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González-Fernández D, Nemeth E, Pons EDC, Rueda D, Sinisterra OT, Murillo E, Sangkhae V, Starr L, Scott ME, Koski KG. Multiple Infections, Nutrient Deficiencies, and Inflammation as Determinants of Anemia and Iron Status during Pregnancy: The MINDI Cohort. Nutrients 2024; 16:1748. [PMID: 38892681 PMCID: PMC11174717 DOI: 10.3390/nu16111748] [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: 04/26/2024] [Revised: 05/25/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
In pregnant women with multiple infections, nutrient deficiencies, and inflammation (MINDI), the study of anemia and iron status is limited. For this cross-sectional study (n = 213 Panamanian indigenous women), we investigated if hemoglobin, anemia (Hb < 110 g/L), ferritin, serum iron, serum transferrin receptor, and hepcidin were associated with (1) maternal nutritional status and supplementation practices, (2) biomarkers of inflammation, and (3) presence/absence of infections. Hierarchical generalized linear and logistic regression models and dominance analyses identified the relative importance of these predictors. Anemia (38%), which was likely underestimated due to low plasma volume (95%), was associated with lower ferritin, vitamin A, and weight-for-height, suggesting anemia of undernutrition. Inflammation was not associated with Hb or anemia; nevertheless, higher CRP was associated with increased odds of low serum iron and higher ferritin and hepcidin, indicating iron restriction due to inflammation. The length of iron supplementation did not enter models for anemia or iron indicators, but a multiple nutrient supplement was associated with higher ferritin and hepcidin. Moreover, iron supplementation was associated with higher odds of vaginal trichomoniasis but lower odds of caries and bacterial vaginosis. The complex pathogenesis of anemia and iron deficiency in MINDI settings may require other interventions beyond iron supplementation.
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Affiliation(s)
- Doris González-Fernández
- School of Human Nutrition, Macdonald Campus, McGill University, Ste-Anne de Bellevue, QC H9X 3V9, Canada;
| | - Elizabeta Nemeth
- Center for Iron Disorders, David Geffen School of Medicine, University of California, Los Angeles, CA 90089, USA; (E.N.); (V.S.)
| | | | - Delfina Rueda
- Comarca Ngäbe-Buglé Health Region, Panamanian Ministry of Health, San Félix, Panama;
| | - Odalis T. Sinisterra
- Panamá Norte Health Region, Panamanian Ministry of Health, Panama City 7104, Panama;
| | - Enrique Murillo
- Department of Biochemistry, University of Panama, Panama City 7096, Panama;
| | - Veena Sangkhae
- Center for Iron Disorders, David Geffen School of Medicine, University of California, Los Angeles, CA 90089, USA; (E.N.); (V.S.)
| | - Lisa Starr
- Institute of Parasitology, Macdonald Campus, McGill University, Ste-Anne de Bellevue, QC H9X 3V9, Canada; (L.S.); (M.E.S.)
| | - Marilyn E. Scott
- Institute of Parasitology, Macdonald Campus, McGill University, Ste-Anne de Bellevue, QC H9X 3V9, Canada; (L.S.); (M.E.S.)
| | - Kristine G. Koski
- School of Human Nutrition, Macdonald Campus, McGill University, Ste-Anne de Bellevue, QC H9X 3V9, Canada;
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Evanchuk JL, Kozyrskyj A, Vaghef-Mehrabani E, Lamers Y, Giesbrecht GF, Letourneau N, Aghajafari F, Dewey D, Leung B, Bell RC, Field CJ. Maternal Iron and Vitamin D Status during the Second Trimester Is Associated with Third Trimester Depression Symptoms among Pregnant Participants in the APrON Cohort. J Nutr 2024; 154:174-184. [PMID: 37984742 DOI: 10.1016/j.tjnut.2023.10.029] [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: 07/12/2023] [Revised: 09/21/2023] [Accepted: 10/16/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The maternal status of multiple micronutrients during pregnancy and postpartum and their potential associations with maternal health outcomes are largely undescribed. OBJECTIVES This study aimed to examine associations between maternal iron and vitamin D status, individually and in combination, on depression symptoms in pregnant individuals. METHODS The Alberta Pregnancy Outcomes and Nutrition cohort study included pregnant participants and their children from Calgary and Edmonton, Canada. Iron biomarkers (serum ferritin [SF], soluble transferrin receptor, and hepcidin) were measured via immunoassays and vitamin D [25-hydroxyvitamin D3 (25(OH)D3) and 3-epi-25-hydoxyvitamin D3 (3-epi-25(OH)D3)] metabolites were quantifed using liquid chromatography with tandem mass spectroscopy. Four categories of maternal iron and vitamin D status during the second trimester were conceptualized using concentrations of SF and total 25-hydoxyvitamin D [25(OH)D], respectively. Maternal Edinburgh Postnatal Depression Scale (EPDS) scores during the third trimester (n = 1920) and 3 mo postpartum (n = 1822) were obtained. RESULTS Concentrations of maternal 25(OH)D3, 3-epi-25(OH)D3, and the ratio of both metabolites were significantly higher during the second trimester compared with their status at 3 mo postpartum. Higher second trimester maternal concentrations of SF (β: -0.8; 95% confidence interval [CI]: -1.5, -0.01), hepcidin (β: -0.5; 95% CI: -0.9, -0.2), and 25(OH)D3 (β: -0.01; 95% CI: -0.02, -0.004) predicted lower maternal EPDS scores during the third trimester. Pregnant individuals with a low iron (SF <15 μg/L) and replete vitamin D (25(OH)D ≥75 nmol/L) (β: 1.1; 95% CI: 0.03, 2.1) or low iron (SF <15 μg/L) and vitamin D (25(OH)D <75 nmol/L) (β: 2.2; 95% CI: 0.3, 4.2) status during midpregnancy had higher third trimester EPDS scores compared with those that were replete in both micronutrients. CONCLUSIONS A higher midpregnancy maternal iron and vitamin D status, independently or in combination, predicted fewer maternal depression symptoms in the third trimester. Concentrations of maternal 25(OH)D3 and 3-epi-25(OH)D3 may be lower in the postpartum period compared with midpregnancy.
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Affiliation(s)
- Jenna L Evanchuk
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Anita Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Yvonne Lamers
- Food, Nutrition and Health Program, University of British Columbia, Vancouver, BC, Canada; British Columbia's Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Gerald F Giesbrecht
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Nicole Letourneau
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Fariba Aghajafari
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Deborah Dewey
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Brenda Leung
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada.
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O'Callaghan KM, Qamar H, Gernand AD, Onoyovwi AK, Zlotkin S, Mahmud AA, Ahmed T, Keya FK, Roth DE. Maternal prenatal, with or without postpartum, vitamin D3 supplementation does not improve maternal iron status at delivery or infant iron status at 6 months of age: secondary analysis of a randomised controlled trial. BMJ Nutr Prev Health 2023; 6:282-292. [PMID: 38264359 PMCID: PMC10800272 DOI: 10.1136/bmjnph-2023-000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/31/2023] [Indexed: 01/25/2024] Open
Abstract
Background Vitamin D may modify iron status through regulation of hepcidin and inflammatory pathways. This study aimed to investigate effects of maternal vitamin D supplementation on iron status in pregnancy and early infancy. Methods In a trial in Dhaka, Bangladesh, women (n=1300) were randomised to one of five vitamin D3 regimens from 17 to 24 weeks' gestation until 26 weeks postpartum (prenatal; postpartum doses): 0;0, 4200;0, 16 800;0, 28 000;0 or 28 000;28 000 IU/week. All participants received standard iron-folic acid supplementation. In this secondary analysis (n=998), we examined effects of prenatal;postpartum vitamin D on serum ferritin and other biomarkers of maternal iron status (transferrin saturation, total iron binding capacity, soluble transferrin receptor and hepcidin) at delivery, and infant ferritin and haemoglobin at 6 months of age. Using linear regression, we estimated per cent mean differences between each intervention group and placebo with 95% CIs, with and without adjustment for baseline ferritin or inflammatory biomarkers (C reactive protein and α-1-acid glycoprotein (AGP)). Results At delivery, ferritin concentrations were similar between each intervention group and placebo in unadjusted (n=998) and baseline ferritin-adjusted analyses (n=992; p>0.05). Compared with placebo, AGP was lower in each intervention group (per cent difference (95% CI) = -11% (-21 to -1.0), -14% (-23 to -3.5) and -11% (-19 to -2.0) in the 4200 IU/week, 16 800 IU/week and 28 000 IU/week groups, respectively; n=779). In the subgroup of women with baseline 25-hydroxyvitamin D < 30 nmol/L, ferritin was lower in each intervention group versus placebo (-23% (-37 to -5.0), -20% (-35 to -1.9) and -20% (-33 to -4.1) in the 4200 IU/week, 16 800 IU/week and 28 000 IU/week groups, respectively; n=645); effects were slightly attenuated after adjustment for inflammation (n=510). There were no effects of vitamin D on other iron biomarkers among women at delivery or infants aged 6 months. Conclusion These findings do not support improvement of iron status by vitamin D. The effect of prenatal vitamin D supplementation on ferritin may reflect an anti-inflammatory mechanism.
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Affiliation(s)
- Karen M O'Callaghan
- Department of Nutritional Sciences, King's College London, London, UK
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Huma Qamar
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - AK Onoyovwi
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stanley Zlotkin
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Abdullah A Mahmud
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Farhana K Keya
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Daniel E Roth
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Hitesh T, Khatuja R, Agrawal P, Dhamnetiya D, Jha RP, Renjhen P. Unlocking the mystery of the role of Vitamin D in iron deficiency anemia in antenatal women: a case control study in a tertiary care hospital in New Delhi. BMC Pregnancy Childbirth 2023; 23:749. [PMID: 37875802 PMCID: PMC10594760 DOI: 10.1186/s12884-023-06047-w] [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: 07/03/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Vitamin D deficiency and anemia are clinical conditions that coexist during pregnancy. A high prevalence of Vitamin D deficiency ranging from 50 to 94% is seen throughout the country. The aim of the study was to discover the association between Vitamin D status and iron deficiency anemia during pregnancy. Improving the vitamin D status of pregnant women is crucial to prevent iron deficiency anemia and can improve maternal and fetal outcomes. METHODS A case-control study including 94 primigravida women of age within the age group 18 to 30 years, divided into two groups: a Case Group of 48 patients with already diagnosed iron deficiency anemia (mild to moderate) and a Control Group of 46 antenatal women with normal hemoglobin levels. Data on sociodemographic, clinical characteristics, and the levels of 25(OH) Vitamin D was estimated in both the groups. The association of 25(OH)D levels and anemia was then determined using suitable statistical analysis. RESULTS Among pregnant women affected with anemia, 75% of women had serum Vitamin D concentrations < 20 ng/ml compared to 52.2% of women in the controls. Maternal serum vitamin D level was significantly lower in pregnant women affected with anemia (19.61 ± 13.12) as compared to control (29.43 ± 24.05); (p = 0.024). A positive correlation was found between hemoglobin and vitamin D levels in pregnant women (Pearson's r = 0.200, p = 0.05). CONCLUSIONS These findings provide evidence suggesting that Vitamin D deficiency or insufficiency during pregnancy may be a risk factor for anemia and correction of Vitamin D levels can improve hemoglobin levels. Educational efforts should be made to include safe vitamin D intake in antenatal care.
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Affiliation(s)
- Tanishq Hitesh
- Dr. Baba Saheb Ambedkar Medical College and Hospital, Delhi, 110085, India
| | - Ritu Khatuja
- Department of Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar Medical College and Hospital, Delhi, 110085, India.
| | - Poonam Agrawal
- Department of Biochemistry, Dr. Baba Saheb Ambedkar Medical College and Hospital, Delhi, 110085, India
| | - Deepak Dhamnetiya
- Department of Community Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Delhi, New Delhi, 110001, India
| | - Ravi Prakash Jha
- Department of Community Medicine, Dr. Baba Saheb Ambedkar Medical College and Hospital, Delhi, 110085, India
| | - Prachi Renjhen
- Department of Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar Medical College and Hospital, Delhi, 110085, India
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Solberg A, Reikvam H. Iron Status and Physical Performance in Athletes. Life (Basel) 2023; 13:2007. [PMID: 37895389 PMCID: PMC10608302 DOI: 10.3390/life13102007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023] Open
Abstract
Iron is an important mineral in the body, essential for muscle function and oxygen transport. Adequate levels of iron in the blood are necessary for athletes, as iron-deficiency anemia can reduce physical performance. Several studies have investigated iron status and supplementation in iron-deficient athletes, and determined how physical strain can change iron balance and markers related to iron status. The question of how to influence and optimize iron status, as well as other markers that can affect iron metabolism, has been less thoroughly investigated. Therefore, the aim of this review is to take a closer look at the importance of iron values, iron markers, and factors that can change iron metabolism for physical performance and the extent to which physical performance can be influenced in a positive or negative way. A systematic search of the PubMed database was performed, with the use of « iron» or «iron deficiency» or «hemoglobin» AND «athletes» AND «athletic performance» as a strategy of the search. After the search, 11 articles were included in the review after the application of inclusion and exclusion criteria. Major findings include that iron supplementation had the best effect in athletes with the lowest iron status, and effects on physical performance were mostly achieved in those who were originally in a deficit. Iron supplementation could be beneficial for optimal erythropoietic response during altitude training, even in athletes with normal iron stores at baseline, but should be performed with caution. Alteration of the hepcidin response can affect the use of existing iron stores for erythropoiesis. Energy intake, and the amount of carbohydrates available, may have an impact on the post-exercise hepcidin response. Optimal vitamin D and B12 levels can possibly contribute to improved iron status and, hence, the avoidance of anemia.
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Affiliation(s)
- Andrea Solberg
- Faculty of Medicine, University of Bergen, 5007 Bergen, Norway;
| | - Håkon Reikvam
- Institute of Clinical Science, Faculty of Medicine, University of Bergen, 5007 Bergen, Norway
- Clinic for Medicine, Haukeland University Hospital, 5009 Bergen, Norway
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Nikooyeh B, Zahedirad M, Kalayi A, Shariatzadeh N, Hollis BW, Neyestani TR. Improvement of vitamin D status through consumption of either fortified food products or supplement pills increased hemoglobin concentration in adult subjects: Analysis of pooled data from two randomized clinical trials. Nutr Health 2023; 29:567-574. [PMID: 35238225 DOI: 10.1177/02601060221085351] [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: 11/15/2022]
Abstract
Background: It is documented that vitamin D may have a role in erythropoiesis as its deficiency is accompanied by an increased risk of anemia. Aim: This study aimed to examine whether improvement of vitamin D status through daily consumption of either fortified foods or supplements could impinge on certain hematologic parameters in adults. Methods: We pooled data from our two separate clinical trials and made five experimental groups. As part of their usual diet, one group consumed 500 mL/day of yogurt drink fortified with 1000 IU of vitamin D (D-yogurt, n = 27) whereas one group consumed 500 mL/day of the plain yogurt drink (P-yogurt, n = 27). In addition three other groups consumed either 50 g/day bread fortified with 1000 IU of vitamin D (D-bread) or supplement containing 1000 IU vitamin D (D-supplement, n = 27) or placebo (placebo, n = 27). Biochemical measurements were performed before and after the intervention. Results: In all three vitamin D-supplemented groups, serum 25(OH)D concentration increased after the intervention period, which was interestingly accompanied by a significant increment of hemoglobin (D-yogurt, p < 0.001, D-bread, p = 0.003, D-supplement, p < 0.001). Analyses indicated that among participants in vitamin D-intervention groups, being in D-yogurt group was more favourable predictor of improvement in hemoglobin concentrations compared with the placebo (p < 0.001), D-bread (p = 0.045) and P-yogurt (p = 0.001). Conclusion: Improvement of vitamin D status via regular intake of either vitamin D-fortified food products or supplements can result in a significant increment of hemoglobin in adult subjects. This finding has very important clinical as well as public health implications.
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Affiliation(s)
- Bahareh Nikooyeh
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maliheh Zahedirad
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Kalayi
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nastaran Shariatzadeh
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bruce W Hollis
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425, United States
| | - Tirang R Neyestani
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Soepnel LM, Mabetha K, Draper CE, Silubonde TM, Smuts CM, Pettifor JM, Norris SA. A Cross-Sectional Study of the Associations between Biomarkers of Vitamin D, Iron Status, and Hemoglobin in South African Women of Reproductive Age: the Healthy Life Trajectories Initiative, South Africa. Curr Dev Nutr 2023; 7:100072. [PMID: 37180853 PMCID: PMC10134444 DOI: 10.1016/j.cdnut.2023.100072] [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: 12/05/2022] [Revised: 02/27/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023] Open
Abstract
Background Vitamin D deficiency and anemia impact the health of women of reproductive age. Evidence suggests an inverse relationship between serum vitamin D (25-hydroxyvitamin D [25(OH)D]) and anemia/iron deficiency, but less is known about these associations in women of reproductive age, in particular in a setting with a combined burden of micronutrient deficiency, food insecurity, and obesity. Objective We aimed to assess the associations between 25(OH)D and biomarkers of iron and anemia in a cohort of women of reproductive age from Soweto, South Africa. The prevalence of vitamin D deficiency was also assessed. Methods In this cross-sectional substudy of the Healthy Life Trajectories Initiative (HeLTI) South Africa pilot trial, 25(OH)D, iron markers (ferritin and soluble transferrin receptor [sTFR]), and altitude-adjusted hemoglobin (Hb) were measured in 493 women aged 18 to 25 years. Associations between iron deficiency/anemia and vitamin D status were evaluated using multivariable logistic regression, adjusting for confounders including fat mass index (FMI). Structural equation modeling (SEM) was performed to evaluate direct and indirect pathways between 25(OH)D, iron and anemia markers, and covariates. Results Of 493 participants, 136 (27.6%) had vitamin D insufficiency (25(OH)D ≥12-20 ng/mL), whereas 28 (5.6%) had vitamin D deficiency (<12 ng/mL). Anemia and iron deficiency were not significantly associated with vitamin D category (25(OH)D<20 ng/mL compared with ≥20 ng/mL) in multivariable logistic regression analyses. In SEM, log-transformed 25(OH)D was not significantly associated with Hb, ferritin, or sTFR, but it was significantly associated with season of data collection, hormonal contraceptive use, and FMI (total effects: B = 0.17, 95% CI: 0.104, 0.236, P < 0.001; B: 0.10, 95% CI: 0.041, 0.154, P < 0.001; B: -0.01, 95%CI: -0.016, -0.003, P = 0.003, respectively). Conclusion No significant association between vitamin D (25(OH)D), anemia (Hb), and iron markers was found. The inverse relationship between FMI and vitamin D status emphasizes the overlap between adiposity and micronutrient deficiencies in young South African women, exacerbating their risk of disease development.
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Affiliation(s)
- Larske M. Soepnel
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Khuthala Mabetha
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine E. Draper
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Takana Mary Silubonde
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Cornelius M. Smuts
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - John M. Pettifor
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A. Norris
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Global Health Research Institute, School of Human Development and Health, University of Southampton, Southampton, United Kingdom
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8
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Savolainen L, Timpmann S, Mooses M, Medijainen L, Tõnutare L, Ross F, Lellsaar M, Piir A, Zilmer M, Unt E, Ööpik V. Vitamin D Supplementation Has No Impact on Cardiorespiratory Fitness, but Improves Inflammatory Status in Vitamin D Deficient Young Men Engaged in Resistance Training. Nutrients 2022; 14:nu14245302. [PMID: 36558461 PMCID: PMC9787541 DOI: 10.3390/nu14245302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Data on the effect of vitamin D (Vit-D) supplementation on cardiorespiratory fitness (VO2max) are conflicting. A possible source of discrepancies in the literature is the heterogeneity in baseline Vit-D status among participants in previous studies. The main objectives of the present study were to assess the impact of Vit-D supplementation on VO2max and inflammatory status in Vit-D deficient young healthy men. Participants (n = 39, baseline serum Vit-D level < 50 nmol/L) were quasi-randomly assigned to one of the two groups, which, in a double-blind manner, supplemented their diet daily with either Vit-D (8000 IU; VD) or placebo (PLC) and concomitantly performed a 12-week supervised resistance training program. During the 12-week intervention, serum Vit-D concentrations increased 3.9-fold (p < 0.001) in the VD group while no changes occurred in the PLC group. Baseline VO2max did not differ in the two groups and remained unchanged during the intervention. Serum interleukin-10/tumour necrosis factor alpha ratio increased significantly (30%, p = 0.007; effect size 0.399) in VD but not in PLC group. In conclusion, 12-week Vit-D supplementation increases serum 25(OH)D levels and improves inflammatory status, but has no impact on VO2max in Vit-D deficient young men engaged in resistance training.
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Affiliation(s)
- Lauri Savolainen
- Institute of Sport Sciences and Physiotherapy, University of Tartu, 18 Ülikooli St., 50090 Tartu, Estonia
| | - Saima Timpmann
- Institute of Sport Sciences and Physiotherapy, University of Tartu, 18 Ülikooli St., 50090 Tartu, Estonia
| | - Martin Mooses
- Institute of Sport Sciences and Physiotherapy, University of Tartu, 18 Ülikooli St., 50090 Tartu, Estonia
| | - Luule Medijainen
- Institute of Sport Sciences and Physiotherapy, University of Tartu, 18 Ülikooli St., 50090 Tartu, Estonia
| | - Lisette Tõnutare
- Institute of Sport Sciences and Physiotherapy, University of Tartu, 18 Ülikooli St., 50090 Tartu, Estonia
| | - Frederik Ross
- Institute of Sport Sciences and Physiotherapy, University of Tartu, 18 Ülikooli St., 50090 Tartu, Estonia
| | - Märt Lellsaar
- Institute of Sport Sciences and Physiotherapy, University of Tartu, 18 Ülikooli St., 50090 Tartu, Estonia
| | - Anneli Piir
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, University of Tartu, 50090 Tartu, Estonia
| | - Mihkel Zilmer
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, University of Tartu, 50090 Tartu, Estonia
| | - Eve Unt
- Department of Cardiology, Institute of Clinical Medicine, University of Tartu, 50090 Tartu, Estonia
- Department of Sport Medicine and Rehabilitation, Institute of Clinical Medicine, University of Tartu, 50090 Tartu, Estonia
- Sport Medicine and Rehabilitation Clinic, Tartu University Hospital, 1a Puusepa St., 50406 Tartu, Estonia
| | - Vahur Ööpik
- Institute of Sport Sciences and Physiotherapy, University of Tartu, 18 Ülikooli St., 50090 Tartu, Estonia
- Correspondence: ; Tel.: +372-7-375-366
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Virgolici B, Mohora M, Virgolici H, Posea M, Martin R. HEMATOLOGICAL INDICES RELATED TO VITAMIN D DEFICIENCY IN OBESE CHILDREN. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2022; 18:488-493. [PMID: 37152869 PMCID: PMC10162821 DOI: 10.4183/aeb.2022.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Introduction Vitamin D is involved in differentiation and induction of erythropoiesis in bone marrow cells. Aim We compared the serum 25(OH) vitamin D level in obese children versus control and found correlations between vitamin D level and hematological indices in obese children. Materials and methods 25 overweight and obese patients and 15 normal weight children were enrolled in an observational study . Results In obese children, the serum level of 25(OH) vitamin D was significantly (p<0.04) lower (20.60 ng/mL) compared with the value from normal weight ones (25.63 ng/mL) and the body fat percentage BFP was higher. We found a positive correlation (r=0.44, p<0.05) between serum vitamin D and hemoglobin level and a negative one between serum vitamin D and the number of platelets (r= -0.43, p<0.05). Also, the serum iron was at the lower normal limit in the obese children and negatively correlated with the percent of the body fat (r= -0,62, p<0.05). Conclusion Obese children have vitamin D deficiency. The hemoglobin level and the number of platelets are correlated with the serum level of 25(OH) vitamin D. Supplements with vitamin D may have pleiotropic effects, including those on bone marrow activity.
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Affiliation(s)
- B. Virgolici
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - M. Mohora
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - H.M. Virgolici
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - M. Posea
- “Diet4life” Nutrition and Diabetes Clinic, Bucharest, Romania
| | - R.E. Martin
- “Colentina” Clinical Hospital, Bucharest, Romania
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Adequate Dietary Intake and Vitamin D Supplementation: A Study of Their Relative Importance in Determining Serum Vitamin D and Ferritin Concentrations during Pregnancy. Nutrients 2022; 14:nu14153083. [PMID: 35956259 PMCID: PMC9370739 DOI: 10.3390/nu14153083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 02/01/2023] Open
Abstract
Vitamin D is essential for human health. However, it is not clear if vitamin D supplementation is necessary for all pregnant women. This study examines the relative importance of dietary patterns and vitamin D supplementation frequency in determining serum 25-hydroxyvitamin D (25(OH)D) and ferritin concentrations among pregnant women in Hong Kong, China. A total of 572 healthy women were recruited from antenatal clinics at 25–35 weeks pregnant. Participants completed an electronic version of the food frequency questionnaire and a web questionnaire on supplement use. Their blood samples were tested for serum 25(OH)D and ferritin. The associations of dietary patterns and vitamin D supplementation frequency with serum 25(OH)D and ferritin concentrations were analyzed using moderated hierarchical regression. Two dietary patterns were identified. The adequate dietary intake was characterized by the high probability of meeting recommended daily food group servings, whereas the inadequate dietary intake was characterized by inadequate consumption of vegetables, fruits, meat, fish, and eggs, or alternatives. The association between adequate dietary intake and serum ferritin concentrations was independent of vitamin D supplementation frequency (β = 0.05, p = 0.035), but dietary patterns interacted with vitamin D supplementation frequency to determine serum 25(OH)D concentrations (β = −13.22, p = 0.014). The current study presents evidence on the relative importance of dietary patterns and vitamin D supplementation in maintaining sufficient vitamin D and iron in pregnancy. Antenatal nutrition counselling services should be provided to pregnant women who show signs of inadequate dietary intake.
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Zhang Y, Jukic AMZ, Song H, Zhang L, Yang F, Wu S, Yin D, Jiang H. Serum Vitamin D Concentrations, Time to Pregnancy, and Pregnancy Outcomes among Preconception Couples: A Cohort Study in Shanghai, China. Nutrients 2022; 14:nu14153058. [PMID: 35893912 PMCID: PMC9330297 DOI: 10.3390/nu14153058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The role of vitamin D in reproductive health is still unclear. This study aimed to assess the effect of serum 25-hydroxyvitamin D (25(OH)D), among preconception couples, on fecundity, and the associations between 25(OH)D concentrations before and during pregnancy, and pregnancy outcomes. METHODS 200 preconception couples attempting to conceive were recruited and were followed-up until childbirth. Time to pregnancy was collected via telephone every two months or obtained via a questionnaire during pregnancy. Blood samples were collected to measure serum 25(OH)D levels from both partners at enrollment and from women during the second and third trimester of pregnancy. RESULTS Couples had higher conception rates within six months (adjusted odds ratio (aOR): 3.72, 95% CI: 1.16, 11.9) and reduced time to pregnancy (adjusted fecundability ratio (aFR): 1.50, 95% CI: 1.01, 2.23) if male partners had sufficient 25(OH)D compared with insufficient 25(OH)D. Compared to pregnant women with insufficient 25(OH)D in the third trimester of pregnancy, sufficient 25(OH)D was associated with reduced odds of anemia (OR: 0.22, 95% CI: 0.06, 0.82), longer gestational age (β: 0.53, 95% CI: 0.04, 1.01) and newborns' higher ponderal index (β: 0.10, 95% CI: 0.01, 0.19). CONCLUSIONS Sufficient serum 25(OH)D levels among preconception men or during pregnancy were associated with better reproductive health.
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Affiliation(s)
- Yu Zhang
- School of Public Health, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China; (Y.Z.); (H.S.)
- Vital Statistics Department, Songjiang District Center for Disease Control and Prevention, Shanghai 201600, China
| | - Anne Marie Z. Jukic
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC 27709, USA;
| | - Heqing Song
- School of Public Health, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China; (Y.Z.); (H.S.)
| | - Lifeng Zhang
- Shanghai Jiading Maternal and Child Health Care Hospital, Shanghai 201812, China; (L.Z.); (F.Y.); (S.W.); (D.Y.)
| | - Fengyun Yang
- Shanghai Jiading Maternal and Child Health Care Hospital, Shanghai 201812, China; (L.Z.); (F.Y.); (S.W.); (D.Y.)
| | - Shoule Wu
- Shanghai Jiading Maternal and Child Health Care Hospital, Shanghai 201812, China; (L.Z.); (F.Y.); (S.W.); (D.Y.)
| | - Dongxiao Yin
- Shanghai Jiading Maternal and Child Health Care Hospital, Shanghai 201812, China; (L.Z.); (F.Y.); (S.W.); (D.Y.)
| | - Hong Jiang
- School of Public Health, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China; (Y.Z.); (H.S.)
- Correspondence: ; Tel./Fax: +86-021-64179976
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Si S, Peng Z, Cheng H, Zhuang Y, Chi P, Alifu X, Zhou H, Mo M, Yu Y. Association of Vitamin D in Different Trimester with Hemoglobin during Pregnancy. Nutrients 2022; 14:nu14122455. [PMID: 35745185 PMCID: PMC9230968 DOI: 10.3390/nu14122455] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/11/2022] [Accepted: 06/11/2022] [Indexed: 02/01/2023] Open
Abstract
The association between vitamin D and hemoglobin has been suggested. Vitamin D can affect erythropoiesis by the induction of erythroid progenitor cell proliferation and enhance iron absorption by regulating the iron-hepcidin-ferroportin axis in monocytes. However, this relationship in pregnant women is scarce. The purpose of this study was to investigate the association between plasma vitamin D levels with hemoglobin concentration in pregnant women considering each trimester and iron supplementation. The data were obtained from Zhoushan Pregnant Women Cohort, collected from 2011 to 2018. Plasma 25(OH)D was measured in each trimester using liquid chromatography−tandem mass spectrometry. Generalized estimating equations and multiple linear regressions were performed. Finally, 2962 pregnant women and 4419 observations in the first trimester were included in this study. Plasma 25(OH)D in first trimester (T1) (β = 0.06, p = 0.0177), second trimester (T2) (β = 0.15, p < 0.0001), and third trimester (T3) (β = 0.12, p = 0.0006) were positively associated with Hb. Association between plasma 25(OH)D levels in T1 and Hb concentration was positively associated with gestational age (β = 0.005, p = 0.0421). Pregnant women with VD deficiency in T1 (OR = 1.42, 95% CI: 1.07−1.88) or T2 (OR = 1.94, 95% CI: 1.30−2.89) presented an increased risk of anemia, compared with women without VD deficiency. Moreover, the significant relationship between VD and Hb was only observed among women with iron supplementation during pregnancy. Plasma 25(OH)D levels in each trimester were positively associated with Hb concentration. Iron supplementation might be an important factor affecting the relationship between VD and Hb.
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Affiliation(s)
- Shuting Si
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Zhicheng Peng
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Haoyue Cheng
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Yan Zhuang
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Peihan Chi
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Xialidan Alifu
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Haibo Zhou
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Minjia Mo
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Yunxian Yu
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310058, China; (S.S.); (Z.P.); (H.C.); (Y.Z.); (P.C.); (X.A.); (H.Z.); (M.M.)
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
- Correspondence: ; Tel.: +86-571-8820-8191
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Lima MS, Pereira M, Castro CT, Santos DB. Vitamin D deficiency and anemia in pregnant women: a systematic review and meta-analysis. Nutr Rev 2021; 80:428-438. [PMID: 34969067 DOI: 10.1093/nutrit/nuab114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
CONTEXT Epidemiological studies suggest an association between vitamin D deficiency and anemia. Evidence of this relationship in pregnant women, however, is scarce. OBJECTIVE The aim of this systematic review was to investigate the association between vitamin D deficiency and gestational anemia through observational studies. DATA SOURCES The PubMed, Scopus, Web of Science, ScienceDirect, Embase, and Virtual Health Library databases were searched from inception to April 2021. STUDY SELECTION Original articles reporting observational studies that investigated the association between vitamin D deficiency and gestational anemia were included. Articles that did not have an abstract, as well as reviews articles, experimental studies, and editorials, were excluded. Two reviewers independently performed study selection, data extraction, and assessment of study quality. Disagreements between the reviewers were resolved by a third reviewer. DATA EXTRACTION Study quality was assessed by 2 scales. Data were extracted from eligible studies and arranged in a 2 × 2 table. Odds ratios with 95% confidence intervals for the risk of the outcome were estimated using a fixed-effect model. RESULTS In total, 985 studies were retrieved, of which 17 were included in the systematic review: 11 cohort studies, 3 case-control studies, and 3 cross-sectional studies. For the meta-analysis, 8 studies with a total of 6530 women were included. There was a 61% increase in the odds of anemia in pregnant women with vitamin D deficiency (OR = 1.61; 95%CI, 1.41-1.83; I2 = 48%). CONCLUSIONS Vitamin D deficiency may be a risk factor for anemia in pregnant women. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020182697.
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Affiliation(s)
- Michele S Lima
- M.S. Lima is with the Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil. M. Pereira and C.T. Castro are with the Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil. D.B. Santos is with the Health Sciences Center, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
| | - Marcos Pereira
- M.S. Lima is with the Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil. M. Pereira and C.T. Castro are with the Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil. D.B. Santos is with the Health Sciences Center, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
| | - Caroline T Castro
- M.S. Lima is with the Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil. M. Pereira and C.T. Castro are with the Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil. D.B. Santos is with the Health Sciences Center, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
| | - Djanilson B Santos
- M.S. Lima is with the Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil. M. Pereira and C.T. Castro are with the Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil. D.B. Santos is with the Health Sciences Center, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
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USTUNER B, BEK S, EREN N, BAKİRDOGEN S, KALENDER B. Hepcidin and Vitamin D Levels: Mutual Effects in Anemia of Chronic Kidney Disease. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.30934/kusbed.661316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Yuniati T, Judistiani RTD, Natalia YA, Irianti S, Madjid TH, Ghozali M, Sribudiani Y, Indrati AR, Abdulah R, Setiabudiawan B. First trimester maternal vitamin D, ferritin, hemoglobin level and their associations with neonatal birthweight: Result from cohort study on vitamin D status and its impact during pregnancy and childhood in Indonesia. J Neonatal Perinatal Med 2021; 13:63-69. [PMID: 31609704 DOI: 10.3233/npm-180043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Vitamin D deficiency and anemia are examples of nutritional problems of global health significance. When these health issues effect pregnant women, they may become a threat to the fetus' potention for intrauterine growth. It has been known that the first trimester is the golden period of fetal programming which influences the fetuses and their life after birth. This study was aiming to analyze the association between first trimester maternal vitamin D, serum ferritin, hemoglobin level and neonatal birth weight. METHODS From July 2016 a prospective cohort of pregnant women had been observed in four cities in West Java, Indonesia. Two hundred ninety four pregnant women were recuited in the first trimester and 203 of them had complete follow up until delivery. Collected data included maternal demography, blood analysis for ferritin, 25(OH) vitamin D in the first trimester of pregnancy and the birth weight of neonates. Associations were analyzed with multiple regression models. RESULTS Vitamin D deficiency was highly prevalent among pregnant women in this study (approximately 75%) while anemia was found in 7.5 %, a little above the target of 5 %. However, no significant association was found between maternal serum vitamin D, serum ferritin, hemoglobin level in the first trimester and birth weight of the neonates, before and after adjustment for maternal age, pre-pregnancy body mass index, and parity. CONCLUSION There were no associations found between vitamin D, ferritin, and hemoglobin level in the first trimester and neonatal birth weight. The negative results in this study should not diminish the benefit of nutritional supplementation during pregnancy. The possibility of other explanatory variables that influence these associations warrants further studies.
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Affiliation(s)
- T Yuniati
- Department of Child Health, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia /dr Hasan Sadikin Hospital, Bandung, Indonesia
| | - R T Dewi Judistiani
- Public Health Department-Centre for Immunology Studies, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia
| | - Y Adelwin Natalia
- Public Health Department-Centre for Immunology Studies, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia
| | - S Irianti
- Obstetric and Gynecology Department, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia/dr Hasan Sadikin Hospital, Bandung, Indonesia
| | - T Husnitawati Madjid
- Obstetric and Gynecology Department, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia/dr Hasan Sadikin Hospital, Bandung, Indonesia
| | - M Ghozali
- Department of Biomedical Sciences, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia
| | - Y Sribudiani
- Department of Biomedical Sciences, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia
| | - A Rengga Indrati
- Clinical Pathology Department, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia/dr Hasan Sadikin Hospital, Bandung, Indonesia
| | - R Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy Universitas Padjadjaran, Sumedang, Indonesia
| | - Budi Setiabudiawan
- Department of Child Health, Faculty of Medicine Universitas Padjadjaran, Sumedang, Indonesia /dr Hasan Sadikin Hospital, Bandung, Indonesia
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Prevalence and Predictors of Vitamin D Deficiency and Insufficiency among Pregnant Rural Women in Bangladesh. Nutrients 2021; 13:nu13020449. [PMID: 33572898 PMCID: PMC7911263 DOI: 10.3390/nu13020449] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 12/18/2022] Open
Abstract
Although adequate vitamin D status during pregnancy is essential for maternal health and to prevent adverse pregnancy outcomes, limited data exist on vitamin D status and associated risk factors in pregnant rural Bangladeshi women. This study determined the prevalence of vitamin D deficiency and insufficiency, and identified associated risk factors, among these women. A total of 515 pregnant women from rural Bangladesh, gestational age ≤ 20 weeks, participated in this cross-sectional study. A separate logistic regression analysis was applied to determine the risk factors of vitamin D deficiency and insufficiency. Overall, 17.3% of the pregnant women had vitamin D deficiency [serum 25(OH)D concentration <30.0 nmol/L], and 47.2% had vitamin D insufficiency [serum 25(OH)D concentration between 30–<50 nmol/L]. The risk of vitamin D insufficiency was significantly higher among nulliparous pregnant women (OR: 2.72; 95% CI: 1.75–4.23), those in their first trimester (OR: 2.68; 95% CI: 1.39–5.19), anaemic women (OR: 1.53; 95% CI: 0.99–2.35; p = 0.056) and women whose husbands are farmers (OR: 2.06; 95% CI: 1.22–3.50). The risk of vitamin deficiency was significantly higher among younger pregnant women (<25 years; OR: 2.12; 95% CI: 1.06–4.21), nulliparous women (OR: 2.65; 95% CI: 1.34–5.25), women in their first trimester (OR: 2.55; 95% CI: 1.12–5.79) and those with sub-optimal vitamin A status (OR: 2.30; 95% CI: 1.28–4.11). In conclusion, hypovitaminosis D is highly prevalent among pregnant rural Bangladeshi women. Parity and gestational age are the common risk factors of vitamin D deficiency and insufficiency. A husband’s occupation and anaemia status might be important predictors of vitamin D insufficiency, while younger age and sub-optimal vitamin A status are risk factors for vitamin D deficiency in this population.
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Rauf A, Shariati MA, Khalil AA, Bawazeer S, Heydari M, Plygun S, Laishevtcev A, Hussain MB, Alhumaydhi FA, Aljohani ASM. Hepcidin, an overview of biochemical and clinical properties. Steroids 2020; 160:108661. [PMID: 32450084 DOI: 10.1016/j.steroids.2020.108661] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/31/2020] [Accepted: 05/17/2020] [Indexed: 12/16/2022]
Abstract
Hepcidin is a peptide hormone which helps in regulating iron homeostasis in the human body. Iron obtained from daily diet is passed through the intestinal enterocyte apical membrane via divalent metal transporter 1 (DMT1), which is either stored as ferritin or moved into the plasma by hepcidin-ferroportin (Fpn) as an exporter. Hepcidin (hepatic bactericidal protein) is a cysteine rich peptide, was initially identified as a urinary antimicrobial peptide. It contains 25 amino acids and four disulfide bridges. It has significant role in regulation of iron in the body. Stimulation of iron in plasma and further its storage is linked with the production of hepcidin. This enhancement of iron hampers the absorption of iron from the diet. The cause of hereditary recessive anemia also known as Iron-refractory iron deficiency anemia (IRIDA) is characterized by increased hepcidin production due to a gene mutation in the suppressor matriptase-2/TMPRSS6. During infection, hepcidin plays a defensive role against various infections by depleting the extracellular iron from the body. Moreover, hepcidin lowers the concentrations of iron from the duodenal enterocytes, macrophages and also decrease its transport across the placenta.This review highlights the significant role of hepcidin in the iron homeostasis and as an antimicrobial agent.
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Affiliation(s)
- Abdur Rauf
- Department of Chemistry, University of Swabi, Anbar 23561, Khyber Pakhtunkhwa, Pakistan.
| | - Mohammad Ali Shariati
- Laboratory of Biocontrol and Antimicrobial Resistance, Orel State University Named After I.S. Turgenev, 302026 Orel, Russia
| | - Anees Ahmed Khalil
- University Institute of Diet and Nutritional Sciences, Faculty of Allied Health Sciences, The University of Lahore, Pakistan
| | - Saud Bawazeer
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Umm Al-Qura University, Makkah, P.O. Box 42, Saudi Arabia
| | - Mojtaba Heydari
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Sciences, Shiraz, Iran
| | - Sergey Plygun
- Laboratory of Biocontrol and Antimicrobial Resistance, Orel State University Named After I.S. Turgenev, 302026 Orel, Russia; European Society of Clinical Microbiology and Infectious Diseases, Basel 4051, Switzerland; Russian Research Institute of Phytopathology, Moscow Region 143050, Russia
| | - Alexy Laishevtcev
- Laboratory of Biocontrol and Antimicrobial Resistance, Orel State University Named After I.S. Turgenev, 302026 Orel, Russia; Federal Research Center - All-Russian Scientific Research Institute of Experimental Veterinary Medicine named after K.I. Skryabin and Y.R. Kovalenko of the Russian Academy of Sciences, Moscow 109428, Russia
| | - Muhammad Bilal Hussain
- Institute of Home and Food Sciences, Government College University, Faisalabad, Pakistan
| | - Fahad A Alhumaydhi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Abdullah S M Aljohani
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim University, Buraydah, Saudi Arabia
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Kasprowicz K, Ratkowski W, Wołyniec W, Kaczmarczyk M, Witek K, Żmijewski P, Renke M, Jastrzębski Z, Rosemann T, Nikolaidis PT, Knechtle B. The Effect of Vitamin D 3 Supplementation on Hepcidin, Iron, and IL-6 Responses after a 100 km Ultra-Marathon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082962. [PMID: 32344650 PMCID: PMC7215841 DOI: 10.3390/ijerph17082962] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023]
Abstract
Deficiencies in iron and vitamin D are frequently observed in athletes. Therefore, we examined whether different baseline vitamin D3 levels have any impact on post-exercise serum hepcidin, IL-6 and iron responses in ultra-marathon runners. In this randomized control trial, the subjects (20 male, amateur runners, mean age 40.75 ± 7.15 years) were divided into two groups: experimental (VD) and control (CON). The VD group received vitamin D3 (10,000 UI/day) and the CON group received a placebo for two weeks before the run. Venous blood samples were collected on three occasions-before the run, after the 100 km ultra-marathon and 12 h after the run-to measure iron metabolism indicators, hepcidin, and IL-6 concentration. After two weeks of supplementation, the intervention group demonstrated a higher level of serum 25(OH)D than the CON group (27.82 ± 5.8 ng/mL vs. 20.41 ± 4.67 ng/mL; p < 0.05). There were no differences between the groups before and after the run in the circulating hepcidin and IL-6 levels. The decrease in iron concentration immediately after the 100-km ultra-marathon was smaller in the VD group than CON (p < 0.05). These data show that various vitamin D3 status can affect the post-exercise metabolism of serum iron.
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Affiliation(s)
- Katarzyna Kasprowicz
- Department of Molecular Biology, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
- Correspondence: (K.K.); (B.K.)
| | - Wojciech Ratkowski
- Department of Athletics, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
| | - Wojciech Wołyniec
- Department of Occupational, Metabolic and Internal Diseases, Medical University of Gdansk, 81-519 Gdynia, Poland; (W.W.); (M.R.)
| | - Mariusz Kaczmarczyk
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, 70-11 Szczecin, Poland;
| | - Konrad Witek
- Department of Biochemistry, Institute of Sport, National Research Institute, 01-982 Warsaw, Poland;
| | - Piotr Żmijewski
- Faculty of Physical Education, Jozef Piłsudski University of Physical Education in Warsaw, 01-813 Warsaw, Poland;
| | - Marcin Renke
- Department of Occupational, Metabolic and Internal Diseases, Medical University of Gdansk, 81-519 Gdynia, Poland; (W.W.); (M.R.)
| | - Zbigniew Jastrzębski
- Department of Physiology, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland;
| | | | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland;
- Medbase St. Gallen Am Vadianplatz, 9001 St. Gallen, Switzerland
- Correspondence: (K.K.); (B.K.)
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Comparison of the Physiological Effect of Billroth-I and Roux-en-Y Reconstruction Following Laparoscopic Distal Gastrectomy. Surg Laparosc Endosc Percutan Tech 2019; 28:328-333. [PMID: 30180143 DOI: 10.1097/sle.0000000000000575] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic distal gastrectomy (LDG) is a widely used minimally invasive surgery. Following LDG, Billroth-I (B-I) provides physiological reconstruction by preserving the duodenal passage but results in a high incidence of reflux esophagitis that decreases postoperative quality of life. Because of this, Roux-en-Y (R-Y) reconstruction is often considered the first choice after LDG. However, very few studies have investigated differences in physiological function between B-I and R-Y after LDG. We hypothesized that B-I would outperform R-Y in clinical and physiological outcomes, including nutrition parameters. METHODS We compared hemoglobin, ferritin, serum iron, Vitamin B12, 25(OH)-Vitamin D (V-D), body weight, and gastric emptying after LDG in patients with either B-I or R-Y reconstruction. RESULTS The levels of hemoglobin in the B-I group were significantly higher than that in the R-Y group at all time points later than 6 months postsurgery. The ferritin levels were significantly higher in the B-I group at all time points later than 9 months postsurgery. The concentration of serum V-D in the B-I group was significantly higher than that in the R-Y group at 1 year 6 months, 1 year 9 months, and 2 years after surgery. Gastric emptying in the R-Y group was significantly slower than in the B-I group. CONCLUSIONS Our data indicate that B-I leads to less postsurgical iron deficiency anemia and V-D deficiency compared with R-Y reconstruction. Furthermore, gastric emptying was preserved in B-I reconstruction compared with R-Y reconstruction. In conclusion, after LDG, B-I reconstruction seems to cause fewer nutritional complications than R-Y reconstruction.
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Braithwaite VS, Crozier SR, D'Angelo S, Prentice A, Cooper C, Harvey NC, Jones KS. The Effect of Vitamin D Supplementation on Hepcidin, Iron Status, and Inflammation in Pregnant Women in the United Kingdom. Nutrients 2019; 11:E190. [PMID: 30669280 PMCID: PMC6356300 DOI: 10.3390/nu11010190] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 12/29/2022] Open
Abstract
Iron and vitamin D deficiencies are common during pregnancy. Our aim was to identify whether antenatal vitamin D₃ supplementation affects iron status (via hepcidin suppression) and/or inflammation. Using a subset of the UK multicenter Maternal Vitamin D Osteoporosis Study (MAVIDOS)-a double-blinded, randomized, placebo-controlled trial (ISRCTN82927713; EudraCT2007-001716-23)-we performed a secondary laboratory analysis. Women with blood samples from early and late pregnancy (vitamin D₃ (1000 IU/day from ~14 weeks gestation n = 93; placebo n = 102) who gave birth in the springtime (March⁻May) were selected as we anticipated seeing the greatest treatment group difference in change in 25-hydroxyvitamin D (25OHD) concentration. Outcomes were hepcidin, ferritin, C-reactive protein, and α1-acid glycoprotein concentration in late pregnancy (25OHD concentration was measured previously). By late pregnancy, 25OHD concentration increased by 17 nmol/L in the vitamin D₃ group and decreased by 11 nmol/L in the placebo group; hepcidin, ferritin, and inflammatory markers decreased but no treatment group differences were seen. In late pregnancy, positive relationships between 25OHD and hepcidin and 25OHD and ferritin in the placebo group were observed but not in the treatment group (group × 25OHD interaction, p < 0.02). Vitamin D₃ supplementation had no effect on hepcidin, ferritin, or inflammatory status suggesting no adjunctive value of vitamin D₃ in reducing rates of antenatal iron deficiency.
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Affiliation(s)
| | - Sarah R Crozier
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Stefania D'Angelo
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Ann Prentice
- MRC Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK.
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford OX1 2JD, UK.
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Kerry S Jones
- MRC Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK.
- NIHR BRC Nutritional Biomarker Laboratory, University of Cambridge, Cambridge CB2 0AH, UK.
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Maternal Anthropometry and Its Relationship with the Nutritional Status of Vitamin D, Calcium, and Parathyroid Hormone in Pregnant Women After Roux-en-Y Gastric Bypass. Obes Surg 2018; 28:3116-3124. [DOI: 10.1007/s11695-018-3331-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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22
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Judistiani RTD, Gumilang L, Nirmala SA, Irianti S, Wirhana D, Permana I, Sofjan L, Duhita H, Tambunan LA, Gurnadi JI, Seno U, Ghrahani R, Indrati AR, Sribudiani Y, Yuniati T, Setiabudiawan B. Association of Colecalciferol, Ferritin, and Anemia among Pregnant Women: Result from Cohort Study on Vitamin D Status and Its Impact during Pregnancy and Childhood in Indonesia. Anemia 2018; 2018:2047981. [PMID: 29888000 PMCID: PMC5985097 DOI: 10.1155/2018/2047981] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/29/2018] [Indexed: 12/21/2022] Open
Abstract
Studies had shown that iron-cycling was disturbed by inflammatory process through the role of hepcidin. Pregnancy is characterized by shifts of interleukin. Our objective was to determine if 25(OH) vitamin D (colecalciferol) status was associated with ferritin, anemia, and its changes during pregnancy. Method. A cohort study was done in 4 cities in West Java, Indonesia, beginning in July 2016. Subjects were followed up until third trimester. Examinations included were maternal ferritin, colecalciferol, and haemoglobin level. Result. 191 (95.5%) subjects had low colecalciferol, and 151 (75.5%) among them were at deficient state. Anemia is found in 15 (7.5%) subjects, much lower than previous report. Proportion of anemia increased by trimester among women with colecalciferol deficiency. Ferritin status and prepregnancy body mass index in the first trimester were correlated with anemia (r = 0.147, p = 0.038 and r = -0.56, p = 0.03). Anemia in the second trimester was strongly correlated with anemia in the third trimester (r = 0.676, p < 0.01). Conclusion. Our study showed that the state of colecalciferol was not associated with either ferritin state or anemia, but proportion of anemia tends to increase by trimester in the colecalciferol deficient subjects.
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Affiliation(s)
| | - Lani Gumilang
- Public Health Department, Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Sefita Aryuti Nirmala
- Public Health Department, Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Setyorini Irianti
- Obstetric and Gynecology Department, Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Deni Wirhana
- Obstetric and Gynecology Department, Waled Regency Public Hospital, Cirebon, West Java, Indonesia
| | - Irman Permana
- Department of Child Health, Waled Regency Public Hospital, Cirebon, West Java, Indonesia
| | - Liza Sofjan
- Department of Child Health, Waled Regency Public Hospital, Cirebon, West Java, Indonesia
| | - Hesty Duhita
- Obstetric and Gynecology Department, Syamsudin SH Public Hospital, Sukabumi, West Java, Indonesia
| | - Lies Ani Tambunan
- Obstetric and Gynecology Department, Cibabat General Hospital, Cimahi, West Java, Indonesia
| | - Jeffry Iman Gurnadi
- Obstetric and Gynecology Department, Cibabat General Hospital, Cimahi, West Java, Indonesia
| | - Umar Seno
- Obstetric and Gynecology Department, Kota Bandung General Hospital, Bandung, West Java, Indonesia
| | - Reni Ghrahani
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Agnes Rengga Indrati
- Clinical Pathology Department, Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Yunia Sribudiani
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Tetty Yuniati
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Budi Setiabudiawan
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java, Indonesia
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23
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Relationship between serum 25-hydroxyvitamin D and red blood cell indices in German adolescents. Eur J Pediatr 2018; 177:583-591. [PMID: 29387981 DOI: 10.1007/s00431-018-3092-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
UNLABELLED Since the impact of vitamin D on red blood cell formation has not been well studied, we aimed at assessing the putative link between serum 25-hydroxyvitamin D (25[OH]D) concentrations and hematological markers of erythropoiesis in a large cohort of German adolescents aged 11 to 17 years. In total, 5066 participants from the population-based, nationally representative KiGGS study (Kinder- und Jugendgesundheitssurvey, German Health Interview and Examination Survey for Children and Adolescents) were grouped into either tertiles or clinically accepted cutoff levels for serum 25(OH)D. Results demonstrated significant and inverse correlations between 25(OH)D levels and several hematological parameters including hemoglobin concentration (r = - 0.04, p = 0.003), mean corpuscular hemoglobin (r = - 0.11, p < 0.001), red blood cell count (r = - 0.04, p = 0.002), and soluble transferrin receptor (r = - 0.1, p < 0.001), whereas, in contrast, serum 25(OH)D was positively correlated to the mean corpuscular volume of erythrocytes (r = 0.08, p < 0.001). Multinomial regression models adjusted for clinically relevant confounders confirmed statistically significant differences between the two strata of 25(OH)D groups with respect to red blood cell markers (hemoglobin concentration, red blood cell count, mean corpuscular volume, and corpuscular hemoglobin, as well as iron and soluble transferrin receptor). CONCLUSIONS The link between serum 25(OH)D and several important hematological parameters may point to an inhibitory role of vitamin D in the regulation of erythropoiesis in adolescents. What is Known: • The physiological effects of vitamin D on calcium homeostasis and bone metabolism have been established. • However, much less is known about the impact of circulating vitamin D on erythropoiesis. What is New: • Data from the KiGGS study in German adolescents demonstrated significant associations between serum vitamin D concentrations and red blood cell indices. • Further studies should be conducted to decipher the underlying mechanisms of vitamin D on erythropoiesis.
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ASSIS MLCD, CARTAXO CGB, COSTA MJDC, QUEIROZ DJM, PERSUHN DC, GONÇALVES MDCR. Association between hematological profile and serum 25-hydroxyvitamin D levels and FokI polymorphism in individuals with cystic fibrosis. REV NUTR 2018. [DOI: 10.1590/1678-98652018000200007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective The present study aimed at investigating the association between hematological profile and serum 25-hydroxyvitamin D (25[OH]D) levels and Fokl polymorphism of the vitamin D receptor gene in individuals with Cystic Fibrosis. Methods A cross-sectional study that involved 18 men and women aged 0-25 years with Cystic Fibrosis. Socio-demographic information and the factors associated with sun exposure were obtained. Weight, height, and arm circumference were also measured. Blood sample was collected for the analysis of biochemical parameters (25[OH]D, parathyroid hormone, and calcium levels and blood count) and for the validation of the presence of FokI polymorphism in the vitamin D receptor gene. Results Among the participants, 33.33% (n=6) had vitamin D deficiency (19.60±6.180 ng/mL), and 27.8% (n=5) presented with anemia and low weight for age. In terms of genotype, 5.6% (n=1) presented with the FF genotype, 72.3% (n=13) had the Ff genotype, and 22.2% (n=4) had the ff genotype. Serum 25(OH)D levels were associated with hemoglobin (p=0.008) and hematocrit (p=0.019) levels and leukocyte count (p=0.0114). No association was observed between 25(OH)D levels and the genotypes (FF, Ff, and ff) (p=0.2451). In addition, an association was observed between FokI polymorphism and the total leukocyte count (p=0.01). Conclusion An association was observed between serum 25(OH)D levels and hemoglobin and hematocrit levels and leukocyte count in individuals with Cystic Fibrosis. Moreover, FokI polymorphism was associated with total leukocyte count.
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The Association of Serum 25-Hydroxyvitamin D With Biomarkers of Hemolysis in Pediatric Patients With Sickle Cell Disease. J Pediatr Hematol Oncol 2018; 40:159-162. [PMID: 28099399 DOI: 10.1097/mph.0000000000000783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although vitamin D deficiency (VDD) has been linked to anemia among sickle cell disease (SCD), its relationship with hemolysis is unclear. Serum 25-hydroxyvitamin D and biomarkers of hemolysis (hemoglobin [Hb]/hematocrit, reticulocyte percentage, absolute reticulocyte, and lactate dehydrogenase [LDH] levels) in 36 hydroxyurea-naive SCD children were quantified. Correlations were significantly positive with Hb/hematocrit (r=0.40, P=0.017; r=0.45, P=0.006, respectively); inverse with reticulocyte percentage, absolute reticulocyte, and LDH (r=-0.44, P=0.008; r=-0.47, P=0.007; r=-0.45, P=0.007, respectively). In VDD groups, Hb was lower (P=0.014), reticulocyte counts and LDH were higher (P=0.047 and 0.003, respectively). Serum 25-hydroxyvitamin D correlated with biomarkers of hemolysis in SCD and VDD may play a role in SCD pathogenesis.
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Eloqayli H, Al-Yousef A, Jaradat R. Vitamin D and ferritin correlation with chronic neck pain using standard statistics and a novel artificial neural network prediction model. Br J Neurosurg 2018; 32:172-176. [PMID: 29447493 DOI: 10.1080/02688697.2018.1436691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM Despite the high prevalence of chronic neck pain, there is limited consensus about the primary etiology, risk factors, diagnostic criteria and therapeutic outcome. Here, we aimed to determine if Ferritin and Vitamin D are modifiable risk factors with chronic neck pain using slandered statistics and artificial intelligence neural network (ANN). METHODS Fifty-four patients with chronic neck pain treated between February 2016 and August 2016 in King Abdullah University Hospital and 54 patients age matched controls undergoing outpatient or minor procedures were enrolled. Patients and control demographic parameters, height, weight and single measurement of serum vitamin D, Vitamin B12, ferritin, calcium, phosphorus, zinc were obtained. An ANN prediction model was developed. RESULTS The statistical analysis reveals that patients with chronic neck pain have significantly lower serum Vitamin D and Ferritin (p-value <.05). 90% of patients with chronic neck pain were females. Multilayer Feed Forward Neural Network with Back Propagation(MFFNN) prediction model were developed and designed based on vitamin D and ferritin as input variables and CNP as output. The ANN model output results show that, 92 out of 108 samples were correctly classified with 85% classification accuracy. CONCLUSIONS Although Iron and vitamin D deficiency cannot be isolated as the sole risk factors of chronic neck pain, they should be considered as two modifiable risk. The high prevalence of chronic neck pain, hypovitaminosis D and low ferritin amongst women is of concern. Bioinformatics predictions with artificial neural network can be of future benefit in classification and prediction models for chronic neck pain. We hope this initial work will encourage a future larger cohort study addressing vitamin D and iron correction as modifiable factors and the application of artificial intelligence models in clinical practice.
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Affiliation(s)
- Haytham Eloqayli
- a Department of Neurosurgery, Faculty of Medicine , Jordan University of Science and Technology (JUST) , Irbid , Jordan
| | - Ali Al-Yousef
- b Computer Department , Computer and Information Technology Collage, Jerash University , Jersah , Jordan
| | - Raid Jaradat
- a Department of Neurosurgery, Faculty of Medicine , Jordan University of Science and Technology (JUST) , Irbid , Jordan
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O'Brien KO, Ru Y. Iron status of North American pregnant women: an update on longitudinal data and gaps in knowledge from the United States and Canada. Am J Clin Nutr 2017; 106:1647S-1654S. [PMID: 29070557 PMCID: PMC5701721 DOI: 10.3945/ajcn.117.155986] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Pregnant women are particularly vulnerable to iron deficiency due to the high iron demands of pregnancy. To avoid the adverse birth outcomes that are associated with maternal iron deficiency anemia, both Canada and the United States recommend universal iron supplementation for pregnant women. Although the benefits of iron supplementation in anemic women are well recognized, insufficient data are currently available on the maternal and neonatal benefits and harms of universal iron supplementation in developed countries as evidenced by the recent conclusions of the US Preventive Services Task Force on the need for further data that address existing gaps. As part of an effort to evaluate the impact of the current North American prenatal iron supplementation policy, this review highlights the lack of national data on longitudinal changes in iron status in pregnant North American women, emphasizes possible limitations with the original longitudinal hemoglobin data used to inform the current CDC reference hemoglobin values, and presents additional normative data from recent longitudinal research studies of iron status in North American pregnant women. Further longitudinal data in North American pregnant women are needed to help identify those who may benefit most from supplementation as well as to help determine whether there are adverse effects of iron supplementation in iron-replete women.
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Affiliation(s)
| | - Yuan Ru
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
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28
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Iron Supplementation in Twin Pregnancy - The Benefit of Doubling the Iron Dose in Iron Deficient Pregnant Women: A Randomized Controlled Trial. Twin Res Hum Genet 2017; 20:419-424. [PMID: 28829001 DOI: 10.1017/thg.2017.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the efficacy of doubling the daily dose of iron supplement in iron-deficient women with twin pregnancies. STUDY DESIGN Using a prospective randomized controlled trial, iron-deficient women with twin gestations were randomized to receive a single or a double dose of daily iron from 16 weeks of gestation until 6 weeks postpartum. The primary outcome was hemoglobin at 32 weeks. Secondary outcomes included ferritin at 32 weeks, hemoglobin during pregnancy and postpartum, birth weights, preterm birth rate, gastrointestinal side effects, intravenous iron administration, and compliance with treatment. RESULTS Eighty-five and 87 women were randomized to receive one capsule (group A) or two capsules (group B) of 34 mg of ferrous sulfate, respectively. Mean hemoglobin (9.6 g/dL and 9.7 g/dL) and ferritin (8.6 ng/ml and 8.5 ng/ml) were similar in both groups A and B, respectively, at allocation. Hemoglobin in group B was significantly higher from 32 weeks onward, until 6 weeks postpartum. There were no significant differences in any of the secondary outcomes examined. CONCLUSIONS In twin pregnancies complicated by iron deficiency anemia, doubling the dose of iron increases hemoglobin and ferritin without worsening gastrointestinal side effects.
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Yoon H, Young Bae N, Young Gi M, Yeon Park B, Min Seong J. The association between serum ferritin and 25-hydroxyvitamin D and metabolic syndrome in Korean women: the Korea National Health and Nutrition Examination Survey 2010-2012. J Clin Biochem Nutr 2017; 61:60-66. [PMID: 28751811 PMCID: PMC5525011 DOI: 10.3164/jcbn.16-115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 01/25/2017] [Indexed: 11/22/2022] Open
Abstract
The present study was conducted to assess the association between serum ferritin and 25-hydroxyvitamin D [25(OH)D] and metabolic syndrome (MetS) in Korean women. The data of a total of 9,256 adults (6,960 women without MetS and 2,296 women with MetS) aged ≥20 years from the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V) (2010–2012) were analyzed. A covariance test adjusted for covariates was performed for serum ferritin levels in relation to vitamin D (vitamin D deficiency, 25(OH)D <10.0 ng/ml; vitamin D insufficiency, 25(OH)D ≥10.0, <20.0 ng/ml; vitamin D sufficiency, 25(OH)D ≥20.0 ng/ml). The key study results were as follows: First, in women without MetS, after adjusting for related variables (smoking, alcohol drinking, regular exercise, current menstruation, hormonal contraceptives, hormone-replacement therapy, SBP, DBP, BMI, WM, TC, TGs, HDL-C, FPG, AST, ALT, and age), vitamin D was positively associated with serum ferritin levels (p<0.001). Second, in women with MetS, after adjusting for related variables (except age), vitamin D was positively associated with serum ferritin levels (p = 0.041). However, when further adjusted for age, vitamin D was not associated with serum ferritin levels (p = 0.293). In conclusion, vitamin D was positively associated with serum ferritin levels in women without MetS but not in women with MetS.
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Affiliation(s)
- Hyun Yoon
- Department of Biomedical Laboratory Science, Hanlyo University, Hanlyo University, 94-13, Hallyeodae-gil, Gwangyange-up, Gwangyang-si, Jeollanamdo, 57764, Korea
| | - Nan Young Bae
- Department of Biomedical Laboratory Science, Gwangyang Health College, 111, Hallyeodae-gil, Gwangyang-eup, Gwangyang-si, Jeollanam-do, 57764, Korea
| | - Mi Young Gi
- Department of Nursing, Christian College of Nursing, 6, Baekseo-ro 70 beon-gil, Nam-gu, Gwangju, 61662, Korea
| | - Bu Yeon Park
- Department of Hospital Administration, Seonam University, 439, Chunhyang-ro, Namwon-si, Jeollabuk-do, 55724, Korea
| | - Jeong Min Seong
- Department of Dental Hygiene, College of Health Science, Kangwon National University, 346, Hwangjo-gil, Dogye-eup, Samcheok-si, Gangwon-do, 25913, Korea
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30
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Yoon H, Young Bae N, Young Gi M, Yeon Park B, Min Seong J. The association between serum ferritin and 25-hydroxyvitamin D and metabolic syndrome in Korean women: the Korea National Health and Nutrition Examination Survey 2010-2012. J Clin Biochem Nutr 2017. [PMID: 28751811 DOI: 10.3164/jcbn.16.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present study was conducted to assess the association between serum ferritin and 25-hydroxyvitamin D [25(OH)D] and metabolic syndrome (MetS) in Korean women. The data of a total of 9,256 adults (6,960 women without MetS and 2,296 women with MetS) aged ≥20 years from the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V) (2010-2012) were analyzed. A covariance test adjusted for covariates was performed for serum ferritin levels in relation to vitamin D (vitamin D deficiency, 25(OH)D <10.0 ng/ml; vitamin D insufficiency, 25(OH)D ≥10.0, <20.0 ng/ml; vitamin D sufficiency, 25(OH)D ≥20.0 ng/ml). The key study results were as follows: First, in women without MetS, after adjusting for related variables (smoking, alcohol drinking, regular exercise, current menstruation, hormonal contraceptives, hormone-replacement therapy, SBP, DBP, BMI, WM, TC, TGs, HDL-C, FPG, AST, ALT, and age), vitamin D was positively associated with serum ferritin levels (p<0.001). Second, in women with MetS, after adjusting for related variables (except age), vitamin D was positively associated with serum ferritin levels (p = 0.041). However, when further adjusted for age, vitamin D was not associated with serum ferritin levels (p = 0.293). In conclusion, vitamin D was positively associated with serum ferritin levels in women without MetS but not in women with MetS.
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Affiliation(s)
- Hyun Yoon
- Department of Biomedical Laboratory Science, Hanlyo University, Hanlyo University, 94-13, Hallyeodae-gil, Gwangyange-up, Gwangyang-si, Jeollanamdo, 57764, Korea
| | - Nan Young Bae
- Department of Biomedical Laboratory Science, Gwangyang Health College, 111, Hallyeodae-gil, Gwangyang-eup, Gwangyang-si, Jeollanam-do, 57764, Korea
| | - Mi Young Gi
- Department of Nursing, Christian College of Nursing, 6, Baekseo-ro 70 beon-gil, Nam-gu, Gwangju, 61662, Korea
| | - Bu Yeon Park
- Department of Hospital Administration, Seonam University, 439, Chunhyang-ro, Namwon-si, Jeollabuk-do, 55724, Korea
| | - Jeong Min Seong
- Department of Dental Hygiene, College of Health Science, Kangwon National University, 346, Hwangjo-gil, Dogye-eup, Samcheok-si, Gangwon-do, 25913, Korea
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Shinar S, Skornick-Rapaport A, Maslovitz S. Iron supplementation in singleton pregnancy: Is there a benefit to doubling the dose of elemental iron in iron-deficient pregnant women? a randomized controlled trial. J Perinatol 2017; 37:782-786. [PMID: 28383533 DOI: 10.1038/jp.2017.43] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/08/2017] [Accepted: 02/20/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the efficacy of doubling the 30 mg dose of iron in women with iron deficiency anemia (IDA) in singleton pregnancies. STUDY DESIGN Prospective randomized controlled trial. Iron-deficient women were randomized during the second trimester to receive one or two capsules of daily iron supplement, containing 34 mg of ferrous sulfate, from 17 weeks until 6 weeks postpartum. The primary outcome was hemoglobin (Hgb) at 35 weeks. Secondary outcomes included ferritin at 35 weeks, Hgb during pregnancy and postpartum, birth weights, preterm birth rate, gastrointestinal side effects, intravenous iron administration and compliance. RESULTS In all, 160 women were randomized to receive one capsule and 164 received two capsules. Both groups had similar Hgb (10.1 g dl-1) and ferritin (9.3 and 9.4 ng l-1) at allocation. Hgb concentration in both groups was similar at 35 weeks (10.8 g dl-1). There were no significant differences in any of the secondary outcomes. CONCLUSION In IDA pregnant women, a single dose of iron is as effective as a double dose.
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Affiliation(s)
- S Shinar
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - A Skornick-Rapaport
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - S Maslovitz
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
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Naseh A, Ashrafzadeh S, Rassi S. Prevalence of vitamin D deficiency in pregnant mothers in Tehran and investigating its association with serum glucose and insulin. J Matern Fetal Neonatal Med 2017; 31:2312-2318. [DOI: 10.1080/14767058.2017.1342796] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ali Naseh
- Department of Pediatrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Ashrafzadeh
- Department of Pediatrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, USA
| | - Sepehr Rassi
- Department of Pediatrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Biology, Dalhousie University, Halifax, Nova Scotia, Canada
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Wright S, Earland D, Sakhuja S, Junkins A, Franklin S, Padilla L, Aung M, Jolly PE. Anemia in pregnancy in Western Jamaica. Int J Womens Health 2017; 9:431-439. [PMID: 28652822 PMCID: PMC5476652 DOI: 10.2147/ijwh.s129567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Anemia is one of the most prevalent problems in pregnancy. In 2011, 29.9% of all pregnant women in Jamaica were diagnosed with anemia. OBJECTIVE The objective of this study was to determine the prevalence and predictors of anemia in pregnancy in Western Jamaica. METHODS A cross-sectional study was conducted among 293 mothers attending post-natal clinics in Western Jamaica. A questionnaire was administered to the mothers, and an abstraction form was used to collect clinical data from the mothers' records. RESULTS The prevalence of anemia among the women was 37.6%. Younger mothers (aged 18-24 years) were more likely to be anemic compared to those ≥35 years (odds ratio [OR]: 3.44, 95% CI: 1.07-11.06). Mothers who reported not always washing their hands after using the toilet were almost 10 times more likely to be anemic (OR: 9.7, 95% CI: 1.72-54.78) compared to those who reported always washing their hands. Mothers who attended a public facility for antenatal care were 2.3 times more likely to be anemic (OR: 2.31, 95% CI: 1.03-5.18) compared to those who obtained care at a private facility, and mothers who reported being told that they were anemic by a health care provider (HCP) were almost six times more likely to be anemic compared with those who were not told (OR: 5.58, 95% CI: 1.73-17.93). CONCLUSION The results of the study indicate that early identification and treatment of anemia, especially among younger pregnant women, should be a priority. HCP should ensure that women understand the need to be cured of their anemia and to adhere to preventive hygienic practices.
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Affiliation(s)
- Saidah Wright
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dominique Earland
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Swati Sakhuja
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anna Junkins
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Franklin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Luz Padilla
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maung Aung
- Western Region Health Authority, Cornwall Regional Hospital, Ministry of Health, Montego Bay, Jamaica
| | - Pauline E Jolly
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Fairchild AJ, McDaniel HL. Best (but oft-forgotten) practices: mediation analysis. Am J Clin Nutr 2017; 105:1259-1271. [PMID: 28446497 PMCID: PMC5445681 DOI: 10.3945/ajcn.117.152546] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 03/23/2017] [Indexed: 12/22/2022] Open
Abstract
This contribution in the "Best (but Oft-Forgotten) Practices" series considers mediation analysis. A mediator (sometimes referred to as an intermediate variable, surrogate endpoint, or intermediate endpoint) is a third variable that explains how or why ≥2 other variables relate in a putative causal pathway. The current article discusses mediation analysis with the ultimate intention of helping nutrition researchers to clarify the rationale for examining mediation, avoid common pitfalls when using the model, and conduct well-informed analyses that can contribute to improving causal inference in evaluations of underlying mechanisms of effects on nutrition-related behavioral and health outcomes. We give specific attention to underevaluated limitations inherent in common approaches to mediation. In addition, we discuss how to conduct a power analysis for mediation models and offer an applied example to demonstrate mediation analysis. Finally, we provide an example write-up of mediation analysis results as a model for applied researchers.
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Michalski ES, Nguyen PH, Gonzalez-Casanova I, Nguyen SV, Martorell R, Tangpricha V, Ramakrishnan U. Serum 25-hydroxyvitamin D but not dietary vitamin D intake is associated with hemoglobin in women of reproductive age in rural northern Vietnam. J Clin Transl Endocrinol 2017; 8:41-48. [PMID: 29067258 PMCID: PMC5651337 DOI: 10.1016/j.jcte.2017.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/02/2017] [Accepted: 05/02/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hypovitaminosis D and anemia are both prevalent in Vietnam, and low vitamin D status may be a risk factor for anemia. This study aimed to 1) describe vitamin D intake and its determinants, and 2) examine the associations of vitamin D intake and serum 25(OH)D concentrations with hemoglobin and anemia. METHODS AND STUDY DESIGN We used data from the baseline survey of a pre-conceptual micronutrient supplementation trial in women of reproductive age (WRA) in Thai Nguyen, Vietnam (N = 4961). Vitamin D intake was estimated using a semi-quantitative food frequency questionnaire (FFQ). Multivariable regression models were used for the analyses. RESULTS Median vitamin D intake was 0.2 µg/d (8.0 IU) [IQR: 0.4]. Age, being a farmer, food insecurity, and body mass index (BMI) were inversely associated with vitamin D intake, while socioeconomic status (SES), total energy intake, and education were positively associated with vitamin D intake. Vitamin D intake was not associated with hemoglobin concentration or anemia after adjusting for age, BMI, total energy intake, transferrin receptor, C-reactive protein, α1-acid glycoprotein, SES, occupation, education, ethnicity, and food insecurity (P = 0.56 and P = 0.65 for hemoglobin and anemia, respectively). Controlling for the same covariates, 25(OH)D <50 nmol/L (vs. ≥50 nmol/L) was associated with decreased hemoglobin concentrations (β = -0.91 (SE:0.42), P = 0.03), but not with anemia (P = 0.11). CONCLUSIONS Low vitamin D status may be linked to reduced hemoglobin concentrations, but the role of diet in this association was not evident in this population of WRA in Vietnam where dietary vitamin D intake was very low.
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Key Words
- 25(OH)D, 25-hydroxyvitamin D
- AGP, α1-acid glycoprotein
- AMDR, acceptable macronutrient distribution range
- Anemia
- CRP, C-reactive protein
- Dietary intake
- EAR, estimated average requirement
- Hemoglobin
- IOM, Institute of Medicine
- IQR, interquartile range
- RBP, retinol binding protein
- SD, standard deviation
- SE, standard error
- SES, socioeconomic status
- Vietnam
- Vitamin D
- WHO, World Health Organization
- WRA, women of reproductive age
- sTfR, soluble transferrin receptor
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Affiliation(s)
- Ellen S. Michalski
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA
| | - Phuong H. Nguyen
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Viet Nam
- International Food Policy Research Institute, Washington, DC 20006, USA
| | | | - Son V. Nguyen
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Viet Nam
| | - Reynaldo Martorell
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA
- Hubert Department of Global Health, Emory University, Atlanta GA 30322, USA
| | - Vin Tangpricha
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA
- Division of Endocrinology, Metabolism & Lipids, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Usha Ramakrishnan
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA
- Hubert Department of Global Health, Emory University, Atlanta GA 30322, USA
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Ru Y, Pressman EK, Cooper EM, Guillet R, Katzman PJ, Kent TR, Bacak SJ, O'Brien KO. Iron deficiency and anemia are prevalent in women with multiple gestations. Am J Clin Nutr 2016; 104:1052-1060. [PMID: 27581469 DOI: 10.3945/ajcn.115.126284] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 07/29/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little attention has been placed on the unique iron demands that may exist in women with multiple gestations. This merits attention because iron deficiency (ID) during pregnancy is associated with adverse pregnancy outcomes that are known to be more prevalent in multiple births. OBJECTIVE We characterized longitudinal changes in iron status across pregnancy in a cohort of healthy women with multiple gestations and identified determinants of maternal ID and anemia. DESIGN A group of 83 women carrying twins, triplets, or quadruplets (aged 20-46 y) was recruited from 2011 to 2014. Blood samples obtained during pregnancy (∼24 wk; n = 73) and at delivery (∼35 wk; n = 61) were used to assess hemoglobin, serum ferritin (SF), soluble transferrin receptor (sTfR), hepcidin, serum iron, erythropoietin, serum folate, vitamin B-12, C-reactive protein, and interleukin-6. RESULTS The prevalence of tissue ID (sTfR >8.5 mg/L) increased significantly from pregnancy to delivery (9.6% compared with 23%, P = 0.03). Women with depleted iron stores (SF <12 μg/L, n = 20) during pregnancy had a 2-fold greater risk of anemia at delivery, and 25% (n = 5) developed iron deficiency anemia (IDA). Overall, 44.6% of women studied (n = 37/83) were anemic at delivery, and 18% of women (n = 11/61) had IDA. Erythropoietin during pregnancy was significantly negatively associated with hemoglobin at delivery. Women with erythropoietin >75th percentile during pregnancy exhibited a 3-fold greater risk of anemia, suggesting that erythropoietin is a sensitive predictor of anemia at delivery. Inflammation was present at delivery, which limited the utility of ferritin or hepcidin as iron-status indicators at delivery. CONCLUSIONS ID and anemia are highly prevalent in women with multiple gestations. Additional screening and iron supplementation may be warranted in this high-risk population given the known associations between ID anemia and adverse maternal and neonatal outcomes. This trial was registered at clinicaltrials.gov as NCT01582802.
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Affiliation(s)
- Yuan Ru
- Division of Nutritional Sciences, Cornell University, Ithaca, NY; and
| | - Eva K Pressman
- School of Medicine, University of Rochester, Rochester, NY
| | | | - Ronnie Guillet
- School of Medicine, University of Rochester, Rochester, NY
| | | | - Tera R Kent
- Division of Nutritional Sciences, Cornell University, Ithaca, NY; and
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Smith EM, Alvarez JA, Kearns MD, Hao L, Sloan JH, Konrad RJ, Ziegler TR, Zughaier SM, Tangpricha V. High-dose vitamin D 3 reduces circulating hepcidin concentrations: A pilot, randomized, double-blind, placebo-controlled trial in healthy adults. Clin Nutr 2016; 36:980-985. [PMID: 27402475 DOI: 10.1016/j.clnu.2016.06.015] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/14/2016] [Accepted: 06/20/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS In vitro studies suggest that vitamin D may reduce hepcidin expression and pro-inflammatory cytokine release from monocytes. However, data assessing the vitamin D-mediated effects on iron recycling in healthy individuals are lacking. We aimed to examine the effect of high-dose vitamin D3 on plasma hepcidin, inflammatory cytokine, and ferritin concentrations in healthy adults. METHODS This was a pilot, double-blind, placebo-controlled trial in healthy adults (N = 28) randomized to receive a one-time oral dose of 250,000 IU of vitamin D3 or placebo. Between- and within-group differences in plasma hepcidin, pro-inflammatory cytokine [interleukin (IL)-1β, IL-6, IL-8, monocyte chemoattractant protein-1 (MCP-1)], and ferritin concentrations at baseline and 1 week were determined using two-sample and paired t-tests, respectively. RESULTS At baseline, plasma 25-hydroxyvitamin D [25(OH)D], hepcidin, pro-inflammatory cytokine, and ferritin concentrations did not differ between the two groups, and greater than 70% of subjects in both groups were vitamin D deficient (25(OH)D < 20 ng/mL). After 1 week, plasma hepcidin concentrations decreased by 73% from baseline in those who received vitamin D3 (geometric mean ratio [GMR] = 0.27 (95% CI: 0.11-0.62); P = 0.005); there was no significant change in the placebo group (GMR = 0.73 (95% CI: 0.49-1.09); P = 0.11). Plasma cytokine and ferritin concentrations did not change significantly in either group. CONCLUSIONS High-dose vitamin D3 significantly reduced plasma hepcidin concentrations in healthy adults 1 week post-dosing, without a change in plasma pro-inflammatory cytokine or ferritin concentrations. These data suggest that vitamin D may have a role in regulating iron recycling by acting independently of changes in pro-inflammatory markers.
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Affiliation(s)
- Ellen M Smith
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA
| | - Jessica A Alvarez
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA; Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Malcolm D Kearns
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Li Hao
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - John H Sloan
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN 46285, USA
| | - Robert J Konrad
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN 46285, USA
| | - Thomas R Ziegler
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA; Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Susu M Zughaier
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322, USA; Atlanta Veterans Administration Medical Center (VAMC), Decatur, GA 30033, USA
| | - Vin Tangpricha
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA; Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA 30322, USA; Atlanta Veterans Administration Medical Center (VAMC), Decatur, GA 30033, USA.
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van Rensburg SJ, van Toorn R, Moremi KE, Peeters AV, Oguniyi A, Kotze MJ. Multiple sclerosis-like diagnosis as a complication of previously treated malaria in an iron and vitamin D deficient Nigerian patient. Metab Brain Dis 2016; 31:197-204. [PMID: 26746433 DOI: 10.1007/s11011-015-9788-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/28/2015] [Indexed: 02/06/2023]
Abstract
In contrast to malaria, multiple sclerosis (MS) is infrequently found in Black Africans. We describe a 29 year old Nigerian female who developed an MS-like condition with symptoms similar to relapsing-remitting MS following malaria infection, leading to a diagnosis of MS. However, absence of hyperintense lesions in the brain and spinal cord presented a conundrum since not all the diagnostic criteria for MS were met. Pathology supported genetic testing (PSGT) was applied to combine family and personal medical history, lifestyle factors, and biochemical test results for interpretation of genetic findings. This approach provides a means of identifying risk factors for different subtypes of demyelinating disease. The patient was subsequently treated according to an individualised intervention program including nutritional supplementation as well as a change in diet and lifestyle. Deficiencies of vitamin B12, iron and vitamin D were addressed. Genetic analysis revealed absence of the HLA DRB1*1501 allele, considered to be the most prominent genetic risk factor for MS. Extended mutation analysis identified variations in three genes in the folate-vitamin B12 metabolic pathway, which could have increased the patient's sensitivity to the antifolate drugs used to treat the malaria. A glutathione-S-transferase GSTM1 null allele, previously associated with neurological complications of malaria, was also detected. Furthermore, a heterozygous variation in the iron-related transmembrane protease serine 6 (TMPRSS6) gene, rs855791 was found, which could have impacted the patient's iron status following two successive blood donations and exposure to malaria preceding the MS diagnosis. PSGT identifies relevant risk factors for demyelinating disorders resembling MS and uses the data for individualised treatment programs, and to systematically build a database that can provide evidence in large patient cohorts. Follow-up investigations may be suggested, such as whole exome sequencing in selected cases, to ensure that remyelination and restoration of function are achieved.
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Affiliation(s)
- Susan J van Rensburg
- Chemical Pathology, National Health Laboratory Service (NHLS) and Stellenbosch University, Cape Town, South Africa.
| | - Ronald van Toorn
- Paediatric Medicine and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Kelebogile E Moremi
- Chemical Pathology, National Health Laboratory Service (NHLS) and Stellenbosch University, Cape Town, South Africa
| | - Armand V Peeters
- Anatomical Pathology, Stellenbosch University, Cape Town, South Africa
| | - Adesola Oguniyi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Maritha J Kotze
- Anatomical Pathology, Stellenbosch University, Cape Town, South Africa
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