Poor Iron Status Research Articles

Fisiopatología e impacto de la deficiencia de hierro y la anemia en las mujeres gestantes y en los recién nacidos/infantes

La deficiencia de hierro es el trastorno de deficiencia más prevalente; y la anemia por deficiencia de hierro es la forma de anemia más frecuente en las mujeres gestantes. Son causas menores de la anemia la deficiencia de folato y de la vitamina B12; así como las hemoglobinopatías y la anemia hemolítica. Se define a la anemia como niveles de hemoglobina <110 g/L en el primer y en el tercer trimestre y <105 g/L en el segundo trimestre de la gestación. El diagnóstico se basa en la medición de los valores de la hemoglobina, así como en un perfil hematológico completo y la determinación de los niveles plasmáticos de ferritina, los cuales pueden sustentarse en la saturación de la transferrina en el plasma y el receptor soluble de transferrina en el suero (sTfR, soluble transferrin receptor). En las mujeres no gestantes en edad reproductiva, un 40% tiene valores de ferritina por debajo de 30 μg/L, lo cual indica que las reservas de hierro o son pequeñas o están ausentes; y, en consecuencia, tienen un pobre nivel del hierro con respecto a un embarazo futuro. Los requerimientos para la absorción del hierro aumentan durante la gestación, de 0,8 mg/día en el primer trimestre a 7,5 mg/día en el tercer trimestre, siendo el promedio 4,4 mg/día. En cuanto a la edad reproductiva, un 40% de las mujeres en Escandinavia y posiblemente hasta un 80% de las mujeres peruanas (dependiendo de su condición social y su lugar de residencia) tienen niveles bajos de hierro con respecto a un embarazo futuro. En el Perú, la prevalencia de la anemia en las mujeres no gestantes de edad reproductiva es 22%, y en las mujeres gestantes es de 27%. La prevalencia de la anemia en el tercer trimestre puede variar desde 14 hasta 52% en las mujeres que no toman suplementos de hierro (dependiendo del país y de la condición social); y de 0 a 25% en las mujeres que toman suplementos de hierro (dependiendo de las dosis del citado elemento). La deficiencia de hierro y la anemia poseen consecuencias severas en las mujeres gestantes, estando asociadas con una menor capacidad para trabajar, fatiga, debilidad y disturbios psíquicos, condiciones que en su totalidad afectan la calidad de vida tanto a nivel físico como psíquico. En el feto/en el recién nacido la deficiencia de hierro puede tener consecuencias serias para el desarrollo de las funciones cerebrales. Incrementa la prevalencia de nacimientos prematuros y la frecuencia de peso bajo al nacer, así como la mortalidad perinatal. Los niños nacidos de madres con deficiencia de hierro tienen un menor desarrollo cognitivo, motor, socio-emocional y neurofisiológico, así como menores valores del cociente de inteligencia en comparación con los infantes y niños nacidos de madres con niveles normales de hierro. La anemia por deficiencia de hierro posee consecuencias serias en las mujeres y en los fetos/neonatos; y requiere una intervención eficiente con una profilaxis y/o tratamiento con hierro. En el futuro, los sistemas de cuidado de la salud prenatal deberán dedicar más esfuerzos para erradicar este problema tan significativo. Palabras clave: Anemia; deficiencia de hierro; embarazo.

Diet-induced obese rats have higher iron requirements and are more vulnerable to iron deficiency

Since obesity is associated with poorer iron status, the effects of diet-induced obesity on iron status and iron-regulatory pathways were examined. Weanling male diet-induced obese sensitive (n = 12/diet group) and resistant (n = 12/diet group) rats were fed one of four high-fat, high-energy diets supplemented with 5 (5Fe, low), 15 (15Fe, marginal), 35 (35Fe, normal) or 70 (70Fe, high) mg iron/kg diet for 12 weeks. At the end of the study, rats in each diet group were categorised as obese (>19 %) or lean (<17 %) based on percentage body fat. Obese rats gained more weight, had larger total lean mass, consumed more food and showed greater feed efficiency compared with lean rats. Obese rats fed the 5Fe and 15Fe diets had poorer iron status than lean rats fed the same diet. Obese 5Fe rats had lower serum iron and more severe iron-deficiency anaemia. Obese 15Fe rats had lower mean corpuscular haemoglobin and liver iron concentrations. Hepcidin mRNA expression in liver and adipose tissue was similar for obese and lean rats. Iron concentration and content of the iron transporters divalent metal transporter 1 and ferroportin 1 in duodenal mucosa were also similar. Obese rats that were larger, regardless of adiposity, had higher iron requirements compared with lean rats that appeared independent of hepcidin, inflammation and intestinal iron absorption. Higher iron requirements may have resulted from larger accretion of body mass and blood volume. Greater food consumption did not compensate for the higher iron needs, indicating increased susceptibility to iron deficiency.

Comparison of serum prohepcidin and iron metabolism parameters in obese and non-obese elderly individuals

Current knowledge indicates that there is a close connection between being overweight, obesity and iron metabolism disorders,but the underlying mechanism is unclear. Hepcidin could be a major contributor to poor iron status observed in the obese population. The study was performed in 58 obese elderly individuals (F/M 34/24) aged 65-91 (78.92 ± 8.32) years. The controlgroup consisted of 15 non-obese elderly volunteers, age- and sex-matched. Based on the WHO definition, 36 (62%) obese individualswere diagnosed with normo- or microcytic anaemia. The following parameters were determined: prohepcidin, haemoglobin, serum iron,erythropoietin, ferritin and C-reactive protein (CRP). Prohepcidin concentrations were significantly increased in obese elderly individuals without anaemia compared to obese andanaemic (p < 0.01) as well as non-obese volunteers (p < 0.01). In obese individuals with anaemia there was a decrease in serum iron,concomitant with increased levels of erythropoietin and CRP compared to two other groups. Ferritin concentration was increased inobese people (with and without anaemia) compared to the non-obese group. Serum prohepcidin levels were positively correlated withfat mass percentage in obese individuals without and with anaemia (r = 0.32; p = 0.02). Results of this preliminary study suggest that body fat content does have an impact on prohepcidin concentration, andthereby on iron homeostasis.

Iron Deficiency After Roux-en-Y Gastric Bypass: Insufficient Iron Absorption from Oral Iron Supplements

Roux-en-Y gastric bypass (RYGB) may reduce the absorption of iron, but the extent to which this absorption is impeded is largely unknown. First, we determined the prevalence of iron deficiency following RYGB and explored the risk factors for its development. Second, we examined to what extent oral iron supplements are absorbed after RYGB. Monocentric retrospective study in 164 patients (123 females, 41 males; mean age 43 years) who underwent RYGB between January 2006 and November 2010 was done. Pre- and postoperative data on gender, age, BMI, serum levels of iron, ferritin, hemoglobin, vitamin B12, 25-hydroxy vitamin D, and use of proton pump inhibitors and H2 antagonists were collected. Generalized linear mixed models were used for the analysis of the data. In 23 patients who developed iron deficiency after surgery, an oral challenge test with 100 mg FeSO4 · 7H2O was performed. Following RYGB, 52 (42.3 %) female patients and 9 male (22.0 %) patients developed iron deficiency (serum ferritin concentration ≤ 20 μg/L). The prevalence of iron deficiency was significantly higher in females than males (p = 0.0170). Young age (p = 0.0120), poor preoperative iron status (p = 0.0004), vitamin B12 deficiency (p = 0.0009), and increasing time after surgery (p < 0.0001) were also associated with iron deficiency. In the oral iron challenge test, only one patient out of 23 showed sufficient iron absorption. Iron deficiency is extremely frequent after RYGB and is linked with different risk factors. Iron supplementation seems essential, but the effect of oral tablets may be limited as absorption of oral iron supplements is insufficient post-RYGB.

Potential factors contributing to poor iron status with obesity

Obesity rates continue to rise and iron deficiency continues to be the number one nutrient deficiency worldwide, and both can lead to significant adverse health issues. Furthermore, the factors contributing to the iron deficiency observed in obese subjects are not fully understood. Aim of the workIs to study the factors contributing to poor iron status in obese rats. Materials and methodsHemoglobin content, Hematocrite value (%), total iron binding capacity (TIBC), and transferrin saturation (TS%) were assessed in 20 obese and non obese female rats. Also Leptin, Interleukin-6 (IL-6) and systemic Hepcidin levels were measured in both groups. Serum ferritin levels were measured in additional 20 obese and non obese rats. The correlation between Hepcidin and different parameters and between ferritin and TS% was assessed. ResultsSerum Hepcidin levels, IL-6, serum ferritin and plasma Leptin were significantly high in obese group; also there was significant decrease in serum iron, TIBC and TS% (P<0.05) in obese group compared with the non obese group. Difference in hemoglobin levels and Hematocrite values between both groups was not statistically significant. A direct correlation was observed between serum Hepcidin and body weight. Also a direct correlation between Hepcidin, and Leptin and IL-6 was observed.Furthermore, there were significant inverse correlations between serum Hepcidin and serum iron and TS% and between ferritin and TS%. ConclusionIL-6 and Leptin may be part of the axis that links obesity, inflammation, and Hepcidin with poor iron status.

Kiwifruit: our daily prescription for health

Kiwifruit are unequalled, compared with other commonly consumed fruit, for their nutrient density, health benefits, and consumer appeal. Research into their health benefits has focussed on the cultivars Actinidia deliciosa 'Hayward' (green kiwifruit) and Actinidia chinensis 'Hort 16A', ZESPRI(®) (gold kiwifruit). Compared with other commonly consumed fruit, both green and gold kiwifruit are exceptionally high in vitamins C, E, K, folate, carotenoids, potassium, fibre, and phytochemicals acting in synergy to achieve multiple health benefits. Kiwifruit, as part of a healthy diet, may increase high-density lipoprotein cholesterol, and decrease triglycerides, platelet aggregation, and elevated blood pressure. Consuming gold kiwifruit with iron-rich meals improves poor iron status, and green kiwifruit aids digestion and laxation. As a rich source of antioxidants, they may protect the body from endogenous oxidative damage. Kiwifruit may support immune function and reduce the incidence and severity of cold or flu-like illness in at-risk groups such as older adults and children. However, kiwifruit are allergenic, and although symptoms in most susceptible individuals are mild, severe reactions have been reported. While many research gaps remain, kiwifruit with their multiple health benefits have the potential to become part of our "daily prescription for health."

Iron Nutrition and Premenopausal Women: Effects of Poor Iron Status on Physical and Neuropsychological Performance

Iron is a nutritionally essential trace element that functions through incorporation into proteins and enzymes, many of which contribute to physical and neuropsychological performance. Poor iron status, including iron deficiency (ID; diminished iron stores) and iron deficiency anemia (IDA; poor iron stores and diminished hemoglobin), affects billions of people worldwide. This review focuses on physical and neuropsychological outcomes associated with ID and IDA in premenopausal women, as the prevalence of ID and IDA is often greater in premenopausal women than other population demographics. Recent studies addressing the physiological effects of poor iron status on physical performance, including work productivity, voluntary activity, and athletic performance, are addressed. Similarly, the effects of iron status on neurological performance, including cognition, affect, and behavior, are summarized. Nutritional countermeasures for the prevention of poor iron status and the restoration of decrements in performance outcomes are described.

Iron Supplementation for Female Athletes

Iron is an essential micronutrient involved in oxidative metabolism and critical to exercise performance. The prevalence of iron deficiency (ID) is much higher in active women for a variety of reasons, and poor iron status has been shown to be detrimental to overall health as well as physical performance. Iron status can be assessed using a number of indicators; however clinical cut-offs for active populations remain controversial. Randomized, placebo-controlled supplementation trials of iron-depleted female athletes have shown that oral iron supplementation in doses of 100-mg FeSO4·d (approximately 20 mg elemental iron) improves iron status and may improve measures of physical performance. It is recommended that female athletes most at risk of ID be screened at the beginning of and during the training season using hemoglobin and serum ferritin, and appropriate dietary and/or supplementation recommendations be made to those with compromised iron status.

Processes Underlying the Nutritional Programming of Embryonic Development by Iron Deficiency in the Rat

Poor iron status is a global health issue, affecting two thirds of the world population to some degree. It is a particular problem among pregnant women, in both developed and developing countries. Feeding pregnant rats a diet deficient in iron is associated with both hypertension and reduced nephron endowment in adult male offspring. However, the mechanistic pathway leading from iron deficiency to fetal kidney development remains elusive. This study aimed to establish the underlying processes associated with iron deficiency by assessing gene and protein expression changes in the rat embryo, focussing on the responses occurring at the time of the nutritional insult. Analysis of microarray data showed that iron deficiency in utero resulted in the significant up-regulation of 979 genes and down-regulation of 1545 genes in male rat embryos (d13). Affected processes associated with these genes included the initiation of mitosis, BAD-mediated apoptosis, the assembly of RNA polymerase II preinitiation complexes and WNT signalling. Proteomic analyses highlighted 7 proteins demonstrating significant up-regulation with iron deficiency and the down-regulation of 11 proteins. The main functions of these key proteins included cell proliferation, protein transport and folding, cytoskeletal remodelling and the proteasome complex. In line with our recent work, which identified the perturbation of the proteasome complex as a generalised response to in utero malnutrition, we propose that iron deficiency alone leads to a more specific failure in correct protein folding and transport. Such an imbalance in this delicate quality-control system can lead to cellular dysfunction and apoptosis. Therefore these findings offer an insight into the underlying mechanisms associated with the development of the embryo during conditions of poor iron status, and its health in adult life.

Iron Status Is Associated with Endurance Performance and Training in Female Rowers

Studies in animals and humans show a link between iron depletion without anemia (IDNA) and physical performance. Consequences of IDNA relevant to athletes include reduced endurance and energetic efficiency. We conducted this cross-sectional study to investigate the relationships between iron status, performance, and training in nonanemic female rowers. Iron status (hemoglobin, serum ferritin, soluble transferrin receptor) of 165 rowers was assessed at the beginning of a training season; 27% (n = 44) of rowers were identified as IDNA (serum ferritin < 20.0 μg·L) and 10% as anemic (n = 16, hemoglobin < 12.0 g·dL). Physical performance of 48 nonanemic rowers (n = 24 normal, n = 24 depleted) was assessed (V˙O(2peak), 4-km time, gross energetic efficiency), and training was recorded. Daily training load was calculated using the session RPE method (training duration × intensity rating). There were no significant differences between the two groups of iron status in any of the potential confounders of the association between iron status and performance that were tested. Compared with rowers with normal iron status, rowers with depleted iron trained ∼10 min less per day (P = 0.02) and had a 0.3-L·min lower V˙O(2peak) (P = 0.03). Both serum ferritin and training group (high vs low based on a session RPE of 3200) were positively related to V˙O(2peak). Less highly trained rowers with poor iron status had a lower V˙O(2peak) (-0.32 L·min, P = 0.02) and were less energetically efficient (-1.7%, P = 0.09) compared with more highly trained rowers with poor iron status. Impaired iron status is a prevalent problem among female endurance athletes. The relationship between rowers' iron status and endurance performance varied depending on training load. IDNA may prevent rowers from training as hard, directly affecting their performance.

Interactive Relations Among Maternal Depressive Symptomatology, Nutrition, and Parenting

Theoretical models linking maternal nutrition, depressive symptomatology, and parenting are underdeveloped. However, existing literature suggests that iron status and depressive symptomatology interact in relation to problematic parenting styles (authoritarian, permissive). Therefore, in the current study the authors investigate these interactive relations in a sample of breastfeeding mothers (n = 105) interviewed at three months postpartum. Participants completed questionnaires (from December 2008 to January 2011) regarding their depressive symptomatology and parenting styles. Iron status (i.e., hemoglobin, soluble transferrin receptors, and serum ferritin concentrations) was assessed from blood samples. Significant interactions were found between iron status and depressive symptomatology in relation to authoritarian parenting style (low warmth, high punishment and directiveness). For those women with hemoglobin below 14.00 g/dL, depressive symptomatology was positively related to authoritarian parenting style (p < 0.001). Thus, screening for poor iron status and depressive sympatomology in postpartum women may help to identify those at risk for problematic parenting. Dietary interventions may help to eliminate relations between depressive symptoms and problematic parenting.

Gender and age differences in mixed metal exposure and urinary excretion

BackgroundLittle is known about the variation in exposure to toxic metals by age and gender and other potential modifying factors. We evaluated age and gender differences by measurements of metal/element concentrations in urine in a rural population in Matlab, Bangladesh, in three age groups: 8–12 (N=238), 14–15 (N=107) and 30–88 (N=710) years of age, living in an area with no point sources of metal exposure but where elevated water arsenic concentrations are prevalent. ResultsWe found marked differences in urine concentrations of metals and trace elements by gender, age, tobacco use, socioeconomic and nutritional status. Besides a clearly elevated urinary arsenic concentration in all age groups (medians 63–85μg As/L), and despite the low degree of contamination from industries and traffic, the urine concentrations of toxic metals such as cadmium and lead were clearly elevated, especially in children (median 0.31μg Cd/L and 2.9μg Pb/L, respectively). In general, women had higher urinary concentrations of toxic metals, especially Cd (median 0.81μg/L) compared to men (0.66μg/L) and U (median 10ng/L in women, compared to 6.4ng/L in men), while men had higher urinary concentrations of the basic and essential elements Ca (69mg/L in men, 30–50 years, compared to 52mg/L in women), Mg (58mg/L in men compared to 50mg/L in women), Zn (182μg/L in men compared to 117μg/L in women) and Se (9.9μg/L in men compared to 8.7μg/L in women). Manganese was consistently higher in females than in males in all age groups, suggesting a biological difference between females and males in Mn metabolism. Increasing socioeconomic status decreased the toxic metal exposure significantly in children and especially in men. Poor iron status was detected in 17% of children, adolescents and women, but only in 6% of men. Also zinc deficiency was more prevalent in females than in males. ConclusionsWomen and children seemed to be more at risk for toxic metal exposure than men and at the same time more vulnerable to micronutrient deficiency. Higher concentrations of the toxic metals in urine in women are likely to reflect an increased gastrointestinal absorption of these metals at micronutrient deficiency, such as low body iron stores and Zn deficiency. Higher urinary concentrations of the essential elements in men likely reflect a better nutritional status. There is a need for information on exposure, lifestyle and socioeconomic factors, stratified by gender and age, for the purpose of conducting balanced risk assessment and management that considers such differences.

Risk factors associated with anemia and iron deficiency among Kuwaiti pregnant women

A cross-sectional study was carried out to indentify the risk factors of anemia and iron deficiency in Kuwaiti pregnant women. Pregnant women (n = 465) aged 18–47 years, of 4–39 weeks at gestation were recruited during antenatal visits from six health facilities in Kuwait. Socio-demographic, pregnancy-related and dietary information were collected. Hemoglobin, serum ferritin and serum C-reactive protein concentrations were determined. Logistic regression analysis revealed that iron deficiency and not taking iron-folate tablets or taking them occasionally were the two most important risk factors associated with anemia. Pregnant women with higher gestational age, short birth spacing ( ≤ 2 years), not taking iron-folate tablets or taking them occasionally, not consuming fruit juice, and consuming brown bread, tea and/or coffee were significant risk factors associated with iron deficiency. In conclusion, various factors including dietary habits appeared to be associated with poor iron status, which is the most important risk factor for anemia among Kuwaiti pregnant women.

Iron Nutrition and the Female Athlete: Countermeasures for the Prevention of Poor Iron Status

Iron is a trace element found in the diet and is essential for cognition and energy metabolism. Poor iron status is a concern for female athletes, who might not consume adequate levels of dietary iron and could experience elevated iron loss from physiologic processes associated with physical activity. Physical performance and cognitive decrements have been demonstrated in female athletes with iron deficiency anemia; both improve with increased iron intake. Two approaches for increasing iron intake in female athletes are the consumption of iron supplements and increasing dietary intake of foods high in iron to include iron-fortified foods. Both of these approaches have advantages and disadvantages that should be considered when treating female athletes with poor iron status.

Adipocyte Hypoxia Increases Hepatocyte Hepcidin Expression

Hepcidin plays a key role in regulating iron metabolism by blocking iron efflux from macrophages and enterocytes. Hepcidin is synthesized primarily in the liver, and its expression is increased by iron overload and inflammation. Obesity is associated with chronic inflammation as well as poor iron status. Central obesity causes adipocyte hypoxia resulting in chronic inflammation. Therefore, the objective of the present study was to determine if adipocyte hypoxia and associated inflammation signal hepatocyte hepcidin expression. The effect of adipocyte hypoxia on hepcidin expression was modeled using a 3T3-L1 adipocyte/Huh7 hepatocyte co-culture model. Adipocytes were cultured at either standard conditions (19% O2) or hypoxic conditions (1% O2). Compared to standard conditions, hypoxic 3T3-L1 cells had significantly higher IL-6 and leptin expression. Treatment of Huh7 cells with media from hypoxic or LPS-treated 3T3-L1 adipocytes significantly increased hepcidin promoter activity and mRNA compared to cells treated with normoxic 3T3-L1 media or control media. When the hepcidin STAT3 binding site was mutated, promoter activation by hypoxic media was abrogated. These data suggest that adipocyte hypoxia (a feature of central obesity) may increase hepcidin expression and plays a role in the association between obesity and poor iron status.

Effect of body mass index reduction on serum hepcidin levels and iron status in obese children

Iron deficiency has been linked to obesity. Hepcidin is the main regulator of iron homeostasis and is higher in obese children compared to controls. To gain insight into the link between obesity and hepcidin, we performed an intervention study in 15 obese children. These children were subjected to a 6-month weight loss program and underwent physical examination and iron status and absorption as well as hepcidin, interleukin-6 and leptin serum levels evaluation at baseline and after the weight loss program. After the program all children reduced their body mass index standard deviation score (BMI SDS) of at least 0.5. We observed a significant decrease in hepcidin (P=0.003) and leptin levels (P=0.005), and a significant increase in iron absorption (P=0.02). A direct correlation between the measure of hepcidin and leptin reduction was observed and this correlation appeared significant (r²=0.33, P=0.003) when adjusted for interleukin-6 and BMI SDS variations. In conclusion, we have shown that, in obese children, BMI reduction is associated with hepcidin reduction, potentially improving iron status and absorption. Implications of these findings could be considered in the management of obese children with poor iron status.

Benefits and Risks of Iron Supplementation in Anemic Neonatal Pigs

Iron deficiency is a common health problem. The most severe consequence of this disorder is iron deficiency anemia (IDA), which is considered the most common nutritional deficiency worldwide. Newborn piglets are an ideal model to explore the multifaceted etiology of IDA in mammals, as IDA is the most prevalent deficiency disorder throughout the early postnatal period in this species and frequently develops into a critical illness. Here, we report the very low expression of duodenal iron transporters in pigs during the first days of life. We postulate that this low expression level is why the iron demands of the piglet body are not met by iron absorption during this period. Interestingly, we found that a low level of duodenal divalent metal transporter 1 and ferroportin, two iron transporters located on the apical and basolateral membrane of duodenal absorptive enterocytes, respectively, correlates with abnormally high expression of hepcidin, despite the poor hepatic and overall iron status of these animals. Parenteral iron supplementation by a unique intramuscular administration of large amounts of iron dextran is current practice for the treatment of IDA in piglets. However, the potential toxicity of such supplemental iron implies the necessity for caution when applying this treatment. Here we demonstrate that a modified strategy for iron supplementation of newborn piglets with iron dextran improves the piglets' hematological status, attenuates the induction of hepcidin expression, and minimizes the toxicity of the administered iron.

Dietary intake and iron status of institutionalized elderly people: relationship with different factors.

Aims of the study were to investigate iron status in institutionalized elderly subjects and to determine its association with different factors including: age, gender, body mass index, dietary intake, consumption of iron supplements, functional status and disease. A cross-sectional study. Seven public nursing homes. 252 subjects, aged 65-96 years. Food intake was assessed by a 4-day weighed-food record. Iron status indices were measured. Barthel' s Index was used to evaluate functional status. Illnesses were ascertained from medical records. Anemia was found in 25.4% of subjects studied. Average dietary intakes fulfilled the amounts of Recommended Dietary Intake for Spanish elderly population, except for folate. A substantial percentage of subjects exhibited folate dietary deficit (89.2%). Mean (SD) BMI was 27.8 (6.4) kg/m2, and functional status 78.1 (26.5). Taking into account hematocrit, red blood cell count and serum iron concentration values, poor iron status was significantly more common in men (59.4, 61.4 and 16.8%, respectively) than in women (36.4, 36.4 and 6.0%, respectively). Hemoglobin concentration was positively associated with the energy and nutrient dietary intake, and negatively with age, BMI and functional status. Based on World Health Organization criteria, anemia was found in 25.4% of elderly subjects studied. Iron deficiency seems to be the main cause of anemia, and chronic disease the second cause of anemia. Dietary intake is not one of the principal causes of anemia in the study population, except for folate intake.

Iron deficiency and iron deficiency anemia among pregnant women in Kuwait

This cross‐sectional study investigated the prevalence of iron deficiency and iron deficiency anemia among pregnant women in Kuwait. It also examined the association of various factors with iron status. A total of 465 women, aged 18–47 years, of 4–39 weeks gestation attending maternity clinics in six governorates in Kuwait participated in the study during January–March, 2009. Socio‐demographic, pregnancy related and dietary information were collected. Blood hemoglobin (Hb) and serum ferritin (SF) concentrations were determined. The prevalence of anemia (Hb&lt;11.0 g/dL) among the participants was 24.1% and 55% had depleted iron stores (SF&lt;12.0 μg/dL). Of all anemic subjects, 73% had iron deficiency anemia (Hb&lt;11.0 g/dL and SF &lt;12.0 μg/dL). There was a significant positive association between Hb and SF levels (r=0.245; p=0.001). Significant positive correlations were observed between SF and education level of the participants, consumption frequency of white bread and meat sandwich, while there was a negative correlation with parity, gestational age and consumption frequency of brown bread, tea and coffee. In conclusion, iron deficiency is highly prevalent among Kuwaiti pregnant women, and nearly three‐fourths of the anemia can be explained by iron deficiency. Various factors including diet may contribute to the poor iron status of these women. Funded by Kuwait University, Research Grant No: WF01/08.

Hepcidin in Obese Children as a Potential Mediator of the Association between Obesity and Iron Deficiency

Obesity and iron deficiency are two of the most common nutritional disorders worldwide. Several studies found higher rates of iron deficiency in obese than in normal-weight children. Hepcidin represents the main inhibitor of intestinal iron absorption, and its expression is increased in adipose tissue of obese patients. Leptin is able, in vitro, to raise hepcidin expression. Aims of this work were 1) to assess the association between poor iron status and obesity, 2) to investigate whether iron homeostasis of obese children may be modulated by serum hepcidin variations, and 3) to assess the potential correlation between leptin and serum hepcidin variations. Iron status and absorption as well as hepcidin, leptin, and IL-6 levels were studied in 60 obese children and in 50 controls. Obese children showed lower iron and transferrin saturation (both P < 0.05) and higher hepcidin levels (P = 0.004) compared with controls. A direct correlation between hepcidin and obesity degree (P = 0.0015), and inverse correlations between hepcidin and iron (P = 0.04), hepcidin and transferrin saturation (P = 0.005), and hepcidin and iron absorption (P = 0.003) were observed. A correlation between leptin and hepcidin (P = 0.006) has been found. The correlation remained significant when adjusted for body mass index, sex, pubertal stage, and IL-6 values. We propose that in obese patients, increased hepcidin production, at least partly leptin mediated, represents the missing link between obesity and disrupted iron metabolism.