstrual bleeding. MATERIALS AND METHODS In this three-blind randomized clinical trial, 160 non-anemic female students of Rafsanjan University of Medical Sciences were selected through a public call and then they were randomly assigned to two intervention and control groups. The intervention group was given a ferrous sulfate tablet containsing 50 mg of elemental iron daily in the first four days of bleeding for three consecutive menstrual cycles, and the control group received a placebo simultaneously. Before and after the intervention, the level of hemoglobin was measured and the Higham chart was completed in each menstrual cycle by the participants of the two groups. The obtained data were analyzed using the SPSS software version 21 and Chi-square, independent t-test, paired t-test, analysis of variance with repeated measures, and nonparametric tests. RESULTS Before performing the intervention, the mean Higham score and hemoglobin level of the two groups were not statistically significant (P = 0.307, P = 0.670). The mean Higham score after each intervention was not statistically significant between the two groups over time or when considering the interaction of the time group (P = 0.77, P = 0.916). The hemoglobin level of these two groups did not change significantly after the intervention compared with that before the intervention (P = 0.444). CONCLUSION Compared with a placebo, taking iron supplements containing 50 mg of elemental iron during the first four days of menstrual bleeding in non-anemic women did not change the volume of menstrual bleeding and hemoglobin level.
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Affiliation(s)
- Elnaz MokhtarKalimi
- Department of Midwifery, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Marzeyeh Loripoor
- Department of Midwifery, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mohsen Rezaeian
- Department of Epidemiology and Biostatistics, School of Medicine, Occupational Environment Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - MohammadReza Gholamrezapour
- Department of Internal Medicine, School of Medicine, Ali Ibn Abitaleb Educational and Treatment Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Sun B, Tan B, Zhang P, Zhu L, Wei H, Huang T, Li C, Yang W. Iron deficiency anemia: a critical review on iron absorption, supplementation and its influence on gut microbiota. Food Funct 2024; 15:1144-1157. [PMID: 38235788 DOI: 10.1039/d3fo04644c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Iron deficiency anemia (IDA) caused by micronutrient iron deficiency has attracted global attention due to its adverse health effects. The regulation of iron uptake and metabolism is finely controlled by various transporters and hormones in the body. Dietary iron intake and regulation are essential in maintaining human health and iron requirements. The review aims to investigate literature concerning dietary iron intake and systemic regulation. Besides, recent IDA treatment and dietary iron supplementation are discussed. Considering the importance of the gut microbiome, the interaction between bacteria and micronutrient iron in the gut is also a focus of this review. The iron absorption efficiency varies considerably according to iron type and dietary factors. Iron fortification remains the cost-effective strategy, although challenges exist in developing suitable iron fortificants and food vehicles regarding bioavailability and acceptability. Iron deficiency may alter the microbiome structure and promote the growth of pathogenic bacteria in the gut, affecting immune balance and human health.
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Affiliation(s)
- Bolun Sun
- College of Food and Pharmaceutical Sciences, Key Laboratory of Animal Protein Food Deep Processing Technology of Zhejiang Province, Ningbo University, Ningbo 315211, China.
- School of Nursing, Wenzhou Medical University, Wenzhou 325035, China
| | - Beibei Tan
- School of Agriculture and Food, Faculty of Science, University of Melbourne, Australia
| | - Panxue Zhang
- College of Food and Pharmaceutical Sciences, Key Laboratory of Animal Protein Food Deep Processing Technology of Zhejiang Province, Ningbo University, Ningbo 315211, China.
| | - Lianlian Zhu
- School of Nursing, Wenzhou Medical University, Wenzhou 325035, China
| | - Huamao Wei
- College of Food and Pharmaceutical Sciences, Key Laboratory of Animal Protein Food Deep Processing Technology of Zhejiang Province, Ningbo University, Ningbo 315211, China.
| | - Tao Huang
- College of Food and Pharmaceutical Sciences, Key Laboratory of Animal Protein Food Deep Processing Technology of Zhejiang Province, Ningbo University, Ningbo 315211, China.
| | - Chao Li
- College of Food and Pharmaceutical Sciences, Key Laboratory of Animal Protein Food Deep Processing Technology of Zhejiang Province, Ningbo University, Ningbo 315211, China.
| | - Wenge Yang
- College of Food and Pharmaceutical Sciences, Key Laboratory of Animal Protein Food Deep Processing Technology of Zhejiang Province, Ningbo University, Ningbo 315211, China.
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Rosa KD, Beatriz Limberger L, de Queiroz Fischer M, Dos Santos C, Reuter CP, Dallazem Bertol C, André Horta J, Franke SIR, Prá D. Anaemia among school children of different socioeconomical status in a city of Southern Brazil. Ann Hum Biol 2024; 51:1-7. [PMID: 38251840 DOI: 10.1080/03014460.2023.2298473] [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: 07/18/2022] [Accepted: 12/06/2023] [Indexed: 01/23/2024]
Abstract
Background: Iron deficiency is one of the leading causes of anaemia, with those most affected being children and women of childbearing age, in Brazil there is a scarcity of studies involving the local prevalence of anaemia. Aim: To evaluate anaemia and associated factors in schoolchildren in Santa Cruz do Sul through the analysis of biochemical and haematological markers and parasitological examination of faeces. Subjects and methods: School children from 10 to 12 years of age were evaluated through complete blood count, serum ferritin, C-reactive protein and stool parasitological examination, as well as socio-demographic characteristics and prophylaxis with ferrous sulphate in childhood. Results: It was found that 13.0% of the population was anaemic, girls were very slightly overrepresented among the anaemic children. Only 5.3% had altered haematocrit levels; 26.6% had low Mean Corpuscular Volume levels; 18.4% had low ferritin levels; 2.4% had increased C-reactive protein levels, and 21.7% had altered eosinophils. As for the socioeconomic level, classes A2 and D presented lower haemoglobin levels, as well as class D presenting lower ferritin levels, although without statistical significance. Only 6.0% of the population presented iron-deficiency anaemia and 46.0% of the schoolchildren had used ferrous sulphate supplementation in childhood. Conclusion: The prevalence of anaemia in the studied municipality is low, probably due to the high municipal human development index. Epidemiological studies are essential to characterise the population in a systematic form, to prevent future problems.
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Affiliation(s)
- Karini da Rosa
- Programa de Pós Graduação em Envelhecimento Humano, Universidade de Passo Fundo, Passo Fundo, Brazil
| | - Luana Beatriz Limberger
- Programa de Pós Graduação em Promoção da Saúde, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, Brazil
| | - Maiara de Queiroz Fischer
- Programa de Pós Graduação em Promoção da Saúde, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, Brazil
| | - Caroline Dos Santos
- Programa de Pós Graduação em Promoção da Saúde, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, Brazil
| | - Cézane Priscila Reuter
- Programa de Pós Graduação em Promoção da Saúde, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, Brazil
| | - Charise Dallazem Bertol
- Programa de Pós Graduação em Envelhecimento Humano, Universidade de Passo Fundo, Passo Fundo, Brazil
| | - Jorge André Horta
- Programa de Pós Graduação em Promoção da Saúde, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, Brazil
| | - Silvia Isabel Rech Franke
- Programa de Pós Graduação em Promoção da Saúde, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, Brazil
| | - Daniel Prá
- Programa de Pós Graduação em Promoção da Saúde, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, Brazil
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Li T, Zhang J, Li P. Ferritin and iron supplements in gestational diabetes mellitus: less or more? Eur J Nutr 2024; 63:67-78. [PMID: 37775606 DOI: 10.1007/s00394-023-03250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 09/08/2023] [Indexed: 10/01/2023]
Abstract
Iron metabolism has been found to be closely related to gestational diabetes mellitus (GDM). Excessive ferritin levels were shown to be related to an increased risk of GDM because of iron overload which may lead to insulin resistance and β-cell injury by enhancing oxidative stress and inflammatory responses. On the contrary, insufficient ferritin levels can cause a number of obstetric complications, such as high incidence rates of anaemia and gestational hypertension. Therefore, high or low ferritin levels may have adverse effects on the mother and the foetus, putting clinicians in a dilemma when giving pregnant women iron supplements. This also explains why there have been more conflicting findings in the studies on dietary or oral iron supplementation during pregnancy. Hence, there is an urgent need for more evidence and strategies for appropriate recommendations for ferritin levels and iron supplementation during pregnancy to prevent iron insufficiency without causing iron overload and increasing the risk of GDM. Therefore, we gave an updated review on the association of GDM with ferritin metabolism, ferritin levels and iron supplementation based on the summary of the latest research.
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Affiliation(s)
- Tianlian Li
- Department of Endocrinology, Shengjing Hospital of China Medical University, No. 39, Huaxiang Road, Tiexi District, Shenyang, 110022, Liaoning, China
| | - Jingfan Zhang
- Department of Endocrinology, Shengjing Hospital of China Medical University, No. 39, Huaxiang Road, Tiexi District, Shenyang, 110022, Liaoning, China
| | - Ping Li
- Department of Endocrinology, Shengjing Hospital of China Medical University, No. 39, Huaxiang Road, Tiexi District, Shenyang, 110022, Liaoning, China.
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Mahoro P, Kwon E, Kim YS, Kim SA, Cho J, Cha YS, Bae JM, Kim S. In vitro and in vivo genotoxicity evaluation of ALP1018, a nanomineral food supplement. Food Chem Toxicol 2024; 184:114437. [PMID: 38185402 DOI: 10.1016/j.fct.2024.114437] [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: 11/20/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024]
Abstract
The use of nano-based dietary supplements is increasing around the world, as nanotechnology can help enhance nutrient bioavailability. ALP1018 is a newly developed iron-zinc complex supplement designed as a nanoformulation to improve the efficacy of iron and zinc supplementation. However, safety concerns have been raised, as there is no clear evaluation of ALP1018 toxicity. The goal of this study was to determine the potential mutagenicity and genotoxicity of ALP1018 through three standard screenings: the Ames test, which evaluates bacterial reverse mutations; the in vitro test of chromosomal aberration in Chinese hamster lung cells; and the in vivo micronucleus assay using ICR mice. ALP1018 showed no mutagenic effect, as no increase was observed in the presence or absence of metabolic activation (S9 mix) in revertant colonies on all the bacterial strains used in the Ames test. No structural chromosomal abnormalities were observed in the presence or absence of the S9 mix in mammalian cells used in the chromosomal aberration assay. In the micronucleus test, the frequency of micronucleated polychromatic erythrocytes was not significantly increased in mouse bone marrow cells. Based on these findings, we can conclude that ALP1018 is safe to use and has no mutagenic or genotoxic potential.
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Affiliation(s)
- Patience Mahoro
- The Food Industry Promotional Agency of Korea, Iksan, Republic of Korea; Department of Food Science and Human Nutrition, Jeonbuk National University, Jeonju, Republic of Korea.
| | - Euna Kwon
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yun-Soon Kim
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soon-Ae Kim
- Department of Pharmacology, School of Medicine, Eulji University, Daejeon, Republic of Korea
| | - Junlae Cho
- Department of Nanotech Research and Development, Ferramed Inc., Daejeon, Republic of Korea; School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Youn-Soo Cha
- Department of Food Science and Human Nutrition, Jeonbuk National University, Jeonju, Republic of Korea
| | - Jung-Min Bae
- The Food Industry Promotional Agency of Korea, Iksan, Republic of Korea.
| | - Seyl Kim
- Department of Nanotech Research and Development, Ferramed Inc., Daejeon, Republic of Korea.
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Stefos GC, Dalaka E, Papoutsi G, Palamidi I, Andreou V, Katsaros G, Bossis I, Politis I, Theodorou G. In vitro evaluation of the effect of yogurt acid whey fractions on iron bioavailability. J Dairy Sci 2024; 107:683-694. [PMID: 37709016 DOI: 10.3168/jds.2023-23643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
A side effect of the raised consumption of Greek yogurt is the generation of massive amounts of yogurt acid whey (YAW). The dairy industry has tried several methods for handling these quantities, which constitute an environmental problem. Although the protein content of YAW is relatively low, given the huge amounts of produced YAW, the final protein amount in the produced YAW should not be underestimated. Taking into consideration the increased interest for bioactive peptides and the increased demand for dietary proteins, combined with protein and peptides content of YAW, efforts should be made toward reintroducing the latter in the food supply chain. In this context and in view of the prevalent dietary iron deficiency problem, the objective of the present study was the investigation of YAW fractions' effect on Fe bioavailability. With this purpose, an in vitro digest approach, following the INFOGEST protocol, was coupled with the Caco2 cell model. To evaluate whether YAW digest fractions exert positive, negative or neutral effect on Fe bioavailability, they were compared with the ones derived from milk, a well-studied food in this context. Milk and YAW showed the same effectiveness on both Fe bioavailability and the expression of relative genes (DCYTB, DMT1, FPN1, and HEPH). Focusing further on YAW fractions, by comparison with their blank digest control counterparts, it resulted that YAW 3- to 10-kDa digests fraction had a superior effect over the 0- to 3-kDa fraction on Fe-uptake, which was accompanied by a similar effect on the expression of Fe metabolism-related genes (DCYTB, FPN1, and HEPH). Finally, although the 3- to 10-kDa fraction of bovine YAW digests resulted in a nonsignificant increased Fe uptake, compared with the ovine and caprine YAW, the expression of DCYTB and FPN1 genes underlined this difference by showing a similar pattern with statistically significant higher expression of bovine compared with ovine and bovine compared with both ovine and caprine, respectively. The present study deals with the novel concept that YAW may contain factors affecting Fe bioavailability. The results show that it does not exert any negative effect and support the extensive investigation for specific peptides with positive effect as well as that YAW proteins should be further assessed on the prospect that they can be used in human nutrition.
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Affiliation(s)
- Georgios C Stefos
- Laboratory of Animal Breeding and Husbandry, Department of Animal Science, Agricultural University of Athens, 118 55 Athens, Greece.
| | - Eleni Dalaka
- Laboratory of Animal Breeding and Husbandry, Department of Animal Science, Agricultural University of Athens, 118 55 Athens, Greece
| | - Georgia Papoutsi
- Laboratory of Animal Breeding and Husbandry, Department of Animal Science, Agricultural University of Athens, 118 55 Athens, Greece
| | - Irida Palamidi
- Laboratory of Nutritional Physiology & Feeding, Department of Animal Science, Agricultural University of Athens, 112 55 Athens, Greece
| | - Varvara Andreou
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization-DEMETER, Lykovrissi 14123, Attica, Greece
| | - George Katsaros
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization-DEMETER, Lykovrissi 14123, Attica, Greece
| | - Ioannis Bossis
- Laboratory of Animal Husbandry, Department of Animal Production, School of Agriculture, Faculty of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Ioannis Politis
- Laboratory of Animal Breeding and Husbandry, Department of Animal Science, Agricultural University of Athens, 118 55 Athens, Greece
| | - Georgios Theodorou
- Laboratory of Animal Breeding and Husbandry, Department of Animal Science, Agricultural University of Athens, 118 55 Athens, Greece.
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Fougère B, Puisieux F, Chevalet P, Annweiler C, Michel E, Joly L, Blanc F, Azouzi AE, Desré-Follet V, Cacoub P. Prevalence of iron deficiency in patients admitted to a geriatric unit: a multicenter cross-sectional study. BMC Geriatr 2024; 24:112. [PMID: 38287253 PMCID: PMC10826072 DOI: 10.1186/s12877-024-04719-6] [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: 08/01/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Iron deficiency (ID) is often associated with other comorbidities in older patients and is a factor of morbimortality. However, the prevalence of ID remains poorly documented in this population. METHODS The CARENFER PA study was a French multicenter cross-sectional study whose objective was to evaluate ID in patients (> 75 years) admitted to a geriatric unit. The primary endpoint was the ID prevalence defined as: serum ferritin < 100 µg/L and/or transferrin saturation coefficient (TSAT) < 20%. The Short Physical Performance Battery (SPPB) test was used to identify older patients at high risk of adverse events (e.g., disability, falls, hospitalization, death). RESULTS A total of 888 patients (mean age, 85.2 years; women, 63.5%) from 16 French centers were included from October 2022 to December 2022. The prevalence of ID was 57.6% (95% CI, 54.3-60.9) in the cohort of older patients (62.6% in anemic and 53.3% in non-anemic patients; p = 0.0062). ID prevalence increased significantly with the presence of more than three comorbidities (65.6% vs. 55.9%; p = 0.0274), CRP ≥ 12 mg/L (73.0% vs. 49.3%; p < 0.001) and treatment that may influence ID/anemia (60.5% vs. 49.6%; p = 0.0042). In multivariate analysis, only CRP ≥ 12 mg/L was an independent predictive factor of ID (odds ratio, 2.78; 95% CI, 1.92-4.08; p < 0.001). SPPB scores were low (0-6) in 60.5% of patients with ID versus 48.6% of patients without ID (p = 0.0076). CONCLUSION More than half of older patients had ID, including non-anemic patients. ID was associated with the presence of inflammation and a low SPPB score. TRIAL REGISTRATION NCT05514951.
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Affiliation(s)
- Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, Tours, France.
- CHRU Tours - Pôle Vieillissement, Hôpital Bretonneau, 2 Boulevard Tonnelé, 37044, Tours Cedex 9, France.
| | | | - Pascal Chevalet
- Nantes Université, CHU Nantes, Pôle de Gérontologie Clinique, Nantes, France
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center On Autonomy and Longevity, University Hospital & Laboratoire de Psychologie Des Pays de La Loire, LPPL EA 4638, SFR Confluences, University of Angers, Angers, France
| | - Emeline Michel
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Nice, France
- Université Côte d'Azur, LAHMESS, Nice, France
| | - Laure Joly
- Geriatric Department, CHRU Nancy, Université de Lorraine, Nancy, France
- INSERM, DCAC, Université de Lorraine, Vandœuvre-Lès-Nancy, France
| | - Frédéric Blanc
- Team IMIS, ICube Laboratory, UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), University of Strasbourg and CNRS, Strasbourg, France
- 3CM2R (Research and Resources Memory Centre), Geriatrics Department, Day Hospital and Cognitive-Behavioral Unit University Hospitals of Strasbourg, Strasbourg, France
| | | | | | - Patrice Cacoub
- UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, Paris, France
- Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Krieg S, Loosen S, Krieg A, Luedde T, Roderburg C, Kostev K. Association between iron deficiency anemia and subsequent stomach and colorectal cancer diagnosis in Germany. J Cancer Res Clin Oncol 2024; 150:53. [PMID: 38289465 PMCID: PMC10827837 DOI: 10.1007/s00432-023-05534-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/26/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE Iron deficiency anemia (IDA) is the most common form of anemia worldwide, resulting in a high burden of disease. Accumulating evidence suggests that IDA is associated with the development of gastrointestinal (GI) cancers. METHODS Data from the IDA database (IQVIA) of primary care practices in Germany of adult patients first diagnosed with IDA between January 2005 and December 2021 were retrospectively analyzed and compared with a 1:1 propensity score-adjusted cohort without IDA. Study outcomes were first stomach cancer or colorectal cancer (CRC) diagnosis up to 10 years after the index date as a function of IDA. RESULTS A total of 122,502 individuals with IDA and 122,502 individuals without IDA were included. The 10-year cumulative incidence of CRC was 1.4% in the IDA patients compared to 0.8% in the cohort without IDA (p < 0.001). Regression analysis revealed a significant association between IDA and subsequent CRC (HR 2.05; 95% CI 1.83-2.30). Stomach cancer was diagnosed in 0.3% of IDA patients compared to 0.2% in the non-IDA cohort during the 10-year follow-up period (p = 0.002). However, this was significant only in the age group > 80 years (HR 2.73; 95% CI 1.60-4.67) and in men (HR 1.90; 95% CI 1.38-2.61). CONCLUSION These findings add to the literature and suggest an association between IDA and GI cancers. The extent to which this association is due to GI bleeding or other pathophysiological processes that may be caused by IDA requires further investigation, particularly experimental studies.
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Affiliation(s)
- Sarah Krieg
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Sven Loosen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Andreas Krieg
- Department of Surgery (A), University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, 40225, Duesseldorf, Germany
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Christoph Roderburg
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
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Ogawa C, Tsuchiya K, Tomosugi N, Maeda K. High Ferritin Is Not Needed in Hemodialysis Patients: A Retrospective Study of Total Body Iron and Oral Iron Replacement Therapy. Int J Mol Sci 2024; 25:1508. [PMID: 38338786 PMCID: PMC10855056 DOI: 10.3390/ijms25031508] [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: 12/19/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
In vivo iron levels can be adjusted through intestinal iron absorption to be maintained at a suitable level; however, optimal iron levels in hemodialysis (HD) patients are unclear. In this study, we investigated total body iron (TBI), calculated as the sum of red blood cell (RBC) iron and iron stores, during courses of low-dose oral iron replacement therapy, and evaluated in vivo iron sufficiency and its indicators in HD patients. We analyzed data on 105 courses of low-dose iron replacement therapy administered to 83 patients on maintenance HD over 7 months. We evaluated changes in TBI, RBC iron, and iron stores from the initiation of treatment to month 7 in two groups of patients, namely, iron-therapy responders and non-responders. TBI showed significant increases until month 4 and plateaued thereafter in iron-therapy responders, and tended to increase and then reached a similar plateau in non-responders (month 7: 1900 ± 447 vs. 1900 ± 408 mg). Steady-state TBI was strongly correlated with body surface area (y = 1628.6x - 791.91, R2 = 0.88, p < 0.001). We observed constant TBI during oral iron replacement therapy suggesting the activation of a "mucosal block". The results suggest that body surface area has utility for estimating the required TBI with regression equations.
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Affiliation(s)
- Chie Ogawa
- Maeda Institute of Renal Research, 6F-1-403 Kosugi-cho, Nakahara-ku, Kawasaki 211-0063, Kanagawa, Japan;
- Biomarker Society, INC, 6F-1-403 Kosugi-cho, Nakahara-ku, Kawasaki 211-0063, Kanagawa, Japan; (K.T.); (N.T.)
| | - Ken Tsuchiya
- Biomarker Society, INC, 6F-1-403 Kosugi-cho, Nakahara-ku, Kawasaki 211-0063, Kanagawa, Japan; (K.T.); (N.T.)
- Department of Blood Purification, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Tokyo, Japan
| | - Naohisa Tomosugi
- Biomarker Society, INC, 6F-1-403 Kosugi-cho, Nakahara-ku, Kawasaki 211-0063, Kanagawa, Japan; (K.T.); (N.T.)
- Division of Systems Bioscience for Drug Discovery Project Research Center, Medical Research Institute, Kanazawa Medical University, 1-1 Daigaku, Kahoku-gun, Uchinada-machi 920-0293, Ishikawa, Japan
| | - Kunimi Maeda
- Maeda Institute of Renal Research, 6F-1-403 Kosugi-cho, Nakahara-ku, Kawasaki 211-0063, Kanagawa, Japan;
- Biomarker Society, INC, 6F-1-403 Kosugi-cho, Nakahara-ku, Kawasaki 211-0063, Kanagawa, Japan; (K.T.); (N.T.)
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50
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Link H, Kerkmann M, Holtmann L, Detzner M. Anemia diagnosis and therapy in malignant diseases: implementation of guidelines-a representative study. Support Care Cancer 2024; 32:113. [PMID: 38240843 PMCID: PMC10799088 DOI: 10.1007/s00520-023-08267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/18/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE Anemia in cancer should be diagnosed and treated according to guideline recommendations. The implementation of ESMO and German guidelines and their effect on anemia correction was analyzed. METHODS This retrospective epidemiological study, representative for Germany, analyzed data on anemia management of cancer patients with anemia ≥ grade 2. The Guideline Adherence Score (GLAD) for diagnosis (GLAD-D) and therapy (GLAD-T) was defined as follows: 2 points for complete, 1 point for partial, 0 point for no adherence. RESULTS Data were analyzed for 1046 patients. Hb levels at diagnosis of anemia were 8-10 g/dL in 899 (85.9%) patients, 7-8 g/dL in 92 (8.7%), and < 7 g/dL (5.0%) in 52. Transferrin saturation was determined in 19% of patients. Four hundred fifty-six patients received RBC (43.6%), 198 (18.9%) iron replacement, 106 (10.1%) ESA, and 60 (5.7%) vitamin B12 replacement. 60.6% of patients receiving iron replacement were treated intravenously and 39.4% were treated orally. Two hundred eighty-eight (36.6%) of 785 patients receiving transfusions had no guideline-directed indication. GLAD-D was 2 in 310 patients (29.6%), 1 in 168 (16.1%), and 0 in 568 (54.3%). GLAD-T was 2 in 270 patients (25.8%), 1 in 320 patients (30.6%), and 0 in 456 patients (43.6%). Higher GLAD-D significantly correlated with higher GLAD-T (τB = 0.176, p < 0.001). GLAD-T 2 was significantly associated with greater Hb increase than GLAD-T 0/1 (p < 0.001) at 28 days (10.2 vs. 9.7 g/dL) and at 2 months (10.4 vs. 9.9 g/dL). CONCLUSIONS Anemia assessment is inadequate, transfusion rates too high, and iron and ESA therapy too infrequent. TRIAL REGISTRATION ClinicalTrials.gov, NCT05190263, date: 2022-01-13.
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Affiliation(s)
- Hartmut Link
- Internal Medicine, Hematology and Medical Oncology, D-67661, Kaiserslautern, Germany.
- Working Groups Supportive Care (AGSMO), Medical Oncology (AIO) of the German Cancer Society, Berlin, Germany.
| | - Markus Kerkmann
- MMF GmbH, Lindberghweg 132, D-48155, Münster, Germany
- Working Groups Supportive Care (AGSMO), Medical Oncology (AIO) of the German Cancer Society, Berlin, Germany
| | - Laura Holtmann
- MMF GmbH, Lindberghweg 132, D-48155, Münster, Germany
- Working Groups Supportive Care (AGSMO), Medical Oncology (AIO) of the German Cancer Society, Berlin, Germany
| | - Markus Detzner
- AIO-Studien-gGmbH, Kuno-Fischer-Straße 8, D-14057, Berlin, Germany
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