Demographic, clinical, and biochemical predictors of pica in a large cohort of blood donors

Prevalence and associated factors of symptoms of pica among adolescent schoolchildren in northern Sudan: a cross-sectional study

BACKGROUND

Pica, the craving for and purposive eating of non-food items, is a common worldwide problem, especially among children and pregnant women. There are few published data on pica among adolescents in sub-Saharan Africa, and no study has been carried- out in Sudan. This study was conducted to determine the prevalence and associated factors of symptoms of pica among adolescent schoolchildren in northern Sudan.

METHODS

A school‑based cross‑sectional study was conducted from July to September 2022 among adolescent students (aged 10-19 years) in four public primary and secondary schools in Almatamah locality in north Sudan. Sociodemographic information (age, sex, mother's education, mother's occupation, and father's education) was collected through a questionnaire. Weight and height were measured using a standard procedure, and the body mass index Z-score was computed using the World Health Organization's reference values. Logistic regression analysis was performed.

RESULTS

Of the 384 enrolled adolescents, 180 (46.9%) were male and 204 (53.1%) were female. Their median (interquartile range) age was 15.1 (13.1‒16.3) years. The prevalence of symptoms of pica was found to be 30.7%, accounting for 118 adolescents. The most common type of pica was geophagia (eating clay and sand; 102 adolescents, 86.4%), followed by pagophagia (eating ice; 14 adolescents, 11.8%) and flour (starch; two adolescents, 1.6%). In the logistic regression analysis, females (adjusted odds ratio = 3.52, 95% confidence interval (CI) = 2.15‒5.78) and a lower level of father's education (adjusted odds ratio = 2.05, 95% CI = 1.26‒3.34) were associated with symptoms of pica.

CONCLUSION

In Sudan, symptoms of pica are common among adolescents, especially females. Caregivers need to assess pica in adolescents. Further research is needed to develop guidelines, medical training, and practice.

Iron Deficiency and Blood Donation: Links, Risks and Management

The purpose of this review is to raise awareness about the frequently underappreciated association of blood donation with iron deficiency, and to describe methods for its prevention and management. Blood donors cannot expect any health benefits from the donation but have justified expectations of no harm. Iron deficiency without anemia (IDWA) and iron deficiency anemia (IDA) are common consequences of regular blood donation, and this activity is the most important factor affecting iron status in regular blood donors. Awareness of blood donation as a primary cause of sideropenia is surprisingly low among physicians. Blood donation screening identifies potential donors with IDA but is frequently inadequate to detect IDWA. For the assessment of body iron stores, plasma or serum ferritin, transferrin saturation (TSAT) and soluble transferrin receptors (sTfR) concentrations are the most widely used biochemical markers, although the percentage of hypochromic mature erythrocytes and the hemoglobin content of reticulocytes are also useful. IDWA can be prevented by limiting the total volume of blood collected, by iron deficiency screening and deferral of sideropenic donors, by prolonging the interdonation intervals, and by iron supplementation between donations. IDWA tends to be more prevalent in younger people, females, and high-intensity donors. A potentially effective strategy to address sideropenia in blood donors is serum ferritin testing, but this may lead to a higher rate of deferral. Most regular blood donors cannot replenish their iron deficit by an iron-rich diet alone and will benefit from low-dose oral iron administration with various commercially available products post-donation, a well-tolerated strategy. However, valid concerns exist regarding the possibility of worsening the iron overload in donors with undiagnosed hemochromatosis or masking the symptoms of a clinically important gastrointestinal hemorrhage or other underlying medical condition. Finally, educational efforts should be intensified to improve the awareness of blood donation as a primary cause of iron deficiency among physicians of all specialties.

Iron status of blood donors

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.

Demographic, clinical, and biochemical predictors of pica in high-intensity blood donors

BACKGROUND

Frequent blood donors who contribute multiple times annually are important for maintaining an adequate blood supply. However, repeated donations exacerbate iron deficiency, which can lead to pica, a condition characterised as repeated eating or chewing of a non-nutritious substance such as ice, clay and dirt. Understanding characteristics of frequent donors that are associated with increased risk for developing pica will help to identify them and prevent this adverse consequence of blood donation.

METHODS

Demographic, clinical, haematological, and biochemical factors associated with pica were investigated using univariable and multivariable logistic regression analysis in a cohort of 1693 high-intensity donors who gave nine or more units of whole blood in the preceding 2 years. Pica was classified by questionnaire responses as consuming at least 8 oz of ice daily and/or consumption of non-ice substances regardless of the amount and frequency.

RESULTS

Pica was present in 1.5% of the high-intensity donors, and only occurred in those with ferritin <50 ng/ml. Of 16 candidate variables, only haematocrit (OR = 0.835, p = 0.020) was independently associated with pica. Although severe iron deficiency was more prevalent in high-intensity donors, pica behaviours were less prevalent than in less frequent donors (2.2%).

CONCLUSION

We have uncovered predictors of pica in high-intensity donors, which further emphasises the need to continue to implement iron replacement programs to reduce the prevalence of pica and maintain a robust pool of frequent donors.

Prevalence of pica and rumination behaviours in adults and associations with eating disorder and general psychopathology: findings form a population-based study

AIMS

Pica and rumination disorder are known as feeding disorder diagnoses in childhood, but little is known about their occurrence in adulthood. This study aimed to assess prevalence rates of one-time and recurrent pica and rumination behaviours (PB and RB) in adults, including sociodemographic subgroups, and to examine associations with other eating disorder and general psychopathology.

METHODS

The representative population sample (N = 2403) completed measures on PB and RB, symptoms of avoidant/restrictive food intake disorder (ARFID), body image and symptoms of depression and anxiety.

RESULTS

Any PB and RB were reported in 5.33 and 5.49%, respectively, while recurrent PB or RB occurred in 1.08 and 0.71%, respectively. Co-occurrence was high, with 35.29% of recurrent PB in RB, and 23.08% vice versa. Prevalence rates of recurrent PB or RB did not differ by gender, weight status, educational or migration history from those without recurrent behaviours. Adults with v. without recurrent PB and RB showed more symptoms of ARFID, general eating disorders depression and anxiety, and behavioural symptoms of eating disorders (with the exception of compensatory behaviours in recurrent PB), and less positive body image. However, there were no differences regarding age and body mass index.

CONCLUSIONS

Our findings highlight the clinical significance of PB and RB in adults regarding both prevalence and associations with other psychopathological symptoms. In particular, associations with body image need to be investigated further, as in contrast to other eating disorders, body image disturbance is not yet represented in the diagnostic criteria for pica and rumination disorder. In sum, the findings highlight the need for clinical attention for these disorders and related behaviours in adults.