Effect of Oral Iron on Markers of Oxidative Stress and Antioxidant Status in Children with Iron Deficiency Anaemia

Comparative evaluation of different oral iron salts in the management of iron deficiency anemia

BACKGROUND

Anemia affects one-fourth of the world's population and is caused mostly by iron deficiency. Iron supplementation is the most essential strategy for preventing iron deficiency anemia. Conventional oral iron salts have many drawbacks such as poor absorption & bioavailability, and poor tolerability resulting in poor clinical outcomes.

OBJECTIVE

To compare the effectiveness and safety of ferrous ascorbate, ferrous fumarate, ferrous bis-glycinate, and Sucrosomial iron in the management of iron deficiency anemia.

METHOD

The study is a retrospective observational clinical study comprising 260 subjects with hemoglobin between 7-10 g/dl. The patients were divided into four groups I, II, III, and IV, and received ferrous fumarate, ferrous ascorbate, ferrous bis-glycinate, and Sucrosomial iron respectively. Hematological profile and iron store indices were measured at baseline and month 3. One-way ANOVA followed by Tukey multiple comparison test was used to assess statistical significance (P < 0.05) using GraphPad Prism V.9.3.1 software.

RESULTS

The observational study showed that hemoglobin levels were significantly increased in the ferrous ascorbate group (11.86 ± 0.09; P < 0.0001), ferrous fumarate group (11.72 ± 0.08; P < 0.0001), ferrous bis-glycinate group (11.69 ± 0.11; P = 0.0003) and Sucrosomial iron group (12.20 ± 0.1; P < 0.0001) compared to the baseline. The Sucrosomial iron-supplemented group showed significantly higher improvement in hemoglobin levels and serum ferritin levels compared to conventional oral iron salts (P < 0.05) with a better safety profile.

CONCLUSION

The Sucrosomial iron showed significantly higher improvement in hemoglobin levels and higher improvement in iron store indices parameters along with a good tolerability profile compared to other conventional oral iron salts.

Environmental exposures associated with elevated risk for autism spectrum disorder may augment the burden of deleterious de novo mutations among probands

Although the full aetiology of autism spectrum disorder (ASD) is unknown, familial and twin studies demonstrate high heritability of 60-90%, indicating a predominant role of genetics in the development of the disorder. The genetic architecture of ASD consists of a complex array of rare and common variants of all classes of genetic variation usually acting additively to augment individual risk. The relative contribution of heredity in ASD persists despite selective pressures against the classic autistic phenotype; a phenomenon thought to be explained, in part, by the incidence of spontaneous (or de novo) mutations. Notably, environmental exposures attributed as salient risk factors for ASD may play a causal role in the emergence of deleterious de novo variations, with several ASD-associated agents having significant mutagenic potential. To explore this hypothesis, this review article assesses published epidemiological data with evidence derived from assays of mutagenicity, both in vivo and in vitro, to determine the likely role such agents may play in augmenting the genetic liability in ASD. Broadly, these exposures were observed to elicit genomic alterations through one or a combination of: (1) direct interaction with genetic material; (2) impaired DNA repair; or (3) oxidative DNA damage. However, the direct contribution of these factors to the ASD phenotype cannot be determined without further analysis. The development of comprehensive prospective birth cohorts in combination with genome sequencing is essential to forming a causal, mechanistic account of de novo mutations in ASD that links exposure, genotypic alterations, and phenotypic consequences.

Alterations in glutathione redox homeostasis among adolescents with obesity and anemia

The reduced (GSH)-to-oxidized (GSSG) glutathione ratio represents a dynamic balance between oxidants and antioxidants. However, redox status in adolescents with obesity and anemia has not been investigated. This study investigated the association of erythrocyte GSH redox status (GSH, GSH:GSSG ratio, and glutathione peroxidase [GPx] activity) with anemia and adiposity in adolescents. This case–control study nested in a cross-sectional study enrolled 524 adolescents (268 boys; 256 girls). The prevalence of anemia in overweight and obesity (OWOB) was 5.2% in boys and 11.7% in girls. The GSH:GSSG ratio and GPx activity were significantly higher in girls than in boys (p < 0.001), in anemic than in non-anemic subjects (p < 0.001), and in OWOB than in normal-weight subjects (p < 0.001). Similarly, significantly higher GSH: GSSG level (p < 0.001) and GPx activity (p < 0.001) were found in subjects with 90th percentile waist circumference than in those with < 90th percentile. GPx and GSH:GSSG were positively associated with anemia after adjusting for age, sex, and body mass index (adjusted odds ratio, adjOR [95% confidence interval, CI] 2.18 [1.44–3.29]) or tertiles (adjOR [95% CI], T3 = 2.49 [1.03–6.01]). A similar association was noted for GSH and GPx. A compensatory increased redox defense mechanism exists in anemia and obesity among adolescents without metabolic disturbances.

Effectiveness of inulin-type on the iron bioavailability in anemic female rats fed bio-yogurt

It is well-documented that iron deficiency leads to anemia, which is the utmost critical problem of nutrition worldwide. Inulin, indigestible polysaccharides, or prebiotic agents may act as vehicles to enhance the iron bioavailability through the formation of the polysaccharide-iron complex. The present study was undertaken to evaluate the therapeutic effects of yogurt fortified with iron and supplemented by long- or short-chain inulin on the growth status, blood parameters, antioxidant capacity, and liver function enzymes in anemic rats. Five animal groups were assigned as the control (G1), which were fed a standard diet and there were four anemic groups, in which haemolytic anemia was induced by phenylhydrazine. The anemic rats were divided into 4 groups according to the regime of feeding as G2: control anemic group fed low-iron diet while the remaining anemic groups were fed yogurt fortified with Fe2(SO4)3 without inulin (G3) or with either long- (G4) or short-chain (G5) inulin. The results showed that the animals subjected to treatment G4 had the highest (P ≤ 0.05) weight gain and organ coefficient compared with other anemic groups (G2, G3, and G5). Among the anemic groups, the animals that belonged to G4 showed a significant restorative effect by returning the hemoglobin and hematocrit levels and the red blood cell count to the normal control liver. Also, the liver iron content, enzymatic activities, and antioxidant capacities improved in the animals subjected to G4 and G5 treatment groups. The histological structures of the liver tissues of the animals that belonged to G4 and G5 were extremely close to that of the normal control liver. Long-chain inulin-containing yogurt exhibited the best effects in terms of iron supplementation, bioavailability, and antioxidant activities. This formula might be a potential new iron supplement and a good functional food candidate.

Low Dose Iron Therapy in Children with Iron Deficiency: DNA Damage and Oxidant Stress Markers

Conflicting data are available regarding oral iron therapy in iron deficiency (ID), iron deficiency anemia (IDA) and its relation to DNA damage, oxidative stress and antioxidant markers. Our aim was assessment of DNA damage, oxidative stress and anti-oxidant markers in children with ID and IDA before and after low dose iron therapy. The study was conducted in two stages, first stage was assessment of DNA damage using comet assay, malondialdehyde (MDA) and anti-oxidant enzymes levels (superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) & total antioxidant capacity (TAC) in thirty-nine children with IDA, forty-five children with ID without anemia and sixty healthy controls. Second stage was assessment of previous markers together with hematological response following oral therapy with 10 mg/day ferric ammonium citrate for 8 weeks. Before treatment, there was no significant difference between the three groups regarding MDA, GPx, SOD, CAT and TAC. A significant increase was detected in the DNA damage in the 2 groups compared to control (p < 0.005). Following iron therapy, hematological parameters was improved together with a significant increase in GPx (P = 0.04), SOD (p = 0.002), TAC (P = 0.001) and non-significant reduction in DNA damage in IDA group. There was a significant increase in SOD (p = 0.001) & TAC (p = 0.001) and significant decrease in DNA damage (p = 0.001) in ID group. Low dose iron therapy could be sufficient to improve antioxidant status and DNA damage together with correction of hematologic indices.

Increased Levels of Glycated Hemoglobin A1c and Iron Deficiency Anemia: A Review

Worldwide, the prevalence of diabetes remains high. Studies have shown that iron deficiency anemia (IDA) is associated with increased levels of glycated hemoglobin A1c (HbA1c), but the mechanism remains unclear. Hematological changes, iron metabolism, study methodology, and other factors could affect the results of diagnostic investigations, leading to false results. Red blood cell turnover in the bone marrow and the quality and heterogeneity of erythrocytes may influence the rate of hemoglobin glycation. By changing the structure of hemoglobin and inducing peroxidation, iron deficiency accelerates glycation. This review aims to discuss the possible causes of the association between increased levels of HbA1c and IDA.

Status of malondialdehyde, catalase and superoxide dismutase levels/activities in schoolchildren with iron deficiency and iron-deficiency anemia of Kashere and its environs in Gombe State, Nigeria

Background

Iron-deficiency anemia (IDA) or iron deficiency (ID) is by far the most common form of disorder affecting the cognitive development, physical growth and school performance of children in developing countries including Nigeria.

Objectives

In the present study, we aimed to examine whether IDA or ID, or both are associated with oxidative stress or otherwise by assessing the perturbations in oxidative stress markers including malondialdehyde (MDA), catalase (CAT) and superoxide dismutase (SOD).

Methods

Here, a total of eighty-one IDA, ID, and healthy control subjects of twenty-seven replicates each, were recruited and investigated. Human serum MDA, CAT and SOD levels were quantitatively analyzed using Enzyme-Linked Immunosorbant Assay.

Results

Mean serum MDA levels of IDA (5.10 ± 2.35 mmol/L) and ID (4.05 ± 1.35 mmol/L) groups were found to perturb significantly (p < 0.05), being higher than those of control (3.30 ± 0.95 mmol/L) subjects. Similarly, mean serum MDA levels of IDA (5.10 ± 2.35 mmol/L) group was found to be significantly (p < 0.05) higher when compared with ID (4.05 ± 1.35 mmol/L) subjects. Conversely, mean serum CAT and SOD activities of IDA (8.35 ± 2.21 ng/mL and 340.70 ± 153.65 ng/mL) group were found to differ significantly (p < 0.05), and those of ID (9.40 ± 1.47 ng/mL and 435.00 ± 144.75 ng/mL) subjects were found to perturb slightly (p > 0.05), being lower than those of control (10.40 ± 4.31 ng/mL and 482.12 ± 258.37 ng/mL) subjects.

Conclusions

Taken together, the results of the present study showed that lipid peroxidation was dramatically increased in both IDA and ID subjects in hydroperoxide-superoxide-dependent manner; in contrast, enzymatic antioxidant capacity was drastically decreased in both IDA and ID groups as evidenced by biochemical markers.

Oxidative Stress and Genomic Damage Induced In Vitro in Human Peripheral Blood by Two Preventive Treatments of Iron Deficiency Anemia

Iron deficiency is the most prevalent nutritional deficiency and the main cause of anemia worldwide. Since children aged 6-24 months are among the most vulnerable groups at risk, daily supplementation with ferrous sulfate is recommended by the Argentine Society of Pediatrics as preventive treatment of anemia. However, a single weekly dose would have fewer adverse side effects and has been therefore proposed as an alternative treatment. Ferrous sulfate is known by its pro-oxidative properties, which may lead to increased oxidative stress as well as lipid, protein, and DNA damage. We analyzed the effect of daily and weekly preventive treatment of iron deficiency anemia (IDA) on cell viability, oxidative stress, chromosome, and cytomolecular damage in peripheral blood cultured in vitro. The study protocol included the following: untreated negative control; bleomycin, hydrogen peroxide, or ethanol-treated positive control; daily 0.14 mg ferrous sulfate-supplemented group; and weekly 0.55 mg ferrous sulfate-supplemented group. We assessed cell viability (methyl-thiazolyl-tetrazolium and neutral red assays), lipid peroxidation (thiobarbituric acid reactive substances assay), antioxidant response (superoxide dismutase and catalase enzyme analysis), chromosome damage (cytokinesis-blocked micronucleus cytome assay), and cytomolecular damage (comet assay). Lipid peroxidation, antioxidant response, and chromosome and cytomolecular damage decreased after weekly ferrous sulfate supplementation (p < 0.05), suggesting less oxygen free radical production and decreased oxidative stress and genomic damage. Such a decrease in oxidative stress and genomic damage in vitro positions weekly supplementation as a better alternative for IDA treatment. Further studies in vivo would be necessary to corroborate whether weekly supplementation could improve IDA preventive treatment compliance in children.

Glycosylated Hemoglobin in Subjects Affected by Iron-Deficiency Anemia

Previous studies have suggested that iron-deficiency anemia affects glycosylated hemoglobin (HbA1c) measurements, but the results were contradictory. We conducted a retrospective case-control study to determine the effects of iron deficiency on HbA1c levels. Starting with the large computerized database of the Italian Hospital of Desio, including data from 2000 to 2016, all non-pregnant individuals older than 12 years of age with at least one measurement of HbA1c, cell blood count, ferritin, and fasting blood glucose on the same date of blood collection were enrolled. A total of 2,831 patients met the study criteria. Eighty-six individuals were diagnosed with iron-deficiency anemia, while 2,745 had a normal iron state. The adjusted means of HbA1c were significantly higher in anemic subjects (5.59% [37.37 mmol/mol]), than those measured in individuals without anemia (5.34% [34.81 mmol/mol]) (P<0.0001). These results suggest that clinicians should be cautious about diagnosing prediabetes and diabetes in individuals with anemia.