Impact of oral iron dosing regimens on iron biomarkers during pregnancy: insights from the PANDA trial.

Iron deficiency has been reported in up to 50% of patients with heart failure (HF), irrespective of the presence of anemia. Although no formally validated definition for iron deficiency in patients with HF exists, both the American and European Heart Failure Guidelines define iron deficiency as a serum ferritin of < 100 ng/ml, or a ferritin of 100-299 ng/ml, provided that the transferrin saturation (TSAT) is less than 20%. The presence of iron deficiency has been associated with poor patient-oriented outcomes, prompting the assessment of intravenous (IV) iron as a treatment for iron deficiency. This review summarizes the totality of the evidence on the diagnosis, evaluation and treatment of patients with iron deficiency. In addition, we highlight our approach to patients with HF with reduced ejection fraction and highlight areas for both clinical improvement and research.

Effects of spermine on osteoblasts during iron deficiency in vitro and in vivo during chronic kidney disease.

Iron, autoimmunity, and thrombosis: Exploring sex-specific interactions.

This clinical report includes strategies for the prevention of iron deficiency (ID) and iron deficiency anemia (IDA), updates for screening, as well as diagnostic and treatment recommendations. It relates broadly to children, from birth through adolescence, affected by either nutritional ID or IDA attributable to insufficient dietary iron, malabsorption, or loss of iron from heavy menstrual, gastrointestinal, or other external blood loss. Recommended diagnostic strategies emphasize important features of the history, physical examination, and informative laboratory tests available to both generalists and subspecialists. Treatment of children with ID, mild IDA, and moderate or severe IDA or when IDA is refractory or recurrent is discussed. Recommendations regarding oral iron therapy and intravenous iron treatment options are described.

Despite the growing adoption of bariatric surgery (BS) in China, data on its nutritional impacts remain limited. This study aimed to investigate the nutritional status of Chinese patients at 1 year post-BS. A retrospective analysis of 562 patients treated between January 2022 and January 2023 was conducted, with 231 patients completing 12-month follow-ups. Baseline and postoperative data on anthropometrics, metabolism and nutrition were gathered at 1, 3, 6 and 12 months. Preoperative vitamin D deficiency was most prevalent (77.1%), followed by ferritin (9.5%), folate (3.0%), vitamin B12 (2.2%), anemia (2.2%) and albumin (0.4%). Compared to baseline, the serum levels of albumin, folate and 25-hydroxyvitamin D [25 (OH) D] increased throughout the first postoperative year, while hemoglobin and ferritin declined at 12 months (P < 0.05). Anemia and ferritin deficiency rates increased to 11.7% and 33.8% at 12 months post-operation, respectively, while folate deficiency decreased to 0.4% (P < 0.05). Non-compliance with multivitamin supplementation demonstrated significantly higher prevalence of vitamin D deficiency (70.7% vs. 52.6%), iron deficiency (58.6% vs. 25.4%) and anemia (20.7% vs. 8.7%) compared to regularly supplemented counterparts (all P < 0.05). Multivariable linear regression revealed preoperative hemoglobin, ferritin and 25 (OH) D levels were independent predictors of 12-month postoperative changes in their corresponding nutrients. Despite improved body composition and metabolism, postoperative nutritional deficiencies remain common. Routine preoperative nutritional assessment and long-term postoperative monitoring are essential for nutritional balance.

To evaluate diagnostic utility of reticulocyte hemoglobin equivalent (Ret-He) in identifying iron deficiency anemia (IDA) in acutely ill hospitalized children in comparison to serum ferritin. After excluding chronic inflammatory and anemic conditions unrelated to iron deficiency (ID), patients were categorized as (1) IDA: low hemoglobin+ microcytosis+ red-cell-distribution-width (RDW) index >220, (2) Non-anemia-iron-deficiency (NAID): normal haemoglobin+ microcytosis+ RDW index >220 and (3) Normal-group: normal hemoglobin+ normocytosis. Diagnostic utility indices for IDA were calculated using low hemoglobin+ microcytosis + RDW index >220 as surrogate standard. Correlation coefficients and receiver-operating-characteristic (ROC) curve cut-offs for Ret-He and ferritin were calculated. Anemic (n = 180) and non-anemic (n = 66) acutely ill children, after exclusion criteria, were classified into IDA (n = 102), NAID (n = 14) and normal (n = 21). IDA group had significantly lower Ret-He levels (p <0.001). Ferritin levels showed no significant difference (p = 0.062). For IDA detection, Ret-He cut-off of 27.7 pg yielded sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 87.2%, 80.9%, 95.7%, 56.7% and 86.2% whereas ferritin at cut-off of 147.0 ng/ml showed values of 58.8%, 66.7%, 89.5%, 25.0% and 60.2% respectively. For NAID detection, Ret-He cut-off of 29.1 pg showed sensitivity, specificity, PPV, NPV and accuracy of 71.4%, 57.1%, 52.6%, 75.0% and 62.9%, while ferritin at cut-off of 153 ng/ml showed values of 57.1%, 61.9%, 50.0%, 68.4%, and 60.0% respectively. Ret-He demonstrated superior diagnostic utility compared to serum ferritin for IDA in acutely ill hospitalized children. Optimal cut-off for serum ferritin for IDA was significantly higher than WHO reference standard.

Reimagining the contribution of iron in Parkinson's disease.

KDOQI US Commentary on the KDIGO 2026 Clinical Practice Guideline for the Management of Anemia in CKD.

Iron supplementation prevents abdominal aortic aneurysm by increasing Tregs via maintained mitochondrial homeostasis.

The global prevalence of iron (Fe) deficiency anemia (IDA) continues to pose major public health challenges, necessitating the development of effective fortification strategies. Dairy-based systems are promising vehicles for Fe fortification and delivery due to their widespread consumption and nutritional value, although their complex matrix presents significant challenges for maintaining Fe bioavailability and product quality. This review critically evaluates current knowledge on Fe fortification in dairy systems, integrating evidence on Fe forms, physicochemical interactions between Fe and the matrix, and their consequent effects on Fe bioavailability and physical functionality. Emerging fortification strategies are highlighted. Conventional Fe salts, including ferrous sulfate, ferrous fumarate, and ferric pyrophosphate, have varying degrees of solubility and absorption but are often associated with adverse sensory changes, lipid oxidation, and reduced product stability. Fe-ligand complexes, including protein-, carbohydrate-, and Maillard reaction product (MRP)-based systems, can impart improved stability to the fortified product and bioavailability by minimizing interactions with inhibitors of Fe absorption. The incorporation of Fe into dairy matrices influences product pH and structural and functional properties while also accelerating lipid oxidation and sensory deterioration when inorganic salts are used. Strategies such as Fe chelation, microencapsulation, and co-fortification with enhancers have shown potential to mitigate these limitations. In addition, the role of prebiotics, probiotics, and MRPs in modulating Fe absorption remains complex and context dependent. Despite promising advancements, gaps remain in understanding interactions between Fe, proteins, carbohydrates and MRP and their implications for Fe fortification of dairy systems. Future research should focus on developing integrated fortification approaches enabling the design of next-generation functional dairy foods to effectively combat global Fe deficiency.

Functional hypothalamic amenorrhea (FHA) is a common form of secondary amenorrhea caused partly by undernutrition relative to demand. To compare the dietary nutritional intake between women with FHA and eumenorrheic controls and evaluate micronutrient profiles. This cross-sectional study included 30 women with FHA and 29 eumenorrheic controls not on hormones. FHA was defined as ≥3 consecutive months of amenorrhea, estradiol of <50 pg/mL, and FSH and LH of <10 mIU/L, excluding other etiologies. A 3-day food diary was collected for dietary analysis, excluding dietary supplements using ESHA Research Food Processor. The mean age of women with FHA and controls was 26.4 years ± 6.2 versus 30.3 years ± 3.7 (p = 0.002), with no differences in BMI (p = 0.16) or the waist-to-hip ratio (p = 0.71). Women with FHA and controls consumed comparable median calorie intake (1784 kcal [1465, 2011] vs. 1732 kcal [1578, 1982], p = 0.62), with no differences in self-reported exercise patterns. Women with FHA consumed more dietary protein (84.2g [74, 112] vs. 74 g [59, 92], p = 0.001) and dietary fiber (30.1 g [22, 43] vs. 17.3 g [15, 23], p = 0.02) versus controls, respectively. When expressed as a percentage of estimated average requirements (% estimated average requirement), women with FHA had higher intakes of vitamin A (105% [45, 219] vs. 43% [21, 86], p = 0.005), vitamin C (201% [139, 351] vs. 107% [75, 190], p = 0.004), and iron (169% [146, 220] vs. 120% [99, 192], p = 0.027) compared with controls. Women with FHA had similar caloric intake to eumenorrheic controls but consumed more dietary protein, fiber, vitamin A, vitamin C, and iron. Future studies should examine the nutritional profiles of women with FHA in relation to long-term health consequences such as bone and vascular health.

Ferritin in motion: How systemic iron balance and tumor trafficking shape glioblastoma.

In low-risk populations, the faecal immunochemical FIT test is excellent at excluding colonic malignancy, with a negative predictive value (NPV) of 99.8%. However, effectiveness in a high-risk iron deficiency anaemia (IDA) population is unclear. This has significant resource implications for health care services worldwide. This study aims to establish the NPV of FIT for colorectal cancer in patients with IDA. Single-centre retrospective study. Over 12 months, paired cases of FIT <10µg Hb/g faeces and IDA were identified. Those not completing colonoscopy or CT pneumocolon were excluded. The prevalence of cancer, low-risk and high-risk polyps, defined by British Society of Gastroenterology (BSG) guidelines, was established, and the NPV was calculated. One thousand twenty-three cases were identified, of which 451 had undergone complete colonic investigation. Mean age was 68 (SD: 11.8). 286/451 (63%) were female. 381/451 had undergone colonoscopy, 78/451 CT pneumocolon with 404/451 also having gastroscopy (OGD). 8/451 (1.8%) had a colonic malignancy. 11/404 (2.7%) had an upper GI malignancy and 14/451 (3.1%) a cancer outside the GI tract. The NPV for colorectal cancer was 98.2% (95% CI: 96.9-99.5). In 24/451 (5.3%) advanced polyps were found, NPV 94.7% (95% CI: 92.6%-96.8%). In 118/451 (26%) low-risk polyps were found, NPV 73.8% (95% CI: 69.8%-77.9%). The NPV of FIT in IDA appears lower than reported in low-risk symptomatic populations, and it is unclear if this is adequate to negate the need for colonoscopy. Prospective multicentre studies are needed to evaluate this fully.

Iron deficiency anemia (IDA) is associated with adverse maternal and neonatal outcomes. Patient navigation tools have improved treatment and surveillance completion among postpartum populations. Our study aimed to evaluate the impact of prospectively implementing a digital patient navigation tool for IDA in prenatal care (PN-IDA). This pilot type 1 hybrid effectiveness-implementation trial utilized a difference-in-differences (DiD) design to compare pre- and postimplementation outcomes at an intervention site to a control site. The trial was performed at a tertiary academic center in the northeastern United States between April 2023 and April 2024. Patients with third-trimester Hgb < 9.5 g/dL were institutionally eligible for IV iron (IVFe) and included in this analysis. Dual primary outcomes were completion of ≥ 1 IVFe infusion and perceived health competence (validated eight-item survey). Implementation outcomes assessed penetration and fidelity. Multivariable logistical and linear regression models controlling for differences in site characteristics over time used interaction terms to estimate DiD. Three hundred and seventy-eight patients were included. While IVFe completion increased at both sites (66-84% at the intervention site vs. 78-83% at the control site), there was no statistically significant difference (DiD RR: 1.13, 95% CI: 0.91-1.38). Perceived health competence remained similar at both sites (median score: 3.3-3.3 at the intervention site vs. median score: 3.3-3.1 at the control site, DiD RR: 0.15, 95% CI: -0.08 to 0.38). PN-IDA had a high level of penetration (i.e., integration of practice within a service setting), but poor fidelity (i.e., degree to which an intervention is delivered as intended). Sixty-six percent of eligible patients enrolled, but only 24% accessed PN-IDA more than once. PN-IDA implementation increased IVFe completion by 18% at the intervention site, but our study was underpowered to assess this difference. Future work will refine PN-IDA to optimize fidelity. · Completion of > 1 infusion increased by 18% at the intervention versus 5% at the control site (95% CI: 0.91-1.38).. · Two-thirds of eligible patients enrolled in the tool.. · Only 24% of enrolled patients accessed the tool > 1 time..

Iron deficiency limits legume production on calcareous soils, and commonly used synthetic iron chelates (e.g., Fe-EDTA) are effective but non-biodegradable and may mobilize toxic metals. Microbial siderophores offer an environmentally sound alternative, yet their direct application as biofertilizers remains underexplored. Here, we evaluated the iron-carrying siderophore produced by Amycolatopsis lurida strain 407 as a biofertilizer for chickpea. Siderophore extracts were quantified and characterized by the CAS assay, Fe (III)-ICP-OES, Arnow and FeCl₃ tests, UV-Vis spectroscopy, and genome mining (antiSMASH). Results indicate strain 407 secretes a mixed catecholate-hydroxamate siderophore whose UV-Vis spectrum (200-600nm) matches mirubactin C and is supported by a mirubactin-like biosynthetic gene cluster in its closest type strain. When applied to chickpea, the Fe + siderophore from strain 407 increased root dry weight and yielded the highest shoot biomass (28g/ plant), pod/plant (41 pods), and seed/pod (36 seeds), outperforming chemical iron fertilizer, Fe-EDTA/ Sequestrin 138 (22g, 24 pods, 24 seeds). Furthermore, seed soluble protein (20mg/g dry seed) was 17% higher than with Sequestrin 138. In this study, for the first time, findings show the mirubactin-like Fe-siderophore from A. lurida 407 enhances plant growth and seed quality and represents a promising, eco-friendly alternative to synthetic iron fertilizers.

Migraine headache is a common primary headache disorder which is multifactorial in origin. On the other hand, iron deficiency anemia causes metabolic abnormalities in the brain which leads to a reduction in neuronal activities. The study was designed to determine the association between iron deficiency anemia and migraine. This was a case-control study which was conducted among patients attending at the outpatient department of Neurology of Mymensingh Medical College Hospital with migraine headache fulfilling the International Headache Society criteria and non-Migraine age and sex matched healthy individuals from November 2019 to April 2021. Total 155 migraine patients (case) and 155 non-migraine healthy individuals (control) were included in this study. After signing the informed written consent, the blood samples were collected for complete blood count and serum ferritin level. The study result showed that iron deficiency anemia was more common in migraine patients than non-migraine healthy individuals (p<0.001). In female patients, serum hemoglobin and ferritin level were significantly low in migraine (p<0.001 and p<0.001 respectably) but in male patients only serum ferritin level was significantly low (p=0.001). There is also an association between severity of migraine attack and iron deficiency anemia (p=0.042). The patients with severe headache had lower serum hemoglobin and ferritin level which were statistically significant (p=0.005 and p<0.01 respectably). The study observed an association between iron-deficiency anemia, serum hemoglobin and ferritin levels with migraine. Therefore, iron deficiency anemia may be investigated in migraine patients and iron supplements might be an effective treatment in patients with migraine.

This study aimed to examine the association between iron deficiency (ID) and thyroid dysfunction among Jordanian adults. A cross-sectional analysis was conducted using data from 3,605 participants in a 2017 nationwide survey covering all 12 Jordanian governorates. Sociodemographic, anthropometric, and biochemical data were collected, including serum ferritin, thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4). Participants were categorized as having iron deficiency (ID), iron deficiency anemia (IDA), or control group (CG). Kruskal-Wallis and chi-square tests were used, with p < 0.05 considered significant. Individuals with ID and IDA had significantly lower FT3 and FT4 levels and higher TSH levels compared to CG. The prevalence of hypothyroidism and combined hypothyroidism plus subclinical hypothyroidism was higher in the IDA group (p = 0.0011 and p = 0.0126, respectively). No significant associations were observed for hyperthyroidism or subclinical hyperthyroidism. Iron deficiency, particularly IDA, was associated with an increased prevalence of hypothyroidism among Jordanian adults. These findings highlight the importance of thyroid function screening in individuals with low iron status and underline the need for longitudinal studies to clarify causal pathways.

Intravenous iron administration and management of adverse events: a systematic review and Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis consensus recommendations.

Retraction notice to "Amino acid chelated iron versus an iron salt in the treatment of iron deficiency anemia with pregnancy: A randomized controlled study" [Eur. J. Obstet. Gynecol. Reprod. Biol. 210 (2017) 242-246