High Prevalence Of Iron Deficiency Research Articles

HAEMATOLOGICAL PROFILE AND MENTZER INDEX IN PEDIATRIC PATIENTS PRESENTING WITH ANEMIA

Objective: The objective of this study was to analyze clinical and hematological profile of children with anemia and determine the Mentzer index of all cases presenting with anemia. Methods: This was a cross-sectional observational study conducted in the Department of pediatrics of a tertiary care medical college. Eighty pediatric age group patients diagnosed to be having anemia on clinical examination were included in this study. Demographic details such as age and gender were noted in all cases. A through history was obtained and a clinical examination was done. Presenting complaints were also noted. Complete blood count with peripheral blood smear examination was done in all cases. The Mentzer index was determined from complete blood count reports. Results: Out of 80 studied cases, there were 57 (71.25%) boys and 23 (28.75%) girls. The mean age for boys was 9.12±3.14 years and for girls, it was slightly higher at 10.24±3.46 years. Fatigue (73.75%), pallor (71.25%), and anorexia (56.25%) were common complaints. About 55% had mild anemia 22.5% had moderate anemia and 22.5% suffered from severe. Mean hemoglobin concentration of studied cases was found to be 8.42±3.98 g/dL. The most prevalent blood picture was the normocytic normochromic blood picture, representing 60% of cases. Mentzer index ranged from a minimum of 10.83 to a maximum of 27.76, with the mean value being 17.40±2.92. Notably, the vast majority of patients (97.5%) had a Mentzer Index >13, suggesting a high prevalence of iron deficiency. Conversely, only 2.5% of the patients had a Mentzer Index at or below 13, indicating a much smaller subset in whom Hb electrophoresis was needed to rule out thalassemia trait. Conclusion: Although most of the children with anemia are secondary to iron deficiency Mentzer index should be determined in all patients of anemia so as to avoid inadvertently prescribing iron supplementation in cases of thalassemia trait.

High prevalence of iron deficiency and socioeconomic disparities in laboratory screening of non-pregnant females of reproductive age: A retrospective cohort study.

Iron deficiency anemia (IDA) and non-anemic iron deficiency (NAID) are highly prevalent among non-pregnant females of reproductive age. Canada has no national screening guidelines for this population. Screening, when performed, is often with a complete blood count alone without ferritin or iron indices. The primary objective was to determine the prevalence of screening for NAID and IDA over a 3-year period in non-pregnant females of reproductive age who had tests performed at outpatient laboratories in Ontario, Canada. Retrospective cohort study of non-pregnant females ages 15-54 in Ontario, from 2017 to 2019. NAID was defined as ferritin <30 μg/L, anemia as hemoglobin <120 g/L, and IDA as ferritin <30 μg/L and hemoglobin <120 g/L. Annual household income was estimated using patient postal codes. A total of 784 132 non-pregnant females were included. The 82.1% were screened for iron deficiency, 38.3% had NAID and 13.1% had IDA; 55.6% with IDA had normal mean corpuscular volumes. The median household income was $89454.80 compared with a provincial median of $65285.00. Patients in the lowest income quintile had the highest odds of being anemic, and the lowest odds of having a ferritin checked. A large proportion of non-pregnant females of reproductive age in this cohort were screened for iron deficiency. In this relatively privileged cohort, NAID affected nearly 40%, and IDA 13%. Most patients with IDA did not have microcytosis. Low household income was associated with the greatest odds of anemia and the lowest odds of being screened, highlighting inequitable access to screening for IDA in Ontario, Canada.

Correlates of iron deficiency among adult patients with sickle cell nephropathy at a tertiary health facility in Lagos, Nigeria: A cross-sectional study

Background: Iron deficiency presents a muddled clinical picture in patients with sickle cell anemia (SCA). The picture is further complicated when these patients develop sickle cell nephropathy (SCN). This study aimed to identify the correlates of iron deficiency among adult patients with SCN in Lagos, Nigeria. Methods: This was a cross-sectional study conducted among adult patients with SCN who presented at the nephrology clinic of the tertiary health facility. Data on demographics, clinical history, laboratory investigations, and iron status were collected and analyzed using the Statistical Package for the Social Sciences (SPSS) version 28. Results: One hundred and nineteen adult patients with SCN were enrolled in the study. The mean age was 28.9 ± 9.5 years, and the majority were females. Iron deficiency was present in 36 (30.2%) subjects, while 7.6% had elevated iron status. Younger age and male sex were associated with iron deficiency state. Participants with an estimated glomerular filtration rate (eGFR) of ≥60 mL/min had a higher prevalence of iron deficiency (r = −0.28 P &lt; 0.01/r = −0.32 P &lt; 0.01). A logistic regression analysis showed no independent association between these factors and iron deficiency. Conclusion: This study showed that iron deficiency is common in adults with SCN, seen in one-third of participants. Therefore, although iron overload is frequently acknowledged as a significant issue in SCA, it should not be automatically assumed in cases where nephropathy is present. The study findings also highlight the need for routine screening for iron deficiency among SCN patients, especially among males, younger patients or those with an eGFR ≥60 mL/min, to optimize their management and improve their outcomes.

Relationship between hemoglobin and grip strength in older adults: the ActiFE study

IntroductionAlthough anemia is associated with low muscle strength, hemoglobin has been rarely studied considering ferritin.AimTo analyze the association between hemoglobin and grip strength in community-dwelling older adults.MethodsWe used data from a German cohort of adults ≥ 65 years, excluding those with CRP > 10 mg/L or taking iron supplements. Grip strength (kg) was measured using a Jamar dynamometer. Analysis was performed using multiple linear regression, adjusted for established confounders. Due to interaction, age-stratified (< 80, 80 +), further sex-stratified analysis in those < 80 years old and ferritin-stratified in men < 80 years were performed.ResultsIn total, 1294 participants were included in this analysis (mean age 75.5 years, 549 (42.3%) women, 910 (70.3%) < 80 years). On average, hemoglobin and grip strength were 14.9 g/dL and 41.3 kg for men, 13.9 g/dL and 25.1 kg for women. Hemoglobin was significantly positively associated with grip strength only among women < 80 years (β 0.923 [95% CI 0.196, 1.650]). For men < 80 years, the association was significant when ferritin was ≥ 300 µg/L (β 2.028 [95% CI 0.910, 3.146]). No association was detected among those participants 80 + .Discussion and conclusionsOur data show an association between hemoglobin and grip strength only in women < 80 years old. For men < 80 years, the association was only significant with ferritin levels ≥ 300 µg/L. Considering the decreasing levels of hemoglobin and grip strength and the high prevalence of iron deficiency in older adults further analyses investigating this relationship with more iron specific parameters such as transferrin saturation are warranted.

Transferrin Saturation, Serum Ferritin, and C-Reactive Protein vs. Serum Ferritin for an optimal Iron Deficiency Diagnosis in Candidates for Bariatric Surgery.

Iron has different physiological processes and is regulated by hepcidin that is also an acute phase reactant, which increases with inflammation. Obesity produces a pro-inflammatory state, affecting directly the normal regulation of iron, causing ferritin (FER) deficiency. FER is used as the only indicator of the status of iron in patients with obesity, so the majority of them would be underdiagnosed, leading to a high prevalence of iron deficiency (ID) and anemia. The aim of this study is to evaluate the diagnostic tests: transferrin saturation (TS), FER, and C-reactive protein (CRP) vs. FER with the objective of analyzing the most accurate variable for the diagnosis of ID. We present a cross-sectional, analytical, and retrospective study, evaluating the diagnostic tests in 96 patients, to whom two methods were applied for the diagnosis of ID: method 1 (FER < 30ng/mL) and method 2 divided into 2A (FER < 30ng/mL), 2B (FER 30-100ng/mL + CRP ≥ 5mg/L), 2C (FER 100-300ng/mL + CRP ≥ 5mg/L + TS < 20%), and 2D (TS < 20%). The prevalence of ID obtained using method 1 was 30.2% while 69.8% presented ID using total method 2, confirming an underdiagnosis of 39.6%. The inflammatory state in patients with obesity must be considered in the diagnosis of ID. The use of TS, FER, and CRP has greater validity than the use of serum FER for the diagnosis of ID in patients with obesity.

South East Asian Nutrition Surveys II (SEANUTS II) Thailand: Triple burden of malnutrition among Thai children aged 6 months to 12 years.

This study assessed nutritional status among Thai children using anthropometry, dietary intakes, and micronutrient status. Cross-sectional survey with multi-stage cluster sampling. Body weight and height were measured in all children. Dietary intakes were assessed using 24-hour dietary recall. Biochemical assessment was performed in one-third of the children. The study was conducted in Thailand's four geographical regions and Bangkok. 3478 Thai children aged 0.5-12.9 years. Stunting showed a downward trend by age group and was most prevalent among infants and toddlers. Overweight and obesity showed a significant upward trend by age group, location, and sex, and was highest among children aged 7-12.9 years. Risks of inadequate micronutrient intakes (calcium, iron, zinc, vitamins A, C, and D) were high (53.2-93.6%). Prevalence of zinc and mild vitamin A deficiencies were low; vitamin D and B12 deficiencies were nil. Vitamin D insufficiency was significantly higher in the urban area and among girls aged 7-12.9 years. Anemia was very high in infants and toddlers (56.6 and 35.2%), but showed a significant downward trend by age group. There was an overall high prevalence of iron deficiency without anemia (25%) versus iron deficiency anemia (4.2%) among children aged 4-12.9 years old. The high prevalence of stunting and anemia among children aged 1-3.9 years and overweight and obesity among children aged 7-12.9 years requires continued attention. While prevalence of biochemical micronutrient deficiencies was not high (except for iron), high prevalence of dietary inadequacies for several micronutrients warrants further in-depth investigations.

Parenteral Iron Therapy: Examining Current Evidence for Use in Athletes.

A high prevalence of iron deficiency exists in athlete populations. Various mechanisms, including increased losses through sweat, haemolysis, haematuria, and gastrointestinal micro-ischemia; inadequate dietary intake; and transient exercise-induced increases in the regulatory hormone, hepcidin, contribute to the increased prevalence in athletes. Indeed, hepcidin has been shown to peak around 3-6 hours post-exercise, limiting iron absorption from the gut. As the practitioner's ability to control losses is limited, the key to treatment of iron deficiency in athletes is optimal timing of dietary and oral iron supplementation around these periods of reduced gut absorption. While timing and dosing schedule strategies might be sufficient to treat iron deficiency non-anaemia, the significant lag to impact iron status is relatively long. Therefore, in iron deficiency anaemia, the use of parenteral iron has the benefit of rapid repletion of iron stores and normalisation of haemoglobin status, while bypassing the action of hepcidin at the gut. Furthermore, newer intravenous formulations can be administered as a single total dose over 15-60 min and have a similar safety profile to oral treatment. This review discusses the existing evidence for parenteral iron use in athletes and the unique context for consideration when choosing the parenteral route in this population.

Evaluating Sex-Based Hemoglobin Reference Intervals Using Strict Definitions of Health

Introduction: Hemoglobin reference intervals (RIs) are developed by laboratory assay manufacturers, and laboratories establish a RI using 120 “normal” samples when first implementing a new assay. Many institutions report different hemoglobin RIs for females and males with wide variation between institutions. Re-evaluation of hemoglobin RIs is warranted to ensure that optimal health for all patients is accurately represented. Using National Health and Nutrition Examination Survey (NHANES) data, we evaluated the impact of excluding adults with chronic disease, iron deficiency (ID), inflammation, and red blood cell (RBC) disorders on hemoglobin lower limit of normal (LLN). Methods: Adults &amp;gt; 20 years in the NHANES from 2001-2006 and 2017-2020 were included. Demographic characteristics, self-reported medical history and medication use, and laboratory parameters were extracted. We generated hemoglobin distributions weighted to represent the population of the USA. From these distributions, 2.5%, 50%, and 97.5% values were individually and compositely evaluated when excluding chronic disease (defined as the healthy cohort), ID, inflammation, and RBC disorders. The healthy cohort excluded patients with a medical history of anemia, malignancy, current pregnancy, smoking, or liver, lung, kidney, or heart disease. Iron deficiency was defined as ferritin &amp;lt; 50 ng/mL, transferrin saturation (Tsat)&amp;lt;20%, or total iron binding capacity (TIBC) &amp;gt; 400 μg/dL. Inflammation was defined as ferritin&amp;gt;300 ng/mL, hs-CRP&amp;gt;1 mg/L, albumin&amp;lt;3.5 g/dL, white blood cells&amp;gt;10 K/uL, or TIBC&amp;lt;200 μg/dL. RBC disorders were defined as history of blood transfusion, MCV &amp;lt;80 or &amp;gt;100, Tsat&amp;gt;55%, MCHC &amp;gt;36, Mentzer index&amp;lt;13, or hydroxyurea or iron chelator use. Finally, we conducted several sensitivity analyses that assessed degree of ID at different levels of ferritin ranging from &amp;lt; 15 ng/mL to &amp;lt; 100 ng/mL. All analyses were conducted in R using the survey package. Results: There were 10,338 individuals in the total cohort, 5757 in the healthy cohort, and 1609 in the cohort with all exclusions applied. Among females, the hemoglobin LLN was 10.7g/dL in the total cohort, 10.6g/dL in the healthy cohort, 10.4g/dL in the cohort excluding inflammation, 11.7g/dL in the cohort excluding RBC disorders, 12.2g/dL in the cohort excluding ID, and 12.3g/dL in the cohort with all exclusions applied. Among males, the hemoglobin LLN was 12.5g/dL in the total cohort, 12.9g/dL in the healthy cohort, 12.9g/dL in the cohort excluding inflammation, 13.2g/dL in the cohort excluding RBC disorders, 13.0g/dL in the cohort excluding ID, and 13.3g/dL in the cohort with all exclusions applied. The difference between male and female hemoglobin LLN narrowed from 2.3g/dL (12.9g/dL vs 10.6g/dL) in the healthy cohort to 1g/dL (13.3g/dL vs 12.3g/dL) in the cohort with all exclusions applied. For males, the largest difference in hemoglobin LLN was seen when RBC disorders were excluded (12.9g/dL to 13.2g/dL; 0.3g/dL difference), and for females the greatest difference was seen when ID was excluded (10.6g/dL to 12.2g/dL; 1.6g/dL difference). Hemoglobin LLN by menopausal status for females and by age for males is shown in Figure 1. Pre-menopausal females had a significant increase in hemoglobin LLN when ID alone was excluded (10.3g/dL to 12.3g/dL), but this degree of change was not observed in healthy post-menopausal females or males. Degree of ID by ferritin level by sex and menopausal status or age is shown in Figure 2. Using a threshold of ferritin &amp;lt;30 ng/mL, 38.9% of pre-menopausal females were iron deficient compared with 10.3% of post-menopausal females and 3.5% of males. Discussion: Applying strict criteria for health and specifically excluding inflammation, RBC disorders, and ID resulted in higher hemoglobin LLN for both sexes and narrowed the difference in LLN between males and females. Pre-menopausal females had the most significant change in hemoglobin LLN from the healthy cohort to the cohort with all exclusions applied, and this was predominately driven by a very high prevalence of ID. ID is a pandemic that disproportionally impacts females of reproductive age. These findings emphasize the burden of ID and its systemic consequences, including normalization of anemia. It is imperative that institutions rigorously and thoughtfully define their hemoglobin RIs by ensuring that strict definitions of health are applied with an emphasis on excluding those with ID.

High Prevalence of Iron Deficiency Among Daratumumab-Treated Newly Diagnosed Multiple Myeloma Patients

Background: Iron deficiency (ID), a common cause of anemia, is often overlooked among patients with hematologic malignancies given alternative etiologies. Daratumumab is an anti-CD38 monoclonal antibody used in the management of multiple myeloma (MM). Approximately 45% of patients on daratumumab are anemic. In a study of 22 patients with relapsed refractory AL amyloidosis treated with daratumumab, 40% developed iron deficiency requiring IV iron replacement. It is unclear whether iron deficiency in this setting is specific to AL amyloidosis, or whether it is universally seen with daratumumab treatment. In this study we evaluated iron deficiency parameters, including bone marrow iron stores, in MM patients treated with daratumumab. Methods: We conducted a retrospective study to evaluate the prevalence of ID among newly diagnosed MM patients who were treated uniformly in a phase II study with the combination of daratumumab, ixazomib, lenalidomide and dexamethasone conducted at our center. Laboratory values of ferritin, hemoglobin and MCV were extracted from the medical records at trial enrollment and at 1-year from treatment initiation. ID was defined as ferritin &amp;lt;30 mcg/L. Bone marrow iron stores were assessed at pre-trial and 1-year from therapy initiation by Prussian blue stain of bone marrow clot sections, with grade 0 (absent iron) or grade 1 (trace to low iron) considered as depleted iron storage. Results: Among 54 included patients, 2 (3.7%) had ferritin &amp;lt;30 mcg/L at trial-enrollment, while 27 (50%) developed ID within 1 year and 33 (61%) became iron deficient during their treatment course. All patients (100%) had lower ferritin at 1 year compared to pre-trial value. The median reduction of ferritin at 1-year was 109 (IQR: 41-239 mcg/L), a decrease by 75% (IQR:56- 86%) from baseline value. Fifteen patients (28%) received IV or oral iron replacement, and 4 were already on iron-repletion before the 1-year landmark assessment. The median ferritin improved from 16 to 84 mcg/L (p&amp;lt;.0001) following iron replacement. Forty patients (74%) had improved hemoglobin at 1-year compared to baseline correlated to disease response to therapy. The median increment in hemoglobin was 1.1 (IQR: -0.3 - 2.7 g/dL). Hemoglobin at 1-year was higher in patients having ferritin ≥ 30 mcg/L compared to the ID group: 13.5 (IQR: 12.3-14.1 g/dL) vs 12.8 (IQR: 12.3-13.4 g/dL), p=.05. BM samples from pre-trial (n=37) and 1-year on-trial (n=36) were available for iron staining. Depleted iron storage was more frequent at1-year compared to baseline (63.9% vs 40.5%, p&amp;lt;.05). The median ferritin was lower in patients with iron depleted versus non-iron depleted BM: 58 (IQR: 31-120 mcg/L) vs 243 (IQR: 125-486 mcg/L) at baseline, p=.0002; 27 (IQR: 16-41 mcg/L) vs 59 (IQR: 19-245 mcg/L) at 1-year landmark, p=.07. Comparisons of laboratory markers at initiation and after 1-year on daratumumab trial are listed in Table 1. Conclusions: Our study demonstrated a high prevalence of ID among patients receiving daratumumab-based treatment for newly diagnosed MM. While some decrease in ferritin over treatment course may be caused by myeloma disease control and improved systemic inflammation, this study should increase awareness for ID among MM patients treated with daratumumab. Future studies are needed to better understand the possible role of daratumumab in the pathogenesis of ID in MM and other plasma cell disorders.

Symptomatic Iron Deficiency without Anemia: An Underrecognized Phenomenon

Background: Iron deficiency is a multifactorial condition affecting millions globally and is the leading cause of anemia worldwide. The identification of iron deficiency usually occurs during the work-up of anemia. However, iron deficiency without anemia may adversely affect patients' quality of life. Our objective is to highlight the link between iron deficiency and various patient symptoms in the absence of anemia. Methods: We conducted a retrospective chart review of patients identified using ICD-10 codes D64.9 (Anemia, unspecified), D50.9 (Iron deficiency anemia, unspecified), and E61.1 (Iron deficiency) who were seen in a tertiary care hospital hematology clinic between 01/2019 and 09/2022. Patient symptoms were obtained from two consecutive visit notes. Hemoglobin (Hb), hematocrit, MCV, ferritin, and iron profile values associated with the visits were obtained from the electronic health records. Documentation of intravenous (IV) treatment was obtained from infusion center flowsheets. Results: Our study identified a total of 65 patients. 24 patients with Hb above 12 g/dL were found, 16.67% (4/24) were male, 83.33% (18/24) were female. The most common age groups were 30-40 at 33.33% (8/24) and 40-50 at 20.83% (5/24). The mean Hb for this group of patients was 13.44 ± 1 g/dL, MCV 83.3 ± 7.1 fL, and the mean ferritin was 16.13 ± 10.37 ng/mL. 87.5% (21/24) of patients reported symptoms, with fatigue being reported by 83.33% (20/24) of patients. Pica was reported by 8.33% (2/24), restless leg syndrome by 12.5% (3/24), cold intolerance by 12.5% (3/24), and hair and/or nail changes by 25% (6/24) of patients. 70.83% (17/24) of patients received IV iron treatment, 16.67% (4/24) received oral iron treatment. Iron dextran was the most frequently used preparation at 76.47% (13/17). Mean post-treatment Hb was 13.92 ± 0.77 g/dL, MCV 88.53 ± 5.18 fL, and mean post-treatment ferritin 135.64 ± 99.66 ng/mL. In our study, 62.5% (15/24) of patients stated their symptoms improved, 4.17% (1/24) of patients stated their symptoms did not improve, 33% (8/24) of patients could not be evaluated at a subsequent visit for symptoms. Discussion:Iron deficiency without anemia can be a significant contributor to patient morbidity, and patients are not routinely assessed for iron deficiency in the absence of anemia. A recent study (Weyand et al. JAMA 2023) suggests up to 40% of females can have iron deficiency when defined by a ferritin level of 15 ng/mL, and up to 80% of females when a less stringent cut-off of 50 ng/mL is used. Our study suggests both male and female patients can report symptoms of iron deficiency without the presence of anemia and subjective improvement following iron replacement without significant changes in Hb. The high prevalence of iron deficiency indicates a greater need for screening for this underrecognized phenomenon. We recommend considering ferritin and iron panel evaluation while assessing patients for symptoms such as those seen in iron deficiency anemia, even without the presence of low Hb. Importantly, it appears correction of the iron deficiency can improve fatigue, even without affecting the Hb level. Further studies utilizing validated Quality of Life instruments should be done to more accurately assess this issue.

Nearly Half of Extreme Preterm Infants Are Iron Deficient at 4-6 Months of Corrected Age Despite Prophylactic Iron Supplementation

Background: Iron deficiency (ID) is the most prevalent micronutrient deficiency globally and has been associated with negative neurodevelopmental and behavioral outcomes in infants and young children. Susceptibility to ID is heightened in preterm infants due to lower iron reserves at birth, rapid growth during the initial weeks of life, immature erythropoiesis, and frequent blood samplings during hospitalization. To mitigate this problem, international bodies recommend prophylactic iron therapy from 2-6 weeks of age until at least 6-12 months in preterm infants. Currently, the literature regarding iron status in extremely preterm infants (EPI, infants born less than 28 weeks gestational age) who receive prophylactic iron supplementation after birth is limited. Considering the potential long-term detrimental effects of ID on the developing brain of these high-risk preterm infants, examining the prevalence and risk factors for ID are crucial to implement prevention strategies. Objective: To investigate the prevalence and risk factors associated with ID in EPI Methods: A retrospective cohort study was conducted using a population-based Provincial Perinatal Follow-Up database on all live EPIs born in Nova Scotia between 2005 and 2018. Infants with congenital malformations, chromosomal anomalies, blood disorders or those who died before outcome assessment were excluded. Prophylactic iron supplementation (2-3 mg/kg/day) starting at 2-4 weeks of chronological age was a standard of care for all included infants. Further, the dosage of iron was adjusted regularly during the hospital stay based on serum ferritin (SF) levels. Discharge instructions recommended continuing iron prophylaxis until 9-12 months corrected age (CA). At 4-6 months CA, all infants underwent blood tests to evaluate hemoglobin, and SF levels. ID was defined as SF levels below 20g/L or 12g/L at 4 and 6 months CA, respectively. A univariate analysis was performed by using a series of single-variable logistic regression models to identify the factors associated with presence of ID. Factors with a p-value &amp;lt; 0.20 in the univariate analysis were entered into a multivariable risk model using a backward selection procedure. Variables with a p-value &amp;lt; 0.05 were retained. Results: Among 146 infants, 67 (45.9%) had ID. Ferritin (16.4 µg/L vs 50.0 µg/L, p &amp;lt; .001) and reticulocyte hemoglobin equivalent (28.4pg vs 31.6pg, p &amp;lt; .001) were significantly lower in the ID group than non-ID group. The prevalence of ID decreased over time, from 59.7% in 2005-2011 to 40.3% in 2012-2018 (p = 0.52). Table 1 compares the antenatal and neonatal characteristics of the ID and non-ID groups. Table 2 compares sociodemographic variables and clinical variables at 4-6 months CA between two groups. Breastfeeding (exclusive or partial) versus formula alone at a 4-6 months CA was identified as an independent factor protective for ID (Odds: 0.2 (0.1 - 0.6), p = 0.003). Iron therapy at follow-up was also protective for ID but did not remain significant in the final model. Of note, iron therapy was stopped in 40 (27.4%) EPI before 4-6 months CA. Supplemental iron intake at 4-6 months CA was significantly lower in the infants receiving exclusive formula feeding (66.1%) compared with those breastfed (99.1%, p = 0.006). Conclusion(s): Despite prophylactic iron supplementation, nearly half of the EPI had ID at 4-6 months CA, and iron therapy was discontinued in roughly a quarter of all EPI before 4-6 months CA. Breastfeeding at 4-6 months follow-up was found to be protective for ID. High prevalence of ID in EPI highlights the need for further research in this area to avert the negative neurodevelopmental consequences of ID on the developing brain of these high-risk infants. Closer monitoring of iron status and early identification of children at high risk for ID is imperative to maximize the benefits of prophylactic iron supplementation in EPI. Further, there is lack of sufficient data for iron requirements in EPI leading to a variability in iron therapy recommendations by different professional organizations. Future prospective studies to investigate specific iron requirements of EPI as well as risk factors for ID in this high-risk vulnerable population are essential to optimize their neurodevelopmental outcomes.

Empagliflozin effects on iron metabolism as a possible mechanism for improved clinical outcomes in non-diabetic patients with systolic heart failure

Sodium-glucose co-transporter-2 (SGLT2) inhibitors improve clinical outcomes in patients with heart failure (HF), but mechanisms of action are incompletely understood. In the EMPA-TROPISM trial, empagliflozin reversed cardiac remodeling and increased physical capacity in stable non-diabetic patients with systolic HF. Here we explore, post hoc, whether treatment effects in this cohort, comprising patients who had a high prevalence of iron deficiency, were related to iron metabolism. Myocardial iron content estimated by cardiac magnetic resonance T2* quantification increased after initiation of empagliflozin but not placebo (treatment effect: P = 0.01). T2* changes significantly correlated with changes in left ventricular volumes, mass and ejection fraction, peak oxygen consumption and 6-minute walking distance; concomitant changes in red blood cell indices were consistent with augmented hematopoiesis. Exploratory causal mediation analysis findings indicated that changes in myocardial iron content after treatment with empagliflozin may be an important mechanism to explain its beneficial clinical effects in patients with HF.ClinicalTrials.gov: NCT03485222.

493. IRON DEFICIENCY AFTER ONCOLOGICAL ESOPHAGECTOMY AND GASTRECTOMY

Abstract Removal of the entire stomach or parts of it may affect iron absorption and storage. These conditions mainly caused by altering the acid environment, bypassing the duodenal passage during reconstruction or by chronic inflammatory processes. In addition, patients with esophageal or gastric cancer often have an iron deficiency preoperatively due to malnutrition, gastrointestinal hemorrhage, or inflammatory processes. Sometimes these iron deficiencies lead to microcytic hypochromic deficiency anemia. Between January 2015 and December 2019, 103 (=66%) esophagectomy patients and 54 (=34%) (sub)total gastrectomy patients were included. Fe, transferrin and ferritin were collected prospectively to be used for retrospective descriptive analysis: preoperatively and three, six, twelve, 18 and 24 months after the operations. The exclusion criteria were: Age below 18, primary bone marrow disease, hereditary forms of anemia, postoperative tumor recurrence, R1/R2 situation. Iron supplementation was not used in the first postoperative year, and thereafter only in cases of a severe iron deficiency. The severity of iron deficiency was classified by ferritin, according to iron deficiency stages I—III. 18% of patients with oncological esophagectomy and 45% of patients with oncological (sub)total gastrectomy have an iron deficiency two years after the operations. This is manifested mainly by pathologically decreased ferritin levels. There is only a significant difference between the groups, with respect to ferritin (p = 0.021) and transferrin levels (p = 0.028), after 2 postoperative years. 75% of esophagectomy patients with iron deficiency were in stage I, 12.5% in stage II and 12.5% in stage III of iron deficiency. 56% of iron deficiency patients with (sub)total gastrectomy were in stage I, 22% in stage II and 22% in stage III. Patients with (sub)total gastrectomy are more likely to have iron deficiency than patients with esophagectomy during the 24-month postoperative follow-up period. Due to the duodenal bypassing in the (sub)total gastrectomy group a higher prevalence of iron deficiency could have been expected. Most patients have storage iron deficiency (= stage I). Only few patients with iron deficiency have the more severe and decompensated form of iron deficiency, iron deficiency anemia (= stage III).

Association between green tea and coffee consumption and body iron storage in Japanese men and women: a cross-sectional study from the J-MICC Study Saga.

This study examined the association between daily green tea and coffee consumption and body iron stores among Japanese middle-aged and older adults. This cross-sectional study used data obtained from 2005 to 2007. A total of 10,435 participants were recruited for this study. The participants completed a validated, self-administered food frequency questionnaire on green tea and coffee consumption. A multivariate linear regression analysis was conducted to assess the relationship between green tea and coffee consumption and serum ferritin levels. Additionally, logistic regression analysis was performed to ascertain whether excessive consumption of these beverages was linked to iron deficiency. We observed that higher green tea and coffee consumption was associated with lower ferritin levels in men and postmenopausal women, even after adjusting for covariates (all P for trends <0.05). Among premenopausal women, we found an inverse association between green tea consumption and serum ferritin levels, while no significant association was observed for coffee consumption after adjusting for covariates (green tea, P for trend <0.05; coffee, P for trend = 0.08). Notably, the association between these beverages and iron deficiency was found only in postmenopausal women; the odds ratios (95% confidence intervals) for iron deficiency associated with almost None, <1 cup/day, 1-2 cups/day, and ≥ 3 cups/day were 1.00 (reference), 0.78 (0.26-2.49), 1.29 (0.49-3.39), and 1.59 (0.63-4.04) (P for trend = 0.05), respectively, for green tea and 1.00, 1.32 (0.64-2.73), 1.46 (0.68-3.13), and 2.20 (1.06-4.55) (P for trend <0.01), respectively, for coffee. Higher green tea and coffee consumption was associated with lower serum ferritin levels in men and postmenopausal women. In premenopausal women, consumption of green tea, but not coffee, was associated with lower serum ferritin levels. However, postmenopausal women who ≥3 cups of coffee demonstrated a higher prevalence of iron deficiency compared to those who consumed almost none.

Effectiveness of weekly and daily iron administration for the prevention of iron deficiency anemia in infants.

Introduction. Iron deficiency (ID) is the most prevalent nutritional deficiency and the main cause of anemia in infants. There is consensus on daily iron supplementation as a preventive strategy; and weekly iron supplementation has also been shown to be effective, but evidence in infants is scarce. The objective of this study was to compare the effectiveness of daily versus weekly iron administration for the prevention of ID anemia (IDA) in infants. Population and methods. Randomized, controlled clinical trial. Infants seen at a public health center, without anemia at 3 months of age, were randomized into 3 groups: daily supplementation (1 mg/kg/day), weekly supplementation (4 mg/kg/week), or no supplementation (control group with exclusive breastfeeding [EB]). Anemia and ID were assessed at 3 and 6 months old. Adherence and adverse events were recorded. Data were analyzed using the R software, version 4.0.3. Results. A total of 227 infants participated. At 6 months, the group of infants with EB without supplementation (control) had a higher prevalence of ID and IDA than the intervention groups (daily and weekly). ID: 40.5% versus 13.5% and 16.7% (p = 0.002); IDA: 33.3% versus 7.8% and 10% (p < 0.001). There were no differences between the daily and weekly supplementation groups. There were also no differences in the percentage of high adherence to supplementation (50.6% daily versus 57.1% weekly) or adverse events. Conclusions. No significant differences in effectiveness were observed between daily and weekly administration for the prevention of infant IDA.

Epidemiology of iron deficiency in Russia: serum ferritin values depending on sex and age

The high prevalence of iron deficiency (ID) in women and its important negative impact on the health care system is beyond doubt. The presence of severe problems of a systemic nature requires the development of special state programs to combat ID. The development of such programs is impossible without conducting epidemiological studies in each specific country. The purpose of this work is to determine the frequency and severity of ID in terms of serum ferritin (SF) in primary outpatients, depending on gender and age. The study was conducted in 15 large cities of Russia, in total, 1737 primary patients were included, of which 97 were males and 1640 were females. When studying the parameters of SF in general groups, its values are significantly lower in females, and average 40 ± 99 μg/l, while 61% of this cohort of patients have SF less than 30 μg/l, and 70% live in conditions of SF below target values, which requires the development of preventive programs to combat ID among female patients. Between the ages of 16 and 49, almost all females live in conditions of absolute ID, and it is probably in this group that the above activities should be carried out. On the contrary, as regards male patients, judging by the data obtained, a mandatory determination of SF is required to make a decision on conducting ferrotherapy.

P18-023-23 High Prevalence of Iron Deficiency in Canadian Toddlers With Adequate Dietary Iron Intakes and Weak Association With Maternal Dietary Iron Intake at 18 Months Postpartum

P18-023-23 High Prevalence of Iron Deficiency in Canadian Toddlers With Adequate Dietary Iron Intakes and Weak Association With Maternal Dietary Iron Intake at 18 Months Postpartum

Low bioavailability of dietary iron among Brazilian children: Study in a representative sample from the Northeast, Southeast, and South regions.

Despite all efforts, iron deficiency anemia remains a serious public health problem among Brazilian children. To evaluate dietary iron intake and dietary practices that interfere with the absorption of this nutrient from three regions of Brazil. Brazil Kids Nutrition and Health Study is a cross-sectional dietary intake study in children aged 4-13.9 years old designed to investigate nutrient intakes and gaps of Brazilian children in a representative sample of households from Northeast, Southeast and South regions. Nutrient intake was assessed based on multiple-pass 24-h dietary recall and U.S. National Cancer Institute method was used to estimate usual micronutrients intakes and compliance with Dietary Reference Intakes. Five hundred sixteen individuals participated in the study (52.3% male). The top three most consumed food sources of iron were products of plant origin. Food sources of animal origin contributed with <20% of the total iron intake. Vitamin C intake was adequate, but the concomitant consumption of food sources of vitamin C with plant food sources of iron was not common. On the other hand, the concomitant intake of plant food sources of iron with food sources of iron chelators (e.g., coffee and teas) was frequent. Adequate iron intake was observed in all three regions in Brazil. Children's diet showed low iron bioavailability and insufficient consumption of food sources of iron absorption stimulants. Frequent presence of iron chelators and inhibitors of iron absorption might help to explain the high prevalence of iron deficiency in the country.

High Prevalence of Iron Deficiency Exhibited in Internationally Competitive, Non-Professional Female Endurance Athletes—A Case Study

While iron deficiency is commonly discussed in populations of professional female athletes, less is known about highly trained, sub-elite female athletes (e.g., those winning international age-group competitions) who generally have less access to medical and allied health support. Thirteen non-professional highly trained female endurance athletes provided training diaries and completed a blood test, where iron markers of haemoglobin (Hb), haematocrit (Hct), C-reactive protein (Crp), serum iron, serum ferritin, and transferrin were assessed. Resting metabolic rate (RMR) and body composition using dual-energy X-ray absorptiometry (DXA) were also obtained. Participants were classified as iron deficient (ID) if serum ferritin was <30 ug/L serum ferritin. Six of the 13 females were classified as ID. Serum iron, ferritin, Hb, Hct, and ferrin were greater in the ID group (p < 0.05). Crp resulted in large to very large correlations with serum iron (r = -0.72), serum ferritin (r = -0.66), and transferrin (r = 0.70). In this population of highly trained female athletes, 46% were diagnosed with sub-optimal iron levels, which could have lasting health effects and impair athletic performance. The need for more education and support in non-professional athletes regarding iron deficiency is strongly advised.

Iron Status and Homeostasis Across 2 Competitive Seasons in NCAA Division I Collegiate Cross-Country Runners Residing at Low Altitude.

Inflammatory cytokines including interleukin-6 can upregulate hepcidin and decrease iron absorption. Endurance exercise is associated with transient increases in cytokines, which may alter the risk of iron deficiency (ID). This study examined whether chronic elevations in basal levels of cytokines and hepcidin were associated with ID in highly trained runners. Fifty-four collegiate runners (26 males and 28 females) living at ∼1625m were recruited from an NCAA Division I cross-country team for this prospective cohort study. Over 2 seasons, fasted, preexercise blood draws were performed in the morning 4 times per season and were analyzed for hemoglobin concentration, ferritin, soluble transferrin receptor (sTfR), hepcidin, and 10 cytokines. Stages of ID were defined using ferritin, sTfR, and hemoglobin concentration. During the study, a registered dietician provided all runners with iron supplements using athletic department-created guidelines. Fifty-seven percent of females and 35% of males exhibited stage 2 ID (ferritin <20ng/mL or sTfR >29.5nmol/L) at least once. Cytokines, ferritin, and sTfR exhibited changes through the 2years, but changes in cytokines were not associated with alterations in hepcidin, ferritin, or sTfR. In males and females, lower ferritin was associated with lower hepcidin (both P < .0001). One female exhibited higher hepcidin and lower iron stores compared with other individuals, suggesting a different etiology of ID. ID is common in highly trained collegiate runners. In general, the high prevalence of ID in this population is not associated with alterations in basal hepcidin or cytokine levels.