Serum Transferrin Receptor Levels Research Articles

Iron Deficiency Anemia: A Review Into Newer Insights

Many people globally suffer from iron deficiency. It is the most common cause of iron deficiency anemia IDA that has a devastating effect on infants and their mothers. It occurs when the body's iron storage, iron intake, and iron loss are all out of balance, making it impossible for erythropoiesis to function properly. Microcytic hypochromic anemia is the medical term for this condition. Thalassemia, anemia of chronic disease, and sideroblastic anemias are among the other possible causes of microcytic anemia. Iron parameters such as MCV, MCH and RDW are cost-effective and useful in the diagnosis of iron deficiency. After routine hematological tests like CBC and hemoglobin, serum ferritin is often used as a first diagnostic check. The total iron binding capacity, transferrin saturation, and the serum iron and serum transferrin receptor levels may be beneficial. Stainable iron may be necessary to confirm the diagnosis. High rates of prevalence have negative consequences for both health and the economy. IDA has been known for a while, yet there are still unresolved problems and room for improvement in the way this condition is managed. Every day, new directions in its diagnostic and treatment choices open.

Is Helicobacter Pylori a Reason for Unexplained Iron Deficiency Anemia: A Systematic Review.

Iron deficiency anemia (IDA) is a worldwide public health problem affecting millions, with developing nations accruing a significant disease burden. Helicobacter pylori (H. pylori) has been proposed in many studies as a causative factor for unexplained iron deficiency anemia. In this systematic review, we searched PubMed, Google Scholar, and ScienceDirect to come up with five cross-sectional studies and five Randomized Controlled Trials (RCTs), which evaluated the association between H. pylori and unexplained iron deficiency anemia and the response of IDA to anti-H. pylori therapy. H. pylori eradication therapy included triple therapy (proton pump inhibitor, clarithromycin, amoxicillin) or quadruple therapy (proton pump inhibitor, bismuth, metronidazole, tetracycline) for 10-14 days. Quadruple therapy was used if there is a penicillin allergy or a local antibiotic resistance level of more than 15% to clarithromycin. The cross-sectional studies concluded that H. pylori infection was associated with low serum ferritin levels. The RCTs confirmed that H. pylori are associated with iron deficiency anemia by demonstrating improvement in markers of iron status (ferritin, hemoglobin, Mean Corpuscular Volume (MCV), serum transferrin receptor levels) with H. pylori eradication therapy. In a nutshell, this systematic review concludes that H. pylori testing and treatment must be considered as a differential diagnosis of unexplained IDA in all age groups and serves as a benchmark for more randomized clinical trials to prove causation.

Serum Soluble Transferrin Receptor and Transferrin Levels among Regular Blood Donors

Background: The study evaluated the effects of regular blood donation on serum transferrin and soluble transferrin receptor levels at Wenchi Methodist Hospital. Methods: This was a hospital-based cross-sectional study conducted at the Medical Laboratory Department of the Wenchi Methodist Hospital in the Bono Region of Ghana. A total of eighty-nine (89) venous blood samples from apparently healthy blood donors were analyzed. Complete blood count parameters were analyzed using an automated haematology analyzer and serum transferrin and transferrin receptor using ELISA. The data were analyzed using SPSS version 22.0. Results: Haemoglobin (p<0.001) and HCT (p=0.004) were significantly lower among the regular blood donors compared with the first-time donors. Regular blood donors had relatively higher serum transferrin (p<0.001) and soluble transferrin receptor levels (p<0.001). A negative correlation was observed between Hb and serum transferrin (r=-0.552, p<0.001), as well as Hb and serum soluble transferrin receptor (r=-0.552, p<0.001). Remunerated donors had lower Hb (p=0.001) and HCT% (p=0.001) but a higher transferrin receptor (p=0.041) than non-remunerated donors. Conclusion: Regular blood donors had relatively lower erythrocyte parameters but higher serum transferrin and soluble transferrin receptors, indicating a possible reduction in serum iron and iron stores. Moderate negative correlations exist between Hb and both transferrin and soluble transferrin receptors. Again, remunerated donors had lower erythrocyte parameters but higher transferrin and soluble transferrin receptors than non-remunerated donors. Periodic assessment of iron parameters among regular blood donors is recommended. A future longitudinal study to assess the entire iron profile of regular blood donors is recommended. Doi: 10.28991/SciMedJ-2022-04-03-01 Full Text: PDF

Role of Soluble Transferrin Receptor in Diagnostic Work Up for The Assessment of Iron Status and Iron Deficiency

Background: Iron deficiency anaemia (IDA) is the most frequent form of anaemia in human population. For diagnosing IDA usually conventional laboratory tests such as serum iron, serum ferritin and transferrin saturation are used. However, both ferritin and transferrin proteins are markedly influenced by inflammation, behaving as acute-phase reactants and making it difficult to diagnosis iron-deficiency anemia (IDA) when it is combined with any inflammatory condition. Soluble transferrin receptor (sTfR) is a truncated extracellular form of the membrane transferrin receptor produced by proteolysis. Concentrations of serum sTfR are related to iron status and erythropoiesis in the body. Serum transferrin receptor (sTfR) levels are raised in iron deficiency but are not influenced by inflammatory changes.
 Aim: The aim of this study is to evaluate the significance of soluble transferrin receptors in diagnostic work up of iron deficiency.
 Materials and Methods: It was a prospective observational study carried out from June 2021 to November 2021 at the Department of Haematology and Biochemistry of Armed Forces Institute of Pathology (AFIP), Dhaka Cantonment. A total of 50 blood sample were collected and subjected to diagnose as microcytic hypochromic anaemia through complete blood count (CBC) and peripheral blood film (PBF). Then serum iron profile and serum sTfR was done by automated analyzer to evaluate differentials of microcytic hypochromic anaemia.
 Results: Among 50 cases 5 (10%) were male and 45 (90%) were female. Most of the patients were between 31-40 years age group (34%). Out of 50 patients 42 (84%) showed mild anaemia,6 (12%) showed moderately anaemia and 2(4%) showed severely anaemia according to reference range. Then serum iron profile was done. Among 50 samples 37 (74 %) had low serum iron, 18 (36 %) had high TIBC and 45 (90%) had low serum ferritin in comparison with reference range. Also this study revealed high serum sTfR than normal in 48 (96%) patients. While evaluating the frequency of sTfR level in perspective of both male and female anaemic patients, p-value was found < 0.0001 which was statistically significant.
 Conclusion: This study demonstrates that sTfR level in conjunction with other biochemical markers of iron deficiency anaemia is very useful in evaluating iron status. Serum sTfR is a new diagnostic tool for evaluating of iron deficiency anemia when it is associated with other inflammatory condition.

Evaluation of serum transferrin receptor level in Children Undergoing Regular Hemodialysis

Evaluation of serum transferrin receptor level in Children Undergoing Regular Hemodialysis

Prophylactic Iron Supplementation in Pregnancy and its Implications in Development of Pre-eclampsia: A Case-control Study

Introduction: Pre-eclampsia is a serious complication of pregnancy and is associated with increased maternal and perinatal morbidity and mortality. Increased iron and ferritin concentration is associated to a higher risk of pre-eclampsia and prophylactic iron supplementation can sometimes be harmful to pregnant women who are otherwise not iron deficient. Aim: To analyse serum iron, serum ferritin, serum Transferrin Receptor (sTFR) levels, Total Iron Binding Capacity (TIBC) among iron supplemented pre-eclamptic cases and normotensive pregnant controls. Materials and Methods: This prospective, observational, case- control study was conducted in Jaipur National University Institute of Medical Sciences and Research Centre (JNUIMSRC), Jaipur, Rajasthan, India for a period of one year from (February 2019-January 2020). A total of 200 pregnant females, all on iron supplementation during the course of their pregnancy, 100 in pre-eclampsia group (case group); 100 in normotensive group (control group), in third trimester and between 18- 45 years of age were enrolled in the study. Serum iron, serum ferritin, sTFR and TIBC were estimated using fully automated analysers. Results: Median Interquartile Range (IQR) of serum ferritin levels in cases were higher than the controls [41 (30-70) vs 24 (17-44); p<0.001]. Serum ferritin in cases were also found to correlate positively with systolic (r=0.37, p=0.001) Blood Pressure (BP) whereas TIBC correlated negatively with diastolic BP (r=-0.238, p-value=0.017). The median IQR differences of TIBC values among cases and controls were insignificant {485 (404-523) vs 493 (448- 544)} and differences of median IQR of sTFR values among cases and controls were significant {8.5 (7-9) vs 8.9 (8-10)}. Subjects with serum feritin levels >40 ng/mL had three times increased risk of PE (Odds ratio=3, 95% Cl=1.571-5.157). Conclusion: Elevated serum ferritin, decreased sTFR levels and correlation of Ferritin and TIBC to BP in pre-eclampsia compels us to put cautionary remarks over testing these parameters before continuing with iron supplements. This may prevent a possible iron related added complications in pre-eclampsia and help clinicians decide about restricting/lowering iron supplement doses in case a situation of iron overload arise.

Association of Meat Consumption and Iron Deficiency Among Women of Reproductive Age in Sub Saharan Africa

Abstract Objectives Globally, it is estimated that about 2 billion people are affected by iron deficiency, with sub-Saharan Africa (SSA) carrying the highest burden. We thus conducted a cross-sectional study to assess whether meat consumption was associated with altered risk of iron deficiency, as assessed by serum transferrin receptor (TfR) levels among women of reproductive aged 15–49 y in Tanzania. Methods This was a weighted population-based cross-sectional study of 3811 women of reproductive aged 15–49 y in Tanzania using 2010 Demographic and Health Surveys (DHS). Iron status was assessed using serum TfR. Iron deficiency was defined if TfR levels were >8.3 µg/mL. Number of days of meat intake in a week was assessed through a questionnaire. Prevalence Ratio was calculated using robust multivariable Poisson regression to identify the association between meat intake and iron deficiency, adjusting for age, fish intake, food insecurity, anemia, education status, married status, wealth index, pregnancy status, and breastfeeding status, place of residence, employment status, and geographic zone. Interactions between meat intake, pregnancy and wealth status were conducted. As a secondary analysis, the association between fish intake and iron deficiency was also examined. Results The overall prevalence of iron deficiency for the present study was 31%. There was a dose-response relation between the number of days/week of meat intake and iron deficiency (P-trend = 0.006). After adjusting for other covariates, women who consumed meat ≥2 times per week were 14% less likely to have iron deficiency [adjusted Prevalence Ratio (aPR): 0.86; 95% CI: 0.76, 0.97] compared to those with low meat consumption (<2 times per week). In contrast, we did not find significant association between fish intake and iron deficiency – the aPR was 1.05 (95% CI: 0.94, 1.18) for ≥2 times of fish vs. (<2 times per week). We did not find significant interaction between meat intake and pregnancy status (P-interaction = 0.80). Lastly, we did not find significant interaction between meat intake and wealth status (P-interaction = 0.09). Conclusions Prevalence of iron deficiency was high in Tanzania women of reproductive age. Greater consumption of meat, but not fish, was significantly associated with low rates of iron deficiency. Funding Sources There was no external or internal funding to support this study.

Improvement of Vitamin A and Trace Elements in Children with Anemia

In order to study the improvement of vitamin A and trace elements in children with anemia, children whose serum vitamin A is lower than 0.7 μmol/l or hemoglobin is lower than 115 g/l were selected as research subjects and were divided into the iron supplementation group, the vitamin A supplementation group and the control group (only nutrition education). Serum vitamin A was determined using high performance liquid chromatography. Hemoglobin was measured by semi-automatic hematology analyzer. Serum ferritin and serum transferrin receptor were measured using enzyme-linked immunosorbent assay. Serum vitamin A, hemoglobin, serum ferritin, serum transferrin receptor, prevalence of vitamin A deficiency and anemic changes were compared and analyzed before and after the treatment. The results showed that the serum vitamin A, hemoglobin and serum transferrin receptor levels in the group supplemented with vitamin A were significantly higher than those recorded prior to starting treatment. The level of serum ferritin, vitamin A deficiency and anemia were significantly lower after the treatment. The levels of hemoglobin and serum transferrin receptors in the group supplemented with iron were significantly higher after the treatment while serum ferritin level, vitamin A deficiency decreased significantly after the treatment. Although the level of vitamin A in serum increased but this increase was not significant, while the levels of all these indicators in the control group remain unchanged after treatment.

Evaluation of Iron Status in Patients of Chronic Kidney Disease - A study to assess the best Indicators Including Serum Transferrin Receptor Assay

Anemia is an early complication of chronic kidney disease (CKD). The iron deficiency is an important contributor, more so in the Pakistani population. As routine standalone iron tests do not accurately reflect the actual status in the complex environment of CKD, there is a need to study better indicators. Serum iron, ferritin, total iron-binding capacity (TIBC), and serum transferrin receptor (sTfR) levels were estimated in 100 primary iron deficiency anemia (IDA) patients (controls-Group 1) and 68 newly diagnosed CKD cases. The CKD patients were divided into two groups: Serum ferritin 100 μg/L (Group 3). The values of percentage saturation, log of ferritin (log_ferritin), and the ratio of sTfR to log ferritin (sTfR/log_f or sTfR index) were calculated. The CKD cases were further divided depending on ferritin cut-offs of 30, 50, 70, and 100 μg/L and statistically analyzed including ROC and AUC, to choose the best diagnostic parameter for accurate assessment of iron status in CKD cases. The mean serum ferritin was 11.34 μg/L, 28.70 μg/L, and 281.81 μg/L, and the mean sTfR was 2.34 μg/ml, 1.82 μg/ml, and 1.28 μg/ml in Groups 1, 2, and 3. Among all groups, the difference was found to be significant for serum iron, log_ferritin, and sTfR/log_f. The sTfR and sTfR/log_f showed good discrimination between IDA and Anemia of chronic disease in CKD cases, but sTfR/log_f gave the best discrimination at all cut-off levels of ferritin. At a ferritin cut-off of 50 μg/L, the sTfR/log_f value of 0.83 had a sensitivity of 93.5% and specificity of 95.45%, and at a ferritin cut-off 100 μg/L, the same value of 0.83 had a sensitivity of 95.5% and specificity of 86.5%. The ratio of sTfR/log_f is the best indicator for assessing iron status in CKD. Keywords: Anemia, chronic kidney disease, ferritin, transferrin receptor DOI : 10.7176/JMPB/57-03 Publication date : July 31 st 2019

Meta-analysis of efficacy of iron and iodine fortified salt in improving iron nutrition status.

Salt fortification with iron is a potential strategy to increase population-level iron intake. The current evidence regarding double-fortified salt (DFS) in improving iron nutrition status is equivocal. To study the efficacy of DFS as compared to iodine fortified salt (IS) in improving iron nutrition status. Randomized controlled trials comparing DFS and IS until August 2016 were systematically searched across multiple databases to assess for change in mean hemoglobin (Hb), prevalence of anemia, iron deficiency (ID), ID anemia (IDA), serum ferritin, and serum transferrin receptor (TfR). Meta-analysis was performed using R software. Of the initial 215 articles retrieved using the predetermined search strategy, data from 10 comparisons of DFS and IS across 8 randomized controlled trials are included. There was significant heterogeneity across included studies and the studies were of low to very low quality as per GRADE criteria. DFS significantly increased mean Hb by 0.44 g/dl (95% confidence interval [CI]: 0.16, 0.71) and significantly decreased anemia (risk difference -0.16; 95% CI: -0.26, -0.06) and ID (risk difference -0.20; 95% CI: -0.32, -0.08) as compared to IS. There was no statistically significant difference in change in ferritin levels (mean difference 0.62 μg/L; 95% CI: -0.12, 1.37), serum TfR levels (mean difference -0.23 mg/dL; 95% CI: -0.85, 0.38), and IDA (risk difference -0.08; 95% CI: -0.28, 0.11). DFS is a potentially efficacious strategy of addressing anemia as a public health problem at population level. There is a need for effectiveness trials before DFS can be scaled up in program mode at population level.

Evaluation of Iron Status in Patients of Chronic Kidney Disease - A Study to Assess the Best Indicators Including Serum Transferrin Receptor Assay.

Anemia is an early complication of chronic kidney disease (CKD). The iron deficiency is an important contributor, more so in the Indian population. As routine standalone iron tests do not accurately reflect the actual status in the complex environment of CKD, there is a need to study better indicators. Serum iron, ferritin, total iron-binding capacity (TIBC), and serum transferrin receptor (sTfR) levels were estimated in 100 primary iron deficiency anemia (IDA) patients (controls-Group 1) and 68 newly diagnosed CKD cases. The CKD patients were divided into two groups: Serum ferritin <=100 μg/L (Group 2) and >100 μg/L (Group 3). The values of percentage saturation, log of ferritin (log_ferritin), and the ratio of sTfR to log ferritin (sTfR/log_f or sTfR index) were calculated. The CKD cases were further divided depending on ferritin cut-offs of 30, 50, 70, and 100 μg/L and statistically analyzed including ROC and AUC, to choose the best diagnostic parameter for accurate assessment of iron status in CKD cases. The mean serum ferritin was 11.34 μg/L, 28.70 μg/L, and 281.81 μg/L, and the mean sTfR was 2.34 μg/ml, 1.82 μg/ml, and 1.28 μg/ml in Groups 1, 2, and 3. Among all groups, the difference was found to be significant for serum iron, log_ferritin, and sTfR/log_f. The sTfR and sTfR/log_f showed good discrimination between IDA and Anemia of chronic disease in CKD cases, but sTfR/log_f gave the best discrimination at all cut-off levels of ferritin. At a ferritin cut-off of 50 μg/L, the sTfR/log_f value of 0.83 had a sensitivity of 93.5% and specificity of 95.45%, and at a ferritin cut-off 100 μg/L, the same value of 0.83 had a sensitivity of 95.5% and specificity of 86.5%. The ratio of sTfR/log_f is the best indicator for assessing iron status in CKD.

Risk Factors Associated with Low Birth Weight

Neonatal deaths are associated with preterm birth complications. Preterm birth is also related to low birth weight (LBW), which can have multiple causes. The aim of this study was to analyze the risk factors associated with LBW. This was a cross-sectional study held in Bulu Primary Health Care, Temanggung, Central Java, Indonesia. The sample size required for this study was 69 based on the Slovin formula. Data were collected using questionnaires and semi-quantitative FFQ forms. Data on infant birth weight was taken from midwives’ delivery cohort records. Mid upper arm circumference (MUAC), hemoglobin level, blood pressure, maternal age, parity, nutritional intake, and serum transferrin receptor data were taken from the infant’s mother using a MUAC tape, automatic blood pressure monitor and blood laboratory analysis by Prodia. Data analysis procedures were carried out with quantitative methods. Descriptive statistics were analyzed as means and standard deviations. Inferential statistics used the chi-square test for bivariate analysis and binary logistic regression for multivariate analysis. The results of this study showed that mean infant birth weight was 2917.68 ± 374.673 kg. Inferential analysis showed that MUAC and pregnancy at a risky age are significant risk factors associated with LBW, while serum transferrin receptor levels, anemia, parity, energy and protein consumption levels, and systolic and diastolic blood pressure are nonsignificant risk factors. The probability of LBW in pregnant women with LILA under 23.5 cm and pregnancy at a risky age is 68.9%.

Association between serum transferrin receptor levels and malaria recurrence in a malaria endemic area in Tanzania

Background: The relationship between body iron levels and malaria presents a complex interaction that provide variable and contradicting results. We designed a study to investigate associations between concentrations of biomarkers of body iron and malaria recurrence among children.Methods: We conducted a longitudinal descriptive community based study in a malaria endemic area in north- eastern Tanzania. The study involved 428 children of ≤5 years of age who were positive for malaria. Over a period of 6 months, sick children visited the study clinic for screening of malaria and measurement of iron storage biomarkers by serological assays. Correlations between levels of biomarkers and malaria was determined by Spearman correlations and Mann-Whitney U-Test. Associations between malaria recurrence and serum levels of iron biomarkers were determined by odds ratio (OR) with significance cut-off points of &lt;0.15 in univariate and &lt;0.05 in multivariate logistic regression analyses.Results: Only serum Transferrin Receptor (sTfR) levels had a positive correlation with malaria recurrence. When Mann-Whitney U test was used higher Hepcidin, sTfR and Leptin levels were significantly associated with malaria recurrence when malaria incidence was grouped into ‘once’ versus ‘more than once’. When malaria incidence was recategorised to ‘up to twice’ versus ‘more than twice’, only higher level of sTfR was associated with recurrence of malaria. With univariate regression analysis, only sTfR was found to be significantly associated with malaria recurrence, although this associated was not observed in Multivariate analyses.Conclusion: Despite the absence of association in multivariate analyses, univariate analyses suggest elevated levels of sTFR as a likely predictor of Plasmodium falciparum re-infection.

Pengaruh suplementasi glisin terhadap kadar serum transferrin receptor (stfr) dan kadar hemoglobin (hb)

Background: Iron deficiency anemia ( IDA) is still become a health problem in female adolescents. Iron supplementation only as a treatment for IDA still can not reach an optimum results. With that result, there was necessary to developing a strategy for iron supplementation, once treatment with glicyne .Objective: to describe the effect of glycine supplementation on serum transferrin receptor (sTfR) levels and Hemoglobin (Hb) levels in female teenagers with IDA.Methods: This study was quasi experimental, pre post test control group design. The population was female teenagers age 12 – 18 years, Hb &lt; 12 mg/dl, sTfR &gt; 18,4 nmol/L, involving 50 subjects, devided into two groups. The first group was experiment group that given the supplement of 60 mg iron and 1 gr glycine a day for 4 weeks. The second group was control group that given the supplement of only 60 mg iron a day for 4 weeks. The data were analyzed with bivariate test, paired t test, independent t test.Results: There was significantly lower decreased of sTfR levels in treatment group 6,923±10,13 nmol/L than control group 0.809,65±9,076 nmol/L with p=0,008, and significant increased of Hb levels in both treatment group 0,79±1,15 mg/dl and control group 0,22±0,48 mg/dl with p=0,03. Conclusion: Glycine supplementation for 4 weeks decreased sTfR levels in female teenagers with IDA before controlled by vitamin c intake (p=0,04) and after controlled by vitamin c intake variable (p=0,002) and increased Hb levels before controlled by vitamin c intake (p=0,02) and after controlled by vitamin c intake variable (p=0,04).

Reference Values of Reticulocyte Hemoglobin Content and Their Relation With Other Indicators of Iron Status in Healthy Children.

Reticulocyte hemoglobin content (CHr) is considered an indicator of functional iron deficiency, but is understudied in children. The goals of this study are to determine the reference intervals for CHr in healthy children, and their relation with iron parameters, erythropoiesis, and individual conditions. A total of 902 children without iron deficiency, aged 1 to 11 years were analyzed in a cross-sectional study. Besides a physical examination of the subjects and a questionnaire completed by their parents, the complete blood count, serum transferrin receptor, ferritin, transferrin saturation, erythrocyte protoporphyrin, serum erythropoietin, C-reactive protein, and CHr levels were measured. Changes in CHr, iron status, and erythropoiesis at different age intervals were analyzed and linear multiple regression was used to identify the factors that determine CHr variability. Mean value obtained for CHr was 30.9±1.8 pg (P2.5-P97.5: 26.9 to 34.3 pg), but the influence of age on CHr (the values increased with age) and on the iron parameters justified the establishment of different reference ranges. In addition to age, nutritional status, hematologic measurements, reticulocytes, transferrin saturation, and erythrocyte protoporphyrin accounted for 39% of CHr variability.

Infant Arterial Stiffness and Maternal Iron Status in Pregnancy: A UK Birth Cohort (Baby VIP Study)

Background: In animal studies, iron deficiency during pregnancy has been linked to increased offspring cardiovascular risk. No previous population studies have measured arterial stiffness early in life to examine its association with maternal iron status. Objective: This study aimed to examine the association between maternal iron status in early pregnancy with infant brachio-femoral pulse wave velocity (PWV). Methods: The Baby VIP (Baby's Vascular Health and Iron in Pregnancy) study is a UK-based birth cohort which recruited 362 women after delivery from the Leeds Teaching Hospitals postnatal wards. Ferritin and transferrin receptor levels were measured in maternal serum samples previously obtained in the first trimester. Infant brachio-femoral PWV was measured during a home visit at 2-6 weeks. Results: Iron depletion (ferritin <15 μg/l) was detected in 79 (23%) women in early pregnancy. Infant PWV (mean = 6.7 m/s, SD = 1.3, n = 284) was neither associated with maternal ferritin (adjusted change per 10 μg/l = 0.02, 95% CI: -0.01, 0.1), nor with iron depletion (adjusted change = -0.2, 95% CI: -0.6, 0.2). No evidence of association was observed between maternal serum transferrin receptor level and its ratio to ferritin with infant PWV. Maternal anaemia (<11 g/dl) at ≤20 weeks' gestation was associated with a 1.0-m/s increase in infant PWV (adjusted 95% CI: 0.1, 1.9). Conclusion: This is the largest study to date which has assessed peripheral PWV as a measure of arterial stiffness in infants. There was no evidence of an association between markers of maternal iron status early in pregnancy and infant PWV.

The effects of regular consumption of a multiple micronutrient fortified milk beverage on the micronutrient status of school children and on their mental and physical performance

Multiple micronutrient deficiencies exist in school going children in India and bridging the gap between nutrient intake and requirements is an effective way to combat the deficiencies. This study aimed to test the effect of a multi-micronutrient fortified malt and cocoa based milk beverage on the micronutrient status, cognition, physical performance and nutritional deficiencies of 7-10 years old south Indian children. A randomized, double blind placebo controlled study design was used with normal healthy children from low to middle income families, aged 7-10 years randomly assigned to receive either a multi-micronutrient fortified or an unfortified milk based control drink. The drinks were provided 6 days/week for 5 months. Assessments included anthropometry, blood biochemistry, physical performance and cognition at baseline and endline. The baseline characteristics of the study groups were similar. The changes in body weight and height were similar between the groups at the end of the study. Levels of vitamin B12, red cell folate and vitamin B2 significantly improved in the intervention group, while vitamin D, selenium and body iron showed no difference. The Hemoglobin (Hb) and serum ferritin levels of the control group decreased at endline, while those in the intervention group maintained their levels. The serum transferrin receptor levels increased in both the groups. The prevalence of iron deficiency and Vitamin B2 deficiency were significantly lower in the intervention group at endline. Overall improvement in cognitive and physical performance was seen in both the groups at endline, with no significant differences between the groups. The micronutrient fortified milk based drink was efficacious in improving the micronutrient status of Vitamin B2, Vitamin B12 and red cell folate and in preventing a decline in Hb level compared to an unfortified milk based drink. It also reduced anemia and the risk of deficiencies of iron, and B12, in apparently healthy children. ClinicalTrials.gov IdentifierNCT01415557. Clinical Trial RegistryIndia - REF/2012/12/004332.

Study of serum haptoglobin level and its relation to erythropoietic activity in Beta thalassemia children.

BackgroundSerum haptoglobin (Hp) is a reliable marker for hemolysis regardless the inflammatory state.ObjectiveWe investigated the possible relation between Hp depletion and hemolysis severity, hepatitis C virus (HCV) infection and iron load in β-thalassemia children.MethodsTwenty two β-thalassemia major (TM),20 β-thalassemia intermedia (TI) children with 20 age and sex matched healthy controls were involved. Pre-transfusion hemoglobin level was considered. Serum ferritin, Hp and transferrin receptor levels (sTfR) (by ELISA ), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (by colorimetric method) were assayed. Markers of hepatitis C virus (HCV) were done by PCR.ResultsThe mean Hp levels among the studied groups were as follows; 8.02 ± 0.93 (mg/dl), 8.6 ±0.72 (mg/dl) and 122 ± 18.5(mg/dl) for TM, TI and the controls respectively. Both patient groups had significantly lower Hp level compared to the controls (P<0.0001) with significant lower level in TM compared to TI children ( P= 0.034). Significant inverse correlations were found between serum Hp and sTfR levels ( reflecting the erythropoietic activity) in thalassemia children combined and in each group (TM and TI) as well as among HCV infected children. STfR was the only significant independent predictor for serum Hp level (t= −5.585, P<0.0001). Among HCV infected patients, no significant correlation was found between serum Hp and serum transaminases.ConclusionSerum Hp depletion in thalassemia had significant relation to disease severity and correlated well with their erythropoietic activity, as assessed by the measurement of sTfR without significant relation to HCV infection. Extensive multicenter studies are recommended.

The impact of maternal obesity on iron status, placental transferrin receptor expression and hepcidin expression in human pregnancy.

Obesity is associated with decreased iron status, possibly due to a rise in hepcidin, an inflammatory protein known to reduce iron absorption. In animals, we have shown that maternal iron deficiency is minimised in the foetus by increased expression of placental transferrin receptor (pTFR1), resulting in increased iron transfer at the expense of maternal iron stores. This study examines the effect of obesity during pregnancy on maternal and neonatal iron status in human cohorts and whether the placenta can compensate for decreased maternal iron stores by increasing pTFR1 expression. A total of 240 women were included in this study. One hundred and fifty-eight placentas (Normal: 90; Overweight: 37; Obese: 31) were collected at delivery. Maternal iron status was measured by determining serum transferrin receptor (sTFR) and ferritin levels at 24 and 34 weeks and at delivery. Hepcidin in maternal and cord blood was measured by ELISA and pTFR1 in placentas by western blotting and real-time RT-PCR. Low iron stores were more common in obese women. Hepcidin levels (ng ml(-1)) at the end of the pregnancy were higher in obese than normal women (26.03±12.95 vs 18.00±10.77, P<0.05). Maternal hepcidin levels were correlated with maternal iron status (sTFR r=0.2 P=0.025), but not with neonatal values. mRNA and protein levels of pTFR1 were both inversely related to maternal iron status. For mRNA and all women, sTFR r=0.2 P=0.044. Ferritin mRNA levels correlated only in overweight women r=-0.5 P=0.039 with hepcidin (r=0.1 P=0.349), irrespective of maternal body mass index (BMI). The data support the hypothesis that obese pregnant women have a greater risk of iron deficiency and that hepcidin may be a regulatory factor. Further, we show that the placenta responds to decreased maternal iron status by increasing pTFR1 expression.

Effect of maternal cigarette smoking on newborn iron stores

Maternal smoking has been known to have a negative impact on the well being of the developing fetus. Prenatal smoking has been associated with premature births, low birth weight and with certain birth defects. Small research studies have also found a negative correlation between maternal smoking and neonatal body iron. To study and compare the relationship between maternal and infants' body iron in smokers and non-smokers in a large matched-pair cohort. This was a prospective cohort study involving 144 mothers - 72 smokers and 72 non-smokers and their respective infants. Samples were obtained from maternal and infants' cord blood at delivery for Serum transferrin receptor (sTfR) and ferritin levels. Serum TfR and ferritin were measured by RAMCO ELISA and RIA assays. Total Body Iron (TBI) was calculated using the sTfR/ferritin ratio in a previously described formula by Cook et al. Women who smoked had lower sTfR, higher ferritin and higher body iron compared to nonsmoking women. In contrast to their respective mothers, we found a small, but statistically significant negative correlation between smoking and infants' total body iron. The number of packs per day smoked was also negatively correlated with infants' ferritin and total body iron. Lower birth weight was noted in babies of smokers compared to nonsmokers (mean /- SD =3270 +/-475 vs. 3393 g +/- 475 g, p=0.03). Women who smoked during pregnancy had higher iron stores but their newborn infants had lower iron stores than those of non-smoking mothers. The more packs per day (PPD) and more days smoked during pregnancy led to lower total body iron of the babies. There may be a negative dose-dependent response between fetal smoke exposure and infant iron stores.