Higher Serum Ferritin Concentrations Research Articles

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.

RETROSPECTIVE ANALYSIS OF THE RELATIONSHIP BETWEEN SERUM FERRITIN LEVELS, INSULIN RESISTANCE, METABOLIC SYNDROME, AND NUTRITIONAL STATUS IN OBESE INDIVIDUALS

Bu çalışmada, obez bireylerin beslenme durumlarının serum ferritin değerleri, insülin direnci ve metabolik sendrom ile ilişkisi bakımından retrospektif olarak incelenmesi amaçlanmıştır. Araştırmanın örneklemini Özel 19 Mayıs Hastanesi Beslenme ve Diyet polikliniğine 1 Ocak 2020’den itibaren başvurmuş 210 obez birey oluşturmaktadır. Bu bireylerin antropometrik ölçümleri, biyokimyasal bulguları, genel sağlık durumları ve beslenme durumları hasta dosyalarından kaydedilmiştir. Çalışmaya dahil edilen bireyler serum ferritin değerlerine göre; ferritin düzeyi ˂14,52 ng/mL ise kuartil 1 (Q1), 14,52-35,49 ng/mL ise Q2, 35,49-70,68 ng/mL ise Q3, ˃70,68 ng/mL ise Q4 olarak 4 gruba ayrılmıştır. Bireylerin beden kütle indeksi (kg/ m2) ferritin kuartillerine göre incelendiğinde Q2’de en yüksek beden kütle indeksi (32,5±6,4 kg/m2) gözlenmiştir (p˃0,05). Bel çevresi ölçümlerinde en yüksek bel çevresi ortalaması Q4’te olup (114,85±15,09 cm), kuartiller arasındaki fark anlamlı bulunmamıştır (p˃0.05). Bireylerin serum HOMA-IR ortalama değerleri en yüksek Q4’de (4,10±5,05) bulunmaktadır. HOMA-IR düzeyleri ferritin kuartiline göre istatistiksel açıdan önemli bulunmuştur (p˂0.05) Trigliserit değerleri Q4’te (169,43±93,40); HDL değerleri Q2’de (58,68±11,69); LDL değerleri ise Q4’te (127,21±35,15) en yüksek bulunmuştur. (˂0.05) Bireylerin ferritin quartillerine göre beslenme durumlarına bakıldığında protein tüketiminin en yüksek Q4’te olduğu (112,1±29,8 g/gün), karbonhidrat tüketiminin ise en yüksek Q1’de (395,2±83,6 g/gün) olduğu görülmüştür (p˂0.05). Obez bireylerin protein tüketimleri (g/gün) ile serum ferritin düzeyleri arasında pozitif yönlü orta kuvvetli bir ilişki tespit edilmiştir (r:0,506, p:0,000). Sonuç olarak yüksek serum ferritin konsantrasyonları yüksek trigliserit, yüksek LDL, yüksek HOMA, AST ve ALT değerleri ve daha düşük HDL değerleri ile ilişkilendirilmiştir. Obez bireylerde serum ferritinin yüksek olması insülin direnci ve metabolik sendrom için risk faktörü olabileceği belirlenmiştir. Bu risk faktörlerinden korunmak için obez bireylere yaşam tarzı değişikliği önerilmelidir.

Infant Iron Stores at Three Months of Age Are Associated With Maternal Hepcidin and Serum Ferritin Concentrations During the Second Trimester

ObjectivesTo determine if relationships exist between maternal concentrations of hepcidin and serum ferritin (SF) throughout pregnancy and infant SF concentrations at 3 months of age.MethodsPregnant women from Edmonton and Calgary, Alberta, Canada were recruited into the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study from 2009–2012. Blood samples were collected from 358 women at each trimester of pregnancy and their infants at 3 months of age. Maternal hepcidin concentrations were assessed using enzyme linked immunosorbent assays. Maternal and infant SF concentrations were measured by chemiluminescent microparticle immunoassays. General linear models and multiple regression models, adjusting for maternal age, ethnicity, pre-pregnancy body-mass-index, and inflammation via direct acyclic graphs, were performed by SAS−9.4.ResultsIn the maternal cohort, 63.4% had suboptimal iron stores (SF < 15 ng/mL) during late gestation. Infant SF concentrations were ordered into quartiles arranged by maternal SF and hepcidin concentrations (Q1 being the highest). During the second trimester, women with hepcidin concentrations in Q3 (4.8–9.9 ng/mL) had infants with significantly higher concentrations of SF at 3 months [β = 39.6 ng/mL (11.6,67.6); p = 0.013], compared to those in Q1, Q2, and Q4. Infant SF concentrations were significantly higher when second trimester maternal SF concentrations were in Q2 (31.5–46.5 ng/mL) [β = 33.1 ng/mL (5.6,60.5); p = 0.018] and Q3 (18.0–31.4 ng/mL) [β = 30.8 ng/mL (3.5,58.2); p = 0.027] compared to Q1 and Q4. There were no relationships between maternal SF and hepcidin concentrations during the first or third trimesters and infant SF concentrations. A positive relationship was found between maternal hepcidin and SF concentrations during mid-gestation (P < 0.0001), which may partly explain why higher infant SF concentrations were similarly associated with moderate maternal concentrations of both iron biomarkers.ConclusionsSecond trimester maternal concentrations of SF (18.0–46.5 ng/mL) and hepcidin (4.8–9.9 ng/mL) were associated with higher SF concentrations in 3-month-old infants. Future studies are needed to explore the complex relationships between maternal iron status and infant iron status during the first year of life.Funding SourcesAPrON study by Alberta Innovates, CIHR; J. Evanchuk by CIHR, WCHRI.

Health status of patients with β-thalassemia in the West Bank: a retrospective study

BackgroundThe management of β-thalassemia in developing countries is challenging due to few treatments being available other than recurrent transfusions. We assessed the haematological, biochemical, and hormonal findings among patients with β-thalassemia in the West Bank, occupied Palestinian territory. MethodsThis retrospective study was done between Jan 1, 2017, and Dec 31, 2018. Data on haematological, biochemical, and hormonal tests were collected from medical files of patients with β-thalassemia in eight primary health-care clinics, nine emergency departments, and eleven Palestinian Ministry of Health hospitals across the West Bank. Additionally, we collected data on demographics and the use of iron chelation. The study was approved by the research ethics committee at Al-Quds University and the Palestinian Ministry of Health (reference 162/1075/2019). The data had no identifying information and, therefore, informed consent from patients was waived for this study. Findings309 patients with β-thalassemia were included in the study (154 men and 155 women), with an average age of 23·4 (SD 10·4) years. 202 (79%) patients had pretransfusion haemoglobin concentrations lower than 9 g/dL (mean 8·4 [SD 1·4]). Additionally, 185 (73%) had iron overload, with the mean ferritin concentration in serum being 3175·8 μg/L (SD 3378·8). Concentrations of alanine aminotransferase and aspartate aminotransferase were high in 91 (38%) and 145 (61%) patients, respectively, and correlated positively with serum ferritin concentrations (r=0·527 and r=0·254, respectively; both p<0·0001). Kidney function tests (serum creatinine and blood urea nitrogen) did not correlate with serum ferritin (p=0·553 and 0·280, respectively). Deferoxamine was used for iron chelation in 63 (27%), and these patients had significantly higher ferritin concentrations in serum than patients receiving deferasirox (175 [74%], p=0·009). A small proportion of patients had endocrine function data that indicated abnormal total tri-iodothyronine, free thyroxine, and thyroid-stimulating hormone levels in 24 (34%), 29 (37%), and 24 (15%) patients, respectively, in addition to abnormal parathyroid hormone levels in 25 (50%) patients. However, these findings were not sufficient to diagnose or interpret endocrinopathies. InterpretationOur findings showed a lack of adherence to international guidelines in the management of β-thalassemia, which was reflected by the low pretransfusion haemoglobin and high serum ferritin concentrations. This study highlights the importance of establishing patient-tailored comprehensive assessment and follow-up protocols for the management of β-thalassemia with an emphasis on blood transfusion and iron chelation practices. FundingNone.

Erythropoietin Resistance Development in Hemodialysis Patients: The Role of Oxidative Stress.

Oxidative stress (OS) is considered a significant risk factor for the development of anemia in patients treated by regular hemodialysis (HD). Moreover, OS represents a risk factor for the development of erythropoietin (EPO) resistance in these patients. The aim of this study was to examine the role of OS regarding EPO resistance development in patients treated by regular HD. 96 patients treated with standard HD and on-line hemodiafiltration were included in this study. The patients were treated with short-acting and long-acting EPOs for anemia. The concentration of superoxide anion radical, hydrogen peroxide, thiobarbituric acid reactive substances, and nitric oxide in the form of nitrites and the activity of catalase, superoxide dismutase and reduced glutathione were measured in patients' blood spectrophotometrically. Standard biochemical analysis, inflammatory markers, nutritional status, HD parameters, and erythropoietin resistance index were also determined. Patients with resistance to short-acting EPO had significantly lower concentration of hemoglobin in the blood and hematocrit value, a significantly higher serum ferritin concentration, and significantly lower catalase activity in erythrocytes than patients without EPO resistance. Patients with resistance to long-acting EPO have a significantly lower hemoglobin concentration in the blood, hematocrit values, and serum concentration of prealbumin and vitamin D, as well as significantly higher concentration of C-reactive protein, superoxide anion, and hydrogen peroxide concentration than those without resistance. OS significantly contributes to EPO resistance development. OS, higher ferritin and CRP levels, lower hemoglobin, hematocrit and prealbumin levels, and vitamin D deficiency represent significant risk factors for EPO resistance development in HD patients.

IRE-dependent Regulation of Intestinal Dmt1 Prevails During Chronic Dietary Iron Deficiency but is Dispensable in Conditions of Acute Erythropoietic Stress.

IRE-dependent Regulation of Intestinal Dmt1 Prevails During Chronic Dietary Iron Deficiency but is Dispensable in Conditions of Acute Erythropoietic Stress.

IL-22 and its interaction with amino acid and glycolipid metabolite in polycystic ovary syndrome (PCOS) patients

IL-22 and its interaction with amino acid and glycolipid metabolite in polycystic ovary syndrome (PCOS) patients

Impact of SARS-CoV-2 in Hematopoietic Stem Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy Recipients

Coronavirus disease 2019 (COVID-19), a respiratory illness caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic in March 2020, and has caused more than 600,000 deaths in the United States at the time of this report. Hematopoietic stem cell transplantation (HCT) or chimeric antigen receptor T cell (CAR-T) therapy recipients have a higher risk of mortality with COVID-19 owing to profound immune dysregulation. In this study, we investigated the impact of SARS-CoV-2 in HCT/CAR-T therapy recipients. This single-center prospective study included all (n = 58) adult HCT/CAR-T recipients who were diagnosed with COVID-19 at the University of Kansas Medical Center between March 2020 and May 2021. Baseline and disease-related characteristics were ascertained from medical records. Data were analyzed using SPSS version 21 (IBM, Armonk, NY). Bivariate analyses, using the chi-square and t-test, and logistic regression analyses were conducted. The study included 58 HCT/CAR-T patients who acquired SARS-CoV-2 infection, including recipients of allogeneic HCT (n = 32), autologous HCT (n = 23), and CAR-T therapy (n = 3). The median patient age was 58 years (range, 24 to 77 years), and 64% were males. The median time from HCT/CAR-T therapy to SARS-CoV-2 infection was 17.7 months (range, 0.2 to 201.9 months), and 22% of the patients acquired SARS-CoV-2 within the first 100 days post-HCT/CAR-T therapy. The primary hematologic disorders were plasma cell (36%), myeloid (38%), and lymphoid (26%) malignancies. Myeloablative conditioning was performed in 62% of patients. Donors were autologous (45%), matched sibling (15%), matched unrelated (21%), and haploidentical (19%). Prior history of grade II-IV acute graft-versus-host disease (GVHD), active GVHD, and current immunosuppressive therapy (IST) was noted in 22%, 31%, and 36% of patients, respectively. Concurrent infections were observed in 19%. Lymphopenia (P = .049) and high serum ferritin concentration (P = .020) were associated with mortality. COVID-19 severity was mild in 50% of the patients, moderate in 22%, and severe in 28%. Clinical findings included pneumonia or abnormal chest imaging (in 50%), hypoxia (28%), intensive care unit admission (19%), and mechanical ventilation (10%). Therapies included remdesivir (in 41%), convalescent plasma (35%), dexamethasone (22%), monoclonal antibodies (19%), and tocilizumab (3%). The median duration of viral shedding (positive SARS-CoV-2 PCR) was 7.7 weeks (range, 2 to 18.7 weeks), and 2 patients had a persistent infection for >5 months post-CAR-T therapy. After a median follow-up of 6.1 months (range, 0.5-13.6 months), the mortality rate was 16% in all patients and 28% in allogeneic HCT recipients. Among 9 patients who died, the median survival after SARS-CoV-2 infection was 23 days (range, 14 to 140 days). In survivors with moderate-severe COVID-19, the median time to recovery was 4.2 weeks (range, 1.1 to 24.7 weeks). Among allogeneic HCT recipients, 5 (16%) developed subsequent pulmonary chronic GVHD necessitating systemic steroids and additional IST. Significant predictors of COVID-19 severity included allogeneic HCT (odds ratio [OR], 3.6, 95% confidence interval [CI], 1.2 to 10.8; P = .020), history of grade II-IV acute GVHD (OR, 4.6; 95% CI, 1.10 to 18.86; P = .036) and concurrent IST (OR, 5.9; 95% CI, 1.8 to 19.8; P = .004). HCT and CAR-T cell therapy recipients are at an increased risk of moderate-severe COVID-19 pneumonia and higher mortality with SARS-CoV-2 infection. Our findings confirm the need for continuing vigilance with social distancing and masks, vaccination prioritization, close monitoring, and aggressive treatment of HCT/CAR-T therapy recipients.

Association of High Serum Ferritin Level in Early Pregnancy with Development of Gestational Diabetes Mellitus- A Prospective Observational Study

Introduction: Gestational Diabetes Mellitus (GDM) has a negative impact on maternal and perinatal outcome and several long-term complications. The evidence from different experimental studies have shown that high serum ferritin concentration can lead to pancreatic β-cell dysfunction and impaired glucose metabolism leading to GDM. Aim: To determine the association of increased serum ferritin level in first trimester and GDM in course of pregnancy. Materials and Methods: A prospective observational study was conducted in 204 women in Institute of Post Graduate Medical Education and Research and SSKM Hospital, West Bengal, India, during the period from January 2015 to December 2015. The blood samples were collected and screened for GDM by Oral Glucose Tolerance Test (OGTT) at the beginning of the study and then assayed for serum ferritin level who were screened negative. The women were divided into four groups by quartiles of serum ferritin levels (Q1 to Q4). Then they were followed-up with OGTT at 24-28 weeks and again at 32-34 weeks. Statistical analysis was done by using paired t-test, Chi-square test and Fisher’s- exact test. Results: The participants had an average serum ferritin concentration of 77.44 ng/mL. GDM prevalence within each serum ferritin quartile was 7.84%, 11.76%, 19.61% and 23.53% respectively (p-value=0.016). The odds ratio for GDM in the ferritin Q2-Q4 was 1.57 (CI=0.41-5.92), 2.87 (CI=0.84-9.83) and 3.62 (CI=1.08-12.11) compared with Q1, respectively. In addition, primigravida and women with high Haemoglobin (Hb) level (&gt;13 gm%) have an increased risk of developing GDM. Conclusion: Elevated serum ferritin level is associated with increased incidence of GDM irrespective of other risk factors. Iron supplementation should therefore be individualised based on serum ferritin in early pregnancy to minimise the risk of GDM.

Ferritin levels in children and adolescents with type 1 diabetes mellitus: relationship with microvascular complications and glycemic control.

Evaluate ferritin levels in children and adolescents with type 1 diabetes mellitus and its relation to diabetic microvascular complications, and metabolic control. This study included 180 children and adolescents with type 1 diabetes mellitus (T1DM) with a mean age of 14.9 ± 3.1 years and 180 apparently normal children matched for age and sex (control group). All children were evaluated with full history taking, thorough clinical examination, laboratory assessment of high-sensitivity C-reactive protein and hemoglobin A1c (HbA1c), and evaluation of the presence of microvascular complications. Serum ferritin levels were measured using electrochemiluminescence immunoassay. The patients were divided into two groups according to the presence or absence of microvascular complications. Serum ferritin levels were significantly higher in patients with T1DM in both groups compared with healthy controls (p < 0.001). Additionally, patients with microvascular complications had higher serum ferritin concentrations than those without microvascular complications (p < 0.001). Patients with microalbuminuria showed higher ferritin levels compared with patients without microalbuminuria (p < 0.05). Stepwise regression analysis revealed that levels of HbA1c and urinary albumin excretion were independently related to ferritin levels (p < 0.001 for both). On receiver operating characteristic (ROC) curve analysis, a ferritin cutoff value of 163.6 ng/mL differentiated patients with microvascular complications from those without microvascular complications with a sensitivity of 92.1% and specificity of 93.4%. Serum ferritin levels are elevated in T1DM, particularly in patients with microvascular complications.

Cross-Sectional Study on the Association between Dietary Non-Enzymatic Antioxidant Capacity and Serum Liver Enzymes: The Furukawa Nutrition and Health Study.

We examined the association of dietary non-enzymatic antioxidant capacity (NEAC) in overall diet, and separately from foods and beverages, with serum liver enzymes in a Japanese working population. This cross-sectional study was conducted among 1791 employees aged 18–69 years, who underwent a comprehensive health checkup in 2012–2013. A brief validated self-administered diet-history questionnaire was used for dietary assessment, and dietary NEAC intake was determined from databases of NEAC values, obtained using ferric reducing-antioxidant power (FRAP) and oxygen radical absorbance capacity (ORAC) assays. The dietary NEAC intake was calculated by multiplying the estimated NEAC values by the amounts consumed and summing the resulting values. A multiple-regression analysis was performed to explore the association between dietary NEAC intake and the serum levels of liver enzymes (aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT)), after adjustment for confounding factors. No significant associations were found between overall dietary NEAC intake and AST (FRAP, p for trend = 0.97; ORAC, p = 0.72), ALT (FRAP, p = 0.73; ORAC, p = 0.92), and GGT (FRAP, p = 0.96; ORAC, p = 0.19) levels. Food-derived, but not beverage-derived, NEAC intake was inversely associated with serum GGT levels (FRAP, p for trend = 0.001; ORAC, p = 0.02), particularly among older participants and those with high serum ferritin concentrations. The results imply that overall dietary NEAC intake is not associated with liver dysfunction, and that the NEAC values from foods may be inversely associated with serum GGT levels.

Immune mechanisms of pulmonary intravascular coagulopathy in COVID-19 pneumonia.

SummaryThe lung pathology seen in patients with coronavirus disease 2019 (COVID-19) shows marked microvascular thrombosis and haemorrhage linked to extensive alveolar and interstitial inflammation that shares features with macrophage activation syndrome (MAS). We have termed the lung-restricted vascular immunopathology associated with COVID-19 as diffuse pulmonary intravascular coagulopathy, which in its early stages is distinct from disseminated intravascular coagulation. Increased circulating D-dimer concentrations (reflecting pulmonary vascular bed thrombosis with fibrinolysis) and elevated cardiac enzyme concentrations (reflecting emergent ventricular stress induced by pulmonary hypertension) in the face of normal fibrinogen and platelet levels are key early features of severe pulmonary intravascular coagulopathy related to COVID-19. Extensive immunothrombosis over a wide pulmonary vascular territory without confirmation of COVID-19 viraemia in early disease best explains the adverse impact of male sex, hypertension, obesity, and diabetes on the prognosis of patients with COVID-19. The immune mechanism underlying diffuse alveolar and pulmonary interstitial inflammation in COVID-19 involves a MAS-like state that triggers extensive immunothrombosis, which might unmask subclinical cardiovascular disease and is distinct from the MAS and disseminated intravascular coagulation that is more familiar to rheumatologists.

Iron metabolism and type 2 diabetes mellitus: A meta-analysis and systematic review.

Aims/IntroductionIron metabolism can directly or indirectly affect the occurrence and development of type 2 diabetes. This meta‐analysis and systematic review aimed to analyze the association between serum iron metabolism indicators and type 2 diabetes.Materials and MethodsThe databases PubMed and Embase were searched for studies on the correlations between serum iron metabolism indicators (iron, ferritin, transferrin, hepcidin and soluble transferrin receptor) and type 2 diabetes since January 2006. Relevant data were extracted from the included studies, and meta‐analysis was carried out.ResultsA total of 12 case–control and cohort studies were analyzed. Of the 12 studies, 11 described the correlation between serum ferritin levels and type 2 diabetes. The median and high serum ferritin concentrations were significantly associated with the risks of type 2 diabetes (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.08–1.33 and OR 1.43, 95% CI 1.29–1.59, respectively). However, the low concentration was not correlated with the risk of type 2 diabetes (OR 0.99, 95% CI 0.89–1.11). No significant association was observed between serum soluble transferrin receptor and type 2 diabetes, whereas the soluble transferrin receptor‐to‐ferritin ratio was significantly inversely related to the risk of type 2 diabetes in the median and high ratio subgroups (OR 0.71, 95% CI 0.51, 0.99 and OR 0.65, 95% CI 0.45–0.95).ConclusionsThe elevated serum ferritin was one of the risk factors for type 2 diabetes, and soluble transferrin receptor‐to‐ferritin ratio was inversely related to the risk of type 2 diabetes. A systematic review showed that serum transferrin and hepcidin might be directly or indirectly related to the development of diabetes.

Do free thyroxine levels influence the relationship between maternal serum ferritin and gestational diabetes mellitus in early pregnancy?

PurposeThe objective of this study was to estimate the combined effect of serum ferritin (SF) concentration and free thyroxine (fT4) levels on the risk of gestational diabetes mellitus (GDM). MethodsWomen presented for antenatal care at a tertiary hospital in Shanghai, China were included in this study from December 2012 to March 2014. Women were divided into six groups according to the SF and fT4 level. Multiple logistical regression model was used to estimate odds ratio (OR) among different groups. Relative excess risk of interaction (RERI), the attributable proportion (AP) of the interaction and the synergy index (SI) were applied to evaluate the additive interaction of SF concentration and fT4 level. ResultsA total of 6542 qualifying pregnant women were included in this study. We observed that a high SF concentration in early pregnancy was related to an increased risk of GDM (OR = 1.21, 95%CI: 1.02–1.43); while a low fT4 level was not (OR = 1.18, 95%CI: 0.89–1.58). There is no addictive interaction between SF and fT4 level on the presence of GDM. ConclusionsThe study suggests that only high serum ferritin concentration is associated with an increased risk of GDM in early pregnancy. The level of fT4 in early pregnancy might have no effect on the association between high SF and risk of GDM.

Association between serum ferritin and non-alcoholic fatty liver disease among middle-aged and elderly Chinese with normal weight.

Non-alcoholic fatty liver disease (NAFLD) in normal-weight population is becoming an important health issue. This study aimed to assess the association between serum ferritin (SF) and NAFLD among middle-aged and elderly Chinese with normal weight. A total of 2029 Chinese adults aged 35-70 years with normal weight were involved in this cross-sectional study. General information, lifestyle factors and laboratory characteristics were collected. The concentrations of serum alanine aminotransferase (ALT) and SF were recorded. Receiver operating characteristic (ROC) was applied to assess predictive performance of SF for NAFLD. Logistic regression analysis was conducted to evaluate the associations of SF with NAFLD and elevated ALT. Compared with controls, subjects with NAFLD had higher SF concentrations (p<0.001). In multivariate logistic regression analyses, the odds ratios (ORs) with 95% confidence intervals (CIs) of NAFLD were 3.19 (2.07-4.92) for the highest versus lowest quartile of SF. ROC analysis revealed a predictive ability of SF for NAFLD with an area under the curve of 0.660 (95% CI, 0.63-0.69). In addition, higher SF was significantly associated with increased risk of elevated ALT (OR=1.84, 95% CI: 1.32-2.55). In stratified analyses by gender and age, the positive associations of SF with the risk of NAFLD and elevated ALT were only observed in women and 35~49y group. SF was positively associated with the risk of NAFLD and elevated ALT among normal-weight Chinese adults. ROC analysis suggested that SF may serve as an indicator of predicting NAFLD.

Transferrin as a predictor of survival in cirrhosis.

Patients with cirrhosis frequently present with high serum ferritin and low transferrin concentrations, reflecting impaired liver function and inflammation. Recent studies have shown that transferrin and its saturation with iron are Model for End‐Stage Liver Disease–independent predictors of mortality in patients with acute‐on‐chronic liver failure or decompensated cirrhosis. The aim of this study was to evaluate the prognostic utility of serum iron parameters in relation to markers of liver function and immune activation. Clinical, demographic, and biochemical data were retrospectively analyzed from a cohort of 1255 consecutive patients with cirrhosis (age ≥ 18 years) who presented from August 1, 2004 until December 31, 2014 at the University Hospital of Innsbruck. Patients with malignancies at diagnosis including hepatocellular carcinoma were excluded. Survival analysis was carried out by Cox regression by using baseline laboratory parameters, and findings were validated in an independent patient cohort. During a median follow‐up of 2.4 years, 193 deaths occurred and 254 patients underwent liver transplantation. In patients with transferrin < 180 mg/dL, 3‐month, 1‐year, and 5‐year transplant‐free survival estimates were significantly lower (91.7%, 79.0%, and 30.5%) when compared with the group of patients with transferrin ≥ 180 mg/dL (98.9%, 95.5%, and 68.0%, P < 0.001). Transferrin predicted transplant‐free survival independently of Model for End‐Stage Liver Disease–sodium (MELD‐Na) and C‐reactive protein (CRP) in multivariate regression analysis including all patients. When patients with alcoholic or nonalcoholic fatty liver disease were excluded, transferrin was in addition an albumin‐independent predictor of transplant‐free survival. In conclusion, the association of transferrin with transplant‐free survival is independent of MELD‐Na score and CRP. In patients without fatty liver disease, transferrin also predicts survival independently of albumin. Liver Transplantation 24 343–351 2018 AASLD.

Wait a minute? An observational cohort study comparing iron stores in healthy Swedish infants at 4 months of age after 10-, 60- and 180-second umbilical cord clamping

Background and objectiveUmbilical cord blood (UCB) is a valuable stem cell source used for transplantation. Immediate umbilical cord (UC) clamping is widely practised, but delayed UC clamping is increasingly advocated...

Inflammatory markers, sarcopenia and its diagnostic criteria among the elderly: a systematic review

Abstract Objective: To identify the relationship between inflammatory markers and sarcopenia, and the diagnostic criteria of the condition among the elderly. Methods: A systematic review was performed based on the consultation of the PubMed and LILACS databases. Eligible original articles were those involving individuals aged 60 years or more, which investigated sarcopenia [low muscle mass (MM) associated with poor muscle strength and/or reduced physical performance, according to the European Working Group on Sarcopenia in Older People consensus (EWGSOP)] or its diagnostic criteria, published in English or Portuguese, between 2010-2015. Results: Four articles were included in the review, the principle results of which were: the growth differentiation factor (GDF-15) exhibited a negative correlation with MM, handgrip strength and gait speed; the insulin-like growth factor-1 (IGF-1) correlated positively with MM; follistatin exhibited a weak correlation with physical performance; activin A and myostatin did not correlate with the diagnostic criteria; the highest tercile of extracellular heat shock protein 72 (eHsp72) was associated with lower median levels of MM, handgrip strength and gait speed; elderly persons with low MM had higher serum ferritin concentrations; women with low MM exhibited lower serum concentration levels of C-reactive protein (CRP). Conclusion: the six investigated inflammatory markers (GDF-15, IGF-1, follistatin, eHsp72, ferritin and CRP) were associated with the diagnostic criteria for sarcopenia, but not with sarcopenia itself. As research in this area is still developing, additional studies are required to broaden knowledge and eventually establish the role of these markers in the diagnosis and management of sarcopenia.

Serum Ferritin as a Predictor of Shock in Children with Dengue Infection

Background: Dengue shock syndrome causes high morbidity and mortality among children worldwide. Several laboratory monitoring can be used to evaluate the progressivity of dengue virus infection. This study aimed to analyze ferritin serum as a predictor of shock in children with dengue infection, and to determine the cut off point that can be used to diagnose dengue shock. Subje cts and Met hod: This was a cross sectional study conducted at pediatric ward, Dr. Moewardi hospital Surakarta Dr. Soetrasno hospital Rembang, Central Java. Study population was children aged less than 18 years old with dengue infection. Study subjects were selected by consecutive sampling. Tha dependent variable was dengue shock. The independent variable was serum ferritin concentration. Mann Whitney test was used to compare mean ferritin concentration between children with and without dengue shock. Cut off point of serum ferritin concentration was determined by ROC curve. Results: Mean serum ferritin concentration in children with dengue shock (mean= 3628.8; SD= 1582.4) was higher than in children without dengue shock (mean= 717.8 ; SD= 695.8), with p<0.001. Therefore, there was a statistically significant asssociation between serum ferritin concentration and dengue shock . The cut off point of serum ferritin concentration that could be used to show dengue shock with high sensitivity (0.92) and specificity (0.97) was 2304.5. Conclusion: High serum ferritin concentration is a predictor of dengue shock. Keywords : ferritin, dengue shock syndrome, children Correspondence: Putri Evalda. Dr. Moewardi Hospital, Jl. Kolonel Sutarto No.132 Jebres, Surakarta, Central Java 57126. Email: dr. putri.evalda@gmail.com. Mobile: 081227970440 Indonesian Journal of Medicine (2017), 2(3): 154-160 https://doi.org/10.26911/theijmed.2017.02.03.02

Metabolomic profiling identifies potential pathways involved in the interaction of iron homeostasis with glucose metabolism

ObjectiveElevated serum ferritin has been linked to type 2 diabetes (T2D) and adverse health outcomes in subjects with the Metabolic Syndrome (MetS). As the mechanisms underlying the negative impact of excess iron have so far remained elusive, we aimed to identify potential links between iron homeostasis and metabolic pathways. MethodsIn a cross-sectional study, data were obtained from 163 patients, allocated to one of three groups: (1) lean, healthy controls (n = 53), (2) MetS without hyperferritinemia (n = 54) and (3) MetS with hyperferritinemia (n = 56). An additional phlebotomy study included 29 patients with biopsy-proven iron overload before and after iron removal. A detailed clinical and biochemical characterization was obtained and metabolomic profiling was performed via a targeted metabolomics approach. ResultsSubjects with MetS and elevated ferritin had higher fasting glucose (p < 0.001), HbA1c (p = 0.035) and 1 h glucose in oral glucose tolerance test (p = 0.002) compared to MetS subjects without iron overload, whereas other clinical and biochemical features of the MetS were not different. The metabolomic study revealed significant differences between MetS with high and low ferritin in the serum concentrations of sarcosine, citrulline and particularly long-chain phosphatidylcholines. Methionine, glutamate, and long-chain phosphatidylcholines were significantly different before and after phlebotomy (p < 0.05 for all metabolites). ConclusionsOur data suggest that high serum ferritin concentrations are linked to impaired glucose homeostasis in subjects with the MetS. Iron excess is associated to distinct changes in the serum concentrations of phosphatidylcholine subsets. A pathway involving sarcosine and citrulline also may be involved in iron-induced impairment of glucose metabolism.