Risk Of Iron Deficiency Anemia Research Articles

Efficacy of an iron-fortified infant cereal to reduce the risk of iron deficiency anemia in young children in East Cameroon.

Complementary foods in Africa are often poor sources of bioavailable iron. We assessed the efficacy of iron‐fortified wheat‐based infant cereal (IC) to reduce the risk of iron deficiency anemia in children aged 18–59 months in Cameroon. A 6‐month double‐blind, cluster‐randomized controlled trial was conducted in 2017 among anemic (hemoglobin 7–11 g/dl) but otherwise healthy children. In conjunction with usual diet, children received two 50 g servings/day of a standard, micronutrient‐fortified IC (providing 3.75 mg iron/serving; n = 106) or the same IC without iron fortification (n = 99). Anthropometric measurements, blood sampling, and systematic deworming were performed in all children at baseline (pre‐intervention), 3, and 6 months. Mean hemoglobin, ferritin adjusted for C‐reactive protein (CRP), serum iron, transferrin saturation, prevalence of anemia, iron deficiency, and iron deficiency anemia as well as anthropometrics were compared between the groups at baseline, 3, and 6 months. Compared to the control group, children consuming the iron‐fortified IC had significantly higher baseline‐adjusted mean hemoglobin (10.0 ± 1.8 vs. 9.7 ± 1.4 g/dl, respectively; p = .023), ferritin adjusted for CRP (16.1 ± 8.3 vs. 9.5 ± 7.5 μg/L, p < .001), serum iron (14.5 ± 3.9 vs. 11.2 ± 4.4 μg/dl; p < .001), and transferrin saturation (19.0 ± 17.4 vs. 10.7 ± 12.5%; p ˂ .001) at 6 months. The prevalence of anemia, iron deficiency, and iron deficiency anemia at 6 months decreased by a larger extent in the iron‐fortified group versus controls (all p < .01). In addition, at 6 months, children in the iron‐fortified group demonstrated higher weight‐for‐age z‐scores (p = .016) compared to the control group. Wheat‐based IC fortified with 7.5 mg ferrous fumarate administered daily for 6 months improved iron and nutritional status and decreased the prevalence of iron deficiency anemia in children aged 18–59 months in Salapoumbé, Cameroon.

Annual Prevalence, Health Expenditures, and Co-Morbidities Trend of Iron Deficiency Anemia in Korea: National Health Insurance Service Data from 2002 to 2013.

Despite improvements in nutritional status, iron deficiency anemia (IDA) remains a debilitating nutritional problem worldwide. We estimate annual IDA prevalence rates by sex and age and the trends therein in Korea. We also calculate the health expenditures of IDA and its co-morbidities by analyzing claims data in the National Health Information Database from 2002 to 2013. All analyses were performed based on diagnosis codes of IDA (D50, D50.0, D50.8, and D50.9) regardless of whether IDA was the principal or a coexisting disease. Trends in IDA prevalence rates were evaluated by calculating annual percent changes (APCs) in prevalence. The health expenditures of IDA were calculated based on the direct medical costs (outpatient and hospitalization costs, pharmaceutical costs) and direct non-medical costs (travel costs). The overall IDA prevalence in both sexes increased approximately 2.3-fold from 2002 to 2013; the APC was +7.6%. In females, the prevalence of IDA was highest in aged 30–39 and 40–49 years. The APC was highest in those aged <10 years (+18.2%), followed by those aged ≥80 (+14.7%) and 70–79 (+9.8%) years. In males, the prevalence rates were highest in aged <10 years, followed by those aged ≥60 years. The APC was highest in those aged <10 years (+19.1%), followed by those aged ≥80 years (+10.5%). The total health expenditures increased 2.8-fold during 12 years. Diseases of the respiratory or gastrointestinal tract were the most prevalent co-morbidities in both males and females. The annual prevalence of IDA continues to rise in association with adverse health expenditures and co-morbidities in spite of improvements in nutritional status. Most importantly, infants and young children, the elderly, and females aged 30–49 years are at highest risk of IDA. A national, prospective, and well-organized effort to improve iron status and to manage IDA is required.

The Effect of Antenatal 60 mg Iron Supplementation on Neonatal Mortality: A Meta-Analysis

Abstract Objectives There is strong evidence that prenatal iron and folic acid supplementation reduces the risk of iron deficiency anaemia during pregnancy and low birth weight. However, evidence it reduces neonatal mortality is still inconclusive. We aim to investigate the effects of prenatal iron supplementation either alone or in conjunction with folic acid, or with other vitamins and minerals on neonatal mortality. Methods We included five studies that assessed the effect of iron supplementation either alone or in conjunction with folic acid or with other vitamins and minerals on neonatal mortality. We then undertook several subgroup meta-analyses which include supplements containing any amount of iron versus placebo/vitamin/minerals/no treatment, supplements containing 60 mg iron versus placebo/vitamin/minerals/no treatment, supplements containing 60 mg iron and folic acid versus placebo/vitamin/minerals/no treatment and supplements containing less than 60 mg iron versus placebo/vitamin/minerals/no treatment. For all analyses, we used a fixed-effect model to calculate pooled RRs and 95% CIs. Our input variables were log RR, and we later we exponentiate all effect sizes and confidence intervals. Results The meta-analysis of the effect of supplements containing any iron versus placebo/vitamin/minerals/no treatment on neonatal death showed a 20% reduction (RR 0.80, 95% CI 0.68–0.94) in neonatal mortality rate. The meta-analysis of any supplements containing 60 mg iron versus placebo/vitamin/minerals/no treatment showed a 22% (RR 0.78, 95% CI 0.64–0.95) reduction in neonatal mortality rate. The meta-analysis of supplements containing 60 mg iron and folic acid versus placebo/vitamin/minerals/no treatment showed a 33% (RR 0.67, 95% CI 0.52–0.85) reduction in neonatal mortality rate. The meta-analysis analysis of any supplements containing less than 60 mg iron versus placebo/vitamin/minerals/no treatment did not show any effect on neonatal mortality rate. Conclusions Our findings provided vital evidence that iron supplementation in pregnancy significantly reduces neonatal mortality. This evidence justifies further investments to improve that at-scale implementation of this program in low- and middle-income countries where there are high levels of maternal anaemia and high neonatal mortality rates. Funding Sources The University of Sydney.

Dietary management of food protein–induced enterocolitis syndrome during the coronavirus disease 2019 pandemic

As communities struggle to adapt to life under the threat of the global pandemic, COVID-19, those living with Food Protein-Induced Enterocolitis Syndrome (FPIES) must adapt with additional difficulties. Social distancing and shelter-in-place strategies have been implemented, resulting in fewer supermarkets trips, stockpile-purchasing behaviors in up to 74.5% of those surveyed(1), and shortages of staple food items all with potential impact on the availability of foods for those on limited diets. Concern about allergic reactions make exploring alternative or new ingredients undesirable or untenable. Remaining safe at home is important to avoid trips to the emergency department where families may be exposed to the COVID-19 virus and medical attention can be limited due to the burden on global health systems. Parents of children with FPIES are also understandably concerned about meeting their child’s nutritional needs during these times of sheltering-in-place. Now more than ever, advice on what foods to serve and when to serve them is critically important.

Androgen deprivation therapy and the risk of iron-deficiency anaemia among patients with prostate cancer: a population-based cohort study.

ObjectivesThe administration of androgen deprivation therapy (ADT) to patients with metastatic prostate cancer might be associated with some adverse effects such as anaemia; however, few studies have been performed in East Asian populations. This study aimed to investigate the association between ADT and iron-deficiency anaemia (IDA) among patients with prostate cancer in a population-based nationwide cohort.DesignCohort study.SettingTaiwan.ParticipantsData for the cohort study were retrieved from the Taiwan National Health Insurance Research Database. Propensity score matching was used to select 7262 patients with prostate cancer who received ADT as the study group and 3631 patients who did not receive ADT as the control group.Primary and secondary outcome measuresThis study individually tracked patients over a 3-year study period and identified those who were subsequently diagnosed with IDA following the index date.ResultsThe incidence rates of IDA in the study and control groups were 1.66 (95% CI CI 1.45 to 1.86) and 1.01 per 100 person-years (95% CI 0.78 to 1.25), respectively. Furthermore, proportional Cox regression revealed an HR of 1.62 (95% CI 1.24 to 2.12) for IDA in the study group after adjusting for patients’ age, monthly income, geographic location, residential urbanisation level and incidence of hyperlipidaemia, diabetes, hypertension, coronary heart disease, inflammatory bowel disease, other cancers and gastrointestinal bleeding.ConclusionCompared with its non-use among patients with prostate cancer, ADT use was associated with a higher risk of IDA.

Anemia to Blood Donors at the National Blood Transfusion Center of Abidjan Cote D&amp;apos;Ivoire

Blood transfusion is an essential replacement therapy which many patients benefit from during various medical and surgical pathologies. However, transfusion therapy is associated with complications including the risk of iron deficiency anemia to blood donors in whom the pre-donation haemoglobin dosage is an important parameter of transfusion safety. This study therefore aims to determine the prevalence of anemia among blood donors at Côte d’Ivoire National Blood Transfusion Center. This prospective cross-sectional study took place from September 01 to October 31, 2015 at Abidjan National Blood Transfusion Center in Côte d’Ivoire and concerned 50 samples of regular blood donors excluded solely because of anemia out of a total of 1200 regular donors. After the consultation te excluded donor is then taken on an EDTA tube to perform an haemogram on an automated device and from a dry tube which will be used for the determination of ferritinemia. Statistical analyzes were carried out using Epi Info 6.04, Excel and the Chi-square test. The prevalence of anemia to our blood donor was 3.85%. The Hb level was significantly lower to women than men (p = 0.048) and more frequent anemia beyond 10 donations. The anemia was hypochromic microcytic to 31 donors (62%), hypochromic normocytic to 2 donors (4%), normochromic normocytic to 17 donors (34%). Martial assessment was performed to 31 donors and ferritin was lowered to 22 donors indicating the absence of an iron reserve. The prevalence of anemia to Côte d’Ivoire blood donors is 3.85%. Anemia to regular blood donors is mainly due to an iron deficiency. This deficiency is correlated with sex and the number of donations. Iron IV has been shown to be more effective than oral iron in the treatment of iron deficiency anemia in blood donors.

Железодефицитная анемия: взгляд гематолога и гинеколога. Оптимизируем диагностику и лечебную тактику

Iron-deficiency anemia (IDA) is an acquired disease characterized by the reduced levels of iron in the serum, tissues, and bone marrow that mainly result from hemorrhages (e.g., nasal, gastrointestinal etc.). Women are at risk for IDA due to the physiological monthly loss of blood, childbearing, and breastfeeding but also due to various gynecological disorders leading to iron depletion and anemia. The paper describes the pathogenic mechanisms, diagnostic criteria, and clinical presentations of IDA and the potential consequences of iron overload. Considering a high medical and social importance of anemia in pregnancy, the data on IDA prevalence in this cohort as well as the potential complications both for the mother and the child are addressed. Current therapeutic approaches for anemia using peroral and parenteral iron preparations and their indications are highlighted. The prevention of iron deficiency and the effective options of its correction are viable tasks which allow for improving the health and quality of women’s life. KEYWORDS: anemia, iron-deficiency anemia, diagnosis, pregnancy, latent iron deficiency, iron overload, treatment, iron (II) fumarate. FOR CITATION: Lukina E.A., Ledina A.V., Rogovskaya S.I. Iron-deficiency anemia: a view of hematologist and gynecologist. Optimizing diagnostic and treatment approach. Russian Journal of Woman and Child Health. 2020;3(4):248–253. DOI: 10.32364/2618-8430-2020-3-4-248-253.

Predictors of iron-deficiency anemia in primary care older adults: a real-world European multi-country longitudinal study.

Iron deficiency is a major cause of anemia in older people. Increasing the knowledge on the predictors of iron-deficiency anemia (IDA) may facilitate its timely diagnosis. To investigate the predictors of IDA in older people in four European countries. Retrospective longitudinal study. Primary care patients aged 65 or older (N = 24,051) in four European countries. IDA predictors were estimated using multivariate Cox regression based on information gathered from national primary care databases: Italy (years 2002-2013), Belgium, Germany and Spain (years 2007-2012). Adjusted hazard ratios (aHR) with 95% confidence intervals (CIs) were estimated. In Spain and Belgium, men were at greater risk of IDA than women, while they had a lower risk in Italy. Weakness, irritability, alopecia and xerostomia were signs and symptoms significantly associated with IDA. Concurrent diseases, potential causes of anemia, positively associated with IDA were small bowel polyposis, stomach cancer, obesity, gastritis and peptic ulcer, esophagitis, Crohn's disease, celiac disease, lymphangiectasis, gastrectomy or gastric atrophy, gut resection or bypass, and cardiac prosthetic valve. Aspirin users had a 12-35% higher hazard of IDA than non-users. Similarly, corticosteroids and anti-acids were positively associated with IDA. A higher level of comorbidity was associated with an increased hazard of IDA in all countries. Specific signs and symptoms, chronic conditions, a greater comorbidity burden, and specific pharmacological treatments registered in primary care databases represent relevant predictors and correlates of incident IDA in older people in Europe. General practitioners might employ this information to obtain early diagnosis of IDA in community-dwelling older adults.

Building a prediction model for iron deficiency anemia among infants in Shanghai, China.

Iron deficiency anemia (IDA) is a common micronutrient deficiency worldwide in infants. Iron deficiency anemia, during infancy, can have long‐lasting detrimental effects on the immune and neural systems; the damage is irreversible. This study aimed to build a prediction model to predict the potential risk of IDA among infants. To collect relevant information for model building, we recruited 528 infants from Fenglin Community Health Service Center in Shanghai, China, and collected the information of infants and their parents by using a structured questionnaire. We also got the blood routine examination results of the infants. Then, we used a multilayer perceptron model (MLP) of the neural network model in IBM SPSS Modeler 18.0 to construct the prediction model. Of the 528 included infants, 80 (15.2%) of them had lower hemoglobin values (<110 g/L) and were finally diagnosed with IDA. Based on the accuracy of different models, the model with the highest accuracy rate (97.3%) was chosen, and all the preselected 26 variables were included in the model. After the modeling, the results indicated that the number of months of exclusive breastfeeding was the most important predictive variable, followed by the mother having anemia during pregnancy, and then the number of months of feeding the infant with iron‐fortified rice flour. The model has good sensitivity (100%) and specificity (100%). By using this model, we can predict the potential risk of an infant having IDA and can take the initiative to prevent iron deficiency through the improvement of feeding methods.

A Systematic Review and Meta-Analysis on the Effects of Probiotic Species on Iron Absorption and Iron Status.

Background: Strategies to prevent iron deficiency anemia (IDA) have varying effectiveness. The purpose of this systematic review of the literature and meta-analysis was to examine the effects of probiotics on iron absorption and iron status-related markers in humans. Methods: We followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) reporting guidelines. Relevant articles were identified from Embase, Pubmed, Scopus, and CINAHL from inception to February, 2019. We conducted a meta-analysis for eight studies examining the effect of the probiotic Lactobacillus plantarum 299v (Lp299v) on iron absorption. Results: Fifteen studies reported in 12 articles were identified (N = 950). Our meta-analysis of eight studies using a random-effects model demonstrated a significant increase in iron absorption following administration of the probiotic Lp299v with a pooled standardized mean difference (an average intervention effect size) of 0.55 (95% CI 0.22–0.88, p = 0.001). Of the seven randomized clinical trials (RCTs) and nonrandomized clinical trials examining a range of probiotic species on iron status, only one study supplementing with Lp299v showed improvement in serum iron; no other studies reported improvement in iron status-related indices with probiotic treatment. Conclusions: Lp299v significantly improved iron absorption in humans. Future research should include the assessment of Lp299v effect on iron absorption and iron status in populations at high risk of IDA, including pregnant women.

Analysis of the iron profile and the incidence of iron deficiency anemia in the third-trimester pregnant women in the coendemic areas of Bengkulu City, Indonesia

Pregnant women are at risk for iron deficiency anemia especially pregnant women in malaria-endemic areas. This study aimed to analyze the profile of iron in the third trimester pregnant women with iron deficiency anemia in co-endemic area of Bengkulu city. This study was cross-sectional study with a total sample of 66 pregnant women who met the inclusion criteria. Examination profile of iron in pregnant women is done by taking blood specimen through the vena cubity. Profile iron includes examination sTfR levels, hepcidin, transferrin were examined by ELISA. Determination of iron deficiency anemia is based on the results of Hb, serum iron and TIBC. The results showed 39.4% of pregnant women experience iron deficiency anemia. There is an average difference between hepcidin levels with the incidence of iron deficiency anemia (p-value 0.031). Based on binary logistic regression analysis profile iron with irondeficiency anemia in pregnant women, hepcidin levels are predictors factors on the incidence of iron deficiency anemia (p-value 0.000, 95% CI .296-.709).

Iron Depletion, Iron Deficiency, and Iron Deficiency Anaemia Among Children Under 5 Years Old in Kilimanjaro, Northern Tanzania: A Hospital-Based Cross-Sectional Study

Background: Iron depletion results from reduced iron stores, and it is an early stage of disease progression before iron deficiency, which leads to iron deficiency anaemia (IDA). IDA is associated with delayed infant growth and development, diminished cognitive function, poor academic performance, decreased exercise tolerance, and impaired immune function. This study aimed to determine the prevalence of iron depletion and IDA and factors associated with low ferritin levels among children under 5-years-old receiving care at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. Methods: Under-5 children presenting at KCMC were successively enrolled and screened for iron depletion and IDA using complete blood count and serum ferritin levels. The generally accepted World Health Organization cut‑off levels for normal haemoglobin (Hb) and ferritin level were used. Iron depletion, iron deficiency, and IDA prevalences were estimated in relation to the combination measures of haemoglobin, mean corpuscular volume, and ferritin levels. Dietary and sociodemographic characteristic of the children were recorded after parents or caretakers provided informed consent. Data analysis was conducted using SPSS version 21.0. Results: A total of 303 children aged 2 to 59 months were enrolled in the study. Anaemia was detected in169 (55.8%) children. Children aged 2 to 12 months had a higher prevalence of anaemia (n=101, 60.1%). The overall prevalences of iron depletion, iron deficiency with no anaemia, and IDA were 2.6% (n=8), 9.6% (n=29), and 28.1% (n=84), respectively. Low ferritin levels were detected in 124 (40.9%) children. Drinking more than 500 ml of cow's milk per day was associated with an increased risk of anaemia (adjusted odds ratio [AOR] 5.6; 95% confidence interval [CI], 2.6 to 12.1) relative to those not drinking cow's milk. Children whose families had meals that included beef more than 3 times per week were less likely to have low ferritin (AOR 0.6; 95% CI, 0.3 to 1.3), though the difference was not significant. Conclusion: The IDA prevalence among children in the Kilimanjaro area was high, with more than 50% of infants being anaemic. Drinking cow's milk was associated with an increased risk of IDA. Future community-based research is recommended to elucidate more details about iron deficiency in the general population.

Iron Supplementation Necessities for Subjects with Celiac Disease in KSA –A Retrospective Study (P12-040-19)

ObjectivesTo assess the iron (Fe) supplementation necessities for subjects with celiac disease (CD) in KSA. MethodsThe study was conducted among the subjects with CD registered in King Abdulaziz Medical City (KAMC), KSA for medical care during 2008–18. Those who are pregnant/lactating or with blood loss due to non-CD causes/gastrointestinal (GI) abnormalities/chronic disease of liver/kidney/febrile diseases/cancer/metabolic disorders were excluded from the study. The design of the study was retrospective cross-sectional. The data of the subjects with CD entered in the Hospital Information system of KAMC was used. Accordingly, 71 subjects with CD were selected by using convenient sampling technique.Demography, clinical manifestations, hematological and Fe profile of the subjects were studied. SPSS Version 22 was used for data analysis. Frequencies, percentages and mean + SD, Student’s t and non-parametric Mann-Whitney U tests were used. P-value of <0.05 considered as statistically significant. IRB of KAIMRC, Riyadh approved the study. ResultsAdults formed 54.8% of the subjects, children and females formed 31% and 78.9% respectively. Diarrhea and vomiting were the major clinical manifestations observed among 55% of the subjects. Anthropometric data indicated that 38.3% of them was malnourished. Reduced RBC counts perceived among 40.1% of the subjects. Among them, 88.23% were females while 18.3% were with low WBC count. Platelet counts < normal were exhibited by 12.7%. MCV, MCHC, and Hematocrit (HCT) values were lower congruently for 16.9, 69 and 41% (66.66% were females) of the subjects. Iron Deficiency Anemia (IDA) pointed out by low hemoglobin (Hb) level was observed in 38.02%. Of them, 88.19% were females. Abridged Serum iron was detected in 67.59% (85.41% are females) while increased TIBC values were shown by 22.9%. Of the subjects (22.53%) with low serum ferritin(SF) values 68.75% were females. There was a significant difference between the values of RBC count, MCV, MCHC, HCT, Hb and SF levels of both genders. ConclusionsThe study signifies the importance of the provision of Fe supplements for subjects with CD. Females more than the males with CD are at risk for IDA. Funding SourcesNIL. Supporting Tables, Images and/or Graphs▪

Dietary Iron Intake Does Not Predict Anemia, Iron Deficiency or Iron Deficiency Anemia Among 12-month Old Rwandan Children (P10-124-19)

ObjectivesIn Rwanda, anemia affects 38% of all under five and 61% of those aged 9–11 months old; however, the contribution of diet to anemia remains less known. This study aimed to assess if dietary iron intake predicts the risk of anemia and iron deficiency among Rwandan children of 12 months old. MethodsA longitudinal study of 192 children was conducted in 2016–2018 in a rural setting in Rwanda. We measured hemoglobin concentration, and collected blood samples from the infant-mother pairs at birth, 4 and 12 months post-partum. Plasma or serum ferritin, soluble transferrin receptors (sTfR), C-reactive protein (CRP), and α-Acid Glycoprotein (AGP) concentrations were measured using sandwich ELISA technique. Body iron stores were calculated from the sTfR/Ferritin ratio. Hemoglobin and ferritin values were adjusted for altitude and infection, respectively. Dietary iron intake data were collected using a full 24-hour recall, and the intake of iron from micronutrient powders was captured by questionnaire. Predictors of anemia, iron deficiency, and iron deficiency anemia at 12 months of age were modelled using Cox proportional hazard regression with robust variance. ResultsAnemia, iron deficiency (ID), and iron deficiency anemia (IDA) occurred in 73%, 56%, and 44% of the infants at 4 months, and 48%, 88% and 45% of the children at 12 months, respectively. For their mothers, anemia, ID, and IDA occurred in 12%, 59%, and 9% at 4 months, and 12%, 49%, and 8% at 12 months. Child’s dietary iron intake did not significantly predict anemia [PR = 1.00 (0.96–1.04)], ID [PR = 0.99 (0.98–1.01)], or IDA [PR = 0.99 (0.95–1.03)] at 12 months. However, this study revealed that the child’s hemoglobin concentration at birth was inversely associated with anemia at 12 months [PR = 0.92 (0.86–0.99)], whereas inflammation [PR = 1.23 (1.03–1.46)] and IDA at 4 months [PR = 1.44 (1.04–1.99)] increased the risk of anemia at 12 months. Presence of inflammation additionally predicted risk of IDA at 12 months [PR = 1.27 (1.05–1.54)]. ConclusionsWhile dietary iron intake is not a significant predictor of anemia, 94% of anemia cases coincide with ID at 12 months of age. In addition, inflammation is the most important predictor of anemia and IDA at this age. Therefore, prevention of inflammation is crucial to make dietary measures effective. Funding SourcesEmbassy of the Kingdom of the Netherlands in Rwanda; UNICEF Rwanda; Nuffic.

Effect of timing of umbilical cord clamping on maternal and neonatal outcomes: A protocol for systematic review and network meta-analysis.

Background:Umbilical cord clamping is one of the most commonly used medical or complementary medical interventions. The different timing of cord clamping may have any significant impact on public health. However, the results remain controversial. The aim of the study was to evaluate and compare the effect of different timing of umbilical cord clamping on maternal and neonatal outcomes.Methods:A systematic literature search for relevant articles will be conducted in the Cochrane Central Register of Controlled Trials, PubMed, Embase, and Chinese Biomedical Literature Database from their inception to December 2018. Any randomized controlled trial (RCT), case-control study, observational study, that reported the effect of different timing of cord clamping will be included regardless of sample size. There are no language restrictions. Mortality and risk of iron-deficiency anemia will be used to assess the clinical effect. Risk of bias assessment of the included RCTs will be conducted by the Cochrane risk of bias tool and the Newcastle–Ottawa Scale is used to assess observational studies. All statistical analyses will be performed using Stata V.15.0. A modified version of Grades of Recommendation, Assessment, Development, and Evaluation will be used to assess the quality of evidence in network meta-analysis (NMA).Results:The results will be published in a peer-reviewed journal.Conclusion:This will be the first NMA to evaluate and compare the effect of different timing of umbilical cord clamping. We hope that the results of this NMA will help clinicians and caregivers make more appropriate choices when clamping umbilical cord.

Perceived Benefits and Intakes of Protein, Vitamin C and Iron in Preventing Anemia among Pregnant Women

Introduction: Nutritional adequacy is essential in ensuring the normal growth and development of the fetus. Perceived benefits will be able to strengthen pregnant women to meet optimum nutritional intake to prevent anemia. Adequacy of protein, vitamin C and iron will reduce the risk of iron deficiency anemia in pregnancy. This study aims to examine the association between perceived benefits with protein, vitamin C, and iron intake in preventing pregnancy anemia.Methods: This study used a cross-sectional design and was conducted in August-October 2017 among105 pregnant women. This study used the multistage random sampling method. The population of this study was pregnant women who had antenatal care in four Community Health Centre in Surabaya namely Jagir, MedokanAyu, SidotopoWetan, and Gundih. Results: The average daily protein intake was 76.34 (SD = 35.88) gram/day. There was a significant association between perceived benefits with protein intake (r = 0.272; p = 0.005). The average daily vitamin C intake was 90.67 (SD = 116.54) mg/day. There was no significant association between perceived benefits and vitamin C intake (r = 0.175; p = 0.074). The average daily iron intake was 64.73 (SD = 23.13) mg/day. There was a significant association between perceived benefits and iron intake (r = 0.219; p = 0.025).Conclusion: The knowledge of pregnant women about the benefits of nutrition will affect the adequacy of pregnancy nutrition. Health workers need to provide health education on the importance of nutrition for pregnant women to prevent anemia during pregnancy.

Iron Depletion, Iron Deficiency, and Iron Deficiency Anaemia Among Children Under 5 Years Old in Kilimanjaro, Northern Tanzania: A Hospital-Based Cross-Sectional Study.

Background:Iron depletion results from reduced iron stores, and it is an early stage of disease progression before iron deficiency, which leads to iron deficiency anaemia (IDA). IDA is associated with delayed infant growth and development, diminished cognitive function, poor academic performance, decreased exercise tolerance, and impaired immune function. This study aimed to determine the prevalence of iron depletion and IDA and factors associated with low ferritin levels among children under 5-years-old receiving care at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania.Methods:Under-5 children presenting at KCMC were successively enrolled and screened for iron depletion and IDA using complete blood count and serum ferritin levels. The generally accepted World Health Organization cut-off levels for normal haemoglobin (Hb) and ferritin level were used. Iron depletion, iron deficiency, and IDA prevalences were estimated in relation to the combination measures of haemoglobin, mean corpuscular volume, and ferritin levels. Dietary and sociodemographic characteristic of the children were recorded after parents or caretakers provided informed consent. Data analysis was conducted using SPSS version 21.0.Results:A total of 303 children aged 2 to 59 months were enrolled in the study. Anaemia was detected in169 (55.8%) children. Children aged 2 to 12 months had a higher prevalence of anaemia (n=101, 60.1%). The overall prevalences of iron depletion, iron deficiency with no anaemia, and IDA were 2.6% (n=8), 9.6% (n=29), and 28.1% (n=84), respectively. Low ferritin levels were detected in 124 (40.9%) children. Drinking more than 500 ml of cow's milk per day was associated with an increased risk of anaemia (adjusted odds ratio [AOR] 5.6; 95% confidence interval [CI], 2.6 to 12.1) relative to those not drinking cow's milk. Children whose families had meals that included beef more than 3 times per week were less likely to have low ferritin (AOR 0.6; 95% CI, 0.3 to 1.3), though the difference was not significant.Conclusion:The IDA prevalence among children in the Kilimanjaro area was high, with more than 50% of infants being anaemic. Drinking cow's milk was associated with an increased risk of IDA. Future community-based research is recommended to elucidate more details about iron deficiency in the general population.

Iron deficiency and anemia in patients with inherited bleeding disorders

Patients with inherited bleeding disorders are predisposed to acute and chronic blood loss, which places them at high risk of iron deficiency anemia (IDA). The clinical effects of iron deficiency (ID) and IDA in the general population are significant and include low energy, reduced cardiovascular health, impaired cognition and reduced health-related quality of life. However, the incidence and impact of ID and IDA in patients with bleeding disorders is largely unknown. Here we review our approach to the diagnosis and management of iron deficiency in patients with inherited bleeding disorders. Given their risk of future iron losses, we propose more aggressive iron supplementation and higher target ferritin values in patients with ID and ongoing bleeding.

Association between Maternal Weight Indicators and Iron Deficiency Anemia during Pregnancy

Background:The effect of maternal weights on the risk of iron deficiency anemia (IDA) during pregnancy remains unclear. The study aimed to investigate the association between maternal weight indicators and IDA during pregnancy.Methods:We conducted a cohort study to examine the association between maternal weight indicators, including prepregnancy body mass index and the rate of gestational weight gain (GWG), and the risk of IDA among Chinese pregnant women. Data about new-onset IDA at different trimesters from a national cross-sectional survey were collected; information regarding baseline variables and rate of GWG from women participating in the survey were retrospectively collected. Tested IDA and reported IDA were documented. Multilevel logistic regression to examine the association between maternal weight indicators and the risk of IDA after adjusting for potential confounders was conducted.Results:This study enrolled 11,782 pregnant women from 24 hospitals from September 19, 2016, to November 20, 2016. Among those, 1515 (12.9%) IDA events were diagnosed through test (test IDA); 3915 (33.3%) were identified through test and patient reporting (composite IDA). After adjusting for confounders and cluster effect of hospitals, underweight pregnant women, compared with normal women, were associated with higher risk of test IDA (adjusted odds ratio [aOR]: 1.35, 95% confidence interval [CI]: 1.17–1.57 and composite IDA (aOR: 1.35, 95% CI: 1.21–1.51); on the contrary, overweight and obese women had lower risk of test IDA (aOR: 0.68, 95% CI: 0.54–0.86 overweight; aOR: 0.30, 95% CI: 0.13–0.69 obese) and composite IDA (aOR: 0.77, 95% CI: 0.67–0.90 overweight; aOR: 0.34, 95% CI: 0.21–0.55 obese). The higher rate of GWG was associated with higher risk of IDA (test aOR: 1.86 95% CI: 1.26–2.76; composite aOR: 1.54, 95% CI: 1.16–2.03).Conclusions:Pregnant women who are underweight before pregnancy and who have faster GWG are more likely to develop IDA. Enforced weight control during pregnancy and use of iron supplements, particularly among underweight women, may be warranted.

Half of IBD Patients Without Anemia Have Iron Deficiency Leading to Similar Rates of Fatigue as Iron Deficiency Anemia

Introduction: Inflammatory bowel disease (IBD) patients are at high risk for iron deficiency anemia due to chronic intestinal inflammation, malabsorption and dietary restrictions. Iron deficiency alone develops prior to anemia, although little is known about the prevalence, clinical significance and management of non-anemic iron deficiency. Our aim was to describe the prevalence and clinical manifestations of non-anemic iron deficiency. Methods: Adult IBD patients with available laboratory data including iron studies were included. Patient demographics, disease phenotype, medications, laboratory data for iron deficiency and presence of fatigue were abstracted from the medical records. Iron deficiency was defined as a ferritin < 30 ug/L in the absence of inflammation (normal C-reactive protein [CRP]) or ferritin < 100 in the presence of inflammation (elevated CRP), according to European Crohn's and Colitis Organization guidelines. Anemia was determined based on the study center's laboratory references: hemoglobin levels < 13.9 g/dL for men and < 12.0 g/dL for women. The presence and degree of fatigue was documented at each office visit. Laboratory data within 30 days of the office visit was used. Results: Of 116 IBD patients, 47 patients (41%) had iron deficiency anemia, whereas 28 patients (24%) had non-anemic iron deficiency. Of the 63 IBD patients with anemia, 47 (74%) had iron deficiency anemia. Of the 53 IBD patients without anemia, 28 (53%) had iron deficiency. Patients with non-anemic iron deficiency were more likely to have ulcerative colitis whereas iron deficiency anemia patients were more likely to have Crohn's disease (p < 0.05). The presence of fatigue in patients with non-anemic iron deficiency was similar to those with iron deficiency anemia (75% vs. 70%; p = 0.79). Severe fatigue was seen in 36% of patients with non-anemic iron deficiency compared to 40% of patients with iron deficiency anemia, p = 0.81. Conclusion: Iron deficiency is found in half of IBD patients without anemia and a quarter of all IBD patients. Non-anemic iron deficiency is associated with a similar level of fatigue as iron deficiency anemia. Therefore, clinicians should consider screening for and treating iron deficiency even in the absence of anemia in IBD patients with symptoms of fatigue.