Iron Status In Children Research Articles

Iron status in children with acute COVID-19 and paediatric inflammatory multisystem syndrome during infection and after recovery

BackgroundCOVID-19 has significant effects on organ function, particularly on lung function and iron metabolism. Studies have shown increased levels of ferritin, an iron storage protein, in COVID-19 patients, indicating potential changes in iron utilization. Research has focused primarily on adults, with limited studies on paediatric patients and a lack of comparisons with MIS-C patients. This study aimed to assess iron status in paediatric COVID-19 patients using traditional and new biomarkers, soluble transferrin receptors (sTfR) and Reticulocyte hemoglobin equivalent (RET-He), to improve diagnosis and prognosis. Additionally, we sought to compare iron status between acute COVID-19 patients and MIS-C patients and evaluate the relationships among iron dysmetabolism, disease severity, and prognosis in paediatric patients. The study also involved monitoring iron status during and after infection to understand its impact on patient severity and prognosis.MethodsA cohort study involving 49 patients aged 1 month to 18 years was conducted at the isolation department of Mansoura University Children's Hospital. The study included 36 patients with acute COVID-19 and 13 with multisystem inflammatory syndrome of childhood (MIS-C). Diagnosis was based on PCR from a deep nasopharyngeal swab or a positive antibody test. Follow-up of survivors was conducted 3 months after recovery. Blood samples were obtained during infection and at follow-up for CBC, Ret-He, iron kinetics, and sTfR analyses.ResultsSignificant iron deficiency anaemia was observed in all patients during infection, with improvement after 3 months of recovery in survivors. The improvement was more obvious in MIS-C patients, with Hb and iron kinetics not significantly affected by disease severity. The STfR was significantly lower in nonsurvivors than in survivors. The ROC curve showed that a baseline sTfR ≤ 18 nmol/L was a statistically significant difference between nonsurvivors and survivors (area under the curve (AUC) = 0.810, p < .001), with 66.7% sensitivity and 82.5% specificity. Regression analysis revealed that patients with baseline sTfRs ≤ 18 nmol/L were 5.9 times more susceptible to death.ConclusionThis study revealed that COVID-19 in children caused iron deficiency anaemia, which improved within 3 months after recovery. Haemoglobin and sTfRs were identified as reliable indicators of IDA in these patients, unlike iron kinetics and RET-He.

Safety and efficacy of iron supplementation with 3 months of daily ferrous sulphate in children living with HIV and mild-to-moderate anaemia in Uganda: a double-blind, randomised, placebo-controlled trial

Iron deficiency is the most common nutritional deficiency in the world, but iron supplementation can increase risk of opportunistic infections, especially in children living with HIV. We aimed to assess the effect of supplemental iron on haemoglobin concentration in children living with HIV and mild-to-moderate anaemia in Uganda. We did a double-blind, randomised, placebo-controlled trial of iron supplementation in children aged 6 months to 12 years living with HIV at two sites (ie, Kampala and Fort Portal, Uganda). Inclusion criteria were confirmed diagnosis of HIV and stable treatment with antiretroviral therapy for at least 6 months. Exclusion criteria were already taking iron supplementation, acute illness, current opportunistic infection, fever, known sickle cell disease, severe undernutrition, or any chronic illness requiring medical attention. Children were randomly assigned (1:1) via simple randomisation to an 84-day course of either ferrous sulphate or identical placebo tablets once per day. Randomisation codes were computer-generated and stratified by age (ie, 6-23 months or 24 months and older) by the Toronto Institute of Pharmaceutical Technology, the tablet manufacturer. Participants and all individuals giving the interventions, assessing outcomes, and analysing data were masked to group assignment. Children aged 6-23 months received tablets of 12·5 mg ferrous sulphate or identical placebo; children aged 24 months or older received tablets of 30·0 mg ferrous sulphate or identical placebo. Caregivers were instructed to give the supplement after a meal, preferably after an evening meal. The primary outcome was mean haemoglobin concentration at day 84. All analyses were intention to treat. This trial is registered at ClinicalTrials.gov (NCT03596996). Between May 5, 2018, and Nov 6, 2019, 973 children living with HIV were screened, of whom 200 (20%) met all inclusion criteria and were enrolled. 102 (51%) were randomly assigned to receive iron and 98 (49%) to receive placebo. In the iron group, 57 (56%) of 102 children were male and 45 (44%) were female. In the placebo group, 44 (45%) of 98 children were male and 54 (55%) were female. Iron supplementation was associated with improvement in haemoglobin in unadjusted analysis (p=0·029), but not adjusted analysis (p=0·10), and with improvement in ferritin and hepcidin in both adjusted (p=0·0046; p=0·0079) and unadjusted (p<0·0001; p<0·0001) analyses at day 84. There were four hospital admissions, all for children in the iron group; none were fatal: two children were admitted to hospital with pneumonia, one with severe malaria, and one with hepatitis. Frequency of admissions was not significantly different between groups (p=0·12). Iron could have haematological benefit and improve iron status in children living with HIV in Uganda. Future studies powered for morbidity outcomes with longer follow-up are needed, as are those that evaluate the effects of iron supplementation on neurocognitive outcomes. Minnesota Masonic Charities, the Department of Pediatrics at the University of Minnesota, the Hennepin Healthcare Research Institute, and the US National Institutes of Health.

Key performance indicators for monitoring of anemia management and iron status in children attending a pediatric dialysis unit: the experience of Ain Shams University

BackgroundAnemia in children on maintenance hemodialysis (HD) leads to poor quality of life. Our study aimed to assess and monitor anemia and iron status management in children on maintenance HD over 18 months using key performance indicators.MethodsKey performance indicators, formulated as the percentage of patients achieving the KDIGO (2012) guideline-recommended targets for hemoglobin (Hb) (11–12 g/dl), transferrin saturation (TSAT) (20–40%) and serum ferritin (200–500 ng/ml), were reported quarterly over the 18-month-period of this study.ResultsThis study was carried out over an 18 month-period, from April 1st, 2020, till October 31st, 2021. A total of 78 patients (45 males and 33 females) were included; mean age 12.16 ± 3.3 years and HD duration range 3.0—140.88 months, median 16.51 months. The three most common primary causes of CKD were Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) (29.5%), unknown cause (24.4%), and chronic glomerular diseases (20.5%). The quarterly reported percentages of patients achieving the recommended targets for Hb, TSAT, and serum ferritin ranges were 18.2–35.7%, 38.8–57.1%, and 11.9–26.6%, respectively.ConclusionAlthough the mean Hb trend was nearing the KDIGO (2012) target, the key performance indicators showed that only a small percentage of our HD patients were achieving the targets for Hb, TSAT, & serum ferritin, thus alerting us to the need to revise our protocol for the management of anemia and iron status.Graphical abstract

Impact of vitamin D deficiency on iron status in children with type I diabetes

Vitamin D deficiency (VDD) and anemia are both public health nutrition concerns. An association between VDD and anemia has been suggested in various healthy and diseased populations. The current study aimed to elucidate the effect of VDD on iron status in children with type I diabetes mellitus (T1DM). The study recruited two groups of children with T1DM: control group comprised of 38 T1DM children with sufficient vitamin D (> 30 ng/ml) and a case group, consisted of 52 T1DM children with VDD (< 20 ng/ml). Both groups had comparable gender, age, BMI, and disease duration. The laboratory measurements included analysis of blood indices, markers of iron metabolism, hepcidin and inflammatory markers included interleukin 6 (IL-6) and C-reactive protein (CRP). Compared to control group, T1DM children with VDD differs specifically in terms of some markers of blood indices, such as decreased hemoglobin and increased red blood cell distribution width. Moreover, decreased serum iron, ferritin, total iron-binding capacity and transferrin along with elevated inflammatory markers were observed in case group. Results of the study indicated that VDD had increased the risk of iron deficiency anemia in children with T1DM as well as inflammatory related anemia. Furthermore, in T1DM children, VDD had raised the incidence of both absolute and functional iron deficiency, with greater incidence of the former. This study may indicate that VDD may be a risk factor that may worsen iron deficiency anemia in T1DM.

Evaluation of the Coverage of Iron Requirements in Young Children Aged 6 to 59 Months from Basic Foods in Two Localities in North Togo: Awandjelo and Lama (Kara)

Iron deficiency is one of the most widespread nutritional disorders in the world. It affects almost 60% of the population in developing countries, i.e. 3.5 billion people. Women of childbearing age and young children are the most vulnerable. Iron deficiency occurs when the intake and absorption of iron cannot compensate physiological needs, which are particularly high in young children because of their growth. Due to its impact on children&amp;apos;s health, iron deficiency remains a major public health problem in Togo, with 70% of children aged between 6 and 59 months suffering from anaemia. In the face of this problem, the present study aims to establish the adequacy between dietary iron intake and physiological needs in order to contribute to strategies for handling this nutritional deficiency. To achieve this, 479 children (243 urban and 236 rural) aged 6-59 months from 447 households were the subject of this study. Food consumption was assessed using the 24-hour recall method; the nutritional value of the rations was assessed using the food composition table available in Africa. The results showed that 62% of the children studied had dietary iron intakes below the recommended levels and only 38% were able to cover their iron requirements. In fact, the mother&amp;apos;s level of school education and the mother&amp;apos;s economic activity were found to be strongly correlated with iron status in children. In the light of these data, it would seem wise to consider better nutritional intervention strategies, including nutritional education for women of childbearing age. The introduction of nutritional counselling through Information, Education and Communication (IEC), mobilisation and social marketing campaigns should therefore be promoted.

Evaluation of dietary composition between hemoglobin categories, total body iron content and adherence to multi-micronutrients in preschooler residents of the highlands of Puno, Peru

BackgroundThe anemia prevalence is higher in highlands populations. It is assumed that iron deficiency anemia (IDA) in children is mainly due to low dietary intake. However, other suggest that high prevalence of anemia is due to an inappropriate hemoglobin (Hb) adjustment for altitude.Materials and methodsCross-sectional study conducted in 338 preschoolers (PSC) from Puno-Peru. Hb was measured in whole blood, and ferritin, Soluble transferrin receptor, and Interleukin 6 in serum.The dietary iron intake was assessed by 24-h dietary recall, using NutriCap Software. Hb concentration was assessed as adjusted or unadjusted for altitude.ResultsWith unadjusted Hb, the anemia prevalence was 4.7%, whereas after Hb correction, the prevalence raised-up to 65.6% (p < 0.001). Reciprocally, erythrocytosis proportion decreased from 20.35 to 0.30% (p < 0.001). Total Body Iron (TBI) showed that 7.44% had ID and 0.32% had IDA. PSC with normal unadjusted Hb levels have more protein and micronutrients intake than anemic ones. PSC with erythrocytosis consumed less fat, and more niacin and ascorbic acid than anemics. Total iron intake was lower in anemic than the other groups, but without statistical significance due to the standard deviation of the data in a small number of anemic PSC (n = 16). TBI, unadjusted Hb, and adjusted Hb were not different between groups consuming or not multimicronutrients.ConclusionsThe consumption of iron and iron status in children who live at high altitude is adequate, and that anemia could be due to other micronutrient deficiencies and/or that the adjustment of Hb by altitude is inappropriate.

Effects of Cucurbita Moschata squash (Butternut) seed paste in improving zinc and iron status in children attending Early Childhood Development centres in Limpopo province, South Africa.

Cucurbita moschata (Butternut squash) seeds are a rich source of nutrition containing nutrients including iron, zinc, copper, calcium, potassium, and phosphorus. The aim of this study was to determine if Cucurbita Moschata squash seed paste improves zinc and iron status, anthropometric status, and dietary intake in preschool children. A pretest-posttest control group trial using cluster randomisation was conducted over 6 months. Four preschools were randomly assigned to receive 100 g of intervention or 100 g of a placebo as the control to enhance iron and zinc status. A total of 276 preschool children were recruited from eight government registered Early Childhood Development centres in Limpopo province, South Africa. The control group consumed Cucurbita moschata flesh twice-weekly, while the intervention group consumed Cucurbita moschata seed paste twice-weekly during a six-month period. Iron (serum iron, transferrin, transferrin saturation, ferritin) and zinc (serum zinc) status and anthropometric indices such as weight, height and mid upper arm circumference for children were evaluated at baseline and the endpoint. Iron and zinc-rich food consumption was measured using a 24-hour dietary recall and food record during the study, and dietary intake was estimated using a food frequency questionnaire which was conducted at the beginning and endpoint. The intervention group significantly improved in the mean serum iron 0.23 μg/dL (95% CI: 0.11;0.33); ferritin 0.21μg/dL (95% CI: 0.13;0.39), transferrin saturation 0.33% (0.23;0.74) and zinc 0.16 μmol/dl (95% CI: 0.13;0.25) at the end of the study. In addition, the intervention group exhibited greater mean weight for age of 0.13 z-score (95% CI: 0.28; 0.34) and weight for height of 0.04 z-score (95% CI: 0.12,0.05), as well as the consumption of iron (p < 0,001), zinc (p < 0,001), and vitamin C (p < 0.001). At the end of the trial, fiber (p < 0.001), riboflavin (p = 0.001), vitamin B6 (p < 0.001), and vitamin B12 (p < 0.001) were significantly higher in the control group. Thus, the inclusion of intervention in the diet of children in an impoverished area of South Africa improved the iron and zinc status of these children. This supplement could be a cost effective and sustainable approach to improve nutrient status in rural South Africa. Trial registration: Pan African Clinical Trial Registry (PACTR202308740458863).

A study of iron status in children with cyanotic congenital heart disease

Background: Iron deficiency is a common problem in patients with cyanotic congenital heart disease (CCHD), but it is often underdiagnosed. Cyanotic patients with iron deficiency will experience higher morbidity due to symptoms of hyper viscosity. The consequences of iron deficiency anemia in cyanotic heart disease may manifest either in infancy or later. The tendency to develop metabolic acidosis and hyper-cyanotic attacks is exacerbated by relative iron deficiency anemia. This study was performed to identify the prevalence of iron deficiency in children with CCHD based on definitive tests like serum ferritin. Methods: We included 100 patients with congenital cyanotic heart diseases between 3 months to 18 years. Baseline characteristics were noted in specific proforma. Data from the blood tests were collected and analysed statistically to find out the prevalence of iron deficiency, along with tests that best predict the presence of iron deficiency. Results: Serum ferritin-based prevalence of iron deficiency in CCHD was 46%. Iron status based on haemoglobin, MCV values with the serum ferritin, and the strength of agreement were almost perfect. The strength of agreement for PCV, MCH, RDW, and peripheral smear was substantially significant. The strength of agreement for MCHC was moderate significance (Kappa value 0.41-0.60). Red cell distribution width (RDW) was an independent predictor of iron deficiency in logistic regression analysis. Conclusions: RDW seems to be a good indicator for predicting iron deficiency in children with congenital cyanotic heart diseases.

Correlations between Sleep Features and Iron Status in Children with Neurodevelopmental Disorders: A Cross-Sectional Study.

A high prevalence of sleep disturbances has been reported in children with neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and intellectual disability (ID). The etiology of sleep disorders in these children is heterogeneous and, recently, iron deficiency has received increasing attention. This study aims to investigate sleep features in children with NDDs and to explore a possible correlation between serum iron status biomarkers and qualitative features of sleep. We included 4- to 12-year-old children with a diagnosis of ASD, ADHD, or ID and assessed their sleep features through the children's sleep habits questionnaire (CSHQ). Venous blood samples were collected to investigate ferritin, transferrin, and iron levels. The mean CSHQ total score exceeds the cut-off in all groups of children. In the ASD group, the Parasomnias subscale negatively correlated with serum ferritin levels (Rho = 0.354; p = 0.029). Our findings may suggest the existence of an association between iron status, sleep quality, and neurodevelopmental processes. In clinical practice, sleep assessment should be included in the routine assessment for patients with NDDs. Furthermore, a routine assessment of iron status biomarkers should be recommended for children with NDDs who have sleep disturbances.

Can providing daily iron-fortified lunches to school-going children living in an impoverished Guatemalan community improve iron status?

Background Iron deficiency anemia (IDA) remains one of the most common diet-related micronutrient deficiency disorders in the world. Although iron supplementation can effectively improve iron status, it is often a short-term solution to this endemic, chronic health problem. Lucky Iron Fish® (LIF) offers a novel, long-term approach to treat IDA that can be easily utilized in regions of the world where IDA is most prevalent. While the beneficial use of LIF for household preparation of meals has been demonstrated, its use in quantity food production has not been investigated. The purpose of this study was to develop methodology for large-scale iron fortification of cooking water and to assess changes in hemoglobin and hematocrit values in school-going children following 8 months of receiving iron-fortified school lunches prepared with LIF. Methods Laboratory studies were conducted to develop the protocol to prepare iron fortification of cooking water using LIF. Study participants were school-going children from economically, disadvantaged families attending private schools in Jocotenango, Guatemala. Baseline measures (weight, height, hemoglobin, and hematocrit) were taken at the start and completion of the academic calendar. The sample was divided into quintiles based on pre-hemoglobin and hematocrit values where quintile 1 had the lowest baseline hemoglobin and hematocrit values and quintile 5 had the highest baseline hemoglobin and hematocrit values. Paired t-tests were used to determine if there were overall significant pre- and post-differences in iron status values by quintile groupings. Results A total of 286 (77%) of children between the ages of 5 – 16 (y) completed the study. Post- hemoglobin values were significantly higher than pre-hemoglobin values for those in quintile 1, whereas post-hematocrit values significantly increased for quintiles 1 and 2. Conclusions Study results suggest that LIF can be used to prepare large quantities of food and that regular consumption of iron-fortified school lunches can improve iron status in children with marginal status. Equally important is the finding that iron-fortified meals do not negatively impact those with healthy iron values.

In Transfusion-Dependent Thalassemia Children, Increased Iron Overload is Associated with Lower Serum Alpha-Klotho, Which is Strongly Associated with Lower Total and Ionized Calcium Concentrations.

Patients with transfusion-dependent thalassemia (TDT) show disorders in calcium metabolism. The α-Klotho protein is predominantly expressed in tissues that are involved in calcium homeostasis, and lowered levels are associated with bone disease. The aim of the study is to examine the associations between low α-Klotho status and calcium metabolism in relation to iron status in children with TDT. Calcium, α-Klotho, parathyroid hormone (PTH), calcyphosin, vitamin D3, phosphorous, fibroblast growth factor receptor 2 (FGFR2), as well as iron and erythron biomarkers were measured in 60 children with TDT and 30 healthy control children. A meaningful part of TDT patients showed lowered α-Klotho levels, and those children also showed low serum total and ionized calcium concentrations. TDT patients showed increased PTH, FGFR2, and calcyphosin and lowered vitamin D3 as compared with healthy children. The α-Klotho levels were significantly correlated with total and ionized calcium (positively) and with iron overload and transfusions biomarkers (inversely). Partial Least Squares path analysis showed that 40.1% of the variance in serum total calcium could be explained by the regression on α-Klotho, vitamin D3 (both positively), and calcyphosin (inversely) and that the effects of the latter are mediated by iron overload and the number of blood transfusions. In conclusion, the iron overload in TDT and its consequences may induce lowered levels of α-Klotho which in turn may lead to lower calcium thereby explaining at least in part the effects of TDT on bone metabolism including spontaneous pathological fractures, osteoporosis, osteopenia, and skeletal deformities.

Defining Pathological Iron Status in Children with Thalassemia

The purpose of this review is to summarize the recent knowledge that has been gathered, allowing a better understanding of iron status in children with thalassemia. Children with thalassemia major typically have severe anemia during the first two stages of life and receive regular red blood cell (RBC) transfusions. The results show that individuals with thalassemia major who are overtly or inadequately transfused have significant body changes that affect physical growth retardation, hostility, weak musculature, leg muscle fitness, extramedullary development of hematopoiesis, and bone expansion, as seen in some developing countries. Cases of thalassemia intermedia occur late and have mild anemia, and cannot tolerate regular blood transfusions. Treatment for thalassemia major includes regular red blood cell transfusions, iron chelating drugs, and bone marrow surgery. In addition, spleen scanning may be necessary in some cases. Also, a bone marrow transplant is the only definitive treatment currently available. The prognosis for patients with beta-thalassemia has improved most over the past 25 years, mostly due to recent medical advances in blood transfusions, iron-chelating drugs, and bone marrow transplants. However, heart disease (heart disease) has been found to remain the leading cause of death in iron-related cases.

Role of serum hepcidin as a biochemical marker in children with Beta-thalassemia of iron status in Wasit Province Iraq

β-thalassemia is characterized by anemia and depending on the severity of the anemia. Hepcidin is a 25-amino-acid peptide generated by the liver, based on hypoxia, anemia, and iron storage. controls blood iron concentration and tissue distribution and regulates the body's iron hemostasis. To evaluate the usefulness of Serum Hepcidin level as a biochemical marker of iron status in children with β thalassemia major, β thalassemia Intermedia and its relation with serum ferritin level. A cross-section study which will involve 90 included 50 Thalassemia Major (TM) and 40 Thalassemia Intermedia (TI). Patients will be collected from the thalassemia center in Kut Hospital for Gynecology and Pediatrics, were randomly selected for this study. All patients child in both gender from (5-17 years). Enzyme-linked immunosorbent assay [ELISA] used for determination of Hepcidin, Abbott Architect C4000 And cobas c 111 analyzer used for the determination of Ferritin, Iron and Hemoglobin was measured by Sysmex XP-300. The study included both gender 62.2% were male and 37.8% were females, regarding male gender 57.1% had βTM and 42.9% had βTI while female gender 52.9% had B-thalassemia major and 47.1% had β-thalassemia Intermedia.

Iron-Deficiency Anemia as a Risk Factor for the First Simple Febrile Convulsion

Background: Febrile seizure is the most common convulsive disorder in childhood. The role of iron in the metabolism of neurotransmitters and carrying oxygen to the brain suggests the possibility of a relationship between iron-deficiency anemia and febrile seizures. Objectives: The aim of study is to study the role of iron-deficiency anemia as a risk factor for febrile seizures. Materials and Methods: This is a hospital-based case–control study performed in 30 children with febrile seizures (case) and 80 febrile children without seizures (control) who were aged between 6 and 60 months. The groups were matched in terms of age, gender, and the use of supplemental iron. Laboratory tests consisted of complete blood count, serum iron, plasma ferritin were done for each patient. Results: Thirty-four percent of the cases with febrile seizure had iron-deficiency anemia compared with 20% of children with febrile illness without seizure and 12% of healthy children. The odds ratio for iron-deficiency anemia in the patients with febrile seizure was 3.059 (95% confidence interval (CI) = 0.969–9.657) compared with the febrile children without convulsion and 5.608 (95% CI = 1.834–17.146) compared with the healthy group. Conclusion: Based on the result of this study, iron deficiency could be an important risk factor for the development of febrile convulsion. This encourages the evaluation of iron status in children with febrile seizure.

Iron status in children with attention - Deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder is one of the most common neurobehavioral disorders of childhood. The objectives of the study were to evaluate the status of iron stores in children with ADHD and to investigate a possible correlation between serum ferritin levels and severity of ADHD.60 children aged 3-12 years of age who were diagnosed to have ADHD as per the ICD 10 research Criteria for Hyperkinetic Disorder, were included in this study. After obtaining written informed consent from the child’s guardian, severity score of ADHD was determined using Conner’s Parent Rating Scale(CPRS), and blood investigations including Hb, PCV, blood indices, RDW, and serum ferritin were sent and results were statistically analysed Serum ferritin levels were between 15-30 ng/ml in 16 children (26.7%) and more than 30 in 44 children (73.3%). The CPRS severity scores were found to be higher among children belonging to the combined (72.7%) and hyperactive (59.4%) categories than among those belonging to the inattentive category (23.5%). The haemoglobin level was found to be low as per the WHO standards in only 3 out of the 60 children studied. All 3 children with Hb&amp;#60;11.5 belonged to the inattentive category. No significant correlation was found between serum ferritin levels and CPRS rating scores.The iron status in children with ADHD in our study was not suggestive of iron deficiency. Iron deficiency probably occurs in a subset of children with ADHD and illy found. The study also did not find any significant correlation between serum ferritin levels and the severity scores of ADHD on CPRS.

The Influence of Intensive Nutritional Education on the Iron Status in Infants.

Iron is an essential nutrient for a child’s proper development at every growth stage. It is crucial for the production of red blood and muscle cells, DNA replication, and the development of the brain, nervous and immune systems. Iron deficiency is the most common micronutrient deficiency in children worldwide. Despite widespread access to nutritional information for children, parents continue to make many feeding mistakes. This study aimed to assess whether any nutritional intervention would affect the iron status in children. The parents of 203 children were randomly assigned to one of two groups: the study group received intensive mobile nutritional education for a year, while the control group received no intervention. Blood tests were performed on both groups at the beginning of the study and one year later. The educational intervention resulted in statistically significantly higher levels of RBC (red blood cells; p = 0.020), HGB (haemoglobin; p = 0.039), HCT (haematocrit; p = 0.036), MCV (mean cell volume; p = 0.018) parameters and iron dietary intake (p ≤ 0.001). Even a non-targeted dietary intervention improves the iron status in children. As iron management is insufficient in most children, an iron-targeted nutritional intervention appears necessary.

361 Predictors of Iron Status in Children With ESKD

361 Predictors of Iron Status in Children With ESKD

Saliva Iron Levels to Assess Iron Status in Children

BACKGROUND: Iron plays an essential role in the process of neurotransmitter synthesis and neuron myelination. Iron deficiency impacts low cognitive performance, even involved in long-term effects even though iron deficiency has been overcome. Given the impact caused by iron deficiency, it is necessary to monitor the status of iron in the body. Diagnostic tests carried out so far use blood specimens taken with invasive method. This creates fear for the child because of the pain it causes. AIM: This study aims to obtain a non-invasive alternative diagnostic test in detecting iron deficiency in children using saliva as an examination specimen. METHODS: The design of this study was case control, with a sample of elementary school children aged 9–12 years and for women who had not experienced menstruation. The sample consisted of 40 people who were taken randomly and grouped into iron deficiency and normal. Determine the group of iron deficiency and normal was based on the results of an examination of serum iron levels. Next, saliva samples were taken to determine saliva iron levels. The characteristics of the sample data were obtained through a questionnaire, while the measurement of serum iron levels was carried out by the spectrophotometric method, and the measurement of saliva iron levels was carried out by the ELISA method. Data were analyzed using Spearman’s test. RESULTS: Based on serum iron measurements, it was found that the mean serum iron levels in children with iron deficiency were lower than normal children (38.153 ± 8.99 q/dL vs. 79.198 ± 14.2219 q/dL), on the contrary, on examination of iron levels, it was found that in children with iron deficiency, saliva iron levels were higher than in normal children (5.745 ± 3.04 q/dL vs. 2,576 ± 1.43 q/dL). The correlation test results showed a significant negative correlation between serum iron levels and moderate iron levels (p = 0.000, r = –0.518). CONCLUSION: Saliva iron levels can be used as an alternative non-invasive diagnostic test to assess children’s iron status.

Iron Deficiency Anemia in Children and Adolescents with Type I Diabetes, Is it a Real Problem?

Abstract Background: Iron deficiency anemia (IDA) in children with type I diabetes (T1D) represents a significant burden. Aim of Study: To asses iron status in children and adoles-cent with T1D of and to correlate it with glycemic control and diabetic vascular complications. Patients and Methods: Two hundred children with T1D recruited from Pediatrics and Adolescent Diabetes Unit (PADU), Ain Shams University in the period from December 2019 to July 2020. They were 123 males (61.5%) and 77 females (38.5%) aged 10.97±3.93 years (Range: 2-18 years). History taking, fundus examination and general examination were done stressing on anthropometric measurements. Labo-ratory evaluation including complete blood count, glycosylated haemoglobin (HbA1c), urinary albumin/creatinine ratio (ACR), lipid profile and patients with microcytic hypochromic anaemia underwent Serum iron, total iron-binding capacity (TIBC), serum ferritin, Hepcidin, Anti-tissue transglutaminase (IgA), Occult blood in stool and H-pylori antigen in stool. Results: Seventy two of diabetic children were anemic (36%) and fifty one had IDA (25.5). IDA was more prevalent in males. Children with T1D and IDA experienced more clinically significant hypoglycemic attacks, more DKA attacks, high fatigue severity scale and history of menorrhagia. Low body weight, low BMI, low mean corpuscular volume (MCV), high TIBC and low hepcidin level were present in diabetic children with IDA. They also had high HbA1c, neuropathy, high triglycerides and high level of low density lipoprotein (LDL cholesterol). Conclusions: IDA is a significant morbidity among chil-dren with T1D and it should be screened. Serum hepcidin levels are significantly associated with iron status in children, and could be useful indicators of ID.

The Association between Hepcidin and Iron Status in Children and Adolescents with Obesity.

Introduction Iron deficiency (ID) is the most common nutritional deficiency found in pediatric practice. A higher prevalence of ID may be found in children with obesity. Obesity is a chronic low-grade inflammatory condition. It is postulated that inflammation increases hepcidin, a regulator of iron homeostasis. The aim of this study was to investigate the associations between iron status, hepcidin, and BMI-standard deviation score (BMI-SDS) in children with and without obesity. Methods A cross-sectional study of Thai children with obesity (5 to 15 years old) versus age- and sex-matched, nonobese controls was conducted. A total of 63 children with obesity and 27 controls were enrolled. Complete blood count, serum iron, ferritin, transferrin saturation, and total iron binding capacity were analyzed. Serum hepcidin-25 was assayed using a hepcidin ELISA Kit (Human Hepc25). Results There were 63 children with obesity, the median age (IQR) being 10 (9–13) years, and 27 controls. The median (IQR) BMI-SDS of the obese group was 2.3 (2.0–2.6) vs. −0.5 ((−1.3)−0.4) of the control group. ID was diagnosed in 27 children in the obese group (42.9%); 4 of the children with obesity and ID had anemia. Serum hepcidin-25 levels of the children with ID vs. without ID in the obese group were not significantly different (median (IQR) 25 (12.9–49.2) and 26.4 (12.6–43.6), respectively) but both of them were significantly higher than controls (19.7 (8.3–25.5) ng/ml, p = 0.04). BMI-SDS was positively correlated with hepcidin-25 (r = 0.28, p = 0.001). Conclusion Prevalence of iron deficiency in Thai children with obesity and serum hepcidin-25 was higher than controls. Further study in a larger population, preferably with interventions such as weight loss program, is warranted to clarify this association.