High Prevalence Of Iron Deficiency Research Articles

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.

High Prevalence of Iron Deficiency and Socioeconomic Disparities in Laboratory Screening of Non-Pregnant Females of Reproductive Age

BACKGROUND Iron deficiency anemia (IDA) is one of the most prevalent medical conditions in the world. Iron deficiency (ID) and IDA are common among females of reproductive age, with health consequences both during and outside of pregnancy. However, screening for ID and IDA is variable, and often screening is performed with a complete blood count (CBC) alone, which is neither sensitive nor specific for IDA, in contrast to ferritin. OBJECTIVES The primary objective was to determine the prevalence of screening for ID and IDA over a 3-year period in non-pregnant females of reproductive age who had tests performed at outpatient laboratories in Ontario, Canada. Secondary objectives were to determine the prevalence and severity of ID and IDA, and to identify demographic and provider characteristics that influence the likelihood of screening. METHODS This was a retrospective cohort study of non-pregnant females ages 15-54 in Ontario, Canada. Laboratory data was provided by Dynacare, the second-largest laboratory company in the province, performing around 30% of annual non-hospital outpatient laboratory testing. Tests between January 2017 and December 2019 were retrieved. Tests ordered by providers other than physicians, midwives, or nurse practitioners were excluded. As this was a study of non-pregnant patients, records from patients who had a beta-hCG test of 5 IU or greater, explicitly defined antenatal laboratory testing, or who fulfilled criteria of a previously published laboratory definition of pregnancy were excluded. ID was defined as ferritin < 30 µg/L and severe ID ferritin < 15 µg/L. Anemia was defined as hemoglobin < 120 g/L, and IDA defined as a ferritin < 30 µg/L and hemoglobin < 120 g/L measured within 90 days of each other. Annual household income was estimated using the patient's postal code and Statistics Canada census data. Research ethics board approval was obtained. Dynacare was not involved in study design or analysis. RESULTS 6,652,487 records were retrieved from the Dynacare database. 4,623,284 records representing 784,132 non-pregnant females were eligible for inclusion (Figure 1). Of this cohort, 644,066 patients (82.1%) had a ferritin checked at least once during the study period, with a mean ferritin of 60.7 µg/L (SD 86.9 µg/L). 245,953 (38.3%) were iron deficient with a < 30 µg/L at least once, with 14.4% of patients having severe ID with ferritin < 15 µg/L. Family physicians or general practitioners ordered most ferritin tests (74.1%). 709,434 patients (90.5%) had a CBC checked at least once, with a mean hemoglobin of 130.1 g/L (SD 12.9 g/L). Of those who had a CBC checked, 134,265 (19%) had anemia (hemoglobin < 120 g/L) at least once. 633,396 patients (80.8%) were screened for and 82,655 (13.1%) had IDA. The proportion of ferritin testing increased with increasing anemia severity (Table 1), ranging from 40.2% of patients with normal hemoglobin levels having a ferritin test, to 66.4% of patients with hemoglobin < 70 g/L having a ferritin checked. Median annual household income was CAD$89,387.80 (IQR 69178.8, 107037.5) at the first service date. Compared to patients in the lowest household income quintile (Q1, <CAD$60,000 per year), the odds of ever having a normal hemoglobin generally increased with increasing income quintiles, with odds ratio (OR) 1.08 (95% CI 1.05-1.11), 1.07 (95% CI 1.04-1.10), 1.36 (95% CI 1.30-1.43), and 1.47 (95% CI 1.25-1.72) for Q2-5 respectively. Compared to patients in Q1, the odds of having a ferritin checked was also greater with higher income quintiles with OR for Q2-5 1.20 (95% CI 1.18-1.23), 1.56 (95% CI 1.53-1.60), 1.67 (95% CI 1.61-1.73), and 1.21 (95% CI 1.09-1.34) respectively (Figure 2). CONCLUSION: This was a large study of non-pregnant females of reproductive age in Ontario, Canada, a high-income province within a publicly funded health services system. Our cohort had a high median household income ($89,387.80, compared to a province-wide median of $65,285 in 2016). A large proportion of patients were screened for ID - yet even in this relatively privileged population, ID affected nearly 40% and IDA 13% of those screened. Screening for ID was more likely with increasing anemia severity. Despite low household income being associated with the greatest odds of anemia, low income was associated with lower odds of having a ferritin check. These findings highlight socioeconomic disparities in screening and inequitable diagnosis of ID and IDA in this population. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The Relationship Between Iron Status and Atherosclerotic Cardiovascular Disease Risk in Non-anemic Patients Without a History of Cardiovascular Diseases: A Cross-Sectional Study.

Iron deficiency (ID) and iron status in non-anemic patients with atherosclerotic cardiovascular disease (ASCVD) risk without a history of cardiovascular diseases is still weakly explored. In this study, the authors evaluated the most common ID definitions in this group of patients. A total of 533 participants from the National Health and Nutrition Examination Survey (NHANES) were collected from 2005-2006, 2017-2018, and 2017-2020 records. Participants were divided according to their ASCVD risk score to the following groups: low (n=168, 32%), borderline (n=43, 8%), intermediate (n=200, 37%), and high (n=122, 23%). There was a higher prevalence of ID in low- and borderline-risk groups in contrast to intermediate- and high-risk groups. Higher serum ferritin concentrations were observed in groups with a greater ASCVD risk score. Transferrin saturation (TSAT) was comparable in all ASCVD categories. Lack of ID, defined by three different guidelines that are mainly based on serum ferritin levels, predisposed to a higher ASCVD risk category. Normal iron status, defined by these three guidelines, was positively associated with the male gender. The opposite association was observed for non-Hispanic Whites. The analyzed criteria of ID, based mostly on serum ferritin levels, demonstrated limited usefulness in patients with increased ASCVD risk. Further studies should be done to determine proper ID diagnostic criteria in non-anemic patients without a previous cardiovascular history with elevated ASCVD risk.

A contemporary understanding of iron metabolism in active premenopausal females.

Iron metabolism research in the past decade has identified menstrual blood loss as a key contributor to the prevalence of iron deficiency in premenopausal females. The reproductive hormones estrogen and progesterone influence iron regulation and contribute to variations in iron parameters throughout the menstrual cycle. Despite the high prevalence of iron deficiency in premenopausal females, scant research has investigated female-specific causes and treatments for iron deficiency. In this review, we provide a comprehensive discussion of factors that influence iron status in active premenopausal females, with a focus on the menstrual cycle. We also outline several practical guidelines for monitoring, diagnosing, and treating iron deficiency in premenopausal females. Finally, we highlight several areas for further research to enhance the understanding of iron metabolism in this at-risk population.

The effect of iron deficiency on quality of life outcomes after surgery for obstructive sleep apnoea.

This study aimed to assess the effect of iron deficiency on parent-reported changes in quality of life (QOL) among children receiving an adenotonsillectomy for paediatric obstructive sleep apnoea (OSA). This was a retrospective review study that recruited children under 16 years of age undergoing an adenotonsillectomy, adenoidectomy, or tonsillectomy for clinically diagnosed paediatric OSA between June 2020 and January 2021 inclusive, in Western Australia. The main outcome measures for this study were changes in QOL by age group and iron status, defined by an absolute change of more than 3 points on OSA-18 survey domains. About 249 participants had iron studies performed on perioperative blood samples drawn at operation and completed both pre-operative and post-operative OSA-18 QOL questionnaires at initial consultation and 8-12 weeks post-surgery, respectively. 41.8% were iron deficient, 53.8% were borderline iron deficient and 4.4% had normal iron levels. Following surgery, a decrease was observed for all OSA-18 score domains in post-operation scores compared to pre-operation scores in both iron-deficient and borderline iron-deficient cohorts. 'Daytime Problems' in the <2 years group, within the iron-deficient cohort, was the only domain that found to be non-superior (i.e. 'not better') following surgery. Following adenotonsillectomy, patients with paediatric OSA reported significant improvements in QOL regardless of their iron status. Those undergoing an adenotonsillectomy for paediatric OSA had a high prevalence of iron deficiency at operation, especially those under 6 years of age.

Management of iron deficiency in chronic heart failure

Iron deficiency is frequent in patients with chronic heart failure (CHF) with a prevalence of 50%, and its frequency varies depending on the study groups. The presence of iron deficiency limits erythropoiesis, leading to the development of anemia over time in patients with CHF, regardless of gender, race, and left ventricular ejection fraction (LVEF). Observational studies demonstrate a higher prevalence of iron deficiency in women and in patients with higher NYHA (New York Heart Association) functional class, decreased LVEF, increased brain natriuretic peptide (NT-proBNP), or increased high-sensitivity C-reactive protein. Iron deficiency and anemia in patients with CHF are independently associated with a decreased exercise capacity, hospitalizations for CHF, an increase in overall mortality and mortality from cardiovascular diseases. The clinical significance of iron deficiency requires the need to diagnose iron metabolism in all patients with CHF. Current guidelines for the diagnosis and treatment of CHF indicate the need to determine the level of ferritin and saturation of transferrin in all patients with a suspected diagnosis of heart failure. The use of oral iron therapy in patients with CHF demonstrates its low efficacy in correcting this condition according to the clinical trials. At the same time the use of intravenous iron therapy is safe and improves symptoms, exercise capacity and quality of life in patients with heart failure with reduced ejection fraction and iron deficiency, which has been shown both in international placebo-controlled trials and meta-analyses. The use of iron carboxymaltose should improve CHF symptoms, exercise capacity and quality of life in patients with CHF and LVEF45%. Intravenous iron therapy has also been shown to reduce readmissions for CHF in patients with an LVEF50% who have recently been hospitalized for worsening CHF.

Prévalence de la carence martiale dans une population de patients insuffisants rénaux chroniques non dialysés : étude nationale multicentrique observationnelle CARENFER

IntroductionIron deficiency is common and associated with worse outcomes in patients with non-dialysis chronic kidney disease. We performed a national, multicentre, observational and transversal study to assess the prevalence of iron deficiency as well as current iron deficiency screening practices in this population. Patients and methodsA total of 25 nephrology centres in France participated in the study. All adult non-dialysis chronic kidney disease patients who met the inclusion (GFR>15mL/min/1.73m2) and exclusion criteria and provided consent were systematically recruited over a 4-week inclusion period. Investigators were asked to perform a blood test (hemoglobin concentration, serum iron, serum ferritin and transferrin saturation) and to complete a questionnaire about their iron status monitoring practices. The primary objective was to assess the prevalence of iron deficiency (serum ferritin<100μg/L and/or transferrin saturation<20%). Secondary objectives were to evaluate the prevalence of absolute iron deficiency (serum ferritin<100μg/L and transferrin saturation<20%) and functional iron deficiency (serum ferritin≥100μg/L and transferrin saturation<20%), the prevalence of iron deficiency according to haemoglobin concentration and chronic kidney disease stage, the proportion of centres that perform routine evaluation of iron status and the number of patients receiving iron supplementation. ResultsA total of 1211 patients with non-dialysis chronic kidney disease were included in the analysis. The overall prevalence of iron deficiency was 47.1%. The rates of absolute iron deficiency and functional iron deficiency and anaemia were 13.4% and 17.1%, respectively. Among the 25 participating centres, 12 reported routine assessment of iron status in non-dialysis chronic kidney disease patients. ConclusionIn this observational study, a high prevalence of iron deficiency was observed among non-dialysis chronic kidney disease patients. Less than half of participating centres reported routine assessment of iron status.

Evaluation of Hematological Profile in Oral Submucous Fibrosis.

Background: The aim of the study is to assess the hematological profile in oral submucous fibrosis (OSMF) patients.Methods: The study's participants (100) were divided into two groups. Group I consisted of fifty areca nut chewers with complaints of burning sensations, blanching, and stiffness of the oral mucosa. Group II consisted of fifty healthy patients as controls. A hematological profile was estimated in all subjects.Results: The control group had a mean hemoglobin (Hb) of 13.87±1.26 g/dL, while the OSMF group had a mean Hb of 11.03±2.16 g/dL (P=0.001). The mean serum iron level in the control group was 120.36±41.22 g/dL, while it was 44.97±13.45 g/dL in the OSMF group (P=0.001). The control group's mean serum vitamin B12 values were 424.77±110.95 g/dL, while the OSMF group's was 210.11±44.88 g/dL (P=0.001). In the research population, 47 patients had iron deficiency. The odds ratio (OR) was 28.11, which meant that the high prevalence of iron deficiency was predicted 28.11 times more often than in the control group.Conclusion: As part of a biochemical assessment, iron status is assessed as part of a prevention mechanism for people who are at high risk. Biochemical testing has been suggested as a potential tool for mass screening OSMF patients.

Prevalence of Iron Deficiency Anemia among Moroccan Pregnant Women

Background: Iron deficiency anemia in pregnant women is a serious public health problem, especially in developing countries. Aim: The objective of this study is to determine the prevalence of iron deficiency anemia and its associated factors during pregnancy in the south of Morocco. Methods: A cross-sectional study was carried in the regional Hospital Center Hassan II (RHC) from April to august 2021 in all the pregnant women coming for consultation in the maternity service. 500 pregnant women were randomly recruited for the study. A complete blood count and serum ferritin was performed in every case. They have been the subjects of a questionnaire containing their background and health data. The analysis of our data was done by the IBM SPSS Statistics 25 software. Results: The prevalence of iron deficiency anemia was 20% with a CI of (44.7% - 53.5%). The most affected age group was 25 to 35 years with a rate of 42.86%. The majority of women had mild anemia (84.61%) followed by moderate anemia (11.54%) and severe anemia (3.85%). 57.14% of the anemic pregnant women were primigravida. The results of serum ferritin made it possible to identify 70% of women deficient, with a dominance of normocytic normochromic anemia. The influence of geographic origin and place of birth was not significant. Conclusion: The prevalence of iron deficiency anemia is more or less low in our study. However, there is a high prevalence of iron deficiency and anemia during pregnancy. Statistically, there was no significant association between iron deficiency anemia and the various parameters studied, such as age, parity, origin and place of birth.

69P Transferrin saturation shows high prevalence of iron deficiency in cancer patients under adjuvant and neo-adjuvant treatment

While iron deficiency (ID) in cancer patients is frequent, it is likely under-diagnosed and under-treated, in particular in patients without anaemia or at an early stage of the disease. Also, ID diagnosis is rarely based on the transferrin coefficient saturation (TSAT) which is very sensitive in patients with inflammatory diseases. We previously showed that ID was frequent in patients under metastatic treatment. Here, we aimed to assess the prevalence of ID based on TSAT index in cancer patients treated at an early stage of the disease.

The Association between Hepcidin and Iron Status in Children and Adolescents with Obesity.

Introduction Iron deficiency (ID) is the most common nutritional deficiency found in pediatric practice. A higher prevalence of ID may be found in children with obesity. Obesity is a chronic low-grade inflammatory condition. It is postulated that inflammation increases hepcidin, a regulator of iron homeostasis. The aim of this study was to investigate the associations between iron status, hepcidin, and BMI-standard deviation score (BMI-SDS) in children with and without obesity. Methods A cross-sectional study of Thai children with obesity (5 to 15 years old) versus age- and sex-matched, nonobese controls was conducted. A total of 63 children with obesity and 27 controls were enrolled. Complete blood count, serum iron, ferritin, transferrin saturation, and total iron binding capacity were analyzed. Serum hepcidin-25 was assayed using a hepcidin ELISA Kit (Human Hepc25). Results There were 63 children with obesity, the median age (IQR) being 10 (9–13) years, and 27 controls. The median (IQR) BMI-SDS of the obese group was 2.3 (2.0–2.6) vs. −0.5 ((−1.3)−0.4) of the control group. ID was diagnosed in 27 children in the obese group (42.9%); 4 of the children with obesity and ID had anemia. Serum hepcidin-25 levels of the children with ID vs. without ID in the obese group were not significantly different (median (IQR) 25 (12.9–49.2) and 26.4 (12.6–43.6), respectively) but both of them were significantly higher than controls (19.7 (8.3–25.5) ng/ml, p = 0.04). BMI-SDS was positively correlated with hepcidin-25 (r = 0.28, p = 0.001). Conclusion Prevalence of iron deficiency in Thai children with obesity and serum hepcidin-25 was higher than controls. Further study in a larger population, preferably with interventions such as weight loss program, is warranted to clarify this association.

Evaluation of One Egg per Day on Iron and Anemia Status Among Young Malawian Children: A Randomized Controlled Trial

ObjectivesYoung children with complementary feeding diets that lack diversity and have low micronutrient density are at risk of iron deficiency anemia. Our objectives were to determine the impact of supplementing diets with 1 egg/day on: (1) plasma ferritin, soluble transferrin receptor (sTfR), and hemoglobin (Hb) concentrations; and (2) the prevalence of iron deficiency (ID), anemia, and iron deficiency anemia (IDA). MethodsChildren age 6–9mo in the Mangochi District of Malawi were individually randomized to receive 1 egg/day for 6mo (n = 331) or continue their usual diet (n = 329). Venous blood samples were collected at enrollment and a 6mo follow-up by assessors masked to group assignment. Plasma ferritin, sTfR, c-reactive protein (CRP), and α1-acid glycoprotein (AGP) were assessed using ELISA and hemoglobin was measured using Hemocue analyzers. Ferritin and sTfR were corrected for inflammation using CRP and AGP in linear regression models. Ferritin, sTfR, and hemoglobin concentrations were compared between groups using linear regression models, adjusting for baseline values. The prevalence ratios (PR) of ID (fer < 12μg/L, sTfR >8.3mg/L, or total body iron< 0mg/kg), anemia (Hb< 11g/dL), and IDA (Hb < 11g/dL and ID) were compared between egg and control groups using binomial or Poisson regression models. ResultsA total of 585 children were included in this analysis (Egg: n = 286; Control: n = 299). At enrollment, the prevalence of anemia and IDA was 61% and 55%. At the 6mo follow-up, there was no difference between groups in inflammation-adjusted ferritin (geometric mean [95% CI]; Egg: 6.52μg/L [5.98,7.10]; Control: 6.82 [6.27, 7.42]) or sTfR (Egg: 11.34mg/L [10.92,11.78]; Control: 11.46 [11.04,11.89]) concentrations. There was also no difference in mean hemoglobin concentration between groups (mean [95%CI]; Egg: 11.0g/L [10.8,11.1]; Control:11.1 [11.0,11.3]). Overall, 43% of children had anemia, 89% had ID, and 40% had IDA. No group-level differences were observed in the prevalence of anemia [PR: 1.15 (95% CI: 0.96, 1.38)], ID [PR: 0.99 (0.94, 1.05)], or IDA [PR: 1.12 (0.92, 1.36)]. ConclusionsIron and anemia indices did not differ between the egg intervention group and control group. Other interventions are needed to address the high prevalence of iron deficiency and anemia among young, Malawian children. Funding SourcesBill & Melinda Gates Foundation.

526 Characteristics of Augmented RLS Patients on Dopamine Agonists at a Tertiary Referral Center: Where Do We Go From Here?

Abstract Introduction Augmentation is a management dilemma in RLS patients on dopaminergic therapy. Understanding the clinical characteristics of such patients may assist in better management strategies. Methods Consecutive new consultations for RLS from 4/2016-6/2020 were identified from a single tertiary referral center in Boston, USA. Patients were included in this analysis if they had augmentation and current treatment with a dopamine agonist. Clinical information from initial consultation was collected. RLS severity at time of consultation was determined retrospectively with a modified IRLSSG severity score (0–12), assessing RLS symptom frequency (0–4), duration (0–4), and severity (0–4). Results Out of 209 referrals with RLS, 105 patients had augmentation, of whom 88 were on dopamine agonists at initial evaluation. Average age was 67 years (SD 11 years, range 39–88); 62 were female (59%). Mean duration of RLS symptoms was 27 years (SD 20), and 91% had symptoms &amp;gt; 10 years. Mean duration of dopamine agonist therapy was 11 years; 72% had previously been treated with pramipexole, 65% with ropinirole, 73% with rotigotine, and 16% with levodopa; 72% of patients had been treated with alpha-2-delta ligands, and 28% with opioids. Common comorbidities included obstructive sleep apnea (47%), obesity (49%), and depression (44%). Serotonergic medications were currently used by 25%. Of the 88 augmented patients on dopamine agonist therapy, 97% had earlier onset of symptoms and 33% had symptoms in both morning and afternoon; 53% reported anatomical extension. The mean modified IRLSSG score was 8.4 (SD 3.2). 66% of patients had either ferritin &amp;lt;75 mcg/L or transferrin saturation &amp;lt;20%. At the time of initial assessment, 49% were on pramipexole, 47% on rotigotine, 5% on rotigotine and 7% on levodopa: mean daily dopamine agonist dose was 1.23 mg (SD 1.20) of pramipexole equivalent. 37% were on alpha-2-delta ligands: mean daily dose 1014 mg (SD 830, median 700 mg) of gabapentin equivalent. Conclusion Higher than FDA-recommended dopamine agonist dosing and high prevalence of iron deficiency in patients with augmented RLS represent a treatment gap in the care of RLS patients in the community. Controlled studies of guideline-based therapy are indicated to determine optimal management of augmented RLS. Support (if any) Baszucki Brain Research Fund

Effect of Sepsis on Iron Parameters in a Population with High Prevalence of Malnutrition and Iron Deficiency: A Cross-Sectional Case-Control Pilot Study.

There is lack of data on iron metabolism in critically ill sepsis children from population with high prevalence of iron deficiency (ID). The study was designed to study impact of sepsis on iron parameters in children with ID. Sepsis patients (age 6-59months) and their apparently healthy sibling/cousin as controls were enrolled in this case-control pilot study. Serum iron, TIBC, transferrin saturation, ferritin and sTfR were measured in the two groups. sTfR-Ferritin index was calculated. Patients (n = 134) were significantly underweight compared to controls (n = 54) (WAZ score < -2; 58% vs. 28%; p < 0.001). Serum iron and sTfR (mg/L) were lower [71.5 (51.0, 115.0) vs. 87.0 (64.5, 130.5), p = 0.068; 3.1 (2.1, 4.5) vs. 3.5 (2.8, 4.8), p = 0.026 respectively] while serum ferritin was higher [229 (94, 484.5) vs. 22 (9.2, 51); p < 0.001] in patients compared to controls. sTfR-Ferritin index was lower in patients [1.3 (0.8, 2.3) vs. 2.5 (1.8, 4.5); p < 0.001]. ROC AUC (patients vs. controls) were 0.89 (95% CI 0.83-0.95) and 0.76 (95% CI 0.68-0.85) for ferritin and sTfR-ferritin index respectively. Survivors and non-survivors were similar in terms of iron parameters. Sepsis-induced alterations in iron parameters among ID children are complex. Qualitatively it is similar (with quantitative differences) to non-ID adult population. Lack of correlation of iron parameters with mortality may be due to ID-associated immune dysfunction.

Iron Deficiency and Iron Deficiency Anemia Are Common Epidemiological Conditions in Saudi Arabia: Report of the National Epidemiological Survey.

Iron deficiency is the most prevalent nutritional deficiency worldwide. According to an estimate by the World Health Organization, up to 27% of the world's population experience iron deficiency anemia (IDA). Studies conducted in the Middle East, including Saudi Arabia, have suggested that IDA is the most common cause of anemia, especially among females. This study aimed to determine the prevalence of IDA and iron deficiency (ID) among apparently healthy young university students from four regions in Saudi Arabia. Students were asked to complete a simple survey questionnaire; blood samples were then collected and analyzed after obtaining informed consent. A total of 981 students completed the survey, with 11% of the participants reporting symptoms of anemia; 34% of participants were diagnosed with IDA and 6% reported a diagnosis of hemoglobinopathy. Blood analysis confirmed the prevalence of ID and IDA in 28.6% and 10.7% of the participants, respectively; those with ID and IDA were mostly females (88.5% and 94%, resp.). Thalassemia trait and sickle cell trait were detected in 1.3% and 7% of participants, respectively. Our findings from a national survey among young university in Saudi Arabia indicate a high prevalence of ID and IDA.

Prevalence of Iron Deficiency in Infants of Diabetic Mothers at the Age of 6 to 12 Months

Background: Iron deficiency (ID) and iron deficiency anemia (IDA) are worldwide problems in infants. The infants of diabetic mothers (IDMs) usually have low iron storage at birth. Therefore, they are at risk for developing ID and IDA during late infancy. Objective: To determine the prevalence of ID and IDA in IDMs aged 6 to 12 months and to identify the risk factors associated with abnormal iron status. Materials and Methods: The present study was a prospective descriptive study conducted in healthy, full-term, IDMs between the ages of 6 to 12 months. Growth and dietary history of IDMs as well as maternal history of diabetes were evaluated. Anemia and iron status were determined by hemoglobin, serum ferritin, and transferrin saturation. Results: Of the 50 IDMs, the prevalence of ID was 46%, and iron depletion was 14%. IDA was found in 11 IDMs. Although the gender, gestational age, birthweight, and the age of complementary food introduction were not found to be associated with abnormal iron status, infants with ID and iron depletion were more likely to be breastfed, or breastfed longer than six months, when compared to iron sufficient infants (p&lt;0.001). No exclusively breastfed infants had iron sufficiency in the study. Conclusion: There was a high prevalence of ID and IDA in IDMs. Therefore, screening for iron status along with anemia is crucial in IDMs at an earlier age. Moreover, iron supplementation starting at four months should be considered in IDMs who were exclusively or mainly breastfed. Keywords: Anemia, Iron deficiency, Iron deficiency anemia, Infants of diabetes mothers

Intravenous Iron or Red Blood Cell Supplementation and Risk of Serious Infection in Left Ventricular Assist Device Patients

Introduction Patients with durable left ventricular assist devices (LVADs) are at high risk for serious infection and associated mortality. Furthermore, these patients also have a high prevalence of iron deficiency due to ongoing hemolysis, increased propensity for gastrointestinal bleeding, and dysregulated iron metabolism that accompanies mechanical circulatory support and heart failure. Intravenous (IV) iron-related supplementation [IVIRS, including IV iron infusion or red blood cell transfusion (RBC)] has been hypothesized to increase risk of infection. Hypothesis IVIRS (IV iron infusion or RBC transfusion) is associated with an increased risk of serious infection in LVAD patients. Methods This is a single center, retrospective, observational cohort study of 211 consecutive adult patients [median age 57.2 years (25th-75th percentile: 48.7-65.7 years), 19% female] who were discharged and followed after de-novo LVAD implantation between May 2008 and December 2019. Patients were followed until either end of the study period, or occurrence of death, heart transplantation, or LVAD removal/replacement, whichever came first. All administration of IVIRS and diagnosis of serious infection after discharge from index hospitalization was abstracted from the electronic medical record. Serious infection was defined as the first incident infection requiring hospitalization, divided into LVAD-associated infections (pump/cannula, pocket or driveline infection) and non-LVAD infections. Multivariate logistic regression was used to examine the association between IVIRS and serious infections. Results Over a median follow-up of 15.2 months (25th-75th percentile: 6.9-29.4 months), 69 (33%) LVAD patients received IVIRS, of whom 47 (68%) received IV iron and 44 (64%) received RBC transfusion. During follow-up, 87 (41%) patients suffered a serious infection, of which 48 (55%) were LVAD-associated infections and 39 (45%) were non-LVAD infections. After adjustment for age, sex, diabetes, chronic kidney disease, prior cardiac surgery, destination therapy and pre-IVIRS serious infection, LVAD patients who received IVIRS had 2.85 times higher odds of any first serious infection compared to those who did not receive IVIRS during the study period (95% CI 1.49-5.46, p=0.002). Patients who received IVIRS had a significant 3.03 times greater odds of non-LVAD infection (95% CI 1.37-6.70, p=0.006) and a non-significant 1.54 times greater odds of LVAD infection (95% CI 0.75-3.18, p=0.24), compared to LVAD patients who did not receive IVIRS. Conclusion IVIRS use is associated with a higher risk of serious infection in LVAD patients, primarily due to serious non-LVAD infections. These findings merit further study in larger cohorts and randomized trials to determine best practices surrounding IVIRS in LVAD patients.