Determinants Of Iron Status Research Articles

Could Reticulocyte Haemoglobin Content (CHr) Help in Determination of Iron Status? Review article

Could Reticulocyte Haemoglobin Content (CHr) Help in Determination of Iron Status? Review article

Анализ рекомендаций ВОЗ по использованию концентраций сывороточного ферритина для оценки статуса железа с позиции медицины 5П

According to the World Health Organization statistics, iron deficiency is among 10 most dangerous risk factors of developing various diseases, disability, and mortality throughout the world. Therefore, a correct determination of iron status in clinical practice is of decisive importance for diagnosis and screening in order to work out preventive and therapeutic measures. The new WHO guidelines emphasize the significance of monitoring the levels of ferritin, and also of serum iron, haemoglobin, transferrin, transferrin saturation, and inflammatory index in order to correctly assess iron status. The most vulnerable groups (small infants and pregnant women) have been identified, which should be given special attention with regard to monitoring iron metabolism. Key words: anaemia, haemochromatosis, iron deficiency, ferritin

Iron Deficiency and Neuroendocrine Regulators of Basal Metabolism, Body Composition and Energy Expenditure in Rats.

Although dietary iron is a determinant of iron status in animals, body fat mass has been reported to have an inverse association with iron status in human studies. The goal of this study was to determine the relationship between Fe homeostasis, body composition, energy expenditure and neuroendocrine regulators for severe Fe-deficiency anaemia. Forty male Wistar albino rats recently weaned were divided at random into two groups: the control group was fed the basal diet, AIN-93G diet (normal-Fe) and the anaemic group received a low-Fe diet for 40 days. Neuroendocrine parameters that regulate basal metabolism and appetite (thyroid hormones, ghrelin, glucose-dependent insulinotropic polypeptide (GIP), glucagon, insulin, adrenocorticotropic hormone and corticosterone), body composition, respiratory volumes, energy expenditure, haematological and biochemical were assessed. Total body fat was lower, whereas lean mass, free and total water were higher in the anemic group. O2 consumption, CO2 production, energy expenditure (EE) and respiratory quotient (RQ) were lower in the Fe-deficient animals. Triiodothyronine and thyroxine hormones decreased, while thyroid-stimulating hormone increased in the anemic group. Circulating levels of ghrelin were lower in the anemic group, while GIP, glucagon, insulin, corticosterone and adrenocorticotropic hormone levels were higher. Fe-deficiency impairs weight gain in the rats, with marked reductions in lean mass and body fat, indicating lower energy stores.

Serum ferritin as an indicator of iron status: what do we need to know?

Determination of iron status in pregnancy and in young children is essential for both clinical and public health practice. Clinical diagnosis of iron deficiency (ID) through sampling of bone marrow to identify the absence of body iron stores is impractical in most cases. Serum ferritin (SF) concentrations are the most commonly deployed indicator for determining ID, and low SF concentrations reflect a state of iron depletion. However, there is considerable variation in SF cutoffs recommended by different expert groups to diagnose ID. Moreover, the cutoffs used in different clinical laboratories are heterogeneous. There are few studies of diagnostic test accuracy to establish the sensitivity and specificity of SF compared with key gold standards (such as absent bone marrow iron stores, increased intestinal iron absorption, and hemoglobin response to SF) among noninflamed, outpatient populations. The limited data available suggest the commonly recommended SF cutoff of <15 μg/L is a specific but not sensitive cutoff, although evidence is limited. Data from women during pregnancy or from young children are especially uncommon. Most data are from studies conducted >30 y ago, do not reflect ethnic or geographic diversity, and were performed in an era for which laboratory methods no longer reflect present practice. Future studies to define the appropriate SF cutoffs are urgently needed and would also provide an opportunity to compare this indicator with other established and emerging iron indexes. In addition, future work would benefit from a focus on elucidating cutoffs and indexes relevant to iron adequacy.

Assessment of iron status in settings of inflammation: challenges and potential approaches

The determination of iron status is challenging when concomitant infection and inflammation are present because of confounding effects of the acute-phase response on the interpretation of most iron indicators. This review summarizes the effects of inflammation on indicators of iron status and assesses the impact of a regression analysis to adjust for inflammation on estimates of iron deficiency (ID) in low– and high–infection-burden settings. We overviewed cross-sectional data from 16 surveys for preschool children (PSC) (n = 29,765) and from 10 surveys for nonpregnant women of reproductive age (WRA) (n = 25,731) from the Biomarkers Reflecting the Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Effects of C-reactive protein (CRP) and α1-acid glycoprotein (AGP) concentrations on estimates of ID according to serum ferritin (SF) (used generically to include plasma ferritin), soluble transferrin receptor (sTfR), and total body iron (TBI) were summarized in relation to infection burden (in the United States compared with other countries) and population group (PSC compared with WRA). Effects of the concentrations of CRP and AGP on SF, sTfR, and TBI were generally linear, especially in PSC. Overall, regression correction changed the estimated prevalence of ID in PSC by a median of +25 percentage points (pps) when SF concentrations were used, by −15 pps when sTfR concentrations were used, and by +14 pps when TBI was used; the estimated prevalence of ID in WRA changed by a median of +8 pps when SF concentrations were used, by −10 pps when sTfR concentrations were used, and by +3 pps when TBI was used. In the United States, inflammation correction was done only for CRP concentrations because AGP concentrations were not measured; regression correction for CRP concentrations increased the estimated prevalence of ID when SF concentrations were used by 3 pps in PSC and by 7 pps in WRA. The correction of iron-status indicators for inflammation with the use of regression correction appears to substantially change estimates of ID prevalence in low– and high–infection-burden countries. More research is needed to determine the validity of inflammation-corrected estimates, their dependence on the etiology of inflammation, and their applicability to individual iron-status assessment in clinical settings.

Determinants of iron status and Hb in the Bangladesh population: the role of groundwater iron.

Using data from the national micronutrients survey 2011-2012, the present study explored the determinants of Fe status and Hb levels in Bangladesh with a particular focus on groundwater Fe. Cross-sectional study conducted at the nationwide scale. Settings The survey was conducted in 150 clusters, fifty in each of the three strata of rural, urban and slum. Three population groups: pre-school age children (6-59 months; PSAC), school age children (6-14 years; SAC) and non-pregnant non-lactating women (15-49 years; NPNLW). National prevalence of Fe deficiency was 10·7 %, 7·1 % and 3·9-9·5 % in PSAC, NPNLW and SAC, respectively. Prevalence of anaemia was 33·1 % (PSAC), 26·0 % (NPNLW) and 17·1-19·1 % (SAC). Multivariate regression analyses showed that the area with 'predominantly high groundwater Fe' was a determinant of higher serum ferritin levels in NPNLW (standardized β=0·19; P=0·03), SAC (standardized β=0·22; P=0·01) and PSAC (standardized β=0·20; P=0·03). This area also determined higher levels of Hb in PSAC (standardized β=0·14; P=0·01). National prevalence of Fe deficiency in Bangladesh is low, contrary to the widely held assumption. High Fe level in groundwater is associated with higher Fe status (all populations) and higher Hb level (PSAC).

M1246 Diaphragm Strictures (DS): Location, Number and Dose-Relation to NSAID Exposure as Evaluated by Double Balloon Enteroscopy (DBE)

evaluation of IDA. Methods: Adults presenting for outpatient EGD and colonoscopy were prospectively enrolled. Sera were obtained for determination of iron status, serum transferrin receptor(sTfR), ESR, and CRP. Subjects with IDA were compared to a control group without anemia. Quantification of stool blood was performed. Extensive data including socioeconomic factors and clinical features were collected. Serum for hepcidin was collected fasting, at the same time of day; measurements were performed by a combination of cation exchange chromatography and time-of-flight mass spectrometry. Results: 46 subjects were enrolled. Age, gender, BMI, race, and ethnicity were all similar (p = NS). The subjects were stratified into those who had ongoing blood loss to account for IDA, and those who did not. In only 1 control subject was hepcidin undetectable. In 5 subjects with IDA, hepcidin levels were elevated. None of these 5 subjects had a history of menorrhagia, or evidence of blood loss from the GIT. Mean ESR and CRP were not significantly different, however sTfR was found to be increased in the group with IDA when compared to the control group (p <0.05). Conclusion: In this cohort of subjects with IDA, sTfR was significantly higher than in the controls, consistent with the diagnosis of IDA. However, contrary to prior assertions, hepcidin levels are not always undetectable in adults with IDA. In these patients, who do not have “anemia of chronic disease,” and do not have ongoing blood loss, hepcidin levels may be a reflection of the etiology of, rather than a response to, IDA. Support: This study was supported by NIH Grant UL1RR024982.

Do diets high in iron impair manganese status?

A recent study investigated the effect of dietary heme- and nonheme iron intake on iron and manganese status in young women. Despite representing only 5% of total dietary iron intake, heme iron was the primary determinant of iron status but had no influence on manganese status. In contrast, diets high in nonheme iron were not associated with better hematologic status, but serum manganese values were lower.

Dietary Patterns as Determinants of Iron Status in African Women in the Northwest Province of South Africa

Dietary Patterns as Determinants of Iron Status in African Women in the Northwest Province of South Africa

Randomized, double-blind, placebo-controlled study to evaluate the effect of two dosing regimens of darbepoetin alfa in patients with heart failure and anaemia

We appreciate the comments by Drs Leszek and Kruszewski. It is clear that they recognize that the aetiology of anaemia in heart failure is complex and that the non-invasive assessment of body iron stores is challenging. Non-invasive determination of iron status typically includes ferritin and TSAT. Ferritin is an acute-phase reactant. Its level can change independently of iron status, which limits its use as a marker for body iron stores. As Leszek and Kruszewski noted, the coefficient of variation for basal ferritin in …

Iron status at birth, umbilical cord clamping time, breastfeeding status and infant sex are determinants of iron status at six months of age

Iron status at birth, umbilical cord clamping time, breastfeeding status and infant sex are determinants of iron status at six months of age

‘Ferritin as an indicator of suspected iron deficiency in children with autism spectrum disorder: prevalence of low serum ferritin concentration’

‘Ferritin as an indicator of suspected iron deficiency in children with autism spectrum disorder: prevalence of low serum ferritin concentration’

Lack of clinical manifestation of hereditary haemochromatosis in South African patients with multiple sclerosis

Caucasian South African patients with multiple sclerosis (MS) were screened for the most common hereditary haemochromatosis (HH) mutations, H63D and C282Y, in order to determine the impact of iron overload on clinical outcome of MS. DNA screening for mutations H63D and C282Y in 118 apparently unrelated MS patients did not reveal significant differences in allele frequencies in comparison with a control group from the same population. Of 17 MS patients heterozygous for C282Y, 3 had below normal and none had above normal transferrin saturation levels. One of the index MS patients, and subsequently also her sister who also has MS, tested positive for two copies of mutation C282Y. Determination of iron status revealed high serum ferritin and transferrin saturation levels in both patients. However, the index patient, being unaware of her C282Y status, had received treatment for iron deficiency in the past and her MS symptoms were less severe than those of her sister who has been wheelchair bound for the past 12 years and who did not take iron supplements. Lack of clinical manifestation of HH without any signs of organ damage in the C282Y homozygous MS patients is in accordance with a role of iron dysregulation in the aetiology of MS.

The influence of high-altitude living on body iron

AbstractThe quantitative assessment of body iron based on measurements of the serum ferritin and transferrin receptor was used to examine iron status in 800 Bolivian mothers and one of their children younger than 5 years. The survey included populations living at altitudes between 156 to 3750 m. Body iron stores in the mothers averaged 3.88 ± 4.31 mg/kg (mean ± 1 SD) and 1.72 ± 4.53 mg/kg in children. No consistent effect of altitude on body iron was detected in children but body iron stores of 2.77 ± 0.70 mg/kg (mean ± 2 standard error [SE]) in women living above 3000 m was reduced by one-third compared with women living at lower altitudes (P < .001). One half of the children younger than 2 years were iron deficient, but iron stores then increased linearly to approach values in their mothers by 4 years of age. When body iron in mothers was compared with that of their children, a striking correlation was observed over the entire spectrum of maternal iron status (r = 0.61, P < .001). This finding could provide the strongest evidence to date of the importance of dietary iron as a determinant of iron status in vulnerable segments of a population. (Blood. 2005;106:1441-1446)

Determinants of iron status in Malaysian adolescents from a rural community

Iron deficiency anaemia is the most common micronutrient deficiency worldwide. The prevalence of anaemia in the developing countries is three to four times higher than that in the developed countries. The iron status was assessed in 199 apparently healthy male and female adolescents aged 12–19 years living in a fishing community in Sabah, Malaysia. Data on socio-economic characteristics, lifestyles, anthropometry measurements, iron status, and dietary intake were gathered. Dietary intake of energy, iron, and most nutrients (with the exception of protein and vitamin C) were below the recommended levels for Malaysian adolescents. Three-quarters of the iron was derived from plant foods. The mean haemoglobin value for the male was 13.9±1.3 g/dl with 9.5% having less than 12 g/dl, while the respective figures for the female were 12.4±1.6 g/dl and 28.6%. The mean serum ferritin concentrations for male and female adolescents were 21.5 and 15.4 μg/l, respectively; with 25.7% of the males and 49.5% of the females having deficient levels of ferritin. Dietary intake of total energy and iron, and gender were found to be independent determinants of serum ferritin and haemoglobin levels, accounting for over 40% of the variations for each of these iron indicators. In males, but not in females, the intake of dietary protein and iron, and physical activity were also found to be significant determinants of serum ferritin. The age of subjects and household size were significant determinants of haemoglobin levels for male subjects, but not for female subjects. The findings indicate the importance of adequate intake of energy and dietary iron for improving the iron status of adolescents.

Restless Legs Syndrome.

With suitable pharmacotherapy, patients with any degree of restless legs syndrome (RLS) should be able to obtain substantial relief of symptoms. The best therapeutic success is attained when the physician tailors therapy to the patient's specific symptoms and can flexibly try a variety of agents, if needed. Therapy should be reserved for those in whom RLS cannot be managed with just sleep hygiene and related practices. It should not be withheld, however, if a patient reasonably believes that his or her quality of life is being impaired by RLS. The optimal initial approach to RLS in the general patient is usually the use of a dopaminergic agent: low-dose levodopa in milder cases, a dopamine agonist in more severe ones. Patients whose problems are primarily sleep related can initially be treated with a benzodiazepine. Patients who have symptoms primarily while awake can initially be treated with a dopaminergic agent or an opioid. Patients whose RLS discomfort is truly painful can initially be treated with gabapentin. Combination therapy with two or three agents from different classes can be useful as well. Determination of iron status is the most important initial laboratory evaluation in patients with RLS. Iron supplementation should be used as indicated. In the future, delivery modes other than oral administration of medications may be of significant benefit, especially in more severe cases.

Effects of calcium supplementation and lactation on iron status

Calcium has been shown to inhibit iron absorption. The consequences of chronic calcium supplementation on iron status are unclear, however. As part of a randomized calcium-supplementation trial in lactating and nonlactating women in the postpartum period, we determined whether long-term calcium supplementation and lactation status affected iron stores as measured by serum ferritin concentrations. Subjects (95 lactating and 92 nonlactating) were enrolled at approximately 6 mo postpartum and then randomly assigned to receive either 500 mg Ca as calcium carbonate or a placebo twice daily with meals for 6 mo. Lactating women weaned their infants approximately 2 mo after enrollment (ie, approximately 8 mo postpartum). Calcium supplementation had no effect on serum ferritin concentrations. At the end of the study, geometric mean serum ferritin concentrations were 28.4 microg/L in the calcium-supplemented group and 27.5 microg/L in the placebo group (P > 0.5). Lactation status was significantly related to serum ferritin concentrations. At baseline, serum ferritin concentrations were higher in lactating women than in nonlactating women (47.7 compared with 31.5 microg/L, P < 0.001). In lactating women, serum ferritin concentrations decreased by a mean of 17 microg/L after weaning. By 12 mo postpartum, mean serum ferritin concentrations in women who were previously lactating were not significantly higher than those of nonlactating women (30.5 compared with 25.5 microg/L). These findings provide reassurance that long-term calcium supplementation does not impair iron stores. Furthermore, lactation status should be considered when assessing iron nutriture of women and determinants of iron status in populations.

The determinants of iron status in early pregnancy.

In pregnancy, the additional demands for Fe are thought to be met principally through increased maternal dietary Fe absorption and by mobilization of maternal Fe stores. In a general population sample of 576 women we examined the maternal and dietary characteristics which influenced Fe stores (assessed by serum ferritin concentration) in early pregnancy. The effects of these characteristics on two measures of functional Fe status (mean cell volume and haemoglobin concentration) were also considered. Serum ferritin concentrations were lower in multiparous women (P < 0.0001) and in those with a lower BMI (P = 0.01), and rose with increasing alcohol intake (P < 0.0001). Ferritin concentrations fell with increasing Ca intake (P < 0.0001); the proportion of women with serum ferritin values < or = 12 micrograms/l rose from 14% of the women in the lowest quarter of Ca intake to 29% of the women in the highest quarter. Mean cell volume and haemoglobin concentration were not related to Ca intake in early pregnancy. Although Ca added to test-meals reduces Fe absorption, long-term Ca supplementation has not been shown to lower plasma ferritin concentration, suggesting that high habitual Ca intakes would be unlikely to influence Fe status in non-pregnant individuals. Our findings show that in early pregnancy there is an association between high dietary Ca intake and lower Fe stores. This effect of Ca on one aspect of Fe status may result from its influence on Fe bioavailability.