Serum Transferrin Receptor Research Articles

Multiple Indicators of Undernutrition, Infection, and Inflammation in Lactating Women Are Associated with Maternal Iron Status and Infant Anthropometry in Panama: The MINDI Cohort.

Maternal infections, nutrient deficiencies, and inflammation (MINDI) co-exist in lactating indigenous women in Panama, but their impact on maternal iron status and infant growth is unknown. For this secondary analysis of cross-sectional data of lactating mothers from our MINDI cohort, we investigated associations of MINDI variables with maternal anemia, elevated serum transferrin receptor (sTfR), low serum iron, hepcidin, ferritin, and infant weight-for-age (WAZ), length-for-age (LAZ), and head-circumference-for-age (HCAZ) Z-scores in 99 mother-infant dyads. A bootstrapping resampling procedure preselected covariates for inclusion in multivariable regressions models from chronic maternal infections and nutritional status [folate, vitamins A, D, retinol-binding protein (RBP), insulin-growth factor-1 (IGF-1)] and inflammation [C-reactive protein (CRP), cytokines, platelet indices] indicators. Anemia was prevalent (53.5%) but underestimated due to widespread low plasma volume (<2.2 L, 79.9%) and was associated with indicators of malnutrition [lower IGF-1, body mass index (BMI), vitamin D, and intake of green/leafy vegetables], but not inflammation. Higher CRP was associated with lower serum iron, and higher hepcidin and ferritin, whereas maternal platelets were associated with lower HCAZ (β = −0.22), WAZ (β = −0.17), and LAZ (β = −0.17). Higher LAZ was also associated with maternal serum vitamin D (β = 0.23), whereas maternal iron supplementation lowered LAZ (β = −0.22). Assessment of iron status in this MINDI cohort is complex and supplementation strategies must consider consequences for both the mother and the infant.

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.&#x0D; Aim: The aim of this study is to evaluate the significance of soluble transferrin receptors in diagnostic work up of iron deficiency.&#x0D; 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.&#x0D; 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 &lt; 0.0001 which was statistically significant.&#x0D; 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.

Associations of bacterial enteropathogens with systemic inflammation, iron deficiency, and anemia in preschool-age children in southern Ghana.

Anemia remains a pervasive public health problem among preschool-age children in Ghana. Recent analyses have found that anemia in Ghanaian children, particularly in Southern regions, is largely attributable to infectious causes, rather than nutritional factors. Infections with enteropathogens can reduce iron absorption and increase systemic inflammation, but few studies have examined direct links between enteropathogens and anemia. This study investigated associations between detection of individual bacterial enteropathogens and systemic inflammation, iron deficiency, and anemia among 6- to 59-month-old children in Greater Accra, Ghana. Serum samples were analyzed from a cross-sectional sample of 262 children for concentrations of hemoglobin (Hb), biomarkers of systemic inflammation [C-reactive protein (CRP) and α-1-acid glycoprotein (AGP)], and biomarkers of iron status [serum ferritin (SF) and serum transferrin receptor (sTfR)]. Stool samples were analyzed for ten bacterial enteropathogens using qPCR. We estimated associations between presence of each enteropathogen and elevated systemic inflammation (CRP > 5 mg/L and AGP > 1 g/L), iron deficiency (SF < 12 μg/L and sTfR > 8.3 mg/L) and anemia (Hb < 110 g/L). Enteropathogens were detected in 87% of children’s stool despite a low prevalence of diarrhea (6.5%). Almost half (46%) of children had anemia while one-quarter (24%) had iron deficiency (low SF). Despite finding no associations with illness symptoms, Campylobacter jejuni/coli detection was strongly associated with elevated CRP [Odds Ratio (95% CI): 3.49 (1.45, 8.41)] and elevated AGP [4.27 (1.85, 9.84)]. Of the pathogens examined, only enteroinvasive Escherichia coli/Shigella spp. (EIEC/Shigella) was associated with iron deficiency, and enteroaggregative Escherichia coli (EAEC) [1.69 (1.01, 2.84)] and EIEC/Shigella [2.34 (1.15, 4.76)] were associated with anemia. These results suggest that certain enteroinvasive pathogenic bacteria may contribute to child anemia. Reducing exposure to enteropathogens through improved water, sanitation, and hygiene practices may help reduce the burden of anemia in young Ghanaian children.

Body iron stores had no impact on coronary heart disease outcomes: a middle-aged male cohort from the general population with 21-year follow-up

BackgroundBody iron stores (BISs) have been proposed to be related to the development of cardiovascular diseases. However, results from epidemiological studies are conflicting. Knowledge on the long-term impact of BIS...

Discussion on Protein Metabolism and Requirement of Aerobics Athletes during Training Based on Multisensor Data Fusion.

Competitive aerobics has emerged as a highly competitive sport beyond its own physical limit. Modern competitive aerobics competition is very fierce; athletes cannot only rely on a specific competitive skill to achieve good results. Protein is the physical basis of life activity. The life activity of human body is closely related to protein, and protein is closely related to human exercise ability. This article aims to study protein metabolism and demand of aerobics athletes during training based on multisensor data fusion. A total of 26 female aerobics athletes were randomly divided into two groups: exercise group and exercise + nutrition group. According to the characteristics of human motion, a comprehensive measurement acquisition sensor system for collecting human motion information is designed and implemented, and the system is used to monitor the subject's protein condition in real time. The subjects took protein nutrient solution before breakfast every day. The dynamic recognition algorithm designed in this paper also has shortcomings, and the monitoring protein method based on gait and other signs is not completely correct. The experiment lasted for 7 weeks. The results showed that the level of serum transferrin receptor decreased significantly in the quiet + nutrition group for 4 weeks, which was significantly different from that at 0 and 3 weeks in the same group (P < 0.01) and was significantly different from that in the same group at 7 weeks (P < 0.05). In the exercise group, the level of serum transferrin receptor increased significantly at 5 weeks, compared with the same group at 0 and 3 weeks (P < 0.05).

ASSOCIATION BETWEEN IRON AND THYROID STATUS IN PREGNANT WOMEN

Purpose: Pregnancy is often complicated by iron deficiency, affecting negatively thyroid gland physiology. The aim of our study is to investigate parameters of iron and thyroid status during І, ІІ and ІІІ trimester of pregnancy in order to establish potential correlations in their dynamics. Materials and methods: The study involved 61 pregnant women and 43 controls. Their iron and thyroid status was determined by measuring hemoglobin (Hb), serum ferritin (SF), serum transferrin receptor (sTfR), thyroxine (FT4) and thyroid-stimulating hormone (TSH). Results: Significant differences between pregnant women and the control group were found, indicating an iron deficiency risk: sTfR level was higher, while Hb, ferritin and FT4 levels were lower in pregnant women. Thyroxine correlated positively with Hb (p = 0.016) and ferritin (p = 0.003) in pregnant women. In the I trimester, there was a negative association between sTfR and FT4 (p = 0.013), and in the III trimester, there was a positive association between sTfR and TSH (p &lt; 0.0001). Conclusions: sTfR represented the relationship between iron and thyroid status in the I and III trimester. Iron deficiency was expressed in the III trimester with a positive association between sTfR and TSH. The increased maternal iron requirement (sTfR) correlated with increased TSH secretion induced by decreased thyroxine.

DIAGNOSTIC ACCURACY OF SERUM FERRITIN AND SOLUBLE SERUM TRANSFERRIN RECEPTOR, TAKING BONE MARROW IRON STAIN AS A GOLD STANDARD FOR IRON DEFICIENCY ANEMIA IN HETEROGENOUS GROUP OF PATIENTS

Objective: To determine the diagnostic accuracy of serum ferritin and soluble serum transferrin receptor (sTfR), taking bone marrow iron stain as a gold standard for iron deficiency anaemia in heterogeneous group of patients.&#x0D; Study Design: Cross-sectional diagnostic accuracy study.&#x0D; Place and Duration of Study: Department of Diagnostic, Combined Military Hospital Lahore, from Mar to Aug 2020.&#x0D; Methodology: A total of 55 adult patients, of both genders, undergoing bone marrow examination for any reason were enrolled. Patients with known hemolytic condition (sickle cell anemia, megaloblastic anemia), taking erythropoietin/iron supplements, transfused red cell concentrate (RCC) recently or undergoing chemotherapy were excluded. Age, gender, clinical history and results of bone marrow examination, complete blood count (CBC), serum Ferritin and C-reactive protein (CRP) were recorded.&#x0D; Results: Serum ferritin was found to be less sensitive (28%) but more specific (100%) for reflecting reduced bone marrow iron stores as compared to sTfR (sensitivity: 60%, specificity: 96.6%). sTfR had highest likelihood ratio (15) and diagnostic accuracy (80%). On Receiver Operator Characteristic (ROC) graph Transferrin index (AUC=0.908) showed maximum accuracy, followed by Ferritin (AUC=0.884) and sTfR (AUC=0.879).&#x0D; Conclusion: Serum soluble transferring receptor (sTfR) and transferrin index has advantage over serum ferritin alone in predicting the bone marrow iron stores and differentiating iron deficiency anemia from anemia of chronic disease.

Evaluation of serum transferrin receptor level in Children Undergoing Regular Hemodialysis

Evaluation of serum transferrin receptor level in Children Undergoing Regular Hemodialysis

Seasonal patterns of malaria, genital infection, nutritional and iron status in non-pregnant and pregnant adolescents in Burkina Faso: a secondary analysis of trial data

BackgroundAdolescents are considered at high risk of developing iron deficiency. Studies in children indicate that the prevalence of iron deficiency increased with malaria transmission, suggesting malaria seasonally may drive iron deficiency. This paper examines monthly seasonal infection patterns of malaria, abnormal vaginal flora, chorioamnionitis, antibiotic and antimalarial prescriptions, in relation to changes in iron biomarkers and nutritional indices in adolescents living in a rural area of Burkina Faso, in order to assess the requirement for seasonal infection control and nutrition interventions.MethodsData collected between April 2011 and January 2014 were available for an observational seasonal analysis, comprising scheduled visits for 1949 non-pregnant adolescents (≤19 years), (315 of whom subsequently became pregnant), enrolled in a randomised trial of periconceptional iron supplementation. Data from trial arms were combined. Body Iron Stores (BIS) were calculated using an internal regression for ferritin to allow for inflammation. At recruitment 11% had low BIS (< 0 mg/kg). Continuous outcomes were fitted to a mixed-effects linear model with month, age and pregnancy status as fixed effect covariates and woman as a random effect. Dichotomous infection outcomes were fitted with analogous logistic regression models.ResultsSeasonal variation in malaria parasitaemia prevalence ranged between 18 and 70% in non-pregnant adolescents (P < 0.001), peaking at 81% in those who became pregnant. Seasonal variation occurred in antibiotic prescription rates (0.7–1.8 prescriptions/100 weekly visits, P < 0.001) and chorioamnionitis prevalence (range 15–68%, P = 0.026). Mucosal vaginal lactoferrin concentration was lower at the end of the wet season (range 2–22 μg/ml, P < 0.016), when chorioamnionitis was least frequent. BIS fluctuated annually by up to 53.2% per year around the mean BIS (5.1 mg/kg2, range 4.1–6.8 mg/kg), with low BIS (< 0 mg/kg) of 8.7% in the dry and 9.8% in the wet seasons (P = 0.36). Median serum transferrin receptor increased during the wet season (P < 0.001). Higher hepcidin concentration in the wet season corresponded with rising malaria prevalence and use of prescriptions, but with no change in BIS. Mean Body Mass Index and Mid-Upper-Arm-Circumference values peaked mid-dry season (both P < 0.001).ConclusionsOur analysis supports preventive treatment of malaria among adolescents 15–19 years to decrease their disease burden, especially asymptomatic malaria. As BIS were adequate in most adolescents despite seasonal malaria, a requirement for programmatic iron supplementation was not substantiated.

Reference Ranges of Iron Profiles in Apparently Healthy Elderly in Sokoto, Nigeria

Background: Iron is an important micronutrient in the body, lead to anaemia, frailty and cognitive disorders in the elderly when deficient.&#x0D; Aim: This study was aimed to determine reference values of iron profile in apparently healthy elderly persons in Sokoto and compared with the local reference values.&#x0D; Study Design: This was a comparative study&#x0D; Duration of Study: The study lasted for a period of one year between January to December, 2020.&#x0D; Methodology: This was a comparative study involving 105 apparently healthy elderly persons aged 60 years and above in Sokoto metropolis. Serum iron and total-iron binding capacity (TIBC) were determined using Iron Ferrozine method. Serum ferritin, Serum transferrin (Tf) and Serum Transferrin Receptors (sTfR) were assayed using enzyme-linked immunosorbent assay (ELISA). Transferrin Saturation (TS) and Serum Transferrin Receptors ferritin log (sTfR/FL) was calculated. Data were expressed as percentiles, mean and standard deviation and analysed using t-test and one way ANOVA.&#x0D; Results: The study established reference ranges of Serum iron,TIBC, Serum ferritin, Tf, sTfR, TS and sTfR/FL was calculated. in Sokoto. The study showed that iron and ferritin have high reference ranges than the local values in Sokoto. The local values for TIBC, ferritin, sTfR, TS and sTfR/FL were not available. Mean Ferritin (µg/L), sTfR (ng/L) and sTfR/Fl the test subjects were significantly higher in males than females in Sokoto (p=0.026), (p= 0.001), (p=0.044) and (p= 0.003) respectively. Iron, ferritin and TS increased as the BMI was increasing (p=&lt;0.001).&#x0D; Conclusion: In conclusion, normal reference values obtained in this study notably vary with the local reference ranges used in the Sokoto metropolis. There is a need for each locality to have separate reference ranges for the elderly for their proper diagnosis and management of iron related disorders.

Improving Micronutrient Status of Children and Women in Rural Communities in India Using Crystal Salt Enriched with Multiple Micronutrients.

To demonstrate that fortified crystal salt enriched with iron, iodine, vitamin B12, folic acid and zinc can combat multi-micronutrient deficiencies. A randomized controlled study was conducted in 6 villages in Tiruvallur district, in Tamilnadu, South India. All the women and children aged 5-17 y in households in the experimental villages (n=117) were provided the fortified salt for 8 mo. Similar demographic group in the control villages (n=95) used regular non-fortified salts for the same time period. Blood from study subjects were analysed for hemoglobin, serum ferritin, serum transferrin receptor, AGP, CRP, and serum zinc, at the beginning and end of the study. Urine was analyzed for iodine at the same times. The experimental group showed a statistically significant increase in hemoglobin (>1.05 g/dL), serum zinc (>12.23 μg/dL), ferritin (>6.97 μg/L) and body iron stores (>0.73 mg/kg body weight), compared to the control group. A significant decrease in the prevalence of anaemia from 67.5% to 29.1% and zinc deficiency from 32.7% to 12.4% was observed in the experimental group relative to control group, using Binary logistic regression. There was no change in urinary iodine in the experimental group while it decreased significantly in the control. The fortified crystal salt was effective in decreasing multi-micronutrient deficiencies.

INTERGROWTH-21 Identifies High Prevalence of Low Symphysis-Fundal Height in Indigenous Pregnant Women Experiencing Multiple Infections, Nutrient Deficiencies, and Inflammation: The Maternal Infections, Nutrient Deficiencies, and Inflammation (MINDI) Cohort.

ABSTRACTBackgroundIn the absence of ultrasound, symphysis–fundal height (SFH) can assess maternal–fetal well-being as it is associated with gestational age, fetal weight, and amniotic fluid volume. However, other modifiers of SFH, including maternal infections, nutrient deficiencies, and inflammation (MINDI), have not been widely explored.ObjectivesOur objectives were 2-fold: 1) to assess prevalence of low SFH in indigenous Panamanian women using both Pan-American Health Organization (PAHO) and INTERGROWTH-21 standards and 2) to explore associations of SFH with maternal health indicators: infections (oral, skin, urogenital, nematode infections), nutrient deficiencies [protein and iron indicators (ferritin, serum iron, serum transferrin receptor, hepcidin), folate, and vitamins A, D, and B-12], and inflammation [leukocytes, C-reactive protein (CRP), cytokines].MethodsFor this cross-sectional study, low-SFH-for-gestational-age was assessed using PAHO and INTERGROWTH <10th centile in 174 women at ≥16 weeks of gestation. Bootstrapping selected MINDI variables for inclusion in multivariable fractional polynomial (MFP) logistic regressions for low SFH. Associations of MINDI variables with hepcidin were also investigated.ResultsPrevalence of low SFH was 8% using PAHO, but using INTERGROWTH, 50.6% had SFH <10th centile, including 37.9% <3rd centile. Both PAHO-SFH <10th centile and INTERGROWTH-SFH <3rd centile were associated with higher hepcidin (OR = 1.12, P = 0.008, and OR = 3.04, P = 0.001, respectively) and with lower TNF-α (OR = 0.73, P = 0.012, and OR = 0.93, P = 0.015, respectively). Wood-smoke exposure increased the odds of PAHO-SFH <10th centile (OR = 1.19, P = 0.009), whereas higher BMI decreased the odds of INTERGROWTH-SFH <3rd centile (OR = 0.87, P = 0.012). Lower pulse pressure (OR = 0.90, P = 0.009) and lower inflammatory responses [lower lymphocytes (OR = 0.21, P = 0.026), IL-17 (OR = 0.89, P = 0.011)] distinguished SFH <3rd centile from SFH ≥3rd to <10th centiles using INTERGROWTH-21 standards. The MFP regression for hepcidin controlling for SFH (adjusted R2 = 0.40, P = 0.001) revealed associations with indicators of inflammation (CRP, P < 0.0001; IL-17, P = 0.012), acidic urinary pH (P = 0.008), and higher intake of supplements (P = 0.035).ConclusionsAssociations of low SFH with MINDI variables, including hepcidin, highlight its potential for early detection of multicausal in utero growth faltering.

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.

Correlation between maternal hemoglobin and serum transferrin receptor with lactoferrin concentration in breastfeeding mothers

Correlation between maternal hemoglobin and serum transferrin receptor with lactoferrin concentration in breastfeeding mothers

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&lt;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 &gt;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.

Compared to Normal-Weight Pregnant Women, Overweight Pregnant Women Fail to Upregulate Iron Absorption in the Third Trimester Despite Iron Deficiency and Their Infants Are Born with Lower Body Iron Stores

Introduction: Overweight/obesity (OWOB) causes low-grade systemic inflammation which induces hepcidin and a reduces fractional iron absorption (FIA) even when iron stores are low. Pregnancy increases iron needs because of the expansion of maternal blood volume and fetal needs. It is unclear whether and/or to what extent OWOB during pregnancy influences FIA, iron supply of the fetus and risk of iron deficiency in mother and newborn. In this study, we (1) determined the impact of maternal OWOB on FIA in pregnancy and on the transfer of iron to the fetus and newborn iron status; (2) confirmed the relationship between BMI, hepcidin, serum ferritin (SF) and inflammatory markers. Methods: In this prospective experimental multi-center case-control study (normal-weight (NW) n=40; OWOB n=37) we administered labeled [57Fe]- or [58Fe]-FeSO4 to women during the 2nd and 3rd trimester of pregnancy. We measured FIA by determining erythrocyte incorporation of iron stable isotopes 14 days after administration. From pregnancy week (PW) 12 until PW 36, iron-, inflammation and hepcidin were monitored. Iron transfer to the fetus was determined isotopically as the concentration of circulating iron in the infant aged three days. We assessed iron status in infants born to NW (n=29) and OWOB (n=31) at age three days, three months and six months. Results: Subject characteristics in PW 12 for the NW/OWOB were: mean (±SD) age: 29±6/ 30±6 years, median (IQR) pre-pregnancy BMI: 21.6 (20.3-23.7)/ 31.6 (28.4-35.9) kg/m2 (p&amp;lt;0.001), mean (±SD) hemoglobin: 12.3±1.1/ 12.4±0.9 g/dL, median (IQR) SF: 27.7 (17.3-48.2)/ 30.6 (16.6-64.4) µg/L and median (IQR) interleukin-6: 1.41 (1.03-1.95)/ 2.37 (1.91-3.85) pg/ml (p&amp;lt;0.001). Independent sample t-test showed no difference in FIA between NW and OWOB in the 2nd trimester with median FIA (IQR) 12.3 (7.2-20.6) and 10.1 (6.9-17.2) % (p=0.788). Despite the OWOB had ≈30% lower body iron stores (BIS) and comparable hepcidin concentrations to the NW in the 3rd trimester, FIA was significantly higher in the NW compared to the OWOB with median FIA (IQR) 22.3 (10.6-33.8) and 12.7 (10.4-18.1) % (p=0.042). In the NW, FIA was upregulated by 80% in the 3rd trimester compared to the 2nd trimester, whereas in the OWOB FIA, it was only upregulated by 25%. Linear mixed effect model analysis (LMM) showed a significant group-effects on weight, IL-6 and CRP throughout pregnancy (all p&amp;lt;0.05), but surprisingly no group-effect on hepcidin. In multiple regression analysis, the main predictor of hepcidin throughout pregnancy was BIS, not inflammation. Iron transfer to the newborn was non-significantly higher in the NW compared to the OWOB with mean (±SD) circulating iron in the newborn at age three days 136.6 ± 42.7 and 126.3 ± 32.4 mg. LMM on infant BIS and on infant serum transferrin receptor (sTfR) over the first six months showed significant group (p=0.024, p=0.046) and time-effects (both p&amp;lt;0.001) with lower BIS and higher sTfR in infants born to OWOB. Median (IQR) BIS at age six months were 7.7 (6.3-8.8) and 6.6 (4.6-9.2) mg/kg bodyweight in infants born to NW and OWOB. Conclusion: In normal pregnancy, FIA increases over time to support increased iron needs of mother and fetus. Our data show a dramatically reduced increase in FIA in OWOB pregnant women in the 3rd trimester, despite low BIS and low hepcidin, and this results in less iron transfer to the fetus. Future molecular studies are needed to clarify the mechanism of reduced FIA and fetal iron transfer in OWOB. To our knowledge, this is the first study assessing the impact of maternal OWOB on infant iron status at multiple time points over the first six months. Our findings strongly argue for careful monitoring of iron status in OWOB pregnancy and for defining a more effective iron supplementation regimen for this population group. Prevalence of anemia in pregnancy and infancy is high, especially in low and middle income countries and is often associated with severe health consequences. If iron status of OWOB pregnant women and their infants could be improved by optimizing iron supplementation guidelines for OWOB, this could have major benefits. Disclosures No relevant conflicts of interest to declare.

Effect of iron and folate supplementation on Pb levels in pregnant anemic women: a prospective study

There are few reports revealing association between iron intake and environmental lead exposure during pregnancy. Therefore, the present study was undertaken to investigate the effect of iron supplementation on biochemical modulation of certain lead toxicity markers associated with pregnancy. Iron and folic acid supplementations were given to 250 pregnant anemic women (mild = 100, moderate = 100 and severe = 50) and 100 age matched nonanemic pregnant women as controls for 100 days. Lead (Pb) toxicity markers, enzymatic and nonenzymatic antioxidant were estimated as per standard protocols. The levels of Pb, serum transferrin receptors (sTfR), zinc protoporphyrin (ZPP), δ-aminolevulinic acid (δ-ALA, both in blood and urine) were found significantly increased in all pretreated subjects and these were decreased after oral iron supplementation. Iron-deficient pregnant women reflected a significant increase in lipid peroxide levels (LPO) and protein carbonyl levels (PC) which were found to be further increased after iron supplementation. The levels of iron (Fe), haemoglobin (Hb), ferritin, delta aminolevulinic acid dehydratase (δ-ALAD), catalase (CAT), superoxide dismutase (SOD), and reduced glutathione levels (GSH) were significantly decreased in pretreated groups and these parameters were found significantly increased in all supplemented subjects after treatment. Antioxidant vitamins viz. C and E were found significantly decreased in all post treated groups. Our observation suggests that recommended iron dose is not only effective for blood indices parameters, but it also decreases Pb concentrations in the blood during pregnancy. However, further studies with larger sample size are needed to confirm these findings.

Contribution of iron status at birth to infant iron status at 9 months: data from a prospective maternal-infant birth cohort in China.

BACKGROUND/OBJECTIVESThe contribution of iron status at birth to iron status in infancy is not known. We used a physiologic framework to evaluate how iron status at birth related to iron status at 9 months, taking iron needs and sources into account.SUBJECTS/METHODSIn a longitudinal birth cohort in China, iron status measures in cord blood and venous blood in infancy (9 months) and clinical data were prospectively collected in 545 healthy term maternal–infant dyads. We used structural equation modeling (SEM) to create a 9-month iron composite and to assess direct and indirect contributions of multiple influences on 9-month iron status. Logistic regression was used to calculate odds ratios (OR) for iron deficiency (ID), iron deficiency anemia (IDA), and anemia.RESULTSApproximately 15% (78/523) of infants were born with cord SF<75 μg/l, suggesting fetal-neonatal ID. At 9 months, 34.8% (186/535) and 19.6% (105/535) of infants had ID and IDA, respectively. The following factors were independently associated with poorer 9-month iron status: higher cord zinc protoporphyrin/heme (ZPP/H) (adjusted estimate −0.18, P< 0.001) and serum transferrin receptor (sTfR) (−0.11, P=0.004), lower cord hemoglobin (Hb) (0.13, P=0.004), lower birth weight (0.15, P< 0.001), male sex (0.10, P=0.013), older age at testing (−0.26, P<0.001), higher 9-month weight (−0.12, P=0.006) and breastfeeding (0.38, P<0.001). Breastfeeding at 9 months showed the strongest association, adjusting for all other factors. Compared to formula-fed infants, the odds of IDA were 19.1 (95%CI: 6.92, 52.49, P< 0.001) and 3.6 (95%CI: 1.04, 12.50, P=0.043) times higher in breastfed and mixed-fed infants, respectively.CONCLUSIONSIndicators of iron status at birth, postnatal iron needs, and iron sources independently related to iron status at 9 months. Sex was an additional factor. Public health policies to identify and protect infants at increased risk of ID should be prioritized.

Iron Deficiency Anemia at Time of Vaccination Predicts Decreased Vaccine Response and Iron Supplementation at Time of Vaccination Increases Humoral Vaccine Response: A Birth Cohort Study and a Randomized Trial Follow-Up Study in Kenyan Infants.

Background: Iron deficiency may impair adaptive immunity and is common among African infants at time of vaccination. Whether iron deficiency impairs vaccine response and whether iron supplementation improves humoral vaccine response is uncertain.Methods: We performed two studies in southern coastal Kenya. In a birth cohort study, we followed infants to age 18 mo and assessed whether anemia or iron deficiency at time of vaccination predicted vaccine response to three-valent oral polio, diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine, ten-valent pneumococcal-conjugate vaccine and measles vaccine. Primary outcomes were anti-vaccine-IgG and seroconversion at age 24 wk and 18 mo. In a randomized trial cohort follow-up, children received a micronutrient powder (MNP) with 5 mg iron daily or a MNP without iron for 4 mo starting at age 7.5 mo and received measles vaccine at 9 and 18 mo; primary outcomes were anti-measles IgG, seroconversion and avidity at age 11.5 mo and 4.5 y.Findings: In the birth cohort study, 573 infants were enrolled and 303 completed the study. Controlling for sex, birthweight, anthropometric indices and maternal antibodies, hemoglobin at time of vaccination was the strongest positive predictor of: (A) anti-diphtheria and anti-pertussis-IgG at 24 wk (p = 0.0071, p = 0.0339) and 18 mo (p = 0.0182, p = 0.0360); (B) anti-pertussis filamentous hemagglutinin-IgG at 24 wk (p = 0.0423); and (C) anti-pneumococcus 19 IgG at 18 mo (p = 0.0129). Anemia and serum transferrin receptor at time of vaccination were the strongest predictors of seroconversion against diphtheria (p = 0.0484, p = 0.0439) and pneumococcus 19 at 18 mo (p = 0.0199, p = 0.0327). In the randomized trial, 155 infants were recruited, 127 and 88 were assessed at age 11.5 mo and 4.5 y. Compared to infants that did not receive iron, those who received iron at time of vaccination had higher anti-measles-IgG (p = 0.0415), seroconversion (p = 0.0531) and IgG avidity (p = 0.0425) at 11.5 mo.Interpretation: In Kenyan infants, anemia and iron deficiency at time of vaccination predict decreased response to diphtheria, pertussis and pneumococcal vaccines. Primary response to measles vaccine may be increased by iron supplementation at time of vaccination. These findings argue that correction of iron deficiency during early infancy may improve vaccine response.

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 &amp;gt;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 (&amp;lt;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. (&amp;lt;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.