Iron Supplementation Research Articles

Anemia in patients ten years after bariatric surgery.

More than 10% of the global population has a BMI above 35. Bariatric surgery is an efficient way to treat this condition. Unfortunately, there is a risk of nutritional deficiencies. The number of studies after a longer time span is scarce. The aim of this study was to determine the occurrence of anaemia five and ten years after bariatric surgery and how it was related to substitution therapy. Registry data from individuals having primary bariatric surgery in the Scandinavian Obesity Surgery Registry (SOReg) from 2007 to 2022 and with a follow-up at five or ten years was retrieved. Demographic data including weight, as well as method of surgery, Hb levels, supplementation, PPI use and stomal ulcerations were recorded. In total, 39,992 individuals (mean age 41 years, range 18-74, 77% women) could be included. The majority, 78%, had undergone laparoscopic Roux-en-Y gastric bypass. After five years, 2838/13,944 women (20.3%) and 456/4049 men (11.2%) had anaemia. After ten years, 644/3400 women (18.9%) and 178/947 men (18.8%) had anaemia. The use of oral iron increased from 40 to 45%, and the need for parenteral iron intake increased from 5 to 11%. Anaemia is a significant but manageable condition five and ten years after bariatric surgery. Despite the prescription of oral iron supplements to 45% ten years after surgery, the Hb levels could still not be fully restored. Consequently, the importance of follow-up visits and continuous supplementation is emphasised.

Retrospective analysis of ferrotherapy methodology in patients with chronic heart failure and chronic kidney disease

The course of chronic non-infectious diseases is often accompanied by the development of comorbid conditions. In chronic heart failure and chronic kidney disease, special attention is drawn to iron deficiency and anemia. Intravenous iron preparations have become widely used for the prevention and treatment of anemia. Their use contributes to the progression of structural changes in vital organs. However, attempts to implement high-dose intravenous ferrotherapy as a routine strategy for compensating iron deficiency in patients with heart failure, with or without anemia, raise questions related to the search for diagnostic markers of iron deficiency states, goals, and conditions for its use. The article discusses the influences of a combination of opposing factors (inflammation, hypoxia) on the erythron system, its humoral regulators, and iron metabolism based on the author’s own research to justify the choice of strategy and tactics for ferrotherapy in patients with heart failure and chronic kidney disease.

Compliance to iron folic acid consumption and factors associated among antenatal care attendant mothers in southern Ethiopia

Iron and folic acid (IFA) consumption is an important strategy for the prevention of birth defects and anemia during pregnancy. In Ethiopia, low proportion of pregnant mothers took an iron tablet for 90 plus days. Therefore, the aim of this study was to assess compliance to IFA consumption and its associated factors among mothers attending antenatal care in Southern Ethiopia, 2021. An institution-based cross-sectional study triangulated with qualitative methods was conducted. The data was collected data from 378 respondents selected by a simple random sampling technique and 21 in-depth interviews were conducted. Epi Data version 3.1 was used to enter data, which was then exported to Statistical Package for the social Science (SPSS) version 21 for further processing and analysis. Bivariable and multivariable logistic regression analyses were carried out to identify the significant association. Variables with a P-value of less than 0.05 were considered significant. The Open code software version 4.03 was used to code and categorize qualitative data, and then thematic analysis was employed to qualitative data. The compliance rate of IFA consumption was 66.58% 95% CI: 61.5-71.4%) Maternal education (AOR: 3.01, 95%CI:1.29, 6.35), knowledge about anemia (AOR: 2.63, 95% CI:1.29), 5.37), knowledge about IFA (AOR: 2.95, 95% CI (1.45, 6.02)), ANC visits (AOR: 2.70, 95% CI 1.17, 6.22), fear of side effect (AOR: 0.08, 95% CI:0.02, 0.24), registration time for initiation of ANC visits (AOR:4.63, 95% CI:1.50, 14.26), and counseling on IFA (AOR:3.95, 95% CI:1.57, 9.98) were significantly associated with compliance IFA consumption of the pregnant mothers. Supplement-related, pregnancy and experience-related, facility related, behavioral -related, perceived family support, and perceived cultural belief findings were identified from qualitative study. In this study, the compliance with IFA consumption was low and influenced by huge range factors. To improve compliance with IFA, health workers provide proper counseling and education for pregnant women on IFA and follow up supplementation.

PENYULUHAN DAN PEMBERIAN SUPLEMEN BESI DALAM UPAYA PREVENTIF ANEMIA DI SMPN 9 DENPASAR

Iron deficiency anemia is a global public health problem in young women which is influenced by blood loss, diet, physical activity and socioeconomic conditions. It can cause various impacts on growth and development, resistance to infectious diseases, activity, concentration, and intelligence. Support for understanding and intake of iron through community service activities is expected to strengthen cadres at SMPN 9 Denpasar in setting a positive example in a healthy lifestyle to prevent anemia which is still a problem for those who can afford it at the school. The method used were by providing counseling and giving supplement tablets in addition to cadre, as well as providing partner assistance. After the implementation of community service, there was an increase in cadre knowledge of 70.9% (followed by 25 cadre) regarding iron deficiency anemia and management of food sources. In addition, 25 packages of iron tablets have been distributed to cadres and all cadres have consumed the iron tablets regularly and there have been no side effects.

A Systematic Review of Isotopically Measured Iron Absorption in Infants and Children Under 2 Years

Background: Iron is an essential element for critical biological functions, with iron deficiency negatively affecting growth and brain development and iron excess associated with adverse effects. The goal of this review is to provide a comprehensive assessment of up-to-date evidence on iron absorption measured isotopically in children, preterm infants, and full-term infants, up to 24 months of age. Methods: Search databases included Pubmed, Cochrane, Web of Science, and Scopus from a date range of 1 January 1953 to 22 July 2024. The included articles were experimental studies with iron absorption outcomes measured by isotopic techniques. The risk of bias was assessed using the Cochrane Risk of Bias Tool. Results: A total of 1594 records were identified from databases, and 37 studies were included in the quality review with a total of 1531 participants. Article results were grouped by study commonality: absorption and red blood cell incorporation, type of milk feedings, additives to improve absorption, how and when to supplement with iron, and iron forms and complimentary foods. Conclusions: The results from this review support the current recommendations of oral iron supplementation. Iron from breast milk has high bioavailability, and unmodified cow’s milk reduces iron absorption. Supplemental iron is required at 4–6 months for healthy, full-term infants and sooner for preterm infants. Ascorbic acid increases iron absorption in full-term infants and children. Lactoferrin and prebiotics are promising candidates for enhancing iron absorption, but they require further investigation. Research evidence of iron absorption mechanisms and modulating factors in preterm infants is limited and should be a research priority.

Roxadustat Efficacy and Safety in Patients Receiving Peritoneal Dialysis: Pooled Analysis of Four Phase 3 Studies

Background/Objectives: Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor approved to treat anemia of chronic kidney disease (CKD). The efficacy and safety of roxadustat compared with parenteral erythropoiesis-stimulating agents (ESAs) were evaluated in patients with anemia of CKD receiving peritoneal dialysis (PD). Methods: This analysis pooled data from four phase 3, multicenter, randomized, open-label, active-comparator studies (PYRENEES, SIERRAS, HIMALAYAS, ROCKIES). The primary endpoints evaluated were hemoglobin change from baseline (CFB) to Weeks 28–36 without rescue therapy and hemoglobin CFB to Weeks 28–52 regardless of rescue therapy use. Safety data were reported. Results: This analysis included 422 patients (215 roxadustat, 207 ESA). Hemoglobin CFB to Weeks 28–36 without rescue therapy and hemoglobin CFB to Weeks 28–52 regardless of rescue therapy achieved non-inferiority for roxadustat vs. ESAs. The mean weekly dose of roxadustat was maintained over time (Weeks 1–4, 3.86 mg/kg/week; Weeks 101–104, 3.27 mg/kg/week), whereas the mean weekly ESA dose increased by 24% (Weeks 1–4, 115.70 IU/kg/week; Weeks 101–104, 143.40 IU/kg/week). Fewer patients treated with roxadustat received intravenous iron supplementation and rescue therapy, and patients treated with an ESA required blood transfusions sooner. Roxadustat-treated patients experienced a greater decrease in low-density lipoprotein cholesterol levels relative to baseline vs. ESA-treated patients. Treatment-emergent adverse events were similar in both treatment groups. Major adverse cardiovascular event (MACE), MACE plus unstable angina or congestive heart failure, and all-cause mortality hazard ratios were <1; the lower limit of the 95% CIs was <0.6, and the upper limit was >1.3. Conclusions: Roxadustat was non-inferior to ESAs in correcting and maintaining hemoglobin levels, with stable dosing and a comparable safety profile, in anemic patients receiving PD.

Iron deficiency anemia and anemia of chronic disease – what is known?

Anemia is the most common disease in the world, affecting about 30–40% of people. Children, adolescents, and women are most often affected by anemia. The main causes of true iron deficiency (ID and IDA) are insufficient iron intake, increased iron loss (chronic bleeding), increased iron requirement, and impaired iron absorption (gastrointestinal diseases). Chronic diseases, inflammatory conditions, autoimmune diseases, obesity cause an increase in the synthesis of hepcidin in the liver and block the entry of iron into the bloodstream, leading to functional iron deficiency. Anemia of chronic diseases (ACD) or anemia of chronic inflammation (the second most common anemia) is associated with the fact that iron is present in the body, but the absorption of iron in various areas is limited. Until recently, it was believed that treatment with iron supplements in the absence of iron deficiency does not bring benefit to patients with ACD. The opinion has been repeatedly expressed about the harm of iron therapy, since iron is necessary for the growth of some pathogenic microorganisms and tumor cells. However, the real clinical significance of these mainly theoretical provisions is unknown. Therefore, the prescription of iron preparations for anemia is justified and logical. Ferrous sulfate (ferrous iron) is most often prescribed orally due to its low cost, high bioavailability and effectiveness. The drug Tardiferon, containing iron sulphate 247.25 mg (in terms of iron (II) 80.00 mg), is widely used in patients with IDA and ID, since divalent iron has a high ability to overcome the intestinal barrier by “passive” transport and quickly create high concentrations in the blood, restoring the level of hemoglobin and iron stores in the body. The drug Tardiferon has a relatively low dose of iron – 80 mg with slow-release technology to avoid irritating effects on the intestine, contributing to good tolerability. A number of studies confirmed a high safety profile – patients did not refuse to take the drug due to side effects. Timely examination and identification of patients with anemia allows you to prescribe an effective correction. The drug Tardiferon promotes rapid restoration of hemoglobin and iron stores in the body and has good tolerability.

Understanding the longitudinal trends (2005-2018) and multilevel risk factors of complementary feeding in Guinea.

This study aimed to define complementary feeding trends in Guinea from 2005 to 2018 and complementary feeding risk factors at the individual, household, and community levels. Data from 2005 to 2018 demographic health surveys (DHS) and Multiple Indicator Cluster Surveys were used to describe complementary feeding trends in Guinea. The most recent DHS was used to examine complementary feeding risk factors at the individual, household, and community levels. Complementary feeding indicators including introduction to complementary foods (INTRO), minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) were calculated based on the 2010 World Health Organisation guidance. Multivariate logistic regressions were used to identify significant risk factors (p < 0.05). Since 2005, there has been a marginal increase in MDD and MAD, but a decrease in INTRO and MMF. The 2018 DHS survey revealed various complementary feeding risk factors. At the individual level, travelling 1-60 min to get water was associated with decreased odds of meeting INTRO, while iron supplementation and maternal education were associated with increased odds of meeting MMF and MDD, respectively. Routine vitamin A supplementation, fever in the past 2 weeks, and low birth weight were associated with increased odds of meeting MAD. At the household level, being in a lower wealth quintile was associated with decreased odds of meeting MDD and MAD. National and subnational programmes and policies designed to improve infant and young child diets may consider tailored approaches that address the specific indicators and risk factors associated with poorer diets in this Guinean context.

Obesity and iron deficiency: what is the connection and how to treat?

The article presents a review of the literature and our own data on the etiology and pathogenesis of iron deficiency and iron deficiency anemia in patients with obesity. Obesity is considered as a subclinical systemic chronic inflammation, which is associated with an increase in the level of hepcidin, which is a key mediator of anemia during inflammation. Patients with obesity should undergo periodic screening of iron status and ferrokinetic parameters. Today, new oral iron preparations with increased tolerability and improved absorption are used in clinical practice. These include sucrosomial iron preparations. Sucrosomial iron (SI) is an innovative oral iron-containing carrier in which iron pyrophosphate is enclosed in a phospholipid matrix coated with sucrester, which protects sucrosomial iron from the effects of gastric juice, excluding contact with the mucous membrane of the gastrointestinal tract. Resistance to the action of gastric juice allows intact sucrosomes to reach the mucous membrane of the small intestine, where they are absorbed through special M cells, followed by the release of iron in liver cells. This allows prescribing SI to patients with iron deficiency and inflammatory bowel diseases, celiac disease, cancer and patients with obesity. Sucrosomial iron should be considered as an alternative treatment for iron deficiency in obese women. SI is innovative, allowing to bypass the “hepcidin barrier”, convenient for administration, effective for treatment, well tolerated than traditional oral iron salts.

Impact of a virtual antenatal intervention for improved diet and iron intake in Kapilvastu district, Nepal - the VALID randomized controlled trial

IntroductionCounseling, together with iron and folic acid supplements, can improve hemoglobin levels in pregnant women, but few interventions have tested a virtual method of delivering counseling. We hypothesized that a virtual counseling intervention delivered via a mobile device (mHealth) would prevent and treat anemia, compared with routine antenatal care (ANC).MethodsVirtual antenatal intervention for improved diet and iron intake (VALID) was a non-blinded parallel group two-arm, individually randomized superiority trial (1:1 allocation). Participants were pregnant women who were married, aged 13–49 years, able to answer questions, 12–28 weeks’ gestation and living in Kapilvastu district, Nepal. Women were randomized to receive routine ANC (control arm), or ANC plus a virtual antenatal intervention of two problem-solving counseling sessions via video call. The primary outcome was iron folic acid (IFA) tablet compliance (consumption on 12 or more days of the previous 14 days). Secondary outcomes were dietary diversity, promoted food consumption, iron bioavailability enhancement, and knowledge of iron-rich foods. Primary logistic regression analysis was by intention-to-treat, adjusting for baseline values.ResultsWe enrolled 319 pregnant women (161 control, 158 intervention) from 23 January 2022 to 6 May 2022 and analyzed outcomes in 144 control and 127 intervention women. Compliance with IFA increased in both arms. In the intervention arm, compliance increased by 29.7 percentage points (pp) (49.0–78.7%) and 19.8 pp. in the control arm (53.8–73.6%). Despite the more significant increase in the intervention arm, we found no intervention effect upon IFA compliance (adjusted odds ratio [aOR] 1.33; 95% confidence interval [CI]: 0.75, 2.35; p = 0.334), dietary diversity, or ANC visits. The intervention increased knowledge of iron-rich foods (coefficient 0.96; 95% CI: 0.50, 1.41; p &amp;lt; 0.001), consumption of promoted foods (aOR: 1.81; 95% CI: 1.08, 3.02; p = 0.023), behavior to enhance iron bioavailability (aOR: 4.41; 95% CI: 1.23, 15.83; p = 0.023), and coronavirus disease 2019 (COVID-19) knowledge (aOR: 4.06; 95% CI: 1.56, 10.54; p = 0.004). The total intervention cost was US$35,193, and the cost per pregnant woman receiving two virtual counseling sessions was US$277.ConclusionVirtual counseling can improve antenatal health behaviors, such as the consumption of promoted foods and methods to enhance bioavailability. Improved IFA consumption and ANC attendance may require additional family/community support.Clinical trial registrationhttps://www.isrctn.com/ISRCTN17842200, identifier ISRCTN17842200.

Update on diagnosis and treatment in autoimmune gastritis

Autoimmune gastritis (AIG) is a special type of atrophic gastritis caused by autoimmune abnormalities. Diagnosis of AIG is often delayed because of the absence of typical symptoms in the early stage, which results in inadequate treatment and poor cancer screening. It is crucial to improve the awareness of this disease. This article summarizes the clinical manifestations, endoscopic features, and treatments of autoimmune gastritis. Conventional therapy consists of adequate iron and vitamin B12 supplementation as well as symptomatic approaches. The associated risk for gastric adenocarcinoma and gastric neuroendocrine tumors requires regular endoscopic follow up. This article is helpful in prevention and treatment of AIG.

Genetic Variants Affecting Iron Metabolism in Healthy Adults: A Systematic Review to Support Personalized Nutrition Strategies

Background/Objectives: Increased interest in personalized nutrition has led to a growing focus on exploring genetic variants and their impact on nutritional uptake (nutrigenomics). Nevertheless, no systematic review to date has compiled scientific evidence on genetic variants (such as single-nucleotide polymorphisms (SNPs)) affecting mineral metabolism in humans. This review aims to fill this gap and enable optimized personalized nutrition recommendations in health care. Methods: Cochrane, Embase and MEDLINE databases were systematically searched for English and German studies published between 2007 and 2023, focusing on genetic variants linked to nutrition. Studies on overweight, diseased, or underage individuals were excluded. Papers with verified findings were assessed for methodological quality using the Joanna Briggs Institute critical appraisal tool. Results: Twenty-one scientific papers on SNPs associated with mineral metabolism were included. The majority were observational studies (n = 19) conducted on Caucasian populations. Women outnumbered men (37.4%) women, 18.9% men, 43.7% sex not reported. All identified SNPs linked to minerals influenced iron parameters, with the TMPRSS6 gene showing the strongest correlation. Two HFE SNPs (rs1800562 and rs1799945) and one TF SNP (rs1799852) exhibited protective effects, while the other 11 SNPs were linked to increased risk of iron deficiency, suggesting potential benefits from iron supplementation for individuals with those genetic variants. Conclusions: This review provides comprehensive insights into the association between genetic variants and mineral metabolism, and the findings highlight the relevance of genetic makeup in optimizing health through nutritional interventions. The generalizability of the findings may be limited to Caucasians, warranting future research with diverse populations. This review was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) on 12 July 2022, under INPLASY202270068 and funded by the University Centre for Prevention and Sports Medicine at Balgrist University Hospital Zurich and the Swiss Innovation Agency Innosuisse, Switzerland.

Rituximab in lupus anticoagulant hypoprothrombinemia syndrome: A case report.

Lupus anticoagulant hypoprothrombinemia syndrome (LAHPS) is a rare autoimmune condition characterized by acquired prothrombin (FII) deficiency associated with antiphospholipid syndrome (APS) and life-threatening bleeding. We present the case of a 34-year-old woman with heavy menstrual bleeding (HMB), positive Lupus anticoagulant (LA) test, and high titer anticardiolipin antibodies Immunoglobulin G (ACA IgG) and anti-β2 glycoprotein I antibodies IgG (antiB2GPI IgG). Severe iron deficiency anemia necessitated recurrent blood transfusions and intravenous iron infusions from 2018 to 2021. In January 2022, she was admitted to our clinic. Von Willebrand disease screening and platelet function analysis (PFA100) were normal. FII and FIX deficiencies were detected, without factor IX inhibitors. Anti-phosphatidylserine/prothrombin antibodies were confirmed by Padua University lab. To reduce antibody titers and menstrual bleeding, immunosuppressive therapy (Rituximab 375 mg/m2 weekly ×4 weeks) and hormonal therapy (desogestrel 75 mcg/day) were initiated. After 1-year, complete remission of clinical symptoms was achieved, with normalization of FII and FIX values and moderate reduction of aPS/PT titers, especially IgM isotype.

Comparative analysis of ferric carboxymaltose and iron sucrose in treating iron deficiency anemia in perimenopausal women with heavy menstrual bleeding: a randomized controlled trial.

To evaluate the impact of intravenous ferric carboxymaltose (FCM) compared to iron sucrose (ISC) in perimenopausal women with heavy menstrual bleeding (HMB) and anemia. This prospective, open-label, randomized controlled trial enrolled perimenopausal women (40-50 years) with HMB and hemoglobin levels between 6-10 g/dL, intolerant or non-compliant to oral iron therapy. The study compared FCM and ISC by assessing hematological parameters, including hemoglobin, ferritin, and iron levels, over a 12-week period. The patients were followed up at 3, 6, and 12 weeks after initiation. The adverse effects were also evaluated. The study included 60 perimenopausal women, with 30 in each group. The baseline patient characteristics were comparable. FCM demonstrated a statistically significant higher mean increase in hemoglobin (4.97 g/dL) than ISC (4.63 g/dL) over 12 weeks. The proportion of patients achieving correction of anemia (Hb ≥12%) was higher in the FCM group (75.9% vs. 65.5%). Serum ferritin levels were significantly higher in the FCM group after 3 weeks. Adverse effects were minimal and comparable between the groups. Although the direct cost of FCM is high, its ability to be administered in larger doses may result in lower total costs. In perimenopausal women with heavy menstrual bleeding and iron deficiency anemia, FCM and ISC show comparable efficacy in increasing hemoglobin levels with similar side effect profiles. This study highlights the potential benefits of FCM and calls for further exploration of these therapies in diverse patient populations.

Understanding Behavioral Drivers of Iron and Folic Acid Supplementation and Vitamin A- and Iron-Rich Food Consumption among Women and Adolescent Girls in Niger.

This study examined drivers and barriers to iron and folic acid (IFA) supplementation and consumption of iron- and vitamin A-rich foods among women of reproductive age (WRA) and adolescent girls in Niger. This was an exploratory qualitative study using focus group discussions and semi-structured interviews. This study was conducted in the rural areas of three districts in Maradi and Zinder regions of southern Niger. The study included a purposive sample of 56 WRA (15-49 years), 34 non-pregnant adolescent girls (10-14 years), 105 family members and community leaders, 32 health workers, and 12 national and regional level stakeholders. Respondents demonstrated widespread knowledge of recommendations for IFA during pregnancy and had positive attitudes toward supplements. However, supply barriers were significant, and adherence was limited by side effects, among other constraints. Despite knowledge about and positive attitudes towards micronutrient source foods, respondents reported that limited food access was an overriding constraint to increasing consumption. WRA were seen as nutritionally vulnerable, however husbands were often not able to provide sufficient nutritious food and there was a cultural expectation that wives serve themselves food last. Adolescent girls were not seen as nutritionally vulnerable and there was little family support for their consumption of nutritious foods. Projects should work with local actors to develop multi-pronged solutions that address supply and access barriers for IFA and micronutrient-rich foods and to improve social support for nutrition.

Intravenous iron preoperatively for woman with severe anaemia

Iron deficiency is the main cause of anaemia, especially in premenopausal due to heavy menstrual bleeding. In this case report, an asymptomatic woman presented with a haemoglobin level of 3.9 mmol/l. Due to uterine fibroids, she was scheduled for myomectomy, and she was treated with IV iron. Fourteen days post infusion her haemoglobin level was 6.3 mmol/l. This highlights the importance of screening women for heavy menstrual bleeding causing iron deficiency, and encourage at-risk women to take iron supplements. Furthermore, one should be aware of IV iron therapy as an alternative to blood transfusion in treating iron deficiency anaemia.

Ferric carboxymaltose reduces the burden of arrhythmic events in heart failure with reduced ejection fraction: the role of the non-invasive arrhythmic biomarkers

BackgroundTreating iron deficiency (ID) with ferric carboxymaltose (FCM) in patients with heart failure with reduced ejection fraction (HFrEF) enhances morbidity, quality of life (QoL), and exercise capacity. MethodsThis single center, prospective follow-up study aims to assess FCM's impact on arrhythmic events and non-invasive markers in HFrEF patients with cardiac implantable electronic devices (CIEDs) and ID. Symptomatic HFrEF patients with ID and CIEDs scheduled for IV FCM were followed for 12-months. Arrhythmic activity was evaluated from CIEDs and non-invasive markers from Holter recordings pre- and post-FCM. Ventricular tachycardia/ventricular fibrillation (VT/VF) episodes, non-sustained VT (nsVT), late potentials (LPs), Microvolt T-wave alternans (MTWA), heart rate variability, turbulence (HRT) QTc, and premature ventricular contractions (PVCs, number and Lown and Wolf classification) were assessed. Left ventricular EF (LVEF), global longitudinal strain (LV GLS), QoL (KCCQ, EQ-5D-5L), six-minute walking distance (6MWD), peak oxygen consumption, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels were also recorded. ResultsNinety-six patients in optimal medical treatment participated (median age 71.9 [12.3] years, 83% male). Post-FCM treatment, VT/VF (P=0.043) and nsVT (P<0.001) frequency decreased significantly. The Lown and Wolf classification improved (P=0.002) and predicted VT/VF episodes better than other markers (AUC 0.737, P=.001). MTWA, LPs and HRT improved statistically significantly post-FCM. Hospitalization rates and NT-proBNP levels decreased, while LVEF, LV GLS, 6MWD, QoL and peak VO2 improved statistically significantly (P<0.001). ConclusionsOur study provides real-world evidence that IV FCM led to statistically significant reduction in ventricular arrhythmic episodes, as well as an improvement in non-invasive arrhythmic markers.

Diammonium glycyrrhizinate alleviates iron overload-induced liver injury in mice via regulating the gut-liver axis

BackgroundEvidence indicates a close association between iron overload (IO) and the pathogenesis of chronic liver diseases, highlighting the potential for interventions targeted at IO to impede or decelerate the progression of chronic liver diseases. Diammonium glycyrrhizinate (DG), the medicinal form of glycyrrhizic acid, a principal constituent of licorice, has been clinically employed as a hepatoprotective agent; however, its protective effect against IO-induced liver injury and underlying molecular mechanisms remain elusive. PurposeThe aim of the present study is to investigate the hepatoprotective effect of DG against IO-induced liver injury with a focus on the gut-liver axis. Study design and methodsAnimal models of IO-induced liver injury and DG treatment have been established in vivo. Iron deposition, liver injury, intestinal barrier damage, and liver inflammation were assessed in mice treated with iron dextran or DG. The microbiome composition in feces was analyzed using 16S rRNA full-length sequencing. Bile acids (BAs) profiles in feces were detected by UPLC-Q-TOF-MS technique, and the expression levels of receptors, enzymes or transporters involved in BAs metabolism were also determined. ResultsDG partially reduced the iron deposition and the levels of ferrous ion in the livers of mice with IO, thereby mitigating oxidative damage. DG also improved gut microbiota dysbiosis, repaired intestinal barrier damage, inhibited endotoxin translocation to the liver, and subsequently suppressed TLR4/NF-κB/NLRP3 pathway-mediated liver inflammation caused by IO. Moreover, DG modulated BAs metabolism disorder in IO mice, reducing the accumulation of BAs in the liver. ConclusionDG alleviates IO-induced liver injury in mice by regulating the gut-liver axis. This study provides novel insights into the underlying mechanisms through which DG ameliorates liver injury caused by IO.

Associations of maternal serum ferritin levels across gestation with gestational diabetes mellitus: A longitudinal cohort study.

The longitudinal changes in maternal serum ferritin (SF) levels across gestation, which indirectly reflect iron supplementation, have not been extensively investigated in relation to gestational diabetes mellitus (GDM). We conducted a retrospective cohort study at a tertiary maternal hospital in Shanghai. Women with SF concentration measurements at 8.0-13.6 weeks' gestation (GW), 29.0-31.6 GW, and an oral glucose tolerance test (OGTT) at 24-28 GW were included. We utilized logistic regression analysis to assess GDM association with maternal SF levels and longitudinal changes. The study included 17 560 women, with 2160 (12.3%) participants diagnosed with GDM. Adjusted odds ratios (ORs) (95% confidence intervals [CIs]) for GDM across increasing quartiles of SF concentrations at 8.0-13.6 GW were 1.00 (reference), 1.139 (95% CI: 1.012-1.283), 1.093 (95% CI: 0.969-1.233), and 1.248 (95% CI: 1.111-1.403). Similarly, at 29.0-31.6 GW, increasing quartiles of SF concentrations were associated with higher adjusted ORs for GDM: 1.00 (reference), 1.165 (95% CI: 1.029-1.320), 1.335 (95% CI: 1.184-1.505), and 1.428 (95% CI: 1.268-1.607). Pregnant women with higher SF levels (upper 25th percentile) at 8.0-13.6 GW had a reduced GDM risk if their SF levels decreased to the lower 25th percentile at 29.0-31.6 GW. Conversely, the subgroup with higher SF levels (upper 25th percentile) at both time points had the highest incidence rate of GDM (15.3%, 1.235 [95% CI: 1.087-1.404]). Maternal SF levels independently and positively associated with GDM risk during early and late gestational stages. Considering the increased GDM risk, routine iron supplementation for iron-replete women is questionable.

Intravenous ferric carboxymaltose (FCM) in the treatment of iron deficiency anaemia (IDA) in pregnancy: short-term effects on maternal and foetal wellbeing

Intravenous ferric carboxymaltose (FCM) in the treatment of iron deficiency anaemia (IDA) in pregnancy: short-term effects on maternal and foetal wellbeing