Side Effects Of Iron Supplementation Research Articles

Development and testing of a nutrition education tool on iron supplementation for pregnant women

Background: Although iron supplementation may prevent iron deficiency anaemia (IDA) during pregnancy, a nutrition education tool highlighting the importance of iron supplementation during pregnancy is also important. Objectives: The aim was to develop and test a nutrition education tool on iron supplementation for pregnant women. Design: A cross-sectional study was conducted. Setting: Mutare City Clinic, Manicaland province, Zimbabwe. Subjects: Sixty-seven pregnant women in their second or third trimesters of pregnancy and attending Mutare City Clinic for antenatal care (ANC) participated in the study. Outcome measures: The preferences of pregnant women regarding form, structure and content of the nutrition education tool were established using eight focus-group discussions (FGDs) in which 67 pregnant women participated. Three additional FGDs were conducted with another 28 pregnant women to assess the user-friendliness and acceptability of the developed tool. Results: A pamphlet was the most preferred tool, with English being the most preferred language, along with some Shona phrases. Women wanted information on IDA, dosage, duration and side-effects of iron supplementation and iron food sources to be included in the pamphlet. The participants identified clinics, pharmacies and churches as ideal sites for dissemination of the tool. Conclusions: A pamphlet on iron supplementation in simple English with some Shona phrases was the nutrition education tool most preferred by the pregnant women. Offering the pamphlet together with iron supplements to pregnant women could improve compliance with iron supplements. However, follow-up ANC consultations are important for effective implementation of all key messages in the pamphlet.

Effects of Iron and Amloki (EmblicaOfficinalis) on Serum Zinc Level in Anaemia with Pregnancy

Pregnancy is associated with several trace elements deficiency in developing countries. Supplementation of iron in iron deficiency anaemia (IDA) has several side effects including alterations of serum zinc level. Traditionally, amloki is used as a well known supplement in pregnancy, which is rich in trace elements.To determine the effects of iron and amloki on serum zinc level in IDA with pregnancy. The study was a non blind, non random sampling interventional type of clinical trial. This study was performed in the Department of Physiology, Dhaka Medical College, Dhaka on 43 pregnant women between 13th to 20th weeks of gestation with IDA from July 2016 to June 2017. They were recruited from Outpatient Department of Obstetrics and Gynaecology of Dhaka Medical College Hospital. Anaemic pregnant women supplemented with oral iron and amloki were considered as study group (A) and control group (B) were with only iron supplementation for 45 days. Serum zinc level was estimated in the laboratory of the Department of Soil, Water and Environment, University of Dhaka, Bangladesh. For statistical analysis, Paired Student’s‘t’ test and Unpaired Student’s‘t’ test were considered using SPSS 22.0 version. Significant decrease (p<0.001) of serum zinc level was observed after intervention of iron in both groups. In this study, there was no significant difference in serum zinc level in between study and control group. It can be concluded that oral iron supplementation causes decrease in serum zinc level in IDA with pregnancy. Amloki shows no significant role in preventing decrease of serum zinc level in this study. Emblicaofficinalis (amloki) is traditionally used to treat iron deficiency anaemia. It can increase haemoglobin concentration and decrease side effects of iron supplementation.
 Bangladesh Med J. 2020 Jan; 49 (1): 33-37

Long-Term Prognosis of Hyperferritinemia Induced by Intravenous Iron Therapy in Patients Undergoing Maintenance Hemodialysis: A 10-Year, Single-Center Study.

Optimal ferritin level in hemodialysis patients between Japan and other countries is controversial. Long-term side effects of iron supplementation in these patients remain unclear. We aimed to elucidate whether past hyperferritinemia in hemodialysis patients was associated with high risk of death and cerebrovascular and cardiovascular diseases (CCVDs). This small retrospective cohort study included approximately 44 patients unintentionally supplemented with excessive intravenous iron. A significantly higher risk of CCVDs was observed in patients with initial serum ferritin levels ≥1000 ng/mL than in the remaining patients. High ferritin levels slowly decreased to <300 ng/mL in a median of 24.2 (10.5–46.5) months without treatment. However, compared with the remaining patients, only patients whose ferritin levels did not decrease to <300 ng/mL steadily had a significantly higher risk of all-cause death (hazard ratio, 9.6). Long-term hyperferritinemia due to intravenous iron therapy is a risk factor for death in maintenance hemodialysis patients. For a prolonged better prognosis, intravenous iron should be carefully administered so as to avoid hyperferritinemia in patients with hemodialysis.

Emblica Officinalis (Amloki) – Could Be the Remedy for Side Effects of Iron Supplementation in Pregnancy

Emblica Officinalis (Amloki) – Could Be the Remedy for Side Effects of Iron Supplementation in Pregnancy

Influence of mitochondrial and systemic iron levels in heart failure pathology.

Iron deficiency or overload poses an increasingly complex issue in cardiovascular disease, especially heart failure. The potential benefits and side effects of iron supplementation are still a matter of concern, even though current guidelines suggest therapeutic management of iron deficiency. In this review, we sought to examine the iron metabolism and to identify the rationale behind iron supplementation and iron chelation. Cardiovascular disease is increasingly linked with iron dysmetabolism, with an increased proportion of heart failure patients being affected by decreased plasma iron levels and in turn, by the decreased quality of life. Multiple studies have concluded on a benefit of iron administration, even if just for symptomatic relief. However, new studies field evidence for negative effects of dysregulated non-bound iron and its reactive oxygen species production, with concern to heart diseases. The molecular targets of iron usage, such as the mitochondria, are prone to deleterious effects of the polyvalent metal, added by the scarcely described processes of iron elimination. Iron supplementation and iron chelation show promise of therapeutic benefit in heart failure, with the extent and mechanisms of both prospects not being entirely understood. It may be that a state of decreased systemic and increased mitochondrial iron levels proves to be a useful frame for future advancements in understanding the interconnection of heart failure and iron metabolism.

Side Effects of Daily versus Weekly Iron Supplementation in Pregnant Women

Background &amp; Objective: Iron supplementation in pregnant women is highly recommended, however there is reduced compliance due to the common gastrointestinal side effects. This study aimed to compare the clinical side effects between pregnant women with daily and weekly iron supplementation. Methods: Seventy-nine pregnant women who met the inclusion and exclusion criteria were given iron supplements every day (group 1, n=37) and twice a week (group 2, n=42). All numerical data were assessed by independent t-test. Side effects were assessed after one month of administration using a questionnaire containing complaints felt by pregnant women and were evaluated by chi-square test using SPSS 25. A P value &lt;0.05 was considered as statistically significant. Results: The most common side effects of iron supplementation in both groups were black feces (35.4%) and nausea (31.6%). Nausea (45.9% vs. 19.0%; P&lt;0.05) and constipation (35.1% vs. 11.9%; P&lt;0.05) were more frequent in group 1 than in group 2, respectively. Other side effects, such as heartburn, flatulence, vomiting, black feces, and urine discoloration did not differ significantly between the two groups (P&gt;0.05). Conclusion: The daily iron supplementation elevated the episodes of nausea and constipation during pregnancy than the weekly supplementation. The daily iron supplementation in pregnant women increases the risk of side effects, potentially reducing compliance.

Encapsulation of iron in liposomes significantly improved the efficiency of iron supplementation in strenuously exercised rats.

To investigate the effect of iron liposome supplementation, a rat model of exercise-associated anemia was established by subjecting the animals to high-intensity running exercises for 4 weeks. Rats with confirmed anemia were strenuously exercised for another 2 weeks while receiving iron supplements by intragastric administration of ferric ammonium citrate (FAC) liposomes or heme iron liposomes. Control groups were administered equivalent amounts of FAC, heme iron, or blank liposomes. Subsequently, complete blood count (CBC), serum iron, and liver iron levels were tested to determine the efficiency of iron liposomes in relieving anemia. Superoxide dismutase (SOD) and malonyldialdehyde (MDA) were also detected to determine potential side effects of iron supplementation. The CBC, as well as serum iron and liver iron contents, significantly increased and reached much higher levels in anemic rats treated with iron liposomes, compared with those of control groups. The increase of SOD and decrease of MDA levels were also observed after supplementation with iron liposomes. These results demonstrate that iron liposomes can efficiently relieve the iron deficiency in strenuously exercised rats and may potentially be used as a supplement for the treatment of exercise-associated iron deficiency anemia with minimal side effects.

Malabsorption anemia and iron supplement induced constipation in post-Roux-en-Y gastric bypass (RYGB) patients

Over 250,000 bariatric surgical procedures for the management of morbid obesity are performed in the United States annually. The Roux-en-Y gastric bypass (RYGB) is an effective bariatric procedure because of its efficacy in achieving significant weight loss, low complication rates, and outcomes in reducing cardiovascular and all cause mortality. Because food bypasses the portion of the small intestine whereby micronutrients are normally absorbed, micronutrient deficiencies following surgery may lead to iron deficiency anemia. Iron deficiency anemia is estimated to occur in 6%-50% of post-RYGB patients. Consequently, the procedure requires lifelong behavioral change to ensure therapeutic iron supplementation. A nonsystematic literature search for clinical guidelines, review articles, and research was conducted. Clinical recommendations include prophylactic iron supplementation with ferrous sulfate to prevent iron deficiency anemia. Ferrous sulfate is a well-established cause of constipation possibly resulting in low patient tolerability and subsequent low adherence rates. Strategies for managing the side effects of iron supplementation including constipation may require a unique approach based on the anatomical and functional changes in the post-RYGB patient and the requirement for lifelong iron supplementation.

Iron Status and Analysis of Efficacy and Safety of Ferric Carboxymaltose Treatment in Patients with Inflammatory Bowel Disease

Background and Aims: We analyzed iron deficiency and the therapeutic response following intravenous ferric carboxymaltose in a large single-center inflammatory bowel disease (IBD) cohort. Methods: 250 IBD patients were retrospectively analyzed for iron deficiency and iron deficiency anemia. A subgroup was analyzed regarding efficacy and side effects of iron supplementation with ferric carboxymaltose. Results: In the cohort (n = 250), 54.4% of the patients had serum iron levels ≤60 µg/dl, 81.2% had ferritin ≤100 ng/ml, and 25.6% had hemoglobin (Hb) of ≤12 g/dl (females) or ≤13 g/dl (males). In the treatment subcohort (n = 80), 83.1% of the patients had iron ≤60 µg/dl, 90.4% had ferritin ≤100 ng/ml, and 66.7% had Hb ≤12/13 g/dl before ferric carboxymaltose treatment. After a median dose of 500 mg ferric carboxymaltose, 74.7% of the patients reached iron >60 µg/dl, 61.6% had ferritin >100 ng/ml, and 90.7% reached Hb >12/13 g/dl at follow-up (p < 0.0001 for all parameters vs. pretreatment values). The most frequent adverse event was a transient increase of liver enzymes with male gender as risk factor (p = 0.008, OR 8.62, 95% CI 1.74–41.66). Conclusions: Iron deficiency and anemia are frequent in IBD patients. Treatment with ferric carboxymaltose is efficious, safe and well tolerated in iron-deficient IBD patients.

Community-Led Initiative for Control of Anemia among Children 6 to 35 Months of Age and Unmarried Adolescent Girls in Rural Wardha, India

Studies in India have reported a high prevalence of nutritional anemia among children and adolescent girls. Nutritional anemia is associated with impaired mental, physical, and cognitive performance in children and is a significant risk factor for maternal mortality. To evaluate the effect of a community-led initiative for control of nutritional anemia among children 6 to 35 months of age and unmarried rural adolescent girls 12 to 19 years of age. This Participatory Action Research was done in 23 villages of the Primary Health Centre, Anji, in Wardha District of Maharashtra. In February and March 2008, needs assessment was undertaken by interviewing the mothers of 261 children and 260 adolescent girls. Hemoglobin levels of adolescent girls and children were measured with the use of the hemoglobin color scale. The girls were given weekly iron-folic acid tablets, and the children were given daily liquid iron prophylaxis for 100 days in a year through community participation. The adolescent girls and the mothers of the children and adolescent girls were also given nutritional education on the benefits and side effects of iron supplementation. In June and July 2008, follow-up assessment was performed by survey and force field analysis. There was a significant reduction in the prevalence of nutritional anemia from 73.8% to 54.6% among the adolescent girls and from 78.2% to 64.2% among the children. There was improvement in awareness of iron-rich food items among the adolescent girls and the mothers of the children. The benefits to girls, such as increase in appetite and reduction in scanty menses, tiredness, and weakness, acted as positive factors leading to better compliance with weekly iron supplementation. The benefits to children perceived by the mothers, such as increase in appetite, weight gain, reduction in irritability, and reduction in mud-eating behavior, acted as a dominant positive force and generated demand for iron syrup. The community-led initiative for once-weekly iron supplementation for adolescent girls and iron prophylaxis for children, in addition to nutritional education, improved the hemoglobin status of children 6 to 35 months of age and unmarried rural adolescent girls 12 to 19 years of age.

Increased level of serum iron and gastrointestinal toxicity in patients with solid tumor treated with cytotoxic chemotherapy.

e13049 Background: The mechanism of gastrointestinal toxicity of chemotherapy including nausea and vomiting especially in late phase remains unclear. Nausea and vomiting are also known as major side effects of iron supplementation in pregnancy or anemia patients. The relationship between serum iron level and toxicity of chemotherapy was investigated. Methods: A total of 17 patients with solid tumor treated with cytotoxic chemotherapy were examined. The blood samples were taken before and on day 2 or 3 of chemotherapy. The changes of serum iron, unsaturated iron capacity (UIBC) and ferritin were measured to analyze the relationship with adverse effect. Results: The number of patients received each chemotherapy were 5 for carboplatin /gemcitabine, 2 for calboplatin/etoposide, calboplatin/paclitaxel, and irinotecan, and 1 for cisplatin/etoposide, calboplatin/pemetrexed, amurubicin, docetaxel, gemcitabine and pemetrexed. Mean values of iron, UIBC and ferritin before and after chemotherapy were 60.5±18.0 vs. 220.5±17.0μg, 202.5±42.8 vs. 23.0±45.7μg, and 211.4±103.8 vs. 263.5±164.2 ng/ml, respectively. Statistically there were no significant correlation between iron level and adverse effects, however there were tendency that nausea and vomiting of grade 3 or 4 were observed more in patients with higher iron level. Conclusions: Regardless of various chemotherapy regimens, the iron levels on day 2 or 3 of chemotherapy were markedly increased in all patients. Correspondingly, UIBC were extremely decreased and reached to 0μg in 4 patients sufffering severe nausea and vomiting. These results imply that increased radial iron in serum is one of causes of gastrointestinal toxicity, which may be a target of minimizing complications of cancer chemotherapy.

Oral iron supplementation leads to oxidative imbalance in anemic women: A prospective study

This study was aimed to assess the desirable and undesirable effects of iron (100mg/day as ferrous sulphate) and folic acid (500μg/day) supplementation in iron deficient anemic women. Iron and folic acid supplementations were given to 117 anemic women (mild=55, moderate=40, and severe=22) and 60 age matched placebo treated (100mg cane sugar) non-anemic controls for 100 days. Blood index values, oxidative stress parameters, antioxidant enzymes and vitamins were estimated as per standard protocols. Haemoglobin (Hb) levels along with antioxidant enzymes, namely catalase, superoxide dismutase (SOD), glutathione reductase (GSH-Rd), reduced glutathione (GSH) and total antioxidant capacity (TAC) were found significantly increased (P<0.01) in anemic women after treatment. However, the glutathione peroxidase (GSH-Px) and antioxidant vitamins A, C and E were found significantly decreased (P<0.01) in all treated groups. Lipid peroxide levels (LPO), protein carbonyl (PC), conjugated dienes (CD), lipid hydroperoxide (LOOH) and oxidized glutathione (GSSG) levels were found significantly increased (P<0.01) after oral iron supplementation groups. Moreover, undesirable side effects of iron supplementation were observed maximally in mild as compared with moderate and severe anemic groups, whereas nausea, vomiting, systemic reactions were negligible in all treated subjects. Study found recommended dose of iron effective for improving Hb, but at the cost of increased oxidative stress (mild>moderate>severe). It is suggested that blind iron supplementation should be avoided and shall be provided on need basis.

Predicting Factors in Iron Supplement Intake among Pregnant Women in Urban Care Setting.

The world health organization estimates that 58% of pregnant women in developing countries are anemic. In spite of the fact that most ministries of health in developing countries have policies to provide pregnant women with iron supplementation, prevalence of maternal anemia has not declined significantly. The aim of this study was to assess adherence to the current recommendation in the local population and to describe factors associated with taking iron supplementation during pregnancy. A questionnaire assessing the use of prenatal iron supplementation was distributed among women recently having delivered in Urmia, west Azerbaijan Province, northwest Iran. The questionnaire consisted of two sections. The first included demographic information and the second part covered questions regarding duration of iron supplementation, awareness of per partum anemia and management including benefits and side effects of iron supplementation. SPSS version 10 was used for statistical analysis; data were analyzed by Chi-Square and logistic regression. Eighty seven percent of participants took iron supplements for at least 4 months. Training during pregnancy was associated with longer duration of iron use. In logistic regression analysis nuliparity was the only variable, which remained in the model .Knowledge of participants on anemia, was obviously poor. Health care stuffs were the main source of information. The compliance was rather high but knowledge of subjects was low. Therefore, increasing effort is required to mobilize health workers to distribute information on anemia prevention and using iron supplements properly.

Iron Deficiency in Physically Active Adults

Learning Objective Iron deficiency without anemia is common in men and women who regularly engage in weight-bearing exercise of moderate to high intensity. Signs, symptoms, and laboratory tests of iron deficiency with and without anemia are presented. Dietary strategies to minimize iron deficiency and to maximize efficacy of supplemental iron are discussed, including side effects of iron supplementation and possible iron overload.