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Zeidan RS, Martenson M, Tamargo JA, McLaren C, Ezzati A, Lin Y, Yang JJ, Yoon HS, McElroy T, Collins JF, Leeuwenburgh C, Mankowski RT, Anton S. Iron homeostasis in older adults: balancing nutritional requirements and health risks. J Nutr Health Aging 2024; 28:100212. [PMID: 38489995 DOI: 10.1016/j.jnha.2024.100212] [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: 12/13/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
Iron plays a crucial role in many physiological processes, including oxygen transport, bioenergetics, and immune function. Iron is assimilated from food and also recycled from senescent red blood cells. Iron exists in two dietary forms: heme (animal based) and non-heme (mostly plant based). The body uses iron for metabolic purposes, and stores the excess mainly in splenic and hepatic macrophages. Physiologically, iron excretion in humans is inefficient and not highly regulated, so regulation of intestinal absorption maintains iron homeostasis. Iron losses occur at a steady rate via turnover of the intestinal epithelium, blood loss, and exfoliation of dead skin cells, but overall iron homeostasis is tightly controlled at cellular and systemic levels. Aging can have a profound impact on iron homeostasis and induce a dyshomeostasis where iron deficiency or overload (sometimes both simultaneously) can occur, potentially leading to several disorders and pathologies. To maintain physiologically balanced iron levels, reduce risk of disease, and promote healthy aging, it is advisable for older adults to follow recommended daily intake guidelines and periodically assess iron levels. Clinicians can evaluate body iron status using different techniques but selecting an assessment method primarily depends on the condition being examined. This review provides a comprehensive overview of the forms, sources, and metabolism of dietary iron, associated disorders of iron dyshomeostasis, assessment of iron levels in older adults, and nutritional guidelines and strategies to maintain iron balance in older adults.
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Affiliation(s)
- Rola S Zeidan
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Matthew Martenson
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Javier A Tamargo
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christian McLaren
- Department of Clinical and Health Psychology, College of Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Armin Ezzati
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Food, Nutrition, Dietetics and Health, Kansas State University, Manhattan, KS, USA
| | - Yi Lin
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jae Jeong Yang
- UF Health Cancer Center, Gainesville, FL, USA; Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Hyung-Suk Yoon
- UF Health Cancer Center, Gainesville, FL, USA; Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Taylor McElroy
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - James F Collins
- Department of Food Science & Human Nutrition, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL, USA
| | - Christiaan Leeuwenburgh
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Robert T Mankowski
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Stephen Anton
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Clinical and Health Psychology, College of Health and Health Professions, University of Florida, Gainesville, Florida, USA.
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Hammer T, Braisch U, Rothenbacher D, Denkinger M, Dallmeier D. Relationship between hemoglobin and grip strength in older adults: the ActiFE study. Aging Clin Exp Res 2024; 36:59. [PMID: 38451343 PMCID: PMC10920471 DOI: 10.1007/s40520-024-02698-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/05/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Although anemia is associated with low muscle strength, hemoglobin has been rarely studied considering ferritin. AIM To analyze the association between hemoglobin and grip strength in community-dwelling older adults. METHODS We used data from a German cohort of adults ≥ 65 years, excluding those with CRP > 10 mg/L or taking iron supplements. Grip strength (kg) was measured using a Jamar dynamometer. Analysis was performed using multiple linear regression, adjusted for established confounders. Due to interaction, age-stratified (< 80, 80 +), further sex-stratified analysis in those < 80 years old and ferritin-stratified in men < 80 years were performed. RESULTS In total, 1294 participants were included in this analysis (mean age 75.5 years, 549 (42.3%) women, 910 (70.3%) < 80 years). On average, hemoglobin and grip strength were 14.9 g/dL and 41.3 kg for men, 13.9 g/dL and 25.1 kg for women. Hemoglobin was significantly positively associated with grip strength only among women < 80 years (β 0.923 [95% CI 0.196, 1.650]). For men < 80 years, the association was significant when ferritin was ≥ 300 µg/L (β 2.028 [95% CI 0.910, 3.146]). No association was detected among those participants 80 + . DISCUSSION AND CONCLUSIONS Our data show an association between hemoglobin and grip strength only in women < 80 years old. For men < 80 years, the association was only significant with ferritin levels ≥ 300 µg/L. Considering the decreasing levels of hemoglobin and grip strength and the high prevalence of iron deficiency in older adults further analyses investigating this relationship with more iron specific parameters such as transferrin saturation are warranted.
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Affiliation(s)
- Theresa Hammer
- Research Unit on Ageing at Agaplesion Bethesda Clinic Ulm, Ulm, Germany
- Institute for Geriatric Research, Ulm University, Ulm, Germany
| | - Ulrike Braisch
- Research Unit on Ageing at Agaplesion Bethesda Clinic Ulm, Ulm, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Michael Denkinger
- Research Unit on Ageing at Agaplesion Bethesda Clinic Ulm, Ulm, Germany
- Institute for Geriatric Research, Ulm University, Ulm, Germany
- Medical Faculty, Ulm University, Ulm, Germany
| | - Dhayana Dallmeier
- Research Unit on Ageing at Agaplesion Bethesda Clinic Ulm, Ulm, Germany.
- Medical Faculty, Ulm University, Ulm, Germany.
- Department of Epidemiology, Boston University School of Public Health, Boston, USA.
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Al-Mubarak AA, Grote Beverborg N, Zwartkruis V, van Deutekom C, de Borst MH, Gansevoort RT, Bakker SJL, Touw DJ, de Boer RA, van der Meer P, Rienstra M, Bomer N. Micronutrient deficiencies and new-onset atrial fibrillation in a community-based cohort: data from PREVEND. Clin Res Cardiol 2023:10.1007/s00392-023-02276-3. [PMID: 37589740 DOI: 10.1007/s00392-023-02276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/24/2023] [Indexed: 08/18/2023]
Abstract
AIM Malnutrition has been linked to cardiovascular diseases. Both selenium and iron deficiency have been associated with worse prognosis in patients with heart failure (HF). Yet, little is known about the role of micronutrients in the development of atrial fibrillation (AFib). In this study, we aimed to elucidate the association of micronutrient deficiencies with new-onset AFib. METHODS Selenium, magnesium, and iron parameters were measured in a well-characterized prospective cohort study (N = 5452). Selenium deficiency was defined as serum selenium < 70 μg/L, iron deficiency as serum ferritin < 30 μg/L, and magnesium deficiency as plasma magnesium < 0.85 mmol/L. New-onset AFib was the primary outcome. Additionally, we tested for previously reported effect-modifiers where applicable. RESULTS Selenium, iron, and magnesium deficiency was observed in 1155 (21.2%), 797 (14.6%), and 3600 (66.0%) participants, respectively. During a mean follow-up of 6.2 years, 136 (2.5%) participants developed new-onset AFib. Smoking status significantly interacted with selenium deficiency on outcome (p = 0.079). After multivariable adjustment for components of the CHARGE-AF model, selenium deficiency was associated with new-onset AFib in non-smokers (HR 1.69, 95% CI 1.09-2.64, p = 0.020), but not in smokers (HR 0.78, 95% CI 0.29-2.08, p = 0.619). Magnesium deficiency (HR 1.40, 95% CI 0.93-2.10, p = 0.110) and iron deficiency (HR 0.62, 95% CI 0.25-1.54, p = 0.307) were not significantly associated with new-onset AFib. CONCLUSION Selenium deficiency was associated with new-onset AFib in non-smoking participants. Interventional studies that investigate the effects of optimizing micronutrients status in a population at risk are needed to assess causality, especially in those with selenium deficiency. Micronutrients deficiencies (selenium, iron, and magnesium) have been associated with cardiovascular diseases and mitochondrial dysfunction in human cardiomyocytes. However, it is not known whether these deficiencies are associated with atrial fibrillation. To investigate this question, we measured all three micronutrients in 5452 apparently healthy individuals. After a mean follow-up of 6.2 years, there were 136 participants who developed atrial fibrillation. Participants with selenium deficiency had a significant increased risk to develop atrial fibrillation, as did the participants with two or more deficiencies.
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Affiliation(s)
- Ali A Al-Mubarak
- Department of Cardiology, University of Groningen, University Medical Center Groningen, UMCG Post-Zone AB43, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Niels Grote Beverborg
- Department of Cardiology, University of Groningen, University Medical Center Groningen, UMCG Post-Zone AB43, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Victor Zwartkruis
- Department of Cardiology, University of Groningen, University Medical Center Groningen, UMCG Post-Zone AB43, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Colinda van Deutekom
- Department of Cardiology, University of Groningen, University Medical Center Groningen, UMCG Post-Zone AB43, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Martin H de Borst
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ron T Gansevoort
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, Erasmus University Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter van der Meer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, UMCG Post-Zone AB43, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, UMCG Post-Zone AB43, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Nils Bomer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, UMCG Post-Zone AB43, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
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Jiménez-Jiménez FJ, Ayuso P, Alonso-Navarro H, Calleja M, Díez-Fairén M, Álvarez I, Pastor P, Plaza-Nieto JF, Navarro-Muñoz S, Turpín-Fenoll L, Millán-Pascual J, Recio-Bermejo M, García-Ruiz R, García-Albea E, Agúndez JAG, García-Martín E. Serum Trace Elements Concentrations in Patients with Restless Legs Syndrome. Antioxidants (Basel) 2022; 11:antiox11020272. [PMID: 35204155 PMCID: PMC8868060 DOI: 10.3390/antiox11020272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 12/04/2022] Open
Abstract
Increased brain and serum zinc levels in patients with idiopathic restless legs syndrome (idiopathic RLS or iRLS) were described when compared with controls, suggesting a possible role of zinc in the pathogenesis of this disease. However, serum magnesium, calcium, manganese, iron, and copper levels of RLS patients were similar to controls, suggesting a specific impairment of zinc-dependent metabolism in RLS. The aim of this study is to assess the serum concentrations of trace elements involved in oxidative stress or causing peripheral nerve toxicity in a large series of patients with iRLS and controls. We determined serum levels of iron, copper, manganese, zinc, magnesium, selenium, calcium, aluminium, lead, cadmium, arsenic and mercury in 100 patients diagnosed with iRLS and in 110 age- and sex-matched controls using Inductively Coupled Plasma Mass Spectrometry. Serum copper, magnesium, selenium, and calcium concentrations were significantly higher in RLS patients than in controls. These differences were observed both in men and women. There were no major correlations between serum trace metal concentrations and age at onset of RLS or RLS severity, nor was there any association with a family history of RLS or drug response. This study shows an association between increased serum concentrations of copper, magnesium, selenium, and calcium with RLS in a Spanish Caucasian population and does not confirm the previously reported increase in serum zinc concentrations in patients suffering from this disease, suggesting that the different accuracy of the analytical methods used could have influenced the inconsistent results found in the literature.
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Affiliation(s)
- Félix Javier Jiménez-Jiménez
- Section of Neurology, Hospital Universitario del Sureste, 28500 Arganda del Rey, Spain; (H.A.-N.); (M.C.); (J.F.P.-N.)
- Correspondence: (F.J.J.-J.); (J.A.G.A.)
| | - Pedro Ayuso
- University Institute of Molecular Pathology Biomarkers, ARADyAL Instituto de Salud Carlos III, Universidad de Extremadura, 10071 Cáceres, Spain; (P.A.); (E.G.-M.)
| | - Hortensia Alonso-Navarro
- Section of Neurology, Hospital Universitario del Sureste, 28500 Arganda del Rey, Spain; (H.A.-N.); (M.C.); (J.F.P.-N.)
| | - Marisol Calleja
- Section of Neurology, Hospital Universitario del Sureste, 28500 Arganda del Rey, Spain; (H.A.-N.); (M.C.); (J.F.P.-N.)
| | - Mónica Díez-Fairén
- Fundació per la Recerca Biomèdica i Social Mútua de Terrassa, 08221 Terrassa, Spain; (M.D.-F.); (I.Á.); (P.P.)
- Movement Disorders Unit, Department of Neurology, Univeristy Hospital Mutua de Terrassa, 08221 Terrassa, Spain
| | - Ignacio Álvarez
- Fundació per la Recerca Biomèdica i Social Mútua de Terrassa, 08221 Terrassa, Spain; (M.D.-F.); (I.Á.); (P.P.)
- Movement Disorders Unit, Department of Neurology, Univeristy Hospital Mutua de Terrassa, 08221 Terrassa, Spain
| | - Pau Pastor
- Fundació per la Recerca Biomèdica i Social Mútua de Terrassa, 08221 Terrassa, Spain; (M.D.-F.); (I.Á.); (P.P.)
- Movement Disorders Unit, Department of Neurology, Univeristy Hospital Mutua de Terrassa, 08221 Terrassa, Spain
| | - José Francisco Plaza-Nieto
- Section of Neurology, Hospital Universitario del Sureste, 28500 Arganda del Rey, Spain; (H.A.-N.); (M.C.); (J.F.P.-N.)
| | - Santiago Navarro-Muñoz
- Section of Neurology, Hospital La Mancha-Centro, 13600 Alcázar de San Juan, Spain; (S.N.-M.); (L.T.-F.); (J.M.-P.); (M.R.-B.); (R.G.-R.)
| | - Laura Turpín-Fenoll
- Section of Neurology, Hospital La Mancha-Centro, 13600 Alcázar de San Juan, Spain; (S.N.-M.); (L.T.-F.); (J.M.-P.); (M.R.-B.); (R.G.-R.)
| | - Jorge Millán-Pascual
- Section of Neurology, Hospital La Mancha-Centro, 13600 Alcázar de San Juan, Spain; (S.N.-M.); (L.T.-F.); (J.M.-P.); (M.R.-B.); (R.G.-R.)
| | - Marta Recio-Bermejo
- Section of Neurology, Hospital La Mancha-Centro, 13600 Alcázar de San Juan, Spain; (S.N.-M.); (L.T.-F.); (J.M.-P.); (M.R.-B.); (R.G.-R.)
| | - Rafael García-Ruiz
- Section of Neurology, Hospital La Mancha-Centro, 13600 Alcázar de San Juan, Spain; (S.N.-M.); (L.T.-F.); (J.M.-P.); (M.R.-B.); (R.G.-R.)
| | - Esteban García-Albea
- Department of Medicine-Neurology, Hospital “Príncipe de Asturias”, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain;
| | - José A. G. Agúndez
- University Institute of Molecular Pathology Biomarkers, ARADyAL Instituto de Salud Carlos III, Universidad de Extremadura, 10071 Cáceres, Spain; (P.A.); (E.G.-M.)
- Correspondence: (F.J.J.-J.); (J.A.G.A.)
| | - Elena García-Martín
- University Institute of Molecular Pathology Biomarkers, ARADyAL Instituto de Salud Carlos III, Universidad de Extremadura, 10071 Cáceres, Spain; (P.A.); (E.G.-M.)
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Alnuwaysir RIS, Hoes MF, van Veldhuisen DJ, van der Meer P, Beverborg NG. Iron Deficiency in Heart Failure: Mechanisms and Pathophysiology. J Clin Med 2021; 11:125. [PMID: 35011874 PMCID: PMC8745653 DOI: 10.3390/jcm11010125] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 12/15/2022] Open
Abstract
Iron is an essential micronutrient for a myriad of physiological processes in the body beyond erythropoiesis. Iron deficiency (ID) is a common comorbidity in patients with heart failure (HF), with a prevalence reaching up to 59% even in non-anaemic patients. ID impairs exercise capacity, reduces the quality of life, increases hospitalisation rate and mortality risk regardless of anaemia. Intravenously correcting ID has emerged as a promising treatment in HF as it has been shown to alleviate symptoms, improve quality of life and exercise capacity and reduce hospitalisations. However, the pathophysiology of ID in HF remains poorly characterised. Recognition of ID in HF triggered more research with the aim to explain how correcting ID improves HF status as well as the underlying causes of ID in the first place. In the past few years, significant progress has been made in understanding iron homeostasis by characterising the role of the iron-regulating hormone hepcidin, the effects of ID on skeletal and cardiac myocytes, kidneys and the immune system. In this review, we summarise the current knowledge and recent advances in the pathophysiology of ID in heart failure, the deleterious systemic and cellular consequences of ID.
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Affiliation(s)
| | | | | | | | - Niels Grote Beverborg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (R.I.S.A.); (M.F.H.); (D.J.v.V.); (P.v.d.M.)
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