Burden Of Iron Deficiency Anemia Research Articles

The Beneficial Impact of Iron-Fortified Complementary Feeding in the Burden of Iron Deficiency Anaemia (IDA) in Children of Bangladesh

Fortifying food with iron is the most cost-effective way to avoid iron deficiency anemia, a global public health crisis. In addition to choosing the appropriate dietary context for ingestion, it is critical to choose the appropriate iron form and food carrier. Among the increased hazards include low birth weight and preterm delivery. Children with IDA have slower development, worse cognitive performance, and lower levels of physical activity. In women, it also raises the risk of morbidity and death. The amount of iron required in the diet, one's socioeconomic status, and overall health are all crucial factors to take into account. To combat IDA, a variety of dietary approaches, iron-fortified foods, supplements, and disease management techniques have all been employed. Nowadays, food fortification with iron is seen to be a long-term, sustainable solution. To be effective, the iron fortification program's food transporters and fortificants must be deemed safe, pleasant, and acceptable by the target population. It also shouldn't have a detrimental effect on the stability and acceptance of the finished product. This article provides a thorough summary of the current state of iron deficiency in women and children in Bangladesh. This study addresses current issues as well as the efficacy of current therapeutic strategies. Prevention-focused treatments ought to take precedence over treatment-focused ones in high-risk populations. Unknown are the long-term benefits, and unfavorable outcomes are possible. Despite the tremendous progress made, several plans and initiatives are still being supported. These issues are to coverage, quality, and compliance. The findings suggest that iron deficiency and anemia are still major problems in Bangladesh, despite the fact that certain severe deficiencies have been addressed by current intervention efforts. There is a need for more integrated solutions to assist current intervention efforts. Furthermore, new approaches to the management of certain types of iron deficiency anemia are proposed.

The challenge of defining the global burden of iron deficiency anaemia

The challenge of defining the global burden of iron deficiency anaemia

A prescription pattern of iron preparations among pregnant women with iron deficiency anemia attending antenatal clinic in a tertiary care hospital in Telangana, India

Background: Understanding and documenting the burden of Iron deficiency anemia (IDA) in pregnancy serves as feedback to realign the ongoing efforts in tackling it. Aim and Objectives: This study was conducted with the Objectives: (1) To estimate the prevalence of IDA in pregnancy (2) To determine the factors affecting the choice and the route of administration and (3) To compare the tolerability, efficacy, and adherence of oral and parenteral iron preparations. Material and Methods: A prospective observational study was conducted in an antenatal clinic at Mediciti Institute of Medical Sciences from April 1st, 2018 to March 31st, 2019 after obtaining Institutional Ethics Committee approval. Results: IDA was more in multigravida (66.17%). Majority of the participants were anaemic during their 2nd trimester (54.14%). By the time of delivery, 6 (33.33%), 34 (47.22%), and 20 (46.51%) participants enrolled in their first, second, and third trimesters, respectively, showed improved Hemoglobin (Hb) levels. Ferrous Sulphate (90.4%) and Iron Sucrose (98.53%) were the most prescribed oral and parenteral iron preparations, respectively. Among the participants on oral iron therapy, 30.65% had high adherence with Morisky’s Medication Adherence Scale and about 20.16% of participants had 100% adherence by pill count. Conclusion: Parenteral iron infusions, though brought about a significant rise in the mean Hb levels of the participants in a shorter time span than oral iron therapy, could not correct their anemic status by the time of their delivery. Almost half of the participants delivered in anemic status. Both the treatment modalities were well tolerated and the majority had good adherence.

Evaluating Anemia Related Morbidity in Premenopausal Female Minority and Disadvantaged Populations

Title: Evaluating anemia related morbidity in premenopausal female minority and disadvantaged populations Authors: Alexander Krule, M.D. M.S., Kristy Abraham, M.D., David Dulce, Sandra Cuellar Puri Pharm. D., Ameen Salahudeen, M.D. Ph.D., Amina Chaudhry, M.D. Introduction: In the United States, there are pronounced racial disparities in anemia prevalence among adult women under 50 years of age with 3.3% of white, 8.7% of Latina, and 24.4 % of Black women affected. The most common etiology of this anemia is iron deficiency anemia (IDA) affecting up to 12% of reproductive-aged American women across all racial groups with a disparate increased burden of IDA among Black women where 19% have iron deficiency. This presents an opportunity for multimodal interventions for patients and the medical community to improve health outcomes in women with iron deficiency anemia. The purpose of this study is to assess the severity and burden of iron deficiency anemia in the Black versus non-Black communities at University of Illinois (UI Health). Methods: We underwent a retrospective chart review of patients at UI Health with anemia from 1 June 2011 - 21 May 2021. Included patients were 18-40 years old, listed female sex in their charts, and had a diagnosis of iron deficiency anemia defined as serum hemoglobin less than 12 mg/dL and serum ferritin less than 30 ng/mL or transferrin saturation less than 19%. Exclusion criteria were male sex, amenorrhea, induced menopause, primary ovarian insufficiency, history of bariatric procedures circumventing the duodenum, autoimmune disease, and heart failure. In total, 951 patients with iron deficiency anemia were identified, of which 756 met criteria for analysis. We then grouped patients by listed race and ethnicity and stratified patients by severity of anemia as defined by the World Health Organization (WHO). WHO anemia severity grades anemia based on hemoglobin ranging from Grade 0 for hemoglobin values within reference range to Grade III and Grade IV for severe and life-threatening hemoglobin values below 7.9 and 6.5 g/dL, respectively. Statistical differences between groups were analyzed by ANOVA and logistic regression models. Results: Of the 756 patients included in the analysis, 68% identified as Black, 21% as Latinx, 12% as White, 5% as Asian, and 0.7% as American Indian/Alaskan Native. A one-way ANOVA revealed that there was a statistically significant difference in mean hemoglobin values between groups. Testing of the a priori hypotheses were conducted using Bonferroni adjusted alpha levels of .0125 (0.5/4) per test and showed a significantly lower mean serum hemoglobin for Black patients (M=9.7, SD=0.6) than non-Black patients (M=10.4, SD=0.4, F(4,1242)=14.8, p<10-11). In an unadjusted logistic regression model, Black race was significantly associated with more severe degree of anemia compared to non-Black race (OR=1.79, 95% CI [1.38,2.32]). Conclusion: More than two-thirds of female patients of reproductive age in the UI Health patient population with iron deficiency anemia self-report as Black. Black patients in this population have clinically significant lower hemoglobin levels than non-Black patients, and have a significantly increased hazard ratio for severe anemia. In our health system, symptomatic patients with severe and life-threatening anemia require emergent blood transfusion as standard of care, incurring further risk of morbidity and potentially mortality. Given the disparity we observe, and increased hazard for severe and potentially life-threatening anemia warrants further assessment into the delivery of healthcare to this underrepresented patient population. Evaluating what barriers may exist in delivering care to IDA patients in screening, diagnosis, and management of oral versus parenteral iron therapy should also be further studied. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Predictors of iron deficiency anaemia among children aged 6-59 months in Tanzania: Evidence from the 2015-16 TDHS-MIS cross-sectional household survey.

Iron deficiency anaemia remains a public health problem, particularly in children aged 6-59 months. This study assessed factors associated with iron deficiency anaemia among children aged 6-23 months, 24-59 months and 6-59 months in Tanzania. Data for this cross-sectional study were extracted from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015-16 TDHS-MIS). The study covered 8014 children aged 6-59 months and their mothers. Iron deficiency anaemia was defined (haemoglobin < 11g/dL). Univariable and multivariable logistic regression analyses that adjust for clustering and sampling weights were conducted to describe the associations between anaemia and potential confounding variables. The prevalence of iron deficiency anaemia among children aged 6-23 months, 24-59 months and 6-59 months were 76%, 49% and 59%, respectively. Factors associated with increased odds of iron deficiency anaemia among children aged 6-23 months included a mother being employed, being a male child, child perceived to small size at birth by mothers, a mother being anaemic and children belonging to the poorest socio-economic quintile. In addition, being a mother with no schooling, children not being dewormed, a mother being anaemic, delivering a baby at home, child fever and stunting, were factors associated with increased odds of iron deficiency anaemia among children aged 24-59 months. Factors associated with increased odds of iron deficiency anaemia among children aged 6-59 months were: a mother being employed, being a mother with no schooling, being a male child, belonging to the 6-59 months age bracket, a mother having a BMI of between 19 and 25 kg/m2, a mother being anaemic, having a baby at home, children belonging to bigger households, child fever and stunting. Interventions to minimise the burden of iron deficiency anaemia in children should target employed and/or anaemic mothers, poor and rich households, as well as male children.

Impact of Fortified Infant Cereals on the Burden of Iron Deficiency Anemia in 6- to 23-Month-Old Indonesian Infants and Young Children: A Health Economic Simulation Model.

Iron deficiency and iron deficiency anemia (IDA) are highly prevalent among Indonesian infants and young children (IYC). Severe IDA hampers mental development in young children and is linked to lower quality of life and lower productivity as adults. The consumption of fortified infant cereals (FIC) increases iron intake during the weaning period, thus reducing the social burden of IDA. In this manuscript, we aimed to assess the impact of FIC on the burden of IDA on IYC in Indonesia. We analyzed data for IYC aged 6–23 months from the fifth wave (2014–2015) of the Indonesia Family Life Survey (IFLS) and the Indonesia Demographic and Health Survey 2017 (IDHS-17). We adapted a health economic simulation model to estimate the impact of FIC that accounted for lifetime health and cost consequences in terms of reduced future income and DALYs. The mean Hb level was 10.5 ± 1.4 g/dL. Consumers of FIC had a reduced burden of disease (43,000 DALYs; USD 171 million) compared with non-consumers. The consumption of fortified infant cereals plays an important role in reducing the burden of IDA, and it might complement the available strategy of nutritional interventions to address this problem in Indonesian IYC.

Dhatri Lauha in the management of iron deficiency anemia: A prospective open-label single-arm multi-center trial.

The burden of iron-deficiency anemia (IDA) remains persistently high in India due to the poor tolerability of oral iron supplementation. Therefore, more focus is required to explore traditional medicine for safe and effective options for managing IDA. To assess the clinical safety and efficacy of Dhatri Lauha in patients with IDA. An open-label, prospective, single-arm, multi-center trial was conducted at 12 centers with a sample size of 40 participants per study site. Patients with IDA aged 18-60 years with hemoglobin levels in the range of 6-10gm/dl, mean corpuscular volume (MCV) <80 fl, mean corpuscular hemoglobin concentration (MCHC) <34 μg/dl, serum ferritin <30 μg/dl and serum iron <50 μg/dl were included in the study. Dhatri Lauha 500 mg capsule was administered twice daily with lukewarm water after meals for 45 days. The primary outcome measure was the change in hemoglobin (Hb%) level from baseline to day 45. Secondary outcome measures included the change in MCV, MCHC, serum iron and ferritin levels, incidence of adverse events, and change in safety parameters (liver and kidney function tests). The mean (statistical) change in outcome measures from baseline to day 45 was compared using a paired sample t-test. Out of 458 participants enrolled in the study, 400 contributed to the final analysis. A significant difference was observed in the outcome parameters such as Hb%, MCV, MCHC, serum ferritin, and serum iron levels (P < 0.001) after 45 days of treatment. Mean Hb% changed from 8.46 ± 1.14 g/dl at baseline to 9.18 ± 1.61 g/dl on day 45 (P < 0.001). LFT and KFT were within the normal limits after the study period. No participant withdrew from the study due to adverse events. Dhatri Lauha is a safe intervention and can be expected to improve hemoglobin levels, red blood cell parameters, and iron stores in patients with IDA. Future RCTs with a larger sample size, standard care as control and a longer follow-up may produce more accurate and reliable results.

Iron stores in pregnant women with sickle cell disease: a systematic review

BackgroundGradual improvements in the management of sickle cell disease (SCD), have led to an increase in the number of women with SCD who reach the age of procreation. However, evidence on the iron status of pregnant women with sickle cell disease (PWSCD) remains inconclusive. We conducted the first systematic review on the prevalence, determinants and maternal/foetal outcomes of iron deficiency anaemia among PWSCD.MethodsWe searched MEDLINE, EMBASE, Global Health, Africa Index Medicus, the Cochrane library databases and reference lists of retrieved publications for studies describing the iron status of PWSCD. The literature search was done over a period of 1 month, with no language or date restrictions applied. Data were extracted on a Microsoft excel sheet. Two authors assessed all included studies for methodological quality and risk of bias.ResultsA total of 710 reports were identified for title and article screening. Five retained studies were conducted before or during the 90s and included 67 participants. After quality assessment, the observational studies were designated to have a “fair” quality assessment while the randomised control trial had an “unclear” quality assessment. The prevalence of iron deficiency anaemia among PWSCD varied by study design and diagnostic method. The overall prevalence ranged from 6.67–83.33%. None of the studies provided evidence on factors associated with iron deficiency anaemia and the randomized trial reported no difference in outcomes between PWSCD who had iron supplementation and those who did not.ConclusionEvidence on factors associated with iron deficiency anaemia among PWSCD and maternal/foetal outcomes in PWSCD who have iron deficiency anaemia is poor. The studies included in this review suggests that iron deficiency anaemia may be highly prevalent in PWSCD but due to the very small sample sizes and varied study designs, this evidence is inconclusive. The review shows that there is a need for more studies with robust designs and adequate sample sizes to assess the disease burden of iron deficiency anaemia in PWSCD.

Estimation of the Burden of Iron Deficiency Anemia in France from Iron Intake: Methodological Approach.

Dietary iron deficiency (ID) is the first nutritional deficiency in the world, in terms of disability adjusted life years (DALY). This nutritional deficiency may lead to anemia, especially among children, adolescents, and adult women. The aim of this study was to build an original probabilistic model to quantitatively assess the ID, the iron deficiency anemia (IDA) and the subsequent health burden in France expressed in DALY, per age class and gender. The model considered the distribution of absorbed iron intake, the iron requirement distribution established by the European Food Safety Authority and the iron status in France. Uncertainty due to lack of data and variability due to biological diversity were taken into account and separated using a second-order Monte Carlo procedure. A total of 1290 (95% CI = 1230–1350) IDA cases corresponding to 16 (95% CI = 11–20) DALY were estimated per 100,000 individuals per year. The major contributors to IDA burden were menstruating females aged from 25 to 44 years old. Then, a consumption scenario was built with ground beef as intake, an increase in red meat consumption to 100 g/d would not eliminate entirely the IDA burden. The quantitative methodology applied here for France could be reused for other populations.

Parenteral Versus Oral Iron for Treatment of Iron Deficiency Anaemia During Pregnancy and post-partum: A Systematic Review

The burden of iron deficiency anaemia during pregnancy and post-partum continues to remain high especially in India. Challenges to treatment include gastrointestinal side effects and non compliance to oral iron therapy. Newer parenteral formulations need to be explored as alternatives. Meta-analysis of randomized controlled trials published between years 2011 and 2018 comparing anaemic pregnant and post-partum women treated with intravenous iron sucrose versus oral iron was performed. The primary outcomes were mean maternal haemoglobin, serum ferritin and haematocrit at the end of 1st, 2nd, 4th and 6th weeks and comparison of adverse effects. Eighteen studies including 1633 antenatal women were randomly assigned to intravenous iron sucrose (n = 821) or oral iron [ferrous sulphate, ferrous ascorbate or fumarate] group (n = 812) in ten trials . Another eight studies compared iron sucrose infusion with oral iron in 713 post-partum women who were randomly assigned to intravenous iron sucrose group (n = 351) or oral iron group (n = 362). Cumulative analysis of all the time points indicates that the estimated mean values of Hb in the intravenous iron sucrose and oral iron groups were 10.11g/dl and 9.33g/dl, respectively, in antenatal group, while it was 10.57g/dl and 9.74g/dl in post-partum. The estimated mean ferritin level from first week to six weeks was 63.1μg/l and 28.6μg/l, respectively, in intravenous and oral iron groups. Cumulative estimate of haematocrit in the intravenous sucrose and oral iron over 6weeks showed that the mean values in the respective groups were 30.5% and 29.5% in antenatal and 33.8% and 31.6%, respectively, in post-partum groups. Sensitivity analysis confirmed the reliability and consistency of the results. Oral iron was associated with significant gastrointestinal side effects. There was no significant difference in birthweight between the groups. This meta-analysis demonstrates that intravenous iron sucrose is more effective than oral iron therapy for pregnant and post-partum women with iron deficiency anaemia. It is an effective and safe alternative to address the problem of iron deficiency especially in those who require rapid replacement of iron stores though medical personnel for intravenous administration of drug is required.Trial registration CRD42015024343.

The burden of iron-deficiency anaemia among women in India: how have iron and folic acid interventions fared?

Iron-deficiency anaemia (IDA) among women in India is a problem of major public health significance. Using data from three waves of the National Family Health Survey, this article discusses the burden of and trend in IDA among women in India, and discusses the level of iron and folic acid (IFA) supplementation and its potential role in reducing the burden of IDA. Between 2005-2006 and 2015-2016, IDA in India decreased by only 3.5 percentage points (from 56.5% in 2005-2006 to 53.0% in 2015-2016) for women aged 15-49 years. However, during the same period, of 27 states compared, IDA increased in eight: Delhi, Haryana, Himachal Pradesh, Kerala, Meghalaya, Tamil Nadu, Punjab and Uttar Pradesh; furthermore, some of these (e.g. Kerala) are states that rank among the highest on the state Human Development Index but had failed to contain the burden of IDA. Although there is a standard guideline for IFA supplementation in place, the IFA intervention appears to be ineffective in reducing the burden of IDA in India (nationally only 30.3 % of mothers consumed IFA for 100 days or more when they were pregnant), probably due to irregular consumption of IFA where the provision of screening under the National Iron+ Initiative scheme appears to be unsuccessful. To strengthen the IFA intervention and its uptake, a concerted effort of community-level health workers (accredited social health activists, auxiliary nurse midwives and anganwadi workers) is urgently needed. In addition, food-based strategies (dietary diversification and food fortification), food supplementation and improvement of health services are required to reduce the burden of anaemia among women in India.

Adherence to iron supplements among women receiving antenatal care at Mulago National Referral Hospital, Uganda-cross-sectional study

BackgroundAntenatal iron supplementation is a cost effective way of reducing iron deficiency anaemia among pregnant women in resource limited countries like Uganda. Poor adherence to iron supplements has limited its effectiveness in reducing maternal anaemia as evidenced by the high burden of iron deficiency anemia in Sub-saharan Africa. The aim of this study was to determine the level of and factors associated with adherence to iron supplementation among women attending antenatal clinic at Mulago National Referral Hospital, Kampala, Uganda.MethodsThree hundred and seventy pregnant women were recruited in a cross sectional survey in Mulago National Referral Hospital antenatal clinic after informed consent between February and April 2014. Levels of adherence to iron supplements were assessed using visual analogue scale and factors associated collected using an interviewer administered questionnaire.ResultsAbout 12% (11.6%) of the mothers attending the antenatal clinic adhered to iron supplements over 30 day period. Mothers who had had four or more antenatal visits prior to the survey [odds ratio (OR) = 1.49, 95% confidence interval (CI) 1.12–1.97], had more than 2 week supply of iron supplements in the previous visit (OR 2.81, 95% CI 1.02–1.09), prior health education (OR 1.56, 95% CI 1.07–2.29) were more likely to adhere to iron supplements. Inadequate drug supplies and fear for side effects were the main reasons why participants missed the iron supplements.ConclusionsThere was low adherence to iron supplements among mothers attending antenatal clinic at Mulago National Referral Hospital. We recommend a national evaluation of adherence to iron supplements and look at ways of increasing adherence.

PHP117 - Estimating the contribution on the reduction of the burden of iron deficiency anemia from the current fortification strategy of commercial foods targeted to infants and toddlers in india. Scenarios using systematic review and real world evidence

PHP117 - Estimating the contribution on the reduction of the burden of iron deficiency anemia from the current fortification strategy of commercial foods targeted to infants and toddlers in india. Scenarios using systematic review and real world evidence

Burden of Iron Deficiency Anemia in a Bariatric Surgery Population in the United States.

Obesity is a serious condition affecting more than 35% of adults in the United States. In obese individuals for whom other weight control methods have been ineffective, bariatric surgery is a safe and effective method of weight control. An estimated 150,000 to 160,000 bariatric surgeries are performed in the United States yearly. Iron deficiency anemia is common in patients after bariatric surgery, with incidence rates up to 49%, and may be due to malabsorption of nutrients. To (a) compare the medical resource utilization (MRU)- both medical care and treatment resources-and associated costs in a sample of commercially insured adult bariatric surgery patients with and without iron deficiency anemia (IDA), and (b) describe anti-anemia treatment patterns in those bariatric surgery patients diagnosed with IDA. Using Truven Health MarketScan claims data, bariatric surgery patients were identified by the ICD-9-CM and CPT procedure codes for bariatric surgery and classified by surgery and IDA diagnosis within 2 years of initial surgery. Intravenous (IV) iron treatment was determined by HCPCS codes, prescription oral iron by NDC numbers, and blood transfusions by CPT and ICD-9-CM codes. Clinical, MRU, and economic outcomes for all-cause health services were compared between IDA and non-IDA patients. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression, controlling for demographic and clinical characteristics on outcomes of complications and hospitalization. Of the 24,344 bariatric surgery patients analyzed, 11.6% received an IDA diagnosis 2 years after surgery (average days to diagnosis = 279). Most IDA patients (78.5%) received a test for iron in the post-index period; only 9.1% received IV iron treatment, with iron dextran (3.8%) and iron sucrose (3.4%) being the most common (average days to IV iron treatment = 403 days). Prescription oral iron was found in 4.9% of all IDA patients (average days to oral iron treatment = 476.7). Approximately 9% of IDA patients received a blood transfusion (average days to transfusion = 304.8). For the total sample, the average age was 46 years with a higher percentage of females (83.9% IDA; 78.7% non-IDA). Most clinical characteristics were similar among patients with and without IDA, except heart disease (1.3% IDA vs. 0.8% non-IDA; P = 0.005) and gallbladder disease (0.0% IDA vs. 0.2% non-IDA; P = 0.037). More IDA patients had complications after surgery (40.4% vs. 27.7%; P less than 0.001), such as nonabsorption (22.4% vs. 16.5%; P less than 0.001); digestive (15.6% vs. 10.2%; P less than 0.001); and gastrojejunal ulcer (7.6% vs. 2.0%; P less than 0.001). Multivariate results showed that IDA patients were more likely to have a bariatric surgery complication over non-IDA patients (OR = 1.367, 95% CI = 1.257-1.487; P less than 0.05). Adjusted results showed IDA patients more than twice as likely to be hospitalized (OR = 2.567, 95% CI = 2.363-2.790; P less than 0.05). Total costs were twice as much in the IDA group compared with the non-IDA group ($37,882 vs. $19,253; P less than 0.001). Bariatric surgery patients who develop IDA may be subject to higher complication rates, MRU, and direct medical costs. Although most bariatric surgery patients who develop IDA are tested for iron, most are not treated with IV iron or oral iron and do not receive blood transfusions. Further research is needed to determine if IDA is a result of bariatric surgery complications or a predictor of increased MRU and costs.

Sa1103 Economic and Medical Resource Use (MRU) Burden of Iron Deficiency Anemia (IDA) in an Inflammatory Bowel Disease (IBD) Population in the United States (US)

Sa1103 Economic and Medical Resource Use (MRU) Burden of Iron Deficiency Anemia (IDA) in an Inflammatory Bowel Disease (IBD) Population in the United States (US)

Mo2039 Economic and Medical Resource Use (MRU) Burden of Iron Deficiency Anemia (IDA) in a Bariatric Surgery Population in the United States (US)

BACKGROUND: An estimated 220,000 bariatric surgeries are performed in the US yearly. Malabsorption of nutrients after bariatric surgery is common and may lead to IDA, with incidence rates of up to 49%. OBJECTIVE: To evaluate the economic, MRU, clinical outcomes, and treatment of IDA in adult bariatric surgery patients with commercial insurance coverage. METHODS: Using Truven Health MarketScan® claims data, bariatric surgery patients were identified by ICD-9-CM and CPT codes then classified by surgery and IDA diagnosis within two years of initial surgery. Intravenous (IV) iron treatment was determined by HCPCS codes, prescription oral iron by NDC codes, and blood transfusions by CPT and ICD-9CM codes. Clinical, MRU, and economic outcomes for all-cause health services were compared between IDA and non-IDA patients. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression, controlling for demographic and clinical characteristics on outcomes of complications and hospitalization. RESULTS: Of the 24,382 bariatric surgery patients analyzed, 11.7% received an IDA diagnosis 2 years post-surgery (avg days to diagnosis=279). Most (98.7%) of the IDA group developed anemia post surgery. Most IDA patients received a test for iron in the post-index period; only 9.3% received IV iron treatment, with iron dextran (3.8%) and iron sucrose (3.4%) being the most common (avg days to IV iron treatment=403 days). Prescription oral iron was found in 4.8% of all IDA patients (avg days to oral iron treatment=477). Approximately 9% of IDA patients received a blood transfusion (avg days to transfusion=306). Average age was 46 years with a higher percentage of females (83.8% IDA, 78.8% non-IDA). Most clinical characteristics were similar, except heart disease (1.3% IDA vs 0.8% non-IDA; P=0.003) and gallbladder disease (0.0% IDA vs 0.2% non-IDA; P=0.037).More IDA patients had post-surgery complications (40.4% vs 27.7%; P<0.001), such as nonabsorption (22.4% vs 16.5%; P<0.001), digestive (15.6% vs 10.2%; P<0.001), and gastrojejunal ulcer (7.6% vs 2.0%; P<0.001). Multivariate results showed IDA patients were more likely to have a bariatric surgery complication over non-IDA patients (OR [95 % CI]=1.372 [1.262, 1.492]]. Adjusted results showed IDA patients over twice as likely to be hospitalized (OR [95% CI]=2.574 [2.370,2.796]]. Total costs were twice as much in IDA over non-IDA groups ($38,025 vs $19,245; P<0.001). CONCLUSIONS: Bariatric surgery patients who develop IDA may have higher complication rates, MRU, and direct medical costs. Though most bariatric surgery patients who develop IDA are tested for their iron, most are not treated with IV iron or oral iron and do not receive blood transfusions. Further research is needed to determine if IDA is a result of bariatric surgery complications or a predictor of increased MRU and costs.

PTH-101 The Burden of Iron Deficiency Anaemia in a Tertiary IBD Centre Population

IntroductionAnaemia is the most common extraintestinal manifestation of IBD, with iron deficiency being the most prevalent cause. The ECCO guidelines published in 2012 included the management of anaemia in UC....

Challenges in the diagnosis of iron deficiency in children exposed to high prevalence of infections.

BackgroundWhile WHO guidelines recommend iron supplements to only iron-deficient children in high infection pressure areas, these are rarely implemented. One of the reasons for this is the commonly held view that iron supplementation increases the susceptibility to some infectious diseases including malaria. Secondly, currently used markers to diagnose iron deficiency are also modified by infections. With the objective of improving iron deficiency diagnosis and thus, its management, we evaluated the performance of iron markers in children exposed to high infection pressure.Methodology/Principal FindingsIron markers were compared to bone marrow findings in 180 anaemic children attending a rural hospital in southern Mozambique. Eighty percent (144/180) of the children had iron deficiency by bone marrow examination, 88% (155/176) had an inflammatory process, 66% (119/180) had moderate anaemia, 25% (45/180) severe anaemia and 9% (16/180) very severe anaemia. Mean cell haemoglobin concentration had a sensitivity of 51% and specificity of 71% for detecting iron deficiency. Soluble transferrin receptor (sTfR) and soluble transferrin receptor/log ferritin (TfR-F) index (adjusted by C reactive protein) showed the highest areas under the ROC curve (AUCROC) (0.75 and 0.76, respectively), and were the most sensitive markers in detecting iron deficiency (83% and 75%, respectively), but with moderate specificities (50% and 56%, respectively).Conclusions/SignificanceIron deficiency by bone marrow examination was extremely frequent in these children exposed to high prevalence of infections. However, even the best markers of bone marrow iron deficiency did not identify around a quarter of iron-deficient children. Tough not directly extrapolated to the community, these findings urge for more reliable, affordable and easy to measure iron indicators to reduce the burden of iron deficiency anaemia in resource-poor settings where it is most prevalent.

Combating Hidden Hunger: The Role of International Agencies

The importance of micronutrient deficiencies or "hidden hunger" was clearly emphasized by the inclusion of specific goals on iron, vitamin A, and iodine deficiency at the 1990 World Summit for Children and other major international nutrition conferences. Significant progress has since been made toward eliminating vitamin A and iodine deficiencies, with less progress made toward reducing the burden of iron-deficiency anemia. The role of international agencies, such as the World Health Organization, United Nations Children's Fund, Food and Agricultural Organization, and World Bank in assisting countries to make progress toward the World Summit for Children goals has been very important. International agencies have played a critical role in advocating for and raising awareness of these issues at the international, regional, and national levels among policymakers and the general population. Using a rights-based approach, UNICEF and other agencies have been instrumental in elevating to the highest political level the discussion of every child's right to adequate nutrition. International agencies have also been very supportive at the national level in providing technical guidance for programs, including monitoring and evaluation. These agencies have played a critical role in engaging the cooperation of other partners, including bilateral donors, non-governmental organizations, and the private sector for micronutrient programs. Furthermore, international agencies provide financial and material support for micronutrient programs. In the future, such agencies must continue to be heavily involved in programs to achieve the newly confirmed goals for 2010. The present paper focuses on the role of international agencies in combating micronutrient deficiencies, drawing on the lessons learned over the last decade. The first section of the paper summarizes the progress achieved since 1990, and the second section describes the specific role of international agencies in contributing to that progress.

Epidemiological evidence for a differential effect of hookworm species, Ancylostoma duodenale or Necator americanus, on iron status of children.

The hookworms, Ancylostoma duodenale and Necator americanus, cause significant gastrointestinal blood loss. In clinical studies, greater blood losses have been reported with A. duodenale. However, there has been no evidence that endemic A. duodenale infection has greater impact than N. americanus infection on the iron status of populations. In a sample of 525 school children in Pemba Island, Tanzania, we compared the degree of anaemia and iron deficiency associated with the two hookworm species at the individual and community (i.e. school) levels. Multiple regression was used to control for infection intensities and other child characteristics. In the 492 children with hookworm positive faecal cultures, haemoglobin and ferritin concentrations decreased with increasing proportions of A. duodenale. Among children with only N. americanus larvae, the prevalence of anaemia was 60.5 % and the prevalence of ferritin <12 microg/l was 33.1%, while in children with > or =50% A. duodenale larvae, the respective prevalences were 80.6% and 58.9%. When children were grouped by the prevalence of A. duodenale at the school level, children from high prevalence (> or =20%) schools had significantly worse iron deficiency and anaemia than children from low prevalence schools. The species of hookworm being transmitted in a community influences the burden of iron deficiency anaemia in the community, and should be considered in prioritizing and planning programmes for hookworm and anaemia control.