Improve Iron Absorption Research Articles

Iron deficiency without anemia in children with newly diagnosed celiac disease: 1-year follow-up of ferritin levels, with and without iron supplementation.

Most children with newly diagnosed celiac disease and iron deficiency, who adhere to GFD, will normalize ferritin levels within 12 months without the need of iron supplementation. • Iron deficiency and iron deficiency anemia are common in newly diagnosed celiac disease. • Improved iron absorption may follow mucosal healing processin patients adhering to a strict gluten-free diet. • This single-center, retrospective cohort study evaluated the effect of iron supplementation versus no treatment on ferritin levels in children with newly diagnosed celiac disease with iron deficiency adhering to a gluten-free diet. • Most children with newly diagnosed celiac disease and iron deficiency, who adhere to gluten-free diet, will normalize ferritin levels within 12 months without the need of iron supplementation.

A novel scenario in the therapeutic management of anemia of chronic kidney disease: placement and use of roxadustat.

Anemia is a frequent and early chronic kidney disease (CKD) complication. Its management is currently based on oral or intravenous iron supplements, erythropoiesis-stimulating agents, and red blood cell transfusions, when the benefits of transfusion outweigh the risks. Anemia in CKD patients is underdiagnosed and undertreated. Current standard of care is associated with challenges and therefore new treatment approacheshave been sought. Hypoxia-inducible factor-prolyl-hydroxylase enzyme inhibitors are a new class of orally administered drugs used to treat anemia associated with CKD. Small-molecule hypoxia-inducible factor-prolyl-hydroxylase inhibitors have a novel mechanism of action that activates the hypoxia-inducible factor (oxygen-sensing) pathway resulting in a coordinated erythropoietic response, leading to increased endogenous erythropoietin production, improved iron absorption and transport, and reduced hepcidin. Roxadustat is the first hypoxia-inducible factor-prolyl-hydroxylase inhibitor approved by the European Medicines Agency (EMA) and reimbursed in Italy by the Italian Medicines Agency (AIFA) for the treatment of adult patients with symptomatic CKD-related anemia. This authorization was based on the outcome of a globally-conducted phase 3 clinical trial program comprising eight pivotal multicenter randomized studies. In the absence of up-to-date guidelines, we performed a critical appraisal of the placement and use of roxadustat in this therapeutic context.

Nutrition Challenges and Opportunities When Shifting to Plant-Based Diets.

There has been a significant increase in the number of people shifting towards plant-based dietary patterns over the past decade due to interest in protecting the health of the planet as well as improving human health. Studies have shown that vegetarian diets are associated with a lower prevalence of obesity in adults and children; therefore, moving towards a vegetarian diet in childhood may help prevent obesity later in life. The VeChi study in Germany found that on average vegetarian and vegan children grew equally well as omnivorous children. It is important to ensure that children following plant-based diets have adequate amounts of key nutrients, such as energy, fats, iron, calcium, iodine, vitamin B12, and omega-3 fats. In the VeChi studies, vegan children had the lowest intakes of calcium and iodine out of the three diet groups. The vegan children also had the lowest vitamin B12 intakes without supplements, but when supplements were taken into account, they had the highest vitamin B12 intakes. Iron intake in vegetarian children is consistently reported as higher than in omnivorous children. However, iron stores (indicated by low ferritin levels) tend to be lower in vegetarian compared to omnivorous children, due to decreased bioavailability of non-haem iron found in plant foods. When introducing solids, iron-rich foods should be offered early and paired with iron enhancers such as vitamin C and beta-carotene to improve iron absorption.

Hyperthyroidism in Sickle Cell Anaemia

Sickle cell anaemia is an excruciating disease with anaemia as a major pathological issues in the patients. Developing worlds are affected heavily by sickle cell anaemia and in malaria endemic region with high prevalent sickle cell trait. IDA and iron deficiency anaemia are common in thyroid disease and can lead to fatigue. Both hypothyroidism and hyperthyroidism can cause iron deficiency and anaemia. In turn, iron deficiency can also trigger hypothyroidism. Iron deficiency/IDA symptoms are similar to those of thyroid disease, making them hard to spot. Healthcare providers can order a blood test to check iron levels. This is called a serum ferritin test. Treatment for iron deficiency includes thyroid replacement medication, iron supplements, and/or a high-iron diet. Vitamins C, B6, B12, and others may improve iron absorption. When you have two conditions with similar symptoms, it can be hard to tell what's causing what symptoms. Pay attention to any new or worsening symptoms. Also, look at what does and doesn't improve with thyroid treatments. If you're still fatigued when your thyroid levels return to normal, talk to your doctor about the possibility of iron deficiency and IDA. Keywords: hyperthyroidism, anaemia, sickle cell, nutritional and anaemia.

Excessive Erythrocytosis Is Not Associated With Altered Iron Homeostasis in Men From the World's Highest City.

Excessive Erythrocytosis Is Not Associated With Altered Iron Homeostasis in Men From the World's Highest City.

Lactoferrin: A Promising New Player in Treatment of Iron Deficiency Anemia in Patients on Regular Hemodialysis: A Randomized Controlled Trial.

Hepcidin is secreted in inflammatory states as in patients on regular hemodialysis (HD). Therefore, novel agents modulating hepcidin secretion may have the potential to effectively reverse anemia in HD patients. Bovine milk derivative lactoferrin (BLF) is a glycoprotein that was found to decrease serum interleukin-6, therefore, having anti-inflammatory properties. Thus, it can downregulate hepcidin secretion in various inflammatory states including patients on regular HD, so improving iron absorption and utilization in those patients. In addition, BLF is a source of iron as each BLF molecule chelates two ferric ions. We started an interventional study. Seventy patients on regular HD with iron deficiency anemia received 100 mg of 20%-30% iron-saturated BLF (corresponding to 70-84 μg of elemental iron) orally b.i.d for 6 months. We compared those patients with another 70 patients on regular HD with iron deficiency anemia who were given 576 mg of ferrous glycine sulfate (corresponding to 100 mg of elemental iron) orally b.i.d for 6 months. BLF significantly decreased serum hepcidin level (from 340-350 ng/mL to 101-112 ng/mL), P <0.0001 and significantly increased hemoglobin (Hb) concentration (from 7.5-8.1 g/dL to 9.3-10 g/dL), P <0.0001, and transferrin saturation (TSAT) (from 5%-9% to 26%-31%), P <0.0001. Furthermore, ferrous glycine sulfate significantly decreased serum hepcidin level (from 335-350 ng/mL to 330--341 ng/mL), P <0.0001, and significantly increased Hb (from 7.5-8.1 to 7.6-8.5 g/dL), P <0.0001, and TSAT (from 5%-9% to 7%-12%), P <0.0001. However, the magnitude of decrease in serum hepcidin level and rise in Hb and TSAT in the BLF group was significantly higher than in the ferrous glycine sulfate group, P <0.0001. Oral BLF can be considered a promising novel agent in treatment of iron deficiency anemia in patients on regular HD.

Prebiotics, Probiotics, and Postbiotics in the Prevention and Treatment of Anemia.

Iron deficiency anemia (IDA) is very common and affects approximately 1/3 of the world’s human population. There are strong research data that some probiotics, such as Lactobacillus acidophilus and Bifidobacterium longum improve iron absorption and influence the course of anemia. Furthermore, prebiotics, including galactooligosaccharides (GOS) and fructooligosaccharides (FOS), increase iron bioavailability and decrease its destructive effect on the intestinal microbiota. In addition, multiple postbiotics, which are probiotic metabolites, including vitamins, short-chain fatty acids (SCFA), and tryptophan, are involved in the regulation of intestinal absorption and may influence iron status in humans. This review presents the actual data from research studies on the influence of probiotics, prebiotics, and postbiotics on the prevention and therapy of IDA and the latest findings regarding their mechanisms of action. A comparison of the latest research data and theories regarding the role of pre-, post-, and probiotics and the mechanism of their action in anemias is also presented and discussed.

Prevention of micronutrient deficiencies in the elderly

&amp;lt;jats:p&amp;gt;The ageing process is characterized by numerous changes in the body that negatively affect the health, lifestyle and diet of the elderly. An adequate and balanced diet plays a vital role in the quality of life of the elderly, including physical, mental and social health. Physiological decline in food intake in the elderly is a risk factor for certain micronutrient deficiencies such as osteoporosis, anaemia and decreased immunity. To prevent these public health diseases, it is suggested to promote the intake of foods of animal origin (offal, meat) to prevent iron and vitamin B group deficiency. An adequate intake of anthocyanidins, fruits and vegetables with blue-purple pigments is recommended for the prevention of anaemia. Adequate intake is also important, i.e. intake of at least two portions of dairy products per day and fish products per week in combination with physical activity can provide adequate intake of calcium and vitamin D for the prevention of osteoporosis. The intake of fresh or minimally processed foods has played a significant role in ensuring an adequate intake of vitamin C, which, in addition to improving iron absorption and preventing anaemia, also affects the proper functioning of the immune system. For the same reason, it is recommended to take vitamin A from offals or beta-carotene from yellow-brown and orange fruits and vegetables. In general, appropriate nutritional interventions can be effective and financially effective forms of preventing and treating micronutrient deficits, thus improving the overall quality of life of the elderly&amp;lt;/jats:p&amp;gt;

Prolyl Hydroxylase Inhibitors: a New Opportunity in Renal and Myocardial Protection.

Hypoxia, via the activity of hypoxia-inducible factors (HIFs), plays a crucial role in fibrosis, inflammation, and oxidative injury, processes which are associated with progression of cardiovascular and kidney diseases. HIFs are key transcription heterodimers consisting of regulatory α-subunits (HIF-1α, HIF-2α, HIF-3α) and a constitutive β-subunit (HIF-β). The stability of HIFs is regulated by the prolyl hydroxylases (PHDs). Specific PHD inhibitors (PHD-i) are being investigated as a therapeutic approach to modulate the cellular signaling pathways and harness the native protective adaptive responses to hypoxia. Selective inhibition of PHD leads to the stabilization of the HIFs, which is the transcriptional gatekeeper of a multitude of genes involved in angiogenesis, energy metabolism, apoptosis, inflammation, and fibrosis. PHD-i downregulate hepcidin, improve iron absorption, and increase the endogenous production of erythropoietin. Furthermore, this pharmacological group has also been proven to ameliorate ischemic injuries in several organs, opening a new and promising field in cardiovascular research.. In this review, we present the basic and clinical potential of PHD-i treatment in different scenarios, such as ischemic heart disease, cardiac hypertrophy and heart failure, and their interplay with other pharmacological agents with proven cardiovascular benefits, such as sodium-glucose cotransporter 2 (SGLT2) inhibitors.

Optimizing iron adequacy and absorption to prevent iron deficiency anemia: The role of combination of fortified iron and vitamin C

Iron is a vital nutrient to promote the availability of tissue oxygen, cell growth and control of differentiation, and energy metabolism. Preventing Iron Deficiency Anemia (IDA) is necessary because iron is vital to central nervous system growth and development especially in the first years of life. Iron-rich complementary foods are recommended in infants around 6 months of age because iron store is depleted. Better understanding of iron absorption process and factors affecting its absorption and bioavailability is necessary to prevent iron deficiency and can be a dietary strategy to mitigate iron deficiency. Meat and iron-fortified food are the main sources of iron in the diet, and it is essential to introduce supplementary food to improve iron absorption. Additional foods such as cereals, cow milk and soybeans such as phytate, polyphenol and calcium are inhibitors which require care to prevent IDA. Ascorbic acid is an effective iron-absorbing enhancer, which is useful to reduce the effects of any known nonheme iron inhibitor. In iron-fortified foods, Combination use of vitamin C (ascorbic acid) is recommended in molar ratio of 2:1 (with cow's milk and low-phytate cereal foods) and higher molar ratio of 4:1 (with higher phytate such as soybeans).

Iron Deficiency in Obesity and after Bariatric Surgery.

Iron deficiency (ID) is particularly frequent in obese patients due to increased circulating levels of acute-phase reactant hepcidin and adiposity-associated inflammation. Inflammation in obese subjects is closely related to ID. It induces reduced iron absorption correlated to the inhibition of duodenal ferroportin expression, parallel to the increased concentrations of hepcidin. Obese subjects often get decreased inflammatory response after bariatric surgery, accompanied by decreased serum hepcidin and therefore improved iron absorption. Bariatric surgery can induce the mitigation or resolution of obesity-associated complications, such as hypertension, insulin resistance, diabetes mellitus, and hyperlipidemia, adjusting many parameters in the metabolism. However, gastric bypass surgery and sleeve gastrectomy can induce malabsorption and may accentuate ID. The present review explores the burden and characteristics of ID and anemia in obese patients after bariatric surgery, accounting for gastric bypass technique (Roux-en-Y gastric bypass—RYGB) and sleeve gastrectomy (SG). After bariatric surgery, obese subjects’ iron status should be monitored, and they should be motivated to use adequate and recommended iron supplementation.

Salivary cystatin SN is a factor predicting iron bioavailability after phytic acid rich meals in female participants

Phytic acid is an inhibitor of iron bioavailability, but it has been suggested that individuals may adapt to phytic acid over time, and that the salivary protein, cystatin SN, may be involved. This study evaluated the relationship between human cystatin SN levels and iron bioavailability after a phytic acid rich meal. Three groups of ten women consumed meals with: (1) 500 mg phytate sprinkles, (2) 500 mg phytate capsules, or (3) no phytic acid. Iron bioavailability was measured by the mealtime percentage of maximum iron recovery; cystatin SN was measured pre-and post-meal by enzyme-linked immunosorbent assay. Pre-to-post meal cystatin SN was positively correlated with improved iron bioavailability in group 1. Pre-to-post meal cystatin SN was correlated with improved iron absorption in groups 1 and 2. Cystatin SN recovery after phytic acid rich meals may be a physiological factor predicting iron bioavailability.

Acute Consumption of Prebiotic Galacto-Oligosaccharides Increases Iron Absorption from Ferrous Fumarate, but not from Ferrous Sulfate and Ferric Pyrophosphate: Stable Iron Isotope Studies in Iron-Depleted Young Women

Although acute consumption of high doses of prebiotic galacto-oligosaccharides (GOS) increases fractional iron absorption (FIA) from ferrous fumarate (FeFum), it is uncertain if low doses of GOS have this effect. Furthermore, whether GOS improve iron absorption from other commonly used iron compounds and whether ascorbic acid (AA) enhances the effect of GOS on iron absorption from FeFum is unclear. In iron-depleted women [serum ferritin (SF) <30μg/L], we assessed: 1) whether the acute enhancing effect of GOS on FeFum is dose dependent; 2) if GOS would affect FIA from ferrous sulfate (FeSO4) or ferric pyrophosphate (FePP); and 3) if AA and GOS given together enhance FIA from FeFum to a greater extent compared with GOS alone. We recruited 46 women (mean age 22.0 y, mean BMI 21.3kg/m2, median SF 17.1μg/L), and measured FIA from 14mg iron labeled with stable isotopes in the following conditions: 1) FIA from FeFum given with 3.5g, 7g GOS, and without GOS; 2) FIA from FeSO4 and FePP given with and without 15g GOS; and 3) FIA from FeFum given with 7g GOS with and without 93mg AA. FIA was measured as erythrocyte incorporation of stable isotopes after 14 d. Comparisons were made using paired samples t-test or Wilcoxon rank sum test where appropriate. Giving 7g of GOS significantly increased FIA from FeFum (+26%; P=0.039), whereas 3.5g GOS did not (P=0.130). GOS did not significantly increase FIA from FeSO4 (P=0.998) or FePP (P=0.059). FIA from FeFum given with GOS and AA was significantly higher compared with FeFum given with GOS alone (+30%; P <0.001). In iron-depleted women, GOS does not increase FIA from FeSO4 or FePP, but it increases FIA from FeFum. Thus, a combination of FeFum and GOS may be a well-absorbed formula for iron supplements. The study was registered at clinicaltrials.gov as NCT03762148.

Optimization of the Red Tilapia (Oreochromis spp.) Viscera Hydrolysis for Obtaining Iron-Binding Peptides and Evaluation of In Vitro Iron Bioavailability.

Iron deficiencies continue to cause significant health problems in vulnerable populations. A good strategy to combat mineral deficiency includes fortification with iron-binding peptides. This research aims to determine the optimal conditions to hydrolyze red tilapia viscera (RTV) using Alcalase 2.4 L and recovery of iron-binding protein hydrolysate. The result showed that under the optimal hydrolysis condition including pH 10, 60 °C, E/S ratio of 0.306 U/g protein, and substrate concentration of 8 g protein/L, the obtained hydrolysate with 42.5% degree of hydrolysis (RTVH-B), displayed the maximal iron-binding capacity of 67.1 ± 1.9%. Peptide fractionation was performed using ultrafiltration and the <1 kDa fraction (FRTVH-V) expressed the highest iron-binding capacity of 95.8 ± 1.5%. Iron content of RTVH-B and its fraction was assessed, whereas iron uptake was measured indirectly as ferritin synthesis in a Caco-2 cell model and the result showed that bioavailability of bound minerals from protein complexes was significantly higher (p < 0.05) than iron salt in its free form, increased 4.7 times for the Fe2+–RTVH-B complex. This research suggests a potential application of RTVH-B as dietary supplements to improve iron absorption.

Antarctic krill derived peptide as a nanocarrier of iron through the gastrointestinal tract

Antarctic krill (Euphausia superba) might have specific peptides that chelate iron ions and are iron carriers. In this study, iron-binding peptides were isolated from Antarctic krill using enzymatic (trypsin) hydrolysis and immobilized metal affinity chromatography (IMAC); the binding mode and surface morphology of Antarctic krill peptides (AKP)-iron complexes as well as their iron delivery behavior in the gastrointestinal tract were investigated. Results showed that the AKP bound 79.3% of available iron from the enzymatic hydrolysis for 180 min. The contents of negatively-charged amino acids (Asp and Glu) on the AKP showed a positive correlation (r = 0.80) with iron-binding activities (the data includes Asn and Gln), while positively-charged amino acids showed a negative correlation (r = −0.83). Moreover, His, Ser and Thr on the AKP were also involved in the iron-binding activities. Iron-binding peptides from Antarctic krill hydrolysates, isolated using IMAC-Fe3+ and identified using HPLC-MS/MS, showed a mass of 712–2451 Da, and were enriched in Asp (Asn), Glu (Gln), His, Ser or Thr. The iron ions mainly bound to carboxyl groups of AKP, thus forming nano-scale, spherical particles. The iron nanocarriers formed by AKP showed a significant iron transport activity after simulated gastrointestinal digestion, as compared to FeSO4 (P < 0.05). The results suggested that the AKP-iron nanocomposite has the potential to be a nutraceutical supplement for improving iron absorption.

Biological Effect of some Herbs in Improvement of Anemia in Rats

The potential health benefits of Safforn (Crocus sativus), Ginger (zingiber officinale) andCumin (Cuminumcyminum ) powder as functional food supplement to improve iron absorption as well as to treat anemia associated with deficiency in iron intake were evaluated in rats. Four experimental groups were fed on diet supplemented with 5% of tested herbs and 1%iron gluconate for 4 week versus the control rats group fed on basal diet free in iron as positive control group and the group fed on basal diet as negative control.At the end of the experiment, rat groups fed herbs supplemented diets were characterized by the level of serum iron, measured levels of hemoglobin, hematocrit and ferritin. Liver functions was assessed by estimation of plasma concentration of enzymes activities of aspartate amino transferase (AST), alanine amino transferase (ALT), uric acid, creatinine, MDA level, GSH and GSSG activity.Results showed significant increasing in the level of serum iron, in addition, there were variable increases in the measured levels of hemoglobin, hematocrit and ferritin in herbs fed groups as compared with the positive control group. In addition, there was an improvement in case of tested herbs at the level of 5% for the above parameters as compared to positive control group. These data suggested that saffron followed by ginger, herbs mixtures andcumin powder could improve tested parameters and iron bioavailability when incorporated in daily diets and therefore, could be considered as a very effective food supplement to prevent and treat anemia.

Food protein-derived iron-chelating peptides: The binding mode and promotive effects of iron bioavailability.

Iron is known as an essential nutrient in the human body. Insufficient iron uptake is easy to result in iron deficiency anemia, which is a public health problem in both developing and developed countries. Iron, complexed by iron-chelating peptides, have been proposed as a superior candidate to ionized iron for improving iron absorption and bioavailability. Nowadays, as more and more iron-chelating peptides are identified from different food sources, the iron-peptide binding mode attracts much attention. Meanwhile, many studies have been conducted on the iron-chelating peptides to make clear their iron bioavailability enhancement potential. The aim of this review is to provide an overview of research progress in food protein-derived iron-chelating peptides. The review would be of particular value for iron-peptide complexes as functional ingredients or iron supplements.

A Systematic Review and Meta-Analysis on the Effects of Probiotic Species on Iron Absorption and Iron Status.

Background: Strategies to prevent iron deficiency anemia (IDA) have varying effectiveness. The purpose of this systematic review of the literature and meta-analysis was to examine the effects of probiotics on iron absorption and iron status-related markers in humans. Methods: We followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) reporting guidelines. Relevant articles were identified from Embase, Pubmed, Scopus, and CINAHL from inception to February, 2019. We conducted a meta-analysis for eight studies examining the effect of the probiotic Lactobacillus plantarum 299v (Lp299v) on iron absorption. Results: Fifteen studies reported in 12 articles were identified (N = 950). Our meta-analysis of eight studies using a random-effects model demonstrated a significant increase in iron absorption following administration of the probiotic Lp299v with a pooled standardized mean difference (an average intervention effect size) of 0.55 (95% CI 0.22–0.88, p = 0.001). Of the seven randomized clinical trials (RCTs) and nonrandomized clinical trials examining a range of probiotic species on iron status, only one study supplementing with Lp299v showed improvement in serum iron; no other studies reported improvement in iron status-related indices with probiotic treatment. Conclusions: Lp299v significantly improved iron absorption in humans. Future research should include the assessment of Lp299v effect on iron absorption and iron status in populations at high risk of IDA, including pregnant women.

1754 Plummer-Vinson Syndrome: A Time for a Redefinition and New Perspective

INTRODUCTION: Plummer-Vinson syndrome (PVS), or Kelly-Patterson syndrome, is a rare condition defined by the classic triad of dysphagia, iron-deficiency anemia, and esophageal webs, and dominated by Caucasian females. The pathophysiology remains unknown although iron deficiency is one theory as well as part of an autoimmune spectrum. We present two patients seen recently meeting criteria for PVS in whom new observations were made. CASE DESCRIPTION/METHODS: A 46-year-old Hispanic female with history of hypothyroidism presented with a Hgb of 3 and a ferritin of 16. She reported 2 weeks of fatigue, dyspnea, and constipation without overt bleeding, preceded by several months of dysphagia to solids. She was severely hypothyroid and placed on IV levothyroxine. Barium swallow suggested an esophageal web in the upper esophagus. At esophagogastroduodenoscopy (EGD) both adult and neonatal scopes could not be passed through a tight stenosis at the cricopharyngeus (Figure 1). This was dilated with Savary dilators to 8 mm. She was discharged home on iron supplements and follow up EGD with dilations scheduled. A 55-year-old Hispanic female with history of lupus, a positive ANA, Raynaud's, prior partial thyroidectomy, and chronic anemia was referred to GI clinic for evaluation of chronic dysphagia which had required multiple dilations at an outside facility over the past 18 months without improvement. She had a hgb of 6.7 with iron deficiency without any overt GI bleeding. EGD was performed and showed two benign appearing areas of intrinsic stenosis 15 and 20 cm from the incisors that were smooth and not ulcerated and could not be passed with the adult or pediatric endoscopes (Figure 2). Savary dilators were used to dilate to 11 mm diameter. Patient was placed on iron replacement and a fo llow up EGD was scheduled. DISCUSSION: Why PVS is only in females with accompanying iron deficiency anemia and a personal/family history of autoimmune phenomena and now is decreasing in recognition are not clear. The resolution of dysphagia with iron supplementation, could also be explained by the accompanying esophageal dilations restoring oral intake and hence improving iron absorption. Our cases highlight that PVS: 1) is not a true “esophageal web” but rather a tight fibrotic stricture at the level of the upper esophageal sphincter requiring aggressive dilation approach 2) occurs also in Hispanic females presenting with iron deficiency, dysphagia, and an autoimmune picture.

Is Body Mass Index a potential biomarker for anemia in obese adolescents?

The two paradoxical major health problems namely obesity and anemia are confirmed to affect millions around the world. Hepcidin, a protein synthesized in liver is a negative iron binding regulator. There is an affirmative relation between hepcidin and leptin levels and an inverse co-relation between hepcidin and iron status due to inflammation mediated by obesity in adolescents. So this implicates an alliance between anemia and obesity wherein weight reduction can be a powerful medium to improve iron absorption in obese adolescents. Also the Body Mass Index can serve as a preliminary non-invasive screening tool to identify potential adolescents prone to anemia.