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Li T, Zhang J, Li P. Ferritin and iron supplements in gestational diabetes mellitus: less or more? Eur J Nutr 2024; 63:67-78. [PMID: 37775606 DOI: 10.1007/s00394-023-03250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 09/08/2023] [Indexed: 10/01/2023]
Abstract
Iron metabolism has been found to be closely related to gestational diabetes mellitus (GDM). Excessive ferritin levels were shown to be related to an increased risk of GDM because of iron overload which may lead to insulin resistance and β-cell injury by enhancing oxidative stress and inflammatory responses. On the contrary, insufficient ferritin levels can cause a number of obstetric complications, such as high incidence rates of anaemia and gestational hypertension. Therefore, high or low ferritin levels may have adverse effects on the mother and the foetus, putting clinicians in a dilemma when giving pregnant women iron supplements. This also explains why there have been more conflicting findings in the studies on dietary or oral iron supplementation during pregnancy. Hence, there is an urgent need for more evidence and strategies for appropriate recommendations for ferritin levels and iron supplementation during pregnancy to prevent iron insufficiency without causing iron overload and increasing the risk of GDM. Therefore, we gave an updated review on the association of GDM with ferritin metabolism, ferritin levels and iron supplementation based on the summary of the latest research.
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Affiliation(s)
- Tianlian Li
- Department of Endocrinology, Shengjing Hospital of China Medical University, No. 39, Huaxiang Road, Tiexi District, Shenyang, 110022, Liaoning, China
| | - Jingfan Zhang
- Department of Endocrinology, Shengjing Hospital of China Medical University, No. 39, Huaxiang Road, Tiexi District, Shenyang, 110022, Liaoning, China
| | - Ping Li
- Department of Endocrinology, Shengjing Hospital of China Medical University, No. 39, Huaxiang Road, Tiexi District, Shenyang, 110022, Liaoning, China.
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Yang H, Zang X, Jin X, Chen J, Lv Y, Lv Z. Efficacy of polysaccharide iron complex in IDA rats: A comparative study with iron protein succinylate and ferrous succinate. Biomed Pharmacother 2024; 170:115991. [PMID: 38086149 DOI: 10.1016/j.biopha.2023.115991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Iron deficiency anemia (IDA) is the most common nutrient-related health problem in the world. There is still a lack of comprehensive comparative study on the efficacies of commonly used iron supplements such as polysaccharide iron complex (PIC), iron protein succinylate (IPS) and ferrous succinate (FS) for IDA. In this study, we compared the PIC, IPS and FS efficacies in IDA rats via intragastric administration. The results showed that the three iron supplements had similar efficacies. PIC/IPS/FS at a dose of 15 mg Fe/kg/d for 10 d increased the hematological and serum biochemical parameters to 2.15/2.12/2.18 (Hb), 1.71/1.67/1.69 (RBC), 2.10/2.11/2.12 (HCT), 1.26/1.22/1.22 (MCV), all 1.34 (MCH), 1.15/1.15/1.14 (MCHC), 1.94/1.82/1.91 (SF), 9.75/9.67/9.53 (SI), and 23.30/22.68/21.64 (TS) times, and reduced TIBC to 0.42/0.43/0.44 times, compared to untreated IDA rats. PIC performed slightly better than IPS and FS in restoring MCV level. Meanwhile, the heart, spleen and kidney coefficients reduced to 67%/74%/65% (heart), all 59% (spleen) and 87%/88%/88% (kidney), and the liver coefficient increased to 116%/115%/116%, compared to untreated IDA rats. The liver iron content was found to be more affected by IDA than the spleen iron content. PIC/IPS/FS at 15 mg Fe/kg/d increased organ iron contents to 4.20/3.97/4.03 times (liver) and 1.36/1.24/1.41 times (spleen) within 10 d compared to untreated IDA rats, and PIC-H and FS were slightly better than IPS in restoring spleen iron content. The results of this study can provide useful data information for the comparison of three iron supplements, PIC, IPS and FS.
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Affiliation(s)
- Huanhuan Yang
- School of Medicine and Pharmacy, Ocean University of China, Qingdao, Shandong 266003, China
| | - Xiaoling Zang
- School of Medicine and Pharmacy, Ocean University of China, Qingdao, Shandong 266003, China; Laboratory of Marine Drugs and Biological Products, Pilot National Laboratory for Marine Science and Technology, Qingdao, Shandong 266235, China.
| | - Xinyu Jin
- School of Medicine and Pharmacy, Ocean University of China, Qingdao, Shandong 266003, China
| | - Jiejun Chen
- SPH Qingdao Growful Pharmaceutical Co., Ltd., Qingdao, Shandong 266510, China
| | - Yinggang Lv
- SPH Qingdao Growful Pharmaceutical Co., Ltd., Qingdao, Shandong 266510, China
| | - Zhihua Lv
- School of Medicine and Pharmacy, Ocean University of China, Qingdao, Shandong 266003, China; Laboratory of Marine Drugs and Biological Products, Pilot National Laboratory for Marine Science and Technology, Qingdao, Shandong 266235, China
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Babayev M, Klaunig J, Silveyra P, Henschel B, Gletsu-Miller N. Impact on oxidative stress of oral, high-dose, iron supplementation for management of iron deficiency after bariatric surgery, a preliminary study. J Trace Elem Med Biol 2023; 80:127310. [PMID: 37801789 DOI: 10.1016/j.jtemb.2023.127310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES High-dose oral iron supplementation for patients who develop iron deficiency after bariatric surgery may induce oxidative stress in the gastrointestine. The study's objective was to test this hypothesis by determining the impact of high-dose oral iron on systemic oxidative stress. METHODS We used archived plasma samples from a randomized controlled clinical trial (NCT02404012) comparing FeSO4 (195 mg/day, NatureMade®, West Hills, CA) with a heme iron polypeptide (HIP, 60.4 mg/day, Proferrin®, Colorado Biolabs, Lafayette, CO) for 8 weeks. Systemic oxidative stress was measured using malondialdehyde and total antioxidant capacity (MDA, Abcam, ab238537 and TAC, Abcam, ab65329 Cambridge, UK) assays. Data was log-transformed and presented as means and standard deviations; a mixed model was used to determine the effects of time (0, 2, 4, and 8 weeks) and treatment (FeSO4 versus HIP) on oxidative stress. RESULTS The FeSO4 (N = 8) and HIP (N = 5) participants were balanced in body mass index (35.0 ± 5.5 kg/m2), race (93 % White), time post-surgery (7.3 ± 3.3 years), as well as serum concentrations of iron (P > 0.05). The FeSO4 group tended to be older (44.3 ± 4.5 years) and they had lower concentrations of serum ferritin (6.5 ± 2.7 µg/mL) than the HIP (38.2 ± 9.3 years, and 12.9 ± 16.8 µg/mL) group (P = 0.080, and P = 0.017 respectively). We observed a larger increase in serum iron in the FeSO4 group during the 8 weeks of Fe supplementation, compared to that in the HIP group (p = 0.004). We observed a decreasing trend in MDA over the 8 weeks (p = 0.080) in the FeSO4 treatment group. There were no significant differences in TAC between and within FeSO4 and HIP groups over the 8 week supplementation period. CONCLUSIONS This preliminary study suggests that high-dose oral iron supplementation for iron deficiency does not adversely impact systemic oxidative stress in patients undergoing bariatric surgery.
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Affiliation(s)
- Maksat Babayev
- Department of Environmental and Occupational Health, Indiana University School of Public Health Bloomington, 1025 E 7th Street, Bloomington, IN 47405, United States
| | - James Klaunig
- Department of Environmental and Occupational Health, Indiana University School of Public Health Bloomington, 1025 E 7th Street, Bloomington, IN 47405, United States
| | - Patricia Silveyra
- Department of Environmental and Occupational Health, Indiana University School of Public Health Bloomington, 1025 E 7th Street, Bloomington, IN 47405, United States
| | - Beate Henschel
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health Bloomington, 2719 E. 10th Street, Bloomington, IN 47405, United States
| | - Nana Gletsu-Miller
- Department of Applied Health Science, Indiana University School of Public Health Bloomington, 1025 E 7th Street, Bloomington, IN 47405, United States.
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Loveikyte R, Bourgonje AR, van Goor H, Dijkstra G, van der Meulen-de Jong AE. The effect of iron therapy on oxidative stress and intestinal microbiota in inflammatory bowel diseases: A review on the conundrum. Redox Biol 2023; 68:102950. [PMID: 37918126 PMCID: PMC10643537 DOI: 10.1016/j.redox.2023.102950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 10/28/2023] [Indexed: 11/04/2023] Open
Abstract
One in five patients with Inflammatory Bowel Disease (IBD) suffers from anemia, most frequently caused by iron deficiency. Anemia and iron deficiency are associated with worse disease outcomes, reduced quality of life, decreased economic participation, and increased healthcare costs. International guidelines and consensus-based recommendations have emphasized the importance of treating anemia and iron deficiency. In this review, we draw attention to the rarely discussed effects of iron deficiency and iron therapy on the redox status, the intestinal microbiota, and the potential interplay between them, focusing on the clinical implications for patients with IBD. Current data are scarce, inconsistent, and do not provide definitive answers. Nevertheless, it is imperative to rule out infections and discern iron deficiency anemia from other types of anemia to prevent untargeted oral or intravenous iron supplementation and potential side effects, including oxidative stress. Further research is necessary to establish the clinical significance of changes in the redox status and the intestinal microbiota following iron supplementation.
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Affiliation(s)
- R Loveikyte
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands; Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - A R Bourgonje
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; The Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - H van Goor
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - G Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A E van der Meulen-de Jong
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
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Rudy MJ, Salois G, Cubello J, Newell R, Mayer-Proschel M. Gestational iron deficiency affects the ratio between interneuron subtypes in the postnatal cerebral cortex in mice. Development 2023; 150:dev201068. [PMID: 36805633 PMCID: PMC10110419 DOI: 10.1242/dev.201068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023]
Abstract
Gestational iron deficiency (gID) is highly prevalent and associated with an increased risk of intellectual and developmental disabilities in affected individuals that are often defined by a disrupted balance of excitation and inhibition (E/I) in the brain. Using a nutritional mouse model of gID, we previously demonstrated a shift in the E/I balance towards increased inhibition in the brains of gID offspring that was refractory to postnatal iron supplementation. We thus tested whether gID affects embryonic progenitor cells that are fated towards inhibitory interneurons. We quantified relevant cell populations during embryonic inhibitory neuron specification and found an increase in the proliferation of Nkx2.1+ interneuron progenitors in the embryonic medial ganglionic eminence at E14 that was associated with increased Shh signaling in gID animals at E12. When we quantified the number of mature inhibitory interneurons that are known to originate from the MGE, we found a persistent disruption of differentiated interneuron subtypes in early adulthood. Our data identify a cellular target that links gID with a disruption of cortical interneurons which play a major role in the establishment of the E/I balance.
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Affiliation(s)
- Michael J. Rudy
- Department of Biomedical Genetics, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA
- Department of Neurology, University of Colorado Denver – Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO 80045, USA
| | - Garrick Salois
- Department of Biomedical Genetics, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Janine Cubello
- Department of Biomedical Genetics, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Robert Newell
- Department of Biomedical Genetics, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Margot Mayer-Proschel
- Department of Biomedical Genetics, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA
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Asperti M, Cantamessa L, Gryzik M, Bugatti M, Codenotti S, Denardo A, Vermi W, Fanzani A, Poli M. The modulation of iron metabolism affects the Rhabdomyosarcoma tumor growth in vitro and in vivo. Clin Exp Med 2023; 23:2487-2502. [PMID: 36764998 PMCID: PMC10543952 DOI: 10.1007/s10238-023-01012-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/25/2023] [Indexed: 02/12/2023]
Abstract
Rhabdomyosarcoma (RMS) is an aggressive rare neoplasm that derives from mesenchymal cells, which frequently develops resistance to the current therapies and the formation of metastases. Thus, new therapies are needed. The alteration of iron metabolism in cancer cells was effective in reducing the progression of many tumors but not yet investigated in RMS. Here we investigated the effect of iron modulation in RMS both in vitro and in vivo. We first characterized the most used RMS cell lines representing the most common subtypes, embryonal (ERMS, RD cells) and alveolar (ARMS, RH30 cells), for their iron metabolism, in basal condition and in response to its modulation. Then we investigated the effects of both iron overload and chelation strategies in vitro and in vivo. RMS cell lines expressed iron-related proteins, even if at lower levels compared to hepatic cell lines and they are correctly modulated in response to iron increase and deprivation. Interestingly, the treatment with different doses of ferric ammonium citrate (FAC, as iron source) and with deferiprone (DFP, as iron chelator), significantly affected the cell viability of RD and RH30. Moreover, iron supplementation (in the form of iron dextran) or iron chelation (in the form of DFP) were also effective in vivo in inhibiting the tumor mass growth both derived from RD and RH30 with iron chelation treatment the most effective one. All the data suggest that the iron modulation could be a promising approach to overcome the RMS tumor growth. The mechanism of action seems to involve the apoptotic cell death for both iron supplementation and chelation with the concomitant induction of ferroptosis in the case of iron supplementation.
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Affiliation(s)
- Michela Asperti
- Department of Molecular and Translational Medicine, University of Brescia, 25123, Brescia, Italy
| | - Luca Cantamessa
- Department of Molecular and Translational Medicine, University of Brescia, 25123, Brescia, Italy
| | - Magdalena Gryzik
- Department of Molecular and Translational Medicine, University of Brescia, 25123, Brescia, Italy
- Unit of Pathology, ASST Spedali Civili Di Brescia, 25100, Brescia, Italy
| | - Mattia Bugatti
- Unit of Pathology, ASST Spedali Civili Di Brescia, 25100, Brescia, Italy
| | - Silvia Codenotti
- Department of Molecular and Translational Medicine, University of Brescia, 25123, Brescia, Italy
| | - Andrea Denardo
- Department of Molecular and Translational Medicine, University of Brescia, 25123, Brescia, Italy
| | - William Vermi
- Department of Molecular and Translational Medicine, University of Brescia, 25123, Brescia, Italy
- Unit of Pathology, ASST Spedali Civili Di Brescia, 25100, Brescia, Italy
| | - Alessandro Fanzani
- Department of Molecular and Translational Medicine, University of Brescia, 25123, Brescia, Italy
| | - Maura Poli
- Department of Molecular and Translational Medicine, University of Brescia, 25123, Brescia, Italy.
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Adele BO, Eddie-Anunobi OF, Adewoye EO. Oral iron supplementation ameliorated alterations in iron uptake and utilization in copper-toxic female Wistar rats. JBRA Assist Reprod 2023; 27:474-481. [PMID: 37294699 DOI: 10.5935/1518-0557.20230014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
OBJECTIVE Women are more susceptible to both iron deficiency and copper toxicity due to monthly flow and estrogen action, respectively. Oral iron is beneficial for menstruating women and enhances erythropoiesis, but both deficiency and excess of copper impact iron absorption and mobilization. The aim of this study was to investigate the possibility of mitigating copper toxicity in female Wistar rats while supplementing with iron. METHODS 20 female rats (160-180g) were grouped into four: Groups 1 (Control) received 0.3mls normal saline, 2- copper-toxic (100m mg/kg Copper sulphate), 3- Copper-toxic+Iron (100 mg/kg Copper sulphate + 1 mg/kg Ferrous sulphate) and 4- Iron (1 mg/kg Ferrous sulphate). All treatment was administered orally for 5 weeks. Blood was collected retro-orbitally after light anesthesia into EDTA and plain bottles for hematological, serum copper, iron, ferritin and total iron binding capacity (TIBC) analysis. Liver was excised for copper and iron levels while bone marrow was harvested for myeloid/erythroid ratio. The data were analyzed by one-Way ANOVA and statistical significance was considered at p<0.05. RESULTS Iron supplementation significantly increased packed cell volume, hemoglobin concentration, red blood cell count and myeloid/erythroid ratio, compared to the copper-toxic group. Serum iron and TIBC were significantly increased while liver copper and iron levels reduced significantly in iron supplemented group compared to the copper-toxic group. CONCLUSIONS Oral iron supplementation mitigated alterations in iron absorption and mobilization following copper toxicity.
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Affiliation(s)
- Bernard Omokheshi Adele
- Applied and Environmental Physiology Unit, Department of Physiology, Faculty of Basic Medical Sciences, University of Ibadan, Nigeria
| | - Ogochuckwu F Eddie-Anunobi
- Applied and Environmental Physiology Unit, Department of Physiology, Faculty of Basic Medical Sciences, University of Ibadan, Nigeria
| | - Elsie O Adewoye
- Applied and Environmental Physiology Unit, Department of Physiology, Faculty of Basic Medical Sciences, University of Ibadan, Nigeria
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Abstract
In the United States, colorectal cancer has the fourth highest amount of annual new cancer cases per year between 2014 and 2018. In this article, the authors review the data and guidelines supporting effective direct visualization and stool-based testing methods of colon cancer screening along with work-up and management of Iron Deficiency Anemia.
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Affiliation(s)
- Ethan P Berg
- SIU Decatur Family Medicine Residency, 102 West Kenwood Avenue, Ste 100, Decatur, IL 62526, USA; Department of Family & Community Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Asiya Mohammed
- Department of Family & Community Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA; SIU Springfield Family Medicine Residency, 520 N. 4th Street, Springfield, IL 62702, USA
| | - Zachary J Shipp
- SIU Decatur Family Medicine Residency, 102 West Kenwood Avenue, Ste 100, Decatur, IL 62526, USA; Department of Family & Community Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Johnny C Tenegra
- SIU Decatur Family Medicine Residency, 102 West Kenwood Avenue, Ste 100, Decatur, IL 62526, USA; Department of Family & Community Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA; Department of Family & Community Medicine, Southern Illinois University School of Medicine Decatur Family Medicine Residency, Decatur, IL, USA.
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Chang A, Rugivarodom M, Pungpipattrakul N, Akarapatima K, Suwanno K, Rattanasupar A, Ovartlarnporn B, Prachayakul V. Role of oral iron supplementation for anemia secondary to acute nonvariceal upper gastrointestinal bleeding: a randomized controlled trial. J Gastroenterol Hepatol 2023; 38:1283-1291. [PMID: 36999193 DOI: 10.1111/jgh.16185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/27/2023] [Accepted: 03/27/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND AND AIM Although acute upper gastrointestinal bleeding (UGIB) can lead to anemia, evidence regarding the effects of oral iron supplementation on UGIB-induced anemia following discharge remains lacking. The present study aimed to investigate the effects of oral iron supplementation on hemoglobin response and iron storage in patients with anemia secondary to nonvariceal UGIB. METHODS This randomized controlled trial included 151 patients with nonvariceal UGIB who had anemia at discharge. Patients were assigned to a 1:1 block in which they were either administered 6 weeks of 600 mg/d oral ferrous fumarate (treatment group, n = 77) or treated without iron supplementation (control group, n = 74). The primary outcome was composite hemoglobin response (hemoglobin elevation greater than 2 g/dL or no anemia at the end of treatment [EOT]). RESULTS The proportion of patients achieving composite hemoglobin response was greater in the treatment group than in the control group (72.7% vs 45.9%; adjusted risk ratio [RR], 2.980; P = 0.004). At EOT, the percentage change in the hemoglobin level (34.2 ± 24.8% vs 19.4 ± 19.9%; adjusted coefficient, 11.543; P < 0.001) was significantly higher in the treatment group than in the control group; however, the proportions of patients with a serum ferritin level <30 μg/L and a transferrin saturation <16% were lower in the treatment group (all P < 0.05). No significant differences in treatment-associated adverse effects and adherence rates were observed between the groups. CONCLUSION Oral iron supplementation exerts beneficial effects on anemia and iron storage following nonvariceal UGIB without significantly impacting rates of adverse effects or adherence.
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Affiliation(s)
- Arunchai Chang
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand
| | - Manus Rugivarodom
- Siriraj GI Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Keerati Akarapatima
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand
| | - Komsai Suwanno
- Division of Hematology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand
| | - Attapon Rattanasupar
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand
| | - Bancha Ovartlarnporn
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Varayu Prachayakul
- Siriraj GI Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Nazaryan H, Watson M, Ellingham D, Thakar S, Wang A, Pai M, Liu Y, Rochwerg B, Gabarin N, Arnold D, Sirotich E, Zeller MP. Impact of iron supplementation on patient outcomes for women with abnormal uterine bleeding: a protocol for a systematic review and meta-analysis. Syst Rev 2023; 12:121. [PMID: 37443063 PMCID: PMC10347734 DOI: 10.1186/s13643-023-02222-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/17/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Abnormal uterine bleeding (AUB), which includes heavy menstrual bleeding (HMB), is a common condition placing women at increased risk for developing iron deficiency and iron deficiency anemia (IDA). Depletion of iron stores has negative implications on physical, social, and emotional health, as well as quality of life. Iron supplements are safe, effective, and readily available, while red blood cell (RBC) transfusions have inherent risks including infectious and immune reactions. Despite high prevalence of IDA among women with AUB, there are limited studies on the impact of iron therapies on patient outcomes. This systematic review and meta-analysis will evaluate the impact of iron supplementation on patient outcomes for women with AUB, when compared to combination therapy, no intervention, placebo, or standard of care. METHODS We will conduct a systematic review and meta-analysis of randomized controlled trials and observational studies evaluating the impact of iron interventions on patient outcomes for women with AUB. Systematic literature searches will be conducted in major databases including MEDLINE, EMBASE, CENTRAL, CINAHL, and Web of Science. Studies assessing the impact of iron interventions on patient outcomes in women experiencing AUB, in comparison to combination therapy, no intervention, placebo, or standard of care, will be included in the review. Independent reviewers will screen for eligibility, assess risk of bias, and abstract data. Overall certainty of evidence for each outcome will be assessed using the GRADE approach. We will meta-analyze outcomes which are sufficiently homogeneous to summarize intervention effects and narratively synthesize nonhomogeneous outcomes. The main outcomes of interest are hemoglobin levels immediately prior to surgery and post-operatively, number of RBC transfusions, and adverse effects. Secondary outcomes will include length of hospital stay, intraoperative blood loss, adverse and side effects, quality of life, and iron indices. DISCUSSION This review will evaluate the impact of iron interventions on patient outcomes in women with IDA secondary to AUB with focus on changes in hematological and iron indices, red blood cell utilization, quality of life, cost of treatment, and adverse events. The results will inform evidence-based clinical practice for the management of iron deficiency and IDA secondary to AUB. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019137282.
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Affiliation(s)
- Hasmik Nazaryan
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, 1200 Main Street West HSC-3H50, Hamilton, ON L8N 3Z5 Canada
| | - Megan Watson
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, 1200 Main Street West HSC-3H50, Hamilton, ON L8N 3Z5 Canada
| | - Dana Ellingham
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, 1200 Main Street West HSC-3H50, Hamilton, ON L8N 3Z5 Canada
| | - Swarni Thakar
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, 1200 Main Street West HSC-3H50, Hamilton, ON L8N 3Z5 Canada
| | - Andrea Wang
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - Menaka Pai
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Yang Liu
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, 1200 Main Street West HSC-3H50, Hamilton, ON L8N 3Z5 Canada
| | - Bram Rochwerg
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - Nadia Gabarin
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Donald Arnold
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, 1200 Main Street West HSC-3H50, Hamilton, ON L8N 3Z5 Canada
| | - Emily Sirotich
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, 1200 Main Street West HSC-3H50, Hamilton, ON L8N 3Z5 Canada
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - Michelle P. Zeller
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, 1200 Main Street West HSC-3H50, Hamilton, ON L8N 3Z5 Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
- Canadian Blood Services, Ottawa, Canada
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DelRosso LM, Mogavero MP, Bruni O, Ferri R. Restless Legs Syndrome and Restless Sleep Disorder in Children. Sleep Med Clin 2023; 18:201-212. [PMID: 37120162 DOI: 10.1016/j.jsmc.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Restless legs syndrome (RLS) affects 2% of children presenting with symptoms of insomnia, restless sleep, decreased quality of life, and effects on cognition and behavior. The International RLS Study Group and the American Academy of Sleep Medicine have published guidelines for the diagnosis and treatment of RLS in children. Restless sleep disorder has been recently identified in children and presents with frequent movements during sleep and daytime symptoms with polysomnography findings of at least 5 large muscle movements at night. Treatment options for both disorders include iron supplementation, either oral or intravenous with improvement in nighttime and daytime symptoms.
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Affiliation(s)
- Lourdes M DelRosso
- University of California San Francisco, Fresno, USA; University Sleep and Pulmonary Associates, 6733 North Willow Avenue, Unit 107, Fresno, CA 93710, USA.
| | - Maria Paola Mogavero
- Institute of Molecular Bioimaging and Physiology, National Research Council, Milan, Italy; Division of Neuroscience, Sleep Disorders Center, San Raffaele Scientific Institute, Milan, Italy; Centro di Medicina Del Sonno, IRCCS Ospedale San Raffaele, Turro, Via Stamira D'Ancona, 20, Milano 20127, Italy
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, Sapienza University, Via dei Marsi 78, Rome 00185, Italy
| | - Raffaele Ferri
- Department of Neurology I.C., Sleep Research Centre, Oasi Research Institute - IRCCS, Via C Ruggero 73, Troina 94018, Italy
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Bijlsma J, Moslehi N, Velikov KP, Kegel WK, Vincken JP, de Bruijn WJC. Reactivity of Fe(III)-containing pyrophosphate salts with phenolics: complexation, oxidation, and surface interaction. Food Chem 2023; 407:135156. [PMID: 36525808 DOI: 10.1016/j.foodchem.2022.135156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/16/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
Mixed pyrophosphate salts with the general formula Ca2(1-x)Fe4x(P2O7)(1+2x) potentially possess less iron-phenolic reactivity compared to ferric pyrophosphate (FePP), due to decreased soluble Fe in the food-relevant pH range 3-7. We investigated reactivity (i.e., complexation, oxidation, and surface interaction) of FePP and mixed salts (with x = 0.14, 0.15, 0.18, and 0.35) in presence of structurally diverse phenolics. At pH 5-7, increased soluble iron from all salts was observed in presence of water-soluble phenolics. XPS confirmed that water-soluble phenolics solubilize iron after coordination at the salt surface, resulting in increased discoloration. However, color changes for mixed salts with x ≤ 0.18 remained acceptable for slightly water-soluble and insoluble phenolics. Furthermore, phenolic oxidation in presence of mixed salts was significantly reduced compared to FePP at pH 6. In conclusion, these mixed Ca-Fe(III) pyrophosphate salts with x ≤ 0.18 can potentially be used in designing iron-fortified foods containing slightly water-soluble and/or insoluble phenolics.
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Affiliation(s)
- Judith Bijlsma
- Laboratory of Food Chemistry, Wageningen University & Research, Bornse Weilanden 9, P.O. Box 17, 6700 AA, Wageningen, the Netherlands.
| | - Neshat Moslehi
- Van 't Hoff Laboratory for Physical and Colloidal Chemistry, Debye Institute for Nanomaterials Science, Utrecht University, Padualaan 8, 3584 CH Utrecht, the Netherlands.
| | - Krassimir P Velikov
- Unilever Innovation Centre Wageningen, Bronland 14, 6708 WH Wageningen, the Netherlands; Soft Condensed Matter, Debye Institute for Nanomaterials Science, Utrecht University, Princetonplein 5, 3584 CC Utrecht, the Netherlands; Institute of Physics, University of Amsterdam, Science Park 904, 1098 XH Amsterdam, the Netherlands.
| | - Willem K Kegel
- Van 't Hoff Laboratory for Physical and Colloidal Chemistry, Debye Institute for Nanomaterials Science, Utrecht University, Padualaan 8, 3584 CH Utrecht, the Netherlands.
| | - Jean-Paul Vincken
- Laboratory of Food Chemistry, Wageningen University & Research, Bornse Weilanden 9, P.O. Box 17, 6700 AA, Wageningen, the Netherlands.
| | - Wouter J C de Bruijn
- Laboratory of Food Chemistry, Wageningen University & Research, Bornse Weilanden 9, P.O. Box 17, 6700 AA, Wageningen, the Netherlands.
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13
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Rashidi-Alavijeh J, Nuruzade N, Frey A, Huessler EM, Hörster A, Zeller AC, Schütte A, Schmidt H, Willuweit K, Lange CM. Implications of anaemia and response to anaemia treatment on outcomes in patients with cirrhosis. JHEP Rep 2023; 5:100688. [PMID: 36926273 PMCID: PMC10011825 DOI: 10.1016/j.jhepr.2023.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/29/2022] [Accepted: 01/12/2023] [Indexed: 01/30/2023] Open
Abstract
Background & Aims Anaemia is frequently observed in patients with cirrhosis and was identified as a predictor of adverse outcomes, such as increased mortality and occurrence of acute-on-chronic liver failure. To date, the possible effects of iron supplementation on these adverse outcomes are not well described. We therefore aimed to assess the role of iron supplementation in patients with cirrhosis and its capability to improve prognosis. Methods Laboratory diagnostics were performed in consecutive outpatients with cirrhosis admitted between July 2018 and December 2019 to the University Hospital Essen. Associations with transplant-free survival were assessed in regression models. Results A total of 317 outpatients with cirrhosis were included, of whom 61 received a liver transplant (n = 19) or died (n = 42). In multivariate Cox regression analysis, male sex (hazard ratio [HR] = 3.33, 95% CI [1.59, 6.99], p = 0.001), model for end-stage liver disease score (HR = 1.19, 95% CI [1.11, 1.27], p <0.001) and the increase of haemoglobin levels within 6 months (ΔHb6) (HR = 0.72, 95% CI [0.63, 0.83], p <0.001) were associated with transplant-free survival. Regarding the prediction of haemoglobin increase, intake of rifaximin (beta = 0.50, SD beta = 0.19, p = 0.007) and iron supplementation (beta = 0.79, SD beta = 0.26, p = 0.003) were significant predictors in multivariate analysis. Conclusions An increase of haemoglobin levels is associated with improvement of transplant-free survival in patients with cirrhosis. Because the prediction of haemoglobin increase significantly depends on rifaximin and iron supplementation, application of these two medications can have an important impact on the outcome of these patients. Impact and implications Anaemia is very common in patients with cirrhosis and is known to be a predictor of negative outcomes, but little is known about the effect of iron substitution in these individuals. In our cohort, increase of haemoglobin levels improved transplant-free survival of patients with cirrhosis. The increase of haemoglobin levels was mainly induced by iron supplementation and was even stronger in the case of concomitant use of iron and rifaximin. Clinical trial registration UME-ID-10042.
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Key Words
- ACLF, acute-on-chronic liver failure
- AIH, autoimmune hepatitis
- ALT, alanine aminotransferase
- AP, alkaline phosphatase
- AST, aspartate aminotransferase
- CRP, C-reactive protein
- Haemoglobin
- INR, international normalised ratio
- Iron deficiency
- Iron supplementation
- LT, liver transplantation
- Liver transplantation
- MELD, model for end-stage liver disease
- NASH, non-alcoholic steatohepatitis
- NSBBs, non-selective beta blockers
- PBC, primary biliary cholangitis
- PSC, primary sclerosing cholangitis
- Rifaximin
- SSC, secondary sclerosing cholangitis
- TIPS, transjugular intrahepatic portosystemic shunt
- aPTT, activated partial thromboplastin time
- ΔHb3, difference of haemoglobin levels after 3 months
- ΔHb6, difference of haemoglobin levels after 6 months
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Affiliation(s)
- Jassin Rashidi-Alavijeh
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Duisburg, Germany
| | - Nargiz Nuruzade
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Duisburg, Germany
| | - Alexandra Frey
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Duisburg, Germany
| | - Eva-Maria Huessler
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University of Duisburg-Essen, Duisburg, Germany
| | - Anne Hörster
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Duisburg, Germany
| | - Amos Cornelius Zeller
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Duisburg, Germany
| | - Andreas Schütte
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Duisburg, Germany
| | - Hartmut Schmidt
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Duisburg, Germany
| | - Katharina Willuweit
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Duisburg, Germany
| | - Christian Markus Lange
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Duisburg, Germany
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P DN, B F, T DF, Ldm F, B MGF, M BR, M M, S TA, M EA. Iron Supplementation and Exercise During Pregnancy: Effects on Behavior and the Dopaminergic System. Biol Trace Elem Res 2023; 201:1639-1647. [PMID: 35715717 DOI: 10.1007/s12011-022-03306-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/28/2022] [Indexed: 11/02/2022]
Abstract
Although it is known that regular physical activity is recommended as part of a healthy lifestyle, the number of data concerning efficacy of exercise and your relationship with a demand for iron during pregnancy is limited. The purpose of this study was to evaluate the relationship between iron supplementation and exercise during pregnancy on the behavior of rats. Molecular variables dopamine transporter (DAT) and dopamine receptor (D2) related to the locomotor behavior in response to the exercise and the iron supplemented diet were investigated. Sixty-day-old female Wistar rats were used. The pregnant rats were distributed into the following groups: standard diet (SD, n = 7), iron supplementation (IS, n = 9), exercise (EX, n = 10), and exercise + iron supplementation (EX + IS, n = 9). All rats in both the pregnant and non-pregnant groups were submitted to open-field tests. The iron supplementation diet was shown to reduce locomotor behaviors, with reduced central and peripheral ambulation, reduced rearing, and increased freezing. On the other hand, physical exercise caused an increase in central and peripheral ambulation, and in rearing. The expression of the D2 receptor protein and the dopamine transporter DAT did not show changes with the interventions over 21 days of pregnancy. In this context, the present study demonstrated that both iron supplementation and exercise exerted an influence during pregnancy on the behavior of rats, however, with different effects.
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Affiliation(s)
- Daubian-Nosé P
- Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Jardim Santa Luiza, Rua Pedro Zaccaria, Limeira, São Paulo, 1300CEP 13484350, Brazil
| | - Franco B
- Faculdade de Educação Física, Universidade Estadual de Campinas, Limeira, Brazil
| | - De Fante T
- Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Jardim Santa Luiza, Rua Pedro Zaccaria, Limeira, São Paulo, 1300CEP 13484350, Brazil
| | - Forte Ldm
- Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Jardim Santa Luiza, Rua Pedro Zaccaria, Limeira, São Paulo, 1300CEP 13484350, Brazil
| | - Manchado-Gobatto F B
- Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Jardim Santa Luiza, Rua Pedro Zaccaria, Limeira, São Paulo, 1300CEP 13484350, Brazil
| | - Bezerra R M
- Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Jardim Santa Luiza, Rua Pedro Zaccaria, Limeira, São Paulo, 1300CEP 13484350, Brazil
| | - Manconi M
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Torsoni A S
- Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Jardim Santa Luiza, Rua Pedro Zaccaria, Limeira, São Paulo, 1300CEP 13484350, Brazil
| | - Esteves A M
- Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Jardim Santa Luiza, Rua Pedro Zaccaria, Limeira, São Paulo, 1300CEP 13484350, Brazil.
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15
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Nielsen P. [Influence of iron supplementation on the gut microbiota]. MMW Fortschr Med 2023; 165:20-22. [PMID: 36894842 DOI: 10.1007/s15006-023-2434-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Affiliation(s)
- Peter Nielsen
- Interdisziplinäre Arbeitsgruppe Eisenstoffwechsel, Institut für Biochemie und Molekulare Zellbiologie (IBMZ), Martinistr. 52, 20246, Hamburg, Deutschland
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Kapoor MP, Sugita M, Kawaguchi M, Timm D, Kawamura A, Abe A, Okubo T. Influence of iron supplementation on fatigue, mood states and sweating profiles of healthy non-anemic athletes during a training exercise: A double-blind, randomized, placebo-controlled, parallel-group study. Contemp Clin Trials Commun 2023; 32:101084. [PMID: 36817736 PMCID: PMC9932653 DOI: 10.1016/j.conctc.2023.101084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Iron is specifically important to athletes, and attention has grown to the association between sports performance and iron regulation in the daily diets of athletes. The study presents new insights into stress, mood states, fatigue, and sweating behavior among the non-anemic athletes with sweating exercise habits who consumed a routine low dose (3.6 mg/day) of iron supplementation. In this double-blind, randomized, placebo-controlled, parallel-group study, both non-anemic male (N = 51) and female (N = 42) athletes were supplemented either with a known highly bioavailable iron formulation (SunActive® Fe) or placebo during the follow-up training exercise period over four weeks at their respective designated clinical sites. The effect of oral iron consumption was examined on fatigue, stress profiles, as well as the quality of life using the profile of mood state (POMS) test or a visual analog scale (VAS) questionnaire, followed by an exercise and well-being related fatigue-sweat. Also, their monotonic association with stress biomarkers (salivary α-amylase, salivary cortisol, and salivary immunoglobulin A) were determined using spearman's rank correlation coefficient test. Repeated measure multivariate analysis of variance (group by time) revealed that the total mood disturbance (TMD) score was significantly lower (P = 0.016; F = 6.26) between placebo and iron supplementation groups over the four weeks study period among female athletes. Also, a significant reduction in tired feeling/exhaustion after the exercise (P = 0.05; F = 4.07) between the placebo and iron intake groups was noticed. A significant within-group reduction (P ≤ 0.05) was noticed in the degree of sweat among both male and female athletes after 2 and 4 weeks of iron supplementation, while athletes of the placebo intake group experienced a non-significant within-group reduction in the degree of sweat. Overall, the result indicates routine use of low dose (3.6 mg/day) iron supplementation is beneficial for non-anemic endurance athletes to improve stress, mood states, subjective fatigue, and sweating conditions.
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Affiliation(s)
- Mahendra P. Kapoor
- Taiyo Kagaku Co., Ltd., Research & Development, Nutrition Division, 1-3 Takaramachi, Yokkaichi, Mie, 510-0844, Japan,Corresponding author.
| | - Masaaki Sugita
- Nippon Sport Science University, Faculty of Sport Science, 7-1-1 Fukusawa, Setagaya-Ku, Tokyo, 158 8508, Japan
| | - Mikiko Kawaguchi
- Otsuma Women's University, Faculty of Home Economics, Department of Food Science, 12 Sanbancho, Chiyoda, Tokyo, 102-8357, Japan
| | - Derek Timm
- Taiyo International Inc, 5960 Golden Hills Dr., Minneapolis, MN, 55416, USA
| | - Aki Kawamura
- Nippon Sport Science University, Faculty of Sport Science, 7-1-1 Fukusawa, Setagaya-Ku, Tokyo, 158 8508, Japan
| | - Aya Abe
- Taiyo Kagaku Co., Ltd., Research & Development, Nutrition Division, 1-3 Takaramachi, Yokkaichi, Mie, 510-0844, Japan
| | - Tsutomu Okubo
- Taiyo Kagaku Co., Ltd., Research & Development, Nutrition Division, 1-3 Takaramachi, Yokkaichi, Mie, 510-0844, Japan
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Mohammed NI, Wason J, Mendy T, Nass SA, Ofordile O, Camara F, Baldeh B, Sanyang C, Jallow AT, Hossain I, Faria N, Powell JJ, Prentice AM, Pereira DI. A novel nano-iron supplement versus standard treatment for iron deficiency anaemia in children 6-35 months (IHAT-GUT trial): a double-blind, randomised, placebo-controlled non-inferiority phase II trial in The Gambia. EClinicalMedicine 2023; 56:101853. [PMID: 36880049 PMCID: PMC9985047 DOI: 10.1016/j.eclinm.2023.101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Iron deficiency anaemia (IDA) is the leading cause of years lost to disability in most sub-Saharan African countries and is especially common in young children. The IHAT-GUT trial assessed the efficacy and safety of a novel nano iron supplement, which is a dietary ferritin analogue termed iron hydroxide adipate tartrate (IHAT), for the treatment of IDA in children under 3 years of age. METHODS In this single-country, randomised, double-blind, parallel, placebo-controlled, non-inferiority Phase II study in The Gambia, children 6-35 months with IDA (7≤Hb < 11 g/dL and ferritin<30 μg/L) were randomly assigned (1:1:1) to receive either IHAT, ferrous sulphate (FeSO4) or placebo daily for 3 months (85 days). The daily iron dose was 12.5 mg Fe equivalent for FeSO4 and the estimated dose with comparable iron-bioavailability for IHAT (20 mg Fe). The primary efficacy endpoint was the composite of haemoglobin response at day 85 and correction of iron deficiency. The non-inferiority margin was 0.1 absolute difference in response probability. The primary safety endpoint was moderate-severe diarrhoea analysed as incidence density and prevalence over the 3 months intervention. Secondary endpoints reported herein include hospitalisation, acute respiratory infection, malaria, treatment failures, iron handling markers, inflammatory markers, longitudinal prevalence of diarrhoea and incidence density of bloody diarrhoea. Main analyses were per-protocol (PP) and intention-to-treat (ITT) analyses. This trial is registered with clinicaltrials.gov (NCT02941081). FINDINGS Between Nov 2017 and Nov 2018, 642 children were randomised into the study (214 per group) and included in the ITT analysis, the PP population included 582 children. A total of 50/177 (28.2%) children in the IHAT group achieved the primary efficacy endpoint, as compared with 42/190 (22.1%) in the FeSO4 group (OR 1.39, 80% CI 1.01-1.91, PP population) and with 2/186 (1.1%) in the placebo group. Diarrhoea prevalence was similar between groups, with 40/189 (21.2%) children in the IHAT group developing at least one episode of moderate-severe diarrhoea over the 85 days intervention, compared with 47/198 (23.7%) in the FeSO4 group (OR 1.18, 80% CI 0.86-1.62) and 40/195 (20.5%) in the placebo group (OR 0.96, 80% CI 0.7-1.33, PP population). Incidence density of moderate-severe diarrhoea was 2.66 in the IHAT group and 3.42 in the FeSO4 group (RR 0.76, 80% CI 0.59-0.99, CC-ITT population).There were 143/211 (67.8%) children with adverse events (AEs) in the IHAT group, 146/212 (68.9%) in the FeSO4 group and 143/214 (66.8%) in the placebo group. There were overall 213 diarrhoea-related AEs; 35 (28.5%) cases reported in the IHAT group compared with 51 (41.5%) cases in the FeSO4 group and 37 (30.1%) cases in the placebo group. INTERPRETATION In this first Phase II study conducted in young children with IDA, IHAT showed sufficient non-inferiority compared to standard-of-care FeSO4, in terms of ID correction and haemoglobin response, to warrant a definitive Phase III trial. In addition, IHAT had lower incidence of moderate-severe diarrhoea than FeSO4, with no increased adverse events in comparison with placebo. FUNDING The Bill & Melinda Gates Foundation (OPP1140952).
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Affiliation(s)
- Nuredin I. Mohammed
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - James Wason
- MRC Biostatistics Unit, Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, NE2 4BN, UK
| | - Thomas Mendy
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Stefan A. Nass
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
- Medical Humanities, Amsterdam-UMC - VUmc Location, Vrije Universiteit, Amsterdam, the Netherlands
| | - Ogochukwu Ofordile
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Famalang Camara
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Bakary Baldeh
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Chilel Sanyang
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Amadou T. Jallow
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Ilias Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
| | - Nuno Faria
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK
| | - Jonathan J. Powell
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK
| | - Andrew M. Prentice
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
- Corresponding author. MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, PO Box 273, Banjul, Gambia.
| | - Dora I.A. Pereira
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, Gambia
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK
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Tobias TJ, Vernooij JCM, van Nes A. Comparison of efficacy of needle-free injection versus injection by needle for iron supplementation of piglets: a double blind randomized controlled trial. Porcine Health Manag 2023; 9:2. [PMID: 36642740 PMCID: PMC9841657 DOI: 10.1186/s40813-022-00296-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/09/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND In pig husbandry, most piglets receive an intramuscular injection with iron around three days of age for the prevention of hypochromic, microcytic anaemia. In recent years an increased interest is noted for needle-free injections, because of efficiency and safety for man and animal. This study aims to support the evidence on efficacy to extent the registration of a commercial iron supplement with a needle-free administration application. To this aim the study has two objectives: 1) to determine the effect of needle-free injection of the iron supplement on the mean blood Haemoglobin level at weaning, as primary outcome, and mean Haematocrit and mean Body weight of pigs at weaning as secondary outcome compared to no treatment, as main determinant of iron deficiency anaemia in piglets at time of weaning; 2) to compare the effects of needle-free administration of the iron supplement with regular injection by needle, with regard to the course over time of Haemoglobin, Haematocrit, piglet growth and the differentiated haematological and serum iron parameters. METHODS A double blind randomized controlled trial was conducted with 72 piglets, 8 piglets per litter from 9 litters. At three days of age pigs were selected, based on body weight, and random allocated to three study groups: a) control non-treated group (2 pigs per litter, 18 in total), b) a group with regular iron injection by needle injection (3 pigs per litter, 27 in total), c) a group that received iron by needle-free injection (3 pigs per litter, 27 in total). At four points in time (day 3, 14, 26 and 40) piglets were weighed and bled to analyse the dynamics of red blood counts and haematological parameters as well as serum iron parameters. The primary outcome parameter was the Haemoglobin (Hb) level on day 26. Of secondary importance were Haematocrit (Ht) and body weight (BW) at weaning and parameters with tertiary importance were the course of Hb, Ht and differentiated red blood cell parameters, serum iron, iron binding capacity and iron saturation. In the statistical analyses, linear mixed effect regression modelling was used to account for repeated measures within litters and pigs. RESULTS The analyses showed that needle-free administration was as efficacious to prevent iron deficiency anaemia at day 26 as administration using regular needle injection, compared to the control group. The mean level of Hb and Ht of pigs in the needle and needle-free group did not differ significantly. No side effects were observed. CONCLUSION It is concluded that needle-free iron administration of the tested product is as efficacious as regular administration by needle injection.
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Affiliation(s)
- T. J. Tobias
- grid.5477.10000000120346234Department of Population Health Sciences, Farm Animal Health Unit, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 7, 3584CL Utrecht, The Netherlands
| | - J. C. M. Vernooij
- grid.5477.10000000120346234Department of Population Health Sciences, Farm Animal Health Unit, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 7, 3584CL Utrecht, The Netherlands
| | - A. van Nes
- grid.5477.10000000120346234Department of Population Health Sciences, Farm Animal Health Unit, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 7, 3584CL Utrecht, The Netherlands
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Lee SS, Lee J, Moon YW. Efficacy of immediate postoperative intravenous iron supplementation after staged bilateral total knee arthroplasty. BMC Musculoskelet Disord 2023; 24:17. [PMID: 36611148 PMCID: PMC9824915 DOI: 10.1186/s12891-023-06133-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Approximately 26% of patients undergoing major orthopedic elective procedures have preoperative anemia. This study aimed to investigate the effect of intravenous (IV) iron supplementation on the hemoglobin (Hb) level after staged bilateral total knee arthroplasty (TKA) in patients with or without preoperative anemia. METHODS We retrospectively analyzed 418 patients who underwent staged bilateral TKA (1 week interval). The iron group (n = 220) received IV iron isomaltoside immediately after each TKA. The no-iron group (n = 198) was recommended to receive transfusion if postoperative anemia was diagnosed between the first and second TKA. Preoperative anemia was present in 42 (21.2%) and 50 (22.7%) patients in the no-iron and iron groups, respectively. Demographic data, preoperative and postoperative Hb levels, Hb level change (preoperative minus postoperative 6-week Hb level), and blood drainage amount were compared between groups. RESULTS The transfusion rate was lower in the iron group than in the no-iron group (96.5% vs. 58.6%, P < 0.001). Overall, the demographic data, preoperative and postoperative 6-week Hb levels, Hb level change, and blood drainage amount were not significantly different between the two groups. Among patients with preoperative anemia, the iron group showed lower Hb level change (0.6 ± 0.9 vs. 0.1 ± 1.1, P = 0.016). CONCLUSION Patients with preoperative anemia treated with IV iron showed lower Hb level change than did those without IV iron treatment. Despite the lower transfusion rate, the iron group showed similar postoperative 6-week Hb level and Hb level change to the no-iron group.
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Affiliation(s)
- Sung-Sahn Lee
- grid.411612.10000 0004 0470 5112Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Gyeonggido Goyangsi, South Korea
| | - Jeounghun Lee
- grid.264381.a0000 0001 2181 989XDepartment of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon street, Gangnam-Gu, 06351 Seoul, South Korea
| | - Young-Wan Moon
- grid.264381.a0000 0001 2181 989XDepartment of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon street, Gangnam-Gu, 06351 Seoul, South Korea
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Abstract
OBJECTIVE There is concern that high iron uptake during the critical period of early brain development carries potential risks, especially for nonanemic infants. This study examined the neurocognitive functioning of 16-year-olds who were nonanemic as infants and received iron supplementation. METHODS We studied 562 Chilean adolescents (M 16.2 years; 52.7% female) who participated in a randomized controlled iron supplementation trial in infancy. Between 6 and 12 months, 346 consumed an iron-fortified formula (12.7 Fe mg/L) or, if primarily breastfed, liquid vitamins with 15 mg elemental iron as ferrous sulfate, and 216 consumed unmodified cow milk without iron or liquid vitamins without iron if primarily breastfed. RESULTS Compared to adolescents in the no-added iron condition in infancy, those in the iron-supplemented condition had poorer visual-motor integration, quantitative reasoning skills, and incurred more errors on neurocognitive tasks. Consuming larger amounts of iron-fortified formula in infancy was associated with lower arithmetic achievement. Of adolescents who had high hemoglobin at 6 months (Hb ≥ 125 g/L), those in the iron supplemented condition had poorer performance on arithmetic, quantitative reasoning, and response inhibition tests than those in the no-added iron condition. Of adolescents who had marginally low 6-month hemoglobin (Hb > 100 and < 110 g/L), those who received no-added iron incurred more errors on a visual searching task than those in the iron-supplemented condition. CONCLUSION The physiologic need for iron during the period of rapid and critical brain development in young infants should be considered vis-à-vis the risks associated with supplementing nonanemic infants with high levels of iron.Clinical Trials number: NCT01166451.
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Affiliation(s)
- Patricia L. East
- Department of Pediatrics, University of California, San
Diego, La Jolla, CA, USA
| | - Brie Reid
- Department of Psychiatry and Human Behavior, Brown
University Medical School, Providence, RI, USA
| | - Estela Blanco
- Department of Pediatrics, University of California, San
Diego, La Jolla, CA, USA
- Department of Public Health, Pontifical Catholic University
of Chile, Santiago, Chile
| | - Raquel Burrows
- Institute of Nutrition and Food Technology, University of
Chile, Santiago, Chile
| | - Betsy Lozoff
- Department of Pediatrics, University of Michigan, Ann
Arbor, MI, USA
| | - Sheila Gahagan
- Department of Pediatrics, University of California, San
Diego, La Jolla, CA, USA
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Cui F, Liu H, Li Y, Zheng TZ, Xu S, Xia W, Sheng X. Association of exposure to per- and polyfluoroalkyl substances with hemoglobin and hematocrit during pregnancy. Ecotoxicol Environ Saf 2022; 248:114319. [PMID: 36423372 DOI: 10.1016/j.ecoenv.2022.114319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFASs) are common environmental contaminants and are widely detected in humans. Previous studies have linked PFASs exposure to adverse birth outcomes. However, the association between maternal exposure to PFASs and hemoglobin (Hb) and hematocrit (HCT) remains unclear. OBJECTIVES We aimed to explore the relationship between PFASs exposure with Hb and HCT during pregnancy. METHODS The present birth cohort study included 1044 pregnant women from Wuhan, China. Maternal HCT and Hb were measured in the first, second and third trimesters, and 13 PFASs were detected in the cord sera. Mixed linear models and general linear regression were applied to analyze the association between each single PFASs and Hb and HCT. Weighted quantile sum (WQS) regressions were used to investigate the association between PFASs mixture and Hb and HCT during pregnancy. RESULTS In single-PFAS models, 10 PFASs were positively associated with HCT and Hb across pregnancy (a 10-fold increase in PFASs was associated with 1.47-3.54 % change in HCT and 1.46-3.20 % change in Hb (All P-FDR < 0.05). In addition, Hb and HCT were more positively related to PFASs in the second and third trimesters rather than the first trimester. The association between PFASs exposure and maternal HCT and Hb was not significant in the iron supplementation group, whereas significant in the non-iron supplementation group. A significant interaction between iron supplementation and non-iron supplementation was also detected. WQS regressions showed that perfluorononanoic acid (PFNA) and perfluorohexane sulfonate (PFHxS) contributed most to the association between PFASs and HCT and Hb in the second and third trimesters, respectively. CONCLUSION Maternal PFASs exposure was positive with serum Hb and HCT. Moreover, maternal iron supplementation may play a modifying effect in influencing the relationship between PFASs and HCT and Hb.
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Affiliation(s)
- Fengzhen Cui
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Hongxiu Liu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yuanyuan Li
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Tong-Zhang Zheng
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Shunqing Xu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Wei Xia
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
| | - Xia Sheng
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
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DelRosso LM, Reuter-Yuill LM, Cho Y, Ferri R, Mogavero MP, Picchietti DL. Clinical efficacy and safety of intravenous ferric carboxymaltose treatment for restless legs symptoms and low serum ferritin in children with autism spectrum disorder. Sleep Med 2022; 100:488-493. [PMID: 36265207 DOI: 10.1016/j.sleep.2022.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Restless legs syndrome (RLS) may be underdiagnosed in children with autism spectrum disorder (ASD) due to difficulty expressing the symptoms in their own words. In addition, administration of oral iron may be particularly difficult in children with ASD. METHODS This was a retrospective, open-label case series of children with ASD, restless legs (RL) symptoms, and serum ferritin <30 μg/L, who either had failed or did not tolerate oral iron, and were subsequently treated with intravenous (IV) ferric carboxymaltose (FCM). Patients received a single dose of IV FCM, 15 mg/kg up to a maximum dose of 750 mg. Data collected pre- and eight weeks post-infusion included presenting symptoms, serum ferritin, iron profile, and Clinical Global Impression Scale (CGI-Severity pre- and CGI-Improvement post-infusion). Adverse effects were assessed. RESULTS Nineteen children, 4-11 years old (12 male, median age 6, interquartile range (IQR 4-11) were included. A definite RLS diagnosis was identified in 6 verbal children (31.6%). RL symptoms (designated probable RLS) in the 13 other children met all RLS diagnostic criteria except "improvement of symptoms with movement," which was not definitively determined. Baseline median values were: ferritin 10 μg/L (IQR 10-16), iron 66.5 μg/dL (IQR 57-96), TIBC 382 μg/dL (IQR 360-411) and transferrin saturation 19% (IQR 14-28). Median CGI-S was 4 (moderate symptoms) (IQR 3-4). At eight weeks after IV FCM, all measures were improved. Median ferritin was 68 μg/L (IQR 62.5-109, p < 0.00045). Median CGI-I was 1 (very much improved) (IQR 1-2). All children meeting definite RLS criteria improved. Three children in the probable RLS group did not improve. Children meeting the full RLS criteria had lower baseline ferritin levels than those with a probable diagnosis (9 μg/L, IQR 9-10 vs. 13 μg/L, IQR 10-16, Mann-Whitney test p < 0.045). Adverse effects included lightheadedness, gastrointestinal discomfort, fever, and headache among others. CONCLUSIONS The majority of children (84.2%) with ASD, restless legs symptoms, and serum ferritin <30 μg/L had clinical improvement and significantly better serum iron parameters after a single IV FCM infusion. Although larger, randomized trials are needed, IV FCM appears to be a promising treatment for this subset of children with ASD.
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Affiliation(s)
- Lourdes M DelRosso
- Seattle Children's Hospital and University of Washington, Seattle, WA, USA.
| | - Lilith M Reuter-Yuill
- Western Michigan University, Kalamazoo, MI, Comprehensive Speech and Therapy Center, Jackson, MI, and Southern Illinois University, Carbondale, IL, USA
| | - Yeilim Cho
- Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Research Institute - IRCCS, Troina, Italy
| | - Maria P Mogavero
- Institute of Molecular Bioimaging and Physiology, National Research Council, Milan, Italy; Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Italy
| | - Daniel L Picchietti
- University of Illinois School of Medicine, Carle Illinois College of Medicine, Carle Foundation Hospital, and University of Illinois School of Medicine, Urbana, IL, USA
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Mengistu GT, Mengistu BK, Gudeta TG, Terefe AB, Habtewold FM, Senbeta MD, Sori SA, Jiru HD. Magnitude and factors associated with iron supplementation among pregnant women in Southern and Eastern Regions of Ethiopia: Further Analysis of mini demographic and health survey 2019. BMC Nutr 2022; 8:66. [PMID: 35850710 PMCID: PMC9295274 DOI: 10.1186/s40795-022-00562-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background Anemia is a global public health problem that affects pregnant women. The most common cause of anemia is iron deficiency which is extremely common in developing countries. World health organization reported that 36.5% of pregnant women are anemic globally. In Ethiopia, 27.08% of women of the reproductive age group are anemic. Therefore, this study aimed to identify the magnitude and factors associated with iron supplementation during pregnancy in the southern and eastern regions of Ethiopia. Methods The data used in this analysis were extracted from Mini Demographic and Health Survey 2019. The survey was conducted in 9 regional states and two city administrations. The data used in the analysis were extracted from individual women datasets, and 1780 study participants were included in this study. The logistic regression analysis including bivariate and multivariable logistic regression at a 95% confidence interval and a p-value less than 0.05 was used. Result The finding of the study shows that iron supplementation during pregnancy in Southern and Eastern parts of Ethiopia was 50.06%. Among those who received iron, only about 20% took it for 90 days and more during their pregnancy. Iron supplementation among the pregnant women was affected by secondary education [AOR = 2.20, 95%CI (1.325, 3.638)], residing in urban [AOR = 1.75, 95%CI (1.192, 2.574)], having media at home [AOR = 1.41, 95%CI (1.022, 1.946)], having antenatal care follow up [AOR = 9.27, 95%CI (4.727, 18.169)], having 4 and more ANC follow up [AOR = 2.01, 95%CI (1.468,2.760], having antenatal care follow up at government health institutions [AOR = 3.40, 95%CI (1.934, 5.982)], and giving birth at governmental health institutions [AOR = 1.70, 95%CI (1.236, 2.336)]. Conclusion Only one in two pregnant women was supplemented with iron during their recent pregnancy. The supplementation was affected by women's education, place of residence, presence of media at home, antenatal care follow-up, the number of antenatal care follow up, antenatal care follows up at governmental health institutions, and giving birth at the governmental health institution. The availability and accessibility of maternal care services and their functionality in providing maternal care services improve the supplementation.
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Affiliation(s)
- Girma Teferi Mengistu
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
| | - Bizunesh Kefale Mengistu
- Department of Statistics, College of Natural and Computational Science, Ambo University, Ambo, Ethiopia
| | - Tolesa Gemeda Gudeta
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Ayana Benti Terefe
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | | | - Mebratu Demissie Senbeta
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Seboka Abebe Sori
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Hirut Dinku Jiru
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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DelRosso LM, Mogavero MP, Ferri R, Bruni O. Restless Sleep Disorder (RSD): a New Sleep Disorder in Children. A Rapid Review. Curr Neurol Neurosci Rep 2022. [PMID: 35699902 DOI: 10.1007/s11910-022-01200-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Restless sleep disorder (RSD) is a recently identified pediatric sleep disorder characterized by frequent movements during sleep associated with daytime symptoms. In this review we summarize the expanding evidence of the clinical presentation of RSD, potential pathophysiology, associated comorbidities, and current treatment options that will help the pediatrician identify children with RSD in a timely manner. RECENT FINDINGS RSD is diagnosed in 7.7% of children referred evaluated in a pediatric sleep center. Children with RSD present with frequent nightly movements during sleep for at least 3 months, and have daytime symptoms related to poor sleep quality including excessive sleepiness, hyperactivity, irritability among other symptoms. Current evidence shows an increased sympathetic predominance, increased NREM sleep instability, and iron deficiency, as well as increased prevalence in parasomnias and attention deficit hyperactivity disorder. Consensus diagnostic criteria were recently published to diagnose RSD and emergent evidence suggests that iron supplementation improves its nighttime and daytime symptoms.
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Choukroun G, Kazes I, Dantal J, Vabret E, Couzi L, Le Meur Y, Trochu JN, Cacoub P; investigateurs de l’étude CARENFER IRC. [Prevalence of iron deficiency in patients with non-dialysis chronic kidney disease: The CARENFER national, multicentre, observational study]. Nephrol Ther 2022; 18:195-201. [PMID: 35241379 DOI: 10.1016/j.nephro.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/08/2021] [Accepted: 12/19/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Iron deficiency is common and associated with worse outcomes in patients with non-dialysis chronic kidney disease. We performed a national, multicentre, observational and transversal study to assess the prevalence of iron deficiency as well as current iron deficiency screening practices in this population. PATIENTS AND METHODS A total of 25 nephrology centres in France participated in the study. All adult non-dialysis chronic kidney disease patients who met the inclusion (GFR>15mL/min/1.73m2) and exclusion criteria and provided consent were systematically recruited over a 4-week inclusion period. Investigators were asked to perform a blood test (hemoglobin concentration, serum iron, serum ferritin and transferrin saturation) and to complete a questionnaire about their iron status monitoring practices. The primary objective was to assess the prevalence of iron deficiency (serum ferritin<100μg/L and/or transferrin saturation<20%). Secondary objectives were to evaluate the prevalence of absolute iron deficiency (serum ferritin<100μg/L and transferrin saturation<20%) and functional iron deficiency (serum ferritin≥100μg/L and transferrin saturation<20%), the prevalence of iron deficiency according to haemoglobin concentration and chronic kidney disease stage, the proportion of centres that perform routine evaluation of iron status and the number of patients receiving iron supplementation. RESULTS A total of 1211 patients with non-dialysis chronic kidney disease were included in the analysis. The overall prevalence of iron deficiency was 47.1%. The rates of absolute iron deficiency and functional iron deficiency and anaemia were 13.4% and 17.1%, respectively. Among the 25 participating centres, 12 reported routine assessment of iron status in non-dialysis chronic kidney disease patients. CONCLUSION In this observational study, a high prevalence of iron deficiency was observed among non-dialysis chronic kidney disease patients. Less than half of participating centres reported routine assessment of iron status.
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Unger HW, Bleicher A, Ome-Kaius M, Aitken EH, Rogerson SJ. Associations of maternal iron deficiency with malaria infection in a cohort of pregnant Papua New Guinean women. Malar J 2022; 21:153. [PMID: 35619134 PMCID: PMC9137066 DOI: 10.1186/s12936-022-04177-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Iron deficiency (ID) is common in malaria-endemic settings. Intermittent preventative treatment of malaria in pregnancy (IPTp) and iron supplementation are core components of antenatal care in endemic regions to prevent adverse pregnancy outcomes. ID has been associated with reduced risk of malaria infection, and correspondingly, iron supplementation with increased risk of malaria infection, in some studies. METHODS A secondary analysis was conducted amongst 1888 pregnant women enrolled in a malaria prevention trial in Papua New Guinea. Maternal ID was defined as inflammation-corrected plasma ferritin levels < 15 μg/L at antenatal enrolment. Malaria burden (Plasmodium falciparum, Plasmodium vivax) was determined by light microscopy, polymerase chain reaction, and placental histology. Multiple logistic and linear regression analyses explored the relationship of ID or ferritin levels with indicators of malaria infection. Models were fitted with interaction terms to assess for modification of iron-malaria relationships by gravidity or treatment arm. RESULTS Two-thirds (n = 1226) and 13.7% (n = 258) of women had ID and peripheral parasitaemia, respectively, at antenatal enrolment (median gestational age: 22 weeks), and 18.7% (120/1,356) had evidence of malaria infection on placental histology. Overall, ID was associated with reduced odds of peripheral parasitaemia at enrolment (adjusted odds ratio [aOR] 0.50; 95% confidence interval [95% CI] 0.38, 0.66, P < 0.001); peripheral parasitaemia at delivery (aOR 0.68, 95% CI 0.46, 1.00; P = 0.050); and past placental infection (aOR 0.35, 95% CI 0.24, 0.50; P < 0.001). Corresponding increases in the odds of infection were observed with two-fold increases in ferritin levels. There was effect modification of iron-malaria relationships by gravidity. At delivery, ID was associated with reduced odds of peripheral parasitaemia amongst primigravid (AOR 0.44, 95% CI 0.25, 0.76; P = 0.003), but not multigravid women (AOR 1.12, 95% CI 0.61, 2.05; P = 0.720). A two-fold increase in ferritin associated with increased odds of placental blood infection (1.44, 95% CI 1.06, 1.96; P = 0.019) and active placental infection on histology amongst primigravid women only (1.24, 95% CI 1.00, 1.54; P = 0.052). CONCLUSIONS Low maternal ferritin at first antenatal visit was associated with a lower risk of malaria infection during pregnancy, most notably in primigravid women. The mechanisms by which maternal iron stores influence susceptibility to infection with Plasmodium species require further investigation. TRIAL REGISTRATION
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Affiliation(s)
- Holger W Unger
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Andie Bleicher
- Department of Medicine (RMH), Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Elizabeth H Aitken
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Stephen J Rogerson
- Department of Medicine (RMH), Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia.
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia.
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Cordova LT, Palmer CM, Alper HS. Shifting the distribution: modulation of the lipid profile in Yarrowia lipolytica via iron content. Appl Microbiol Biotechnol 2022; 106:1571-1581. [PMID: 35099573 DOI: 10.1007/s00253-022-11800-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 11/02/2022]
Abstract
Microbial fermentation offers a sustainable source of fuels, commodity chemicals, and pharmaceuticals, yet strain performance is influenced greatly by the growth media selected. Specifically, trace metals (e.g., iron, copper, manganese, zinc, and others) are critical for proper growth and enzymatic function within microorganisms yet are non-standardized across media formulation. In this work, the effect of trace metal supplementation on the lipid production profile of Yarrowia lipolytica was explored using tube scale fermentation followed by biomass and lipid characterization. Addition of iron (II) to the chemically defined Yeast Synthetic Complete (YSC) medium increased final optical density nearly twofold and lipid production threefold, while addition of copper (II) had no impact. Additionally, dose-responsive changes in lipid distribution were observed, with the percent of oleic acid increasing and stearic acid decreasing as initial iron concentration increased. These changes were reversible with subsequent iron-selective chelation. Use of rich Yeast Peptone Dextrose (YPD) medium enabled further increases in the production of two specialty oleochemicals ultimately reaching 63 and 47% of the lipid pool as α-linolenic acid and cyclopropane fatty acid, respectively, compared to YSC medium. Selective removal of iron (II) natively present in YPD medium decreased this oleochemical production, ultimately aligning the lipid profile with that of non-supplemented YSC medium. These results provide further insight into the proposed mechanisms for iron regulation in yeasts especially as these productions strains contain a mutant allele of the iron regulator, mga2. The work presented here also suggests a non-genetic method for control of the lipid profile in Y. lipolytica for use in diverse applications. KEY POINTS: • Iron supplementation increases cell density and lipid titer in Yarrowia lipolytica. • Iron addition reversibly alters lipid portfolio increasing linolenic acid. • Removal of iron from YPD media provides a link to enhanced oleochemical production.
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Affiliation(s)
- Lauren T Cordova
- McKetta Department of Chemical Engineering, The University of Texas at Austin, 200 E Dean Keeton St. Stop C0400, Austin, TX, 78712, USA
| | - Claire M Palmer
- Institute for Cellular and Molecular Biology, The University of Texas at Austin, 2500 Speedway Avenue, Austin, TX, 78712, USA
| | - Hal S Alper
- McKetta Department of Chemical Engineering, The University of Texas at Austin, 200 E Dean Keeton St. Stop C0400, Austin, TX, 78712, USA. .,Institute for Cellular and Molecular Biology, The University of Texas at Austin, 2500 Speedway Avenue, Austin, TX, 78712, USA.
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28
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Luciano R, Romeo DM, Mancini G, Sivo S, Dolci C, Velli C, Turriziani Colonna A, Vento G, Romagnoli C, Mercuri EM. Neurological development and iron supplementation in healthy late-preterm neonates: a randomized double-blind controlled trial. Eur J Pediatr 2022; 181:295-302. [PMID: 34291331 PMCID: PMC8760203 DOI: 10.1007/s00431-021-04181-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
Late-preterm infants (LPT) are at increased risk for long-term neurodevelopmental sequelae and iron deficiency. The aim of the study is to assess the positive effect of iron supplementation on psychomotor development in healthy LPT. We designed a randomized placebo-controlled double-blind trial dividing the newborns into two groups. Every patient was assessed using the Griffiths Mental Development Scales (GMDS)-II edition at 12-month post-conceptional age. The study was performed at the Neonatology Unit of our Hospital, in Italy. Sixty-six healthy LPT infants born between 340⁄7 and 366⁄7 weeks of gestational age were enrolled in the study. One group received martial prophylaxis from the third week of life to 6 months of post-conceptional age (2 mg/kg/day of iron pidolate), the other received placebo. Fifty-two of the enrolled infants were assessed using the GMDS at 12-month of post-conceptional age. Statistical analysis of the mean scores of the Griffiths subscales was performed. There was a difference in the mean developmental quotient (DQ) (p < 0.01) between the two groups: iron group mean DQ 121.45 ± 10.53 vs placebo group mean DQ 113.25 ± 9.70. Moreover, mean scores of the Griffiths subscales A, B, and D showed significant differences between the two groups (scale A p < 0.05, scale B p < 0.02, scale D p < 0.01, respectively).Conclusions: We recommend that all LPT neonates receive iron supplementation during the first 6 months of life in order to improve their 1-year neurodevelopmental quotient. What is Known: • Late-preterm infants (LPT) are at increased risk for long-term neurodevelopmental sequelae and also for iron deficiency. • Iron deficiency is an independent risk factor for adverse neurological outcomes. What is New: • Healthy late-preterm who received iron supplementation during the first 6 months of life achieved better neurological outcomes at 12-month post-conceptional age than LPT who received placebo. • Our study strongly supports the need for the implementation of martial prophylaxis in LPT neonates.
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Affiliation(s)
- R. Luciano
- Neonatology Unit, Department of Woman and Child Health and Public Health, Child Health Area, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - D. M. Romeo
- Pediatric Neurology Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - G. Mancini
- Department of Woman and Child Health and Public Health, Child Health Area, Catholic University of Sacred Heart, Rome, Italy
| | - S. Sivo
- Pediatric Neurology Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - C. Dolci
- Department of Woman and Child Health and Public Health, Child Health Area, Catholic University of Sacred Heart, Rome, Italy
| | - C. Velli
- Pediatric Neurology Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - A. Turriziani Colonna
- Department of Woman and Child Health and Public Health, Child Health Area, Catholic University of Sacred Heart, Rome, Italy
| | - G. Vento
- Neonatology Unit, Department of Woman and Child Health and Public Health, Child Health Area, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - C. Romagnoli
- Neonatology Unit, Department of Woman and Child Health and Public Health, Child Health Area, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - E. M. Mercuri
- Pediatric Neurology Unit, Department of Woman and Child Health and Public Health, Child Health Area, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of Sacred Heart, Rome, Italy
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Liang L, Xiong Q, Kong J, Tian C, Miao L, Zhang X, Du H. Intraperitoneal supplementation of iron alleviates dextran sodium sulfate-induced colitis by enhancing intestinal barrier function. Biomed Pharmacother 2021; 144:112253. [PMID: 34607106 DOI: 10.1016/j.biopha.2021.112253] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/15/2021] [Accepted: 09/26/2021] [Indexed: 02/07/2023] Open
Abstract
Iron supplementation is necessary for the treatment of anemia, one of the most frequent complications in inflammatory bowel disease (IBD). However, oral iron supplementation leads to an exacerbation of intestinal inflammation. Gut barrier plays a key role in the pathogenesis of IBD. The aim of this study was to characterize the interrelationship between systemic iron, intestinal barrier and the development of intestinal inflammation in a dextran sulfate sodium (DSS) induced experimental colitis mice model. We found that DSS-treated mice developed severe inflammation of colon, but became much healthy when intraperitoneal injection with iron. Iron supplementation alleviated colonic and systemic inflammation by lower histological scores, restorative morphology of colonic villi, and reduced expression of pro-inflammatory cytokines. Moreover, intraperitoneal supplementation of iron enhanced intestinal barrier function by upregulating the colonic expressions of tight junction proteins, restoring intestinal immune homeostasis by regulating immune cell infiltration and T lymphocyte subsets, and increasing mucous secretion of goblet cells in the colon. High-throughput sequencing of fecal 16 S rRNA showed that iron injection significantly increased the relative abundance of Bacteroidetes, which was suppressed in the gut microbiota of DSS-induced colitis mice. These results provided evidences supporting the protective effects of systemic iron repletion by intraperitoneal injection of iron on intestinal barrier functions. The finding highlights a novel approach for the treatment of IBD with iron injection therapy.
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Affiliation(s)
- Li Liang
- Key Laboratory of Animal Feed and Nutrition of Zhejiang Province, College of Animal Sciences, Zhejiang University, Hangzhou, China
| | - Qingqing Xiong
- Key Laboratory of Animal Feed and Nutrition of Zhejiang Province, College of Animal Sciences, Zhejiang University, Hangzhou, China
| | - Jingxia Kong
- Department of Investment and Insurance, Zhejiang Financial College, Hangzhou, China
| | - Chenying Tian
- Key Laboratory of Animal Feed and Nutrition of Zhejiang Province, College of Animal Sciences, Zhejiang University, Hangzhou, China
| | - Linfeng Miao
- Key Laboratory of Animal Feed and Nutrition of Zhejiang Province, College of Animal Sciences, Zhejiang University, Hangzhou, China
| | - Xiaofeng Zhang
- Institute of Animal Husbandry and Veterinary Science, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021, China
| | - Huahua Du
- Key Laboratory of Animal Feed and Nutrition of Zhejiang Province, College of Animal Sciences, Zhejiang University, Hangzhou, China.
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Zakrzewski M, Wilkins SJ, Helman SL, Brilli E, Tarantino G, Anderson GJ, Frazer DM. Supplementation with Sucrosomial® iron leads to favourable changes in the intestinal microbiome when compared to ferrous sulfate in mice. Biometals 2021; 35:27-38. [PMID: 34697758 PMCID: PMC8803775 DOI: 10.1007/s10534-021-00348-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/06/2021] [Indexed: 12/12/2022]
Abstract
Iron deficiency is one of the most common nutritional deficiencies worldwide and is often treated with oral iron supplements. However, commonly used supplements, including those based on ferrous iron salts, are associated with gastrointestinal side effects and unfavorable changes in the intestinal microbiome. Sucrosomial® iron is a novel iron formulation that is effective at treating iron deficiency, and with fewer gastrointestinal side effects, yet its effect on the gut microbiome has not been examined previously. Thus, we treated mice for two weeks with diets containing either Sucrosomial® iron or ferrous sulfate as the sole iron source and examined bacterial communities in the intestine using 16S Microbial Profiling of DNA extracted from feces collected both prior to and following dietary treatment. Mice treated with Sucrosomial® iron showed an increase in Shannon diversity over the course of the study. This was associated with a decrease in the abundance of the phylum Proteobacteria, which contains many pathogenic species, and an increase in short chain fatty acid producing bacteria such as Lachnospiraceae, Oscillibacter and Faecalibaculum. None of these changes were observed in mice treated with ferrous sulfate. These results suggest that Sucrosomial® iron may have a beneficial effect on the intestinal microbiome when compared to ferrous sulfate and that this form of iron is a promising alternative to ferrous iron salts for the treatment of iron deficiency.
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Affiliation(s)
- Martha Zakrzewski
- Medical Genomics, QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Sarah J Wilkins
- Iron Metabolism Laboratory, QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Sheridan L Helman
- Molecular Nutrition Laboratory, QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Locked Bag 2000, Herston, QLD, 4029, Australia.,Faculty of Medicine, The University of Queensland, St Lucia, Australia
| | | | | | - Gregory J Anderson
- Iron Metabolism Laboratory, QIMR Berghofer Medical Research Institute, Herston, Australia.,School of Chemistry and Molecular Bioscience, The University of Queensland, St Lucia, Australia
| | - David M Frazer
- Molecular Nutrition Laboratory, QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Locked Bag 2000, Herston, QLD, 4029, Australia. .,School of Biomedical Sciences, The University of Queensland, St Lucia, Australia. .,School of Biomedical Sciences, The Queensland University of Technology, Gardens Point, Brisbane, Australia.
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31
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Unger HW, Laurita Longo V, Bleicher A, Ome-Kaius M, Karl S, Simpson JA, Karahalios A, Aitken EH, Rogerson SJ. The relationship between markers of antenatal iron stores and birth outcomes differs by malaria prevention regimen-a prospective cohort study. BMC Med 2021; 19:236. [PMID: 34607575 PMCID: PMC8491429 DOI: 10.1186/s12916-021-02114-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/31/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Iron deficiency (ID) has been associated with adverse pregnancy outcomes, maternal anaemia, and altered susceptibility to infection. In Papua New Guinea (PNG), monthly treatment with sulphadoxine-pyrimethamine plus azithromycin (SPAZ) prevented low birthweight (LBW; <2500 g) through a combination of anti-malarial and non-malarial effects when compared to a single treatment with SP plus chloroquine (SPCQ) at first antenatal visit. We assessed the relationship between ID and adverse birth outcomes in women receiving SPAZ or SPCQ, and the mediating effects of malaria infection and haemoglobin levels during pregnancy. METHODS Plasma ferritin levels measured at antenatal enrolment in a cohort of 1892 women were adjusted for concomitant inflammation using C-reactive protein and α-1-acid glycoprotein. Associations of ID (defined as ferritin <15 μg/L) or ferritin levels with birth outcomes (birthweight, LBW, preterm birth, small-for-gestational-age birthweight [SGA]) were determined using linear or logistic regression analysis, as appropriate. Mediation analysis assessed the degree of mediation of ID-birth outcome relationships by malaria infection or haemoglobin levels. RESULTS At first antenatal visit (median gestational age, 22 weeks), 1256 women (66.4%) had ID. Overall, ID or ferritin levels at first antenatal visit were not associated with birth outcomes. There was effect modification by treatment arm. Amongst SPCQ recipients, ID was associated with a 81-g higher mean birthweight (95% confidence interval [CI] 10, 152; P = 0.025), and a twofold increase in ferritin levels was associated with increased odds of SGA (adjusted odds ratio [aOR] 1.25; 95% CI 1.06, 1.46; P = 0.007). By contrast, amongst SPAZ recipients, a twofold increase in ferritin was associated with reduced odds of LBW (aOR 0.80; 95% CI 0.67, 0.94; P = 0.009). Mediation analyses suggested that malaria infection or haemoglobin levels during pregnancy do not substantially mediate the association of ID with birth outcomes amongst SPCQ recipients. CONCLUSIONS Improved antenatal iron stores do not confer a benefit for the prevention of adverse birth outcomes in the context of malaria chemoprevention strategies that lack the non-malarial properties of monthly SPAZ. Research to determine the mechanisms by which ID protects from suboptimal foetal growth is needed to guide the design of new malaria prevention strategies and to inform iron supplementation policy in malaria-endemic settings. TRIAL REGISTRATION ClinicalTrials.gov NCT01136850 .
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Affiliation(s)
- Holger W Unger
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Valentina Laurita Longo
- Catholic University of Sacred Heart, Rome, Italy.,Department of Obstetrics and Gynaecology, San Pietro-Fatebenefratelli Hospital, Rome, Italy
| | - Andie Bleicher
- Department of Medicine (RMH), Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
| | - Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Stephan Karl
- Australian Institute of Tropical Health & Medicine, James Cook University, Cairns, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth H Aitken
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen J Rogerson
- Department of Medicine (RMH), Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia. .,Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Victoria, Australia.
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DelRosso LM, Ferri R, Chen ML, Kapoor V, Allen RP, Mogavero MP, Picchietti DL. Clinical efficacy and safety of intravenous ferric carboxymaltose treatment of pediatric restless legs syndrome and periodic limb movement disorder. Sleep Med 2021; 87:114-8. [PMID: 34562823 DOI: 10.1016/j.sleep.2021.08.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/23/2021] [Accepted: 08/29/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Iron supplementation is the most commonly considered treatment option for children with restless legs syndrome (RLS) or periodic limb movement disorder (PLMD); however, there is a scarcity of evidence on the effectiveness of intravenous preparations. In this study, we evaluated the effectiveness and tolerability of intravenous ferric carboxymaltose (IV FCM) on clinical symptoms and iron indices in children with RLS or PLMD. METHODS This was a single-center retrospective data analysis. Children with a diagnosis of RLS or PLMD, who underwent a single infusion of IV FCM, were included. Clinical Global Impression (CGI) Scale scores, serum ferritin, and serum iron profile at baseline and after eight weeks post infusion were obtained. Adverse effects were assessed. RESULTS Thirty-nine children received IV FCM, 29 with RLS and 10 with PLMD. Pre-infusion CGI-Severity revealed moderate illness, with post-infusion CGI-Improvement between "very much improved" and "much improved". Ferritin increased from 14.6 μg/L±7.01 to 112.4 μg/L±65.86 (p < 0.00001), together with improvements in iron, total iron binding capacity, and transferrin levels from baseline to post-treatment. When compared to children with RLS, those with PLMD had a similar improvement in clinical symptoms and laboratory parameters. Seven subjects (14.3%) experienced one or two adverse events; all were mild. CONCLUSIONS Children with RLS and PLMD responded to IV iron supplementation with improvement in both clinical severity and laboratory parameters. Treatment was well tolerated. Although larger, randomized-controlled trials are needed, IV FCM appears to be a promising alternative to oral iron supplementation for the treatment of pediatric RLS or PLMD.
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Reggiani F, Colombo G, Astori E, Landoni L, Finazzi S, Milzani A, Angelini C, Dalle-Donne I, Cucchiari D. Preliminary experience on the use of sucrosomial iron in hemodialysis: focus on safety, hemoglobin maintenance and oxidative stress. Int Urol Nephrol 2021; 54:1145-1153. [PMID: 34510284 DOI: 10.1007/s11255-021-02983-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Iron is usually administered in hemodialysis patients by parenteral route, as oral absorption is poor due to high hepcidin levels. However, administrations of intravenous iron and iron overload are associated with high oxidative stress and systemic inflammation that can affect patient survival. With this study, we evaluated an alternative type of oral iron for the treatment of anemia in hemodialysis patients. The formulation consists in ferric pyrophosphate covered by phospholipids plus sucrose ester of fatty acid matrix, named sucrosomial iron, whose absorption is not influenced by hepcidin. METHODS Twenty-four (24) patients undergoing chronic hemodialysis switched iron supplementation from intravenous (ferric gluconate 62.5 mg weekly) to oral (sucrosomial iron, 90 mg weekly in 3 administrations of 30 mg) route for 3 months. Classical anemia, iron metabolism, inflammation and nutritional biomarkers were monitored, as well as biomarkers of oxidative stress, such as protein-bound di-tyrosines, protein carbonylation, advanced oxidation protein products and protein thiols. RESULTS Over the 3 months, hemoglobin values remained stable, as the values of hematocrit and mean corpuscular volume. In parallel, other anemia parameters dropped, including ferritin, transferrin saturation and serum iron. On the other side, nutritional biomarkers, such as total proteins and transferrin, increased significantly during the time frame. We also observed a significant decrease in white blood cells as well as a non-significant reduction in C-reactive protein and some oxidative stress biomarkers, such as protein carbonyls and di-tyrosines. CONCLUSION Our study demonstrates that a therapy with sucrosomial iron in hemodialysis patients is safe and can maintain stable hemoglobin levels in a three-month period with a possible beneficial effect on oxidative stress parameters. However, the reduction of ferritin and transferrin saturation suggests that a weekly dosage of 90 mg is not sufficient in hemodialysis patients in the long time to maintain hemoglobin.
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Affiliation(s)
- Francesco Reggiani
- Nephrology and Dialysis Unit, Humanitas Clinical and Research Center, Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Graziano Colombo
- Department of Biosciences, Università Degli Studi Di Milano, Milan, Italy
| | - Emanuela Astori
- Department of Biosciences, Università Degli Studi Di Milano, Milan, Italy
| | - Lucia Landoni
- Department of Biosciences, Università Degli Studi Di Milano, Milan, Italy
| | - Silvia Finazzi
- Nephrology and Dialysis Unit, Humanitas Clinical and Research Center, Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Aldo Milzani
- Department of Biosciences, Università Degli Studi Di Milano, Milan, Italy
| | - Claudio Angelini
- Nephrology and Dialysis Unit, Humanitas Clinical and Research Center, Manzoni 56, 20089, Rozzano, Milan, Italy
| | | | - David Cucchiari
- Nephrology and Dialysis Unit, Humanitas Clinical and Research Center, Manzoni 56, 20089, Rozzano, Milan, Italy. .,Renal Transplant Unit, Hospital Clínic, Barcelona, Spain.
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Hoffmann A, Haschka D, Valente de Souza L, Tymoszuk P, Seifert M, von Raffay L, Hilbe R, Petzer V, Moser PL, Nairz M, Weiss G. Baseline iron status and presence of anaemia determine the course of systemic Salmonella infection following oral iron supplementation in mice. EBioMedicine 2021; 71:103568. [PMID: 34488018 PMCID: PMC8426537 DOI: 10.1016/j.ebiom.2021.103568] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/29/2021] [Accepted: 08/18/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Iron deficiency anaemia (IDA) is a major health concern. However, preventive iron supplementation in regions with high burden of infectious diseases resulted in an increase of infection related morbidity and mortality. METHODS We fed male C57BL/6N mice with either an iron deficient or an iron adequate diet. Next, they received oral iron supplementation or placebo followed by intraperitoneal infection with Salmonella Typhimurium (S.Tm). FINDINGS We found that mice with IDA had a poorer clinical outcome than mice on an iron adequate diet. Interestingly, iron supplementation of IDA mice resulted in higher bacterial burden in organs and shortened survival. Increased transferrin saturation and non-transferrin bound iron in the circulation together with low expression of ferroportin facilitated the access of the pathogen to iron and promoted bacterial growth. Anaemia, independent of iron supplementation, was correlated with reduced neutrophil counts and cytotoxic T cells. With iron supplementation, anaemia additionally correlated with increased splenic levels of the cytokine IL-10, which is suggestive for a weakened immune control to S.Tm infection. INTERPRETATION Supplementing iron to anaemic mice worsens the clinical course of bacterial infection. This can be traced back to increased iron delivery to bacteria along with an impaired anti-microbial immune response. Our findings may have important implications for iron supplementation strategies in areas with high endemic burden of infections, putting those individuals, who potentially profit most from iron supplementation for anaemia, at the highest risk for infections. FUNDING Financial support by the Christian Doppler Laboratory for Iron Metabolism and Anemia Research.
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Affiliation(s)
- Alexander Hoffmann
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, Innsbruck A-6020, Austria; Christian Doppler Laboratory for Iron Metabolism and Anemia Research, Medical University of Innsbruck, Innsbruck A-6020, Austria
| | - David Haschka
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, Innsbruck A-6020, Austria
| | - Lara Valente de Souza
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, Innsbruck A-6020, Austria; Christian Doppler Laboratory for Iron Metabolism and Anemia Research, Medical University of Innsbruck, Innsbruck A-6020, Austria
| | - Piotr Tymoszuk
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, Innsbruck A-6020, Austria
| | - Markus Seifert
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, Innsbruck A-6020, Austria; Christian Doppler Laboratory for Iron Metabolism and Anemia Research, Medical University of Innsbruck, Innsbruck A-6020, Austria
| | - Laura von Raffay
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, Innsbruck A-6020, Austria
| | - Richard Hilbe
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, Innsbruck A-6020, Austria
| | - Verena Petzer
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, Innsbruck A-6020, Austria
| | - Patrizia L Moser
- Institute of Pathology, INNPATH, Anichstraße 35, Innsbruck A-6020, Austria
| | - Manfred Nairz
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, Innsbruck A-6020, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Medical University of Innsbruck, Anichstraße 35, Innsbruck A-6020, Austria; Christian Doppler Laboratory for Iron Metabolism and Anemia Research, Medical University of Innsbruck, Innsbruck A-6020, Austria.
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Agegnehu CD, Tesema GA, Teshale AB, Alem AZ, Yeshaw Y, Kebede SA, Liyew AM. Spatial distribution and determinants of iron supplementation among pregnant women in Ethiopia: a spatial and multilevel analysis. Arch Public Health 2021; 79:143. [PMID: 34376252 PMCID: PMC8353869 DOI: 10.1186/s13690-021-00669-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal anemia continues as a global public health concern particularly in developing countries including Ethiopia. It is associated with an increased risk of maternal death, obstetric complications, preterm birth, and low birth weight. Even though maternal anemia is the commonest problem in Ethiopia, there is limited evidence on the spatial distribution and determinants of iron supplementation. Therefore, this study aimed to investigate the spatial distribution and determinants of iron supplementation among pregnant women in Ethiopia. METHOD A secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 7589 women was included for analysis. For the spatial analysis; ArcGIS version 10.6, and SaT Scan version 9.6 statistical software were employed to explore the spatial distribution, and to identify significant hotspot areas of iron supplementation in Ethiopia. For the determinant factors, multilevel logistic regression analysis was fitted to identify significant individual and community level determinants of iron supplementation. Deviance, Median Odds Ratio (MOR), and Intra-class Correlation Coefficient (ICC) were used for model comparison and for assessing model fitness. Variables with a p-value of less than 0.2 in the bivariable analysis were considered in the multivariable multilevel analysis. In the multivariable multilevel analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was used to declare significant determinants of iron supplementation. RESULTS The spatial distribution of iron supplementation was significantly varied across the country with Global Moran's index value of 0.3 (p < 0.001). The SaTScan analysis identified a total of 271 significant clusters, of these 89 clusters were primary clusters located in the Southwest Somali and Central Oromia regions (LLR = 66.69, P < 0.001, RR = 1.35). ANC visit (AOR = 3.66, 95%CI: 3.21, 417), community education [AOR = 1.31, 95%CI, 1.07, 1.59), media exposure (AOR = 1.33, 95%CI: 1.15, 1.53), distance to health facility (AOR = 1.32, 95%CI: 1.16, 1.50), region and household wealth index were statistically significant determinant factors of iron supplementation. CONCLUSION Iron supplementation among pregnant women were significantly varied across the country. Therefore, the finding of this study could help to design effective public health interventions targeting areas with low iron supplementation and maternal health services should be delivered in all areas of our country. Besides, public health programs should enhance iron supplementation through promoting ANC visits, media exposure, and giving special emphasis to marginalized and remote areas.
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Affiliation(s)
- Chilot Desta Agegnehu
- School of Nursing, College of Medicine and Health Sciences and Comprehensive specialized hospital, University of Gondar, Gondar, Ethiopia.
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yigizie Yeshaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sewnet Adem Kebede
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Mekuriaw Liyew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mekonen EG, Alemu SA. Determinant factors of poor adherence to iron supplementation among pregnant women in Ethiopia: A large population-based study. Heliyon 2021; 7:e07530. [PMID: 34296018 PMCID: PMC8282951 DOI: 10.1016/j.heliyon.2021.e07530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/17/2021] [Accepted: 07/06/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Anemia during pregnancy increases the risk of premature delivery as well as maternal and child mortality. More than 40% and almost one-third of pregnant women are anemic worldwide and in Ethiopia respectively. Iron supplementation is important to prevent anemia during pregnancy in developing countries including Ethiopia. Despite this fact, it is at a substandard level in Ethiopia. Therefore, this study was conducted to identify the determinant factors of poor adherence to iron supplementation among pregnant women in Ethiopia. Methods A cross-sectional study was conducted based on the EDHS data for 2016 from two city administrations and nine regions of Ethiopia. A total of 3, 266 women were included. Bivariable and multivariable logistic regression analysis was employed. P-value < 0.05 and odds ratios were used to determine the significance and strength of association. Results Those pregnant women who had no mobile telephone [AOR; 0.79, 95% CI (0.65–0.95)], a history of cigarette smoking & alcohol use [AOR; 0.20, 95% CI (0.09–0.45)] and [AOR; 0.77, 95% CI (0.64–0.93)], and less than four antenatal care visits [AOR; 0.56, 95% CI (0.46, 0.68)] had higher odds of poor adherence. Conclusion Not having a mobile telephone, a history of smoking and alcohol use, and less than four antenatal care visits were determinant factors of poor adherence to iron supplementation. It is important to empower women, strengthen communication for behavioral change, and give attention to counseling pregnant women.
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Affiliation(s)
- Enyew Getaneh Mekonen
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Samrawit Abebe Alemu
- Department of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Shi G, Zhang Z, Ma L, Zhang B, Dang S, Yan H. Association between maternal iron supplementation and newborn birth weight: a quantile regression analysis. Ital J Pediatr 2021; 47:133. [PMID: 34090489 PMCID: PMC8180103 DOI: 10.1186/s13052-021-01084-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 05/26/2021] [Indexed: 12/03/2022] Open
Abstract
Objective Our study aimed to explore the association between maternal iron supplementation and newborn birth weight (BW) in Shaanxi Province using quantile regression (QR). Method The data used in this study were derived from a large cross-sectional survey of a population in Shaanxi Province, Northwest China. A total of 28,209 women and their infants were selected using a stratified multistage random sampling method. The effect of iron supplementation on the newborn BW was assessed by a multiple linear regression model and QR. Results A total of 5.15% of the women took iron supplements during pregnancy. Multiple linear regression showed that the iron supplementation during pregnancy had positive effects on the BW, with an average increase of 43.07 g (β = 43.07, t = 3.55, and p < 0.001). The QR showed that the iron supplementation during pregnancy was associated with an increased newborn BW from very low to higher percentiles (quantiles: 0 ~ 0.40), with the β ranging from 136.51 to 43.86. As the percentiles of the BW increased, the neonatal BW gain gradually declined in the iron supplementation group compared with the group that did not receive iron supplementation (quantiles: 0 ~ 0.40, with the β ranging from 136.51 to 43.86). Iron supplementation was more effective among women who suffered from anemia during pregnancy (β = 45.84, t = 2.05, and p = 0.04; quantiles: 0 ~ 0.15, 0.30, 0.80, with β ranging from 150.00 to 39.29) than it was in any other group (β = 38.18, t = 2.62, and p = 0.009; quantiles: 0 ~ 0.15, with β ranging from 133.33 to 28.32). Conclusions Iron supplementation during pregnancy is associated with an increased newborn BW, and the effect was more obvious in the newborns with the lower BW and newborns whose mothers suffered from anemia during pregnancy. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-021-01084-7.
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Affiliation(s)
- Guoshuai Shi
- Department of Epidemiology and Biostatistics, School of Public health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China
| | - Zhuo Zhang
- Institute of Chinese Medical Sciences & State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Macau, China
| | - Lu Ma
- Xi'an Shiyou University, Xi'an, 710065, Shaanxi, China
| | - Binyan Zhang
- Department of Epidemiology and Biostatistics, School of Public health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China
| | - Shaonong Dang
- Department of Epidemiology and Biostatistics, School of Public health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China.
| | - Hong Yan
- Department of Epidemiology and Biostatistics, School of Public health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, China. .,Nutrition and Food Safety Engineering Research Center of Shaanxi Province, Xi'an, 710061, China.
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38
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Shao Y, Mao B, Qiu J, Bai Y, Lin R, He X, Lin X, Lv L, Tang Z, Zhou M, Xu X, Yi B, Liu Q. Association between Iron Supplementation, Dietary Iron Intake and Risk of Moderate Preterm Birth: A Birth Cohort Study in China. Iran J Public Health 2021; 50:1177-1187. [PMID: 34540738 PMCID: PMC8410969 DOI: 10.18502/ijph.v50i6.6416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/06/2020] [Indexed: 01/15/2023]
Abstract
Background: To evaluate the independent and collective effects of maternal iron supplementation and dietary iron intake upon the risk of moderate preterm birth and its subtypes. Methods: In this birth cohort study, 1019 pregnant women with moderate preterm birth and 9160 women with term birth were recruited at Gansu Provincial Maternity and Child Care Hospital from 2010–2012 in China. Unconditional logistic regression models were utilized to evaluate the association between maternal iron supplementation, dietary iron intake, and the risk of moderate preterm birth and its subtypes. Results: Compared with non-users, iron supplement users exerted a protective effect upon the overall (OR=0.54, 95%CI=0.40–0.72) and spontaneous moderate preterm birth (OR=0.39, 95%CI=0.33–0.83). Compared with the 25th quartiles of dietary iron intake, either before or during pregnancy, it exerted a significantly protective effect upon those who had the highest quartiles of dietary iron intake (OR=0.87, 95%CI=0.82–0.95 for the highest quartiles of dietary iron intake before pregnancy OR=0.85, 95%CI=0.79–0.91). Positive association was observed between the additive scale and multiplicative scale for preterm birth, spontaneous preterm rather than medically indicated preterm. Conclusion: Iron supplements (60 mg/day) and high-iron intake (>25.86 mg/day before pregnancy, >30.46 mg/day during pregnancy) reduced the risk of moderate preterm birth. Positive correlation is found between the additive scale and multiplicative scale for preterm birth, spontaneous preterm birth.
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Affiliation(s)
- Yawen Shao
- Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Baohong Mao
- Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Jie Qiu
- Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Yan Bai
- Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Ru Lin
- Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Xiaochun He
- Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Xiaojuan Lin
- Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Ling Lv
- Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Zhongfeng Tang
- Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Min Zhou
- Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Xiaoying Xu
- Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Bin Yi
- Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Qing Liu
- Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
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39
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Awaad A, Abdel Aziz HO. Iron biodistribution profile changes in the rat spleen after administration of high-fat diet or iron supplementation and the role of curcumin. J Mol Histol 2021; 52:751-766. [PMID: 34050395 DOI: 10.1007/s10735-021-09986-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022]
Abstract
Curcumin as active metal chelating and antioxidant agent has a potential role in metal reduction and free radicals' neutralization in tissues. Of note, long-term administration of high fat diet (HFD) is considered as a main factor of blood serum iron deficiency. This study aimed to investigate the biodistribution profiles of iron in the spleen after long-term administration of HFD along with iron supplementation. Furthermore, the ameliorative role of curcumin to reduce iron accumulation level and improve the histological abnormalities produced by iron in spleen will be evaluated in the rats. Treated albino rats of this experiment were divided into six groups. Group I was a control group where group II was treated with HFD. Group III and group IV were treated with combination of HFD and curcumin or HFD and iron supplement respectively. Additionally, group V and group VI were treated with combination of HFD, iron supplement and curcumin or curcumin only respectively. Mainly histological analysis was used to investigate iron biodistribution and induced abnormalities in spleen under light microscope. The histochemical specific staining of iron in the spleen showed different biodistribution profiles of iron in the spleen. Administration of the HFD or HFD and iron supplementation increased the iron accumulation in the spleen. Where, curcumin administration with HFD (Group III) or with HFD and iron supplementation (Group V) significantly reduced the iron levels in the spleen. The splenic tissue inflammation, cellular apoptosis and fibrosis produced by higher iron accumulation was ameliorated after administration of curcumin supplementation as shown in the animals treated with HFD/curcumin (Group III) or HFD/iron supplement/curcumin (Group V). This study recommended that, it is preferable to use iron supplementation along with curcumin supplement for less than 4 months to avoid additional iron accumulation in the healthy organs.
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Affiliation(s)
- Aziz Awaad
- Department of Zoology, Faculty of Science, Sohag University, Sohag, 82524, Egypt.
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40
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Kunst I, Krebs M, Dreschl B, Prager G, Meyer E, Kautzky-Willer A, Ranzenberger-Haider T. Iron Deficiency - Not Only a Premenopausal Topic After Bariatric Surgery? Obes Surg 2021; 31:3242-50. [PMID: 33821393 DOI: 10.1007/s11695-021-05380-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 11/11/2022]
Abstract
Purpose In our centre, specialized high dose multivitamin supplementation designed to meet the needs of patients after gastric bypass surgery is routinely recommended in the early postoperative period. The aim of the present study was to analyse whether iron supplementation prescribed in clinical practice is sufficient in both sexes and whether multivitamin supplementation standardized for women might potentially lead to iron overload in men. Materials/Methods This was a retrospective study covering the period up to 36 months after bariatric surgery. Three groups were compared (men, premenopausal and postmenopausal women). The iron status was evaluated employing serum ferritin concentrations. Results A total of 283 patients who had at least one follow-up visit between January 2015 and April 2018 at a specialized academic outpatient centre were included (71 men, 130 premenopausal women, 82 postmenopausal women). Thirty-six months after surgery, 33.3%, 68.4% and 54.5% of the men, pre- and postmenopausal women, respectively, were iron deficient. The preoperative prevalence of excess ferritin levels was 13.7% in premenopausal, 3.0% in postmenopausal women, 5.7% in men and declined in the following months. Conclusion Iron deficiency is very common after gastric bypass surgery, and even high dosages of multivitamin and mineral supplements might not be sufficient to prevent the development of iron deficiency. Men, pre- and postmenopausal women differ in their prevalence of iron deficiency which demands adapted iron dosage regimens based on the sex and the age. Iron overload is rare in all observed groups and highest in premenopausal women. Graphical abstract ![]()
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Pezel T, Audureau E, Mansourati J, Baudry G, Ben Driss A, Durup F, Fertin M, Godreuil C, Jeanneteau J, Kloeckner M, Koukoui F, Kesri-Tartière L, Laperche T, Roubille F, Cohen-Solal A, Damy T. Diagnosis and Treatment of Iron Deficiency in Heart Failure: OFICSel study by the French Heart Failure Working Group. ESC Heart Fail 2021; 8:1509-1521. [PMID: 33619905 PMCID: PMC8006682 DOI: 10.1002/ehf2.13245] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/23/2021] [Indexed: 01/19/2023] Open
Abstract
AIMS Iron deficiency (ID) occurs in about 50% of patients with heart failure (HF). The European Society of Cardiology (ESC) recommends ID diagnostic testing in newly diagnosed patients with HF and during follow-up, with intravenous iron supplementation (IS) only recommended in patients with HF with reduced ejection fraction (HFrEF). This study aimed to assess prevalence, clinical characteristics, and application of ESC guidelines for ID and IS in patients with HF in the real-life clinical setting. METHODS AND RESULTS The French transversal multicentre OFICSel registry (300 cardiologists) conducted in 2017 included patients hospitalized for HF at least once in the previous 5 years. Diverse adult patients were eligible including inpatients and outpatients and those with acute and chronic HF. Data were collected from cardiologists and patients using study-specific surveys. Data included demographic and clinical data, as well as HF and ID management data. Overall, 2822 patients, mainly male (69.3%) with a median age of 69 years (interquartile range 58-78), were included. A total of 1075 patients (38.1%) were tested for ID, with 364 (33.9%) diagnosed. Of these, 168 (46.2%) received IS: 128 (76.2%) intravenous IS and 40 (23.8%) oral. Among the 201 patients with HFrEF diagnosed with ID, 99 (49.3%) received IS: 79 (79.8%) intravenous IS and 20 (20.2%) oral. CONCLUSIONS In clinical practice, only one-third of patients with HF had a diagnostic test for ID. In patients with ID with HFrEF, only 39.3% received intravenous IS as recommended. Thus, in general, cardiologists should be encouraged to follow the ESC guidelines to ensure optimal treatment for patients with HF.
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Affiliation(s)
- Theo Pezel
- Department of Cardiology, Centre Hospitalo-Universitaire (CHU) Lariboisière, AP-HP, 2 rue Ambroise Paré, Paris, 75010, France.,Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | - Guillaume Baudry
- Department of Cardiology, Heart Failure Unit, CH Louis Pradel, Bron, France
| | | | | | - Marie Fertin
- Department of Cardiology, CHRU Lille, Lille, France
| | - Christian Godreuil
- Service de Réadaptation Cardiovasculaire et Hôpital Médical de Jour, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France
| | | | - Martin Kloeckner
- Service de Cardiologie, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, France
| | - François Koukoui
- Rehabilitation Center, CH Sud Francilien, Corbeil-Essonnes, France
| | | | - Thierry Laperche
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Department of Cardiology, CHU de Montpellier, Montpellier, France
| | - Alain Cohen-Solal
- Department of Cardiology, Centre Hospitalo-Universitaire (CHU) Lariboisière, AP-HP, 2 rue Ambroise Paré, Paris, 75010, France
| | - Thibaud Damy
- Department of Cardiology, Referral Centre for Cardiac Amyloidosis, CHU Henri Mondor, AP-HP, Créteil, France
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Lewis ED, Wu D, Mason JB, Chishti AH, Leong JM, Barger K, Meydani SN, Combs GF. Safe and effective delivery of supplemental iron to healthy older adults: The double-blind, randomized, placebo-controlled trial protocol of the Safe Iron Study. Gates Open Res 2021; 3:1510. [PMID: 33655197 PMCID: PMC7890045 DOI: 10.12688/gatesopenres.13039.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/23/2022] Open
Abstract
The forms of iron currently available to correct iron deficiency have adverse effects, including infectious diarrhea, increased susceptibility to malaria, inflammation and detrimental changes to the gut microbiome. These adverse effects limit their use such that the growing burden of iron deficiency has not abated in recent decades. Here, we summarize the protocol of the "Safe Iron Study", the first clinical study examining the safety and efficacy of novel forms of iron in healthy, iron-replete adults. The Safe Iron Study is a double-blind, randomized, placebo-controlled trial conducted in Boston, MA, USA. This study compares ferrous sulfate heptahydrate (FeSO 4·H 2O) with two novel forms of iron supplements (iron hydroxide adipate tartrate (IHAT) and organic fungal iron metabolite (Aspiron™ Natural Koji Iron)). In Phase I, we will compare each source of iron administrated at a low dose (60 mg Fe/day). We will also determine the effect of FeSO 4 co-administrated with a multiple micronutrient powder and weekly administration of FeSO 4. The forms of iron found to produce no adverse effects, or adverse effects no greater than FeSO 4 in Phase I, Phase II will evaluate a higher, i.e., a therapeutic dose (120 mg Fe/day). The primary outcomes of this study include ex vivo malaria ( Plasmodium falciparum) infectivity of host erythrocytes, ex vivo bacterial proliferation (of selected species) in presence of host plasma and intestinal inflammation assessed by fecal calprotectin. This study will test the hypotheses that the novel forms of iron, administered at equivalent doses to FeSO 4, will produce similar increases in iron status in iron-replete subjects, yet lower increases in ex vivo malaria infectivity, ex vivo bacterial proliferation, gut inflammation. Ultimately, this study seeks to contribute to development of safe and effective forms of supplemental iron to address the global burden of iron deficiency and anemia. Registration: ClinicalTrials.gov identifier: NCT03212677; registered: 11 July 2017.
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Affiliation(s)
- Erin D. Lewis
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, 02111, USA
| | - Dayong Wu
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, 02111, USA
| | - Joel B. Mason
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, 02111, USA
| | - Athar H. Chishti
- Department of Developmental, Molecular and Chemical Biology, Tufts University, Boston, Massachusetts, 02111, USA
| | - John M. Leong
- Department of Molecular Biology and Microbiology, Tufts University, Boston, Massachusetts, 02111, USA
| | - Kathryn Barger
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, 02111, USA
| | - Simin N. Meydani
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, 02111, USA
| | - Gerald F. Combs
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, 02111, USA
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Gao Y, Wang Y, Zou S, Mi X, Kc A, Zhou H. Association of iron supplementation and deworming with early childhood development: analysis of Demographic and Health Surveys in ten low- and middle-income countries. Eur J Nutr 2021; 60:3119-3130. [PMID: 33521887 DOI: 10.1007/s00394-021-02493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE We assessed the associations of iron supplementation and deworming separately or combined with improved early childhood development (ECD) status. METHODS Cross-sectional data were analyzed for 29,729 children aged 36-59 months surveyed using the Demographic and Health Surveys in ten low- and middle-income countries, where iron supplementation and deworming are recommended by the World Health Organization. In each country, we estimated linear regression models for the effects of iron supplementation and deworming individually or combined on the Early Childhood Development Index (ECDI) z score, and whether this association differed between various ECD domains and the sex and residence of the child. Estimates were pooled using random-effects meta-analyses. RESULTS Compared with receiving neither of the two interventions, iron supplementation plus deworming was associated with an increased ECDI z score (β = 0.13, 95% confidence interval (CI) 0.03-0.22, p = 0.009), particularly in rural residences. However, iron supplementation and deworming, individually, were not associated with the ECDI z score. Iron supplementation plus deworming was associated with higher odds of on-track development in literacy-numeracy (OR = 1.57, 95% CI 1.24-2.01, p < 0.001) and learning domains (OR = 1.27, 95% CI 1.09-1.48, p = 0.003), but not with development in the social-emotional and physical domains. CONCLUSION Iron supplementation plus deworming, particularly for populations who are more susceptible to iron deficiency and intestinal worm infections, could be an important intervention for improving ECD. These findings may inform the argument for the necessity of implementing iron supplementation and deworming for preschool-age children.
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Affiliation(s)
- Yaqing Gao
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Yinping Wang
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Siyu Zou
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Xiaoyi Mi
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Ashish Kc
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Hong Zhou
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China.
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Ahmed SM, Sundby J, Aragaw YA, Nordeng H. Medication-related problems among hospitalized pregnant women in a tertiary teaching hospital in Ethiopia: a prospective observational study. BMC Pregnancy Childbirth 2020; 20:737. [PMID: 33243156 PMCID: PMC7690074 DOI: 10.1186/s12884-020-03433-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/17/2020] [Indexed: 12/05/2022] Open
Abstract
Background Studies on medication-related problems (MRPs) among pregnant women are scarce, despite the potential consequences for both mother and child. This study aimed to describe the prevalence, clinical significance, and risk factors for MRPs among hospitalized pregnant or postpartum women at Jimma University Medical Centre (JUMC) in Ethiopia. Methods A prospective follow-up and clinical audit of 1117 hospitalized pregnant or postpartum women in the maternity and gynaecology wards at JUMC was carried out between February and June 2017. Patients were followed throughout their stay in the hospital to assess the presence and development of MRPs. Pre-tested data extraction form and an interview-guided structured questionnaire were used to collect data. Descriptive statistics were used to describe MRPs. Logistic regression analysis was used to identify factors associated with MRPs. Results One or more MRPs occurred among 323 (28.9%) study participants, mostly in relation to lack of iron supplementation. A total of 278 (70.6%) of all MRPs were considered to be of moderate to high clinical significance. When excluding MRPs due to iron from the analysis, chronic disease (adjusted OR 1.91; 95% CI 1.02, 3.58), medication use prior to admission (adjusted OR 2.38; 95% CI 1.24, 4.56), nulliparity (adjusted OR 1.99; 95% CI 1.22, 3.24) and multiparity (adjusted OR 1.91; 95% CI 1.17, 3.12) were significantly associated with experiencing an MRP. Conclusions Nearly 3 out of 10 hospitalized pregnant women at JUMC had one or more MRPs. The need for additional iron therapy was by far the most common type of MRP. Improved adherence to guidelines on iron supplementation are required. Multidisciplinary approaches including physicians, nurses, anesthesia professionals and clinical pharmacists in the maternity and gynaecology wards could possibly prevent MRPs and promote patient safety for women and children. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03433-6.
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Affiliation(s)
- Seid Mussa Ahmed
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway. .,Division of Social and Administrative Pharmacy, School of Pharmacy, Faculty of Health Sciences, Jimma Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Johanne Sundby
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Yesuf Ahmed Aragaw
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, Jimma Institute of Health, Jimma University, Jimma, Ethiopia
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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45
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Cavalcoli F, Gandini A, Matelloni IA, Catalano F, Alicante S, Manfredi G, Brambilla G, Menozzi F, Perolini F, Costi E, Bertè R, Buscarini E. Dietary iron intake and anemia: food frequency questionnaire in patients with hereditary hemorrhagic telangiectasia. Orphanet J Rare Dis 2020; 15:295. [PMID: 33081831 PMCID: PMC7574540 DOI: 10.1186/s13023-020-01554-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Hereditary hemorrhagic telangiectasia (HHT) is a multisystemic inherited vascular disease characterized by a heterogeneous clinical presentation and prognosis. Dietary evaluation is relevant in HHT patients to provide adequate iron and nutrient intake. Additionally, different dietary items have been reported to precipitate epistaxis in this setting. Our primary aim was to investigate the dietary habits of HHT patients through a food-frequency questionnaire (FFQ) to evaluate the presence of precipitants and/or protective factors for epistaxis and the occurrence of possible dietary modifications. The secondary aims were to evaluate the nutritional intake of iron in HHT patients and the self-reported effect of iron treatments on epistaxis. From April 2018 to October 2018, a 138-item FFQ was provided to HHT patients followed up at the HHT Referral Center of Crema Maggiore Hospital. The relationship between food items and epistaxis was ascertained on a separate form. Daily iron intake was calculated to establish the mean iron content of food items reported in the FFQ. Results One hundred forty-nine questionnaires were evaluated [72 females, median age 54 years (12–76). Overall, 26 (18%) patients reported dietary items that improved epistaxis (mostly blueberries and red fruits, green vegetables and legumes), while 38 (26%) reported some dietary items that exacerbated epistaxis (spices, chocolate, alcohol, strawberries and ginger). Dietary modifications were reported in up to 58% of cases. In HHT patients, the mean daily iron intake was 8.46 ± 2.78 mg, and no differences were observed in the iron intake of patients reporting a diet modification and those who did not. Conclusions In the comprehensive management of HHT a healthy and balanced diet, with increased consumption of dietary items with a high iron content, should be encouraged.
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Affiliation(s)
- Federica Cavalcoli
- Gastroenterology Department, HHT Reference Center, Maggiore Hospital, ASST Crema, Largo Ugo Dossena 2, 26013, Crema, Italy.
| | - Alberto Gandini
- Gastroenterology Department, HHT Reference Center, Maggiore Hospital, ASST Crema, Largo Ugo Dossena 2, 26013, Crema, Italy
| | - Irene Aglaia Matelloni
- Gastroenterology Department, HHT Reference Center, Maggiore Hospital, ASST Crema, Largo Ugo Dossena 2, 26013, Crema, Italy
| | | | - Saverio Alicante
- Gastroenterology Department, HHT Reference Center, Maggiore Hospital, ASST Crema, Largo Ugo Dossena 2, 26013, Crema, Italy
| | - Guido Manfredi
- Gastroenterology Department, HHT Reference Center, Maggiore Hospital, ASST Crema, Largo Ugo Dossena 2, 26013, Crema, Italy
| | - Gianfranco Brambilla
- Gastroenterology Department, HHT Reference Center, Maggiore Hospital, ASST Crema, Largo Ugo Dossena 2, 26013, Crema, Italy
| | - Fernanda Menozzi
- Gastroenterology Department, HHT Reference Center, Maggiore Hospital, ASST Crema, Largo Ugo Dossena 2, 26013, Crema, Italy
| | - Federica Perolini
- Gastroenterology Department, HHT Reference Center, Maggiore Hospital, ASST Crema, Largo Ugo Dossena 2, 26013, Crema, Italy
| | - Egon Costi
- Gastroenterology Department, HHT Reference Center, Maggiore Hospital, ASST Crema, Largo Ugo Dossena 2, 26013, Crema, Italy
| | - Roberto Bertè
- Gastroenterology Department, HHT Reference Center, Maggiore Hospital, ASST Crema, Largo Ugo Dossena 2, 26013, Crema, Italy
| | - Elisabetta Buscarini
- Gastroenterology Department, HHT Reference Center, Maggiore Hospital, ASST Crema, Largo Ugo Dossena 2, 26013, Crema, Italy
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East P, Doom J, Blanco E, Burrows R, Lozoff B, Gahagan S. Young adult outcomes associated with lower cognitive functioning in childhood related to iron-fortified formula in infancy. Nutr Neurosci 2020; 25:709-718. [PMID: 32778008 DOI: 10.1080/1028415x.2020.1804099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: This study examined how the lower cognitive skills in children who consumed iron-fortified formula in infancy relate to outcomes in young adulthood.Methods: Participants were 443 Chilean young adults (M age = 21.2y, 55% female) who took part in a randomized controlled iron-deficiency anemia preventive trial during infancy (6-12 m). Slightly over half of participants (n = 237) received iron-fortified formula (12.7 mg/L) and 206 received a low-iron formula (2.3 mg/L). Spatial memory, IQ, and visual-motor integration were measured at age 10, and neurocognition, emotion regulation, educational level, and attainment of adult developmental milestones were assessed at age 21.Results: Consumption of iron-fortified formula in infancy was associated with poorer performance on neurocognitive tests in childhood, and these effects related to poorer neurocognitive, emotional, and educational outcomes in young adulthood. Dosage effects associated with consumption of iron-fortified formula were found for lower educational attainment and, marginally, slower mental processing. Those who received iron-fortified formula and had low age 10 cognitive abilities performed most poorly on neurocognitive tests at age 21.Conclusion: Findings suggest that the long-term development of infants who consume iron-fortified formula may be adversely affected.Clinical Trials number: NCT01166451.
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Affiliation(s)
- Patricia East
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Jenalee Doom
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Estela Blanco
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA.,Public Health Doctoral Program, University of Chile, Santiago, Chile
| | - Raquel Burrows
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Betsy Lozoff
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Sheila Gahagan
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
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Abbruzzese L, Agostini V, Livraghi A, Manzini PM, Marmifero M, Tirindelli CM. How to implement of patient blood management pillar 1: An Italian expert opinion based on a "bundles" approach. Transfus Apher Sci 2020; 59:102874. [PMID: 32713628 DOI: 10.1016/j.transci.2020.102874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
Worldwide iron anemia is a common disorder with a significant economic burden on health-care systems. Red blood cell transfusion is the mainstay to correct anemia in surgical settings, but it is also an overused procedure and recent data support its possible role in worsening patient outcomes. Patient Blood Management (PBM) is a multidisciplinary approach to optimize hemostasis, manage anemia, minimize iatrogenic blood loss, and improve tolerance to anemia. The present paper aims to provide a "bundles" approach, based on several preoperative anemia management measures, to implement PBM Pillar 1 in clinical practice.
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Affiliation(s)
- Luciano Abbruzzese
- Transfusion Medicine, Azienda Ospedaliera "Card. G. Panico", Tricase, Lecce, Italy
| | - Vanessa Agostini
- Transfusion Medicine, Ospedale Policlinico San Martino, Genova, Italy
| | - Alessandra Livraghi
- Immunohematology and Transfusion Medicine Service, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Paola Maria Manzini
- Blood Bank and Transfusion Medicine, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Melania Marmifero
- Transfusion Medicine, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Via Venezia 16, Alessandria, Italy.
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Chen R, Li L, Xiang Z, Li H, Hou XL. Association of iron supplementation with risk of transfusion, hospital length of stay, and mortality in geriatric patients undergoing hip fracture surgeries: a meta-analysis. Eur Geriatr Med 2020; 12:5-15. [PMID: 32691389 DOI: 10.1007/s41999-020-00366-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/13/2020] [Indexed: 02/08/2023]
Abstract
AIMS To assess the efficacy and safety of iron supplementation for perioperative anemia in geriatric patients with hip fracture. METHODS A systematic search was conducted for studies published using PubMed, EMBASE and Cochrane Library Databases that compared iron supplementation with placebo in patients undergoing hip fracture surgery. The outcomes were blood transfusion rate and volume, length of stay, infection and mortality (last follow-up). Sub-group and sensitivity analyses were performed in cases of substantial heterogeneity. RESULTS The meta-analysis (6 studies: 1201 patients) indicated that iron supplements were not associated with reducing blood transfusion rate (OR 0.92, 95% CI 0.60-1.41; P = 0.69), but high heterogeneity (I2 = 61%) was detected and a significant association was found in sensitivity analysis of four studies (n = 637; OR 0.68, 95% CI 0.49-0.95; P = 0.02). A significant reduction was detected in transfusion volume (two studies: n = 234; MD - 0.45 units/patient, 95% CI - 0.74 to - 0.16; P = 0.002), hospital stay (five studies: n = 998; MD - 1.42, 95% CI - 2.18 to - 0.67; P = 0.0002) and caused no increased risk of mortality (five studies: n = 937; OR 0.94, 95% CI 0.65-1.36; P = 0.76) and infection (four studies: n = 701; OR 0.58, 95% CI 0.38-0.90; P = 0.01). Sub-group analyses of four studies showed that the preoperative intravenous use of iron at 200-300 mg (two studies) may be the beneficial option for hip fractures patients. CONCLUSIONS Iron supplementation, especially preoperative intravenous use of 200-300 mg iron, is safe and associated with reducing transfusion requirement and hospital stay. Unfortunately, data were too limited to draw a definite conclusion. Further evaluation is required before recommending iron supplementation for older patients with hip fracture surgeries.
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Affiliation(s)
- Ran Chen
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610000, China.,Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Lang Li
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610000, China.,Department of Orthopedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, 610041, Sichuan, China
| | - Zhou Xiang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610000, China
| | - Hong Li
- School of Stomatology, Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Xiao-Ling Hou
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610000, China.
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Rabindrakumar MSK, Wickramasinghe VP, Arambepola C, Senanayake H, Karunaratne V, Thoradeniya T. Baseline iron and low-grade inflammation modulate the effectiveness of iron supplementation: evidence from follow-up of pregnant Sri Lankan women. Eur J Nutr 2021; 60:1101-9. [PMID: 32613329 DOI: 10.1007/s00394-020-02320-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/25/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE We evaluated the effectiveness of iron supplementation in relation to baseline iron and inflammatory status of pregnant women and their offspring in Sri Lanka. METHODS Apparently healthy women aged 18-36 years at < 12 weeks of gestation prior to receiving any supplementation were randomly recruited at the antenatal clinics. They received 60 mg of elemental iron in combined iron-folic acid pills from 12 weeks of gestation until delivery via the National Maternal Supplementation Programme. Serum ferritins (SF), hemoglobin and high-sensitive C-reactive protein (hs-CRP) were assessed. The women were grouped as iron sufficient-inflammation (+), iron sufficient-inflammation (-), iron deficient-inflammation (+) and iron deficient-inflammation (-) based on their baseline iron stores and low-grade inflammation (hs-CRP > 5 < 10 mg/L) at baseline and late pregnancy. RESULTS Despite supplementation, SF in the iron sufficient-inflammation (+) women reduced significantly (p = 0.037) to deficiency state (SF < 30 µg/L) at mid-pregnancy. Whereas no significant changes were noted in the SF in iron sufficient-inflammation (-) women (p > 0.05). They maintained their stores at sufficient state until delivery. The cord SF was higher (p < 0.001) in iron sufficient-inflammation (-) than the inflammation (+) women. 96.4% of the iron deficient women remained deficient until delivery regardless of their inflammatory state. Low-grade inflammation was higher (p < 0.001) in women with baseline BMI > 25 kg/m2. Whereas inflammation at late pregnancy was higher (p < 0.001) in women who gained weight in excess of the recommended, regardless of their baseline BMI. CONCLUSION Iron status prior to supplementation and low-grade inflammation associated with BMI > 25 kg/m2 and excess weight gain during pregnancy appear to modulate the effectiveness of iron supplementation.
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