Oral Iron Intake Research Articles

Association of urinary glyphosate levels with iron homeostasis among a representative sample of US adults: NHANES 2013–2018

PurposeGlyphosate and glyphosate-based herbicides (GBH), widely used globally, were initially considered harmless to humans. Experimental studies have suggested that these substances can disrupt iron homeostasis by interfering with iron uptake or triggering inflammatory responses. However, their potential impact on human iron homeostasis remains underexplored. Approach and resultsWe analyzed data from 5812 participants aged three and older from the 2013 to 2018 NHANES. We investigated the relationships between urinary glyphosate levels, oral iron intake, and markers of iron homeostasis, including serum iron, unsaturated iron-binding capacity (UIBC), total iron-binding capacity (TIBC), transferrin saturation, ferritin, and transferrin receptor. Higher urinary glyphosate levels were positively associated with oral iron intake (β = 1.310, S.E. = 0.382, P = 0.001). A one-unit increase in the natural logarithm (ln)-glyphosate was associated with lower serum iron (β = − 4.236, 95 % CI = − 6.432 to − 2.039, P < 0.001) and ferritin (β = − 9.994, 95 % CI = − 17.342 to − 2.647, P = 0.009), and higher UIBC (β = 5.431, 95 % CI = 1.061–9.800, P = 0.018) and transferrin receptor levels (β = 0.139, 95 % CI = 0.015–0.263, P = 0.029). Increasing glyphosate exposure was associated with significant decreases in serum iron and ferritin across exposure quintiles (trend P-values = 0.003 and 0.018, respectively). ConclusionsHigher glyphosate exposure is associated with reduced iron availability, suggesting potential disruptions in iron absorption. These findings underscore the need for further research into the health implications of glyphosate exposure on iron homeostasis.

The magnitude of the plasma hepcidin response to oral iron supplements depends on the iron dosage.

Iron deficiency without anaemia is a common health problem, especially in young menstruating women. The efficacy of the usually recommended oral iron supplementation is limited due to increased plasma hepcidin concentration, which reduces iron absorption and leads to side effects such as intestinal irritation. This observation raises the question of how low-dose iron therapy may affect plasma hepcidin levels and whether oral iron intake dose-dependently affects plasma hepcidin production. Fifteen non-anaemic women with iron deficiency (serum ferritin ≤30 ng/ml) received a single dose of 0, 6, 30, or 60 mg of elemental oral iron as ferrous sulfate on different days. Plasma hepcidin was measured before and seven hours after each dose. Subjects had an average age of 23 (standard deviation = 3.0) years and serum ferritin of 24 ng/ml (interquartile range = 16-27). The highest mean change in plasma hepcidin levels was measured after ingesting 60 mg of iron, increasing from 2.1 ng/ml (interquartile range = 1.6-2.9) to 4.1 ng/ml (interquartile range = 2.5-6.9;p< 0.001). Iron had a significant dose-dependent effect on the absolute change in plasma hepcidin (p = 0.008), where lower iron dose supplementation resulted in lower plasma hepcidin levels. Serum ferritin levels were significantly correlated with fasting plasma hepcidin levels (R2= 0.504, p = 0.003) and the change in plasma hepcidin concentration after iron intake (R2= 0.529, p = 0.002). We found a dose-dependent effect of iron supplementation on plasma hepcidin levels. Lower iron dosage results in a smaller increase in hepcidin and might thus lead to more efficient intestinal iron absorption and fewer side effects. The effectiveness and side effects of low-dose iron treatment in women with iron deficiency should be further investigated. This study was registered at the Swiss National Clinical Trials Portal (2021-00312) and ClinicalTrials.gov (NCT04735848).

Testing Equivalence of Two Doses of Intravenous Iron to Treat Iron Deficiency in Pregnancy: A Randomized Controlled Trial

(BJOG. 2023;130:15–23) The most common nutritional disorder worldwide is iron deficiency (ID). Iron is vital for many bodily functions, so when women who are pregnant suffer from ID they are more likely to experience complications during pregnancy as well as deliver babies at risk for neonatal complications. It is estimated that about 47% of women suffer from ID during pregnancy even though it is a treatable disorder. Intravenous iron (IVI) has been proven to help pregnant women who are nonresponsive to oral iron intake. This study compared the effects of 2 different doses of IVI in pregnant women.

Acil Servise Demir Zehirlenmesi İle Başvuran Çocuk Vakalarının Değerlendirilmesi

Purpose: In this study, it was aimed to contribute to the data on childhood iron intoxication in our country due to the retrospective evaluation of demographic, epidemiological, clinical features, treatments, and complications of the patients who applied for intoxication after oral iron intake.&#x0D; Materials and Methods: Patients admitted to a Pediatric Emergency Service of the Faculty of Medicine diagnosed with iron intoxication between 2018 and 2020 were retrospectively investigated. The patients' demographic characteristics, information about intoxication, and laboratory results were recorded, and statistical analyzes were performed.&#x0D; Results: Of the 12 patients included in the study, 66.7% were female, and 33.3% were male. The mean age was 81.3±83.52 months. When separated by age group, 66.6% of the patients were younger than 5-year-old. Those who came to the hospital via an ambulance were only 25%. All patients were transported to the hospital within an average of 40±15 minutes. While there was no life-threatening risk in 7 patients, the condition of 5 patients was severe. Only 2 of the patients took it to suicide. All cases received iron orally. 1 patient presented abdominal pain, and 2 patients presented nausea and vomiting. Activated charcoal was administered to 4 of the patients. In the laboratory follow-ups of the patients, all mean results, excluding iron, were normal. In addition, the blood gases of the patients at the time of admission were compensated metabolic syndrome.&#x0D; Conclusion: As a pediatric emergency, Iron intoxication in children remains important as one of the preventable morbidity and mortality causes. We believe that iron preparations are packaged in a single-dose form and do not have an attractive taste and appearance for children, have protective caps in medicine boxes, and when physicians prescribe iron drugs to adult patients, warning them about toxicity in children will reduce mortality and morbidity.

Effect of Oral Iron Supplementation on Cognitive Function among Children and Adolescents in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

There is abundant evidence showing that iron deficiency is closely linked with delayed brain development, worse school performance, and behavioral abnormalities. However, evidence on the impact of iron supplementation among children and adolescents in low- and middle-income countries (LMICs) has been inconsistent. This study aims to examine the effect of oral iron supplementation on cognitive function among children and adolescents in LMICs. A systematic review and meta-analysis was conducted to examine the impact of iron supplementation on cognitive function (including intelligence, attention, short-term memory, long-term memory, and school performance) among children and adolescents aged 5 to 19. We searched PubMed, Embase, Web of Science, CINAHL, and references of related articles published from the inception of the databases to 1 May 2022. Random-effects pooled standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated to estimate the effect of iron supplementation on cognitive function. We also investigated the heterogeneity of the effects using subgroup and meta-regression analyses. This review was registered with PROSPERO (CRD42020179064). Nine studies with 1196 individual participants from five countries were identified and included. Iron had a positive impact on intelligence test scores among children and adolescents (SMD = 0.47, 95% confidence interval [CI]: 0.10, 0.83). Meta-regression showed that the intelligence test scores improved with increasing the iron supplement dose (odds ratio [CI] = 1.02, 95% CI: 1.00, 1.04). There were no significant effects on attention, short-term memory, long-term memory, or school performance. Oral iron intake can improve the intelligence test scores of children and adolescents in LMICs and should be considered for future nutritional interventions.

Залізодефіцитна анемія під час вагітності та наслідки, пов'язані з нею

Анотація: у статті узагальнено аргументи та контраргументи в рамках наукової дискусії щодо питання механізмів розвитку залізодефіцитної анемії. Основна мета цього дослідження це узагальнення інформації про вплив залізодефіцитної анемії під час вагітності та наслідків, пов’язаних з нею. Завдяки детальному вивченню літературних джерел, їхній систематизації та підходів до вирішення проблеми, було виявлено, що антенатальна анемія є фактором ризику материнської та перинатальної смертності, передчасних пологів, новонароджених з низькою масою тіла та післяпологових кровотеч. Анемія матері також може бути пов’язана з поганими результатами розвитку нервової системи дитини. Останні досягнення системного та плацентарного гомеостазу заліза можуть покращити терапевтичну ефективність шляхом зміни дози та частоти перорального прийому заліза. А внутрішньовенне введення заліза є безпечним засобом для швидкої корекції анемії матері. Актуальність дослідження даної патології полягає в тому, що вона багато в чому визначає перинатальну та материнську захворюваність. Однак, на сьогодні немає чіткого уявлення про особливості молекулярних та судинних механізмів залізодефіцитної анемії, тому це призводить до суперечностей у лікуванні таких вагітних жінок, що перешкоджає своєчасному, адекватному лікуванню та профілактиці. У дослідженні були використані методи бібліографічного та контент-аналізу літератури, семантичного групування, а також порівняльного підходу та синтезу відносно питань нових досліджень по особливостям механізмів розвитку залізодефіцитної анемії, гомеостазу заліза та поточних визначень ЗДА під час вагітності, несприятливі наслідки для матері та новонародженого, пов’язані з анемією, а також останні рекомендації щодо лікування ЗДА під час вагітності та післяпологового періоду. Офіційні документи, знайдені на веб-сайтах, були проаналізовані, а відповідна інформація згрупована та порівняна. В статті представлено результати досліджень, які засвідчили, що залізо відіграє ключову роль у нормальному і патологічному перебігу вагітності та впливає на розвиток новонародженого. Поглинання і метаболізм заліза суворо регулюються, і повне вивчення метаболізму заліза під час вагітності представляє інтерес для запобігання ускладнень у матері та плода. У цій роботі підкреслюється необхідність раннього виявлення дефіциту заліза. Крім того, є важливим лікувати дефіцит для забезпечення оптимального розвитку новонароджених. Наразі такі заходи, як пероральне або внутрішньовенне введення заліза, схоже, не працюють у масштабах, необхідних для досягнення цілей ВООЗ знизити поширеність анемії у жінок репродуктивного віку на 50%. Частково це може бути пов’язано з невизначеністю щодо того, як найкраще досліджувати, запобігати та лікувати материнську анемію. Розвиток нашого розуміння фізіології заліза привів до можливості значного покращення шляхом зміни стратегії дозування перорального заліза. Нові лабораторні показники заліза, такі як гепсидин, можуть в кінцевому підсумку допомогти керувати терапією дефіциту заліза, але нещодавнє дослідження не виявило жодної переваги від використання підходу скринінгу та лікування на основі гепсидину в порівнянні з рекомендованою схемою ВООЗ. Тому необхідні подальші дослідження щодо результатів, орієнтованих на пацієнта та економічної ефективності. Результати проведеного дослідження можуть бути корисними для лікарів первинної ланки, гінекологів, терапевтів.

Treatment Efficacy of Oral and Intravenous Iron Delivery Routes for Anemic Pregnant Women

Background: Although it particularly is prevalent in less-developed countries, anemia in pregnancy remains a significant problem in the developed world. It is one of the major health issues during pregnancy. The principle cause of anemia is iron deficiency, which is dependent on the patient's dietary status. Treatment of iron deficiency anemia is critically essential during pregnancy to prevent bad maternal and neonatal outcomes Objective: The study aimed to compare the oral and intravenous iron delivery routes in anemic pregnant women. Study design: It is an experimental study. The 120 patients who visited the gynecology department of the hospital for the duration of one year from June 2021 to May 2022 were selected. Material and Methods: The data was taken from 120 patients that were admitted in Department of Obstetrics and Gynecology of Sindh Government Hospital Landis, The duration of study was one year. All the patients were aware of the study, as written consent was taken from them. The oral iron intake was given to 58 women and to the other 62 women the intravenous injections of iron was administrated during their pregnancy. All the participants completed their follow-up sessions throughout the year. The blood samples and the other data related to pregnancy was collected from each patient. Results: The back-count of tablets was carried out and it was observed that almost 89% women took their iron supplements daily. There were only 5% patients that took 50% of their iron tablets. The average dose that was given to women was 600mg in case of elemental intravenous iron. The average level of iron and ferritin are observed to be higher in the group administrated with intravenous injection as compared to the other group. The chances of hemoglobin rise were more in case of intravenously administered patients. Conclusion: The study was carried out to compare the oral and intravenous iron delivery routes in anemic pregnant women. It was found that intravenous delivery route of iron in form of iron sucrose is safe and an effective method for the iron therapy in anemic pregnant women, as it restores the hemoglobin stores efficiently as compared to other group. However, it is costly as it need hospitalization. As an alternative oral iron can also be used if the women has severe iron deficiency in the third trimester. Keywords: Intravenous iron delivery routes and anemic pregnant women.

Duodenal Pseudomelanosis: A Literature Review.

Duodenal pseudomelanosis (also known as pseudomelanosis duodeni) is a rare endoscopic incidental finding defined by a pigmentation limited to the apex of the intestinal villi, which requires histological confirmation. While its exact pathogenesis is still poorly understood, it appears free from clinical consequences. This condition is believed to be associated with oral iron intake, antihypertensive drugs containing a sulfur moiety (i.e., hydralazine, furosemide), and several chronic diseases (i.e., hypertension, end-stage renal disease, diabetes). However, the exact prevalence of these treatments and comorbidities among patients with duodenal pseudomelanosis is not clearly defined. Several case reports and case series about duodenal pseudomelanosis have been published in recent years. In this review, we aimed to clearly define its endoscopic and microscopic presentation; its epidemiology, associated comorbidities, and drugs; the most useful special histochemical techniques used to classify the nature of the pigmentation; and the most relevant differential diagnoses. In addition, by considering our findings, we also formulated a number of hypotheses about its pathogenesis.

Carboxymethyl cellulose-based orally disintegrating films enriched with natural plant extract for oral iron delivery

The aim of this work was to provide an alternative for iron intake using carboxymethyl cellulose (CMC)-based orally disintegrating films (ODF) containing ora-pro-nobis (OPN) extract or microparticles. The novelty is based on the use of iron from an alternative vegetable source into ODF systems employing only natural compounds. OPN is a native and underused plant that presents high contents of proteins and minerals. Different formulations of CMC-based ODF were produced employing the tape casting technique and characterised by colour parameters, contact angle, surface pH, mechanical properties, oral disintegration time, infrared spectroscopy, microstructure by scanning electron microscopy (SEM) and atomic force microscopy (AFM), and iron release. The results indicated the formation of hydrophilic systems with fast disintegrating times (<50 s) for all formulations. The release of iron occurred in a maximum time of 26 and 50 min for CMC-based ODF-microparticles and CMC-based ODF-OPN extract, respectively, following a Fickian diffusion mechanism. The systems developed could be a potential and innovative application for a vehicle of oral iron intake, facilitating the reduction of iron-related diseases in human health.

Prevalence of iron deficiency in the first trimester in nonanemic pregnant women at Tanta delta of Egypt

Background Throughout gestation, iron requirements increase significantly to support a growing red cell volume, a developing fetus, and a developing placenta, and also any predicted or unplanned blood loss after birth, especially with cesarean delivery. Aim The scope of this study was to evaluate the occurrence of iron deficiency in the first trimester, in nonanemic pregnant women, and its relation to the outcome of pregnancy. Patients and methods This study was conducted on 100 pregnant women in the first trimester attending the Obstetric Department at Tanta University Hospital duration of research from October 2019 to October 2020, 4 ml of venous blood sample was collected, 2 ml was collected on EDTA vacutainers for complete blood picture, the other 2 ml was collected on plain tube for estimation of maternal serum iron, ferritin, centrifugated at high speed of 2000 rpm, and serum was stored at −20°C until analysis. Results This study was done on 100 cases to evaluate the frequency of iron deficiency in the first trimester, in nonanemic pregnant women and its relation on pregnancy. Conclusion Iron deficiency in gestation is indeed a common problem, according to this study, and it is largely linked to greater maternal per-partum morbidity. Pregnant women should really be encouraged to begin antenatal care as soon as possible, so that their hematological status can be adequately optimized through regular oral iron intake and/or parenteral iron supplementation ahead to labor and delivery, avoiding any need for blood transfusion.

The overbearing physiological changes marring iron indices interpretation in response to iron therapy during pregnancy

Background: Iron deficiency anemia (IDA) is most common cause of anemia in pregnancy. In order to prevent this iron supplementation is routinely practiced as a prophylactic measure in pregnant women all over. The biochemical parameters assessed in IDA comprise an iron profile evaluation which consists of estimation of serum ferritin, serum iron, total iron binding capacity(TIBC), serum transferrin levels and calculation of transferrin saturation. These biochemical parameters are subjected to variations due to maternal adaption phenomenon. Aim: In the current study we have chosen three iron indices, serum iron, serum TIBC and transferrin saturation percent to note their performance in diagnosing and monitoring the response to iron therapy in pregnant women. Methodology: The study population are thirty- six pregnant women in their early second trimester, who are diagnosed with mild iron deficiency anemia (Hemoglobin between 9 and 11 g %). Iron parameters, serum iron, serum TIBC and transferrin saturation levels were analyzed in these women. They are then given oral iron preparation in the form of Ferrous sulphate for a period of twelve weeks. After this the Hemoglobin level, serum iron, TIBC and transferrin saturation levels are re-analyzed in these women. Results: The hemoglobin levels increased (p= 0.002). as expected after oral iron intake. Serum iron levels improved from 58.19±39.07 to 64.78±34.96 μg/dl. Serum TIBC value before supplementation 234.22±134.49 increased to 437.33±94.95 after, which contradicts the expected pattern seen in response to therapy in general population. Similarly absurdity prevails in transferrin saturation index levels which dropped from 36.8 ± 31.8 to 16.3 ± 10.6. Conclusion: The iron status during pregnancy is highly influenced by the maternal changes. And a blind interpretation of the report can lead to erroneous diagnosis. The interpretation of values should be based on the trimester specific reference ranges during pregnancy.

Comparative study of different oral iron preparations in Gynecological and postnatal patients

This study is comparison of different oral iron preparations in females of reproductive age group attending obstetrics and gynecological department as postnatal and gynecological cases. Aim of the study is to identify the target group for correction of anemia in reproductive age group as this will ensure lesser number of anemic females entering state of pregnancy, hence lower maternal and fetal/neonatal morbidity and mortality due to anemia in pregnancy. Because of altered physiology in pregnancy, diagnosis and treatment of anemia poses a challenge, whereas improved hemoglobin and iron storage before conception will ensure better maternal and fetal outcomes. Postnatal patients have better results of oral iron intake and higher compliance for oral iron preparations than gynecological patients. Ferrous ascorbate showed maximum improvement in hemoglobin and serum ferritin levels after 3 months of treatment among 5 different oral iron preparations in postnatal and gynecological cases.

Effects of oral iron and calcium supplement on the pharmacokinetics and pharmacodynamics of molidustat: an oral HIF\u2013PH inhibitor for the treatment of renal anaemia

PurposeThe present studies assessed the drug–drug interaction of molidustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor, with iron and calcium supplements, which are common medications in patients with anaemia due to chronic kidney disease (CKD).MethodsForty-two healthy men received molidustat alone (fasted or fed) or combined with oral iron(II) or calcium(II), given immediately before or between 4 h before and 1 h after molidustat in three randomized, open-label, crossover studies (12–15 participants per study). Molidustat AUC and Cmax were assessed as the main pharmacokinetic parameters, and endogenous erythropoietin (EPO) was measured to evaluate pharmacodynamics.ResultsDepending on prandial state, concomitant intake of iron(II) reduced molidustat AUC and Cmax by 50–75% and 46–84%, respectively, and EPO AUC(0-24) and Cmax by 31–44% and 36–48%, respectively. The influence of iron(II) declined with increasing the time interval to the intake of molidustat, with reductions in molidustat AUC and Cmax of 9% and 10%, respectively, when iron(II) intake occurred 4 h before molidustat. Accordingly, effects on endogenous EPO were less pronounced with increased time separation between oral iron(II) and molidustat intake. Calcium(II) reduced molidustat AUC and Cmax by 15% and 47%, respectively, without influence on EPO response. All treatments were well tolerated.ConclusionsIn contrast to concomitant oral intake of calcium, the effect of oral iron supplements on molidustat pharmacokinetics and pharmacodynamics should be considered, and the two agents should be administered with an appropriate time separation.

Chronic iron overload causing haemochromatosis and hepatopathy in 21 horses and one donkey.

Iron toxicosis is rarely reported in horses and chronic excessive oral iron intake has not been reported to cause clinical symptoms in equids. This case series describes 21 genetically unrelated horses and one donkey with chronic iron overload causing haemochromatosis and hepatopathy. Case series. All equids showing clinical signs compatible with chronic liver disease presented to Utrecht University and diagnosed with iron overload and haemochromatosis based on histopathological evaluation of liver tissue and/or blood transferrin saturation levels of >80% and proof of excess dietary iron intake due to excess iron content in drinking water were included. This study included 22 equids. All tested animals (n=19) had transferrin saturation >80% and 21 of 22 had increased gamma-glutamyltransferase (γGT). Ultrasonography revealed rounded liver margins in five out of six horses and increased echogenicity in 4/6. Histological examination of liver tissue of 12 animals showed hepatitis, fibrosis and haemosiderin accumulation in macrophages and hepatocytes. Post-mortem examination also revealed haemosiderin accumulation in other organs in all seven examined animals. High iron content in drinking water was identified as the source of iron overload in all cases. All animals were housed under the same conditions for a minimum of 9years prior to diagnosis of haemochromatosis. Of 22 animals, 13 survived until 1 January 2018, ranging from 17 to 79months post diagnosis. Histology of liver tissue was not available for 10 of 22 cases. Chronic iron overload can lead to haemochromatosis and hepatopathy in equids. Development of disease is slow and clinical signs are nonspecific. Long-term excessive iron intake in equids should be avoided. If animals drink from natural water sources, it is important to test the water for iron content. The Summary is available in Spanish - see Supporting Information.

Melanosis? Think Again: A Case of Pseudomelanosis duodeni and Jejunal Hemangiomas

Melanosis coli is a common cause of hyperpigmented lesions in the GI tract that typically result from laxative overuse. Herein we describe a case of pseudomelanosis duodeni and jejunal hemangiomas discovered after push enteroscopy for an un-localized GI bleed. Though similar in appearance, pseudomelanosis is actually due to deposition of hemosiderin in lamina propria (LP) macrophages. An 83-year-old Asian female presented with recurrent hospitalizations for melena and severe anemia. Past medical history included transfusion-dependent iron deficiency anemia from chronic GI bleeding, hypertension, diabetes, heart failure, and atrial fibrillation not on anticoagulation. Her initial workup began in 2014 and EGD demonstrated erosive gastropathy with negative H. pylori. Colonoscopy demonstrated three 3-5 mm polyps and diverticulosis but no signs of acute bleeding. Repeat hospitalization for anemia with EGD in 2015 showed no source of bleeding. Colonoscopy showed two 5-8 mm polyps and diverticulosis but no bleeding. Outpatient capsule endoscopy in 2015 was unrevealing. Repeat hospitalization in April 2018 with colonoscopy revealed melena from the ileum and several small polyps in the cecal region. Push-enteroscopy revealed dark speckled pigmentation in the duodenum and jejunum. Two bleeding hemangiomas in the jejunum were found and ablated with APC then clipped. Duodenal biopsies demonstrated hemosiderin deposition within the LP macrophages consistent with a diagnosis of pseudomelanosis duodeni. Pseudomelanosis duodeni is characterized by the presence of brownish or blackish pigmentation in duodenal mucosa. It is associated with various medical conditions including, diabetes, renal disease, GI bleeding, hypertension, heart failure, oral iron intake, and use of erythropoiesis-stimulating agents. Histologic differential includes hemochromatosis, brown bowel syndrome, and malignant melanoma. Pseudomelanosis duodeni has histology notable for iron sulfide and hemosiderin deposits in the LP macrophages. This is in contrast to the accumulation of lipofuscin in the LP macrophages due to laxative overuse seen in melanosis coli. Interestingly, the hyperpigmentation made it easier to identify the jejunal hemangiomas; in a similar fashion to melanosis coli making it easier to identify polyps. Although this disease is quite rare and benign, it warrants tissue biopsy to rule out other worrisome etiologies.2546_A Figure 1. Dark speckled pigmentation scattered throughout the small bowel.2546_B Figure 2. Hemangiomas in the jejunum (blue/white arrows). Right image shows bleeding hemangioma (blue/white arrow).2546_C Figure 3. Left image demonstrates mucosal changes after APC ablation of bleeding hemangiomas (white/blue arrows). Right image demonstrates clips placed (red/white arrow) after APC ablation.

Frequency, types, and treatment of anemia in Turkish patients with inflammatory bowel disease.

AIMTo specify the type and prevalence of anemia along with a treatment approach for inflammatory bowel disease (IBD).METHODSWe conducted a retrospective study on 465 patients who were diagnosed with IBD and followed up at our hospital from June 2015 to June 2016 [male: 254, female: 211; average age: 47 ± 14.4; Crohn’s disease (CD): 257, Ulcerative Colitis (UC): 208]. Epidemiological and clinical data, such as sex, age, age of diagnosis, type of IBD, disease extension, disease behavior and duration, treatments for IBD and anemia, and surgical history were obtained for each patient. Per World Health Organization guidelines, anemia was diagnosed for males if hemoglobin values were less than 13 g/dL and for females if hemoglobin values were less than 12 g/dL.RESULTSWe determined that 51.6% of the patients had anemia, which was more frequent in women then men (64% vs 41.3%, P < 0.001). Anemia frequency was higher in CD cases (57.6%) than in UC cases (44.2%) (P = 0.004). CD involvements were as follows: 48.2% in ileal involvement, 19% in colonic involvement, and 32.8% in ileocolonic involvement. Furthermore, 27.5% of UC patients had proctitis (E1) involvement, 41% of them had involvement in left colitis (E2), and 31.5% had pancolitis involvement. There was no significant relationship between anemia frequency and duration of disease (P = 0.55). Iron deficiency anemia (IDA) was the most common type of anemia in this cohort. Moreover, because anemia parameters have not been evaluated during follow-up of 15.3% of patients, the etiology of anemia has not been clarified. Fifty percent of patients with anemia received treatment. Twenty-three percent of IDA patients had oral iron intake and forty-one percent of IDA patients had parenteral iron treatment. Fifty-three percent of patients who were suffering from megaloblastic anemia received B12/folic acid treatment.CONCLUSIONWe found out that almost half of all IBD patients (51.6%) had anemia, the most frequent of which was IDA. Almost half of these patients received treatment. We should increase the treatment rate in our IBD patients that have anemia.

Pseudomelanosis of the Stomach and Duodenum

Pseudomelanosis of the upper gastrointestinal tract is rare and classically associated with oral iron intake, upper gastrointestinal bleeding, diabetes mellitus, end stage renal disease and antihypertensive medication use. Duodenal involvement is well described, but only few cases of combined stomach and duodenal involvement have been reported to date. The lesion is indolent but can mimic more concerning entities like malignant melanoma.

Effects of an enhanced iron dense foods offering in the daily meals served in geriatric institutions on measures of iron deficiency anemia

BackgroundIron deficiency is one of the most common causes of anemia in geriatric patients. Although the oral iron intake is often inadequate, the potential of iron dense foods in the daily meals of geriatric institutions is rarely considered. To test during a 1- year span whether an improved frequency of iron dense foods in the daily meals has an impact on the oral iron intake, the hemoglobin concentration and anemia prevalence of institutionalized geriatric patients. A parallel, open, pre-and post-oral nutrition intervention study. Two geriatric hospitals participated as intervention centers and one as comparison center.MethodsIn the two intervention centers, a menu plan adapted with iron dense foods was applied. In the comparison center the regular meals provisions was continued. At months 1, 6 and 12 of the intervention time the routine blood-parameter hemoglobin was taken from the geriatric hospital’s medical report. Component analysis assessed the nutrient density of the offered meals. 2-day-weighing records realized at month 1 and 6 of intervention-time assessed the iron intake. Ninety-nine geriatric patients in the intervention centers and 37 in the comparison center. All of them had multiple chronic diseases and an average age of 84 years. With the non-parametric Friedmann-Test for repeated measurements, we establish differences within the groups. With the Mann-Whitney-U-Test, we establish differences between the groups. For dichotomous variables, the chi-square-test was used. A p-value of< 0.05 was considered statistically significant for all analyses.ResultsIn the intervention centers the iron intake (p < 0.001) and the hemoglobin concentration (p = 0.002) improved significantly (p < 0.001). As in the comparison center the frequency of meat and sausage offerings was twice as much as recommended also the hemoglobin concentration improved (p = 0.001).ConclusionGeriatric patients with anemia or low hemoglobin level benefit optimally from a diet rich in iron dense foods. Enhanced access to such can indeed correct iron deficiency anemia.Trial registrationThe ethics committee of the Municipality of Vienna (EK-13-043-0513) approved the study.

Iron Absorption from Iron-Enriched Aspergillus oryzae Is Similar to Ferrous Sulfate in Healthy Female Subjects

BackgroundIron deficiency anemia (IDA) remains a global health issue, affecting mainly children and adolescent and pregnant women. Because of problems associated with current iron compounds used in both supplementation and fortification areas, there is an emerging interest in new natural iron sources to combat IDA. ObjectiveThe objective of this study was to compare the iron absorption of iron-enriched Aspergillus oryzae [Aspiron (ASP)] with FeSO4 in humans. MethodsIron absorption was assessed using stable isotope and serum iron response methods after oral intake of iron by healthy women in 2 separate studies. In the first study, ASP was intrinsically labelled with 58Fe into a dry form containing 8% iron. Subjects (n = 16, 18–35 y) were randomly assigned to consume liquid semipurified meals labelled with 2 stable iron isotopes, 57FeSO4 (10 mg) and ASP containing 2 mg 58Fe and 8 mg natural abundance iron, in 2 visits. Isotope enrichment was measured 2 wk after the last meal was eaten. In the second study, 17 subjects were randomly assigned to consume a test meal with 3 iron supplements during 3 separate visits: FeSO4, 10 mg Fe, and ASP in 2 iron doses, 10 mg and 20 mg. Changes in serum iron were measured at regular intervals for 4 h after supplementation. ResultsThe first study showed that the difference in iron absorption from FeSO4 and ASP was not significant (17.18% ± 14.2% compared to 15.14% ± 12.3%; P = 0.07). The results of the second study suggested that the iron from ASP was released slowly compared to FeSO4 and the area under the curve did not reflect the absorption of ASP iron, but rather the rate of iron release. ConclusionsIron-enriched A. oryzae has high relative bioavailability and may cause lower iron surges into the blood compared to FeSO4.

High-Dosed Intravenous Iron Replacement Therapy for Iron Deficiency Anemia Does Not Hinder Drug-Induced Amelioration of Disease Activity in IBD Patients

BACKGROUND: Iron deficiency and iron deficiency anemia (IDA) are common complications in IBD patients, and can seriously affect quality of life, hospitalization rates, and time lost from work. In IBD patients, anemia is caused by chronic blood loss and/or impaired iron intake and absorption. International guidelines recommend intravenous iron supplementation in IBD patients with moderate-severe anemia or intolerance to oral iron. While oral supplements are convenient and relatively inexpensive, they fail to compensate continuous iron loss due to inadequate intestinal absorption in the presence of inflammation. Oral iron intake is associated with gastrointestinal side-effects including abdominal pain and nausea. Moreover, mounting evidence from animal and human studies shows that non-absorbed iron enhances mucosal inflammation. Intravenous iron has been demonstrated to be safe, effective and well tolerated in correction of IDA and maintenance of iron stores in patients with IBD. Intravenous ferric carboxymaltose (FCM; Ferinject® 50mg ferric iron(III)/mL suspension) can be administered in single 15-minute infusions of up to 1,000mg per week. Here, we assess the effect of high-dosed intravenous FCM on inflammatory activity in IBD patients. METHODS: A prospective non-interventional post-marketing study was performed in 101 centers in Germany to assess efficacy, tolerability, and convenience of Ferinject® in clinical practice. Alongside primary outcomes including response rates and adverse events, changes in clinical disease indices (CDAI/CAI), changes in CRP values, and self-reported disease-related symptoms (fatigue, concentration lack, headache, paleness of mucous membranes, hair loss, (exertional) dyspnoea, sleeping disorders, restless legs syndrome) rated on a severity scale of 1 to 4, were analyzed. Patients were additionally analyzed in subgroups according to baseline CRP levels (<5mg/L, >5mg/L, 5-10mg/L, >10mg/L). RESULTS: Intravenous FCM was administered to 224 subjects (127 CD; 97 UC). Mean total iron dose over ca. 12 weeks was 1,139mg (range: 100mg-4,800mg). 76.7% of doses were between 500mg and 2,000mg. Concomitant drugs included aminosalicylates (89 patients/46.1%), corticosteroids (84/43.5%), immunosuppressants (36/18.7%), biologics (36/19%), antibiotics (8/4.1%) and antidiarrheics (11/5.7%). Although patients (n=97) with elevated CD or UC activity indices (CDAI ≥150; CAI ≥5) presented with lower mean Hb values at baseline compared to those with normal activity indices, mean Hb levels at end of study (EOS) were similar. Subjects with higher activity indices presented with higher mean CRP values at baseline (6.1mg/L) compared to those with normal activity indices (3.6mg/L). CRP levels decreased significantly during the observation period, falling from 6.4mg/L to 3.5mg/L in mean (median 1.9 -1.0mg/L), indicating a general reduction in inflammatory activity, which was independent of baseline Hb levels. Change in CRP levels was statistically significant in subgroups of patients with high disease activity, CD and UC patients treated with a total dose of 500-1000mg iron, and patients who completed therapy. Amelioration of inflammatory activity as indicated by lower CRP levels was confirmed by reduced mean clinical disease activity indices (CDAI/CAI). Patients in both CRP subgroups showed increases in Hb, s-ferritin and TSAT, but reduced CRP levels and fewer symptoms. CONCLUSION(S): High-dosed FCM therapy does not appear to inhibit drug-induced amelioration of inflammatory activity in patients with IBD.