Impact Of Iron Supplementation Research Articles

Impact of Iron Supplementation on Children with Severe Attention Deficit Hyperactive Disorder- A Randomized Clinical Trial

Background: Iron acts as a risk factor and psychostimulant modulator in treatment of ADHD with iron deficiency anemia. Objective: To see the impact of iron supplementation on severe ADHD children. Materials and Methods: This randomized controlled trial conducted in the OPD, Pediatric Neurology from July 2019 to January 2020; NINS 50 children of severe ADHD with iron deficiency were enrolled. Participants were randomized into group A (25 cases) given a combination of Methylphenidate and iron, and group B (25 cases) given Methylphenidate alone for 3 months. Conner’s rating scale, CBC and serum ferritin was evaluated after one and three months, severity was compared between treatment groups. Analysis of data was done by SPSS version of 22.0. Result: Combined ADHD, poor academic performance, poor appetite, frequent infection was common features of IDA among the cases. All hematological parameters were increased from baseline to 1 month and 3 months follow up in all cases but significantly improved in Iron receiving groups. the severity of T scores of ADHD index were decreased at 1 month (p=0.047) and 3 months (p= 0.026) after intervention. Conclusion: This study concluded that iron supplementation along with psychostimulant found better response in severe ADHD children BANGLADESH J CHILD HEALTH 2022; VOL 46 (2) : 48-53

Dose-Responsive Effects of Iron Supplementation on the Gut Microbiota in Middle-Aged Women.

Oral iron supplementation is the first-line treatment for addressing iron deficiency, a concern particularly relevant to women who are susceptible to sub-optimal iron levels. Nevertheless, the impact of iron supplementation on the gut microbiota of middle-aged women remains unclear. To investigate the association between iron supplementation and the gut microbiota, healthy females aged 40-65 years (n = 56, BMI = 23 ± 2.6 kg/m2) were retrospectively analyzed from the Alberta's Tomorrow Project. Fecal samples along with various lifestyle, diet, and health questionnaires were obtained. The gut microbiota was assessed by 16S rRNA sequencing. Individuals were matched by age and BMI and classified as either taking no iron supplement, a low-dose iron supplement (6-10 mg iron/day), or high-dose iron (>100 mg/day). Compositional and functional analyses of microbiome data in relation to iron supplementation were investigated using various bioinformatics tools. Results revealed that iron supplementation had a dose-dependent effect on microbial communities. Elevated iron intake (>100 mg) was associated with an augmentation of Proteobacteria and a reduction in various taxa, including Akkermansia, Butyricicoccus, Verrucomicrobia, Ruminococcus, Alistipes, and Faecalibacterium. Metagenomic prediction further suggested the upregulation of iron acquisition and siderophore biosynthesis following high iron intake. In conclusion, adequate iron levels are essential for the overall health and wellbeing of women through their various life stages. Our findings offer insights into the complex relationships between iron supplementation and the gut microbiota in middle-aged women and underscore the significance of iron dosage in maintaining optimal gut health.

The impact of iron supplementation on the preterm neonatal gut microbiome: A pilot study.

The gastrointestinal microbiome in preterm infants exhibits significant influence on optimal outcomes-with dysbiosis shown to substantially increase the risk of the life-threatening necrotizing enterocolitis. Iron is a vital nutrient especially during the perinatal window of rapid hemoglobin production, tissue growth, and foundational neurodevelopment. However, excess colonic iron exhibits potent oxidation capacity and alters the gut microbiome-potentially facilitating the proliferation of pathological bacterial strains. Breastfed preterm infants routinely receive iron supplementation starting 14 days after delivery and are highly vulnerable to morbidities associated with gastrointestinal dysbiosis. Therefore, we set out to determine if routine iron supplementation alters the preterm gut microbiome. After IRB approval, we collected stool specimens from 14 infants born <34 weeks gestation in the first, second, and fourth week of life to assess gut microbiome composition via 16S rRNA sequencing. We observed no significant differences in either phyla or key genera relative abundance between pre- and post-iron timepoints. We observed notable shifts in infant microbiome composition based on season of delivery. Though no obvious indication of iron-induced dysbiosis was observed in this unique study in the setting of prematurity, further investigation in a larger sample is warranted to fully understand iron's impact on the gastrointestinal milieu.

Impact of iron supplementation on media bed aquaponic system: Focusing on growth performance, fatty acid composition and health status of juvenile mirror carp (Cyprinus carpio var. specularis), production of lettuce (Lactuca sativa var. ramosa Hort), water quality and nitrogen utilization rate

To evaluate the effects of iron supplementation on the growth performance, body composition and health status of mirror carp (Cyprinus carpio var. specularis) (10.34 ± 1.56 g), production of lettuce (Lactuca sativa var. ramosa Hort), and nitrogen utilization efficiency in media bed aquaponic system, a 60-day experiment was conducted. During the experiment, 0 (C), 1, 2, 3 and 4 mg/L iron chelate (ferrous glycinate) was added to fish tank of each system every 20 days. The results indicated as following: (1) Regarding the growth performance of mirror carp, the 1 mg/L group showed the highest weight gain (WG) and the lowest feed conversion ratio (FCR) when compared to the C group and the 4 mg/L group (P < 0.05). (2) In terms of body composition of mirror carp, the 1 mg/L group exhibited a significant increase in crude fat and iron content in the muscle (P < 0.05), and the ∑n-3 LCPUFA (C20:5n-3, EPA; C22:6n-3, DHA) was significantly higher in this group compared to the other groups (P < 0.05). (3) Regarding the health status of mirror carp, the 1 mg/L group had the highest liver catalase (CAT) activity, and the level of superoxide dismutase (SOD) activity was significantly higher than in the C, 3 mg/L, and 4 mg/L groups (P < 0.05). Liver malondialdehyde (MDA) content of mirror carp was significantly lower in 1 mg/L group compare to other groups (P < 0.05). (4) Concerning lettuce growth, the yield increased with rising iron content, and the group with 2 mg/L exhibited the highest chlorophyll content (P < 0.05). (5) Nitrogen utilization results showed that the 2 mg/L chelated iron group had the highest nitrogen utilization rate of 33.95%, while the C group had the lowest nitrogen utilization rate of 28.61%. Additionally, iron supplementation did not have a negative impact on the water quality of the aquaponic system. In summary, under the conditions of this study, adding 1 mg/L of chelate iron every 20 days in the aquaponic system is beneficial to the growth, body composition and health status of the mirror carp, the lettuce in the 2 mg/L group had better growth and yield. It is recommended to add 1–2 mg/L glycine chelated iron in the media bed aquaponic system every 20 days to promote the growth of fish and vegetables and improve the nitrogen utilization efficiency of the system.

Impact of Iron Supplementation in Anemic Voluntary First-Time Blood Donors-Results of a Pilot Trial in Ghana

Introduction : Blood transfusion is a major developmental challenge in sub-Saharan Africa due to chronic inadequacy and shortage of major blood products. In Ghana, deferral of potential blood donors has been identified as a significant challenge. Anemia, accounts for nearly half of ineligible blood donors. The estimated prevalence of anemia is 42.4% in women of reproductive age and 18.8% among peri-urban men ( Spring and Ghana Health service 2016). Thus, a high prevalence of anemia accounting for nearly half of voluntary blood donor deferrals, may contribute to the country's poor availability of safe blood for transfusion. No prior investigation had been carried out in Ghana on whether potential blood donors, deferred due to anemia, would consider donating blood after receiving counselling and appropriate treatment. This study tested the hypothesis that low-dose iron supplementation will increase hemoglobin levels sufficiently among anemic individuals to make them eligible to donate blood. Data from this trial informed the design of a larger randomized control type 1 pragmatic effectiveness implementation hybrid trial. Methods:This was a longitudinal two-arm parallel-group trial (participants aged 18 - 60 years). We compared the hemoglobin levels among those with anemia, iron deficiency (ID) or iron deficiency anemia (IDA) who received iron supplementation to donors without ID or IDA (Control group) in a non-inferiority design(NCT04949165). Anemia, IDA and ID were defined and determined using World Health Organization cut-off values (WHO, 2011). Potential blood donors with hemoglobin values less than 10 g/dl were excluded from the study. Participants in the iron supplementation arm were given low-dose iron (65 mg elemental iron) three times weekly for four months while the control arm received the standard nutritional counselling practice. In-person visits occurred at two, four and six months and included blood draws for full blood count, peripheral blood film smear, malaria rapid test and serum ferritin. The primary outcome was hemoglobin level after four months. A structured questionnaire assessed adherence, nutritional counselling and adverse events every two weeks via phone. Results: Two hundred and twenty-three first-time voluntary blood donors consented and passed pre-screening donation requirements (105 in iron supplementation arm vs. 118 in the control arm). The mean ages were similar between the iron supplementation and control groups (19.7±2.5 vs. 20.1±3.1 years). In both groups, there were more females than males (iron: 75.2%; control: 51.7%). At screening, 43.9% (98/223) had anemia while 3.1% (7/223) had ID. Of those who had anemia, 84.7% (83/98) had ferritin at least 15 g/l while 15.3% (15/98) had IDA. Among controls who donated blood at screening with an interim 1 visit, 42.6% (20/47) of females and 20.9% (9/43) of males were anemic. Only 23.4% (11/47) of females but no male was ID after one blood donation. Among participants assigned to iron supplementation who were anemic at screening, 31.7% (20/63) of females and 28.6% (6/21) of males were no longer anemic at interim visit 1. Among iron participants who were ID at screening 53.3% (8/15) of females and no male (0/2) were iron replete at interim visit 1. Only half of the participants receiving iron supplementation self-reported perfect adherence at the first and second interim visits (end of iron supplementation). A small proportion of participants reported side effects of dark stools and abdominal pain. We did not observe bacterial infections or increased malaria incidence. The mean hemoglobin values decreased over time from baseline to month four in the control group (screening: N=118, 13.4±1.3 g/dl; interim visit 2: N=74, 12.3±1.5 g/dl) and increased in the iron supplementation group (screening: N=105, 11.3±0.9 g/dl; interim visit 2: N=56, 11.4±1.3 g/dl). However, the primary comparison, mean hemoglobin difference between the iron supplementation and control arm at four months, did not meet the threshold to reject the inferiority hypothesis. Conclusion: The prevalence of ID and IDA among voluntary first-time blood donors was lower than previously published estimates. Adherence to low-dose iron supplementation three times a week was poor. Hemoglobin levels in the iron supplementation arm were not close enough to those in the control group after four months of iron supplementation to declare non-inferiority.

What exactly does the PfK13 C580Y mutation in Plasmodium falciparum influence?

BackgroundThe emergence and spread of artemisinin resistance threaten global malaria control and elimination goals, and encourage research on the mechanisms of drug resistance in malaria parasites. Mutations in Plasmodium falciparum Kelch 13 (PfK13) protein are associated with artemisinin resistance, but the unique or common mechanism which results in this resistance is unclear.MethodsWe analyzed the effects of the PfK13 mutation on the transcriptome and proteome of P. falciparum at different developmental stages. Additionally, the number of merozoites, hemozoin amount, and growth of P. falciparum 3D7C580Y and P. falciparum 3D7WT were compared. The impact of iron supplementation on the number of merozoites of P. falciparum 3D7C580Y was also examined.ResultsWe found that the PfK13 mutation did not significantly change glycolysis, TCA, pentose phosphate pathway, or oxidative phosphorylation, but did reduce the expression of reproduction- and DNA synthesis-related genes. The reduced number of merozoites, decreased level of hemozoin, and slowed growth of P. falciparum 3D7C580Y were consistent with these changes. Furthermore, adding iron supply could increase the number of the merozoites of P. falciparum 3D7C580Y.ConclusionsThese results revealed that the PfK13 mutation reduced hemoglobin ingestion, leading to artemisinin resistance, likely by decreasing the parasites' requirement for haem and iron. This study helps elucidate the mechanism of artemisinin resistance due to PfK13 mutations.Graphical

Prognostic implications of iron deficiency and supplementation in patients undergoing valvular heart surgery

Abstract Background Iron deficiency is common in patients with cardiovascular diseases, present in up to 60% of patients with coronary artery disease, heart failure, or pulmonary hypertension. Its role in valvular heart disease, including its prevalence, determinants, and prognostic implications, remains unclear. Purpose The present study aimed to evaluate the prognostic significance of iron deficiency in patients undergoing valvular heart surgery. Methods Pre-operative haematology and iron profiles were retrospectively collected in all patients undergoing valvular heart surgery in Hong Kong between 2010 and 2021. Iron deficiency was defined referencing the ESC 2021 guidelines as a ferritin level &amp;lt;100 ng/mL or a transferrin saturation &amp;lt;20% with a ferritin level of 100 to 299 ng/mL. Logistic regression analyses were conducted to determine variables associated with guideline-defined iron deficiency. Stepwise Cox proportional hazards regression was applied to identify predictors of 5-year mortality. The impact of iron supplementation on outcomes was estimated in iron-deficient patients, modelled by inverse probability of treatment-weighted logistic regression. Results Our study included 578 patients; the median age was 62 (interquartile range 54-70) years, and 47.4% were males. Iron deficiency was present in 324 (56.1%) patients. Independent correlates of iron deficiency were age, male sex, diabetes mellitus, atrial fibrillation, heart failure, diuretics and warfarin use, aortic stenosis, and tricuspid regurgitation (Table 1). Death from any cause occurred in 99 patients over five years of follow-up, of which 45 were due to cardiovascular events. Iron deficiency was associated with a two- to three-fold excess risk of all-cause (hazard ratio [HR] 1.89, 95% CI 1.23-2.90; P = 0.004) and cardiovascular mortality (HR 2.84, 95% CI 1.23-2.90; P = 0.004). Results were consistent in multivariable models incorporating comorbidities, medications, type of valvular intervention, and cardiac surgery risk-scoring systems, even after adjustment for haemoglobin levels (Table 2). For individual components of the guideline criteria, transferrin saturation &amp;lt;20% and ferritin &amp;lt;300 ng/mL were associated with worse all-cause and cardiovascular mortality. Among 324 patients with iron deficiency, 61 (18.8%) received iron supplementation before valvular surgery. Iron supplementation was associated with a 58% lower risk of death in multivariable models with IPTW (HR 0.42; 95% CI, 0.19–0.99; P = 0.047). Conclusions In patients undergoing valvular surgery, iron deficiency is associated with worse survival. This elevated risk may be mitigated by iron supplementation before valvular surgery.Table 1Table 2

DETERMINANTS ELEMENTS OF ANEMIA IN PREGNANT WOMEN CONSULTING IN HEALTH CARE STRUCTURE OF CASABLANCA AND SAFI

Objective: A multicentric cross sectional study conducted in 2021, and carried out in provincial hospital Mensour Bernoussi, provincial hospital Sidi Othman in the region of Casablanca settat and provincial hospital Mohammed V health center Saada and health center Jamaat Shaim in the region of marrakech safi . the first objective is to determine the key elements impacting the anemia ,the second , consist to see the role of the diversity food and the third one , the impact of iron supplementation on anemic and non anemic women. Methodology: All pregnant women (503) attending to the 5 heath structure in the region Casablanca-Settat and Marrakech-Safi and have CBC result . a anonymous questionnary was conducted including CBC result , socio demographic data , (antenatal care ) ANC follow up , iron supplementation , common signs and symptoms of anemia , complication during pregnancy and a total recall and modified MDDW and frequency at food consumption of 1 month . the data was analyzed using the Jamovi database . Result: The mean and standard deviation age of participant was for the non anemic pregnant women 28.9+/- 6.21 years versus for the anemic pregnant women 26.6 +/- 6.26 years .The age range of the population was 33 years from 15 years to 48 years old . most anemic pregnant had a hypochromic 74.3% microcytic type of anemia, 92.9% where housewife and lower monthly income compare to the none anemic pregnant women , also the mean gestity and parity of the pregnant women was 2.55+/-1.44 and 2.14+/-1.37 respectively, a 85.9% patient was followed during pregnancy, a higher level of 75.5% of patient was on iron supplementation and there was significative result concerning anemia signs ( especially pallor , hair loss and headache). Furthermore, using the longitudinal bivaried and multivaried regression revealed that the anemic pregnant women were respectively less exposed the older they are (reference (15-23 years) 28-32 years (p=0.045 OR=19.380 IC95%[1.01-3.706]) and 33-48 years (p=0.005 OR=27.307 IC95% [1.34-5.527]) ), the followed up during the pregnancy reduces significative the risk of anemia (reference (yes) no p=0.005 OR=0.2409 IC95%[0.08839-0.657]), also the consumption of coffee/coffee with milk increased the risk. (Reference (yes) no p=0.020 OR=17.821 IC95%=[1.10-2.879]).

The Impact of Iron Supplementation During Pregnancy and Change of Consumption among Stunting Children Aged 6-24 Months During the COVID-19 Pandemic in Indonesia.

During the COVID-19 pandemic, stunting is estimated to increase 2.4 times higher (It seems that some information is missing here because the usage of the word 'higher' hints at a comparison with some other statistic. Or please consider making the following changes in the statement: "…stunting is estimated to be 2.4 times higher than the normal trend." which can increase mortality, morbidity, and cause economic losses in the future. This study aims to identify the risk factors for stunting during the COVID-19 pandemic. An unmatched case-control study was conducted to compare the exposure of stunted (cases) and non-stunted (controls) children. There were 127 children aged 6-24 months, 43 cases, and 84 controls. The probability of stunting was two times greater in children who experienced good changes in the consumption of tofu/tempeh (p: 0.047; AdjustedOR (aOR): 2.296; 95% CI 1.013-5.205) and fourtimes greater in children who have a mother that did not receive iron supplementation during pregnancy (p: 0.030; aOR: 4.344; 95% CI: 1.154-16.355). Based on the above results, increasing access to nutritious food, and the delivery of services and information related to maternal and child health services during the pandemic needs to be intensified by using innovative low-risk platforms.

Iron supplementation in pregnant Danish women revisited: Effects on prepartum and postpartum iron deficiency, anemia, serum erythropoietin; including iron status, erythropoietin and anthropometrics in newborns. A randomized, placebo-controlled study.

To assess effects of iron supplementation, 66 mg elemental iron daily as ferrous fumarate, on iron status markers during normal pregnancies. Randomized, double-blind, placebo-controlled study of 119 women (62 iron-, 57 placebo -treated) and their newborns. Hemoglobin (Hb), serum (S)-ferritin, S-transferrin saturation percentage (TSAT) and S-erythropoietin (S-EPO) were measured at 14-18, 24-27 weeks of gestation, prepartum, 1 and 8 weeks postpartum. From 24-27 weeks gestation to 8 weeks postpartum, the iron group had higher Hb, S-ferritin and TSAT than the placebo group; prepartum, 11% had iron deficiency (ID) and 0% iron deficiency anemia (IDA) in the iron group, vs 60% and 18% in the placebo group; 8 weeks postpartum 1.6% in the iron group had ID and 1.6% IDA vs 14% and 7% in the placebo group. S-EPO levels in the iron group were lower than in the placebo group (p < 0.001). Mothers prepartum S-EPO values were correlated to newborns cord S-EPO values (p < 0.001). Newborns to iron treated mothers had higher cord S-ferritin levels than those to placebo treated mothers (p = 0.02). Newborn girls had higher cord S-ferritin levels than boys (p < 0.01). There was no impact of iron supplementation on the length of gestation, placental weight, or newborns birth weight. Birth weight was correlated only with mothers' body weight, length of gestation and placental weight. Iron supplementation had a "positive" impact on iron status and Hb both during pregnancy and postpartum, with a low frequency of ID/IDA and also a "positive" influence on newborns iron status.

Impact of iron supplementation on gestational diabetes mellitus: A literature review.

Gestational diabetes mellitus (GDM) is a common complication of pregnancy, affecting 14% of pregnancies worldwide, and the prevention of pathological hyperglycaemia during pregnancy is meaningful for global public health. The role of iron supplementation in the progression of GDM has been of significant interest in recent years. Iron is a micronutrient that is vital during pregnancy; however, given the toxic properties of excess iron, it is probable that prophylactic iron supplementation will increase the risk of adverse pregnancy outcomes, including GDM. It is critical to clarify the effect of iron supplementation on the risk of GDM. Therefore, in this review, we comprehensively assess the role of iron in pregnancy. This review aimed to analyse the necessity of iron supplementation and maintenance of iron homeostasis during pregnancy, particularly reviewing the role and function of iron in beta cells and examining the mechanisms of excess iron contributing to the pathogenesis of GDM. Moreover, we aimed to discuss the association of haemoglobin and ferritin with GDM and identify priority areas for research.

Anaemia in Lambs and Kids Reared Indoors on Maternal Milk and the Impact of Iron Supplementation on Haemoglobin Levels and Growth Rates.

Simple SummaryThe study assessed anaemia (low haemoglobin levels) due to iron deficiency in new-born lambs and goat kids. Blood samples were taken from lambs and kids under different management systems at one month of age, and those reared indoors and suckling their mothers showed lower haemoglobin levels than those on milk replacer (which is fortified with iron) or those reared outdoors, indicating iron deficiency anaemia. As a follow-up, lambs and kids from those “at-risk” settings were enrolled on a trial injecting iron into half the animals in the first one to eight days of life. Those injected animals showed higher haemoglobin levels at one month of age (i.e., not getting anaemia) than untreated ones, and there was also a trend towards higher growth rates in treated animals, especially in twin lambs. This study aimed to assess iron deficiency anaemia in new-born lambs and goat kids and was carried out in two parts: (1) Twenty blood samples were taken from one-month-old lambs and kids under different systems and were tested for haemoglobin. Three groups of lambs were compared: indoor reared on maternal milk, indoor reared on milk replacer, and outdoor reared on maternal milk. Indoor-reared kids were compared: those fed on maternal milk and fed on milk replacer. Indoor-reared kids and lambs on maternal milk showed significantly lower haemoglobin levels than those on milk replacer or reared outdoors. (2) On farms with indoor-reared lambs or goat kids on maternal milk, an intervention trial was carried out: animals were randomly assigned at 1–8 days of age to either receive 300 mg (lambs) or 150 mg iron (goat kids) as intramuscular iron dextran, and growth rates were compared after one and two months. Haemoglobin levels at one month were also compared in randomly selected animals from both groups. Treated lambs and kids showed higher haemoglobin levels at one month of age and a numerically increased growth rate that was statistically significant for twin lambs. Iron dextran improves haemoglobin levels in these animals and may lead to higher growth rates, especially in twin lambs.

Retacrit®, Biosimilar of Epoetin Alfa, in Chemotherapy-Induced Anemia in Routine Practice: Impact of Iron Supplementation.

The aim of the study was to evaluate in real-life conditions the effectiveness and safety of a biosimilar of epoetin alfa (Retacrit®) in chemotherapy-induced anemia and the impact of iron supplementation. This was a longitudinal, observational, prospective study of 12-16 weeks conducted in 195 French centers. The primary endpoint was the achievement of target Hb (with an increase of Hb ≥1 g/dL) or an increase of Hb ≥2 g/dL, in the absence of transfusion in the previous 3 weeks. 2,076 patients (women, 50.6%; mean age, 67.0 years) with malignant diseases (solid tumors, 79.8%; lymphomas, 12.7%; multiple myeloma, 6.6%) were analyzed. A total of 655 patients received oral iron (40.5%), intravenous iron (58.9%), or both (0.6%). At inclusion, 10.0% and 18.2% of patients without and with iron supplementation had serum ferritin <100 μg/L, respectively. Transferrin saturation (TSAT) ≤20% was more frequent in patients with supplementation (76.6%) than without supplementation (33.9%). The mean weekly doses of epoetin alfa biosimilar and planned duration of treatment were comparable regardless of iron supplementation. The primary endpoint was achieved in 70.5% and 70.2% of patients without and with iron supplementation, respectively. Three (0.1%) serious thromboembolic events related to treatment with epoetin alfa biosimilar were reported. Epoetin alfa biosimilar was effective and well tolerated for treating chemotherapy-induced anemia. Patients in subgroup with iron supplementation had lower TSAT at inclusion compared to subgroup without supplementation. Comparable mean Hb levels were achieved in both subgroups. The rate of patients with iron supplementation through the intravenous route was however insufficient.

The misogyny of iron deficiency.

Anaemia is common, particularly in women and the commonest underlying cause, iron deficiency, is often overlooked. Anaemia is associated with increased morbidity and mortality in patients undergoing anaesthesia; however, women are defined as being anaemic at a lower haemoglobin level than men. In this narrative review, we present the history of iron deficiency anaemia and how women's health has often been overlooked. Iron deficiency was first described as 'chlorosis' and a cause of 'hysteria' in women and initial treatment was by iron filings in cold wine. We present data of population screening demonstrating how common iron deficiency is, affecting 12-18% of apparently 'fit and healthy' women, with the most common cause being heavy menstrual bleeding; both conditions being often unrecognised. We describe a range of symptoms reported by women, that vary from fatigue to brain fog, hair loss and eating ice. We also describe experiments exploring the physical impact of iron deficiency, showing that reduced exercise performance is related to iron deficiency independent of haemoglobin concentration, as well as the impact of iron supplementation in women improving oxygen consumption and fitness. Overall, we demonstrate the need to single out women and investigate iron deficiency rather than accept the dogma of normality and differential treatment; this is to say, the need to change the current standard of care for women undergoing anaesthesia.

Seemingly trivial secondary factors may determine microbial competition: a cautionary tale on the impact of iron supplementation through corrosion.

ABSTRACTMicrobial community engineering aims for enrichment of a specific microbial trait by imposing specific cultivation conditions. This work demonstrates that things may be more complicated than typically presumed and that microbial competition can be affected by seemingly insignificant variables, like in this case the type of acid used for pH control. Aerobic bioreactors pulse fed with acetate operated with hydrochloric acid resulted in the enrichment of Plasticicumulans acidivorans, and changing the pH controlling agent to sulfuric acid shifted the community towards Zoogloea sp. Further research demonstrated that the change in community structure was not directly caused by the change in acid used for pH control, but resulted from the difference in corrosive strength of both acids and the related iron leaching from the bioreactor piping. Neither system was iron deficient, suggesting that the biological availability of iron is affected by the leaching process. Our results demonstrate that microbial competition and process development can be affected dramatically by secondary factors related to nutrient supply and bioavailability, and is way more complex than generally assumed in a single carbon substrate limited process.

Gestational iron deficiency anemia is associated with preterm birth, fetal growth restriction, and postpartum infections.

Gestational IDA has been linked to adverse maternal and neonatal outcomes, but the impact of iron supplementation on outcome measures remains unclear. Our objective was to assess the effects of gestational IDA on pregnancy outcomes and compare outcomes in pregnancies treated with either oral or intravenous iron supplementation. We evaluated maternal and neonatal outcomes in 215 pregnancies complicated with gestational IDA (Hb<100g/L) and delivered in our tertiary unit between January 2016 and October 2018. All pregnancies from the same period served as a reference group (n=11,545). 163 anemic mothers received oral iron supplementation, and 52 mothers received intravenous iron supplementation. Gestational IDA was associated with an increased risk of preterm birth (10.2% vs. 6.1%, p=0.009) and fetal growth restriction (FGR) (1.9% vs. 0.3%, p=0.006). The gestational IDA group that received intravenous iron supplementation had a greater increase in Hb levels compared to those who received oral medication (18.0g/L vs. 10.0g/L, p<0.001), but no statistically significant differences in maternal and neonatal outcomes were detected. Compared to the reference group, prematurity, FGR, postpartum infections, and extended hospital stays were more common among mothers with gestational IDA, causing an additional burden on the families and the healthcare system.

Iron metabolism imbalance at the time of listing increases overall and infectious mortality after liver transplantation.

BACKGROUNDLiver transplantation (LT) is the best treatment for patients with liver cancer or end stage cirrhosis, but it is still associated with a significant mortality. Therefore identifying factors associated with mortality could help improve patient management. The impact of iron metabolism, which could be a relevant therapeutic target, yield discrepant results in this setting. Previous studies suggest that increased serum ferritin is associated with higher mortality. Surprisingly iron deficiency which is a well described risk factor in critically ill patients has not been considered.AIMTo assess the impact of pre-transplant iron metabolism parameters on post-transplant survival.METHODSFrom 2001 to 2011, 553 patients who underwent LT with iron metabolism parameters available at LT evaluation were included. Data were prospectively recorded at the time of evaluation and at the time of LT regarding donor and recipient. Serum ferritin (SF) and transferrin saturation (TS) were studied as continuous and categorical variable. Cox regression analysis was used to determine mortality risks factors. Follow-up data were obtained from the local and national database regarding causes of death.RESULTSAt the end of a 95-mo median follow-up, 196 patients were dead, 38 of them because of infections. In multivariate analysis, overall mortality was significantly associated with TS > 75% [HR: 1.73 (1.14; 2.63)], SF < 100 µg/L [HR: 1.62 (1.12; 2.35)], hepatocellular carcinoma [HR: 1.58 (1.15; 2.26)], estimated glomerular filtration rate (CKD EPI Cystatin C) [HR: 0.99 (0.98; 0.99)], and packed red blood cell transfusion [HR: 1.05 (1.03; 1.08)]. Kaplan Meier curves show that patients with low SF (< 100 µg/L) or high SF (> 400 µg/L) have lower survival rates at 36 mo than patients with normal SF (P = 0.008 and P = 0.016 respectively). Patients with TS higher than 75% had higher mortality at 12 mo (91.4% ± 1.4% vs 84.6% ± 3.1%, P = 0.039). TS > 75% was significantly associated with infection related death [HR: 3.06 (1.13; 8.23)].CONCLUSIONOur results show that iron metabolism imbalance (either deficiency or overload) is associated with post-transplant overall and infectious mortality. Impact of iron supplementation or depletion should be assessed in prospective study.

Impact of Iron Supplementation on Patient Outcomes in Women Undergoing Gynecological Procedures: Systematic Review and Meta-Analysis of Randomized Trials

Background. Perioperative red blood cell (RBC) transfusion is associated with poor patient outcomes. RBC transfusion rates have been decreasing across different types of surgeries as a results of implementing Patient Blood Management (PBM) strategies; while RBC transfusion rates in gynecologic surgeries have remained static. Women are at increased risk of anemia, specifically iron deficiency anemia from gynecologic blood loss putting them at increased risk of requiring perioperative RBC transfusion. PBM encourages preoperative iron supplementation to optimize patients' hemoglobin (Hb) levels; however, evidence specific to gynecological procedures is lacking. This systematic review was conducted to address the question: Does the use of iron supplementation during the perioperative period impact patient outcomes in women undergoing gynecological procedures when compared to no treatment, placebo, or standard of care? Methods. MEDLINE, EMBASE, CENTRAL, CINAHL, and Web of Science were searched up to July 2019. Additional records were identified through searching theses, conference proceedings, trials, and grey literature. All randomized controlled trials (RCTs) comparing an intervention group provided with iron supplementation perioperatively to women undergoing gynecological procedures with a comparator were included. Two authors independently assessed studies for inclusion and risk of bias using the Cochrane Risk of Bias tool, extracted data, and evaluated the certainty of evidence using the GRADE approach. Data were pooled using the random-effects (DerSimonian and Laird) method of meta-analysis. Results. A total of eleven RCTs met inclusion criteria. Two RCTs were then excluded; one RCT compared iron supplementation to no intervention but subset data for gynecology patients was unavailable and the full text of another RCT was unavailable. Seven RCTs (n=447) were amenable to meta-analysis; however iron supplementation was used in both treatment arms: four compared iron with erythropoietin stimulating agents (ESA) to iron alone and three compared iron with gonadotropin-releasing hormone (GnRH) analogue/agonist to iron alone. Six studies were judged to be overall low risk of bias and one to be at high risk of bias. RBC Transfusions: There was a statistically significant reduction in RBC transfusions during the perioperative period when iron was used in combination with a blood optimization compound (BOC) compared to iron alone (RR 0.33; 95%CI 0.16 to 0.70; p=0.003) (Figure 1). Preoperative Hb Level: Women who had taken a BOC plus iron had a median preoperative Hb level of 12.87g/dl [95% CI 11.13, 14.61 g/dl]), which was significantly higher (Δ1.16 g/dl; 95% CI 1.01, 1.31g/dl; p&amp;lt;0.00001) than those who took oral iron supplements alone. Postoperative Hb Level: Among 336 women in six RCTs, women who had taken a BOC in addition to iron had a postoperative Hb of 11.53g/dl (95% CI 6.92 g/dl, 16.14g/dl). This was significantly higher (Δ0.96 g/dl; 95% CI 0.45 g/dl, 1.47 g/dl; p&amp;lt;0.00001) than those who took iron supplements alone. Adverse Events (AEs): Five studies including 289 participants reported the incidence of AEs. The addition of a BOC did not have a statistically significant effect on the occurrence of AEs (RR 0.98; 95%CI 0.83, 1.17; p=0.85). One RCT with available data compared iron supplementation to placebo. Meta-analysis was not possible; however, the study found a significant increase in postoperative Hb and decrease in RBC transfusions in patients receiving iron supplementation compared to placebo. Conclusion. Perioperative use of iron in combination with a BOC in women undergoing gynecological procedures may reduce the need for perioperative RBC transfusions and improve preoperative Hb levels with high certainty of evidence. There was very low certainty of evidence for the impact of iron plus BOC on postoperative Hb levels and the number of AEs. The results of this systematic review suggest that the use of perioperative iron with BOC may improve patient outcomes. Lack of RCTs comparing iron to placebo is a limitation. More studies are needed to address the role of perioperative iron supplementation for gynecological procedures, including evaluating different routes of administration. Analysis of existing observational studies may offer additional data to supplement the results of this meta-analysis. Disclosures Arnold: Rigel: Consultancy, Research Funding; Bristol-Myers Squibb: Research Funding; Novartis: Honoraria, Research Funding; Principia: Consultancy. Zeller:Pfizer: Other: Advisory Board; Canadian Blood Services: Consultancy; Ontario Ministry of Health and Long Term Care: Consultancy.

P6226Association of functional iron deficiency with incident cardiovascular diseases and mortality in the general population

Abstract Background Functional iron deficiency (FID) has been established as a risk factor in patients with cardiovascular diseases (CVD). As opposed to absolute iron deficiency, it reflects stored iron as well as utilized iron and allows for a more accurate evaluation of individual iron status. However, evidence is scant on the relevance of FID to the incidence of CVD in the general population. Aim This study aimed to evaluate the association of FID with incident cardiovascular diseases and mortality endpoints in a large population-based cohort. Methods FID was defined as either ferritin below 100 μg/L or ferritin between 100 and 299 μg/L and transferrin saturation below 20%. Only individuals free of CVD at baseline from three population-based European cohorts were included. Multivariable-adjusted sex- and cohort-stratified Cox regression analyses were performed to evaluate the association of functional iron deficiency with incident cardiovascular diseases (coronary heart disease, cerebral infarction, heart failure and atrial fibrillation) as well as with all-cause and cardiovascular mortality. Adjustments were performed for sex (as strata), age (as time scale), smoking, total cholesterol, systolic blood pressure, diabetes, body mass index and high-sensitive C-reactive protein. Results In total, N=12146 individuals were included in the analysis with a median age of 59.0 years (25thpercentile 45.0, 75thpercentile 68.0), and 45.2% men. Incidence of FID was 64.3%. Median follow-up times were 12.3 to 21.8 years, with an all-cause mortality rate of 18.2% and a cardiovascular mortality rate of 6.2%. Incident coronary heart disease, cerebral infarction, heart failure and atrial fibrillation were observed in 8.7%, 6.5%, 5.9% and 11.7%, respectively. FID was significantly associated with all-cause mortality (hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.01–1.24, p=0.034), cardiovascular death (HR 1.26, 95% CI 1.03–1.54, p=0.027) and incident coronary heart disease (HR 1.23, 95% CI 1.06–1.43, p&lt;0.01). There was no significant association with the other tested endpoints. Conclusion In our analysis of population-based cohorts, FID showed a significant positive association with all-cause as well as cardiovascular mortality and incident coronary heart disease. Further research is needed to validate the role of FID as a cardiovascular risk factor in the general population and to evaluate the impact of iron supplementation on gender and outcome.

Effect of a short course of iron polymaltose on acquisition of malarial parasitaemia in anaemic Indonesian schoolchildren: a randomized trial

BackgroundConcern exists about the safety of iron supplementation given to individuals in malarious areas. The possible unfavourable impact of iron supplementation on malaria might be less when slow-release iron compounds are used instead of ferrous salts, because no toxic non-transferrin bound iron is formed. The aim of this study was to determine the effect of iron supplementation using the slow-release iron compound iron polymaltose (IPM) on the acquisition of malarial parasitaemia.MethodsA randomized, placebo-controlled trial was performed in schoolchildren aged 5–18 years with mild or moderate anaemia on the Indonesian island Flores. Microscopic malaria-negative children were randomized to receive 8 weeks of IPM (6 mg elemental iron/kg/day) or placebo . The primary outcomes were the occurrence of microscopically detectable malarial parasitaemia at week 4, 8, 12 and 16 after start of treatment and the proportion of participants with real-time (RT) PCR positive malarial parasitaemia at week 16.Results294 Children were assigned to the IPM group and 297 to the placebo group. Whereas IPM supplementation failed to increased haemoglobin or ferritin concentrations, the IPM group had a significantly higher rate of occurrence of microscopically detectable parasitaemia [hazard ratio 2.2, 95% C.I. 1.2–4.0; P = 0.01]. This higher rate was confined to iron-replete children. At the end of the study, 89% of the children in the IPM group had remained free from microscopically detectable parasitaemia vs 95% of children in the placebo group. The proportion of plasmodial RT-PCR positive children was similar in both groups at week 16 (IPM group 16.6% vs placebo group 14.3%; P = 0.47). When analysis was restricted to iron-replete children (serum ferritin ≥30 µg/l), there was a trend for a higher proportion being RT-PCR positive at week 16 in the IPM group compared with the placebo group (20 vs 13.3%; P = 0.07). Erythrocyte microcytosis was an independent risk factor for microscopically detectable malarial parasitaemia.ConclusionsA short course of IPM should be used cautiously in anaemic children in malaria endemic areas, as it has limited efficacy in treating iron deficiency, while it increases the rate of microscopic malarial parasitaemia in those with replete iron stores.Trial registration ISRCTN 83091970. Registered 16 May 2012 (retrospectively registered)