Serum ferritin <70 μg/L predicts functional iron deficiency in patients with chronic kidney disease

Population iron status in Canada: results from the Canadian Health Measures Survey 2012-2019

BACKGROUND

In Canada, population iron status estimates are dated (2009-2011) and did not consider the presence of inflammation.

OBJECTIVE

To update iron status estimates in Canada using serum ferritin (SF) and evaluate different correction methods for inflammation based on c-reactive protein (CRP).

METHODS

Data from the Canadian Health Measures Survey cycles 3 to 6 (2012-2019) formed a multi-year, cross-sectional, nationally representative sample (3 to 79 years) (n=21,453). WHO cut-offs for SF and hemoglobin were used to estimate iron deficiency (ID), iron deficiency anemia (IDA), anemia and elevated iron stores. ID was first estimated without considering inflammation. Correction approaches evaluated were: excluding individuals with CRP>5 mg/L; using modified SF cut-offs; and regression correction.

RESULTS

Total population uncorrected prevalence estimates were 7% (95%CI: 6.2, 7.9) ID, 6.1% (95%CI: 5.2, 7.0) anemia and 2.0% (95%CI: 1.6, 2.4) IDA. Uncorrected prevalence of ID was highest among females of reproductive age with 21.3% (95%CI: 17.6, 25.0) and 18.2% (95%CI: 15.4, 21.1) in 14-18y and 19-50y respectively. Corrected ID estimates were higher compared to uncorrected values, independent of the correction approach. Regression correction led to a moderate increase in prevalence to 10.5% for the total population while applying the higher modified SF cut-offs (70μg/L for those over 5y) led to the largest increases in prevalence, to 12.6%. Applying modified cut-offs led to implausibly high ID estimates among those with inflammation. Elevated iron stores were identified in 17.2% (95%CI: 16.2, 18.2) of the population, mostly in adult males.

CONCLUSIONS

Correction methods for estimating population iron status need further research. Considering the fundamental drawbacks of each method, uncorrected and regression corrected estimates provide a reasonable range for ID in the Canadian population. Important sex-based differences in iron status and a public health ID problem of moderate magnitude among females of reproductive age are evident in Canada.

Therapeutic potential of induced iron depletion using iron chelators in Covid-19

Ferritin, which includes twenty-four light and heavy chains in varying proportions in different tissues, is primarily responsible for maintaining the body's iron metabolism. Its normal value is between 10 and 200 ngmL^-1 in men and between 30 and 300 ngmL^-1 in women. Iron is delivered to the tissue via them, and they act as immunomodulators, signaling molecules, and inflammatory markers. When ferritin level exceeds 1000 µgL^-1, the patient is categorized as having hyperferritinemia. Iron chelators such as deferiprone, deferirox, and deferoxamine are currently FDA approved to treat iron overload. The inflammation cascade and poor prognosis of COVID-19 may be attributed to high ferritin levels. Critically ill patients can benefit from deferasirox, an iron chelator administered orally at 20-40 mgkg^-1 once daily, as well as intravenous deferoxamine at 1000 mg initially followed by 500 mg every 4 to 12 h. It can be combined with monoclonal antibodies, antioxidants, corticosteroids, and lactoferrin to make iron chelation therapy effective for COVID-19 victims. In this article, we analyze the antiviral and antifibrotic activity of iron chelators, thereby promoting iron depletion therapy as a potentially innovative treatment strategy for COVID-19.

Evaluation of Hypoglycemic Therapy Through Physical Exercise in n5STZ-Induced Diabetes Rats

BACKGROUND

Diabetes mellitus is a syndrome with multiple etiologies involving insulin, in which there is a lack of production and/or loss of sensitivity to this hormone resulting in insulin resistance. Treatment and control of this disease requires changes in diet, use of medication, and lifestyle, such as physical activity. These modifications may compromise quality-of-life if there is no proper guidance for the treatment or alert to possible complications caused by the disease.

METHODS

This study aimed to evaluate biochemical and hematological parameters, and to assess brain derived neurotrophic factor levels in diabetic Wistar rats submitted to chronic physical exercise.

RESULTS

The results demonstrated an increase in plasma concentration of brain-derived neurotrophic factor (BDNF) in association with hyperglycemia reduction in diabetic animals.

DISCUSSION

The results obtained suggest that there is a regulation of glucose homeostasis between peripheral tissues and the central nervous system. Exercise-induced BDNF also improved levels of glycemia, body weight, and dyslipidemia. In hematological evaluation, BDNF increase was positively correlated with an improvement in leukocyte parameters. Electrophoresis analyses demonstrated a reduction in levels of pro-inflammatory proteins, lipoprotein fractions, and albumin preservation in diabetic animals trained with elevated concentration of plasma BDNF.

CONCLUSION

In conclusion, this study demonstrated that chronic exercise was able to elevate BDNF levels in plasma, which resulted directly in positive hypoglycemic activity in diabetic animals and a reduction of the metabolic syndrome associated with diabetes mellitus.