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Šmid AN, Golja P, Hadžić V, Abazović E, Drole K, Paravlic AH. Effects of Oral Iron Supplementation on Blood Iron Status in Athletes: A Systematic Review, Meta-Analysis and Meta-Regression of Randomized Controlled Trials. Sports Med 2024; 54:1231-1247. [PMID: 38407751 PMCID: PMC11127818 DOI: 10.1007/s40279-024-01992-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Iron deficiency in athletes is initially treated with a nutritional intervention. If negative iron balance persists, oral iron supplementation (OIS) can be used. Despite the recent proposal for a refinement of treatment strategies for iron-deficient athletes, there is no general consensus regarding the actual efficiency, dosage, or optimal regimen of OIS. OBJECTIVE The aim of this meta-analysis was to evaluate to what extent OIS affects blood iron parameters and physical performance in healthy adult athletes. METHODS PubMed, Web of Science, PEDro, CINAHL, SPORTDiscus, and Cochrane were searched from inception to 2 November 2022. Articles were eligible if they satisfied the following criteria: recruited subjects were healthy, adult and physically active individuals, who used exclusively OIS, irrespective of sex and sports discipline. EXCLUSION CRITERIA simultaneous supplementation with iron and any other micronutrient(s), intravenous iron supplementation or recent exposure to altitude acclimatisation. The methodological quality of included studies was assessed with the PEDro scale, the completeness of intervention reporting with the TIDieR scale, while the GRADE scale was used for quality of evidence synthesis. The present study was prospectively registered in PROSPERO online registry (ID: CRD42022330230). RESULTS From 638 articles identified through the search, 13 studies (n = 449) were included in the quantitative synthesis. When compared to the control group, the results demonstrated that OIS increases serum ferritin (standardized mean difference (SMD) = 1.27, 95% CI 0.44-2.10, p = 0.006), whereas blood haemoglobin (SMD = 1.31, 95% CI - 0.29 to 2.93, p = 0.099), serum transferrin receptor concentration (SMD = - 0.74, 95% CI - 1.89 to 0.41, p = 0.133), and transferrin saturation (SMD = 0.69, 95% CI - 0.84 to 2.22, p = 0.330) remained unaltered. Following OIS, a trend of small positive effect on VO2max (SMD = 0.49, 95% CI - 0.09 to 1.07, p = 0.086) was observed in young healthy athletes. The quality of evidence for all outcomes ranged from moderate to low. CONCLUSIONS Increase in serum ferritin concentration after OIS was evident in subjects with initial pre-supplementation serum ferritin concentration ≤ 12 µg/l, while only minimal, if any effect, was observed in subjects with higher pre-supplementation serum ferritin concentration. The doses of OIS, that induced a beneficial effect on hematological parameters differed from 16 to 100 mg of elementary iron daily, over the period between 6 and 8 weeks. Shorter supplementation protocols have been shown to be ineffective.
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Affiliation(s)
- Anja Neža Šmid
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva ulica 101, 1000, Ljubljana, Slovenia
| | - Petra Golja
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva ulica 101, 1000, Ljubljana, Slovenia
| | - Vedran Hadžić
- Faculty of Sport, University of Ljubljana, Gortanova ulica 22, 1000, Ljubljana, Slovenia
| | - Ensar Abazović
- Faculty of Sport and Physical Education, University of Sarajevo, Patriotske Lige 41, 71000, Sarajevo, Bosnia and Herzegovina
| | - Kristina Drole
- Faculty of Sport, University of Ljubljana, Gortanova ulica 22, 1000, Ljubljana, Slovenia
| | - Armin H Paravlic
- Faculty of Sport, University of Ljubljana, Gortanova ulica 22, 1000, Ljubljana, Slovenia.
- Faculty of Sports Studies, Masaryk University, 625 00, Brno, Czech Republic.
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Dentand AL, Schubert MG, Krayenbuehl PA. Current iron therapy in the light of regulation, intestinal microbiome, and toxicity: are we prescribing too much iron? Crit Rev Clin Lab Sci 2024:1-13. [PMID: 38606523 DOI: 10.1080/10408363.2024.2331477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/13/2024] [Indexed: 04/13/2024]
Abstract
Iron deficiency is a widespread global health concern with varying prevalence rates across different regions. In developing countries, scarcity of food and chronic infections contribute to iron deficiency, while in industrialized nations, reduced food intake and dietary preferences affect iron status. Other causes that can lead to iron deficiency are conditions and diseases that result in reduced intestinal iron absorption and blood loss. In addition, iron absorption and its bioavailability are influenced by the composition of the diet. Individuals with increased iron needs, including infants, adolescents, and athletes, are particularly vulnerable to deficiency. Severe iron deficiency can lead to anemia with performance intolerance or shortness of breath. In addition, even without anemia, iron deficiency leads to mental and physical fatigue, which points to the fundamental biological importance of iron, especially in mitochondrial function and the respiratory chain. Standard oral iron supplementation often results in gastrointestinal side effects and poor compliance. Low-dose iron therapy seems to be a valid and reasonable therapeutic option due to reduced hepatic hepcidin formation, facilitating efficient iron resorption, replenishment of iron storage, and causing significantly fewer side effects. Elevated iron levels influence gut microbiota composition, favoring pathogenic bacteria and potentially disrupting metabolic and immune functions. Protective bacteria, such as bifidobacteria and lactobacilli, are particularly susceptible to increased iron levels. Dysbiosis resulting from iron supplementation may contribute to gastrointestinal disorders, inflammatory bowel disease, and metabolic disturbances. Furthermore, gut microbiota alterations have been linked to mental health issues. Future iron therapy should consider low-dose supplementation to mitigate adverse effects and the impact on the gut microbiome. A comprehensive understanding of the interplay between iron intake, gut microbiota, and human health is crucial for optimizing therapeutic approaches and minimizing potential risks associated with iron supplementation.
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Affiliation(s)
- Anaëlle L Dentand
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Zurich, Zurich, Switzerland
| | - Morton G Schubert
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Zurich, Zurich, Switzerland
| | - Pierre-Alexandre Krayenbuehl
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Zurich, Zurich, Switzerland
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Kotit S. Benefits of intravenous iron supplementation in heart failure. Glob Cardiol Sci Pract 2024; 2024:e202410. [PMID: 38746071 PMCID: PMC11090186 DOI: 10.21542/gcsp.2024.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/14/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction: Iron deficiency (ID) is one of the most frequent comorbidities in patients with heart failure (HF) and is estimated to be present in up to 80% of acute patients regardless of their ejection fraction. Randomized controlled trials have shown that supplementary intravenous iron results in improved clinical outcomes; however, the current understanding of the effects of intravenous iron on morbidity and mortality remains limited. Study and results: The meta-analysis pooled individual participant data from three randomized placebo-controlled trials of ferric carboxymaltose (FCM) in adult patients (n = 4,501) with heart failure and iron deficiency (CONFIRM-HF, AFFIRM-AHF, and HEART-FID). FCM therapy significantly reduced the co-primary composite endpoint of total cardiovascular hospitalizations and cardiovascular death, with a rate ratio (RR 0.86; 95% CI 0.75 to 0.98; p = 0.029). FCM therapy was associated with a 17% relative rate reduction in total cardiovascular hospitalizations (RR 0.83; 95% CI 0.73 to 0.96; p = 0.009) and a 16% relative rate reduction in total heart failure hospitalizations (RR 0.84; 95% CI 0.71 to 0.98; p = 0.025). Lessons learned: The meta-analysis shows that in iron-deficient patients with heart failure and reduced or mildly reduced left ventricular ejection fraction, intravenous ferric carboxymaltose (FCM) is associated with a reduced risk of total cardiovascular hospitalization and cardiovascular mortality. These findings indicate that intravenous FCM should be considered in iron-deficient patients with heart failure and reduced or mildly reduced ejection fractions.
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Lemaire B, Frias MA, Golaz O, Magnin JL, Viette V, Vuilleumier N, Waldvogel Abramowski S. Ferritin: A Biomarker Requiring Caution in Clinical Decision. Diagnostics (Basel) 2024; 14:386. [PMID: 38396425 PMCID: PMC10887646 DOI: 10.3390/diagnostics14040386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES To determine the ferritin inter-assay differences between three "Conformité Européenne" (CE) marked tests, the impact on reference intervals (RI), and the proportion of individuals with iron deficiency (ID), we used plasma and serum from healthy blood donors (HBD) recruited in three different Switzerland regions. DESIGN AND METHODS Heparinized plasma and serum from HBD were obtained from three different transfusion centers in Switzerland (Fribourg, Geneva, and Neuchatel). One hundred forty samples were recruited per center and per matrix, with a gender ratio of 50%, for a total of 420 HBD samples available per matrix. On both matrices, ferritin concentrations were quantified by three different laboratories using electrochemiluminescence (ECL), latex immunoturbidimetric assay (LIA), and luminescent oxygen channeling immunoassay (LOCI) assays, respectively. The degree of agreement between matrices and between the three sites/methods was assessed by Passing-Bablok and we evaluated the proportion of individuals deemed to have ID per method. RESULTS Overall, no difference between serum and heparinized plasma ferritin values was observed according to Passing-Bablok analyses (proportional bias range: 1.0-3.0%; maximum constant bias: 1.84 µg/L). Significant median ferritin differences (p < 0.001 according to Kruskal-Wallis test) were observed between the three methods (i.e., 83.6 µg/L, 103.5 µg/L, and 62.1 µg/L for ECL, LIA, and LOCI in heparinized plasma, respectively), with proportional bias varying significantly between ±16% and ±32% on serum and from ±14% to ±35% on plasma with no sign of gender-related differences. Affecting the lower end of RI, the proportion of ID per method substantially varied between 4.76% (20/420) for ECL, 2.86% (12/420) for LIA, and 9.05% (38/420) for LOCI. CONCLUSIONS Serum and heparinized plasma are exchangeable for ferritin assessment. However, the order of magnitude of ferritin differences across methods and HBD recruitment sites could lead to diagnostic errors if uniform RI were considered. Challenging the recently proposed use of uniform ferritin thresholds, our results highlight the importance of method- and region-specific RI for ferritin due to insufficient inter-assay harmonization. Failing to do so significantly impacts ID diagnosis.
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Affiliation(s)
- Baptiste Lemaire
- Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
- Medicine Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Miguel A. Frias
- Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Olivier Golaz
- Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Jean-Luc Magnin
- Central Laboratory, HFR-Fribourg, 1700 Fribourg, Switzerland
| | | | - Nicolas Vuilleumier
- Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Sophie Waldvogel Abramowski
- Diagnostic Department, Geneva University Hospitals, 1205 Geneva, Switzerland
- Medicine Department, Geneva University Hospitals, 1205 Geneva, Switzerland
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Ras-Jiménez MDM, Ramos-Polo R, Francesch Manzano J, Corbella Santano M, Morillas Climent H, Jose-Bazán N, Jiménez-Marrero S, Garcimartin Cerezo P, Yun Viladomat S, Moliner Borja P, Torres Cardús B, Verdú-Rotellar JM, Diez-López C, González-Costello J, García-Romero E, de Frutos Seminario F, Triguero-Llonch L, Enjuanes Grau C, Tajes Orduña M, Comin-Colet J. Soluble Transferrin Receptor as Iron Deficiency Biomarker: Impact on Exercise Capacity in Heart Failure Patients. J Pers Med 2023; 13:1282. [PMID: 37623532 PMCID: PMC10455097 DOI: 10.3390/jpm13081282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/05/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023] Open
Abstract
The soluble transferrin receptor (sTfR) is a marker of tissue iron status, which could indicate an increased iron demand at the tissue level. The impact of sTfR levels on functional capacity and quality of life (QoL) in non-anemic heart failure (HF) patients with otherwise normal systemic iron status has not been evaluated. We conducted an observational, prospective, cohort study of 1236 patients with chronic HF. We selected patients with normal hemoglobin levels and normal systemic iron status. Tissue iron deficiency (ID) was defined as levels of sTfR > 75th percentile (1.63 mg per L). The primary endpoints were the distance walked in the 6 min walking test (6MWT) and the overall summary score (OSS) of the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The final study cohort consisted of 215 patients. Overall QoL was significantly worse (51 ± 27 vs. 39 ± 20, p-value = 0.006, respectively), and the 6 MWT distance was significantly worse in patients with tissue ID when compared to patients without tissue ID (206 ± 179 m vs. 314 ± 155, p-value < 0.0001, respectively). Higher sTfR levels, indicating increased iron demand, were associated with a shorter distance in the 6 MWT (standardized β = -0.249, p < 0.001) and a higher MLHFQ OSS (standardized β = 0.183, p-value = 0.008). In this study, we show that in patients with normal systemic iron parameters, higher levels of sTfR are strongly associated with an impaired submaximal exercise capacity and with worse QoL.
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Affiliation(s)
- Maria del Mar Ras-Jiménez
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L’Hospitalet de Llobregat, Spain
- Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Department of Internal Medicine, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
| | - Raúl Ramos-Polo
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L’Hospitalet de Llobregat, Spain
- Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
| | - Josep Francesch Manzano
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L’Hospitalet de Llobregat, Spain
| | - Miriam Corbella Santano
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L’Hospitalet de Llobregat, Spain
| | - Herminio Morillas Climent
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L’Hospitalet de Llobregat, Spain
- Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
| | - Núria Jose-Bazán
- Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
| | - Santiago Jiménez-Marrero
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L’Hospitalet de Llobregat, Spain
- Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Paloma Garcimartin Cerezo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Advanced Practice Nurses, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain
- Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
- Escuela Superior de Enfermería del Mar, Parc de Salut Mar, 08003 Barcelona, Spain
| | - Sergi Yun Viladomat
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L’Hospitalet de Llobregat, Spain
- Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Department of Internal Medicine, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Pedro Moliner Borja
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L’Hospitalet de Llobregat, Spain
- Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Blanca Torres Cardús
- Primary Care Service Delta del Llobregat, Institut Català de la Salut, 08820 Barcelona, Spain
| | - José Maria Verdú-Rotellar
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Primary Care Service Litoral, Institut Català de la Salut, 08023 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Carles Diez-López
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L’Hospitalet de Llobregat, Spain
- Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Advanced Heart Failure and Heart Trasplant Program, Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
| | - José González-Costello
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L’Hospitalet de Llobregat, Spain
- Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Advanced Heart Failure and Heart Trasplant Program, Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
| | - Elena García-Romero
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L’Hospitalet de Llobregat, Spain
- Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Advanced Heart Failure and Heart Trasplant Program, Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
| | - Fernando de Frutos Seminario
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L’Hospitalet de Llobregat, Spain
- Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Advanced Heart Failure and Heart Trasplant Program, Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
| | - Laura Triguero-Llonch
- Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Advanced Heart Failure and Heart Trasplant Program, Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
| | - Cristina Enjuanes Grau
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L’Hospitalet de Llobregat, Spain
- Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Marta Tajes Orduña
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L’Hospitalet de Llobregat, Spain
- Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Josep Comin-Colet
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08907 L’Hospitalet de Llobregat, Spain
- Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, 08907 L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, 08036 Barcelona, Spain
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Anker SD, Khan MS, Butler J, von Haehling S, Jankowska EA, Ponikowski P, Friede T. Effect of intravenous iron replacement on recurrent heart failure hospitalizations and cardiovascular mortality in patients with heart failure and iron deficiency: A Bayesian meta-analysis. Eur J Heart Fail 2023; 25:1080-1090. [PMID: 37062867 DOI: 10.1002/ejhf.2860] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/18/2023] Open
Abstract
AIMS Iron deficiency is common in patients with heart failure (HF) and reduced ejection fraction (HFrEF) and is associated with a poor prognosis. Whether intravenous iron replacement improves recurrent HF hospitalizations and cardiovascular mortality of these patients is uncertain although several trials were conducted. Moreover, none of the trials were powered to assess the effect of intravenous iron in clinically important subgroups. Therefore, we conducted a Bayesian analysis to derive precise estimates of the effect of intravenous iron replacement on recurrent HF hospitalizations and cardiovascular mortality in iron-deficient HFrEF patients using consistent subgroup definitions across trials. METHODS AND RESULTS Individual participant data were used from the FAIR-HF (n = 459), CONFIRM-HF (n = 304) and AFFIRM-AHF (n = 1108) trials. These data were re-analysed following as closely as possible the approach taken in the analyses of IRONMAN (n = 1137), for which study level data were used. Definitions of outcomes and subgroups from the FAIR-HF, CONFIRM-HF and AFFIRM-AHF were matched with those used in IRONMAN. The primary endpoint was recurrent HF hospitalizations and cardiovascular mortality. The analysis of recurrent events was based on rate ratios (RR) derived from the Lin-Wei-Yang-Ying model, and the data were pooled using Bayesian random-effects meta-analysis. Compared with placebo, intravenous iron significantly reduced the rates of recurrent HF hospitalizations and cardiovascular mortality (RR 0.73, 95% credible interval [CI] 0.48-0.99; between-trial heterogeneity tau = 0.16). The pooled treatment effects did not provide evidence for any differential effects for subgroups based on sex (ratio of rate ratios [RRR] 1.49 [95% CI 0.95-2.37], age <69.4 vs. ≥69.4 years) (RRR 0.68 [0.40-1.15]), ischaemic versus non-ischaemic aetiology of HF (RRR 0.73 [0.42-1.33]), transferrin saturation <20% vs. ≥20% (RRR 0.75 [0.40-1.34]), estimated glomerular filtration rate ≤60 versus >60 ml/min/1.73 m2 (RRR 0.97 [0.56-1.68]), haemoglobin <11.8 versus ≥11.8 (RRR 0.95 [0.53-1.60]), ferritin <35 versus ≥35 μg/L (RRR 1.26 [0.72-2.48]) and New York Heart Association class II versus III/IV (RRR 0.91 [0.54-1.56]). CONCLUSIONS Treatment of iron-deficient HFrEF patients with intravenous iron - namely with ferric carboxymaltose or ferric derisomaltose - results in significant reduction in recurrent HF hospitalizations and cardiovascular mortality. Results were nominally consistent across the subgroups studied, but for several of these subgroups uncertainty remains present.
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Affiliation(s)
- Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité, Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, University Medical Center, Göttingen, Germany
| | - Ewa A Jankowska
- Institute of Heart Diseases, Wrocław Medical University, Wroclaw, Poland
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wrocław Medical University, Wroclaw, Poland
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
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West S, Monteyne AJ, van der Heijden I, Stephens FB, Wall BT. Nutritional Considerations for the Vegan Athlete. Adv Nutr 2023; 14:774-795. [PMID: 37127187 PMCID: PMC10334161 DOI: 10.1016/j.advnut.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 05/03/2023] Open
Abstract
Accepting a continued rise in the prevalence of vegan-type diets in the general population is also likely to occur in athletic populations, it is of importance to assess the potential impact on athletic performance, adaptation, and recovery. Nutritional consideration for the athlete requires optimization of energy, macronutrient, and micronutrient intakes, and potentially the judicious selection of dietary supplements, all specified to meet the individual athlete's training and performance goals. The purpose of this review is to assess whether adopting a vegan diet is likely to impinge on such optimal nutrition and, where so, consider evidence based yet practical and pragmatic nutritional recommendations. Current evidence does not support that a vegan-type diet will enhance performance, adaptation, or recovery in athletes, but equally suggests that an athlete can follow a (more) vegan diet without detriment. A clear caveat, however, is that vegan diets consumed spontaneously may induce suboptimal intakes of key nutrients, most notably quantity and/or quality of dietary protein and specific micronutrients (eg, iron, calcium, vitamin B12, and vitamin D). As such, optimal vegan sports nutrition requires (more) careful consideration, evaluation, and planning. Individual/seasonal goals, training modalities, athlete type, and sensory/cultural/ethical preferences, among other factors, should all be considered when planning and adopting a vegan diet.
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Affiliation(s)
- Sam West
- Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Alistair J Monteyne
- Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Ino van der Heijden
- Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Francis B Stephens
- Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Benjamin T Wall
- Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom.
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Kapoor MP, Sugita M, Kawaguchi M, Timm D, Kawamura A, Abe A, Okubo T. Influence of iron supplementation on fatigue, mood states and sweating profiles of healthy non-anemic athletes during a training exercise: A double-blind, randomized, placebo-controlled, parallel-group study. Contemp Clin Trials Commun 2023; 32:101084. [PMID: 36817736 PMCID: PMC9932653 DOI: 10.1016/j.conctc.2023.101084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Iron is specifically important to athletes, and attention has grown to the association between sports performance and iron regulation in the daily diets of athletes. The study presents new insights into stress, mood states, fatigue, and sweating behavior among the non-anemic athletes with sweating exercise habits who consumed a routine low dose (3.6 mg/day) of iron supplementation. In this double-blind, randomized, placebo-controlled, parallel-group study, both non-anemic male (N = 51) and female (N = 42) athletes were supplemented either with a known highly bioavailable iron formulation (SunActive® Fe) or placebo during the follow-up training exercise period over four weeks at their respective designated clinical sites. The effect of oral iron consumption was examined on fatigue, stress profiles, as well as the quality of life using the profile of mood state (POMS) test or a visual analog scale (VAS) questionnaire, followed by an exercise and well-being related fatigue-sweat. Also, their monotonic association with stress biomarkers (salivary α-amylase, salivary cortisol, and salivary immunoglobulin A) were determined using spearman's rank correlation coefficient test. Repeated measure multivariate analysis of variance (group by time) revealed that the total mood disturbance (TMD) score was significantly lower (P = 0.016; F = 6.26) between placebo and iron supplementation groups over the four weeks study period among female athletes. Also, a significant reduction in tired feeling/exhaustion after the exercise (P = 0.05; F = 4.07) between the placebo and iron intake groups was noticed. A significant within-group reduction (P ≤ 0.05) was noticed in the degree of sweat among both male and female athletes after 2 and 4 weeks of iron supplementation, while athletes of the placebo intake group experienced a non-significant within-group reduction in the degree of sweat. Overall, the result indicates routine use of low dose (3.6 mg/day) iron supplementation is beneficial for non-anemic endurance athletes to improve stress, mood states, subjective fatigue, and sweating conditions.
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Affiliation(s)
- Mahendra P. Kapoor
- Taiyo Kagaku Co., Ltd., Research & Development, Nutrition Division, 1-3 Takaramachi, Yokkaichi, Mie, 510-0844, Japan,Corresponding author.
| | - Masaaki Sugita
- Nippon Sport Science University, Faculty of Sport Science, 7-1-1 Fukusawa, Setagaya-Ku, Tokyo, 158 8508, Japan
| | - Mikiko Kawaguchi
- Otsuma Women's University, Faculty of Home Economics, Department of Food Science, 12 Sanbancho, Chiyoda, Tokyo, 102-8357, Japan
| | - Derek Timm
- Taiyo International Inc, 5960 Golden Hills Dr., Minneapolis, MN, 55416, USA
| | - Aki Kawamura
- Nippon Sport Science University, Faculty of Sport Science, 7-1-1 Fukusawa, Setagaya-Ku, Tokyo, 158 8508, Japan
| | - Aya Abe
- Taiyo Kagaku Co., Ltd., Research & Development, Nutrition Division, 1-3 Takaramachi, Yokkaichi, Mie, 510-0844, Japan
| | - Tsutomu Okubo
- Taiyo Kagaku Co., Ltd., Research & Development, Nutrition Division, 1-3 Takaramachi, Yokkaichi, Mie, 510-0844, Japan
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9
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Abstract
PURPOSE OF REVIEW This review examines recent research on the prevalence and importance of iron deficiency in blood donors, and on efforts to mitigate it. RECENT FINDINGS Premenopausal females, teenagers, and high-frequency donors are at the highest risk for donation-induced iron deficiency, in both high-resource and low-resource settings. The physiology relating iron stores to hemoglobin levels and low hemoglobin deferral is well elucidated in blood donor populations, yet the clinical effects attributable to iron loss in the absence of anemia are challenging to identify. Expanded adoption of ferritin testing is improving donor management but may cause decreases in the blood supply from temporary donor loss. The potential for personalized donor management is emerging with development of computational models that predict individual interdonation intervals that aim to optimize blood collected from each donor while minimizing low hemoglobin deferrals. SUMMARY Measures to reduce iron deficiency are available that can be deployed on a standardized or, increasingly, personalized basis. Blood centers, regulators, and donors should continue to evaluate different tactics for addressing this problem, to obtain a balanced approach that is optimal for maintaining adequate collections while safeguarding donor health.
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Affiliation(s)
| | - Alan E. Mast
- Versiti Blood Research Institute, Milwaukee, WI
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI
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10
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Cusack H, Hewlings S. The Impact of Iron Supplementation on Athletic Performance in Elite-Level Female Athletes–A Systematic Review. Strength Cond J 2022. [DOI: 10.1519/ssc.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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Hirosawa T, Hayashi A, Harada Y, Shimizu T. The Clinical and Biological Manifestations in Women with Iron Deficiency Without Anemia Compared to Iron Deficiency Anemia in a General Internal Medicine Setting: A Retrospective Cohort Study. Int J Gen Med 2022; 15:6765-6773. [PMID: 36039305 PMCID: PMC9419906 DOI: 10.2147/ijgm.s376405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The clinical presentation of iron deficiency is not well understood. We aimed to identify the clinical manifestations of iron deficiency without anemia in women. Patients and Methods We conducted a retrospective cohort study of women who visited the general internal medicine outpatient department of a university hospital in Japan between 2016 and 2022. Women who were prescribed iron supplements were included in the study. Anemia was defined as hemoglobin levels below 12 g/dl. Iron deficiency was defined as serum ferritin levels < 30.0 μg/l. The primary outcome was the difference in symptoms between patients with iron deficiency with and without anemia. The secondary outcome was the ratio of symptom, hemoglobin, and serum ferritin improvement (levels > 30.0 μg/l after treatment), comparing the measurements at the beginning and after supplementation. Results A total of 147 women were included in the final analysis. There were no significant differences in the initial symptoms and the ratio of symptom improvement between the groups. Compared to patients with iron deficiency anemia, patients with iron deficiency without anemia had high initial serum ferritin levels (14.8 vs 7.1 μg/l, p<0.001), and hemoglobin (13.2 vs 9.9 g/dl, p<0.001). Iron supplements significantly improved the serum ferritin level in two groups and the hemoglobin in iron deficiency anemia. After treatment, iron deficiency without anemia still had high serum ferritin levels (37.7 vs 28.2 μg/l, p=0.017) and hemoglobin (13.3 vs 12.3 g/dl, p < 0.001). Conclusion There were no differences in any of the investigated symptoms and the ratio of the symptom improvement depending on the anemic state in iron deficiency. After iron supplementation, the serum ferritin levels in the iron deficiency without anemia group improved. Hemoglobin and serum ferritin in iron deficiency without anemia were still highly comparable to that of iron deficiency anemia.
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Affiliation(s)
- Takanobu Hirosawa
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Arisa Hayashi
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan
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12
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Lan M, Wu S, Fernandes TM. Iron deficiency and pulmonary arterial hypertension. Nutr Clin Pract 2022; 37:1059-1073. [PMID: 35748341 DOI: 10.1002/ncp.10884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/11/2022] [Accepted: 05/08/2022] [Indexed: 11/10/2022] Open
Abstract
The purpose of this review article is to provide a comprehensive review of iron deficiency in the setting of pulmonary arterial hypertension (PAH) and to evaluate the utility of iron supplementation in PAH. Iron deficiency is present in 33%-46% of patients with PAH and has been associated with reduced exercise capacity, compromised oxygen handling, deterioration of right ventricular function, and even mortality. Iron homeostasis and the pathophysiology of PAH are highly intertwined, which has inspired the use of iron supplementation in patients with iron deficiency and PAH. A literature search was performed to identify all available evidence on iron supplementation for PAH. Limited evidence has suggested poor oral bioavailability of oral iron dosed three times a day, but newer formulations such as ferrous maltol may provide better absorption and clinical benefit, especially when dosed less frequently, such as every other day. Intravenous (IV) iron has been shown in observational studies to improve outcomes, but the single randomized control trial in patients without anemia has failed to show benefits in any measure of exercise tolerance. Larger randomized control studies on oral iron with good bioavailability or IV iron in patients with anemia are warranted to explore the potential utility of iron supplementation in patients with PAH.
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Affiliation(s)
- Michelle Lan
- Internal Medicine Pharmacy Residency Program, UC San Diego Health, La Jolla, California, USA
| | - Sheryl Wu
- Pulmonary Arterial Hypertension Pharmacy Program, UC San Diego Health, La Jolla, California, USA
| | - Timothy M Fernandes
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, La Jolla, California, USA
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13
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Dijk WEM, Punt MC, Galen KPM, Leeuwen J, Lely AT, Schutgens REG. Menstrual problems in chronic immune thrombocytopenia: A monthly challenge ‐ a cohort study and review. Br J Haematol 2022; 198:753-764. [PMID: 35662003 PMCID: PMC9540539 DOI: 10.1111/bjh.18291] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/15/2022] [Accepted: 05/18/2022] [Indexed: 11/08/2022]
Abstract
Immune thrombocytopenia (ITP) may cause menstrual problems. This cross‐sectional study assessed menstrual problems in premenopausal chronic ITP women by several questionnaires, including the pictorial bleeding assessment calendar (PBAC; score ≥100 indicates heavy menstrual bleeding [HMB]), and the menorrhagia multiattribute scale (MMAS). Spearman was used for assessing correlations. A literature review was performed in Pubmed. The cohort comprised 37 women (mean age 31 ± 9). A total of 29/37 (78%) had experienced clinical menstrual problems in the present or past. Of the 33 patients who returned the PBAC, 13 (39%) had a score of ≥100. The median MMAS score was 79 (IQR 60–95). The PBAC scores correlated with the MMAS. Both questionnaires were unrelated to the platelet count. Patients with a levonorgestrel intrauterine device (LNG‐IUD) had lower PBAC scores than patients with other or no hormonal therapy. MMAS scores were correlated with fatigue. The review identified 14 papers. HMB occurred in 6%–55% at ITP diagnosis and 17%–79% during disease. Menstrual symptoms influenced the quality of life, particularly in patients with a low platelet count. This explorative study suggested that HMB is frequent in women with chronic ITP despite management and platelet counts >50 *109/l. An LNG‐IUD seemed to reduce blood loss significantly.
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Affiliation(s)
- Wobke E. M. Dijk
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Marieke C. Punt
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Karin P. M. Galen
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Jeanette Leeuwen
- Division of Woman and Baby University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - A. Titia Lely
- Division of Woman and Baby University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
| | - Roger E. G. Schutgens
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek University Medical Center Utrecht, Utrecht University Utrecht The Netherlands
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14
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Dietary Iron and the Elite Dancer. Nutrients 2022; 14:nu14091936. [PMID: 35565904 PMCID: PMC9105128 DOI: 10.3390/nu14091936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 12/10/2022] Open
Abstract
Dancers are an athlete population at high risk of developing iron deficiency (ID). The aesthetic nature of the discipline means dancers potentially utilise dietary restriction to meet physique goals. In combination with high training demands, this means dancers are susceptible to problems related to low energy availability (LEA), which impacts nutrient intake. In the presence of LEA, ID is common because of a reduced mineral content within the low energy diet. Left untreated, ID becomes an issue that results in fatigue, reduced aerobic work capacity, and ultimately, iron deficient anaemia (IDA). Such progression can be detrimental to a dancer’s capacity given the physically demanding nature of training, rehearsal, and performances. Previous literature has focused on the manifestation and treatment of ID primarily in the context of endurance athletes; however, a dance-specific context addressing the interplay between dance training and performance, LEA and ID is essential for practitioners working in this space. By consolidating findings from identified studies of dancers and other relevant athlete groups, this review explores causal factors of ID and potential treatment strategies for dancers to optimise absorption from an oral iron supplementation regime to adequately support health and performance.
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15
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Cichoń J, Ostapiuk-Karolczuk J, Cieślicka M, Dziewiecka H, Marcinkiewicz A, Tafil-Klawe M, Basta P, Maciejewski D, Skarpańska-Stejnborn A. Effect of an acute exercise on early responses of iron and iron regulatory proteins in young female basketball players. BMC Sports Sci Med Rehabil 2022; 14:69. [PMID: 35428332 PMCID: PMC9013050 DOI: 10.1186/s13102-022-00465-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/07/2022] [Indexed: 11/27/2022]
Abstract
Background The accumulation of physiological stress and the presence of inflammation disturb iron management in athletes during intense training. However, little is known about the mechanisms regulating iron levels in athletes during training periods with low training loads. In the current study, we analyzed the effect of an acute exercise on early responses of iron and iron regulatory proteins at the end of such training periods. Methods The study was performed at the end of competitive phase of training. A total of 27 trained female basketball players were included in the study after application of the inclusion/exclusion criteria. The participants performed an incremental exercise on a treadmill. Blood samples were taken before the test, immediately after exercise, and after 3 h of restitution. Parameters, such as interleukin (IL) 6, hepcidin, ferritin, transferrin, hemopexin, and lactoferrin levels, total iron-biding capacity (TIBC), unsaturated iron-biding capacity (UIBC) were determined by using appropriate biochemical tests. Results The level of iron increased significantly after exercise, and then decreased within next 3 h restitution. Except for iron levels, only TIBC levels significantly increased after exercise and decreased to baseline level during rest period. No significant changes in the levels of hepcidin, IL-6, and other proteins related to the iron homeostasis were observed. Conclusions The increases in iron level after acute exercise is short-term and transient and appear to have been insufficient to induce the acute systemic effects in rested athletes.
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Affiliation(s)
- Justyna Cichoń
- Department of Biological Sciences, Faculty of Physical Culture in Gorzow Wielkopolski, Poznan University of Physical Education, Estkowskiego 13, 66-400, Gorzów, Wielkopolski, Poland
| | - Joanna Ostapiuk-Karolczuk
- Department of Biological Sciences, Faculty of Physical Culture in Gorzow Wielkopolski, Poznan University of Physical Education, Estkowskiego 13, 66-400, Gorzów, Wielkopolski, Poland
| | - Mirosława Cieślicka
- Department of Physiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, M. Skłodowskiej-Curie 9, 85-094, Bydgoszcz, Poland
| | - Hanna Dziewiecka
- Department of Biological Sciences, Faculty of Physical Culture in Gorzow Wielkopolski, Poznan University of Physical Education, Estkowskiego 13, 66-400, Gorzów, Wielkopolski, Poland
| | - Anita Marcinkiewicz
- Department of Biological Sciences, Faculty of Physical Culture in Gorzow Wielkopolski, Poznan University of Physical Education, Estkowskiego 13, 66-400, Gorzów, Wielkopolski, Poland
| | - Małgorzata Tafil-Klawe
- Department of Physiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, M. Skłodowskiej-Curie 9, 85-094, Bydgoszcz, Poland
| | - Piotr Basta
- Department of Physical Education and Sport, Poznań University of Physical Education, Faculty of Physical Culture in Gorzów Wielkopolski, Estkowskiego 13, 66-400, Gorzów, Wielkopolski, Poland
| | - Dariusz Maciejewski
- Department of Physical Education and Sport, Poznań University of Physical Education, Faculty of Physical Culture in Gorzów Wielkopolski, Estkowskiego 13, 66-400, Gorzów, Wielkopolski, Poland
| | - Anna Skarpańska-Stejnborn
- Department of Biological Sciences, Faculty of Physical Culture in Gorzow Wielkopolski, Poznan University of Physical Education, Estkowskiego 13, 66-400, Gorzów, Wielkopolski, Poland.
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16
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Romero AR, Mu A, Ayres JS. Adipose triglyceride lipase mediates lipolysis and lipid mobilization in response to iron-mediated negative energy balance. iScience 2022; 25:103941. [PMID: 35265813 PMCID: PMC8899412 DOI: 10.1016/j.isci.2022.103941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/23/2021] [Accepted: 02/14/2022] [Indexed: 11/09/2022] Open
Abstract
Maintenance of energy balance is essential for overall organismal health. Mammals have evolved complex regulatory mechanisms that control energy intake and expenditure. Traditionally, studies have focused on understanding the role of macronutrient physiology in energy balance. In the present study, we examined the role of the essential micronutrient iron in regulating energy balance. We found that a short course of dietary iron caused a negative energy balance resulting in a severe whole body wasting phenotype. This disruption in energy balance was because of impaired intestinal nutrient absorption. In response to dietary iron-induced negative energy balance, adipose triglyceride lipase (ATGL) was necessary for wasting of subcutaneous white adipose tissue and lipid mobilization. Fat-specific ATGL deficiency protected mice from fat wasting, but caused a severe cachectic response in mice when fed iron. Our work reveals a mechanism for micronutrient control of lipolysis that is necessary for regulating mammalian energy balance.
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Affiliation(s)
- Alicia R. Romero
- Molecular and Systems Physiology Lab, The Salk Institute for Biological Studies, 10010 N. Torrey Pines Road, La Jolla, CA 92037, USA,Gene Expression Lab, The Salk Institute for Biological Studies, 10010 N. Torrey Pines Road, La Jolla, CA 92037, USA,Nomis Center for Immunobiology and Microbial Pathogenesis, The Salk Institute for Biological Studies, 10010 N. Torrey Pines Road, La Jolla, CA 92037, USA,Division of Biological Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Andre Mu
- Molecular and Systems Physiology Lab, The Salk Institute for Biological Studies, 10010 N. Torrey Pines Road, La Jolla, CA 92037, USA,Gene Expression Lab, The Salk Institute for Biological Studies, 10010 N. Torrey Pines Road, La Jolla, CA 92037, USA,Nomis Center for Immunobiology and Microbial Pathogenesis, The Salk Institute for Biological Studies, 10010 N. Torrey Pines Road, La Jolla, CA 92037, USA
| | - Janelle S. Ayres
- Molecular and Systems Physiology Lab, The Salk Institute for Biological Studies, 10010 N. Torrey Pines Road, La Jolla, CA 92037, USA,Gene Expression Lab, The Salk Institute for Biological Studies, 10010 N. Torrey Pines Road, La Jolla, CA 92037, USA,Nomis Center for Immunobiology and Microbial Pathogenesis, The Salk Institute for Biological Studies, 10010 N. Torrey Pines Road, La Jolla, CA 92037, USA,Corresponding author
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17
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Campodonico J, Junod D, Carulli E, Lo Russo G, Gaudenzi Asinelli M, Doni F, Bonomi A, Agostoni P. Role of impaired iron transport on exercise performance in heart failure patients. Eur J Prev Cardiol 2022; 29:1104-1111. [PMID: 35134891 DOI: 10.1093/eurjpc/zwab216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/30/2021] [Indexed: 12/28/2022]
Abstract
AIMS Impaired iron transport (IIT) occurs frequently in heart failure (HF) patients, even in the absence of anaemia and it is associated with a poor quality of life and prognosis. The impact of IIT on exercise capacity, as assessed by the cardiopulmonary exercise test (CPET), in HF is at present unknown. The aim of this article is to evaluate in HF patients the impact on exercise performance of IIT, defined as transferrin saturation (TSAT) <20%. METHODS AND RESULTS We collected data of 676 patients hospitalized for HF. All underwent laboratory analysis, cardiac ultrasound, and CPET. Patients were grouped by the presence/absence of IIT and anaemia (haemoglobin <13 and <12 g/dL in male and female, respectively): Group 1 (G1) no anaemia, no IIT; Group 2 (G2) anaemia, no IIT; Group 3 (G3) no anaemia, IIT; Group 4 (G4) anaemia and IIT. Peak oxygen uptake (peakVO2) reduced from G1 to G3 and from G2 to G4 (G1: 1266 ± 497 mL/min, G2: 1011 ± 385 mL/min, G3: 1041 ± 395 mL/min, G4: 833 ± 241 mL/min), whereas the ventilation to carbon dioxide relationship slope (VE/VCO2 slope) increased (G1: 31.8 ± 7.5, G2: 34.5 ± 7.4, G3: 36.1 ± 10.2, G4: 37.5 ± 8.4). At multivariate regression analysis, peakVO2 independent predictors were anaemia, brain natriuretic peptide (BNP), and left ventricular ejection fraction, whereas VE/VCO2 slope independent predictors were IIT and BNP. CONCLUSION In HF IIT is associated with exercise performance impairment independently from anaemia, and it is a predictor of elevated VE/VCO2 slope, a pivotal index of HF prognosis.
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Affiliation(s)
- Jeness Campodonico
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20138 Milano, Italy.,Translational Medicine PhD Course, University of Milan, Milan, Italy
| | - Daniele Junod
- Cardiovascular Section, Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Ermes Carulli
- Cardiovascular Section, Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Gerardo Lo Russo
- Cardiovascular Section, Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | | | - Francesco Doni
- Cardiovascular Section, Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20138 Milano, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20138 Milano, Italy.,Cardiovascular Section, Department of Clinical Science and Community Health, University of Milan, Milan, Italy
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18
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Tu SJ, Elliott AD, Hanna-Rivero N, Gallagher C, Mishima RS, Lyrtzis E, Wlochowicz D, Clarke NA, Roberts-Thomson KC, Stokes MB, Emami M, Lau DH, Sanders P, Wong CX. Rationale and design of the IRON-AF study: a double-blind, randomised, placebo-controlled study to assess the effect of intravenous ferric carboxymaltose in patients with atrial fibrillation and iron deficiency. BMJ Open 2021; 11:e047642. [PMID: 34373301 PMCID: PMC8354291 DOI: 10.1136/bmjopen-2020-047642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is associated with significantly impaired quality-of-life. Iron deficiency (ID) is prevalent in patients with AF. Correction of ID in other patient populations with intravenous iron supplementation has been shown to be a safe, convenient and effective way of improving exercise tolerance, fatigue and quality-of-life. The IRON-AF (Effect of Iron Repletion in Atrial Fibrillation) study is designed to assess the effect of iron repletion with intravenous ferric carboxymaltose in patients with AF and ID. METHODS AND ANALYSIS The IRON-AF study is a double-blind, randomised controlled trial that will recruit at least 84 patients with AF and ID. Patients will be randomised to receive infusions of either ferric carboxymaltose or placebo, given in repletion and then maintenance doses. The study will have follow-up visits at weeks 4, 8 and 12. The primary endpoint is change in peak oxygen uptake from baseline to week 12, as measured by cardiopulmonary exercise testing (CPET) on a cycle ergometer. Secondary endpoints include changes in quality-of-life and AF disease burden scores, blood parameters, other CPET parameters, transthoracic echocardiogram parameters, 6-minute walk test distance, 7-day Holter/Event monitor burden of AF, health resource utilisation and mortality. ETHICS AND DISSEMINATION The study protocol has been approved by the Central Adelaide Local Health Network Human Research Ethics Committee, Australia. The results of this study will be disseminated through publications in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12620000285954).
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Affiliation(s)
- Samuel J Tu
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Nicole Hanna-Rivero
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Celine Gallagher
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ricardo S Mishima
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ellen Lyrtzis
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Danielle Wlochowicz
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Nicholas Ar Clarke
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kurt C Roberts-Thomson
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michael B Stokes
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Mehrdad Emami
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher X Wong
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
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19
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Sumi K, Munakata K, Konno S, Ashida K, Nakazato K. Inorganic Iron Supplementation Rescues Hematological Insufficiency Even Under Intense Exercise Training in a Mouse Model of Iron Deficiency with Anemia. Biol Trace Elem Res 2021; 199:2945-2960. [PMID: 33025520 DOI: 10.1007/s12011-020-02402-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
Iron deficiency anemia (IDA) due to malnutrition and/or blood loss is a common condition, especially in women of reproductive age. Intense exercise can induce anemia via an inflammatory response, but whether intense exercise affects the efficacy of iron supplementation to treat IDA is unclear. Here, we show in a mouse model of IDA that acute intense swimming increased IL-6 levels in the blood, but did not affect the maximum elevation of plasma iron following oral administration of 0.5 mg/kg Bw iron. However, compared with the control group without intense exercise, acute intense swimming was associated with a significant decrease in plasma iron 2 and 4 h after iron loading that could be attributed to rapid iron absorption in peripheral tissues. In the chronic experiment, IDA mice administered 0.36, 1.06, or 3.2 mg/kg Bw iron per day that were subjected to 11 intense swimming sessions over 3 weeks showed significantly decreased recovery levels for hemoglobin and red blood cell count during the early phase of the experimental period. At the end of the experimental period, significant, dose-dependent effects of iron, but not the main effect of intense exercise, were seen for recovery of hemoglobin and red blood cell counts, consistent with the acute exercise study. These results suggested that intense exercise in the presence of IDA does not inhibit iron absorption from the gastrointestinal tract and that iron supplementation can enhance the recovery process even after intense exercise.
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Affiliation(s)
- Koichiro Sumi
- Food Microbiology and Function Research Laboratories, R&D Division, Meiji Co., Ltd., 1-29-1 Nanakuni, Hachiouji, Tokyo, 192-0919, Japan.
| | - Kinuyo Munakata
- Food Microbiology and Function Research Laboratories, R&D Division, Meiji Co., Ltd., 1-29-1 Nanakuni, Hachiouji, Tokyo, 192-0919, Japan
| | - Saori Konno
- Food Microbiology and Function Research Laboratories, R&D Division, Meiji Co., Ltd., 1-29-1 Nanakuni, Hachiouji, Tokyo, 192-0919, Japan
| | - Kinya Ashida
- Food Microbiology and Function Research Laboratories, R&D Division, Meiji Co., Ltd., 1-29-1 Nanakuni, Hachiouji, Tokyo, 192-0919, Japan
| | - Koichi Nakazato
- Department of Exercise Physiology, Nippon Sport Science University, 7-1-1 Fukasawa, Setagaya-ku, Tokyo, Japan
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Ameri P, Bertero E, Maack C, Teerlink JR, Rosano G, Metra M. Medical treatment of heart failure with reduced ejection fraction: the dawn of a new era of personalized treatment? EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2021; 7:539-546. [PMID: 34037742 DOI: 10.1093/ehjcvp/pvab033] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/21/2021] [Indexed: 12/19/2022]
Abstract
Recent trials have shown the efficacy of new drugs for the medical therapy of heart failure and reduced ejection fraction (HFrEF). Sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduced hospitalizations for HF, HF events, and cardiovascular death in patients with HFrEF or hospitalized for HF. Iron repletion with ferric carboxymaltose (FCM) improved symptoms, functional capacity, and quality of life in chronic HFrEF patients, and decreased the risk of subsequent HF hospitalizations in subjects with acutely decompensated HF. New-generation potassium binders may allow initiation and up-titration of renin-angiotensin-aldosterone system inhibitors (RASi). Lastly, the guanylate cyclase stimulator vericiguat and the myosin activator omecamtiv mecarbil reduced the primary endpoint in two major controlled trials. These results open novel pathways for the treatment of HFrEF. This review discusses new opportunities of an individualized approach to HFrEF pharmacotherapy, where new compounds expand a spectrum of drugs that target primarily neuroendocrine activation. SGLT2i can be safely applied once daily at a fixed dose to the vast majority of patients with HFrEF, including those with moderate renal dysfunction and/or systolic blood pressure as low as 95-100 mmHg. Additional medications are suitable for more specific phenotypes, with ivabradine providing benefit in patients with sinus rhythm and heart rates ≥70 beats per minute, FCM in the presence of iron deficiency, and potassium-lowering agents to implement RASi when hyperkalaemia occurs. Vericiguat and omecamtiv mecarbil also have potential for tailored approaches towards the hemodynamic status. Thus, a new era is starting for a more personalized medical treatment of HFrEF.
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Affiliation(s)
- Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy-IRCCS Italian Cardiology Network.,Department of Internal Medicine, University of Genova, Genova, Italy
| | - Edoardo Bertero
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Christoph Maack
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Roma, Italy
| | - Marco Metra
- Cardiology Unit, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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21
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Boumosleh JM, El Hage C, Farhat A. Sports nutrition knowledge and perceptions among professional basketball athletes and coaches in Lebanon-a cross-sectional study. BMC Sports Sci Med Rehabil 2021; 13:53. [PMID: 34001207 PMCID: PMC8130284 DOI: 10.1186/s13102-021-00280-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 05/04/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Basketball is the most popular sport in Lebanon. Adequate nutrition has been established to be a key component of optimal athletic performance, recovery from exercise and exercise-induced injury and documented to be associated with adequate nutrition knowledge (NK). In Lebanon, nutrition education is not incorporated into the basketball player training program and there is no established position for sports nutritionists in basketball clubs. To our knowledge, the present study is the first to evaluate the NK status of Division I Basketball (D1B) players /coaches in Lebanon. The objectives of this study are to assess the prevalence of inadequate NK; identify the gaps in NK, main sources of nutrition information, perceptions on sports nutrition and independent predictors of inadequate NK among D1B players and coaches in Lebanon. METHODS All D1B players (n = 184) and coaches (n = 16) in Lebanon were invited to participate in the study. Study participants were asked to complete a questionnaire that included questions on NK, resources and perceptions. A percentage of ≥60% of NK questions answered correctly was used as indicative of having adequate NK. Descriptive statistics were used to summarize the sample characteristics. The T-test and chi square test were used for comparisons of means and proportions, respectively. Logistic regression was used to explore the predictors of inadequate NK in D1B players. RESULTS The sample consisted of 178 D1B players (nM = 126; nF = 52) and 11 male coaches, resulting in survey response rates of 97 and 69%, respectively. Inadequate NK was found among about 80 and 54% of D1B players and coaches, respectively. Inadequate NK was found to be independently associated with lack of nutrition education in D1B players. CONCLUSIONS Despite widespread lack of adequate NK among D1B players and coaches in Lebanon, our sports clubs do not have dietitians. Basketball sports clubs in Lebanon should start to budget for hiring a dietitian or carrying out nutrition education campaigns that are based on analyses of incorrect responses of our study participants. Findings of this study are of tremendous significance to D1B players in Lebanon in terms of improving the athletes' physical health and performance.
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Affiliation(s)
| | - Catherine El Hage
- Faculty of Nursing and Health Sciences, Notre Dame University-Louaize, Zouk Mosbeh, Lebanon
| | - Antoine Farhat
- Faculty of Nursing and Health Sciences, Notre Dame University-Louaize, Zouk Mosbeh, Lebanon
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22
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Abstract
Anemia is a very common comorbidity in patients with heart failure (HF), affecting ∼30% of stable ambulatory patients and 50% patients with acute decompensated HF. Absolute or functional iron deficiency (ID) is seen in ∼50% patients with HF. Both of these comorbidities often coexist and are independently associated with increased mortality and hospitalizations. These findings led several investigators to test the hypotheses that treatment of anemia and ID in HF would improve symptoms and long-term outcomes. Small studies showed that erythropoiesis-stimulating agents (ESAs) improve subjective measures of HF. However, a large pivotal outcome trial found that the ESA darbepoetin alfa did not improve long-term outcomes in patients with HF with reduced ejection fraction and instead was associated with adverse effects. Studies using IV iron have had somewhat greater success, showing improvements in subjective and some objective measures of HF. However, more research is needed to establish the best treatment options for these high-risk patients. We present 5 common scenarios of patients with HF and anemia and describe our personal approach on how we might treat them based on objective evidence where available. An algorithm that offers guidance in regard to personalized therapy for such patients is also presented.
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Sandroni A, House E, Howard L, DellaValle DM. Synbiotic Supplementation Improves Response to Iron Supplementation in Female Athletes during Training. J Diet Suppl 2021; 19:366-380. [PMID: 33615951 DOI: 10.1080/19390211.2021.1887423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Iron deficiency (ID) affects ∼30% of female athletes, and its consequences are highly relevant to athletic performance. Poor iron (Fe) uptake remains a major factor in the development of ID. While studies suggest that consumption of either prebiotics or probiotics may improve Fe uptake, consumption of synbiotics has not been well-studied. The main objective of this study was to determine the effects of synbiotic supplementation on the Fe status of female athletes during Fe repletion. METHODS The Fe status of 32 female athletes was screened early in the season. Twenty eligible athletes (hemoglobin:12.3 ± 0.9g/dL; serum ferritin, sFer:18.1 ± 9.2 µg/L) were randomized to receive either a daily synbiotic supplement (5 g prebiotic fiber + 8 billion colony forming units, CFU probiotic B. lactis) or placebo, along with Fe supplementation (140 mg ferrous sulfate, FeSO4/d) for 8 weeks using a double-blind design. Fe status was assessed again at mid-point and after the trial. RESULTS Nineteen athletes (n = 9 supplement, 10 placebo) completed the trial and there were no differences in compliance or GI symptoms reported between groups. After controlling for baseline Fe status, regression analyses revealed improvements in log sFer in the supplement group after both 4 and 8 weeks (p = 0.01 and p = 0.05, respectively), compared to placebo. CONCLUSIONS Synbiotic supplementation along with FeSO4 improved athletes' Fe status over 8 weeks. This data is essential to advancing our understanding of how dietary and supplemental Fe uptake in active women can be enhanced by synbiotic supplementation, as well as by foods containing pre- and probiotics.
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Affiliation(s)
- Amanda Sandroni
- Department of Nutrition and Dietetics, Marywood University, Scranton, PA, USA
| | - Elaine House
- Department of Nutrition and Dietetics, Marywood University, Scranton, PA, USA
| | - Lindsay Howard
- Department of Athletic Training and Exercise Science, Marywood University, Scranton, PA, USA
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24
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Mansour D, Hofmann A, Gemzell-Danielsson K. A Review of Clinical Guidelines on the Management of Iron Deficiency and Iron-Deficiency Anemia in Women with Heavy Menstrual Bleeding. Adv Ther 2021; 38:201-225. [PMID: 33247314 PMCID: PMC7695235 DOI: 10.1007/s12325-020-01564-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/06/2020] [Indexed: 12/19/2022]
Abstract
Introduction Up to one-third of women of reproductive age experience heavy menstrual bleeding (HMB). HMB can give rise to iron deficiency (ID) and, in severe cases, iron-deficiency anemia (IDA). Aim To review current guidelines for the management of HMB, with regards to screening for anemia, measuring iron levels, and treating ID/IDA with iron replacement therapy and non-iron-based treatments. Methods The literature was searched for English-language guidelines relating to HMB published between 2010 and 2020, using the PubMed database, web searching, and retrieval of clinical guidelines from professional societies. Results Overall, 55 guidelines mostly originating from North America and Europe were identified and screened. Twenty-two were included in this review, with the majority (16/22) focusing on guidance to screen women with HMB for anemia. The guidance varied with respect to identifying symptoms, the criteria for testing, and diagnostic hemoglobin levels for ID/IDA. There was inconsistency concerning screening for ID, with 11/22 guidelines providing no recommendations for measurement of iron levels and four contrasting guidelines explicitly advising against initial assessment of iron levels. In terms of treatment, 8/22 guidelines provided guidance on iron therapy, with oral iron administration generally recommended as first-line treatment for ID and/or IDA. Four guidelines recommended intravenous iron administration for severe anemia, in non-responders, or before surgery. Three guidelines provided hemoglobin thresholds for choosing between oral or intravenous iron treatment. Four guidelines discussed the use of transfusion for severe IDA. Conclusion Many of the guidelines for managing HMB recognize the importance of treating anemia, but there is a lack of consensus in relation to screening for ID and use of iron therapy. Consequently, ID/IDA associated with HMB is likely to be underdiagnosed and undertreated. A consensus guidance, covering all aspects of screening and management of ID/IDA in women with HMB, is needed to optimize health outcomes in these patients. Women who bleed heavily during menstruation are at risk of iron deficiency and anemia. This can have a negative effect on the well-being of women and can cause serious complications after surgery. Iron is an important part of the hemoglobin in red blood cells that carries oxygen around the body. Bleeding causes iron to be lost from the body. If there is heavy blood loss, iron stores in the body can become low, leading to iron deficiency. If the iron deficiency is severe enough to impair red blood cell production, iron-deficiency anemia can develop. We reviewed the current guidelines for the care of women with heavy menstrual bleeding, focusing on the detection and treatment of iron deficiency and anemia. Most guidelines include routine testing for anemia. Fewer guidelines consider measuring iron levels. Not all the guidelines include advice on the best way to treat iron deficiency and anemia. For those that do, the recommendations vary and sometimes offer conflicting advice. There is little agreement on when to give iron therapy, and whether this should be given by mouth or by infusion. A lack of clear guidance on detecting and treating iron deficiency and anemia caused by heavy menstrual bleeding puts women at risk of being undiagnosed and untreated. To address these concerns, the authors recommend the development of consensus guidelines. These should contain comprehensive recommendations on all aspects of the diagnosis and management of iron deficiency and anemia in women with heavy menstrual bleeding.
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25
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Čiburienė E, Čelutkienė J, Aidietienė S, Ščerbickaitė G, Lyon AR. The prevalence of iron deficiency and anemia and their impact on survival in patients at a cardio-oncology clinic. CARDIO-ONCOLOGY 2020; 6:29. [PMID: 33292849 PMCID: PMC7709383 DOI: 10.1186/s40959-020-00086-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/19/2020] [Indexed: 11/24/2022]
Abstract
Background Iron deficiency (ID) and anemia are common in both heart failure (HF) and cancer patients and are associated with poor quality of life and survival. The aims of this study were (1) to evaluate the prevalence, types, and confounding factors of ID and anemia in patients referred to cardio-oncology clinic, and (2) identify the association between iron metabolism parameters and survival of cardio-oncology patients. Methods We assessed iron, ferritin, hemoglobin concentrations, transferrin saturation (TSAT), cancer type, brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), kidney function, cardiovascular risk factors and survival in 599 patients who were referred to cardio-oncology clinic from 2011 to 2017. ID was defined by a TSAT < 20%, absolute iron deficiency (AID) with a serum ferritin level < 100 μg/L while serum ferritin level of ≥ 100 μg/L was considered as functional iron deficiency (FID) and TSAT ≥ 20% was considered as no ID. Results The prevalence of ID, AID, and FID was 46, 31, and 15% of study patients, respectively. Anemia was present in approximately half (54%) of the patients with any ID. Multivariate Cox analyses showed that male gender (HR 1.704 [1.207–2.404] p = 0.002); previous cancer history (HR 1.879 [1.079–3.272] p = 0.026); elevated BNP (HR 2.126 [1.258–3.590] p = 0.005); TSAT< 20% (HR 1.721 [1.214–2.439] p = 0.002); ferritin ≥ 100 μg/L (HR 2.008 [1.088–3.706] p = 0.026); serum iron concentration < 12 μmol/L (HR 2.292 [1.614–3.255] p < 0.001); FID (HR 2.538 [1.1618–3.981] p < 0.001) and anemia (HR 2.462 [1.734–3.495] p < 0.001) were significantly associated with increased risk of all-cause death. Conclusions About half of cardio-oncology patients had anemia and iron deficiency, with the absolute type being twice as prevalent as the functional one. Patients with breast, gastrointestinal, and genitourinary cancer were affected more often. Both anemia and iron deficiency independently predicted all-cause mortality. Future studies are required to confirm ID as a risk factor and evaluate the clinical benefits of iron replacement therapy.
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Affiliation(s)
- E Čiburienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K.Čiurlionis str. 21, 03101, Vilnius, Lithuania.
| | - J Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K.Čiurlionis str. 21, 03101, Vilnius, Lithuania
| | - S Aidietienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K.Čiurlionis str. 21, 03101, Vilnius, Lithuania
| | - G Ščerbickaitė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M.K.Čiurlionis str. 21, 03101, Vilnius, Lithuania
| | - A R Lyon
- Cardio-Oncology Clinic at Royal Brompton Hospital, London, UK.,Imperial College London, London, UK
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26
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Zhang J, Hu S, Jiang Y, Zhou Y. Efficacy and safety of iron therapy in patients with chronic heart failure and iron deficiency: a systematic review and meta-analysis based on 15 randomised controlled trials. Postgrad Med J 2020; 96:766-776. [PMID: 32843482 DOI: 10.1136/postgradmedj-2019-137342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/16/2020] [Accepted: 05/26/2020] [Indexed: 11/04/2022]
Abstract
Trials studying iron administration in patients with chronic heart failure (CHF) and iron deficiency (ID) have sprung up these years but the results remain inconsistent. The aim of this meta-analysis was to comprehensively evaluate the efficacy and safety of iron therapy in patients with CHF and ID. A literature search was conducted across PubMed, Embase, Cochrane Library, OVID and Web of Science up to 31 July 2019 to search for randomised controlled trials (RCT) comparing iron therapy with placebo in CHF with ID, regardless of presence of anaemia. Published studies reporting data of any of the following outcomes were included: all-cause death, cardiovascular hospitalisation, adverse events, New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF), N-terminal pro b-type natriuretic peptide, peak oxygen consumption, 6 min walking test (6MWT) distance and quality of life (QoL) parameters. 15 RCTs with a total of 1627 patients (911 in iron therapy and 716 in control) were included. Iron therapy was demonstrated to reduce the risk of cardiovascular hospitalisation (OR 0.35, 95% CI 0.12 to 0.99, p=0.049), but was ineffective in reducing all-cause death (OR 0.59, 95% CI 0.33 to 1.06, p=0.078) or cardiovascular death (OR 0.80, 95% CI 0.39 to 1.63, p=0.540). Iron therapy resulted in a reduction in NYHA class (mean difference (MD) -0.73, 95% CI -0.99 to -0.47, p<0.001), an increase in LVEF (MD +4.35, 95% CI 0.69 to 8.00, p=0.020), 6MWT distance (MD +35.44, 95% CI 11.55 to 59.33, p=0.004) and an improvement in QoL: EQ-5D score (MD +4.07, 95% CI 0.84 to 7.31, p=0.014); Minnesota Living With Heart Failure Questionnaire score (MD -19.47, 95% CI -23.36 to -15.59, p<0.001) and Patients Global Assessment (PGA) scale (MD 0.71, 95% CI 0.32 to 1.10, p<0.001). There was no significant difference in adverse events or serious adverse events between iron treatment group and control group. Iron therapy reduces cardiovascular hospitalisation in patients with CHF with ID, and additionally improves cardiac function, exercise capacity and QoL in patients with CHF with ID and anaemia, without an increase of adverse events.
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Affiliation(s)
- Junyi Zhang
- Department of Cardiology, The First Affilisted Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Shengda Hu
- Department of Cardiology, The First Affilisted Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yufeng Jiang
- Department of Cardiology, The First Affilisted Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yafeng Zhou
- Department of Cardiology, The First Affilisted Hospital of Soochow University, Suzhou, Jiangsu, China
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27
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Nielsen P. [Not Available]. MMW Fortschr Med 2020; 162:22-24. [PMID: 32578106 DOI: 10.1007/s15006-020-0601-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Peter Nielsen
- Institut für Biochemie und Molekulare Zellbiologie (IBMZ), Interdisziplinäre Arbeitsgruppe Eisenstoffwechsel, Martinistr. 52, D-20246, Hamburg, Deutschland.
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28
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Tang Q, Tang J, Ren X, Li C. Glyphosate exposure induces inflammatory responses in the small intestine and alters gut microbial composition in rats. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 261:114129. [PMID: 32045792 DOI: 10.1016/j.envpol.2020.114129] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/02/2020] [Accepted: 02/02/2020] [Indexed: 05/27/2023]
Abstract
Glyphosate is the most popular herbicide used worldwide. This study aimed to investigate the adverse effects of glyphosate on the small intestine and gut microbiota in rats. The rats were gavaged with 0, 5, 50, and 500 mg/kg of body weight glyphosate for 35 continuous days. The different segments of the small intestine were sampled to measure indicators of oxidative stress, ion concentrations and inflammatory responses, and fresh feces were collected for microbiota analysis. The results showed that glyphosate exposure decreased the ratio of villus height to crypt depth in the duodenum and jejunum. Decreased activity of antioxidant enzymes (T-SOD, GSH, GSH-Px) and elevated MDA content were observed in different segments of the small intestine. Furthermore, the concentrations of Fe, Cu, Zn and Mg were significantly decreased or increased. In addition, the mRNA expression levels of IL-1β, IL-6, TNF-α, MAPK3, NF-κB, and Caspase-3 were increased after glyphosate exposure. The 16 S rRNA gene sequencing results indicated that glyphosate exposure significantly increased α-diversity and altered bacterial composition. Glyphosate exposure significantly decreased the relative abundance of the phylum Firmicutes and the genus Lactobacillus, but several potentially pathogenic bacteria were enriched. In conclusion, this study provides important insight to reveal the negative influence of glyphosate exposure on the small intestine, and the altered microbial composition may play a vital role in the process.
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Affiliation(s)
- Qian Tang
- College of Animal Science and Technology, Nanjing Agricultural University, Nanjing, 210095, China
| | - Juan Tang
- College of Animal Science and Technology, Nanjing Agricultural University, Nanjing, 210095, China
| | - Xin Ren
- College of Animal Science and Technology, Nanjing Agricultural University, Nanjing, 210095, China
| | - Chunmei Li
- College of Animal Science and Technology, Nanjing Agricultural University, Nanjing, 210095, China.
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29
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Mattiello V, Schmugge M, Hengartner H, von der Weid N, Renella R. Diagnosis and management of iron deficiency in children with or without anemia: consensus recommendations of the SPOG Pediatric Hematology Working Group. Eur J Pediatr 2020; 179:527-545. [PMID: 32020331 DOI: 10.1007/s00431-020-03597-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 11/26/2022]
Abstract
Iron deficiency is the most prevalent nutritional deficiency affecting children and adolescents worldwide. A consistent body of epidemiological data demonstrates an increased incidence of iron deficiency at three timepoints: in the neonatal period, in preschool children, and in adolescents, where it particularly affects females.Conclusion: This narrative review focuses on the most suggestive symptoms of iron deficiency in childhood, describes the diagnostic procedures in situations with or without anemia, and provides Swiss expert-based management recommendations for the pediatric context.What is Known:• Iron deficiency (ID) is one of the most common challenges faced by pediatricians.• Significant progress in the diagnosis and therapy of ID has been made over the last decade.What is New:• Our expert panel provides ID management recommendations based on the best available evidence.• They include strategies for ID diagnosis and therapy, both oral and intravenous.
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Affiliation(s)
- Veneranda Mattiello
- Department "Woman-Mother-Child and Adolescent", Pediatric Hematology-Oncology Unit, Division of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - Markus Schmugge
- Division of Pediatric Hematology, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Heinz Hengartner
- Pediatric Hematology-Oncology Unit, Children's Hospital of Sankt Gallen, Sankt Gallen, Switzerland
| | - Nicolas von der Weid
- Pediatric Hematology-Oncology Department, University Children's Hospital and University of Basel, Basel, Switzerland
| | - Raffaele Renella
- Department "Woman-Mother-Child", Pediatric Hematology-Oncology Unit, Division of Pediatrics, Lausanne University Hospital and University of Lausanne, Vaudois, BH11, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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30
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Mayer C, Barker MK, Dirk P, Moore KM, McCrudden E, Karakochuk CD. Menstrual blood losses and body mass index are associated with serum ferritin concentrations among female varsity athletes. Appl Physiol Nutr Metab 2019; 45:723-730. [PMID: 31869248 DOI: 10.1139/apnm-2019-0436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Preventing and treating iron deficiency are important components in the nutritional care of female varsity athletes, as these interventions may improve aerobic endurance and athletic performance. We examined the factors associated with ferritin concentration in 30 female varsity athletes (18-30 years) at the University of British Columbia in Vancouver, Canada. Biochemical indicators of iron and inflammation status, dietary intake, supplementation practices, weight, height, and menstrual blood losses were assessed. Iron deficiency prevalence was 20% (n = 6/30; inflammation-adjusted ferritin <15 μg/L). Multiple linear regression was used to assess the associations of a number of independent explanatory variables with log-transformed serum ferritin (μg/L) as the continuous outcome variable. A 1-unit increase in body mass index (BMI; kg/m2) was associated with 22% (95% CI: 9%-37%) higher mean ferritin concentrations, and a 1-point increase in menstrual loss score was associated with 1% (95% CI: 1%-2%) lower ferritin concentrations. Hemoglobin and hepcidin concentrations, inflammation biomarkers, consumption of iron supplements in any form or dose for ≥3 days/week, and age were not significantly associated with ferritin concentrations in the final adjusted model. Novelty Estimated monthly menstrual losses and BMI were associated with serum ferritin concentrations in female athletes in our study. These are easy-to-measure, noninvasive measurements that should be considered in the assessment of risk of iron deficiency in female athletes.
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Affiliation(s)
- Cara Mayer
- Food, Nutrition and Health, Faculty of Land and Food Systems, University of British Columbia, 2205 East Mall, Vancouver, BC V6T 1Z4, Canada.,British Columbia Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada
| | - Mikaela K Barker
- Food, Nutrition and Health, Faculty of Land and Food Systems, University of British Columbia, 2205 East Mall, Vancouver, BC V6T 1Z4, Canada.,British Columbia Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada
| | - Payge Dirk
- Food, Nutrition and Health, Faculty of Land and Food Systems, University of British Columbia, 2205 East Mall, Vancouver, BC V6T 1Z4, Canada
| | - Kelsey M Moore
- Food, Nutrition and Health, Faculty of Land and Food Systems, University of British Columbia, 2205 East Mall, Vancouver, BC V6T 1Z4, Canada
| | - Emma McCrudden
- School of Kinesiology, Faculty of Education, University of British Columbia, 6081 University Boulevard, Vancouver, BC V6T 1Z1, Canada
| | - Crystal D Karakochuk
- Food, Nutrition and Health, Faculty of Land and Food Systems, University of British Columbia, 2205 East Mall, Vancouver, BC V6T 1Z4, Canada.,British Columbia Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada
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Tyan P, Taher A, Carey E, Sparks A, Radwan A, Amdur R, Tamim H, Gu A, Robinson H, Moawad GN. The effect of anemia severity on postoperative morbidity among patients undergoing laparoscopic hysterectomy for benign indications. Acta Obstet Gynecol Scand 2019; 99:112-118. [PMID: 31449328 DOI: 10.1111/aogs.13718] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/03/2019] [Accepted: 08/05/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION One-third of non-pregnant women worldwide are anemic.1 Anemia is a known independent risk factor for postoperative morbidity.2 Given that the vast majority of hysterectomies are not performed in the emergency setting, we designed this study to evaluate the effect of preoperative anemia on postoperative morbidity following laparoscopic hysterectomy performed for benign indications. Our main goal is to encourage surgeons to use anemia-corrective measures before surgery when feasible. MATERIAL AND METHODS Retrospective cohort study of 98 813 patients who underwent a laparoscopic hysterectomy between 2005 and 2016 for benign indications identified through the American College of Surgeons National Surgical Quality Improvement Program. Anemia was examined as a function of hematocrit and was analyzed as an ordinal variable stratified by anemia severity as mild, moderate or severe. Associations between preoperative anemia and patient demographics, preoperative comorbidities and postoperative outcomes were evaluated using univariate analyses. Multivariable logistic regression models were used to identify independent associations between hematocrit level and postoperative outcomes after adjusting for confounding covariates. At the multivariable logistic regression level, anemia severity was analyzed using hematocrit as a continuous variable to assess the independent association between each 5% decrease in hematocrit level and several postoperative morbidities. RESULTS Of the 98 813 patients who met our inclusion and exclusion criteria, 19.5% were anemic. A lower preoperative hematocrit was associated with higher body mass index, younger age, Black or African American race, longer operative times, and multiple other medical comorbidities. After appropriate regression modeling, anemia was identified as an independent risk factor for extended length of stay, readmission and composite morbidity after surgery. CONCLUSIONS Preoperative anemia is common among patients undergoing laparoscopic hysterectomy. Preoperative anemia increases patients' risk for multiple postoperative comorbidities. Given that most hysterectomies are performed in the elective setting, gynecologic surgeons should consider the use of anemia-corrective measures to minimize postoperative morbidity.
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Affiliation(s)
- Paul Tyan
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Ali Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Erin Carey
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Andrew Sparks
- Department of Surgery, School of Medicine & Health Sciences, The George Washington University, Washington, DC, USA
| | - Amr Radwan
- Department of Internal Medicine, St. Elizabeth's Medical Center, Brighton, MA, USA
| | - Richard Amdur
- Department of Surgery, School of Medicine & Health Sciences, The George Washington University, Washington, DC, USA
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Alex Gu
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Hannah Robinson
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Gaby N Moawad
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, The George Washington University, Washington, DC, USA
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Abiri B, Vafa M. Iron Deficiency and Anemia in Cancer Patients: The Role of Iron Treatment in Anemic Cancer Patients. Nutr Cancer 2019; 72:864-872. [PMID: 31474155 DOI: 10.1080/01635581.2019.1658794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Anemia is a prevalent complication in patients with cancer, both at diagnosis and during treatment, with notable negative effects on quality of life and overall prognosis. Iron deficiency is the most common cause of anemia in the patients and can affect almost half of patients with solid and hematologic malignancies. The pathogenesis is complex and multifactorial, including bleeding, malnutrition, medications, and inflammation resulted from cancer and cancer treatment. In fact, either absolute or functional iron deficiency can occur. Most iron deficient cancer patients present with functional iron deficiency, a condition with adequate iron storage but insufficient iron supply for erythroblasts and other iron dependent tissues. Functional iron deficiency is the result of the cancer related cytokine release, but in absolute iron deficiency iron reserves are depleted leading to similar but often more severe symptoms of inadequate iron store. Current therapeutic options in cancer anemia consist of iron administration, erythropoietic stimulating agents, and blood transfusion. The latter should be administered to a minimum, because of problems regarding risks. Here, we present a review on the epidemiology, pathophysiology, clinical outcomes, and therapeutic options of iron deficiency as well as the effect of iron therapy on tumor progression in anemic cancer patients.
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Affiliation(s)
- Behnaz Abiri
- Department of Nutrition, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammadreza Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.,Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
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Saint A, Viotti J, Borchiellini D, Hoch B, Raimondi V, Hebert C, Largillier R, Evesque L, Follana P, Ferrero JM, Delaby C, Schiappa R, Chamorey E, Barriere J. Iron deficiency during first-line chemotherapy in metastatic cancers: a prospective epidemiological study. Support Care Cancer 2019; 28:1639-1647. [DOI: 10.1007/s00520-019-04938-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/11/2019] [Indexed: 01/01/2023]
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Cegarra L, Colins A, Gerdtzen ZP, Nuñez MT, Salgado JC. Mathematical modeling of the relocation of the divalent metal transporter DMT1 in the intestinal iron absorption process. PLoS One 2019; 14:e0218123. [PMID: 31181103 PMCID: PMC6557526 DOI: 10.1371/journal.pone.0218123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/27/2019] [Indexed: 11/18/2022] Open
Abstract
Iron is essential for the normal development of cellular processes. This metal has a high redox potential that can damage cells and its overload or deficiency is related to several diseases, therefore it is crucial for its absorption to be highly regulated. A fast-response regulatory mechanism has been reported known as mucosal block, which allows to regulate iron absorption after an initial iron challenge. In this mechanism, the internalization of the DMT1 transporters in enterocytes would be a key factor. Two phenomenological models are proposed for the iron absorption process: DMT1’s binary switching mechanism model and DMT1’s swinging-mechanism model, which represent the absorption mechanism for iron uptake in intestinal cells. The first model considers mutually excluding processes for endocytosis and exocytosis of DMT1. The second model considers a Ball’s oscillator to represent the oscillatory behavior of DMT1’s internalization. Both models are capable of capturing the kinetics of iron absorption and represent empirical observations, but the DMT1’s swinging-mechanism model exhibits a better correlation with experimental data and is able to capture the regulatory phenomenon of mucosal block. The DMT1 swinging-mechanism model is the first phenomenological model reported to effectively represent the complexity of the iron absorption process, as it can predict the behavior of iron absorption fluxes after challenging cells with an initial dose of iron, and the reduction in iron uptake observed as a result of mucosal block after a second iron dose.
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Affiliation(s)
- Layimar Cegarra
- Laboratory of Process Modeling and Distributed Computing, Department of Chemical Engineering, Biotechnology and Materials, University of Chile, Santiago, Chile
- Centre for Biotechnology and Bioengineering, Department of Chemical Engineering, Biotechnology and Materials, University of Chile, Santiago, Chile
| | - Andrea Colins
- Laboratory of Process Modeling and Distributed Computing, Department of Chemical Engineering, Biotechnology and Materials, University of Chile, Santiago, Chile
| | - Ziomara P. Gerdtzen
- Centre for Biotechnology and Bioengineering, Department of Chemical Engineering, Biotechnology and Materials, University of Chile, Santiago, Chile
| | - Marco T. Nuñez
- Iron and Biology of Aging Laboratory, Department of Biology, Faculty of Sciences, University of Chile, Santiago, Chile
| | - J. Cristian Salgado
- Laboratory of Process Modeling and Distributed Computing, Department of Chemical Engineering, Biotechnology and Materials, University of Chile, Santiago, Chile
- Centre for Biotechnology and Bioengineering, Department of Chemical Engineering, Biotechnology and Materials, University of Chile, Santiago, Chile
- * E-mail:
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Iron status and associations with physical performance during basic combat training in female New Zealand Army recruits. Br J Nutr 2019; 121:887-893. [PMID: 30862317 DOI: 10.1017/s0007114519000199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Decreases in Fe status have been reported in military women during initial training periods of 8-10 weeks. The present study aimed to characterise Fe status and associations with physical performance in female New Zealand Army recruits during a 16-week basic combat training (BCT) course. Fe status indicators - Hb, serum ferritin (sFer), soluble transferrin receptor (sTfR), transferrin saturation (TS) and erythrocyte distribution width (RDW) - were assessed at the beginning (baseline) and end of BCT in seventy-six volunteers without Fe-deficiency non-anaemia (sFer 10 mg/l at baseline or end. A timed 2·4 km run followed by maximum press-ups were performed at baseline and midpoint (week 8) to assess physical performance. Changes in Fe status were investigated using paired t tests and associations between Fe status and physical performance evaluated using Pearson correlation coefficients. sFer (56·6 (sd 33·7) v. 38·4 (sd 23·8) µg/l) and TS (38·8 (sd 13·9) v. 34·4 (sd 11·5) %) decreased (P<0·001 and P=0·014, respectively), while sTfR (1·21 (sd 0·27) v. 1·39 (sd 0·35) mg/l) and RDW (12·8 (sd 0·6) v. 13·2 (sd 0·7) %) increased (P<0·001) from baseline to end. Hb (140·6 (sd 7·5) v. 142·9 (sd 7·9) g/l) increased (P=0·009) during BCT. At end, sTfR was positively (r 0·29, P=0·012) and TS inversely associated (r -0·32, P=0·005) with midpoint run time. There were no significant correlations between Fe status and press-ups. Storage and functional Fe parameters indicated a decline in Fe status in female recruits during BCT. Correlations between tissue-Fe indicators and run times suggest impaired aerobic fitness. Optimal Fe status appears paramount for enabling success in female recruits during military training.
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Abstract
Iron and zinc are nutritionally essential trace elements that function through incorporation into proteins and enzymes; many of these proteins and enzymes affect physical performance. Poor iron status (iron deficiency and iron deficiency anemia) is prevalent in both developed and developing nations. Zinc deficiency has been reported in clinical and population studies, although the incidence is difficult to quantify due to the lack of a reliable zinc status indicator. The objective of this manuscript is to review the relationship between iron and zinc status and physical performance. In sum, numerous reports indicate diminished physical performance in individuals with poor iron and/or zinc status, whereas, in individuals with adequate status, evidence supporting a beneficial role of iron or zinc at levels beyond the recommended dietary allowance for optimizing physical performance is lacking.
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Affiliation(s)
- James P McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, 01760, USA.
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37
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Pompano LM, Haas JD. Increasing Iron Status through Dietary Supplementation in Iron-Depleted, Sedentary Women Increases Endurance Performance at Both Near-Maximal and Submaximal Exercise Intensities. J Nutr 2019; 149:231-239. [PMID: 30649365 DOI: 10.1093/jn/nxy271] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/12/2018] [Accepted: 10/02/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Iron deficiency persists as the most common micronutrient deficiency globally, despite having known detrimental effects on physical performance. Although iron supplementation and aerobic exercise have been examined individually and are known to improve physical performance, the impact of simultaneous iron supplementation and aerobic training remains unclear. OBJECTIVE The aim of this study was to examine the individual and combined effects of iron supplementation and aerobic training on improving maximal and submaximal physical performance in iron-depleted, nonanemic (IDNA) women. We hypothesized that women receiving iron would improve their endurance performance but not their estimated maximal oxygen consumption (eVO2max). METHODS Seventy-three sedentary, previously untrained IDNA (serum ferritin <25 µg/L and hemoglobin >110 g/L) women aged 18-26 y with a body mass index (kg/m2) of 17-25 participated in a double-blind, 8-wk, randomized controlled trial with a 2 × 2 factorial design including iron supplementation (42 mg elemental Fe/d) or placebo and aerobic exercise training (5 d/wk for 25 min at 75-85% of age-predicted maximum heart rate) or no training. Linear models were used to examine relations between training, supplement, and changes in the primary outcomes of observed maximal oxygen consumption (VO2peak) and eVO2max and ventilatory threshold (absolute oxygen consumption and percentage of maximum). Re-evaluation of a published meta-analysis was used to compare effects of iron supplementation on maximal oxygen consumption (VO2max) and VO2peak. RESULTS There were significant training-by-supplement interactions for VO2peak, volume of oxygen consumption at the ventilatory threshold, and the percentage of eVO2max where the threshold occurred, with the iron-untrained group performing better than the placebo-untrained group. There was no beneficial effect of iron supplementation for VO2max (mean difference: 0.53; 95% CI: -0.75, 1.81; P = 0.42), but a significant benefit was observed for VO2peak (mean difference: 1.87; 95% CI: 0.15, 3.60; P = 0.03). CONCLUSIONS Iron supplementation increases endurance performance at submaximal and maximal (VO2peak) exercise intensities in IDNA women. However, increasing iron status does not increase eVO2max. This trial was registered at clinicaltrials.gov as NCT03002090.
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Affiliation(s)
- Laura M Pompano
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Jere D Haas
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
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38
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Eleven Weeks of Iron Supplementation Does Not Maintain Iron Status for an Entire Competitive Season in Elite Female Volleyball Players: A Follow-Up Study. Nutrients 2018; 10:nu10101526. [PMID: 30336598 PMCID: PMC6213587 DOI: 10.3390/nu10101526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/13/2018] [Accepted: 10/15/2018] [Indexed: 01/27/2023] Open
Abstract
Background: Even though iron supplementation can be effective, it is necessary to be cautious of toxicity and aim to do no harm, therefore, it is important to examine the length of time the benefits of iron supplementation can be maintained following its cessation. The main purpose of this study was to analyze if iron stores and strength performance were maintained in elite female volleyball players for the final 18 weeks of a competitive season following the cessation of 11 weeks of iron supplementation. Methods: Twenty-two volleyballers (age: 27.0 ± 5.6 years.) were assigned to two groups (iron treatment group-ITG, n = 11 or control gropu-CG, n = 11) at the beginning of a previous trial (T0) and ITG consumed 325mg/d of ferrous sulphate for 11 weeks (T11). Then, in the present study iron status and strength were measured again 10 (T21) and 18 weeks later (T29) after the cessation of supplementation. Results: At the end of the previous trial (T11), ITG maintained iron status as measured by hematological parameters (serum iron-sFE, serum ferritin-FER, transferrin saturation index-TSI, and hemogloblin-Hb), however, CG showed a decrease in these markers at T11. Further, from T0 to T11 ITG experienced greater (p < 0.05) changes in clean and jerk, power clean, and total mean strength (TMS-sum of all strength tests) than CG. In the present, follow-up investigation, there was a group-by-time interaction in favor of CG vs. ITG from T11 to T21 for FER (p = 0.028) and Hb (p = 0.042). Further, there was an increase for CG (p < 0.001) in power clean for CG from T11 (38.4 ± 1.7 kg) to T21 (41.3 ± 1.9 kg) and T29 (41.8 ± 1.7 kg), but no change for power clean in ITG (p > 0.05). A group-by-time interaction from T11 to T29 occurred in favor of CG for half-squat (p = 0.049) and TMS (p = 0.049). Conclusion: Our findings suggest that the benefits of iron supplementation are not sustained in elite female volleyballers if supplementation is ceased for 18 weeks.
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Dziembowska I, Kwapisz J, Izdebski P, Żekanowska E. Mild iron deficiency may affect female endurance and behavior. Physiol Behav 2018; 205:44-50. [PMID: 30267737 DOI: 10.1016/j.physbeh.2018.09.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/28/2018] [Accepted: 09/17/2018] [Indexed: 12/25/2022]
Abstract
The function of central nervous system (CNS) processes is highly dependent on iron containing enzymes and proteins. Therefore, even mild iron deficiency (ID) may result in decreased endurance, increased irritability and withdrawal behavior among women. The current study was designed to assess the effects of iron status on perceived energy level along with its electroencephalographical (EEG) correlates and cognitive capacity of young women, since this group is at particular risk of experiencing depleted iron stores and iron deficiency anemia. The study group consisted of 23 non-anemic women of reproductive age (20-32 years) during their follicular phase of menstrual cycle. All participants were moderately physically active with a mean weekly energy expenditure of 1110 ± 450 Metabolic Equivalent of Task per minute-(MET/min). The group's electroencephalographic (EEG) alpha asymmetry and psychometric data - intelligence, anxiety level and temperamental traits (activity, briskness, sensory sensitivity, emotional reactivity, perseveration and endurance) were assessed and compared between iron deficient (serum ferritin <12 μg/l) and iron sufficient (serum ferritin ≥12 μg/l) females. Participants with depleted iron stores reported lower levels of activity (p = .004; partial η2 = 0.34) and endurance (p = .038, partial η2 = 0.25), temperamental traits, and presented increased relative left EEG alpha activity in prefrontal regions (p = .004; partial η2 = 0.63), which is a characteristic EEG pattern for withdrawal tendencies. Iron-depleted females did not differ in anxiety and general intelligence scores from those which were iron sufficient, however needed more time (median difference: 3 min, p = .004; partial η2 = 0.53) to complete an administered intelligence test, which may reflect lowered endurance during a cognitive-demanding task. These data provide proof that that even mild iron deficiency may be connected with CNS function and lead to decreased endurance, or at least cognitive endurance, which may be a risk-factor for mood disorders. Therefore, more attention should be paid to preventing even mild iron deficiency, particularly among young women.
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Affiliation(s)
- Inga Dziembowska
- Department of Pathophysiology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń; Curie - Skłodowskiej 9, Bydgoszcz 85-094, Poland.
| | - Justyna Kwapisz
- Department of Pathophysiology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń; Curie - Skłodowskiej 9, Bydgoszcz 85-094, Poland
| | - Paweł Izdebski
- Institute of Psychology, Kazimierz Wielki University in Bydgoszcz, Leopolda Staffa 1, Bydgoszcz 85-867, Poland
| | - Ewa Żekanowska
- Department of Pathophysiology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń; Curie - Skłodowskiej 9, Bydgoszcz 85-094, Poland
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Gunnarsdottir MG, Jonsson T, Halldorsdottir AM. Circulating plasma microRNAs as biomarkers for iron status in blood donors. Transfus Med 2018; 29 Suppl 1:52-58. [PMID: 30209836 DOI: 10.1111/tme.12554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/18/2017] [Accepted: 07/28/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate whether microRNAs can serve as biomarkers for iron status in blood donors. BACKGROUND Serum ferritin is a widely used biochemical test for detecting iron deficiency, but it has its limitations. Certain microRNAs (miRNAs) reportedly have a role in regulating iron homeostasis. Circulating miRNAs have been reported as potential biomarkers for various conditions but have not yet been studied in iron deficiency. METHODS Participating blood donors were divided into two groups: high ferritin (HF) (>150 µg L-1 ) and low ferritin (LF) (<15 µg L-1 ). MiRNA analysis was performed by an miRNA profiling service (Exiqon) using commercial qPCR assays. The study had two phases: (i) a pilot study (20 participants) where 179 miRNAs were analysed and (ii) a confirmation study (50 participants) of 13 selected miRNAs. RESULTS Mean serum ferritin was 13·8 µg L-1 in the LF arm compared to 231 µg L-1 in the HF group (P < 0·001). Hepcidin plasma levels were higher in the HF arm (P < 0·001), whereas soluble transferrin receptor 1 was higher in the LF group (P < 0·001). In the pilot study, samples did not separate according to study group on unsupervised analysis. When directly comparing HF vs LF groups, 17 miRNAs were differentially expressed (P < 0·05, t-test) but did not pass correction for multiple testing. The confirmation study of 13 selected miRNAs verified these findings as no miRNA was significantly different between the study groups. CONCLUSION In this study, circulating plasma miRNAs did not emerge as promising biomarkers for iron status in healthy individuals. However, in the future, alternative detection methods such as next-generation sequencing might indicate miRNAs that correlate with iron stores.
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Affiliation(s)
- M G Gunnarsdottir
- Faculty of Biomedical Sciences, University of Iceland, Reykjavik, Iceland
| | - T Jonsson
- Blood Bank, Landspitali National University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - A M Halldorsdottir
- Blood Bank, Landspitali National University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Hori S, Hara H, Ishizuka S. Marginal iron deficiency enhances liver triglyceride accumulation in rats fed a high-sucrose diet. Biosci Biotechnol Biochem 2018; 82:2140-2148. [PMID: 30185127 DOI: 10.1080/09168451.2018.1515616] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We investigated whether marginal iron-deficiency (MID) without anemia influences liver lipid accumulation in rats. Ingestion of a MID diet in which the iron concentration was half of AIN-93 formulation (iron-adequate, IA) for 3 weeks decreased liver iron concentration without anemia. We then evaluated the influence of the MID diet on liver lipid accumulation in combination with a high-sucrose (HS) diet and confirmed that the HS-MID diet successfully decreased liver iron concentration without anemia. Additionally, a significant increase in liver triglyceride concentration was found, accompanied by upregulation of hepatic fatty acid synthase expression in the rats fed the HS-MID diet compared to those in the rats fed an HS-IA diet, although no difference was observed in plasma transaminase activity and hepatic interleukin-1β expression. These results suggest that MID enhances de novo lipid synthesis via upregulation of lipogenic gene expression in combination with sucrose in the diet. Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; HS, high sucrose; IA, iron adequate; ID, iron deficiency; MID, marginal irondeficiency; NAFLD, non-alcoholic fatty liver disease.
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Affiliation(s)
- Shota Hori
- a Division of Fundamental Agriscience Research, Research Faculty of Agriculture , Hokkaido University , Sapporo , Japan
| | - Hiroshi Hara
- a Division of Fundamental Agriscience Research, Research Faculty of Agriculture , Hokkaido University , Sapporo , Japan
| | - Satoshi Ishizuka
- a Division of Fundamental Agriscience Research, Research Faculty of Agriculture , Hokkaido University , Sapporo , Japan
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Motonishi S, Tanaka K, Ozawa T. Iron deficiency associates with deterioration in several symptoms independently from hemoglobin level among chronic hemodialysis patients. PLoS One 2018; 13:e0201662. [PMID: 30071093 PMCID: PMC6072073 DOI: 10.1371/journal.pone.0201662] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/19/2018] [Indexed: 12/22/2022] Open
Abstract
Background While iron deficiency (ID) is a frequent cause of anemia in hemodialysis patients, the clinical impact of ID without anemic level of hemoglobin remains unclear. As such, this study was designed to clarify the manifestations of ID itself in subjects on hemodialysis. Methods Maintenance hemodialysis patients achieving target hemoglobin levels (≥ 10.0g/dL) under treatment in our clinic were stratified for comparison from three perspectives: ID (transferrin saturation [TSAT] < 20% or ferritin < 100ng/mL) vs non-ID, level of TSAT (< or ≥ 20%), and level of serum ferritin concentration (< or ≥ 100ng/mL). The severity of frequent symptoms was determined by a self-rating symptom score questionnaire, and the rate of those with severe manifestations was calculated for each symptom. Significant difference was examined between groups; univariate and adjusted multivariate odds ratios and 95% confidence intervals were obtained by logistic regression. Results Among 154 subjects selected for analysis, the ratio of severe arthralgia and fatigue was significantly higher in the ID group (n = 94) compared to the non-ID group (n = 60), in both univariate and adjusted multivariate analyses. Moreover, in multivariate analysis, low TSAT was significantly associated with exacerbation of pain during vascular access puncture and intradialytic leg cramps, while low serum ferritin concentration was related to significant increase in severe arthralgia, fatigue, intradialytic headache and leg cramps. Conclusions ID was identified as a risk factor regarding severity of several symptoms even without low hemoglobin level among chronic hemodialysis patients, and supplementation of iron was considered efficacious for improving critical symptoms affecting those undergoing maintenance dialysis.
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Rationale and Design of a Prospective, Multicenter, Observational Study Evaluating Iron Deficiency in Patients Hospitalized for Heart Failure (FERIC-RO). REV ROMANA MED LAB 2018. [DOI: 10.2478/rrlm-2018-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Introduction: Several landmark studies, which enrolled heart failure (HF) patients who were ambulatory at the time of inclusion, identified iron deficiency (ID) as an important therapeutic target: intravenous iron administration with ferric carboxymaltose (FCM) improves morbidity, exercise capacity, and quality of life in patients with HF and reduced EF (HFrEF). However, there is still limited knowledge about ID prevalence during hospitalization for Worsening Chronic HF (WCHF) and about the relationship between ID during hospitalization and post-discharge outcomes. Although previous studies documented ID as an independent risk factor for poor outcomes in HFrEF, its prognostic significance in HF patients with EF>40% remains unclear.
Method and Results: The FERIC-RO study is a prospective, multicenter, observational study with longitudinal follow up, conducted in 9 Romanian hospitals that will include 200 consecutive patients admitted for worsening HF. A comprehensive description of the Iron metabolism biomarkers will be performed on discharge and 1-month follow up. The primary endpoint is defined as the prevalence of ID on discharge and 1-month post-discharge, and the secondary endpoints include: all-cause re-hospitalization and all-cause-mortality at 1 and 3 months follow up, and quality of life on discharge and 1-month.
Conclusions: FERIC-RO will provide new evidence about the prevalence and the predictors of ID in patients hospitalized for WCHF regardless of LVEF. Furthermore, the study will explore the relationship between in-hospital ID and post-discharge outcomes. The results of FERIC-RO will thus be highly relevant to the management of patients hospitalized for AHF.
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Affiliation(s)
- Inder S. Anand
- VA Medical Center, Minneapolis, MN (I.A., P.G.)
- VA Medical Center, San Diego, CA (I.A.)
- University of Minnesota, Minneapolis (I.A., P.G.)
| | - Pankaj Gupta
- VA Medical Center, Minneapolis, MN (I.A., P.G.)
- University of Minnesota, Minneapolis (I.A., P.G.)
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Lynch S, Pfeiffer CM, Georgieff MK, Brittenham G, Fairweather-Tait S, Hurrell RF, McArdle HJ, Raiten DJ. Biomarkers of Nutrition for Development (BOND)-Iron Review. J Nutr 2018; 148:1001S-1067S. [PMID: 29878148 PMCID: PMC6297556 DOI: 10.1093/jn/nxx036] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/27/2017] [Accepted: 11/07/2017] [Indexed: 12/20/2022] Open
Abstract
This is the fifth in the series of reviews developed as part of the Biomarkers of Nutrition for Development (BOND) program. The BOND Iron Expert Panel (I-EP) reviewed the extant knowledge regarding iron biology, public health implications, and the relative usefulness of currently available biomarkers of iron status from deficiency to overload. Approaches to assessing intake, including bioavailability, are also covered. The report also covers technical and laboratory considerations for the use of available biomarkers of iron status, and concludes with a description of research priorities along with a brief discussion of new biomarkers with potential for use across the spectrum of activities related to the study of iron in human health.The I-EP concluded that current iron biomarkers are reliable for accurately assessing many aspects of iron nutrition. However, a clear distinction is made between the relative strengths of biomarkers to assess hematological consequences of iron deficiency versus other putative functional outcomes, particularly the relationship between maternal and fetal iron status during pregnancy, birth outcomes, and infant cognitive, motor and emotional development. The I-EP also highlighted the importance of considering the confounding effects of inflammation and infection on the interpretation of iron biomarker results, as well as the impact of life stage. Finally, alternative approaches to the evaluation of the risk for nutritional iron overload at the population level are presented, because the currently designated upper limits for the biomarker generally employed (serum ferritin) may not differentiate between true iron overload and the effects of subclinical inflammation.
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Affiliation(s)
| | - Christine M Pfeiffer
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michael K Georgieff
- Division of Neonatology, Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN
| | - Gary Brittenham
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY
| | - Susan Fairweather-Tait
- Department of Nutrition, Norwich Medical School, Norwich Research Park, University of East Anglia, Norwich NR4 7JT, UK
| | - Richard F Hurrell
- Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Harry J McArdle
- Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen AB21 9SB, UK
| | - Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH)
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Tkaczyszyn M, Drozd M, Węgrzynowska‐Teodorczyk K, Flinta I, Kobak K, Banasiak W, Ponikowski P, Jankowska EA. Depleted iron stores are associated with inspiratory muscle weakness independently of skeletal muscle mass in men with systolic chronic heart failure. J Cachexia Sarcopenia Muscle 2018; 9:547-556. [PMID: 29573220 PMCID: PMC5989741 DOI: 10.1002/jcsm.12282] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 08/29/2017] [Accepted: 12/07/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Skeletal and respiratory muscle dysfunction constitutes an important pathophysiological feature of heart failure (HF). We assessed the relationships between respiratory muscle function, skeletal muscle mass, and physical fitness in men with HF with reduced left ventricular ejection fraction (HFrEF), and investigated the hypothesis of whether iron deficiency (ID) contributes to respiratory muscle dysfunction in these patients. METHODS We examined 53 male outpatients with stable HFrEF without asthma or chronic obstructive pulmonary disease (age: 64 ± 10 years; New York Heart Association [NYHA] class I/II/III: 36/51/13%; ischaemic aetiology: 83%; all with left ventricular ejection fraction ≤40%) and 10 middle-aged healthy men (control group). We analysed respiratory muscle function (maximal inspiratory and expiratory pressure at the mouth [MIP and MEP, respectively]), appendicular lean mass/body mass index (ALM/BMI; ALM was measured using dual-energy X-ray absorptiometry), physical fitness (components of Functional Fitness Test for Older Adults), and iron status. RESULTS MIP, MEP, and ALM/BMI (but not MIP adjusted for ALM/BMI) were lower in men with HFrEF vs. healthy men. MIP, MEP, and MIP adjusted for ALM/BMI (but not ALM/BMI) were lower in men with HFrEF with vs. without ID. In a multivariable linear regression model lower serum ferritin (but not transferrin saturation) was associated with lower MIP independently of ALM/BMI, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and haemoglobin concentration. In multivariable linear regression models, lower MIP was associated with worse results in Functional Fitness Test when adjusted for ALM/BMI or relevant clinical variables (NYHA class, estimated glomerular filtration rate, NT-proBNP, and haemoglobin concentration). CONCLUSIONS In men with HFrEF, low ferritin reflecting depleted iron stores is associated with inspiratory muscle weakness independently of skeletal muscle mass. Inspiratory muscle dysfunction correlates with worse physical fitness independently of either skeletal muscle mass or disease severity.
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Affiliation(s)
- Michał Tkaczyszyn
- Laboratory for Applied Research on Cardiovascular System, Department of Heart DiseasesWroclaw Medical UniversityWroclawPoland
- Cardiology Department, Centre for Heart DiseasesMilitary HospitalWroclawPoland
| | - Marcin Drozd
- Laboratory for Applied Research on Cardiovascular System, Department of Heart DiseasesWroclaw Medical UniversityWroclawPoland
- Cardiology Department, Centre for Heart DiseasesMilitary HospitalWroclawPoland
| | - Kinga Węgrzynowska‐Teodorczyk
- Cardiology Department, Centre for Heart DiseasesMilitary HospitalWroclawPoland
- Faculty of PhysiotherapyUniversity School of Physical Education of WroclawWroclawPoland
| | - Irena Flinta
- Cardiology Department, Centre for Heart DiseasesMilitary HospitalWroclawPoland
- Department of PhysiologyWroclaw Medical UniversityWroclawPoland
| | - Kamil Kobak
- Laboratory for Applied Research on Cardiovascular System, Department of Heart DiseasesWroclaw Medical UniversityWroclawPoland
| | - Waldemar Banasiak
- Cardiology Department, Centre for Heart DiseasesMilitary HospitalWroclawPoland
| | - Piotr Ponikowski
- Cardiology Department, Centre for Heart DiseasesMilitary HospitalWroclawPoland
- Department of Heart DiseasesWroclaw Medical UniversityWroclawPoland
| | - Ewa A. Jankowska
- Laboratory for Applied Research on Cardiovascular System, Department of Heart DiseasesWroclaw Medical UniversityWroclawPoland
- Cardiology Department, Centre for Heart DiseasesMilitary HospitalWroclawPoland
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Yu X, Luo Q, Liu Z, Zhao Z, Zhao Q, An C, Huang Z, Jin Q, Gao L, Yan L. Prevalence of iron deficiency in different subtypes of pulmonary hypertension. Heart Lung 2018; 47:308-313. [PMID: 29801672 DOI: 10.1016/j.hrtlng.2018.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/04/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Iron deficiency (ID) prevalence in Chinese patients suffering from pulmonary hypertension (PH) is unclear so far. This study aimed to investigate ID prevalence in different subtypes of PH and its relevant factors. METHODS Hospitalized patients diagnosed with PH from September 2015 to March 2017 were retrospectively enrolled. Patients were grouped based on etiology. Logistic regression analysis was performed to determine factors associated with ID. RESULTS ID was found in 38.25% of 251 PH patients; with the highest prevalence in connective tissue disease associated pulmonary arterial hypertension (CTD-PAH). Univariate logistic regression analysis showed that female sex, age, CTD-PAH diagnosis and high sensitive C reactive protein (hs-CRP) were associated with ID. After adjusting for age, sex and hs-CRP, the diagnosis of CTD-PAH was still associated with ID (OR = 3.01, 95%CI 1.02-8.90, P < 0.05). CONCLUSIONS ID is common in PH in China. CTD-PAH is independently associated with ID, after adjustment for age, sex, and hs-CRP.
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Affiliation(s)
- Xue Yu
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qin Luo
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhihong Liu
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Zhihui Zhao
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Zhao
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenhong An
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiwei Huang
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Jin
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liu Gao
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Yan
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kiss JE, Vassallo RR. How do we manage iron deficiency after blood donation? Br J Haematol 2018; 181:590-603. [DOI: 10.1111/bjh.15136] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Joseph E. Kiss
- Hemapheresis and Blood Services; The institute for Transfusion Medicine; Pittsburgh PA USA
| | - Ralph R. Vassallo
- Chief Medical and Scientific Officer; Blood Systems, Inc.; Scottsdale AZ USA
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Lee EC, Fragala MS, Kavouras SA, Queen RM, Pryor JL, Casa DJ. Biomarkers in Sports and Exercise: Tracking Health, Performance, and Recovery in Athletes. J Strength Cond Res 2018; 31:2920-2937. [PMID: 28737585 PMCID: PMC5640004 DOI: 10.1519/jsc.0000000000002122] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Lee, EC, Fragala, MS, Kavouras, SA, Queen, RM, Pryor, JL, and Casa, DJ. Biomarkers in sports and exercise: tracking health, performance, and recovery in athletes. J Strength Cond Res 31(10): 2920–2937, 2017—Biomarker discovery and validation is a critical aim of the medical and scientific community. Research into exercise and diet-related biomarkers aims to improve health, performance, and recovery in military personnel, athletes, and lay persons. Exercise physiology research has identified individual biomarkers for assessing health, performance, and recovery during exercise training. However, there are few recommendations for biomarker panels for tracking changes in individuals participating in physical activity and exercise training programs. Our approach was to review the current literature and recommend a collection of validated biomarkers in key categories of health, performance, and recovery that could be used for this purpose. We determined that a comprehensive performance set of biomarkers should include key markers of (a) nutrition and metabolic health, (b) hydration status, (c) muscle status, (d) endurance performance, (e) injury status and risk, and (f) inflammation. Our review will help coaches, clinical sport professionals, researchers, and athletes better understand how to comprehensively monitor physiologic changes, as they design training cycles that elicit maximal improvements in performance while minimizing overtraining and injury risk.
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Affiliation(s)
- Elaine C Lee
- 1Department of Kinesiology, University of Connecticut, Storrs, Connecticut; 2Quest Diagnostics, Madison, New Jersey; 3Department of Health, Human Performance, & Recreation, University of Arkansas, Fayetteville, Arkansas; 4Department of Biomedical Engineering and Mechanics, Virginia Tech University, Blacksburg, Virginia; and 5Department of Kinesiology, California State University, Fresno, California
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D'Adamo CR, Novick JS, Feinberg TM, Dawson VJ, Miller LE. A Food-Derived Dietary Supplement Containing a Low Dose of Iron Improved Markers of Iron Status Among Nonanemic Iron-Deficient Women. J Am Coll Nutr 2018. [PMID: 29533710 DOI: 10.1080/07315724.2018.1427158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Iron deficiency is the most common nutrient deficiency in the world. While deficiency can often be resolved through dietary supplementation with iron, adverse events are common and frequently preclude compliance. The objective of this study was to determine whether a food-derived dietary supplement containing a low dose of iron and nutrients that increase iron absorption could resolve iron deficiency with fewer adverse events than reported at higher doses. METHODS A pilot clinical trial (NCT02683369) was conducted among premenopausal women with nonanemic iron deficiency that was verified by blood screening. Participants consumed a dietary supplement (Blood Builder®/Iron Response®) once daily for 8 weeks containing 26 mg of iron, vitamin C, folate, and other food-derived nutrients. Primary outcomes were markers of iron status (serum ferritin, hemoglobin, soluble transferrin receptor, total body iron stores) and secondary outcomes were self-reported fatigue and energy. All outcomes were assessed at baseline and 8 weeks. Adverse events were monitored with questionnaires, daily diaries, and contact with a physician. Dependent samples t test and Wilcoxon signed-rank test were used to analyze outcomes. RESULTS Twenty-three participants enrolled in the study. Iron deficiency was resolved in the sample (mean serum ferritin: baseline = 13.9 μg/L, 8 weeks = 21.1 μg/L, p < 0.001). All other markers of iron status, fatigue, and energy also improved during the study (p < 0.04). No adverse events were reported. CONCLUSIONS While larger and controlled studies are needed to confirm these findings, a food-derived dietary supplement with a low dose of iron and absorption-enhancing nutrients resolved iron deficiency and improved all other markers of iron status without any adverse events.
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Affiliation(s)
- Christopher R D'Adamo
- a Department of Family & Community Medicine , Center for Integrative Medicine, University of Maryland School of Medicine , Baltimore , Maryland , USA
| | - James S Novick
- b Charm City Research Group, University of Maryland St. Joseph Medical Center , Towson , Maryland , USA
| | - Termeh M Feinberg
- a Department of Family & Community Medicine , Center for Integrative Medicine, University of Maryland School of Medicine , Baltimore , Maryland , USA
| | - Valerie J Dawson
- a Department of Family & Community Medicine , Center for Integrative Medicine, University of Maryland School of Medicine , Baltimore , Maryland , USA
| | - Larry E Miller
- c Miller Scientific Consulting , Asheville , North Carolina , USA
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