Iron-deficient Group Research Articles

Effect of Fruit/Vegetable Drink from Potato Skin Water Extract, Beetroots and Fruit Juice Combinations on Iron Bioavailability in Iron Deficient Rats

Iron deficiency anemia is common and major health problems. Therefore it is a concern in all developing and industrialized countries. This study was aimed to investigate the effect of potato skin water extract, beetroots and fruit fresh juice (Orange, strawberry, guava and pomegranate) combinations on iron availability in iron deficiency of rats. Sprague-Dawley rats were randomly divided into seven equal groups: Group1:Normal group: (received basal diet); Group2: Iron deficient group through iron-deficiency; Group3: Iron deficient group treated with iron supplement; Group4: Iron deficient group treated with iron supplement with potato strawberry drink; G5: Iron deficient group treated with iron supplement with potato orange drink; G6: Iron deficient group treated with iron supplement with potato Guava drink; G7: Iron deficient group treated with iron supplement with potato/pomegranate drink. Fe, Cu, folate and vitamin C were determined in drinks. Hemoglobin, hematocrit, Fe was assessed in serum and liver, total iron binding capacity, ferritin, cholesterol, triglycerides, High density lipoprotein, Low denesty lipoprotein, Triiodothyronine, Thyroxine, Total Antioxidant Capacity and Total Oxidant Capacity were estimated in serum. Results indicated that the combinations of potato water extract and fruit juice were more effective than supplement alone for improving Fe in serum and liver Hemoglobin, hematocrit haematocrit, Fe was assessed in serum and liver., total iron binding capacity, ferritin, cholesterol, triglycerides, Low denesty lipoprotein, Triiodothyronine, Thyroxine, Total Antioxidant Capacity and Total Oxidant Capacity. Potato/orange treatment showed the highest hemoglobin level (13.55±0.15 g%); however Potato/strawberry was the effective in Fe elevation (15.78±0.35 µmol/l), ferritin (84.13±1.46 ng/ml) and lowering of the UIBC (55.79±1.51 µmol/l). The findings suggest that the combination of potato skinwater extract and fruit juices is an effective treatment with iron supplement for Iron Deficiency Anemic rats.

Clinical and instrumental characteristics, clinical prognosis in patients with chronic heart failure and reduced left ventricular ejection fraction, depending on the presence and nature of the iron deficiency state

The aim – to compare patients with chronic heart failure and reduced left ventricular ejection fraction (LVEF) with absolute and functional iron deficiency (ID) state according to the main clinical, hemodynamic, laboratory parameters and clinical prognosis indicators. Material and methods. In January – February, 2018, 128 stable patients with chronic heart failure (111 of men and 17 of women), 18–75 years old, NYHA class II–IV, with left ventricular ejection fraction < 40 % were screened. Patients were included in a clinical compensation phase. Quality of life was assessed by the Minnesota living with heart failure questionnaire (MLHFQ), physical activity was estimated by the Duke University index, functional status – by assessing the 6-minute walking test and a standardized lower limb extension test.Results. ID was observed in 61 % of patients, 65 % had absolute ID. Patients with both types of ID were in higher functional class, had a poorer quality of life and worse clinical and laboratory indices than patients without ID. Regardless of the difference in the functional and absolute ID formation mechanisms, no significant distinctions in the clinical and functional parameters, quality of life, as well as the parameters of intracardiac hemodynamics were found. Contrary to expectations, elevated levels of hepcidin were not detected in patients with functional ID compared to the absolute ID group. The reliable differences in survival/hospitalization rate between patients without ID and both groups of patients with ID allow us to recommend the screening of iron deficiency in all patients with chronic heart failure and reduced LVEF.Conclusions. ID is found in 61 % patients. Functional ID was found in 27 patients (21 %), absolute ID – in 51 patients (39.6 %). There were no differences between groups of patients with absolute and functional ID by age, functional class, LVEF, percentage of aneamic patients, 6-minute walking distance, thigh quadriceps endurance, quality of life, physical activity index, NT-proBNP, citrulline and hepcidin levels. Compared to patients with absolute ID, patients with functional ID had higher levels of hemoglobin, MCV, MCH, interleukin-6. Presence of both ID types was associated with worse survival and more frequent hospitalization.

Correction: Iron deficiency associates with deterioration in several symptoms independently from hemoglobin level among chronic hemodialysis patients.

[This corrects the article DOI: 10.1371/journal.pone.0201662.].

Reticulocyte hemoglobin content as an early predictive biomarker of brain iron deficiency.

Fetal and neonatal brain iron content is compromised at the time of anemia, suggesting that screening for iron deficiency by measuring hemoglobin is inadequate to protect the brain. Reticulocyte hemoglobin (Ret-He) reflects iron-deficient (ID) erythropoiesis prior to anemia. At postnatal day (P), 10 and 20 iron-sufficient rat pups were fostered to ID dams to produce a postnatal ID (PNID) group, which was compared to 20 iron-sufficient (IS) pups fostered by IS dams. Pups were assessed from P13 to P15 for hemoglobin, hematocrit, reticulocyte count, and Ret-He. Hippocampal iron status was assessed by transferrin receptor-1 (Tfrc-1) and divalent metal transporter-1 (Slc11a2) mRNA expression. At P13, brain iron status was similar between groups; only Ret-He was lower in the PNID group. At P14, the PNID group had lower Ret-He, hematocrit, mean corpuscular volume (MCV), and reticulocyte percentage (RET%). Tfrc-1 expression was increased, consistent with brain iron deficiency. Both Ret-He and MCV correlated with brain iron status at P14 and P15. Ret-He was the only red cell marker affected prior to the onset of brain ID. The clinical practice of using anemia as the preferred biomarker for diagnosis of iron deficiency may need reconsidering.

Iron deficiency associates with deterioration in several symptoms independently from hemoglobin level among chronic hemodialysis patients

BackgroundWhile iron deficiency (ID) is a frequent cause of anemia in hemodialysis patients, the clinical impact of ID without anemic level of hemoglobin remains unclear. As such, this study was designed to clarify the manifestations of ID itself in subjects on hemodialysis.MethodsMaintenance hemodialysis patients achieving target hemoglobin levels (≥ 10.0g/dL) under treatment in our clinic were stratified for comparison from three perspectives: ID (transferrin saturation [TSAT] < 20% or ferritin < 100ng/mL) vs non-ID, level of TSAT (< or ≥ 20%), and level of serum ferritin concentration (< or ≥ 100ng/mL). The severity of frequent symptoms was determined by a self-rating symptom score questionnaire, and the rate of those with severe manifestations was calculated for each symptom. Significant difference was examined between groups; univariate and adjusted multivariate odds ratios and 95% confidence intervals were obtained by logistic regression.ResultsAmong 154 subjects selected for analysis, the ratio of severe arthralgia and fatigue was significantly higher in the ID group (n = 94) compared to the non-ID group (n = 60), in both univariate and adjusted multivariate analyses. Moreover, in multivariate analysis, low TSAT was significantly associated with exacerbation of pain during vascular access puncture and intradialytic leg cramps, while low serum ferritin concentration was related to significant increase in severe arthralgia, fatigue, intradialytic headache and leg cramps.ConclusionsID was identified as a risk factor regarding severity of several symptoms even without low hemoglobin level among chronic hemodialysis patients, and supplementation of iron was considered efficacious for improving critical symptoms affecting those undergoing maintenance dialysis.

Effect of iron metabolism of preoperation on the length of intensive care unit stay in liver transplant recipients

To evaluate the effect of iron metabolism of preoperation on the length of intensive care unit (ICU) stay in liver transplant recipients. A retrospective study was conducted. 120 adult liver transplant recipients admitted to Tianjin First Central Hospital from September 2015 to September 2017 were enrolled. The basic data, model of end-stage liver disease (MELD) evaluation system score at admission; iron metabolism index, routine blood test, blood biochemistry, coagulation time and C-reactive protein (CRP) level within 24 hours after admission; intraoperative clinical indicators such as operation time, operation bleeding volume, red blood cells and fresh frozen plasma input volume, hot ischemia time, cold ischemia time, urine volume; and the length of ICU stay were collected. All patients were divided into iron deficiency group (ID group; serum ferritin < 100 μg/L, or serum ferritin 100-300 μg/L and transferrin saturation < 0.20) and non-iron deficiency group (non-ID group; serum ferritin > 300 μg/L, or serum ferritin 100-300 μg/L and transferrin saturation > 0.20) according iron deficiency standard. The indexes of iron metabolism, basic data and clinical indicators of two groups were compared. The correlation between serum ferritin level and the length of ICU stay was analyzed by Pearson correlation. Compared with non-ID group, the levels of serum iron concentration and serum ferritin were significantly decreased in ID group [serum iron concentration (μmol/L): 3.50±1.62 vs. 14.50±2.31, serum ferritin (μg/L): 67.00±31.54 vs. 315.00±36.73, both P < 0.01], infusion volume of intraoperative red blood cells and fresh frozen plasma were significantly increased, and the length of ICU stay was significantly prolonged (days: 6.5±2.4 vs. 3.3±0.5, P < 0.01). There was no significant difference in transferrin saturation, CRP and other clinical indicators between the two groups. Correlation analysis showed that serum ferritin level was negative correlated with the length of ICU stay (r = -0.768, P < 0.001). Preoperative iron deficiency in liver transplant recipients will lead to increased blood transfusion and prolonged length of ICU stays.

Clinical, demographic and instrumental characteristics of patients with chronic heart failure and reduced left ventricular ejection fraction depending on iron deficiency

The aim — to establish clinical and other factors associated with iron deficiency (ID) in patients with chronic heart failure (CHF) and reduced left ventricular (LV) ejection fraction (EF).Materials and methods. 134 stable patients with CHF (113 (84.3 %) men and 21 (15.7 %) women), 18 — 75 years old, NYHA class II — IV, with left ventricular ejection fraction &lt; 40 % were screened on a basis of the Heart Failure Department of the National Scientific Center «M. D. Strazhesko Institute of Cardiology» of NAMS of Ukraine in the period from January 13, 2016 till February 28, 2018. Patients were included in a clinical compensation phase. Quality of life was assessed by the Minnesota living with heart failure questionnaire (MLHFQ), physical activity was estimated by the Duke University index, functional status — by assessing the 6­minute walking test (6MWT) and a standardized lower limb extension test.Results and discussion. ID was found in 83 (61.9 %) of 134 patients with CHF and reduced LVEF. They did not differ in regard of presence of coronary artery disease, arterial hypertension, dilated cardiomyopathy, myocardial infarction, persistent/long standing form of atrial fibrillation, chronic obstructive pulmonary disease and diabetes mellitus. There were no significant differences in demographic, clinical and instrumental indices such as gender, age, heart rate, end­diastolic volume index, brachial artery flow­dependent vasodilation in groups with and without ID. However, patients with ID were in more severe (III — IV) NYHA class and inclined to have anemia and worse renal dysfunction. The ID group was characterized by a slightly lower body mass index (BMI) and level of systolic blood pressure (SBP), a higher N­terminal prohormone of brain natriuretic peptide (NTproBNP) level, a lower hemoglobin, lower MCV, MCH, a higher interleukin­6 (IL­6) level, and a lower glomerular filtration rate, as well as a worse quality of life by MLHFQ, worse 6MWT and lower limb extension test results. Ferritin has shown a significant direct correlation with serum iron levels, MCV, MCH, hemoglobin and BMI levels. Transferrin saturation (TSAT) level directly correlated with a serum iron level, hemoglobin, MCV and MCH levels, limb muscles endurance, 6­minute walking test result, SBP, BMI, physical activity index and reversely correlated with citrulline, NTproBNP, IL­6 levels in blood plasma and MLHFQ score.Conclusions. Iron deficiency was observed in 62 % of patients with CHF and reduced LVEF. CHF patients with reduced LVEF and ID versus CHF patients with reduced LVEF without ID had a higher NYHA III — IV class patients percentage, a greater proportion of patients with anemia and greater renal dysfunction, lower BMI, SBP, lower hemoglobin, MCV, MCH; higher NTproBNP, IL­6, citrulline levels; worse quality of life, lower physical activity index, lesser 6MWT distance and lesser quadriceps femoris muscle endurance. Unlike the ferritin plasma level, that correlates only with hemoglobin level and iron metabolism indices, TSAT showed the connection not only with the indicated parameters, but also with the BMI, SBP, physical activity index, 6MWT, quadriceps femoris muscle endurance (direct correlation) and with citrulline, IL­6, NTproBNP plasma levels and quality of life by MLHFQ (reverse correlation).

The impact of erythropoietin and iron status on brain myelination in the newborn rat

Erythropoietin (Epo) drives iron (Fe) utilization for erythropoiesis, but the potentially resultant tissue iron deficiency (ID) can also impede brain development. Conversely, Epo binds to Epo receptors (EpoR) on immature brain oligodendrocytes and neurons, promoting growth and differentiation. The objective of the study was to examine the interaction between Epo and Fe on myelination in brain development during daily Epo treatment. Male and female Sprague-Dawley rats from postnatal day (P) P4-P12 modeled premature newborns. Dam-fed Fe-sufficient (IS) or postnatal ID groups were given daily subcutaneous sham or erythropoietic Epo injections (425 U. kg-1. d-1 ), ± oral Fe (6 mg. kg-1. d-1 ). Tissues and blood were collected and studied at P12. Epo in the ID groups, in the absence of oral Fe, stimulated microcytic ID anemia along with raising inflammatory markers. Both the microcytic anemia and inflammation improved in the ID + Epo + Fe group. Fe treatment positively impacted erythropoiesis and body Fe (µg/g) in all groups. Relative brain Fe (µg/g rat) was improved in the IS + Epo + Fe group. Brain Fe was not worsened in +Epo groups. Brain weight and brain Fe were related to plasma Epo levels. Amount of myelination was impacted by feeding type, but was not inhibited by Epo. Expression of a protein in myelin, mylein basic protein, was greater in all +Fe groups than -Fe groups. With therapeutic Epo, available body Fe was prioritized for erythropoiesis instead of brain, but Epo did not worsen brain Fe and potentially Epo improved myelination and maturation in the brain.

Causes of microcytic anaemia and evaluation of conventional laboratory parameters in the differentiation of erythrocytic microcytosis in blood donors candidates

ABSTRACT Context and Objective: Microcytic anaemia results from defective synthesis of haemoglobin in the erythroid precursors, causing a reduction in its mean corpuscular volume (MCV). The most common causes of microcytosis, without the increase in HbA2 levels, are iron deficiency anaemia (IDA) and α-thalassemia. The aim of this study was to identify the causes of microcytic anaemia and evaluate the haematological parameters from blood donors deemed ineligible (due to the low haematocrit level) that would differentiate the IDA and α-thal, whether isolated or in association. Methods: Genomic DNA was submitted to the polymerase chain reaction multiplex for the diagnosis of the most common allele deletions of α-thal and erythrogram and in order to verify haematological parameters. Iron deficiency (ID) was determined through the measurement of serum ferritin. Results: Of the 204 samples, 82 (40.2%) were identified with ID, 24 (17.8%) with α-thal and 10 (4.9%) with ID associated with α-thal. In the α-thal with ID group haemoglobin (Hb), MCV, mean corpuscular Hb concentration (MCHC) and mean corpuscular Hb (MCH) values were significantly lower compared to the isolated α-thal. In the group with ID Hb, MCV, MCHC and MCH values were significantly lower compared to those with isolated α-thal. The α-thal with ID group, showed Hb, MCV, MCHC and MCH significantly reduced when compared to those with IDA. Conclusions: This study showed that the values of haematological parameters, especially haematocrit, Hb, MCV, MCH, MCHC and red blood cell distribution width (RDW), are lower in patients with IDA, especially when associated with α-thal and therefore it may be useful to discriminate between the different types of microcytic anaemia.

Daño oxidativo en lípidos del sistea nervioso central y bazo de ratones con deficiencia de Hierro

El estrés oxidativo (EO) es factor de riesgo en trastornos neurodegenerativos. Las concentraciones de hierro se han relacionado al EO; sin embargo, el efecto de la deficiencia de hierro (DH) en la inducción de EO en el Sistema Nervioso Central (SNC) es desconocido. Se empleó un modelo murino consistente de 6 machos BALB/c de dos meses de edad para DH crónica inducida por dieta, para determinar su papel en la inducción de EO. La peroxidación lipídica se determinó midiendo especies reactivas al ácido tiobarbitúrico (TBARS) en el SNC de ratones de 2 meses de edad, usando el bazo para comparación. Se encontró una disminución en productos de peroxidación en el SNC DH, comparado con controles alimentados con dieta normal. El bazo mostró un aumento significativo de la peroxidación lipídica en el grupo DH. Los resultados sugieren que la DH crónica puede tener efectos diferenciales en el SNC y tejidos periféricos. Una cantidad reducida de especies reactivas de oxigeno en estado basal podría estar relacionada con alteraciones en el metabolismo y funcionamiento normal del SNC bajo condiciones de DH crónica.

Should sex differences be considered when applying mathematical indices and formulas for discriminating β- thalassemia minor from iron deficiency?

Backgroundβ-thalassemia minor (BTM) and iron deficiency (ID) are common disorders characterized by microcytosis and/or hypochromasia, leading to a challenge in their discrimination during mass-screening programs especially in developing countries where resources are limited. It has been shown with varying reliability that quick exclusion of either disorder could be achieved mathematically using RBC-based indices and formulas. However, none of these proposed indices and formulas considered the sex-based hematological differences. This comparative retrospective study examined the efficacy of using sex-based RBC indices in the mathematical discrimination BTM and ID in adult males and females. MethodsThe CBC of randomly selected eight hundred adults diagnosed with BTM or ID (200M & 200F BTM, and 200M & 200F ID) were used in the comparisons. The discrimination power, in terms of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and Youden index were calculated for all subjects and separately for males and females for 20 mathematical indices and formulas. ResultsData revealed significant differences in the RBC-based indices between males and females for both BTM and ID groups. Significant variation in reliability indicators for the different indices and formulas were discovered between males and females samples. ConclusionSex-based indices and formulas are necessary to improve the reliability in mathematically discriminating between BTM and ID in mass screening programs. We also advocate for a large–scale multicenter study to establish the parameters of such indices and formulas with sex and age.

The Association between Iron and Vitamin D Status in Female Elite Athletes.

Vitamin D may influence iron metabolism and erythropoiesis, whereas iron is essential for vitamin D synthesis. We examined whether vitamin D deficiencies (VDD) are associated with reduced iron status and whether progressive iron deficiency (ID) is accompanied by inferior vitamin D status. The study included 219 healthy female (14–34 years old) athletes. VDD was defined as a 25(OH)D concentration < 75 nmol/L. ID was classified based on ferritin, soluble transferrin receptor (sTfR), total iron binding capacity (TIBC) and blood morphology indices. The percentage of ID subjects was higher (32%) in the VDD group than in the 25(OH)D sufficient group (11%) (χ2 = 10.6; p = 0.001). The percentage of VDD subjects was higher (75%) in the ID than in the normal iron status group (48%) (χ2 = 15.6; p = 0.001). The odds ratios (ORs) for VDD increased from 1.75 (95% CI 1.02–2.99; p = 0.040) to 4.6 (95% CI 1.81–11.65; p = 0.001) with progressing iron deficiency. ID was dependent on VDD in both VDD groups (25(OH)D < 75 and < 50 nmol/L). The ID group had a lower 25(OH)D concentration (p = 0.000). The VDD group had lower ferritin (p = 0.043) and iron (p = 0.004) concentrations and higher values of TIBC (p = 0.016) and sTfR (p = 0.001). The current results confirm the association between vitamin D and iron status in female athletes, although it is difficult to assess exactly which of these nutrients exerts a stronger influence over the other.

Prevalence of Occult Celiac Disease in Females with Iron Deficiency in the United States: An Nhanes Analysis.

Aim:The prevalence of celiac disease in patients with iron deficiency (ID) in the United States is unknown. Estimating the prevalence of Celiac disease (CD) in patients with ID could help to determine the need to screen these patients for occult CD. In 2017, the United States Preventive Services Task Force stated that the current evidence is inadequate to assess the balance of benefits and harms of screening for CD in asymptomatic persons. Also, there are no current guidelines to advise physicians regarding the screening of patients with iron deficiency for occult CD.Methods:Data were obtained from the National Health and Nutrition Examination Survey (NHANES) database, a nationally representative health survey conducted from 2009 to 2010. We included 2,105 females aged 6 years or older. Iron deficiency was defined as serum ferritin level <20 ng/ml, and patients were considered positive for celiac disease when positive for both immunoglobulin A tissue transglutaminase antibody (IgA Ttga) and IgA endomysial antibody (IgA EMA). Subjects with Iron deficiency were divided into two groups (ID and Non-ID). The association of CD and ID, i.e., the primary outcome, was obtained after adjusting other covariates using logistic regression.Results:The mean age of our study population was 29.7 years; 28.0 years in the ID group and 30.3 in the non-ID group (p<0.001). Non-Hispanic whites constituted 41%of the total study sample. The demographic characteristics of the study population are shown in table 1.There were 569 (27%) females who had ID and 1536 (73%) who did not have ID. The overall prevalence of CD in the study population was 0.33% (7/2105). The prevalence of CD in ID females was 0.9% (5/569), and the prevalence of CD in non-ID females was 0.1% (2/1536) with an odds ratio (OR) of 6.79 (95% confidence interval, 1.31-35.2). After adjusting for selected covariates, the prevalence of CD was higher in female subjects with ID with OR of 12.5 (95% CI 1.74-90). Although these results showed that CD did increase the risk of having ID in females, it did not show any difference in hemoglobin between celiac positive and celiac negative females with an odds ratio of 1.75 (95% CI 0.61-5.05).DiscussionIn this study, one in 113 iron-deficient females met the criteria for the diagnosis of occult CD compared to one in 676 non-iron deficient females. So, screening for occult CD could help in diagnosing the cause of ID and subsequently help in treatment. Celiac serology offers a non-invasive test to detect gluten hypersensitivity in females with ID. There is no study looking into the downside of screening for CD in asymptomatic people. However, potential disadvantages of CD screening may include increased anxiety, over-diagnosis, unnecessary serologic tests and increased need for unnecessary endoscopies with biopsy.The strength of this study is that it includes a representative sample from a national database, which was adjusted for minority groups. However, this study also had several limitations. The number of cases of CD was very small due to the relatively low prevalence of CD in the United States (0.71%). Another limitation was our criteria for the diagnosis of CD based on serology only without histological confirmation, as a duodenal biopsy is an invasive test difficult to perform in a population-based study. However, this limitation is partially balanced by the sequential serological testing of IgA EMA in IgA tTGA positive individuals. Another potential limitation is that patients with IgA deficiency were missed by the study as IgA deficiency was not tested.Conclusions:Although the overall prevalence of celiac disease in the United States is low in the female population, the prevalence is higher in subjects with Iron deficiency. We suggest that CD testing should be considered in patients with refractory ID when other obvious causes have been ruled out. Further prospective studies are needed to validate this finding. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Postoperative outcomes following cardiac surgery in non-anaemic iron-replete and iron-deficient patients - an exploratory study.

Iron deficiency anaemia is strongly associated with poor outcomes after cardiac surgery. However, pre-operative non-anaemic iron deficiency (a probable anaemia precursor) has not been comprehensively examined in patients undergoing cardiac surgery, despite biological plausibility and evidence from other patient populations of negative effect on outcome. This exploratory retrospective cohort study aimed to compare an iron-deficient group of patients undergoing cardiac surgery with an iron-replete group. Consecutive non-anaemic patients undergoing elective coronary artery bypass grafting or single valve replacement in our institution between January 2013 and December 2015 were considered for inclusion. Data from a total of 277 patients were analysed, and were categorised by iron status and blood haemoglobin concentration into iron-deficient (n = 109) and iron-replete (n = 168) groups. Compared with the iron-replete group, patients in the iron-deficient group were more likely to be female (43% vs. 12%, iron-replete, respectively); older, mean (SD) age 64.4 (9.7) vs. 63.2 (10.3) years; and to have a higher pre-operative EuroSCORE (median IQR [range]) 3 (2-5 [0-10]) vs. 3 (2-4 [0-9]), with a lower preoperative haemoglobin of 141.6 (11.6) vs. 148.3 (11.7) g.l-1 . Univariate analysis suggested that iron-deficient patients had a longer hospital length of stay (7 (6-9 [2-40]) vs. 7 (5-8 [4-23]) days; p = 0.013) and fewer days alive and out of hospital at postoperative day 90 (83 (80-84 [0-87]) vs. 83 (81-85 [34-86]), p = 0.009). There was no evidence of an association between iron deficiency and either lower nadir haemoglobin or higher requirement for blood products during inpatient stay. After adjusting the model for pre-operative age, sex, renal function, EuroSCORE and haemoglobin, the mean increase in hospital length of stay in the iron-deficient group relative to the iron-replete group was 0.86 days (bootstrapped 95%CI -0.37 to 2.22, p = 0.098). This exploratory study suggests there is weak evidence of an association between non-anaemic iron deficiency and outcome after cardiac surgery after controlling for potentially confounding variables.

Prevalence of occult celiac disease in females with iron deficiency in the United States: an NHANES analysis

ABSTRACTAim: The prevalence of celiac disease (CD) in patients with iron deficiency (ID) is estimated at 0–6% in European countries. The prevalence of celiac disease in patients with iron deficiency in the USA is unknown. Given the treatable nature of gluten hypersensitivity, estimating the prevalence of CD in patients with ID can help to determine the need to screen these patients for occult CD.Methods: Data were obtained from the NHANES database, a nationally representative health survey conducted from 2009 to 2010. We included 2,105 females aged 6 years or older. Iron deficiency was defined as serum ferritin level <20 ng/ml and considered positive for celiac disease when subjects were tested positive for both immunoglobulin A (IgA) tissue transglutaminase antibody and IgA endomysial antibody. Subjects were divided between two groups (ID and non-ID). The association of CD and ID, which was the primary outcome, was obtained after adjusting for other covariates using logistic regression.Results: Among the sample of 2,105 subjects, 569 had ID and 1536 did not have ID. Five people were identified as having CD among the ID group, as were two people in the non-ID group. After adjusting for selected covariates, the prevalence of CD was higher in female subjects with ID with OR of 12.5 (95% CI 1.74–90).Conclusions: The overall prevalence of celiac disease in the USA’ female population is low, however, the prevalence is higher in subjects with iron deficiency. Further prospective studies are needed to validate our findings.

Timing, duration, and severity of iron deficiency in early development and motor outcomes at 9 months.

BACKGROUND/OBJECTIVESPoorer motor development is reported in infants with iron deficiency (ID). The role of timing, duration and severity is unclear. We assessed relations between ID timing, duration, and severity and gross motor scores, neurological integrity, and motor behavior quality at 9 months.METHODSIron status was determined at birth and 9 months in otherwise healthy term Chinese infants. The 9-month motor evaluation included the Peabody Developmental Motor Scale (PDMS-2), Infant Neurological International Battery (INFANIB), and motor quality factor. Motor outcomes were analyzed by ID timing (fetal-neonatal, infancy), duration, and severity. For severity, we also considered maternal iron status.RESULTSData were available for 1194 infants. Iron status was classified as fetal-neonatal and infancy ID (n=253), fetal-neonatal ID (n=256), infancy ID (n=288), and not ID (n=397). Compared with not ID, infants with fetal-neonatal or infancy ID had lower locomotion scores (effect size ds=0.19, 0.18) and those with ID in both periods (longer duration) had lower locomotion and overall PDMS-2 gross motor scores (ds=0.20, 0.18); ID groups did not differ. More severe ID in late pregnancy was associated with lower INFANIB Vestibular function (p=0.01), and total score (p=0.03). More severe ID in infancy was associated with lower scores for locomotion (p=0.03), overall gross motor (p=0.05).CONCLUSIONSFetal-neonatal and/or infancy ID was associated with lower overall gross motor development and locomotion test scores at 9 months. Associations with ID severity varied by ID timing: more severe ID in late pregnancy, poorer neurological integrity; more severe ID in infancy, poorer gross motor development.

Iron Deficiency Anemia, Not Iron Deficiency, Is Associated with Reduced Attention in Healthy Young Women.

Women of reproductive age are at increased risk for iron deficiency (ID) and iron deficiency anemia (IDA), with both implicated in decreased cognitive function (CF). Obesity may complicate this association via inflammatory-mediated ferritin elevation. This cross-sectional study examined the association between hematological iron status (iron replete (IR), ID or IDA) and CF in healthy, young (18–35 years) women of normal-weight (NW: BMI 18.5– 24.9 kg/m2) or obese-weight (OB: BMI >30 kg/m2). Participants completed a validated, computer-based cognition assessment evaluating impulsivity, attention, information processing, memory and executive function; CF reported as z-scores (mean ± SD). Iron status and CF were compared between groups via ANOVA, with adjustment for potential confounders (BMI, physical activity, C-reactive protein) via ANCOVA. A total of 157 NW and 142 OB women (25.8 ± 5.1 years) participated. Prevalence of ID and IDA were 14% and 6% respectively, with no significant difference between NW and OB groups. Women with IDA scored significantly lower on attention (although within normal range; ±1 z-score), compared to ID (IDA: −0.75 ± 1.89; ID: 0.53 ± 1.37; p = 0.004) but not IR (0.03 ± 1.33, p = 0.21) groups; there were no significant differences between ID and IR groups (p = 0.34). Adjustment for confounders did not significantly alter these results. In conclusion, women with IDA showed significantly reduced attention compared to women with ID.

Iron deficiency anemia in children with cyanotic congenital heart disease and effect on cyanotic spells

BackgroundIron deficiency anemia (IDA) in cyanotic congenital heart disease (CCHD) and its association with cyanotic spells has been documented in literature. However, Indian data especially in the pediatric age group is scarce. This study was conducted to find out the prevalence of IDA in this population. MethodsAn observational study was conducted in a tertiary care hospital. Children with CCHD in the age group of birth–12 years were included in the study. Hematological parameters of these patients were determined and compared. An assessment of the incidence of cyanotic spells in the iron-deficient and iron non-deficient children was also done. Data analysis was done using Fischer's exact test. ResultsThe prevalence of IDA was 47.06% in the study population. The study also showed that hemoglobin and hematocrit levels were paradoxically higher in the iron-deficient group as compared to the non-deficient, though the iron studies revealed the iron deficiency. The incidence of cyanotic spells was higher in the iron-deficient group. The mean corpuscular volume (MCV), red cell distribution width (RDW), serum ferritin, serum iron, total iron binding capacity (TIBC), and transferrin saturation (TS) values were the parameters, which were found to be statistically significant to differentiate the study groups. ConclusionThe prevalence of IDA in children with CCHD was found to be high. Iron-deficient group had an increased frequency of cyanotic spells as compared to the non-deficient group, which was statistically significant.

Oxidative stress, hepcidin and nesfatin-I status in childhood iron and vitamin B12 deficiency anemias.

Anemia is a disease that is long and often repetitive and can result in a great burden to the national economy. The most frequent nutritional deficiency anemias in children are related with iron and vitamin B12 deficiencies. The aim of this study was to determine the oxidative stress, hepcidin, and nesfatin-I levels in childhood iron and vitamin B12 deficiency anemias. The study had 3 groups of 15 children, iron anemia deficiency group, vitamin B12 deficiency group and a control group. The TBARS and nesfatin-I levels were significantly higher in the iron and vitamin B12 deficiency groups and the total antioxidant levels were significantly lower when compared to the control group. In contrast, the plasma hepcidin levels were significantly lower in the iron deficiency group (p < 0.01) when compared to the control group; however, no significant differences were observed in the vitamin B12 deficiency group. Plasma homocysteine levels were significantly higher in the vitamin B12 deficiency group when compared to the control group (p < 0.001), but no differences were determined between the iron deficiency and control groups. Our results showed that there are high levels of oxidative stress in childhood iron and vitamin B12 deficiency anemias, and we propose that plasma hepcidin and homocycteine levels may be useful in the differential diagnosis of childhood nutritional deficiency anemias. Nesfatin-1 hormone levels were identified for the first time in childhood iron deficiency and vitamin B12 deficiency anemias within this study and this hormone may also be useful in the differential diagnosis of anemias.

Impact of iron deficiency anemia on CD4 and CD8-T lymphocytes among preschool-school children

Iron is a basic element at cellular and molecular levels for proper development and effective function of the immune system. Children with iron deficiency are more susceptible to infections and have many alterations to their immune profile. The current study investigates the quantitative changes for CD4 and CD8 T-lymphocytes among symptomatic and asymptomatic iron deficient children. Flow cytometry using conjugated monoclonal antibodies was used for assessment of the CD4 and CD8 T-lymphocyte subsets among 30 asymptomatic iron deficient children, 28 iron deficiency anemia (IDA) symptomatic children, and 30 healthy children. A significant decline of CD4+ lymphocyte percentage was observed among both asymptomatic and symptomatic iron deficient children when compared to the control group. The percentage of CD8+ lymphocytes increased among both iron deficient groups. The current study concludes that symptomatic and asymptomatic iron deficient children have an alteration of CD4 and CD8 cell ratios. Early diagnosis and treatment of asymptomatic iron deficiency are mandatory to prevent functional deterioration of cell-mediated immunity.