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Attwell C, McKay A, Sim M, Dugan C, Nicholas J, Hopper L, Peeling P. Timing is everything, but does it really matter? Impact of 8-weeks morning versus evening iron supplementation in ballet and contemporary dancers. Eur J Sport Sci 2023; 23:2275-2282. [PMID: 37291690 DOI: 10.1080/17461391.2023.2224285] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
ABSTRACTThe effectiveness of a morning versus evening oral iron supplement strategy to increase iron stores was explored. Ballet and contemporary dancers with serum ferritin (sFer) < 50μg/L (n = 14), were supplemented daily with 105 mg elemental oral iron in either the morning (FeAM) or evening (FePM) for 8 weeks. A control group (n = 6) with sFer >50μg/L were given no supplement over the same period. Dancers' sFer were measured at baseline and post-intervention. Assessment of daily training load, dietary intake, and menstruation were made. A significant interaction (p < 0.001) showed the within group sFer change over the 8-week intervention in FeAM (+25.9 ± 10.5μg/L) and FePM, (+22.3 ± 13.6μg/L) was significantly different to CON (-30.17 ± 28.7μg/L; both p = 0.001). This change was not different between FeAM and FePM (p = 0.778). sFer levels within FeAM and FePM significantly increased over the 8-weeks; however, they significantly decreased in the CON group (all p < 0.05). Post-intervention sFer levels were no longer different between the three groups (p > 0.05). Training load, dietary intake, and number of menstrual cycles incurred were similar between FeAM and FePM (p > 0.05). Oral iron supplementation in either the morning or evening appears equally effective in increasing sFer levels in dancers with sub-optimal iron status.
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Affiliation(s)
- Caitlin Attwell
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, Australia
| | - Alannah McKay
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Marc Sim
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- Medical School, The University of Western Australia, Crawley, Australia
| | - Cory Dugan
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, Australia
| | - Joanna Nicholas
- Western Australian Academy of Performing Arts, Edith Cowan University, Mount Lawley, Australia
| | - Luke Hopper
- Western Australian Academy of Performing Arts, Edith Cowan University, Mount Lawley, Australia
| | - Peter Peeling
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, Australia
- Western Australian Institute of Sport, Mt Claremont, Australia
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Tateishi Y, Toyoda S, Murakami H, Uchida R, Ichikawa R, Kikuchi T, Sato W, Suzuki K. A short-term intervention of ingesting iron along with methionine and threonine leads to a higher hemoglobin level than that with iron alone in young healthy women: a randomized, double-blind, parallel-group, comparative study. Eur J Nutr 2023; 62:3009-3019. [PMID: 37480367 PMCID: PMC10468430 DOI: 10.1007/s00394-023-03213-w] [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: 03/14/2023] [Accepted: 07/10/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Enhancing iron absorption and utilization is important for amelioration iron status faster and thereby, for improving quality of life. Dietary protein and amino acids, including methionine and threonine, have been reported to facilitate the absorption and utilization of dietary iron. Here, we investigated the effect of combined ingestion of methionine, threonine, and iron on the improvement of iron status during a short-term intervention, by comparing that with iron ingestion alone in healthy young women. METHODS This was a randomized, double-blind, parallel-group, comparative study with 45 participants (aged 20-39) randomly assigned to three groups (n = 15 each): one group was administered 200 mg methionine, 400 mg threonine, and 6 mg iron once daily (FEMT); another ingested 6 mg iron alone (FE); and the third group ingested a placebo (PCG). Blood samples and dietary nutrient data were collected before the intervention (week 0) and after 2, 4, and 6 weeks. Serum iron, hemoglobin, transferrin, and ferritin levels were measured. RESULTS Blood hemoglobin levels were significantly higher in the FEMT than in the FE group (P < 0.05) at week 4. Serum iron, transferrin, and ferritin levels were not changed across groups. In addition, our analyses showed that the observed increase in hemoglobin levels was affected by the intervention rather than changes in dietary nutrient intake. CONCLUSIONS Ingestion of methionine and threonine with low doses of iron leads to a higher hemoglobin levels than that with iron alone in a short period of 4 weeks. TRIAL REGISTRATION University Hospital Medical Information Network Clinical Trial Registry (UMIN000046621).
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Affiliation(s)
- Yuko Tateishi
- Institute of Food Sciences and Technologies, Ajinomoto Co., Inc., Kanagawa, 210-8681, Japan.
| | - Sakiko Toyoda
- Research Institute for Bioscience Products and Fine Chemicals, Ajinomoto Co., Inc., Kanagawa, 210-8681, Japan
| | - Hitoshi Murakami
- Institute of Food Sciences and Technologies, Ajinomoto Co., Inc., Kanagawa, 210-8681, Japan
| | - Ryo Uchida
- Institute of Food Sciences and Technologies, Ajinomoto Co., Inc., Kanagawa, 210-8681, Japan
| | - Reiko Ichikawa
- Institute of Food Sciences and Technologies, Ajinomoto Co., Inc., Kanagawa, 210-8681, Japan
| | - Takuya Kikuchi
- Institute of Food Sciences and Technologies, Ajinomoto Co., Inc., Kanagawa, 210-8681, Japan
| | - Wataru Sato
- Research Institute for Bioscience Products and Fine Chemicals, Ajinomoto Co., Inc., Kanagawa, 210-8681, Japan
| | - Katsuya Suzuki
- Institute of Food Sciences and Technologies, Ajinomoto Co., Inc., Kanagawa, 210-8681, Japan
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Effect of intravenous ferric carboxymaltose on exercise capacity and quality of life in patients with COPD : A pilot study. Wien Klin Wochenschr 2023; 135:35-44. [PMID: 36044093 DOI: 10.1007/s00508-022-02073-4] [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: 02/11/2022] [Accepted: 07/22/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Chronic obstructive pulmonary disease (COPD) is associated with reduced exercise capacity. In COPD iron deficiency is found in up to 50% of patients and may impair exercise capacity, the potential therapeutic effect is yet unknown. We aimed to estimate the beneficial effect of intravenous ferric carboxymaltose on exercise capacity and quality of life in patients with COPD. METHODS In this non-randomized, interrupted time series pilot trial we enrolled outpatients with stable COPD (GOLD II and III) and nonanemic iron deficiency (i.e., ferritin level < 100 μg/l or ferritin level 100-300 μg/l if transferrin saturation < 20%). Patients with cardiovascular-or inflammatory diseases were excluded. Participants performed 6‑minute walking test (6-MWT) and cardiopulmonary exercise testing (CPET) and completed the St. George's Respiratory Questionnaire (SGRQ). RESULTS From 35 screened patients, 11 (72% male, 63 ± 8 years, FEV1%predicted 44 ± 14) were included. Mean ferritin and hemoglobin were 70 ± 41 µg/l and 13.8 ± 1.7 g/dl, respectively. Four weeks after iron administration the 6‑MWT distance increased by 34.7 ± 34.4 m (95% CI, 10.0-59.3); p = 0.011. The VO2max increased by 1.87 ± 1.2 ml/kg/min (95% CI, 0.76-3); p = 0.006. Mean score of SGRQ was reduced by 7.56 ± 6.12 units (95% CI, 3 to 11); p = 0.004. The insignificant alteration in hemoglobin did not correlate with increase in exercise capacity. CONCLUSION Administration of intravenous iron was associated with improved exercise capacity and quality of life in stable COPD patients independent of hemoglobin. Our data provide a basis to calculate a statistically sufficient sample size for a randomized controlled follow-up study.
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4
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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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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: 5] [Impact Index Per Article: 1.7] [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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Semenova EA, Miyamoto-Mikami E, Akimov EB, Al-Khelaifi F, Murakami H, Zempo H, Kostryukova ES, Kulemin NA, Larin AK, Borisov OV, Miyachi M, Popov DV, Boulygina EA, Takaragawa M, Kumagai H, Naito H, Pushkarev VP, Dyatlov DA, Lekontsev EV, Pushkareva YE, Andryushchenko LB, Elrayess MA, Generozov EV, Fuku N, Ahmetov II. The association of HFE gene H63D polymorphism with endurance athlete status and aerobic capacity: novel findings and a meta-analysis. Eur J Appl Physiol 2020; 120:665-673. [PMID: 31970519 PMCID: PMC7042188 DOI: 10.1007/s00421-020-04306-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/16/2020] [Indexed: 12/04/2022]
Abstract
PURPOSE Iron is an important component of the oxygen-binding proteins and may be critical to optimal athletic performance. Previous studies have suggested that the G allele of C/G rare variant (rs1799945), which causes H63D amino acid replacement, in the HFE is associated with elevated iron indexes and may give some advantage in endurance-oriented sports. The aim of the present study was to investigate the association between the HFE H63D polymorphism and elite endurance athlete status in Japanese and Russian populations, aerobic capacity and to perform a meta-analysis using current findings and three previous studies. METHODS The study involved 315 international-level endurance athletes (255 Russian and 60 Japanese) and 809 healthy controls (405 Russian and 404 Japanese). Genotyping was performed using micro-array analysis or by PCR. VO2max in 46 male Russian endurance athletes was determined using gas analysis system. RESULTS The frequency of the iron-increasing CG/GG genotypes was significantly higher in Russian (38.0 vs 24.9%; OR 1.85, P = 0.0003) and Japanese (13.3 vs 5.0%; OR 2.95, P = 0.011) endurance athletes compared to ethnically matched controls. The meta-analysis using five cohorts (two French, Japanese, Spanish, and Russian; 586 athletes and 1416 controls) showed significant prevalence of the CG/GG genotypes in endurance athletes compared to controls (OR 1.96, 95% CI 1.58-2.45; P = 1.7 × 10-9). Furthermore, the HFE G allele was associated with high V̇O2max in male athletes [CC: 61.8 (6.1), CG/GG: 66.3 (7.8) ml/min/kg; P = 0.036]. CONCLUSIONS We have shown that the HFE H63D polymorphism is strongly associated with elite endurance athlete status, regardless ethnicities and aerobic capacity in Russian athletes.
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Affiliation(s)
- Ekaterina A. Semenova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
- Department of Biochemistry, Kazan Federal University, Kazan, Russia
| | - Eri Miyamoto-Mikami
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | | | - Fatima Al-Khelaifi
- Anti Doping Laboratory Qatar, Sports City, Doha, Qatar
- UCL-Medical School, Royal Free Campus, London, UK
| | - Haruka Murakami
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, NIBIOHN, Tokyo, Japan
| | - Hirofumi Zempo
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
- Faculty of Health and Nutrition, Tokyo Seiei College, Tokyo, Japan
| | - Elena S. Kostryukova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Nikolay A. Kulemin
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Andrey K. Larin
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Oleg V. Borisov
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Bonn, Germany
| | - Motohiko Miyachi
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, NIBIOHN, Tokyo, Japan
| | - Daniil V. Popov
- Laboratory of Exercise Physiology, Institute for Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | | | - Mizuki Takaragawa
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Hiroshi Kumagai
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
- Research Fellow of Japanese Society for the Promotion of Science, Tokyo, Japan
| | - Hisashi Naito
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Vladimir P. Pushkarev
- Medical Genetic Centre “Progen”, Moscow, Russia
- Moscow Center of Advanced Sport Technologies, Moscow, Russia
- Department of the Theory of Physical Culture and Biomechanics, Ural State University of Physical Culture, Chelyabinsk, Russia
| | - Dmitry A. Dyatlov
- Department of the Theory of Physical Culture and Biomechanics, Ural State University of Physical Culture, Chelyabinsk, Russia
| | - Eugene V. Lekontsev
- Methodical and Analytical Department, Regional Center for Sports Training, Chelyabinsk, Russia
- Research Institute of Olympic Sports, Ural State University of Physical Culture, Chelyabinsk, Russia
| | - Yuliya E. Pushkareva
- Department of Pediatrics, South Ural State Medical University, Chelyabinsk, Russia
| | | | | | - Edward V. Generozov
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Noriyuki Fuku
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Ildus I. Ahmetov
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
- Department of Physical Education, Plekhanov Russian University of Economics, Moscow, Russia
- Laboratory of Molecular Genetics, Kazan State Medical University, Kazan, Russia
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Byrom St, Liverpool, L3 5AF UK
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7
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McKay AKA, Peeling P, Pyne DB, Welvaert M, Tee N, Leckey JJ, Sharma AP, Ross MLR, Garvican-Lewis LA, Swinkels DW, Laarakkers CM, Burke LM. Chronic Adherence to a Ketogenic Diet Modifies Iron Metabolism in Elite Athletes. Med Sci Sports Exerc 2019; 51:548-555. [PMID: 30363006 DOI: 10.1249/mss.0000000000001816] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE The short-term restriction of carbohydrate (CHO) can potentially influence iron regulation via modification of postexercise interleukin-6 (IL-6) and hepcidin levels. This study examined the effect of a chronic ketogenic low-CHO high-fat (LCHF) diet on iron status and iron-regulatory markers in elite athletes. METHODS International-level race walkers (n = 50) were allocated to one of three dietary interventions: (i) a high-CHO diet (n = 16), (ii) a periodized CHO availability (n = 17), or (iii) an LCHF diet (n = 17) while completing a periodized training program for 3 wk. A 19- to 25-km race walking test protocol was completed at baseline and after adaptation, and changes in serum ferritin, IL-6, and hepcidin concentrations were measured. Results from high-CHO and periodized CHO were combined into one group (CHO; n = 33) for analysis. RESULTS The decrease in serum ferritin across the intervention period was substantially greater in the CHO group (37%) compared with the LCHF (23%) group (P = 0.021). After dietary intervention, the postexercise increase in IL-6 was greater in LCHF (13.6-fold increase; 95% confidence interval [CI] = 7.1-21.4) than athletes adhering to a CHO-rich diet (7.6-fold increase; 95% CI = 5.5-10.2; P = 0.033). Although no significant differences occurred between diets, CI values indicate that 3 h postexercise hepcidin concentrations were lower after dietary intervention compared with baseline in CHO (β = -4.3; 95% CI = -6.6 to -2.0), with no differences evident in LCHF. CONCLUSION Athletes who adhered to a CHO-rich diet experienced favorable changes to the postexercise IL-6 and hepcidin response, relative to the LCHF group. Lower serum ferritin after 3 wk of additional dietary CHO might reflect a larger more adaptive hematological response to training.
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Affiliation(s)
- Alannah K A McKay
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, WA, AUSTRALIA.,Australian Institute of Sport, Bruce, ACT, AUSTRALIA.,Western Australian Institute of Sport, Mt Claremont, WA, AUSTRALIA
| | - Peter Peeling
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, WA, AUSTRALIA.,Western Australian Institute of Sport, Mt Claremont, WA, AUSTRALIA
| | - David B Pyne
- Australian Institute of Sport, Bruce, ACT, AUSTRALIA.,Research Institute for Sport and Exercise, University of Canberra, Canberra, AUSTRALIA
| | - Marijke Welvaert
- Australian Institute of Sport, Bruce, ACT, AUSTRALIA.,Research Institute for Sport and Exercise, University of Canberra, Canberra, AUSTRALIA
| | - Nicolin Tee
- Australian Institute of Sport, Bruce, ACT, AUSTRALIA
| | - Jill J Leckey
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
| | - Avish P Sharma
- Australian Institute of Sport, Bruce, ACT, AUSTRALIA.,Research Institute for Sport and Exercise, University of Canberra, Canberra, AUSTRALIA
| | - Megan L R Ross
- Australian Institute of Sport, Bruce, ACT, AUSTRALIA.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
| | - Laura A Garvican-Lewis
- Australian Institute of Sport, Bruce, ACT, AUSTRALIA.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
| | - Dorine W Swinkels
- Department of Laboratory Medicine (TML 830), Radboud University Medical Center, Nijmegen, THE NETHERLANDS.,Hepcidinanalysis.com, Nijmegen, THE NETHERLANDS
| | - Coby M Laarakkers
- Department of Laboratory Medicine (TML 830), Radboud University Medical Center, Nijmegen, THE NETHERLANDS.,Hepcidinanalysis.com, Nijmegen, THE NETHERLANDS
| | - Louise M Burke
- Australian Institute of Sport, Bruce, ACT, AUSTRALIA.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
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8
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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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9
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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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10
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Dziegala M, Josiak K, Kasztura M, Kobak K, von Haehling S, Banasiak W, Anker SD, Ponikowski P, Jankowska E. Iron deficiency as energetic insult to skeletal muscle in chronic diseases. J Cachexia Sarcopenia Muscle 2018; 9:802-815. [PMID: 30178922 PMCID: PMC6204587 DOI: 10.1002/jcsm.12314] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/05/2018] [Accepted: 04/22/2018] [Indexed: 12/19/2022] Open
Abstract
Specific skeletal myopathy constitutes a common feature of heart failure, chronic obstructive pulmonary disease, and type 2 diabetes mellitus, where it can be characterized by the loss of skeletal muscle oxidative capacity. There is evidence from in vitro and animal studies that iron deficiency affects skeletal muscle functioning mainly in the context of its energetics by limiting oxidative metabolism in favour of glycolysis and by alterations in both carbohydrate and fat catabolic processing. In this review, we depict the possible molecular pathomechanisms of skeletal muscle energetic impairment and postulate iron deficiency as an important factor causally linked to loss of muscle oxidative capacity that contributes to skeletal myopathy seen in patients with heart failure, chronic obstructive pulmonary disease, and type 2 diabetes mellitus.
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Affiliation(s)
- Magdalena Dziegala
- Laboratory for Applied Research on Cardiovascular System, Department of Heart DiseasesWroclaw Medical University50‐981WroclawPoland
| | - Krystian Josiak
- Centre for Heart DiseasesMilitary Hospital50‐981WroclawPoland
- Department of Heart DiseasesWroclaw Medical University50‐367WroclawPoland
| | - Monika Kasztura
- Laboratory for Applied Research on Cardiovascular System, Department of Heart DiseasesWroclaw Medical University50‐981WroclawPoland
| | - Kamil Kobak
- Laboratory for Applied Research on Cardiovascular System, Department of Heart DiseasesWroclaw Medical University50‐981WroclawPoland
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity Medicine Göttingen (UMG)37075GöttingenGermany
| | | | - Stefan D. Anker
- Department of Cardiology and PneumologyUniversity Medicine Göttingen (UMG)37075GöttingenGermany
- Division of Cardiology and MetabolismCharité Universitätsmedizin10117BerlinGermany
- Department of Cardiology (CVK)Charité Universitätsmedizin10117BerlinGermany
- Berlin‐Brandenburg Center for Regenerative Therapies (BCRT)Charité Universitätsmedizin10117BerlinGermany
- German Centre for Cardiovascular Research (DZHK) partner site BerlinCharité Universitätsmedizin10117BerlinGermany
| | - Piotr Ponikowski
- Centre for Heart DiseasesMilitary Hospital50‐981WroclawPoland
- Department of Heart DiseasesWroclaw Medical University50‐367WroclawPoland
| | - Ewa Jankowska
- Laboratory for Applied Research on Cardiovascular System, Department of Heart DiseasesWroclaw Medical University50‐981WroclawPoland
- Centre for Heart DiseasesMilitary Hospital50‐981WroclawPoland
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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: 181] [Impact Index Per Article: 30.2] [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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12
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Houston BL, Hurrie D, Graham J, Perija B, Rimmer E, Rabbani R, Bernstein CN, Turgeon AF, Fergusson DA, Houston DS, Abou-Setta AM, Zarychanski R. Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic iron-deficient adults: a systematic review of randomised controlled trials. BMJ Open 2018; 8:e019240. [PMID: 29626044 PMCID: PMC5892776 DOI: 10.1136/bmjopen-2017-019240] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Iron supplementation in iron-deficiency anaemia is standard practice, but the benefits of iron supplementation in iron-deficient non-anaemic (IDNA) individuals remains controversial. Our objective is to identify the effects of iron therapy on fatigue and physical capacity in IDNA adults. DESIGN Systematic review and meta-analysis of randomised controlled trials (RCTs). SETTING Primary care. PARTICIPANTS Adults (≥18 years) who were iron deficient but non-anaemic. INTERVENTIONS Oral, intramuscular or intravenous iron supplementation; all therapy doses, frequencies and durations were included. COMPARATORS Placebo or active therapy. RESULTS We identified RCTs in Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health, SportDiscus and CAB Abstracts from inception to 31 October 2016. We searched the WHO's International Clinical Trials Registry Platform for relevant ongoing trials and performed forward searches of included trials and relevant reviews in Web of Science. We assessed internal validity of included trials using the Cochrane Risk of Bias tool and the external validity using the Grading of Recommendations Assessment, Development and Evaluation methodology. From 11 580 citations, we included 18 unique trials and 2 companion papers enrolling 1170 patients. Using a Mantel-Haenszel random-effects model, iron supplementation was associated with reduced self-reported fatigue (standardised mean difference (SMD) -0.38; 95% CI -0.52 to -0.23; I2 0%; 4 trials; 714 participants) but was not associated with differences in objective measures of physical capacity, including maximal oxygen consumption (SMD 0.11; 95% CI -0.15 to 0.37; I2 0%; 9 trials; 235 participants) and timed methods of exercise testing. Iron supplementation significantly increased serum haemoglobin concentration (MD 4.01 g/L; 95% CI 1.22 to 6.81; I2 48%; 12 trials; 298 participants) and serum ferritin (MD 9.23 µmol/L; 95% CI 6.48 to 11.97; I2 58%; 14 trials; 616 participants). CONCLUSION In IDNA adults, iron supplementation is associated with reduced subjective measures of fatigue but not with objective improvements in physical capacity. Given the global prevalence of both iron deficiency and fatigue, patients and practitioners could consider consumption of iron-rich foods or iron supplementation to improve symptoms of fatigue in the absence of documented anaemia. PROSPERO REGISTRATION NUMBER CRD42014007085.
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Affiliation(s)
- Brett L Houston
- Department of Internal Medicine, Section of Medical Oncology and Haematology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Daryl Hurrie
- Applied Health Sciences, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeff Graham
- Department of Internal Medicine, Section of Medical Oncology and Haematology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Brittany Perija
- Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Emily Rimmer
- Department of Internal Medicine, Section of Medical Oncology and Haematology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Rasheda Rabbani
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Section of Gastroenterology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alexis F Turgeon
- Population Health and Optimal Health Practices Research Unit, Trauma—Emergency—Critical Care Medicine, CHU de Québec—Université Laval Research Center, Québec City, Québec, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI); Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Donald S Houston
- Department of Internal Medicine, Section of Medical Oncology and Haematology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, Section of Medical Oncology and Haematology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Pathophysiology of Chronic Systolic Heart Failure. A View from the Periphery. Ann Am Thorac Soc 2018; 15:S38-S41. [DOI: 10.1513/annalsats.201710-789kv] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Yerlikaya A, Bulbul MC, Afsar B, Dagel T, Aslan G, Voroneanu L, Siriopol D, Covic A, Kanbay M. Iron in kidney and heart failure: from theory to practice. Int Urol Nephrol 2017; 50:481-493. [DOI: 10.1007/s11255-017-1708-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/13/2017] [Indexed: 12/16/2022]
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Wenger MJ, DellaValle DM, Murray-Kolb LE, Haas JD. Effect of iron deficiency on simultaneous measures of behavior, brain activity, and energy expenditure in the performance of a cognitive task. Nutr Neurosci 2017; 22:196-206. [PMID: 28784049 DOI: 10.1080/1028415x.2017.1360559] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Iron deficiency (ID) - the highly prevalent nutritional deficiency - has been shown to have deleterious effects on measures of cognitive performance and brain activity. Many of these results are suggestive of the impact of ID on neurotransmitter regulation and myelination. A third critical potential effect of ID on brain function is at the level of brain energy expenditure; however, to date there has not been any method for indirectly estimating the impact of ID on energy expenditure in humans in the context of cognitive work. METHODS We report here a study comparing ID and iron sufficient (IS) college students in which simultaneous behavioral, encephelographic (EEG), and metabolic data were collected in a task designed as a cognitive analog to standard physical exertion tasks. RESULTS We show that increases in cognitive demands produced decrements in behavioral measures of performance, and increases in EEG and metabolic measures of work. Critically, we found that the magnitudes of those changes were directly related to iron levels. DISCUSSION We find support for the idea that brain activity mediates the relationship between cognitive demands and energy expenditure, with ferritin and hemoglobin moderating those relationships in distinct ways. Finally, we show that levels of energy expenditure can be indirectly estimated by measures of EEG spectral power.
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Affiliation(s)
- Michael J Wenger
- a Center for Applied Social Research , The University of Oklahoma , 201 Stephenson Parkway, Suite 4100, Norman , OK 73019 , USA.,b Division of Nutritional Sciences , Cornell University , Ithaca , NY , USA
| | - Diane M DellaValle
- b Division of Nutritional Sciences , Cornell University , Ithaca , NY , USA.,c Department of Nutrition and Dietetics , Marywood University , Scranton , PA , USA
| | - Laura E Murray-Kolb
- d Department of Nutritional Sciences , The Pennsylvania State University , State College , PA , USA
| | - Jere D Haas
- b Division of Nutritional Sciences , Cornell University , Ithaca , NY , USA
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Low MSY, Speedy J, Styles CE, De‐Regil LM, Pasricha S. Daily iron supplementation for improving anaemia, iron status and health in menstruating women. Cochrane Database Syst Rev 2016; 4:CD009747. [PMID: 27087396 PMCID: PMC10182438 DOI: 10.1002/14651858.cd009747.pub2] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Iron-deficiency anaemia is highly prevalent among non-pregnant women of reproductive age (menstruating women) worldwide, although the prevalence is highest in lower-income settings. Iron-deficiency anaemia has been associated with a range of adverse health outcomes, which restitution of iron stores using iron supplementation has been considered likely to resolve. Although there have been many trials reporting effects of iron in non-pregnant women, these trials have never been synthesised in a systematic review. OBJECTIVES To establish the evidence for effects of daily supplementation with iron on anaemia and iron status, as well as on physical, psychological and neurocognitive health, in menstruating women. SEARCH METHODS In November 2015 we searched CENTRAL, Ovid MEDLINE, EMBASE, and nine other databases, as well as four digital thesis repositories. In addition, we searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and reference lists of relevant reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs comparing daily oral iron supplementation with or without a cointervention (folic acid or vitamin C), for at least five days per week at any dose, to control or placebo using either individual- or cluster-randomisation. Inclusion criteria were menstruating women (or women aged 12 to 50 years) reporting on predefined primary (anaemia, haemoglobin concentration, iron deficiency, iron-deficiency anaemia, all-cause mortality, adverse effects, and cognitive function) or secondary (iron status measured by iron indices, physical exercise performance, psychological health, adherence, anthropometric measures, serum/plasma zinc levels, vitamin A status, and red cell folate) outcomes. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures of Cochrane. MAIN RESULTS The search strategy identified 31,767 records; after screening, 90 full-text reports were assessed for eligibility. We included 67 trials (from 76 reports), recruiting 8506 women; the number of women included in analyses varied greatly between outcomes, with endpoint haemoglobin concentration being the outcome with the largest number of participants analysed (6861 women). Only 10 studies were considered at low overall risk of bias, with most studies presenting insufficient details about trial quality.Women receiving iron were significantly less likely to be anaemic at the end of intervention compared to women receiving control (risk ratio (RR) 0.39 (95% confidence interval (CI) 0.25 to 0.60, 10 studies, 3273 women, moderate quality evidence). Women receiving iron had a higher haemoglobin concentration at the end of intervention compared to women receiving control (mean difference (MD) 5.30, 95% CI 4.14 to 6.45, 51 studies, 6861 women, high quality evidence). Women receiving iron had a reduced risk of iron deficiency compared to women receiving control (RR 0.62, 95% CI 0.50 to 0.76, 7 studies, 1088 women, moderate quality evidence). Only one study (55 women) specifically reported iron-deficiency anaemia and no studies reported mortality. Seven trials recruiting 901 women reported on 'any side effect' and did not identify an overall increased prevalence of side effects from iron supplements (RR 2.14, 95% CI 0.94 to 4.86, low quality evidence). Five studies recruiting 521 women identified an increased prevalence of gastrointestinal side effects in women taking iron (RR 1.99, 95% CI 1.26 to 3.12, low quality evidence). Six studies recruiting 604 women identified an increased prevalence of loose stools/diarrhoea (RR 2.13, 95% CI 1.10, 4.11, high quality evidence); eight studies recruiting 1036 women identified an increased prevalence of hard stools/constipation (RR 2.07, 95% CI 1.35 to 3.17, high quality evidence). Seven studies recruiting 1190 women identified evidence of an increased prevalence of abdominal pain among women randomised to iron (RR 1.55, 95% CI 0.99 to 2.41, low quality evidence). Eight studies recruiting 1214 women did not find any evidence of an increased prevalence of nausea among women randomised to iron (RR 1.19, 95% CI 0.78 to 1.82). Evidence that iron supplementation improves cognitive performance in women is uncertain, as studies could not be meta-analysed and individual studies reported conflicting results. Iron supplementation improved maximal and submaximal exercise performance, and appears to reduce symptomatic fatigue. Although adherence could not be formally meta-analysed due to differences in reporting, there was no evident difference in adherence between women randomised to iron and control. AUTHORS' CONCLUSIONS Daily iron supplementation effectively reduces the prevalence of anaemia and iron deficiency, raises haemoglobin and iron stores, improves exercise performance and reduces symptomatic fatigue. These benefits come at the expense of increased gastrointestinal symptomatic side effects.
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Affiliation(s)
- Michael Sze Yuan Low
- Walter & Eliza Hall Institute of Medical ResearchDepartment of Immunology1G Royal ParadeParkvilleVictoriaAustralia3006
- Monash HealthDepartment of Clinical Haematology246 Clayton RoadClaytonVictoriaAustralia3168
| | - Joanna Speedy
- Australian Red Cross Blood ServiceClinical Services and Research297 Pirie StreetAdelaideSouth AustraliaAustralia5000
| | - Claire E Styles
- Australian Red Cross Blood ServiceClinical Services and ResearchLevel 1, 69 Walters DriveOsborne ParkPerthWestern AustraliaAustralia6017
| | - Luz Maria De‐Regil
- Micronutrient InitiativeResearch and Evaluation180 Elgin Street, Suite 1000OttawaONCanadaK2P 2K3
| | - Sant‐Rayn Pasricha
- MRC Weatherall Institute of Molecular Medicine, University of OxfordMRC Human Immunology UnitOxfordOxfordshireUKOX3 9DS
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Saraon T, Katz SD. Targeting Iron Deficiency Anemia in Heart Failure. Prog Cardiovasc Dis 2015; 58:407-15. [PMID: 26657161 DOI: 10.1016/j.pcad.2015.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 11/27/2015] [Indexed: 12/12/2022]
Abstract
Iron deficiency is common in heart failure (HF) patients, and is associated with increased risk of adverse clinical outcomes. Clinical trials of intravenous iron supplementation in iron-deficient HF patients have demonstrated short-term improvement in functional capacity and quality of life. In some trials, the benefits of iron supplementation were independent of the hemoglobin levels. Additional investigations of iron supplementation are needed to characterize the mechanisms contributing to clinical benefit and long-term safety in HF.
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Affiliation(s)
- Tajinderpal Saraon
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, NY
| | - Stuart D Katz
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, NY.
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Pratt JJ, Khan KS. Non-anaemic iron deficiency - a disease looking for recognition of diagnosis: a systematic review. Eur J Haematol 2015; 96:618-28. [DOI: 10.1111/ejh.12645] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 01/01/2023]
Affiliation(s)
| | - Khalid S. Khan
- Centre for Primary Care and Public Health; Barts and The London School of Medicine & Dentistry; London
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Barberan-Garcia A, Rodríguez DA, Blanco I, Gea J, Torralba Y, Arbillaga-Etxarri A, Barberà JA, Vilaró J, Roca J, Orozco-Levi M. Non-anaemic iron deficiency impairs response to pulmonary rehabilitation in COPD. Respirology 2015; 20:1089-95. [DOI: 10.1111/resp.12591] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 03/13/2015] [Accepted: 04/07/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Anael Barberan-Garcia
- Hospital Clínic de Barcelona; Thorax Clinic Institute; Respiratory Diagnostic Centre; Barcelona Catalonia Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS); University of Barcelona; Barcelona Catalonia Spain
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES); Barcelona Catalonia Spain
| | - Diego Agustín Rodríguez
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES); Barcelona Catalonia Spain
- Parc de Salut Mar; Pulmonary Medicine Department; Hospital del Mar Medical Research Institute (IMIM); Pompeu Fabra University; Barcelona Catalonia Spain
| | - Isabel Blanco
- Hospital Clínic de Barcelona; Thorax Clinic Institute; Respiratory Diagnostic Centre; Barcelona Catalonia Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS); University of Barcelona; Barcelona Catalonia Spain
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES); Barcelona Catalonia Spain
| | - Joaquim Gea
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES); Barcelona Catalonia Spain
- Parc de Salut Mar; Pulmonary Medicine Department; Hospital del Mar Medical Research Institute (IMIM); Pompeu Fabra University; Barcelona Catalonia Spain
| | - Yolanda Torralba
- Hospital Clínic de Barcelona; Thorax Clinic Institute; Respiratory Diagnostic Centre; Barcelona Catalonia Spain
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES); Barcelona Catalonia Spain
| | - Ane Arbillaga-Etxarri
- Epidemiology Department; Centre for Research in Environmental Epidemiology (CREAL); Barcelona Catalonia Spain
- Center for Biomedical Network Research in Epidemiology and Public Health (CIBERESP); Barcelona Catalonia Spain
| | - Joan Albert Barberà
- Hospital Clínic de Barcelona; Thorax Clinic Institute; Respiratory Diagnostic Centre; Barcelona Catalonia Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS); University of Barcelona; Barcelona Catalonia Spain
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES); Barcelona Catalonia Spain
| | - Jordi Vilaró
- Blanquerna Health Sciences Faculty; Ramon Llull University; Barcelona Catalonia Spain
| | - Josep Roca
- Hospital Clínic de Barcelona; Thorax Clinic Institute; Respiratory Diagnostic Centre; Barcelona Catalonia Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS); University of Barcelona; Barcelona Catalonia Spain
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES); Barcelona Catalonia Spain
| | - Mauricio Orozco-Levi
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES); Barcelona Catalonia Spain
- Parc de Salut Mar; Pulmonary Medicine Department; Hospital del Mar Medical Research Institute (IMIM); Pompeu Fabra University; Barcelona Catalonia Spain
- Respiratory Department; Cardiovascular Foundation from Colombia Floridablanca; Santander Colombia
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Burden RJ, Morton K, Richards T, Whyte GP, Pedlar CR. Is iron treatment beneficial in, iron-deficient but non-anaemic (IDNA) endurance athletes? A systematic review and meta-analysis. Br J Sports Med 2014; 49:1389-97. [DOI: 10.1136/bjsports-2014-093624] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2014] [Indexed: 12/14/2022]
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McClung JP, Gaffney-Stomberg E, Lee JJ. Female athletes: a population at risk of vitamin and mineral deficiencies affecting health and performance. J Trace Elem Med Biol 2014; 28:388-92. [PMID: 25060302 DOI: 10.1016/j.jtemb.2014.06.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Adequate vitamin and mineral status is essential for optimal human health and performance. Female athletes could be at risk for vitamin and mineral insufficiency due to inadequate dietary intake, menstruation, and inflammatory responses to heavy physical activity. Recent studies have documented poor iron status and associated declines in both cognitive and physical performance in female athletes. Similarly, insufficient vitamin D and calcium status have been observed in female athletes, and may be associated with injuries, such as stress fracture, which may limit a female athlete's ability to participate in regular physical activity. This review will focus on recent studies detailing the prevalence of poor vitamin and mineral status in female athletes, using iron, vitamin D, and calcium as examples. Factors affecting the dietary requirement for these vitamins and minerals during physical training will be reviewed. Lastly, countermeasures for the prevention of inadequate vitamin and mineral status will be described.
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Affiliation(s)
- James P McClung
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine (USARIEM), Natick, MA 01760, United States.
| | - Erin Gaffney-Stomberg
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine (USARIEM), Natick, MA 01760, United States
| | - Jane J Lee
- Department of Nutritional Science, University of Texas at Austin, Austin, TX 78712, United States
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Woods A, Garvican-Lewis LA, Saunders PU, Lovell G, Hughes D, Fazakerley R, Anderson B, Gore CJ, Thompson KG. Four weeks of IV iron supplementation reduces perceived fatigue and mood disturbance in distance runners. PLoS One 2014; 9:e108042. [PMID: 25247929 PMCID: PMC4172582 DOI: 10.1371/journal.pone.0108042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 08/25/2014] [Indexed: 01/01/2023] Open
Abstract
Purpose To determine the effect of intravenous iron supplementation on performance, fatigue and overall mood in runners without clinical iron deficiency. Methods Fourteen distance runners with serum ferritin 30–100 µg·L−1 were randomly assigned to receive three blinded injections of intravenous ferric-carboxymaltose (2 ml, 100 mg, IRON) or normal saline (PLACEBO) over four weeks (weeks 0, 2, 4). Athletes performed a 3,000 m time trial and 10×400 m monitored training session on consecutive days at week 0 and again following each injection. Hemoglobin mass (Hbmass) was assessed via carbon monoxide rebreathing at weeks 0 and 6. Fatigue and mood were determined bi-weekly until week 6 via Total Fatigue Score (TFS) and Total Mood Disturbance (TMD) using the Brief Fatigue Inventory and Brunel Mood Scale. Data were analyzed using magnitude-based inferences, based on the unequal variances t-statistic and Cohen's Effect sizes (ES). Results Serum ferritin increased in IRON only (Week 0: 62.8±21.9, Week 4: 128.1±46.6 µg·L−1; p = 0.002) and remained elevated two weeks after the final injection (127.0±66.3 µg·L−1, p = 0.01), without significant changes in Hbmass. Supplementation had a moderate effect on TMD of IRON (ES -0.77) with scores at week 6 lower than PLACEBO (ES -1.58, p = 0.02). Similarly, at week 6, TFS was significantly improved in IRON vs. PLACEBO (ES –1.54, p = 0.05). There were no significant improvements in 3,000 m time in either group (Week 0 vs. Week 4; Iron: 625.6±55.5 s vs. 625.4±52.7 s; PLACEBO: 624.8±47.2 s vs. 639.1±59.7 s); but IRON reduced their average time for the 10×400 m training session at week 2 (Week 0: 78.0±6.6 s, Week 2: 77.2±6.3; ES–0.20, p = 0.004). Conclusion During 6 weeks of training, intravenous iron supplementation improved perceived fatigue and mood of trained athletes with no clinical iron deficiency, without concurrent improvements in oxygen transport capacity or performance.
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Affiliation(s)
- Amy Woods
- University of Canberra, Research Institute for Sport and Exercise, Canberra, Australia
| | - Laura A. Garvican-Lewis
- University of Canberra, Research Institute for Sport and Exercise, Canberra, Australia
- Australian Institute of Sport, Canberra, Australia
- * E-mail:
| | | | - Greg Lovell
- Australian Institute of Sport, Canberra, Australia
| | - David Hughes
- Australian Institute of Sport, Canberra, Australia
| | | | - Bev Anderson
- Australian Institute of Sport, Canberra, Australia
| | | | - Kevin G. Thompson
- University of Canberra, Research Institute for Sport and Exercise, Canberra, Australia
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Vullaganti S, Goldsmith J, Teruya S, Alvarez J, Helmke S, Maurer MS. Cardiovascular effects of hemoglobin response in patients receiving epoetin alfa and oral iron in heart failure with a preserved ejection fraction. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2014; 11:100-5. [PMID: 25009558 PMCID: PMC4076448 DOI: 10.3969/j.issn.1671-5411.2014.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/03/2014] [Accepted: 05/10/2014] [Indexed: 02/06/2023]
Abstract
Background Previous data from a recently conducted prospective, single blind randomized clinical trial among community dwelling older patients with heart failure with a preserved ejection fraction (HFPEF) and anemia randomized to treatment with epoetin alfa (erythropoiesis-stimulating agents, ESA) vs. placebo did not demonstrate significant benefits of therapy regarding left ventricular (LV) structure, functional capacity, or quality of life (QOL). However, several patients randomized to the treatment arm were non-responders with a suboptimal increase in hemoglobin. All patients in the trial also received oral ferrous gluconate, which could have contributed to increases in hemoglobin observed in those receiving placebo. Accordingly, we performed an analysis separating patients into responders vs. non-responders in order to determine if measured improvement in anemia would have any effect on clinical endpoints. Methods A total of 56 patients (age 77 ± 11 years, 68% female) were recruited who had anemia defined as a hemoglobin of ≤ 12 g/dL (average, 10.4 ± 1 g/dL) with HFPEF defined as having NHANES-CHF (National Health And Nutrition Examination Survey: Congestive Heart Failure) criteria score of ≥ 3 and an ejection fraction of > 40% (average EF = 63% ± 15%). Patients were randomly allocated to receive either ESA and ferrous gluconate or ferrous gluconate only. In this analysis, a responder was defined as a patient with an increase of 1 g/dL in the first 4 weeks of the trial. Results Nineteen subjects were classified as responders compared to 33 non-responders. While the average hemoglobin increased significantly at the end of 6 months for responders (1.8 ± 0.3 vs. 0.8 ± 0.2 g/dL, P = 0.004), 50% of the subjects assigned to ESA were non-responders. Left ventricular function including ejection fraction (P = 0.32) and end diastolic volume (P = 0.59) was unchanged in responders compared to non-responders. Responders also showed no significant improvements in New York Heart Association (NYHA) class, Six Minute Walk Test (6 MWT) and peak VO2. Though QOL improved significantly within each group, there was no difference between the two. Conclusions A significant hemoglobin response to anemia treatment with ESA and oral iron does not lead to differences in LV remodeling, functional status, or QOL. Additionally, a significant percent of older adults with HFPEF and anemia do not respond to ESA therapy. Given the results of this small trial, it appears as though using objective improvements in anemia as a marker in older adult subjects with HFPEF does not have significant clinical utility.
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Affiliation(s)
- Sirish Vullaganti
- Clinical Cardiovascular Research Lab for the Elderly, Allen Hospital of New York Presbyterian Hospital, 5141 Broadway, 3 Field West, Room 037, New York, NY 10032, USA
| | - Jeff Goldsmith
- Columbia Mailman School of Public Health, 722 W 168th Street, Rm 630, New York, NY 10032, USA
| | - Sergio Teruya
- Clinical Cardiovascular Research Lab for the Elderly, Allen Hospital of New York Presbyterian Hospital, 5141 Broadway, 3 Field West, Room 037, New York, NY 10032, USA
| | - Julissa Alvarez
- Clinical Cardiovascular Research Lab for the Elderly, Allen Hospital of New York Presbyterian Hospital, 5141 Broadway, 3 Field West, Room 037, New York, NY 10032, USA
| | - Stephen Helmke
- Clinical Cardiovascular Research Lab for the Elderly, Allen Hospital of New York Presbyterian Hospital, 5141 Broadway, 3 Field West, Room 037, New York, NY 10032, USA
| | - Mathew S Maurer
- Clinical Cardiovascular Research Lab for the Elderly, Allen Hospital of New York Presbyterian Hospital, 5141 Broadway, 3 Field West, Room 037, New York, NY 10032, USA
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DELLAVALLE DIANEM, HAAS JERED. Iron Supplementation Improves Energetic Efficiency in Iron-Depleted Female Rowers. Med Sci Sports Exerc 2014; 46:1204-15. [DOI: 10.1249/mss.0000000000000208] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pasricha SR, Low M, Thompson J, Farrell A, De-Regil LM. Iron supplementation benefits physical performance in women of reproductive age: a systematic review and meta-analysis. J Nutr 2014; 144:906-14. [PMID: 24717371 DOI: 10.3945/jn.113.189589] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Animal and human observational studies suggest that iron deficiency impairs physical exercise performance, but findings from randomized trials on the effects of iron are equivocal. Iron deficiency and anemia are especially common in women of reproductive age (WRA). Clear evidence of benefit from iron supplementation would inform clinical and public health guidelines. Therefore, we performed a systematic review and meta-analysis to determine the effect of iron supplementation compared with control on exercise performance in WRA. We searched the Cochrane Central Register of Clinical Trials, MEDLINE, Scopus (comprising Embase and MEDLINE), WHO regional databases, and other sources in July 2013. Randomized controlled trials that measured exercise outcomes in WRA randomized to daily oral iron supplementation vs. control were eligible. Random-effects meta-analysis was used to calculate mean differences (MDs) and standardized MDs (SMDs). Risk of bias was assessed using the Cochrane risk-of-bias tool. Of 6757 titles screened, 24 eligible studies were identified, 22 of which contained extractable data. Only 3 studies were at overall low risk of bias. Iron supplementation improved both maximal exercise performance, demonstrated by an increase in maximal oxygen consumption (VO2 max) [for relative VO2 max, MD: 2.35 mL/(kg ⋅ min); 95% CI: 0.82, 3.88; P = 0.003, 18 studies; for absolute VO2 max, MD: 0.11 L/min; 95% CI: 0.03, 0.20; P = 0.01, 9 studies; for overall VO2 max, SMD: 0.37; 95% CI: 0.11, 0.62; P = 0.005, 20 studies], and submaximal exercise performance, demonstrated by a lower heart rate (MD: -4.05 beats per minute; 95% CI: -7.25, -0.85; P = 0.01, 6 studies) and proportion of VO2 max (MD: -2.68%; 95% CI: -4.94, -0.41; P = 0.02, 6 studies) required to achieve defined workloads. Daily iron supplementation significantly improves maximal and submaximal exercise performance in WRA, providing a rationale to prevent and treat iron deficiency in this group. This trial was registered with PROSPERO (http://www.crd.york.ac.uk/PROSPERO/prospero.asp) as CRD42013005166.
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Affiliation(s)
- Sant-Rayn Pasricha
- Nossal Institute for Global Health, School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia Medical Research Council (MRC) Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Michael Low
- Department of Clinical Haematology and Bone Marrow Transplant, The Alfred Hospital, Melbourne, VIC, Australia
| | - Jane Thompson
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
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Abstract
Iron is a trace mineral that is highly significant to endurance athletes. Iron is critical to optimal athletic performance because of its role in energy metabolism, oxygen transport, and acid-base balance. Endurance athletes are at increased risk for suboptimal iron status, with potential negative consequences on performance, because of the combination of increased iron needs and inadequate dietary intake. This review paper summarizes the role of iron in maximal and submaximal exercise and describes the effects of iron deficiency on exercise performance. Mechanisms that explain the increased risk of iron deficiency in endurance athletes, including exercise-associated inflammation and hepcidin release on iron sequestration, are described. Information on screening athletes for iron deficiency is presented, and suggestions to increase iron intake through diet modification or supplemental iron are provided.
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Affiliation(s)
- Pamela S Hinton
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA
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McClung JP, Murray-Kolb LE. Iron Nutrition and Premenopausal Women: Effects of Poor Iron Status on Physical and Neuropsychological Performance. Annu Rev Nutr 2013; 33:271-88. [DOI: 10.1146/annurev-nutr-071812-161205] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- James P. McClung
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine (USARIEM), Natick, Massachusetts 01760;
| | - Laura E. Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania 16802
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Filippatos G, Farmakis D, Colet JC, Dickstein K, Lüscher TF, Willenheimer R, Parissis J, Gaudesius G, Mori C, von Eisenhart Rothe B, Greenlaw N, Ford I, Ponikowski P, Anker SD. Intravenous ferric carboxymaltose in iron-deficient chronic heart failure patients with and without anaemia: a subanalysis of the FAIR-HF trial. Eur J Heart Fail 2013; 15:1267-76. [PMID: 23787722 PMCID: PMC3806282 DOI: 10.1093/eurjhf/hft099] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Aims Therapy with i.v. iron in patients with chronic heart failure (CHF) and iron deficiency (ID) improves symptoms, functional capacity, and quality of life. We sought to investigate whether these beneficial outcomes are independent of anaemia. Methods and results FAIR-HF randomized 459 patients with CHF [NYHA class II or III, LVEF ≤40% (NYHA II) or ≤45% (NYHA III)] and ID to i.v. iron as ferric carboxymaltose (FCM) or placebo in a 2:1 ratio. We analysed the efficacy and safety according to the presence or absence of anaemia (haemoglobin ≤120 g/L) at baseline. Of 459 patients, 232 had anaemia at baseline (51%). The effect of FCM on the primary endpoints of self-reported Patient Global Assessment (PGA) and NYHA class at week 24 was similar in patients with and without anaemia [odds ratio (OR) for improvement, 2.48 vs. 2.60, P = 0.97 for PGA and 1.90 vs. 3.39, P = 0.51 for NYHA). Results were also similar for the secondary endpoints, including PGA and NYHA at weeks 4 and 12, 6 min walk test distance, Kansas City Cardiomyopathy Questionnaire overall score, and European Quality of Life-5 Dimensions Visual Analogue Scale at most time points. Regarding safety, no differences were noticed in the rates of death or first hospitalization between FCM and placebo both in anaemic and in non-anaemic patients. Conclusions Treatment of ID with FCM in patients with CHF is equally efficacious and shows a similar favourable safety profile irrespective of anaemia. Iron status should be assessed in symptomatic CHF patients both with and without anaemia and treatment of ID should be considered.
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Howard LSGE, Watson GMJ, Wharton J, Rhodes CJ, Chan K, Khengar R, Robbins PA, Kiely DG, Condliffe R, Elliott CA, Pepke-Zaba J, Sheares K, Morrell NW, Davies R, Ashby D, Gibbs JSR, Wilkins MR. Supplementation of iron in pulmonary hypertension: Rationale and design of a phase II clinical trial in idiopathic pulmonary arterial hypertension. Pulm Circ 2013; 3:100-7. [PMID: 23662181 PMCID: PMC3641712 DOI: 10.4103/2045-8932.109923] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Our aim is to assess the safety and potential clinical benefit of intravenous iron (Ferinject) infusion in iron deficient patients with idiopathic pulmonary arterial hypertension (IPAH). Iron deficiency in the absence of anemia (1) is common in patients with IPAH; (2) is associated with inappropriately raised levels of hepcidin, the key regulator of iron homeostasis; and (3) correlates with disease severity and worse clinical outcomes. Oral iron absorption may be impeded by reduced absorption due to elevated hepcidin levels. The safety and benefits of parenteral iron replacement in IPAH are unknown. Supplementation of Iron in Pulmonary Hypertension (SIPHON) is a Phase II, multicenter, double-blind, randomized, placebo-controlled, crossover clinical trial of iron in IPAH. At least 60 patients will be randomized to intravenous ferric carboxymaltose (Ferinject) or saline placebo with a crossover point after 12 weeks of treatment. The primary outcome will be the change in resting pulmonary vascular resistance from baseline at 12 weeks, measured by cardiac catheterization. Secondary measures include resting and exercise hemodynamics and exercise performance from serial bicycle incremental and endurance cardiopulmonary exercise tests. Other secondary measurements include serum iron indices, 6-Minute Walk Distance, WHO functional class, quality of life score, N-terminal pro-brain natriuretic peptide (NT-proBNP), and cardiac anatomy and function from cardiac magnetic resonance. We propose that intravenous iron replacement will improve hemodynamics and clinical outcomes in IPAH. If the data supports a potentially useful therapeutic effect and suggest this drug is safe, the study will be used to power a Phase III study to address efficacy.
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Affiliation(s)
- Luke S G E Howard
- Department of Cardiology, National Pulmonary Hypertension Service, Hammersmith Hospital, London, United Kingdom ; National Heart and Lung Institute, London, United Kingdom
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Casgrain A, Collings R, Harvey LJ, Hooper L, Fairweather-Tait SJ. Effect of iron intake on iron status: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2012; 96:768-80. [PMID: 22932280 DOI: 10.3945/ajcn.112.040626] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The response of status biomarkers to an increase in iron supply depends on several physiologic and environmental factors, which make it difficult to predict the outcome of an intervention. OBJECTIVE We assessed effects of baseline iron status, sex, menopausal status, duration of intervention, iron form, and daily dose on the change in iron status in response to iron supplementation. DESIGN A systematic review of randomized controlled trials (RCTs) of iron-supplementation and -fortification trials that assessed effects on hemoglobin, serum ferritin (SF), soluble transferrin receptor, or body iron was conducted. Subgrouping and straight-line and curved metaregression were used to describe the magnitude and dose-responsiveness of effect modifiers with respect to changes in status. RESULTS Forty-one RCTs were included; none of the RCTs were judged at low risk of bias. Random-effects meta-analyses showed that iron supplementation significantly improved iron status but with high levels of heterogeneity. Metaregression explained approximately one-quarter of between-study variance in effect size. There were clear effects on SF with study duration (increase in SF concentration/wk: 0.51 μg/L; 95% CI: 0.02, 1.00 μg/L; P = 0.04) and dose (increase in SF concentration/g Fe: 0.10 μg/L; 95% CI: 0.01, 0.20 μg/L; P = 0.036) and on hemoglobin concentrations with baseline iron status [-0.08 g/dL (95% CI: 0.15, 0.00 g/dL) per 10-μg/L increase in baseline SF concentration; P = 0.02]. Insufficient data were available to assess effects on body iron, sex, or menopausal status. CONCLUSION Quantitative relations between baseline iron status, study duration, and iron dose on changes in iron-status biomarkers, which were generated from the meta-analyses, can be used to predict effects of trials of iron supplementation and fortification and to design iron-intervention programs.
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Affiliation(s)
- Amelie Casgrain
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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Abstract
The present study examines the effect of animal-source-food (ASF) intake on arm muscle area growth as part of a larger study examining causal links between ASF intake, growth rate, physical activity, cognitive function and micronutrient status in Kenyan schoolchildren. This randomised, controlled feeding intervention study was designed with three isoenergetic feeding interventions of meat, milk, and plain traditional vegetable stew (githeri), and a control group receiving no snack. A total of twelve elementary schools were randomly assigned to interventions, with three schools per group, and two cohorts of 518 and 392 schoolchildren were enrolled 1 year apart. Children in each cohort were given feedings at school and studied for three school terms per year over 2 years, a total of 9 months per year: cohort I from 1998 to 2000 and cohort II from 1999 to 2001. Food intake was assessed by 24 h recall every 1-2 months and biochemical analysis for micronutrient status conducted annually (in cohort I only). Anthropometric measurements included height, weight, triceps skinfold (TSF) and mid-upper-arm circumference (MUAC). Mid-upper-arm muscle area (MAMA) and mid-upper-arm fat area (MAFA) were calculated. The two cohorts were combined for analyses. The meat group showed the steepest rates of gain in MUAC and MAMA over time, and the milk group showed the next largest significant MUAC and MAMA gain compared with the plain githeri and control groups (P< 0.05). The meat group showed the least increase in TSF and MAFA of all groups. These findings have implications for increasing micronutrient intake and lean body mass in primary schoolchildren consuming vegetarian diets.
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Peirano P, Algarin C, Chamorro R, Manconi M, Lozoff B, Ferri R. Iron deficiency anemia in infancy exerts long-term effects on the tibialis anterior motor activity during sleep in childhood. Sleep Med 2012; 13:1006-12. [PMID: 22770698 DOI: 10.1016/j.sleep.2012.05.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 04/19/2012] [Accepted: 05/07/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To explore the eventual connection between iron deficiency anemia (IDA) in infancy and altered leg movements during sleep in a 10-year follow-up study in children who did or did not have IDA in infancy. SUBJECTS AND METHODS Polysomnographic studies were performed in 32 10-year-old children (13 females and 19 males) who had IDA in infancy and 26 peers (10 females and 16 males) who were nonanemic controls. The time structure of their polysomnographically recorded leg movements (LM) was analyzed by means of an approach particularly able to consider their quantity, periodicity, and distribution during the night. RESULTS All LM indexes and those related to periodic LM during sleep (PLMS) were slightly higher in the former IDA group than in the control group, but not always significant. The Periodicity index during NREM sleep was higher and was reflected by a small but significant increase in PLMS separated by 10-50s intervals. PLMS index tended to be higher in former IDA children than in controls throughout the whole night. CONCLUSION The association between IDA in infancy, despite iron therapy, and PLMS in childhood could lead to new research in this area. Indeed, transient infantile IDA, a common nutritional problem among human infants, may turn out to be important for understanding the mechanisms of PLMS or restless legs syndrome, which are common in adulthood.
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Affiliation(s)
- Patricio Peirano
- Laboratory of Sleep and Functional Neurobiology, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile.
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Crouter SE, DellaValle DM, Haas JD. Relationship between physical activity, physical performance, and iron status in adult women. Appl Physiol Nutr Metab 2012; 37:697-705. [PMID: 22624679 DOI: 10.1139/h2012-044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Iron deficiency affects approximately 16% of US females 18-45 years old. Iron is a key component of heme-containing proteins, which are essential for oxygen transport throughout the body. With low iron levels, performance and intense physical activity may be compromised. Thus, the purpose of this study was to examine the relationship between iron status, physical performance, and physical activity in 18- to 45-year-old females. Participants (N = 109) were screened for iron status using a venous blood sample, had their height and mass measured, and self-reported their physical activity level. The screening was used to match iron-depleted nonanemic females (hemoglobin, Hgb > 120 g·L(-1); serum ferritin, sFer < 20 µg·L(-1)) to females with normal iron levels. After participant matching, they had their body composition measured, performed three cycle ergometer tests (maximal, endurance, and efficiency), and wore an ActiGraph GT1M accelerometer for five consecutive days, except when sleeping or during water activities. The final sample consisted of 25 iron-depleted participants and 24 with normal iron levels. Key findings were as follows: (i) after controlling for fat-free mass and vigorous physical activity, iron-depleted females had a significantly lower [Formula: see text]O(2) at ventilatory threshold compared with those with normal iron levels (P < 0.05); and (ii) after controlling for age, iron-depleted females spent significantly more time in sedentary behaviors and significantly less time in light physical activity than those with normal iron levels (P < 0.05). The increased sedentary time in iron-depleted females may contribute to excess mass gain over time; however, further investigation is needed to confirm these results.
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Affiliation(s)
- Scott E Crouter
- Cornell University, Division of Nutritional Sciences, Ithaca, NY 14853, USA.
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Abstract
Adequate body stores of iron are necessary for optimal endurance exercise performance. Severe iron depletion resulting in overt iron-deficiency anemia clearly depresses endurance fitness, but it is not clear if milder degrees of iron deficiency (low serum ferritin with normal hemoglobin levels) impair physical capacity. The question is an important one for athletes, particularly females, who are particularly prone to iron deficiency without anemia. This review examines research data, in both animals and humans, which have addressed this issue. Constructing guidelines based on this often-conflicting body of information is difficult. Routine screening is advocated for at-risk athletes, particularly elite-level female competitors in distance sports, and, although controversial, many authorities recommend iron treatment for athletes with hypoferritemia (ferritin <12-20 ng/mL), even without overt anemia. However, “blind” supplementation with oral iron by athletes is not recommended.
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Affiliation(s)
- Thomas Rowland
- Department of Pediatrics, Baystate Medical Center, Springfield, Massachusetts
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Heming N, Montravers P, Lasocki S. Iron deficiency in critically ill patients: highlighting the role of hepcidin. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:210. [PMID: 21457511 PMCID: PMC3219406 DOI: 10.1186/cc9992] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- Nicholas Heming
- Département d'Anesthésie-Réanimation Chirurgicale, Centre Hospitalo-Universitaire d'Angers, Université d'Angers, Angers, France
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Peeling P, Dawson B, Goodman C, Landers G, Trinder D. Athletic induced iron deficiency: new insights into the role of inflammation, cytokines and hormones. Eur J Appl Physiol 2008; 103:381-91. [PMID: 18365240 DOI: 10.1007/s00421-008-0726-6] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2008] [Indexed: 02/06/2023]
Abstract
Iron is utilised by the body for oxygen transport and energy production, and is therefore essential to athletic performance. Commonly, athletes are diagnosed as iron deficient, however, contrasting evidence exists as to the severity of deficiency and the effect on performance. Iron losses can result from a host of mechanisms during exercise such as hemolysis, hematuria, sweating and gastrointestinal bleeding. Additionally, recent research investigating the anemia of inflammation during states of chronic disease has allowed us to draw some comparisons between unhealthy populations and athletes. The acute-phase response is a well-recognised reaction to both exercise and disease. Elevated cytokine levels from such a response have been shown to increase the liver production of the hormone Hepcidin. Hepcidin up-regulation has a negative impact on the iron transport and absorption channels within the body, and may explain a potential new mechanism behind iron deficiency in athletes. This review will attempt to explore the current literature that exits in this new area of iron metabolism and exercise.
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Affiliation(s)
- Peter Peeling
- School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, WA, Australia.
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Okonko DO, Grzeslo A, Witkowski T, Mandal AKJ, Slater RM, Roughton M, Foldes G, Thum T, Majda J, Banasiak W, Missouris CG, Poole-Wilson PA, Anker SD, Ponikowski P. Effect of intravenous iron sucrose on exercise tolerance in anemic and nonanemic patients with symptomatic chronic heart failure and iron deficiency FERRIC-HF: a randomized, controlled, observer-blinded trial. J Am Coll Cardiol 2008; 51:103-12. [PMID: 18191732 DOI: 10.1016/j.jacc.2007.09.036] [Citation(s) in RCA: 414] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 08/14/2007] [Accepted: 09/11/2007] [Indexed: 01/01/2023]
Abstract
OBJECTIVES We tested the hypothesis that intravenous iron improves exercise tolerance in anemic and nonanemic patients with symptomatic chronic heart failure (CHF) and iron deficiency. BACKGROUND Anemia is common in heart failure. Iron metabolism is disturbed, and administration of iron might improve both symptoms and exercise tolerance. METHODS We randomized 35 patients with CHF (age 64 +/- 13 years, peak oxygen consumption [pVO2] 14.0 +/- 2.7 ml/kg/min) to 16 weeks of intravenous iron (200 mg weekly until ferritin >500 ng/ml, 200 mg monthly thereafter) or no treatment in a 2:1 ratio. Ferritin was required to be <100 ng/ml or ferritin 100 to 300 ng/ml with transferrin saturation <20%. Patients were stratified according to hemoglobin levels (<12.5 g/dl [anemic group] vs. 12.5 to 14.5 g/dl [nonanemic group]). The observer-blinded primary end point was the change in absolute pVO2. RESULTS The difference (95% confidence interval [CI]) in the mean changes from baseline to end of study between the iron and control groups was 273 (151 to 396) ng/ml for ferritin (p < 0.0001), 0.1 (-0.8 to 0.9) g/dl for hemoglobin (p = 0.9), 96 (-12 to 205) ml/min for absolute pVO2 (p = 0.08), 2.2 (0.5 to 4.0) ml/kg/min for pVO2/kg (p = 0.01), 60 (-6 to 126) s for treadmill exercise duration (p = 0.08), -0.6 (-0.9 to -0.2) for New York Heart Association (NYHA) functional class (p = 0.007), and 1.7 (0.7 to 2.6) for patient global assessment (p = 0.002). In anemic patients (n = 18), the difference (95% CI) was 204 (31 to 378) ml/min for absolute pVO2 (p = 0.02), and 3.9 (1.1 to 6.8) ml/kg/min for pVO2/kg (p = 0.01). In nonanemic patients, NYHA functional class improved (p = 0.06). Adverse events were similar. CONCLUSIONS Intravenous iron loading improved exercise capacity and symptoms in patients with CHF and evidence of abnormal iron metabolism. Benefits were more evident in anemic patients. (Effect of Intravenous Ferrous Sucrose on Exercise Capacity in Chronic Heart Failure; http://www.clinicaltrials.gov/ct/show/NCT00125996; NCT00125996).
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McCann JC, Ames BN. An overview of evidence for a causal relation between iron deficiency during development and deficits in cognitive or behavioral function. Am J Clin Nutr 2007; 85:931-45. [PMID: 17413089 DOI: 10.1093/ajcn/85.4.931] [Citation(s) in RCA: 265] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This review, intended for a broad scientific readership, summarizes evidence relevant to whether a causal relation exists between dietary iron deficiency with (ID+A) or without (ID-A) anemia during development and deficits in subsequent cognitive or behavioral performance. An overview of expert opinion and major evidence in humans and animals is provided. Cognitive and behavioral effects observed in humans with ID-A and in animals with ID+/-A are provided in tables. The degree to which 5 conditions of causality are satisfied and whether deleterious effects of ID-A might be expected to occur are discussed. On the basis of the existing literature, our major conclusions are as follows. Although most of the 5 conditions of causality (association, plausible biological mechanisms, dose response, ability to manipulate the effect, and specificity of cause and effect) are partially satisfied in humans, animals, or both, a causal connection has not been clearly established. In animals, deficits in motor activity are consistently associated with severe ID+A, but adverse effects on performance in tests that target cognitive function have not been clearly shown. Resistance to iron treatment was observed in most trials of children <2 y of age with ID+A, but not in older children. Similar observations were made in rodents when ID+A occurred before rather than after weaning. In children >2 y of age and in adolescents with ID-A, evidence suggests cognitive or behavioral deficits; however, the surprisingly small number of studies conducted in either humans or animals prevents a thorough assessment.
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Affiliation(s)
- Joyce C McCann
- Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, CA, USA.
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Newman B. Iron depletion by whole-blood donation harms menstruating females: The current whole-blood-collection paradigm needs to be changed. Transfusion 2006; 46:1667-81. [PMID: 17002622 DOI: 10.1111/j.1537-2995.2006.00969.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Bruce Newman
- American Red Cross, Southeastern Michigan Region, Detroit, Michigan 48232, USA.
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Hinton PS, Sinclair LM. Iron supplementation maintains ventilatory threshold and improves energetic efficiency in iron-deficient nonanemic athletes. Eur J Clin Nutr 2006; 61:30-9. [PMID: 16835600 DOI: 10.1038/sj.ejcn.1602479] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the effect of iron supplementation on iron status and endurance capacity. DESIGN Randomized, double-blind iron supplementation. SETTING University of Missouri-Columbia and surrounding community. SUBJECTS Twenty iron-deficient (serum ferritin, sFer<16 microg/l; serum transferrin receptor, sTfR>8.0 mg/l; or sTfR/log sFer index >4.5), nonanemic (hemoglobin, Hb>120 g/l, women; >130 g/l, men) men and women (18-41 years) were recruited via fliers and newspaper advertisements; 20 of 31 eligible subjects participated. INTERVENTIONS A 30 mg measure of elemental iron as ferrous sulfate or placebo daily for 6 weeks. RESULTS Dietary iron intake and physical activity did not differ between groups before or after supplementation. Iron supplementation significantly increased sFer compared to placebo (P=0.01), but did not affect Hb or hematocrit. Iron supplementation prevented the decline in ventilatory threshold (VT) observed in the placebo group from pre- to post-supplementation (P=0.01); this effect was greater in individuals with lower sFer before intervention (P<0.05). Changes in sFer from pre- to post-treatment were positively correlated with changes in VT (P=0.03), independent of supplementation. The iron group significantly increased gross energetic efficiency during the submaximal test (P=0.04). Changes in sFer were negatively correlated with changes in average respiratory exchange ratio during the submaximal test (P<0.05). CONCLUSIONS Iron supplementation significantly improves iron status and endurance capacity in iron-deficient, nonanemic trained male and female subjects.
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Affiliation(s)
- P S Hinton
- Department of Nutritional Sciences, University of Missouri, Columbia, MO 65211, USA.
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Sinclair LM, Hinton PS. Prevalence of iron deficiency with and without anemia in recreationally active men and women. ACTA ACUST UNITED AC 2005; 105:975-8. [PMID: 15942552 DOI: 10.1016/j.jada.2005.03.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objective of this study was to determine the prevalence of iron deficiency with and without anemia in a convenience sample of trained male and female adults. One hundred twenty-one adults (72 female, 49 male) involved in aerobic training (11.2+/-6.3 hr/wk for >/=6 consecutive months), ages 18 to 41 years old, participated in an iron status screening. The concentrations of hemoglobin (Hb), ferritin, and transferrin receptor were measured in serum to determine the prevalence of iron deficiency with and without anemia. Eight individuals (seven female, one male) had iron deficiency with anemia (serum ferritin <16 microg/L; Hb<120 g/L female, <136 g/L male). Iron deficiency without anemia (serum ferritin </=16 microg/L) was found in 29% of female and 4% of male subjects. Determination of iron deficiency without anemia using the transferrin receptor-ferritin index (serum transferrin receptor:log serum ferritin>/=4.5) found 36% of female and 6% of male subjects to be iron deficient without anemia. Recreational athletes should be screened for iron deficiency without anemia using serum ferritin, serum transferrin receptor, and Hb.
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Affiliation(s)
- Lisa M Sinclair
- Department of Nutritional Sciences, University of Missouri-Columbia, 65211, USA
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Abstract
Optimal athletic performance depends on proper function of many organs, including the blood. This is underscored by the focus of endurance athletes on increased hemoglobin through training at altitude or exogenous erythropoietin. Several other aspects of the hematologic system can also affect or be influenced by physical activity. In this article, the authors briefly discuss inherited abnormalities of the blood that can manifest themselves in athletes. We then discuss the effects of exercise on the blood, and acquired abnormalities of blood cells or coagulation parameters that occur in athletes, and that can influence performance or cause other symptoms.
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Affiliation(s)
- Kelly W Mercer
- Division of Hematology/Oncology, University of Virginia School of Medicine, Box 800716, Charlottesville, VA 22908, USA
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Vaisman N, Silverberg DS, Wexler D, Niv E, Blum M, Keren G, Soroka N, Iaina A. Correction of anemia in patients with congestive heart failure increases resting energy expenditure. Clin Nutr 2004; 23:355-61. [PMID: 15158299 DOI: 10.1016/j.clnu.2003.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2003] [Accepted: 08/23/2003] [Indexed: 11/20/2022]
Abstract
BACKGROUND & AIM Congestive heart failure (CHF) and anemia were reported to affect resting energy expenditure (REE). The aim of this study was to evaluate the effect of the correction of anemia on REE in subjects with CHF. PATIENTS AND METHODS Nine anemic patients with compensated CHF and CRF were studied before and after correction of anemia. REE was studied by an open circuit indirect calorimeter, body composition by dual-energy-X-ray absorption and total body and extracellular water by multi-frequency bioelectrical impedence. Four anemic and 5 non-anemic CHF patients who did not receive any new treatment served as controls. RESULTS After the correction of their anemia patients tended to increase weight (P<0.06), but no significant changes were observed in body composition. Daily caloric intake increased significantly (P<0.02). Ejection fraction increased (P<0.05) and pulse rate decreased significantly (P<0.001). REE and REEPP were in the normal range before correction but increased significantly afterwards (1402+/-256 vs. 1496+/-206 kcal/d, and 101+/-9 vs. 109+/-8, P<0.023 and P<0.006, respectively). CONCLUSION Correction of anemia in patients with CHF increases their REE. This can be related either to improved tissue oxygenation and/or to increased caloric intake.
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Affiliation(s)
- N Vaisman
- Unit of Clinical Nutrition, Tel-Aviv Sourasky Medical Centre, 6 Weizman Street, Tel-Aviv 64239, Israel.
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Brownlie T, Utermohlen V, Hinton PS, Haas JD. Tissue iron deficiency without anemia impairs adaptation in endurance capacity after aerobic training in previously untrained women. Am J Clin Nutr 2004; 79:437-43. [PMID: 14985219 DOI: 10.1093/ajcn/79.3.437] [Citation(s) in RCA: 192] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We previously showed that iron supplementation significantly improves iron status and maximal work capacity in previously untrained, marginally iron-deficient women with a baseline serum transferrin receptor concentration > 8.0 mg/L. However, the effect of transferrin receptor status on adaptation in endurance capacity after aerobic training in these subjects has not been fully explored. OBJECTIVE Our objective was to examine the effect of baseline serum transferrin receptor status on adaptations in endurance capacity. DESIGN Forty-one untrained, iron-depleted, nonanemic women were randomly assigned to receive either 100 mg FeSO(4) or a placebo for 6 wk in a double-blind trial. All subjects trained on cycle ergometers 5 d/wk for the last 4 wk of the study. Endurance capacity was assessed at baseline and after treatment by using a 15-km time trial conducted on a cycle ergometer. RESULTS Significant treatment effects were observed for time to complete the 15-km time trial, work rate, and percentage of maximal oxygen uptake in subjects with a baseline serum transferrin receptor concentration > 8.0 mg/L. No significant treatment effects were observed in subjects with a normal baseline transferrin receptor concentration. CONCLUSIONS Our findings suggest that, in the presence of overt tissue iron deficiency, iron deficiency without anemia impairs adaptation in endurance capacity after aerobic training in previously untrained women. This impairment can be corrected with iron supplementation.
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Affiliation(s)
- Thomas Brownlie
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
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Brutsaert TD, Hernandez-Cordero S, Rivera J, Viola T, Hughes G, Haas JD. Iron supplementation improves progressive fatigue resistance during dynamic knee extensor exercise in iron-depleted, nonanemic women. Am J Clin Nutr 2003; 77:441-8. [PMID: 12540406 DOI: 10.1093/ajcn/77.2.441] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Tissue iron depletion may negatively affect endurance performance and muscle fatigability. OBJECTIVE We investigated tissue-level iron depletion and progressive fatigue of the quadriceps during dynamic knee-extension exercise in young women. DESIGN Twenty iron-depleted (serum ferritin < 20 micro g/L), nonanemic (hemoglobin > 110 g/L) women (macro x +/- SEM age: 29.1 +/- 1.2 y) received iron (iron group) or placebo (placebo group) for 6 wk in a randomized, double-blind trial (n = 10 per group). A protocol integrating 2-3-s maximal voluntary static contractions (MVCs) with dynamic knee extensions was used to assess fatigue. RESULTS No significant differences between the groups in baseline iron status, MVC at rest, or MVC at the end of the protocol were observed. After treatment, serum iron and transferrin saturation increased significantly in the iron group (P = 0.02 and P = 0.03, respectively). Serum transferrin receptor concentrations increased significantly in the placebo group (P < 0.01) but not in the iron group. After treatment, the rate of decrease in MVC was attenuated in the iron group but not in the placebo group (P = 0.01). In the iron group, MVC at the sixth minute of the fatigue protocol and MVC at the end of the protocol were approximately 15% (P = 0.04) and approximately 27% higher (P < 0.01), respectively, after treatment. These improvements were not related to changes in iron-status indexes or tissue iron stores, although power was low (< 0.50) to detect these relations. CONCLUSIONS Iron supplementation was associated with a significant improvement in muscle fatigability. Interpretation regarding the direct role of tissue iron status is limited by the study's low power to detect relations between tissue iron improvement and decreased muscle fatigue.
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Affiliation(s)
- Tom D Brutsaert
- Department of Anthropology, the State University of New York at Albany, 12222, USA.
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Haas JD, Brownlie T. Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. J Nutr 2001; 131:676S-688S; discussion 688S-690S. [PMID: 11160598 DOI: 10.1093/jn/131.2.676s] [Citation(s) in RCA: 619] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The causal relationship between iron deficiency and physical work capacity is evaluated through a systematic review of the research literature, including animal and human studies. Iron deficiency was examined along a continuum from severe iron-deficiency anemia (SIDA) to moderate iron-deficiency anemia (MIDA) to iron deficiency without anemia (IDNA). Work capacity was assessed by aerobic capacity, endurance, energetic efficiency, voluntary activity and work productivity. The 29 research reports examined demonstrated a strong causal effect of SIDA and MIDA on aerobic capacity in animals and humans. The presumed mechanism for this effect is the reduced oxygen transport associated with anemia; tissue iron deficiency may also play a role through reduced cellular oxidative capacity. Endurance capacity was also compromised in SIDA and MIDA, but the strong mediating effects of poor cellular oxidative capacity observed in animals have not been demonstrated in humans. Energetic efficiency was affected at all levels of iron deficiency in humans, in the laboratory and the field. The reduced work productivity observed in field studies is likely due to anemia and reduced oxygen transport. The social and economic consequences of iron-deficiency anemia (IDA) and IDNA have yet to be elucidated. The biological mechanisms for the effect of IDA on work capacity are sufficiently strong to justify interventions to improve iron status as a means of enhancing human capital. This may also extend to the segment of the population experiencing IDNA in whom the effects on work capacity may be more subtle, but the number of individuals thus affected may be considerably more than those experiencing IDA.
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Affiliation(s)
- J D Haas
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853-6301, USA.
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Hinton PS, Giordano C, Brownlie T, Haas JD. Iron supplementation improves endurance after training in iron-depleted, nonanemic women. J Appl Physiol (1985) 2000; 88:1103-11. [PMID: 10710409 DOI: 10.1152/jappl.2000.88.3.1103] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Our objective was to investigate the effects of iron depletion on adaptation to aerobic exercise, assessed by time to complete a 15-km cycle ergometer test. Forty-two iron-depleted (serum ferritin <16 microg/l), nonanemic (Hb >12 g/dl) women (18-33 yr old) received 100 mg of ferrous sulfate (S) or placebo (P) per day for 6 wk in a randomized, double-blind trial. Subjects trained for 30 min/day, 5 days/wk at 75-85% of maximum heart rate for the final 4 wk of the study. There were no group differences in baseline iron status or in 15-km time. Iron supplementation increased serum ferritin and decreased transferrin receptors in the S compared with the P group. The S and P groups decreased 15-km time and respiratory exchange ratio and increased work rate during the 15-km time trial after training. The decrease in 15-km time was greater in the S than in the P group (P = 0.04) and could be partially attributed to increases in serum ferritin and Hb. These results indicate that iron deficiency without anemia impairs favorable adaptation to aerobic exercise.
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Affiliation(s)
- P S Hinton
- Division of Nutritional Sciences, Cornell University, Ithaca, New York 14853, USA
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