Risk Factors For Iron Deficiency Research Articles

Dietary patterns and association with Iron deficiency among children and adolescents aged 9-17 years in rural Guangzhou, China: a cross-sectional study.

Iron deficiency and iron deficiency anemia cause a huge disease burden worldwide. Diet is an important factor affecting the iron levels. This study aims to explore the dietary patterns of school-aged children in rural areas of Guangzhou and their association with iron deficiency. Data on dietary surveys, lifestyle, demographic and laboratory tests were gathered from rural school-age children in Guangzhou. Factor analysis was applied to derive dietary patterns. Robust Poisson regression and subgroup analysis were used to analyze the association between dietary patterns and iron deficiency. A total of 2,530 children and adolescents aged 9-17 years were enrolled. The prevalence of iron deficiency was 13.36%. Four dietary patterns were identified including snack and fast-food pattern, fruit and vegetable pattern, cereal and tuber pattern and meat and offal pattern. Both children and adolescents in the Q4 group (the highest propensity) of snack and fast-food pattern and cereal and tuber pattern had a higher risk of iron deficiency than the Q1 group (the lowest propensity). Both children and adolescents in the Q4 group of meat and offal pattern and fruit and vegetable pattern had a lower risk of iron deficiency than the Q1 group. The results of stratified analysis showed the negative effect of snack and fast-food pattern and the protective benefits of meat and offal pattern are more obvious for boys, and the negative effect of cereal and tuber pattern were obvious for girls. The negative effect or protective benefits of the four dietary patterns were obvious for children aged 9-13. Females, older children, and those with shorter sleep duration are at higher risk of iron deficiency. Snack and fast-food pattern and cereal and tuber pattern are risk factors for iron deficiency, and fruit and vegetable pattern and meat and offal pattern are protective factors for iron deficiency. The impact of diet on body iron levels is more obvious in boys and younger children. The findings of this study can provide evidence for formulating prevention and control measures on children and adolescents iron deficiency and iron deficiency anemia.

Prevalence of Iron Deficiency in Female Collegiate Athletes at a Division I Institution

BACKGROUND: Iron deficiency is widely underdiagnosed in female college athletes and may limit their athletic performance. Routine screening is necessary to identify potential female athletes who might benefit from iron supplementation. A retrospective study on the prevalence of iron deficiency in female collegiate division I athletes is imperative to bring awareness to the prevailing problem. The objective of this study is to determine the prevalence of iron deficiency in female athletes presenting to a Division 1 Athletic Training Room for initial health screening evaluation from January 2017 to July 2022. METHODS: A retrospective chart review was performed for female athletes who presented for initial pre-participation examination health screening to a Division 1 Athletic Training Room The data collected included the patients’ age, BMI, menstrual history, ferritin, and hemoglobin lab values. The primary sports analyzed was swim and dive, soccer, basketball, track and field/cross country, softball, lacrosse, volleyball, high tech, tennis, golf, and cheerleading. Descriptive statistics were used to describe the prevalence of iron deficiency among female athletes and the Student’s t-test and Pearson correlation analysis are used to identify any potential risk factors for iron deficiency. RESULTS: There was a total of 336 participants. The prevalence of athletes with low initial ferritin values under 40 ng/mL at pre-participation examination was 194 (57.74%, n=336). The mean ferritin value at pre-participation examination was 43.18 ng/mL (n=336). Statistical analysis of the other variables collected in this study including body mass index, menstrual history and primary sport showed no significant differences in relationship to initial ferritin levels. Female athletes with low ferritin levels were more likely to receive iron supplementation (p=8.089e-18, 95% CI= -31.33142, -20.19980). An increase in ferritin levels was correlated with iron supplementation (p=0.0217, 95% CI= 1.45825, 18.34014) and hemoglobin levels were higher in female athletes with higher ferritin levels (p-value=0.04971, 95% CI=0.00546, 0.14506). Initial ferritin levels were positively correlated with hemoglobin levels (p=2.402e-11, 95% CI=0.26962, 0.46399). Statistical analysis showed an increase in ferritin levels with usage of contraception (p=0.0073, 95% CI= 3.15448, 20.05362). CONCLUSION: This study’s findings represent the importance of screening ferritin levels in all female collegiate athletes regardless of sport, BMI, or menstrual history due to the high prevalence of low ferritin values. There was an increase in ferritin levels with usage of birth control suggesting the need to further evaluate the impact of menstrual history and contraception usage on ferritin and hemoglobin levels. In these authors experience, it is uncommon for institutions to incorporate routine screening measures in place for screening all female athletes with a ferritin value and complete blood count at initial pre-participation examination.

Early Childhood Anemia in Rural Bangladesh: The Role of Iron Deficiency, Infections, and Inadequate Complementary Feeding Techniques

Anemia and iron deficiency increased quickly until 8 to 9 months of age, while the prevalence of subclinical infections remained stable. Apart from age and male sex, iron deficiency and subclinical infections were the main risk factors for anemia. Similarly, age, male sex, and subclinical illnesses were important risk factors for iron deficiency. In early rural Bangladeshi newborns, the burden of anemia and iron deficiency is particularly severe during the key transition period of increased physiological Fe requirements corresponding to the early phase of supplementary feeding, which lasts from 6 to 11 months of age. Nutritional and infection control strategies alone are insufficient. as soon as they begin providing them with complimentary foods. The increasing prevalence of anaemia and Iron Deficiency during the first 3 months of the complementary feeding period highlights the need to support mothers to introduce Fe supplements or Fe-rich foods or products in their infants’ diet as soon as they start giving them complementary foods. In order to reduce anemia and Iron Deficiency in this population, it is imperative to incorporate methods related to water, sanitation, and hygiene, as well as parasitic disease control, given the high prevalence of subclinical infections and their role in these conditions. In order to avoid anemia during infancy in Bangladesh, a multipronged approach involving both infection control techniques and dietary Fe consumption improvements is required. A person's capacity to work is restricted by anemia and iron deficiency, which can potentially have serious negative economic repercussions and impede the advancement of the country. Because of all of this, it is generally accepted that lowering the global burden of iron deficiency and iron deficiency anemia is a top priority in public health nutrition.

Prevalence of and risk factors for iron deficiency among pregnant women with moderate or severe anaemia in Nigeria: a cross-sectional study

BackgroundAnaemia during pregnancy causes adverse outcomes to the woman and the foetus, including anaemic heart failure, prematurity, and intrauterine growth restriction. Iron deficiency anaemia (IDA) is the leading cause of anaemia and oral iron supplementation during pregnancy is widely recommended. However, little focus is directed to dietary intake. This study estimates the contribution of IDA among pregnant women and examines its risk factors (including dietary) in those with moderate or severe IDA in Lagos and Kano states, Nigeria.MethodsIn this cross-sectional study, 11,582 women were screened for anaemia at 20-32 weeks gestation. The 872 who had moderate or severe anaemia (haemoglobin concentration < 10 g/dL) were included in this study. Iron deficiency was defined as serum ferritin level < 30 ng/mL. We described the sociodemographic and obstetric characteristics of the sample and their self-report of consumption of common food items. We conducted bivariate and multivariable logistic regression analysis to identify risk factors associated with IDA.ResultsIron deficiency was observed among 41% (95%CI: 38 – 45) of women with moderate or severe anaemia and the prevalence increased with gestational age. The odds for IDA reduces from aOR: 0.36 (95%CI: 0.13 – 0.98) among pregnant women who consume green leafy vegetables every 2-3 weeks, to 0.26 (95%CI: 0.09 – 0.73) among daily consumers, compared to those who do not eat it.Daily consumption of edible kaolin clay was associated with increased odds of having IDA compared to non-consumption, aOR 9.13 (95%CI: 3.27 – 25.48). Consumption of soybeans three to four times a week was associated with higher odds of IDA compared to non-consumption, aOR: 1.78 (95%CI: 1.12 – 2.82).ConclusionAbout 4 in 10 women with moderate or severe anaemia during pregnancy had IDA. Our study provides evidence for the protective effect of green leafy vegetables against IDA while self-reported consumption of edible kaolin clay and soybeans appeared to increase the odds of having IDA during pregnancy. Health education on diet during pregnancy needs to be strengthened since this could potentially increase awareness and change behaviours that could reduce IDA among pregnant women with moderate or severe anaemia in Nigeria and other countries.

Effect of Iron Polymaltose Complex Prophylaxis on Frequency of Iron Deficiency and Iron Deficiency Anemia.

To evaluate the effectiveness of national iron prophylaxis policy in 9-12 mo-old infants in Turkey. This study was planned as a cross-sectional study, and it included healthy infants aged 9 to 12 mo who presented to the pediatric outpatient clinic for routine check-ups. Parents were interviewed to identify risk factors for iron deficiency (ID) and gather information on Fe+3- iron polymaltose complex (IPC) prophylaxis usage. Blood samples were collected for hemogram and ferritin analysis. Multiple logistic regression analyses were conducted to determine risk factors for ID and iron deficiency anemia (IDA). The study included 317 infants. In the non-prophylaxis group, the frequency of IDA was 31.1%, compared to 13.4% in the regular prophylaxis group. Iron deficiency was detected in 25% of individuals receiving regular prophylaxis and 13.1% of those without prophylaxis. The risk factors for IDA were insufficient iron diets (OR 2.45, 95% CI: 1.35-4.45) and not receiving Fe+3 - IPC prophylaxis (OR 2.57, 95% CI: 1.24-5.31). The relationship between Fe+3-IPC prophylaxis and ID did not reach statistical significance (p = 0.253). Fe+3- IPC prophylaxis is associated with a lower risk of iron deficiency anemia, but not iron deficiency.

Nearly Half of Extreme Preterm Infants Are Iron Deficient at 4-6 Months of Corrected Age Despite Prophylactic Iron Supplementation

Background: Iron deficiency (ID) is the most prevalent micronutrient deficiency globally and has been associated with negative neurodevelopmental and behavioral outcomes in infants and young children. Susceptibility to ID is heightened in preterm infants due to lower iron reserves at birth, rapid growth during the initial weeks of life, immature erythropoiesis, and frequent blood samplings during hospitalization. To mitigate this problem, international bodies recommend prophylactic iron therapy from 2-6 weeks of age until at least 6-12 months in preterm infants. Currently, the literature regarding iron status in extremely preterm infants (EPI, infants born less than 28 weeks gestational age) who receive prophylactic iron supplementation after birth is limited. Considering the potential long-term detrimental effects of ID on the developing brain of these high-risk preterm infants, examining the prevalence and risk factors for ID are crucial to implement prevention strategies. Objective: To investigate the prevalence and risk factors associated with ID in EPI Methods: A retrospective cohort study was conducted using a population-based Provincial Perinatal Follow-Up database on all live EPIs born in Nova Scotia between 2005 and 2018. Infants with congenital malformations, chromosomal anomalies, blood disorders or those who died before outcome assessment were excluded. Prophylactic iron supplementation (2-3 mg/kg/day) starting at 2-4 weeks of chronological age was a standard of care for all included infants. Further, the dosage of iron was adjusted regularly during the hospital stay based on serum ferritin (SF) levels. Discharge instructions recommended continuing iron prophylaxis until 9-12 months corrected age (CA). At 4-6 months CA, all infants underwent blood tests to evaluate hemoglobin, and SF levels. ID was defined as SF levels below 20g/L or 12g/L at 4 and 6 months CA, respectively. A univariate analysis was performed by using a series of single-variable logistic regression models to identify the factors associated with presence of ID. Factors with a p-value &amp;lt; 0.20 in the univariate analysis were entered into a multivariable risk model using a backward selection procedure. Variables with a p-value &amp;lt; 0.05 were retained. Results: Among 146 infants, 67 (45.9%) had ID. Ferritin (16.4 µg/L vs 50.0 µg/L, p &amp;lt; .001) and reticulocyte hemoglobin equivalent (28.4pg vs 31.6pg, p &amp;lt; .001) were significantly lower in the ID group than non-ID group. The prevalence of ID decreased over time, from 59.7% in 2005-2011 to 40.3% in 2012-2018 (p = 0.52). Table 1 compares the antenatal and neonatal characteristics of the ID and non-ID groups. Table 2 compares sociodemographic variables and clinical variables at 4-6 months CA between two groups. Breastfeeding (exclusive or partial) versus formula alone at a 4-6 months CA was identified as an independent factor protective for ID (Odds: 0.2 (0.1 - 0.6), p = 0.003). Iron therapy at follow-up was also protective for ID but did not remain significant in the final model. Of note, iron therapy was stopped in 40 (27.4%) EPI before 4-6 months CA. Supplemental iron intake at 4-6 months CA was significantly lower in the infants receiving exclusive formula feeding (66.1%) compared with those breastfed (99.1%, p = 0.006). Conclusion(s): Despite prophylactic iron supplementation, nearly half of the EPI had ID at 4-6 months CA, and iron therapy was discontinued in roughly a quarter of all EPI before 4-6 months CA. Breastfeeding at 4-6 months follow-up was found to be protective for ID. High prevalence of ID in EPI highlights the need for further research in this area to avert the negative neurodevelopmental consequences of ID on the developing brain of these high-risk infants. Closer monitoring of iron status and early identification of children at high risk for ID is imperative to maximize the benefits of prophylactic iron supplementation in EPI. Further, there is lack of sufficient data for iron requirements in EPI leading to a variability in iron therapy recommendations by different professional organizations. Future prospective studies to investigate specific iron requirements of EPI as well as risk factors for ID in this high-risk vulnerable population are essential to optimize their neurodevelopmental outcomes.

Overweight as a risk factor for iron deficiency

Overweight as a risk factor for iron deficiency

32 Risk Factors for Iron Deficiency in Formula-fed very Preterm Infants: A Population-based Study from Nova Scotia

Abstract Background Iron prophylaxis is routinely recommended for preterm infants, as they are vulnerable to develop iron deficiency (ID). Recent work from our group has demonstrated that despite early iron prophylaxis, ID is common in very preterm infants (VPI), with an incidence of 32% at 4 to 6 months corrected age (CA). Additionally, ID is more prevalent in exclusively formula-fed (FF) VPI compared to infants who are exclusively or partially breast-fed. Objectives To explore the risk factors associated with ID in the FF infants. Design/Methods A retrospective population-based cohort study was conducted using a provincial database. All VPI born in Nova Scotia from 2005 to 2018 who were exclusively fed with iron-rich formula (&amp;gt;10 mg/L) at 4 to 6 months CA were included. Information about formula type, iron intake from formula, and supplemental iron therapy at 4- to 6-month follow-up was extracted, as were neonatal variables. ID was defined as serum ferritin &amp;lt;20 and &amp;lt;12 mcg/L at 4- and 6-months CA, respectively. Results ID was present in 36.8% (105) of 285 FF infants. Table 1 shows key characteristics of ID and non-ID FF infants. Mean gestational age and birth weight were lower in the ID group. More babies in the ID group received blood transfusion (Odds:1.1-3.0). Other maternal and neonatal variables were comparable between the groups. ID children did not have a lower iron intake than non-ID children. Conclusion Lower gestational age, lower birth weight, and need for blood transfusions increased the risk of ID in FF infants. Optimal iron supplementation in this population should be guided by a risk-adapted strategy.

Rapid increase in the body mass index of very preterm infants is a risk factor for iron deficiency during infancy

Iron deficiency (ID) in very preterm infants born at 28–32 weeks of gestational age (GA) can lower mental and motor test scores. This study aimed to determine whether the rapid growth of very preterm infants might be associated with ID. Among 134 very preterm born between January 2014 and December 2020 at Jeonbuk National University Hospital and discharged home, 93 were included in this study. Rapid BMI increase (RBI) was defined as a z-score difference of > 1 standard deviation between birth and 8 months. ID occurred in 23 of 93 (24.7%) infants at 8 months of corrected age (CA). ID was more common in the RBI group (50%) than in the non-RBI group (18.7%). In the multivariate logistic regression corrected for GA, infants small for gestational age (SGA) (odds ratio [OR] 6.06, 95% confidence interval [CI] 1.34–30.21) and RBI by z-score (OR 4.26, 95% CI 1.28–14.65) were identified as independent risk factors for ID at 8 months of CA. Conclusively, both SGA and RBI in the early life of very preterm were risk factors for ID at 8 months of CA.

Is Obesity a Risk Factor for Iron Deficiency and Anemia? A Pilot Study

Abstract Background The populations suffer from increasing over consumption of food, but continue to have high rates of micronutrient deficiencies. Adipose tissue of obese persons produces increased amount of pro-inflammatory cytokines contributing to the development of a low-grade systemic inflammation in these persons. Objectives To determine the relation between body mass index (BMI) and hemoglobin (Hg) level, serum iron, total iron binding capacity (TIBC) and C reactive protein (CRP). Methodology The study was carried out on 60 women attending the outpatient clinics of the National Nutrition Institute (Egypt). Participants were divided into two groups; 30 obese women (case group) and 30 normal weight women (control group). Diagnosis of obesity was based on BMI &amp;gt;30. Anemia was diagnosed according to Hg level, serum iron and TIBC. Results The mean Hb level of participant women was 11 gm/dl (SD 1.21) and ranged between 8.7 and 13.8 gm/dl. Hb levels showed no significant difference between obese and normal weight women. Serum iron was higher in normal weight women compared with obese women (P &amp;lt; 0.05). No significant correlation was observed between BMI and Hb levels. BMI had a significant negative correlation with serum iron. BMI has significant positive correlations with TIBC and CRP. Linear regression analysis showed a significant association between Hb levels and waist hip ratio. Conclusions High BMI affected negatively levels of serum iron and is associated with inflammatory process as indicated by higher levels of CRP. High waist hip ratio is an important risk factor for anemia.

Effect of imbalance in dietary macronutrients on blood hemoglobin levels: a cross-sectional study in young underweight Japanese women.

Iron deficiency and underweight are common nutritional problems among young Japanese women, many of whom show unhealthy dietary patterns owing to a desire for thinness. We conducted a cross-sectional analysis of the relationship between iron status, nutritional status, and dietary intake among young Japanese women with underweight to identify dietary risk factors for iron deficiency. Of the 159 young women (18-29 years of age) enrolled, 77 underweight and 37 normal-weight women were included in the study. They were further categorized into four groups based on quartiles of hemoglobin levels among all participants. Dietary nutrient intake was ascertained using a brief self-administered diet history questionnaire. Blood level of hemoglobin and nutritional biomarkers such as total protein, albumin, insulin-like growth factor-1 (IGF-1), and essential amino acids were measured. In underweight, the multiple comparison test showed that dietary intakes of fat, saturated fatty acid, and monosaturated fatty acid were significantly higher and carbohydrate intake was significantly lower in the group with the lowest hemoglobin level, whereas intakes of iron were the same across groups. Multivariate regression coefficients suggested that replacing fat with protein or carbohydrates increased hemoglobin levels under isocaloric conditions. Additionally, significant positive correlations were observed between hemoglobin levels and nutritional biomarkers. Dietary iron intake did not change across different hemoglobin groups among Japanese underweight women. However, our results suggested that an imbalanced dietary macronutrient induces anabolic status and hemoglobin synthesis deterioration among them. Especially, a higher fat intake may be a risk factor for lower hemoglobin.

Personalized medicine comes to a blood center near you

Personalized medicine comes to a blood center near you

10 The association between underweight and iron status in early childhood: cross-sectional and prospective study

Abstract Background The American Academy of Pediatrics (AAP) identifies poor growth as a risk factor for iron deficiency (ID). There is limited research to provide evidence of this association. Objectives To examine the association between underweight and ID in early childhood. Design/Methods We enrolled healthy, young children from primary care practices in Toronto, Canada, and used both a cross-sectional and prospective study design. Underweight was defined as a body mass index z-score (zBMI) &amp;lt;-2. In the cross-sectional cohort, children 12-29 months had concurrent measurement of zBMI and serum ferritin. In the prospective cohort, children 6-14 months had measurement of zBMI and at 15-29 months had measurement of serum ferritin. Multivariable regression models examined serum ferritin as a continuous variable (linear models) and categorical variable with ID defined as &amp;lt;12 µg/L (logistic model), adjusted for pre-specified covariates. Results For the cross-sectional cohort (n=1953), the mean age was 18.3 (SD 5.0) months, 51 (2.4%) were underweight, and 269 (13.8%) had ID. There was no association between underweight and serum ferritin (change in median serum ferritin 2.01 µg/L, 95% CI -2.22, 7.01, P=0.37) or underweight and ID (OR 0.98, 95% CI 0.43, 2.21, P= 0.95). In contrast, there was a strong negative association between overweight and serum ferritin (change in median serum ferritin -4.19 µg/L, 95% CI -6.93, -1.04, P=0.01), and a positive association between obesity and ID (OR 3.35, 95% CI 1.10, 10.25, P=0.03). For the prospective cohort (n=672), the mean age at outcome was 21.1 (SD 3.5) months, 34 (5.1%) were underweight, and 104 (15.5%) had ID. There was no association between underweight and serum ferritin or underweight and ID. Conclusion Using both a cross-sectional and prospective study design, we found no association between underweight and ID in young children 1 to 2 years of age. In contrast, we found a strong association between overweight/obesity and ID. For risk stratification and targeted screening, overweight/obesity may be more important than underweight as a risk factor for ID in young children.

Prevalence of and Risk Factors for Iron Deficiency in Twin and Singleton Newborns.

Iron deficiency (ID) in utero and in infancy can cause irreversible neurocognitive damage. Iron status is not routinely tested at birth, so the burden of neonatal ID in the United States is unknown. Infants born from twin or higher-order pregnancies may be at elevated risk of inadequate nutrient endowment at birth. The present study sought to compare the burden of neonatal ID in cord blood serum samples from twin (n = 54) and singleton pregnancies (n = 24). Iron status (serum ferritin (SF), soluble transferrin receptor (sTfR), hepcidin) and inflammation (C-reactive protein (CRP) and interleukin-6 (IL-6)) biomarker concentrations were measured by immunoassay. The prevalence of ID (SF < 76 ng/mL) among twins was 21% (23/108) and among singletons 20% (5/24). Gestational age at birth, maternal race and infant sex predicted SF levels. Maternal anemia (hemoglobin < 11 g/dL) was observed in 40% of mothers but was not associated with neonatal iron biomarkers. More research is needed to identify risk factors and regulatory mechanisms for inadequate fetal iron accrual to identify higher risk pregnancies and neonates for screening and intervention.

Leptin and Adiponectin in Relation to Body Mass Index and Anemia

Obesity/its comorbidities occasionally exist alone, but actually, this is a dynamic network of cross morbidities that are often regarded as separable entities. Obesity is nowadays viewed as an escalating risk factor for iron deficiency, and various theories have been proposed since then explaining their relation. We aimed to determine the relationship of increased body mass index (BMI) with adiponectin, leptin, and iron profile in a sample of middle-aged and older adults with and without iron deficiency anemia. An observational study was performed among 90 participants classified into three groups. Group І included healthy subjects with normal BMI; as a control. Group II included subjects with increased BMI, and group III included subjects with increased BMI and iron deficiency anemia. After overnight fasting, fasting blood glucose, triglycerides, total cholesterol, iron, total iron-binding capacity, complete blood count, serum leptin, and adiponectin were measured. There were significantly higher mean values of BMI among those with anemia, higher mean values of serum leptin, and significantly lower mean values of adiponectin. A significant positive correlation of serum leptin with BMI and a significant negative correlation of serum leptin with iron in Group III were reported. The adiponectin/leptin ratio of (0.8) was correlated with iron and homeostatic model assessment in Group III, and a ratio of (1.1) was significantly correlated with BMI and hemoglobin level in Group II. This could suggest that interventions aimed at increasing the adiponectin/leptin ratio may help in resolving anemia among obese populations by increasing their serum iron and hemoglobin.

Postdischarge Iron Status in Very Preterm Infants Receiving Prophylactic Iron Supplementation after Birth

To determine postdischarge iron status and associated factors in very preterm infants. A retrospective cohort study was conducted through a provincial database on all very preterm infants born in Nova Scotia between 2005 and 2018. As a standard of care, all infants received prophylactic iron supplements starting at 2-4weeks of chronological age and were tested for iron deficiency at 4 or 6months corrected age. Iron deficiency was defined as serum ferritin <20g/L at 4months or <12g/L at 6months. Multivariate logistic regression analysis identified factors associated with iron deficiency. Among 411 infants, 132 (32.1%) had iron deficiency and 11 (2.7%) had iron deficiency anemia. The prevalence of iron deficiency decreased over time, from 37.6% in 2005-2011 to 25.8% in 2012-2018. Gestational hypertension in the mother (P=.01) and gestational age <27weeks (P=.02) were independent risk factors for iron deficiency. In addition, the odds of iron deficiency were lower in the mixed-fed group (ie, with breast milk and formula combined) compared with the exclusive formula-fed group (P=.01). Iron deficiency was prevalent in 32% of the very preterm infants despite early iron prophylaxis. These results demonstrate the importance of monitoring iron stores during preterm follow-up. Information about risk factors is important to mitigate iron deficiency in very preterm infants.

Iron Status of the Moderate and Late Preterm Infant: A Prospective Cohort Study

Guidelines on micronutrient supplementation in moderate to late preterm infants (MLP) are mostly extrapolated from those for smaller preterms, largely due to lack of systematic studies on physiological status in this special group of infants. Actual practices vary widely. We prospectively studied iron status by measurement of serum ferritin (SF) and haematological indices at 4 months corrected age in infants born between 32 and 36 weeks gestation (MLP), after they received 2 mg/kg/day oral iron from 6 weeks of postnatal age. Proportion of MLP having normal iron status (iron replete), i.e., neither iron deficiency (ID) nor iron excess was measured. ID anaemia, growth and development, risk factors for ID were also analysed. Of the 82 infants studied, 78% babies were late preterm. Seventy-four (90.3%) were iron replete (no deficiency or excess) at 4 months. High variability in SF levels (minimum of 9.8 to maximum of 252.2 μg/l) with median (IQR) of 57.45 μg/l (37.02-98.85) was noted in the entire cohort; and also within those who were iron deficient with median (IQR) of 17.50 μg/l (11.70-18.90). There was no difference in haematological indices of ID infants when compared to those with normal iron status. Inspite of oral iron supplementation with reasonable compliance, 8.5% MLP were iron deficient at 4 months corrected age. The high variability noted in SF levels could justify the need for monitoring iron status in this group of preterm infants. This could quintessentially aid individualization of iron supplementation advice.

Scientific reviews. Principles of diagnosis and treatment of iron deficiency anemia in children

Annotation.In Europe, the overall prevalence of iron deficiency anemia is 2-4%, with two peaks: young children (2.3-15%) and adolescents (3.5-13% – in boys, 11-33% – in girls). Iron deficiency occurs earlier than anemia, which is characterized by a decrease in the size and iron saturation of erythrocytes, and they become microcytic and hypochromic. Therefore, anemia can be prevented by early diagnosis and treatment of latent iron deficiency. The aim of the work was to analyze and systematize the main problematic issues of diagnosis and treatment of iron deficiency anemia in children. To conduct the study, we analyzed databases PubMed, Cochrane Library, Google Scholar, etc., referring to the vast majority of publications from the last five years (2016-2021), in addition to three articles published in 2012 and 2014. The main criteria for selecting sources were: the availability of the latest methods for the diagnosis of anemia, modern methods of treatment of iron deficiency anemia in children. Analysis of the identified literature sources showed that iron deficiency in the laboratory and clinically can manifest itself at different stages. Negative iron balance, which persists after a decrease in iron stores, is manifested by a decrease in hemoglobin and the development of anemia. A decrease in the number of erythrocytes or the level of hemoglobin (Hb) by 5 percentile below the normal value of hemoglobin, determined for a given age in healthy people, is called anemia. Routine screening for iron deficiency should be performed in children aged 6 to 24 months. Screening consists of identifying risk factors and laboratory testing if available. Determination of serum ferritin during the first screening is the main diagnostic tool in children with risk factors for iron deficiency and signs of anemia. Ferritin levels should always be carefully evaluated, as ferritin is nonspecifically elevated in a variety of inflammatory conditions. Other screening tests, such as reticulocyte levels, iron transferrin saturation, and serum iron-binding capacity, are performed to confirm the diagnosis. The choice and route of administration of iron requires consideration of the cause that led to its deficiency, the severity of symptoms and condition of the patient, the probable and desired rate of hematological response, risks and complications of treatment, availability of resources and preferences of the patient. Oral iron remains a priority for the treatment of children with iron deficiency anemia, but it is necessary to consider situations where first-line therapy will be administered by intravenous means. Thus, based on the analysis of the literature, we can conclude that iron deficiency anemia remains an urgent medical and social problem today. Children with iron deficiency anemia develop cognitive impairment that does not fully recover even after treatment. Therefore, further research aimed at improving methods of prevention, early diagnosis and treatment of iron deficiency anemia in different age groups of children should be promising.

Associations of maternal characteristics and dietary factors with anemia and iron-deficiency in pregnancy

ObjectiveAnemia and iron deficiency during pregnancy influence maternal and fetal health, birth outcomes, and the risk of chronic disease in offspring. This study aimed to examine the association with sociodemographic, maternal factors, supplement use and dietary intakes, and anemia and iron deficiency in pregnancy. MethodsA cross-sectional study was conducted on 165 pregnant women aged between 19 and 45 years who were interviewed, and dietary intake was assessed by 24-hours dietary recall, supplement records and food frequency questionnaire. Learning Vector Quantization feature selection method which is one of the machine learning techniques was used to extract important variables from sociodemographic, maternal, and dietary factors. ResultsThe prevalence of anemia was 15.2% and prevalence of iron deficiency was 65.5%. Total intake of iron, phosphorus, vitamin B1 and B2 were importance factors for iron deficiency while age, number of births, use of folic acid supplement, dietary folate equivalent and total iron intake were importance factors for anemia. ConclusionsMaternal and dietary characteristics were the most crucial risk factors for anemia while dietary factors were the most important risk factor for iron deficiency in pregnancy. The development of anemia and iron deficiency is associated with the coexistence of many nutrient deficiencies.

Prevalence and associated factors of iron deficiency in Spanish children aged 1 to 11 years.

Iron deficiency (ID) is the most common nutritional deficiency affecting children worldwide. Most traditional laboratory parameters to assess ID can be altered by infections or other inflammatory states, including obesity. The aims of this study were to determine the prevalence of ID in healthy children and to analyse associated factors, avoiding potential confounding factors through the use of serum transferrin receptor (sTfR), reticulocyte haemoglobin content and sTfR/log ferritin index. A cross-sectional population-based study was conducted on 951 children aged 1 to 11 years in Almería (Spain). ID was detected in 7.7% of children and iron deficiency anaemia in 0.9%. Multivariate analysis identified the following as independent risk factors: age under 5 years (OR: 2.2, 95% CI: 1.35-3.6); excessive consumption of cow's milk and dairy products (OR: 1.87, 95% CI: 1.13-3.1); and insufficient consumption of vegetables (OR: 2.7, 95% CI: 1.2-6.1).Conclusions: Using a combination of iron status parameters with greater discriminatory power than classical measures, this study detected a considerable iron deficiency prevalence in Spanish children. Younger children and specific dietary habits exhibit a particular risk for ID, so special attention should be paid to this population. What is Known: • Iron deficiency remains the most prevalent nutritional deficit worldwide, and children aged under 3 years are the most vulnerable to this condition. • Accurate assessment of iron status, based on a combination of biochemical indicators, can often be complicated. What is New: • Iron deficiency continues to present a health problem in Spanish children aged 1 to 11 years, considering the serum transferrin receptor and reticulocyte haemoglobin content for diagnosis. • Excessive consumption of dairy products and low consumption of vegetables are independent risk factors for iron deficiency.