Daily Iron Research Articles

Prevalence of iron deficiency anemia in exclusively breastfed infants after a 5-month iron supplementation

Iron deficiency anemia (IDA) is prevalent in exclusively breastfed (EBF) Thai infants. However, in Thailand, iron supplementation guidelines for EBF infants are not available. This prospective open-label study aimed to estimate the prevalence of IDA in 9-month-old EBF infants after receiving iron supplementation from 4 months of age until they consumed adequate iron-rich food. Forty-seven healthy, 4-month-old EBF infants were prescribed 1 mg/kg/day ferrous sulfate. Their complementary food records from 6 to 9 months were calculated for daily iron intake. Complete blood count and iron study were performed at 9 months of age. The results showed that the prevalence of IDA at 9 months was 6.4%. An employed caregiver and the male sex of the baby were significantly associated with iron deficiency. The food record revealed that the median daily iron intake was less than the Thai dietary reference intake recommendation. In summary, the prevalence of IDA in infants with 9 months of exclusive breastfeeding who received iron supplementation was lower than the background rate (25.7%) when iron was not prescribed. Most infants did not have adequate iron in complementary foods. Iron supplementation should be prescribed routinely during 4–9 months of age in healthy Thai EBF infants.

Treatment of iron deficiency and iron deficiency anaemia in menstruating women

Iron deficiency and anaemia affect premenopausal women's quality of life. Daily oral iron supplements are standard treatment, causing gastrointestinal side effects, which could be overcome by an alternate-day dosing regimen. In this review, we compare dosing strengths and frequencies in trials: Twice-daily doses of 160 mg of elemental iron increases the ferritin- but not the haemoglobin level significantly and is poorly tolerated compared to 60-80 mg elemental iron taken daily or every other day, in mild to moderate anemia, although evidence for severe anaemia is limited.

Iron supplementation post-blood donation in Vietnam: Impact on hemoglobin, red cell indices, and iron reserves

Background. Regular blood donation plays a pivotal role in mitigating the formation of free radicals by regulating iron accumulation. However, frequent blood donation can lead to chronic iron deficiency. In this study, we aimed to evaluate the effectiveness of daily iron supplementation as an intervention to expedite hemoglobin (Hb) recovery among frequent blood donors at a hospital in Vietnam. Methodology. Conducted longitudinally within the Hematology Department of a Hanoi hospital from February to July 2023, our study involved 104 eligible participants. They received a daily iron supplement comprising 100 mg of elemental iron, 0.75 mg of folic acid, and 5 mg of zinc sulfate for a minimum of 8 weeks. Blood samples were collected at three key time points: before blood donation during recruitment, immediately after donation, and at least 8 weeks post-donation. Results. Our findings revealed moderate, statistically significant positive correlations between elemental iron administration and changes in platelet count (PLT), hematocrit (HCT), and mean corpuscular hemoglobin (MCH) (r = 0.753, p <0.001; r = 0.887, p <0.001; and r = 0.703, p <0.001, respectively). Additionally, weak but significant correlations were observed between elemental iron administration and red blood cell count (RBC), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width coefficient of variation (RDWC), and red cell distribution width standard deviation (RDWS) (r = 0.260, p = 0.002; r = 0.302, p = 0.005; r = 0.160, p = 0.010; r = 0.120, p = 0.020; and r = 0.400, p <0.001, respectively). Conclusion. Over an eight-week duration, the regimen of daily iron supplementation yielded significant improvements in both red cell variables, red cell indices, and iron study variables, demonstrating its potential clinical impact.

Efficacy of different doses of daily prophylactic iron supplementation in pregnant women: A systematic review and meta-analysis

IntroductionSeveral randomized controlled trials (RCT) have been conducted in the past to determine the optimum dose of iron supplementation during pregnancy, but there is a lack of consensus among different guidelines regarding the appropriate dosage of iron for prophylaxis during pregnancy. MethodsRelevant electronic databases were searched to identify publications describing RCTs comparing different daily dosages of iron supplementation during pregnancy. Meta-analysis for various efficacy and safety outcomes such as changes in blood hemoglobin, serum ferritin, serum iron, and serum transferrin saturation, as well as the frequency of adverse effects, was performed using random and fixed effect models suitably depending on the degree of heterogeneity. Two groups were compared: those receiving 60 mg elemental iron or less and those receiving more than 60 mg elemental iron per day. Additionally, the efficacy of those receiving 30 mg elemental iron per day and those receiving 60 mg elemental iron per day were also compared. ResultsA to total of 15 RCTs comprising 2726 participants were included in the meta-analysis. Change in blood hemoglobin levels was comparable between the ≤60 mg/day and >60 mg/day group (pooled estimate for mean difference, 0.01 [-0.11, 0.09], p=0.86, I2=96%), but serum ferritin, iron level, and serum transferrin saturation change were higher in the >60 mg group (p<0.0001, 0.008, and 0.02, respectively). Change in blood hemoglobin level was better in the 60 mg/day group compared to the 30 mg/day group (pooled estimate for mean difference, -0.11 [-0.21, 0.00], p=0.04, I2=90%), as well as changes in serum ferritin and serum transferrin saturations (p=0.004 and 0.0004, respectively). ConclusionDaily supplementation of 60 mg elemental iron is more efficacious than daily supplementation of 30 mg elemental iron for the prophylaxis of anemia in pregnant women (certainty of evidence-moderate), and daily supplementation of ≤60 mg elemental iron is equally efficacious compared to daily supplementation of >60 mg elemental iron for the prophylaxis of anemia in pregnant women (certainty of evidence-moderate). PROESPERO registration NoCRD42023455485

Daily versus Alternate-Day Iron Supplementation for Pregnant Women with Iron Deficiency Anemia: A Randomized Controlled Trial.

This study aimed to evaluate the most effective regimen to raise hemoglobin (Hb) by comparing alternate-day dosing of iron to daily dosing in pregnant women with iron deficiency anemia. Women with Hb < 11.0 g/dL and ferritin ≤ 25 µg/L between 120/7 and 340/7 weeks' gestation were recruited. A total of 88 patients were randomized using block randomization with 1:1 allocation to receive either 1 tablet of 325 mg ferrous sulfate on consecutive days or 2 tablets every other day. The primary outcome, the change in Hb after 6 weeks of treatment was assessed using an analysis of covariance to adjust for baseline level. Secondary outcomes included change in ferritin, hepcidin, side effects, and compliance. Patients completed a questionnaire to assess for adverse symptoms and adherence was monitored by installing a pill reminder app on smartphones of patients. A total of 88 patients were consented. The daily iron group had a greater proportion of nulliparous women (40 vs. 7%). Most patients (98%) had mild anemia (Hb: 9-10.9 g/dL) at recruitment, with a median gestational age of 28.1 weeks (interquartile range [IQR]: 25.6, 30.9) and median duration of treatment of 42 days (IQR: 35, 45). At 6 weeks, the daily iron group had a mean increase in Hb of 0.8 ± 0.9 g/dL, whereas the alternate-day iron group had a mean increase of 0.5 ± 1.0 g/dL (baseline adjusted difference of means: -0.3 [95% confidence interval: -0.7, 0.1], p = 0.15). Frequency of adverse effects attributable to iron were similar between groups. Patient self-reported compliance to treatment was also similar between groups. Among those that used the app, compliance was higher among the daily group compared with the alternate daily group (median: 95.5% [IQR: 75, 100] vs. 85% [IQR: 40, 92]), although this difference was not statistically significant (p = 0.07). This trial suggests that there are no significant differences between alternate-day iron supplementation and daily iron supplementation for treating iron deficiency anemia. · Intermittent iron provides no additional benefit compared to daily iron in the treatment of anemia.. · Patient compliance to treatment was similar between the groups.. · The frequency of side effects was not significantly different between the groups..

Iron Supply of Multivitamins-Multiminerals Commercialized Online by Amazon in Western and Southern Europe: A Labeling Analysis.

Background. In high-income countries, shopping for non-prescription multivitamin-multimineral supplements has tremendously increased. Objective and Methods. The purpose of this labeling analysis is to inform on the daily elemental iron (with or without vitamin C) supply provided by multivitamin-multimineral supplements sold online by Amazon in Western and Southern Europe (amazon.es®, amazon.de®, amazon.it®, and amazon.fr®). Results. We identified 298 iron-containing multivitamin-multimineral preparations sold by Amazon marketplaces: 153 preparations sourced from amazon.de®, 68 from amazon.fr®, 54 from amazon.it®, and 23 from amazon.es®. The daily iron dose provided by these preparations was 14 [5-14] mg (median and interquartile range), with no differences among the marketplaces. Approximately 90% (n = 265) of the preparations contained ferrous iron. Moreover, 85% (n = 253) of the preparations were fortified with vitamin C in a dose of 80 [40-100] mg daily. Conclusions. The median supply of iron (about 14 mg) and vitamin C (80 mg) in iron-containing multivitamin-multimineral preparations offered on Amazon platforms in Western and Southern Europe falls below that currently recommended for iron deficiency in review articles, namely 100 mg of iron and 500 mg of vitamin C per day. The iron supply of iron-containing multivitamin-multimineral preparations falls also below the dose of 30-60 mg advocated to prevent iron deficiency in menstruating women.

The impact of different doses of oral iron supplementation during pregnancy: a pilot randomized trial

AbstractOral iron is first-line medication for iron deficiency anemia in pregnancy. We conducted a pilot randomized trial to investigate the impact of different doses of oral iron supplementation started early in pregnancy on women without anemia for 4 main outcomes: recruitment and protocol compliance, adherence, maintenance of maternal hemoglobin, and side effects. At antenatal clinic visits, participants were allocated to 1 of 3 trial arms in a 1:1:1 ratio: 200 mg ferrous sulfate daily, alternate days, or 3 times per week. The participants were followed to delivery. Baseline characteristics of 300 recruited participants were well matched between trial arms. The mean proportion of tablets taken as expected per participant was 82.5% overall (72.3%, 89.6%, and 84.5% for the daily, alternate days, and 3 times a week arm, respectively). There was a lower overall adherence rate in the daily arm (47%) than in the alternate days (62%) and the 3 times per week (61%) arms. A reduction in hemoglobin between randomization and 28 weeks’ gestation seemed smaller for the daily arm. A range of side effects were commonly reported at baseline before starting interventions and at later antenatal visits. Many side effects of iron overlapped with normal pregnancy symptoms. A daily iron dosing schedule might give the best opportunity for delivering an adequate iron load during pregnancy in women without anemia. Further randomized trials powered on clinical outcomes are needed to establish the clinical effectiveness of oral iron supplementation to prevent iron deficiency anemia. This study was registered (#ISRCTN12911644).

Daily oral iron supplementation during pregnancy.

Daily oral iron supplementation during pregnancy.

Maintaining Normal Serum Ferritin Levels During Pregnancy: A Randomized Controlled Trial of Daily versus Weekly Ferrous Sulfate

Background: Serum ferritin is the most reliable indication of stored iron in pregnancy, offering a noninvasive way to detect iron deficiency anemia before it occurs. Therefore, this study aimed to determine serum ferritin levels among women receiving daily versus weekly iron supplementation, with a secondary focus on comparing the proportion developing iron deficiency anemia and compli-ance rates between the two groups.Methods: This non-blinded randomized control trial involved non-anaemic pregnant women attend-ing antenatal clinics at two Teaching Hospitals in Osun State. One hundred twenty-five subjects were recruited to receive 65mg in the control group, while another 125 subjects in the active group re-ceived three tablets (195mg) of ferrous sulfate (Fesulf) once weekly for 17 weeks from the 20th to 37th weeks of gestation. The primary outcome measure was comparing mean serum ferritin levels in both groups at 37 weeks.Results: Among the 240 subjects analyzed, the 37-week serum ferritin level was higher in the daily group (73.26±26.67μg/L) compared to the weekly group (63.04±30.71 μg/L), p value=0.006. Four (3.36%) and 10 (8.26%) of our subjects had Iron deficiency anaemia. Nine subjects (3.75%) reported dyspepsia as a side effect. Daily 65 mg of Felsulf proved more effective than weekly 195mg in main-taining normal blood ferritin levels during pregnancy.Conclusions: Daily iron supplementation with 65mg ferrous sulfate was more effective at main-taining adequate maternal iron concentration in this group of non-anaemic pregnant women. This dosage is recommended for routine iron supplementation in our environment.

Efficacy of daily versus intermittent oral iron supplementation for prevention of anaemia among pregnant women: a systematic review and meta-analysis

The World Health Organization recommends daily oral supplementation of iron for prevention of maternal anaemia. However, the adverse effects due to daily supplementation leads to poor compliance among pregnant women. Also, the mucosal block theory suggests that intermittent oral iron may be more efficient than daily iron with respect to optimum absorption. Our meta-analysis reviewed the existing clinical studies for the efficacy of daily versus intermittent oral iron supplementation. In this systematic review and meta-analysis [PROSPERO ID:CRD42024498180], we searched PubMed, Google Scholar, Scopus, Science Direct and Cochrane database for studies published from 1st January 1970 to 31st December, 2023. Studies comparing daily and intermittent iron supplementation in pregnant women were included. The median intermittent iron dose was 120mg/day and daily iron dose was 60mg/day. The primary outcome was endpoint haemoglobin levels after iron supplementation. The data was analysed using the 'meta' and 'metafor' packages in RStudio using random effects model. The heterogeneity, publication bias, risk of bias and certainty of evidence were assessed using I2 statistics, funnel plots, Cochrane Risk of Bias 2 (ROB2) tool, and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach respectively. Of 4615 search results, 26 studies (n=4365 participants) were included in this meta-analysis. There was no significant difference (p=0.18) between the endpoint mean haemoglobin levels of the daily versus intermittent oral iron groups (standardized mean difference (SMD): 0.51, 95% CI:-0.23 to 1.24, I2=97%, low certainty evidence) irrespective of baseline anaemic status. However, the endpoint ferritin levels were significantly higher in the daily supplementation group (SMD: 0.85, 95% CI: 0.15-1.54, p=0.02, I2=97%, low certainty evidence). The adjusted odds ratio for nausea, (adjusted odds ratio (OR) 3.56, 95% CI: 2.23-5.69, p<0.001, I2=9%, moderate certainty evidence), diarrhoea (adjusted OR 5.40, 95% CI: 1.90-15.33, p=0.002, I2=0%, low certainty evidence) and constipation (adjusted OR 1.95, 95% CI: 1.21-3.14, p=0.006, I2=0%, moderate certainty evidence) was significantly higher in daily oral iron supplementation group. Intermittent oral iron supplementation with a median dose of 120mg/day demonstrates comparable efficacy to daily oral iron supplementation median dose of 60mg/day in increasing haemoglobin levels among pregnant women with a significant reduction in adverse events. There was no funding for this study.

Association between iron intake with diet and diabetes and impaired fasting glucose among PURE Poland study participants

Abstract Introduction Different studies results show that higher iron intake and increased iron stores in the body are significantly associated with a higher risk of diabetes mellitus (DM), a risk factor for cardiovascular diseases. Iron metabolism in the body is associated with the production of free oxygen radicals, which, combined with the stressful effect of glycation end products in pre-diabetes, increases the risk of diabetes and cardiovascular events. The purpose of the study was to assess the relationship between iron intake with diet and diabetes and impaired fasting glucose among PURE Poland study participants. Methods Study group consisted of 1889 individuals (1185 women and 704 men, aged 35-70 years, from urban and rural area), who were participants of the Polish arm of the Prospective Urban Rural Epidemiology (PURE) study. The study was approved by the Ethics Committee. The data were collected between 2007-2009, in the first stage of the PURE Poland study. Diabetes was diagnosed when fasting glucose level was ≥ 126 mg/dl or there was a declaration about DM occurrence in the medical interview. Diagnosis of impaired fasting glucose (IFG) was made when fasting glucose level was between 100-125 mg/dl with no statement about DM in the interview. Analysis were conducted for DM+IFG in three models: 1. crude data, 2. adjusted for energy intake, 3. adjusted for energy intake, age, body mass index and smoking. Food Frequency Questionnaire (FFQ) was used to assess food intake. FFQ was developed and validated for this population within the PURE study. Iron intake with diet was calculated based on the data from FFQ. For further analysis the study group was divided into tertiles based on the daily iron intake with diet, separately for men and women. Results The prevalence of DM+IFG in each tertile (T) of iron intake with diet was: 27.6% (T1), 37.0% (T2) and 38.7% (T3) among women, and 30.3% (T1), 40.9% (T2) and 37.9% (T3) among men. Taking into account crude data the OR (95% CI) for DM+IFG among women was 1.54 (1.14-2.08) in T2 and 1.66 (1.23-2.24) in T3 when comparing with T1. In model 2 the OR (95% CI) for DM+IFG among women was 1.63 (1.16-2.28) in T2 and 1.88 (1.21-2.94) in T3 when comparing with T1. In model 3 in the group of women the OR (95% CI) for DM+IFG was 1.52 (1.07-2.16) and 1.62 (1.02-2.56) when comparing T2 vs T1 and T3 vs T1, respectively. In the group of men in model 1 the OR (95% CI) for DM+IFG prevalence was 1.59 (1.08-2.32) in T2 vs T1 and 1.40 (0.95-2.05, p&amp;gt;0.05) in T3 vs T1. In the group of men in model 2 and 3 the results were not statistically significant, both in T2 vs T1 and T3 vs T1. Taking into account the whole study group the risk of DM+IFG was significantly higher in T2 vs T1 (model 1, 2 and 3) and in T3 vs T1 (model 1 and 2). Conclusions Higher iron intake with diet was associated with a higher risk of diabetes and impaired fasting glucose in the study group, especially among women.

Daily Versus Alternate Day Oral Iron Replacement for Women with Iron Deficiency Anaemia: A Randomized Controlled Trial

Daily Versus Alternate Day Oral Iron Replacement for Women with Iron Deficiency Anaemia: A Randomized Controlled Trial

Dietary Intake among Lebanese Adults: Findings from the Updated LEBANese natiONal Food Consumption Survey (LEBANON-FCS).

The rates of obesity, undernutrition, and other non-communicable diseases are on the rise among Lebanese adults. Therefore, it is crucial to evaluate the food consumption habits of this population to understand diet quality, analyze consumption trends, and compare them to healthy diets known to reduce risks of non-communicable diseases. To evaluate the food consumption patterns, energy intake, as well as macro- and micro-nutrient intake among a nationally representative sample of Lebanese adults aged 18-64 years old. A cross-sectional study was carried out from May to September 2022 involving 444 participants from all eight Lebanese governorates. Sociodemographic and medical information was gathered through a questionnaire, food consumption was evaluated using a validated FFQ and 24 h recall, and anthropometric measurements were recorded. There was a notable lack of adherence to three healthy diets (Mediterranean, EAT-Lancet, USDA) among Lebanese adults. Their dietary pattern is characterized by high energy, added sugars, sodium, and saturated fat intake while being low in healthy fats, vitamin A, D, and E. Adult women are falling short of meeting their daily calcium, vitamin D, iron, and vitamin B12 requirements, putting them at increased risk of anemia, osteoporosis, and other health issues. Grains and cereals were the most consumed food groups, and most participants were found to be overweight or obese. In conclusion, the results highlight the need for public health policies and interventions aimed at encouraging Lebanese adults to make healthier food choices and transition towards diets like the Mediterranean, EAT-Lancet, or USDA diet. These diets have been shown to promote overall health and wellbeing.

Effect of Low-Dose Iron Supplementation on Early Development in Breastfed Infants

Breastfed infants are at risk of iron deficiency, which is associated with suboptimal development. There is a paucity of evidence on the effects of iron supplementation on child development, and current guidelines are divergent. To assess whether daily iron supplementation, 1 mg/kg, between 4 and 9 months in exclusively or predominantly breastfed infants improves psychomotor development at 12 months. This was a randomized, double-blind, placebo-controlled trial conducted between December 2015 and May 2020 with follow-up through May 2023 in an outpatient setting in Poland and Sweden. Participants were healthy singleton infants born at term with birth weight greater than 2500 g who were exclusively or predominantly breastfed (>50%) and did not have anemia (hemoglobin >10.5 g/dL) at age 4 months. Exclusion criteria included major illness, congenital anomaly, food allergy, and difficulty communicating with caregivers. Iron (micronized microencapsulated ferric pyrophosphate), 1 mg/kg, or placebo (maltodextrin) once daily from age 4 to 9 months. The primary outcome was psychomotor development assessed by motor score of Bayley Scales of Infant and Toddler Development III at 12 months, adjusted for gestational age, sex, and maternal education. Secondary outcomes included cognitive and language scores at 12 months; motor, cognitive, and language scores at 24 and 36 months; iron deficiency (serum ferritin <12 ng/mL), and iron deficiency anemia (iron deficiency and hemoglobin <10.5 g/dL) at 12 months. Of 221 randomized infants (111 female), 200 (90%) were included in the intention-to-treat analysis (mean [SD] age, 12.4 [0.8] months). Iron supplementation (n = 104) compared to placebo (n = 96) had no effect on psychomotor development (mean difference [MD] for motor score, -1.07 points; 95% CI, -4.69 to 2.55), cognitive score (MD, -1.14; 95% CI, -4.26 to 1.99), or language score (MD, 0.75; 95% CI, -2.31 to 3.82) at 12 months. There were no significant differences at 24 and 36 months. The intervention did not reduce the risk for iron deficiency (relative risk [RR], 0.46; 95% CI, 0.16 to 1.30) or iron deficiency anemia (RR, 0.78; 95% CI, 0.05 to 12.46) at 12 months. No benefit was found with daily low-dose iron supplementation between 4 and 9 months with respect to psychomotor development, risk of iron deficiency, or iron deficiency anemia among breastfed infants in a setting of low risk of anemia. ClinicalTrials.gov Identifier: NCT02242188.

Physicochemical, nutraceutical, and sensory evaluation of a milk-type plant-based beverage of extruded common bean (Phaseolus vulgaris L.) added with iron

Milk-type beverages are popular vegan products requiring iron and calcium fortification to improve their nutritional value, as iron deficiency is the world’s most prevalent nutritional problem. This research aimed to develop and characterize an extruded common bean (Phaseolus vulgaris L.)-based milk-type beverage added with bean protein isolate and iron. The formulations included flavors (non-flavored, vanilla, and nut) and two iron concentrations (2 and 3 mg FeSO4/100 mL). Extrusion increased the beverages’ protein (+17.38 %) and starch digestibility, and reduced their antinutritional compounds (trypsin inhibitors, condensed tannins, and carbonates). Developed beverages’ formulations differed from a commercial soybean beverage in their physicochemical properties but were more nutritious (protein: 3.33–3.44 %; fiber: 3.43–4.08 %). Iron-added beverages displayed a medium sensory acceptance (best overall likeness: 5.3–6.2). The developed beverage is a suitable, sensory-accepted, and nutritious bean-based beverage, suggesting novel research lines improving vegan beverage formulations to increase average daily iron intake.

Iron deficiency in pregnant women: effect on offspring neuropsychic development

Increasing evidence indicates that adversities in utero and early childhood can have long-lasting effects on physiological and mental health not only in childhood but also in adulthood. Micronutrient deficiency, and in particular iron deficiency, is one of the most significant factors. Based on literature data, to determine the effect of iron deficiency in pregnant women on the neuropsychological development of infants, as well as to determine a cohort of pregnant women who need iron supplements. The search was conducted in MEDLINE (from PubMed), EMBASE (from OVID), Cochrane Library and ClinicalTrials.gov from 2010 to December 2023 without language restrictions. Data were extracted. Primary outcomes included iron deficiency, serum ferritin less than 15 μg/L in pregnant women, perinatal outcomes, and development of children in infancy. The data of serum ferritin in umbilical cord blood in newborns were compared with the serum ferritin of mothers. Data on iron supplementation and its effect on perinatal outcomes were assessed. Daily oral iron supplementation during pregnancy in women without IDA or ID reduces the incidence of iron deficiency anemia at the woman’s due date, reduces the incidence of iron deficiency in fullterm neonates, and reduces the incidence of morbidity in low-birth-weight infants. Iron supplementation during pregnancy and the postpartum period is a strategy for timely replenishment of ID and prevention of IDA to reduce cerebral iron deficiency in the fetus and newborn. The absence of side effects and high bioavailability, enhanced by ascorbic acid, allow us to recommend SunActive®Fe Bonoferlat as a daily supplement for pregnant and lactating women, according to WHO recommendations.

Longitudinal change of energy expenditure, body composition and dietary habits in Progressive Supranuclear Palsy patients.

Alterations in metabolic status, body composition, and food intake are present in all neurodegenerative diseases. Aim of this study was to detect the progression of these changes in Progressive Supranuclear Palsy (PSP). We conducted a longitudinal study of 15 patients with PSP. The assessments were performed at baseline (T0) and after 7(IQR = 5) months of follow-up (T1). We collected anthropometric measures including body weight, height, body mass index and waist circumference, metabolic parameters through indirect calorimeters, body composition using bioimpedance analysis, and dietary habits with a validated questionnaire. PSP-rating scale (PSP-rs) was used to evaluate disease severity and dysphagia. The majority of patients (66.66%) presented PSP-Richardson Syndrome and 33.33% the other variant syndromes of the disease. At T1 there was a decrease in intake of total daily calories (p < 0.001), proteins (p < 0.001), fibers (p = 0.001), calcium (p = 0.008), iron (p < 0.001), zinc (0.034), vitamin E (p = 0.006) and folates (p = 0.038) compared to T0. No other changes were found. As for T1 data, no significant differences were shown according to disease phenotypes or the presence of clinically significant dysphagia for solids. Within a mid-term follow up, PSP patients presented reduced caloric and proteins intake regardless the presence of dysphagia. The PSP-rs is likely not adequate to assess dysphagia, which should be investigated by specific clinical scales or instrumental examinations. With the goal of maintaining adequate nutritional status, the administration of protein and vitamin supplements should be considered even in the absence of dysphagia evidenced by the rating scales.

The Experience of Anaemia and Ingesting Oral Iron Supplementation in Pregnancy: A Qualitative Study

IntroductionThe objective of this study was to understand the experience of iron deficiency anaemia requiring oral iron in pregnancy and the factors affecting compliance with oral iron supplementation. Participants’ understanding regarding the possible consequences of anaemia in pregnancy was also explored. Feedback on a proposed randomised controlled trial of daily versus alternate day oral iron in pregnancy was sought. Materials & methodsFollowing ethical approval, fourteen semi-structured one-to-one interviews were carried out using an interview tool with open-ended questions. Recruitment was carried out through social media and from an antenatal out-patient setting. Interviews were audio-recorded, transcribed and analysed thematically. ResultsFatigue emerged as a predominant and troubling symptom. Awareness was often highlighted through friends/family and from healthcare professionals, particularly in first pregnancies. Knowledge surrounding the potential short-term and long-term adverse consequences of untreated anaemia however was limited.Gastro-intestinal side-effects, a previous experience of poor tolerance and forgetfulness all negatively impacted compliance with oral iron supplementation in pregnancy. Routine, a perceived improvement in fatigue with supplementation and reduced dose frequency recurred as themes which positively affected compliance.Pregnancy as a motivating factor recurred as a theme in analysis. The role of diet was felt to be important. Knowledge of iron-rich foods and absorption aids and inhibitors was good, but practice on optimal ingestion of oral iron supplementation varied.Feedback on trial acceptability was positive with the benefit of extra supportive care noted. Incorporating study visits with routine care was advised in view of time constraints. This area of research was perceived as important. ConclusionIn order to successfully reduce the rates of iron deficiency anaemia in pregnancy, it is crucial that all factors affecting compliance with oral iron are considered. Providing women with the important information on the possible consequences of sub optimally treated anaemia may help to improve this public health issue.

Effect of eight-week controlled dietary modification trial on nutritional biomarkers in young Indian athletes

Objective: Present study was intended to examine the effects of dietary modification on nutritional biomarkers in young Indian male athletes. Methods: Eighty-eight footballers and hockey players were randomly segregated into ad-libitum group (ALG) and nutrition counselling group (NCG). Eight weeks of dietary modification trial was implemented on NCG, resulting in 9.5, 2.6, and 2.1 g/kgbw/day of carbohydrate, protein, and fat respectively. Rate of changes in daily nutrient intake and nutrition biomarkers were captured. Results: NCG revealed significant increases in total serum protein (5.6%, p&lt;0.001), haemoglobin (3.9%, p&lt;0.001) and vitamin E (2.9%, p&lt;0.001). They also exhibited rises in serum vitamin C (6%, p=0.004), folate (4.5%, p=0.004), ferritin (4.8%, p=0.003), calcium (4.2%, p=0.009), serum vitamins B12 (3.9%, p=0.012) and D (12.3%, p&lt;0.001). Haemoglobin levels were positively correlated with daily protein (p&lt;0.01), iron (p&lt;0.05), vitamins B12 and vitamin C (p&lt;0.05 both) intakes. Serum calcium positively correlated with daily calcium (p&lt;0.01), phosphorus and protein (p&lt;0.05 both) intakes. Serum zinc was positively correlated with daily protein, calcium, vitamin B9 and vitamin D intake, while serum ferritin and vitamin B12 were positively correlated with protein and iron intake. Post-intervention, NCG reported optimal blood levels of calcium, zinc, protein, Hb, ferritin, vitamins B12, C and E, whereas the folate and vitamin D values were suboptimal. On the other hand, the ALG revealed marginal levels of zinc and total protein as well as noticeably low levels of calcium, folate, and vitamin D. Conclusion: Enhanced blood levels of nutritional biomarkers noted after eight-weeks of controlled dietary modification was supported by positive correlations observed with the daily nutrient intakes.

Pregnant women's perceptions of daily iron supplementation in rural Ghana

Background/Aims In Ghana, compliance with daily iron supplementation during pregnancy is low, particularly in the Tain district. This may be related to pregnant women's perceptions of iron supplements. The aim of this study was to explore pregnant women's perceptions of daily iron supplements in the Tain district. Methods This descriptive qualitative study used an interpretative approach. Data were gathered from a purposive sample of 20 pregnant mothers, through semi-structured interviews and face-to-face in-depth discussions. Data were analysed thematically. Results Women were unwilling to take iron supplements because of their belief that daily iron supplements make a baby too big for vaginal birth, leading to cervical tears, episiotomy or caesarean section. They were also concerned that supplements could cause nausea and vomiting during pregnancy, and excessive bleeding during labour and birth. Conclusions It is important to educate pregnant women on the benefits of iron supplementation during pregnancy and encourage them to acquire information from verified sources.