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Castro OL, De Franceschi L, Ganz T, Kanter J, Kato GJ, Pasricha SR, Rivella S, Wood JC. Iron restriction in sickle cell disease: When less is more. Am J Hematol 2024; 99:1349-1359. [PMID: 38400590 DOI: 10.1002/ajh.27267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
Primum non nocere! Can iron deficiency, an abnormality that causes anemia, benefit people with sickle cell disease (SCD) who already have an anemia? The published literature we review appears to answer this question in the affirmative: basic science considerations, animal model experiments, and noncontrolled clinical observations all suggest a therapeutic potential of iron restriction in SCD. This is because SCD's clinical manifestations are ultimately attributable to the polymerization of hemoglobin S (HbS), a process strongly influenced by intracellular HbS concentration. Even small decrements in HbS concentration greatly reduce polymerization, and iron deficiency lowers erythrocyte hemoglobin concentration. Thus, iron deficiency could improve SCD by changing its clinical features to those of a more benign anemia (i.e., a condition with fewer or no vaso-occlusive events). We propose that well-designed clinical studies be implemented to definitively determine whether iron restriction is a safe and effective option in SCD. These investigations are particularly timely now that pharmacologic agents are being developed, which may directly reduce red cell hemoglobin concentrations without the need for phlebotomies to deplete total body iron.
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Affiliation(s)
- Oswaldo L Castro
- Center for Sickle Cell Disease, Howard University, Washington, District of Columbia, USA
| | | | - Tomas Ganz
- Center for Iron Disorders, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Julie Kanter
- Division of Hematology and Oncology, University of Alabama, Birmingham, Birmingham, Alabama, USA
| | - Gregory J Kato
- Hematology Therapeutic Area, CSL Behring, King of Prussia, Pennsylvania, USA
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Stefano Rivella
- Division of Hematology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; RNA Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- RNA Gene Therapeutics Group, RNA Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John C Wood
- Division of Cardiology, Department of Pediatrics and Radiology, Children's Hospital of Los Angeles, Los Angeles, California, USA
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Sangeeta, Chandra J. Negative Impact of Iron Deficiency Without Anemia on Health of Children and Adolescents. Indian J Pediatr 2024:10.1007/s12098-024-05163-5. [PMID: 38771553 DOI: 10.1007/s12098-024-05163-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Sangeeta
- Department of Pediatrics, ESIC Medical College and Hospital, NIT-3, Faridabad, Haryana, 121001, India.
| | - Jagdish Chandra
- Department of Pediatrics, ESIC Medical College and Hospital, NIT-3, Faridabad, Haryana, 121001, India
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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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Aparco JP, Santos-Antonio G, Bautista-Olortegui W, Alvis-Chirinos K, Velarde-Delgado P, Hinojosa-Mamani P, Solis-Sanchez G, Santa Cruz FE, Zavaleta N. Iron status and hemoglobin adjustment by altitude to define anemia in children aged 6 to 8 months living in Lima, Arequipa, Cusco and Puno. Rev Peru Med Exp Salud Publica 2024; 40:395-405. [PMID: 38597467 PMCID: PMC11138835 DOI: 10.17843/rpmesp.2023.404.12573] [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: 01/24/2023] [Accepted: 11/08/2023] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVE. To describe the iron status profile and to propose hemoglobin adjustment factors for altitude for children aged 6 to 8 months in Lima, Arequipa, Cusco and Puno. MATERIALS AND METHODS. Cross-sectional study in children aged 6 to 8 months from four cities. We measured hemoglobin and other iron biomarkers, C-reactive protein (CRP), among others. To estimate the adjustment equation, we applied an exponential regression. We excluded children with iron deficiency (ID) and/or inflammation. RESULTS. The proportions of ID were higher in Puno and Arequipa, while inflammation did not exceed 19% in any of the cities. Hemoglobin showed an exponential increase at higher altitude. The adjustment equation was: 10.34249 x (1.00007 ^ Alt). CONCLUSIONS. Children residing in Arequipa and Puno showed higher rates of ID and lower iron reserves; furthermore, the increase in hemoglobin by altitude was exponential, showing the need to adjust hemoglobin at altitude.
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Affiliation(s)
- Juan Pablo Aparco
- National Center for Food, Nutrition, and Healthy Living, Instituto Nacional de Salud, (INS), Lima, Peru.National Center for Food, Nutrition, and Healthy LivingInstituto Nacional de Salud (INS)LimaPeru
| | - Gabriela Santos-Antonio
- National Center for Food, Nutrition, and Healthy Living, Instituto Nacional de Salud, (INS), Lima, Peru.National Center for Food, Nutrition, and Healthy LivingInstituto Nacional de Salud (INS)LimaPeru
| | - William Bautista-Olortegui
- National Center for Food, Nutrition, and Healthy Living, Instituto Nacional de Salud, (INS), Lima, Peru.National Center for Food, Nutrition, and Healthy LivingInstituto Nacional de Salud (INS)LimaPeru
| | - Katherine Alvis-Chirinos
- National Center for Food, Nutrition, and Healthy Living, Instituto Nacional de Salud, (INS), Lima, Peru.National Center for Food, Nutrition, and Healthy LivingInstituto Nacional de Salud (INS)LimaPeru
| | - Patricia Velarde-Delgado
- National Center for Food, Nutrition, and Healthy Living, Instituto Nacional de Salud, (INS), Lima, Peru.National Center for Food, Nutrition, and Healthy LivingInstituto Nacional de Salud (INS)LimaPeru
| | - Paul Hinojosa-Mamani
- National Center for Food, Nutrition, and Healthy Living, Instituto Nacional de Salud, (INS), Lima, Peru.National Center for Food, Nutrition, and Healthy LivingInstituto Nacional de Salud (INS)LimaPeru
| | - Gilmer Solis-Sanchez
- National Center for Food, Nutrition, and Healthy Living, Instituto Nacional de Salud, (INS), Lima, Peru.National Center for Food, Nutrition, and Healthy LivingInstituto Nacional de Salud (INS)LimaPeru
| | - Flor Eliana Santa Cruz
- General Directorate of Strategic Interventions in Public Health, Ministry of Health (MINSA), Lima, Peru.General Directorate of Strategic Interventions in Public HealthMinistry of Health (MINSA)LimaPeru
| | - Nelly Zavaleta
- Nutritional Research Institute (IIN), Lima, Peru.Nutritional Research Institute (IIN)LimaPeru
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Yu Y, Lu D, Zhang Z, Tao L. Association of soluble transferrin receptor/log ferritin index with all-cause and cause-specific mortality: National Health and Nutrition Examination Survey. Front Nutr 2024; 11:1275522. [PMID: 38476599 PMCID: PMC10927731 DOI: 10.3389/fnut.2024.1275522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Background Soluble transferrin receptor (sTfR)/log ferritin index (sTfR Index) can be used to assess the entire spectrum of iron status, and is valuable in evaluating iron status in population studies. There is still a lack of evidence on the association between sTfR index and all-cause mortality. Object To explore the association between sTfR index and all-cause mortality, as well as mortality due to cardiovascular disease (CVD) and cancer. Method Data were from the National Health and Nutrition Examination Survey (NHANES) between 2003 to 2020. Participants aged 16 years and older who had complete data of serum ferritin and sTfR were included. Pregnant individuals or those with ineligible data on death or follow-up were excluded from the analysis. Baseline sTfR index was calculated by baseline sTfR/log (ferritin) and classified as three tertile. We performed the Cox proportional hazard regression to assess the association of sTfR index (both continuous and categorical scale) with all-cause and cause-specific mortality and further assess the non-linear relationship between sTfR index and the outcomes with restricted cubic spline. Result In this study, 11,525 participants, a total of 231 (2.0%) all-cause deaths occurred during a median follow-up of 51 months. The risk of all-cause mortality, CVD-related mortality, and cancer-related mortality was higher in participants with highest tertile of sTfR index. After confounding factors adjustment, participants with highest tertile of sTfR index were associated with an increased risk of all-cause mortality (HR: 1.71, 95% CI: 1.14-2.57) as compared with lowest tertile. Additionally, sTfR index per SD increment was associated with a 25% increasing risk of all-cause mortality (HR: 1.25, 95% CI: 1.08-1.45, p = 0.003) and a 38% cancer-related mortality (HR: 1.38, 95% CI: 1.07-1.77, p = 0.018). These associations remained robust after adjusting for the serum ferritin as well as in various subgroups stratified by age, sex, smoking statue, hypertension, diabetes, and CVD. Spline analysis showed that there is approximately linear relationship between sTfR index with all-cause mortality (p for non-linear = 0.481). Moreover, ferritin was not a predictor of all-cause death after adjustment for confounding factors. Significance This cohort study demonstrated a significant association between sTfR index increment and an increased risk of all-cause and cancer-related mortality, independent of ferritin levels.
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Affiliation(s)
- Yan Yu
- Guangzhou Baiyunshan Hospital, Guangzhou, China
| | - Dongying Lu
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhenhui Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lili Tao
- Department of Critical Care Medicine, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
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Teschke R. Hemochromatosis: Ferroptosis, ROS, Gut Microbiome, and Clinical Challenges with Alcohol as Confounding Variable. Int J Mol Sci 2024; 25:2668. [PMID: 38473913 DOI: 10.3390/ijms25052668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Hemochromatosis represents clinically one of the most important genetic storage diseases of the liver caused by iron overload, which is to be differentiated from hepatic iron overload due to excessive iron release from erythrocytes in patients with genetic hemolytic disorders. This disorder is under recent mechanistic discussion regarding ferroptosis, reactive oxygen species (ROS), the gut microbiome, and alcohol abuse as a risk factor, which are all topics of this review article. Triggered by released intracellular free iron from ferritin via the autophagic process of ferritinophagy, ferroptosis is involved in hemochromatosis as a specific form of iron-dependent regulated cell death. This develops in the course of mitochondrial injury associated with additional iron accumulation, followed by excessive production of ROS and lipid peroxidation. A low fecal iron content during therapeutic iron depletion reduces colonic inflammation and oxidative stress. In clinical terms, iron is an essential trace element required for human health. Humans cannot synthesize iron and must take it up from iron-containing foods and beverages. Under physiological conditions, healthy individuals allow for iron homeostasis by restricting the extent of intestinal iron depending on realistic demand, avoiding uptake of iron in excess. For this condition, the human body has no chance to adequately compensate through removal. In patients with hemochromatosis, the molecular finetuning of intestinal iron uptake is set off due to mutations in the high-FE2+ (HFE) genes that lead to a lack of hepcidin or resistance on the part of ferroportin to hepcidin binding. This is the major mechanism for the increased iron stores in the body. Hepcidin is a liver-derived peptide, which impairs the release of iron from enterocytes and macrophages by interacting with ferroportin. As a result, iron accumulates in various organs including the liver, which is severely injured and causes the clinically important hemochromatosis. This diagnosis is difficult to establish due to uncharacteristic features. Among these are asthenia, joint pain, arthritis, chondrocalcinosis, diabetes mellitus, hypopituitarism, hypogonadotropic hypogonadism, and cardiopathy. Diagnosis is initially suspected by increased serum levels of ferritin, a non-specific parameter also elevated in inflammatory diseases that must be excluded to be on the safer diagnostic side. Diagnosis is facilitated if ferritin is combined with elevated fasting transferrin saturation, genetic testing, and family screening. Various diagnostic attempts were published as algorithms. However, none of these were based on evidence or quantitative results derived from scored key features as opposed to other known complex diseases. Among these are autoimmune hepatitis (AIH) or drug-induced liver injury (DILI). For both diseases, the scored diagnostic algorithms are used in line with artificial intelligence (AI) principles to ascertain the diagnosis. The first-line therapy of hemochromatosis involves regular and life-long phlebotomy to remove iron from the blood, which improves the prognosis and may prevent the development of end-stage liver disease such as cirrhosis and hepatocellular carcinoma. Liver transplantation is rarely performed, confined to acute liver failure. In conclusion, ferroptosis, ROS, the gut microbiome, and concomitant alcohol abuse play a major contributing role in the development and clinical course of genetic hemochromatosis, which requires early diagnosis and therapy initiation through phlebotomy as a first-line treatment.
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Affiliation(s)
- Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, D-63450 Hanau, Germany
- Academic Teaching Hospital of the Medical Faculty, Goethe University Frankfurt/Main, D-60590 Frankfurt am Main, Germany
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Lakhal-Littleton S, Cleland JGF. Iron deficiency and supplementation in heart failure. Nat Rev Cardiol 2024:10.1038/s41569-024-00988-1. [PMID: 38326440 DOI: 10.1038/s41569-024-00988-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/09/2024]
Abstract
Non-anaemic iron deficiency (NAID) is a strategic target in cardiovascular medicine because of its association with a range of adverse effects in various conditions. Endeavours to tackle NAID in heart failure have yielded mixed results, exposing knowledge gaps in how best to define 'iron deficiency' and the handling of iron therapies by the body. To address these gaps, we harness the latest understanding of the mechanisms of iron homeostasis outside the erythron and integrate clinical and preclinical lines of evidence. The emerging picture is that current definitions of iron deficiency do not assimilate the multiple influences at play in patients with heart failure and, consequently, fail to identify those with a truly unmet need for iron. Additionally, current iron supplementation therapies benefit only certain patients with heart failure, reflecting differences in the nature of the unmet need for iron and the modifying effects of anaemia and inflammation on the handling of iron therapies by the body. Building on these insights, we identify untapped opportunities in the management of NAID, including the refinement of current approaches and the development of novel strategies. Lessons learned from NAID in cardiovascular disease could ultimately translate into benefits for patients with other chronic conditions such as chronic kidney disease, chronic obstructive pulmonary disease and cancer.
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Affiliation(s)
| | - John G F Cleland
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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He Q, Wang W, Xu D, Xiong Y, You C, Tao C, Ma L. Causal Association of Iron Status With Functional Outcome After Ischemic Stroke. Stroke 2024; 55:423-431. [PMID: 38095120 DOI: 10.1161/strokeaha.123.044930] [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: 08/21/2023] [Accepted: 11/09/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Iron status has been associated with functional outcomes after ischemic stroke (IS). Nonetheless, this association may be affected by confounders. We perform Mendelian randomization to clarify the causal association between iron status and functional outcome after IS. METHODS We obtained summary-level statistics related to iron status biomarkers from a meta-analysis of a gene-wide association study conducted by the Genetics of Iron Status Consortium, which included 11 discovery cohorts and 8 replication cohorts. We also took genetic variants related to 4 biomarkers of iron status from combining gene-wide association study results of Iceland, the United Kingdom, and Denmark to perform a replicate Mendelian randomization analysis. This data set included 4 iron status biomarkers, namely, ferritin, total iron binding capacity, iron, and transferrin saturation (TSAT). The confounders in these data sets have been adjusted to mitigate the collider bias. We acquired summary statistics data sets for functional outcomes following IS from the gene-wide association study meta-analysis conducted by the Genetics of Ischemic Stroke Functional Outcome Consortium. The genetic estimates for functional outcomes at 90 days after IS were evaluated by the modified Rankin Scale score, including 3741 cases with good functional outcomes (modified Rankin Scale score, 0-2) and 2280 subjects with poor functional outcomes poststroke (modified Rankin Scale score, 3-6). Inverse variance weighting was used as the primary method, complemented by sensitivity analyses for pleiotropy and increasing robustness. RESULTS Reported with odds ratios (ORs) of stroke outcome with per SD unit increase in genetically determined iron status biomarker, TSAT and iron were associated with poor functional outcome after IS (TSAT: OR, 1.36 [95% CI, 1.23-1.50]; P=2.27×10-9; iron: OR, 1.44 [95% CI, 1.13-1.85]; P=0.0033). In replicate Mendelian randomization analysis, the detrimental effects of iron on poor functional outcome after IS remained stable (OR, 1.60 [95% CI, 1.24-2.08]; P=0.0003). In the meta-analysis, iron and TSAT were associated with poor functional outcomes after IS (TSAT: ORmeta, 1.35 [95% CI, 1.23-1.48]; iron: ORmeta, 1.51 [95% CI, 1.27-1.81]). Through sensitivity analyses and reverse Mendelian randomization analyses, we confirmed the robustness of the results. CONCLUSIONS Our study provides evidence suggesting a potential causal relationship between iron status and poor functional outcomes after IS. Future studies are required to illuminate the underlying mechanism.
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Affiliation(s)
- Qiang He
- Department of Neurosurgery (Q.H., C.Y., C.T., L.M.), West China Hospital, Sichuan University, Chengdu
| | - Wenjing Wang
- Department of Pharmacy, Institute of Metabolic Diseases and Pharmacotherapy (W.W.), West China Hospital, Sichuan University, Chengdu
| | - Dingkang Xu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, China (D.X.)
| | - Yang Xiong
- Department of Urology (Y.X.), West China Hospital, Sichuan University, Chengdu
| | - Chao You
- Department of Neurosurgery (Q.H., C.Y., C.T., L.M.), West China Hospital, Sichuan University, Chengdu
| | - Chuanyuan Tao
- Department of Neurosurgery (Q.H., C.Y., C.T., L.M.), West China Hospital, Sichuan University, Chengdu
| | - Lu Ma
- Department of Neurosurgery (Q.H., C.Y., C.T., L.M.), West China Hospital, Sichuan University, Chengdu
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Mohandas S, Milan KL, Anuradha M, Ramkumar KM. Exploring Lactoferrin as a novel marker for disease pathology and ferroptosis regulation in gestational diabetes. J Reprod Immunol 2024; 161:104182. [PMID: 38159430 DOI: 10.1016/j.jri.2023.104182] [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: 10/15/2023] [Revised: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
Iron overload is linked to heightened susceptibility to ferroptosis, a process increasingly implicated in diabetes pathogenesis. This present study aims to assess the utility of Lactoferrin in predicting different stages of GDM and explore its association with disease pathology and ferroptosis. In this observational study, 72 pregnant women were recruited and categorized into three groups: healthy pregnant women without diabetes (NGDM, n = 24), early gestational diabetes (eGDM, n = 24), and established gestational diabetes (GDM, n = 24), all receiving standard antenatal care at 12 weeks of gestation. Circulating levels of ferritin, soluble transferrin receptor (sTFR), and Lactoferrin using multiplexed bead-based cytokine immunoassay. Gene expression analysis focused on analyzing crucial ferroptosis regulators, SLC7A11 and GPX4, in isolated peripheral blood mononuclear cells (PBMCs). A significant elevation in ferritin levels and a decrease in the sTFR: Ferritin ratio supported iron overload and disrupted iron homeostasis in GDM subjects. Notably, Lactoferrin levels were significantly lower in women with GDM than in the control group and those with eGDM. This decline in Lactoferrin correlated with increased hyperglycemia indicators and reduced expression of ferroptosis regulators among GDM patients. Furthermore ROC curve analysis demonstrated that Lactoferrin shows promise as a valuable marker for distinguishing individuals with GDM from those with eGDM. Lactoferrin shows promise as a biomarker for detecting GDM. These findings indicate its role as a potential biomarker and highlight Lactoferrin as a critical regulator of hyperglycemia and ferroptosis in women with GDM.
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Affiliation(s)
- Sundhar Mohandas
- Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur 603203, Tamil Nadu, India
| | - Kunnath Lakshmanan Milan
- Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur 603203, Tamil Nadu, India
| | - Murugesan Anuradha
- Department of Obstetrics & Gynecology, SRM Medical College Hospital and Research Centre, Kattankulathur 603203, Tamil Nadu, India
| | - Kunka Mohanram Ramkumar
- Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur 603203, Tamil Nadu, India.
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Xiao G, Li C, Chen Y, Zhao P, Li W, Xiao H, Yang Y, Zhang Y, Zhou R, Liu A, Liu L, Du L, Xiang Q, Yang J, Wang Y. Risk prediction of iron deficiency for plasmapheresis donors in China: Development and validation of a prediction model. Vox Sang 2024; 119:144-154. [PMID: 38152043 DOI: 10.1111/vox.13572] [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: 08/16/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND AND OBJECTIVES The present study aims to evaluate the iron stores in plasmapheresis donors and develop and validate an iron deficiency (ID) risk prediction model for plasmapheresis donors with potential or existing ID. MATERIALS AND METHODS We assessed plasmapheresis donors' serum ferritin (SF) and haemoglobin (Hb) levels. The candidate factors showing significant differences in the multivariate logistic regression analysis were used to establish a risk prediction scoring system. The participants were divided into a training cohort and an internal validation cohort in a 7:3 ratio. Additional plasmapheresis donors from a different station were recruited for external validation. RESULTS The SF levels in both male and female donors in the high-frequency group were significantly lower than those of new donors (male: p < 0.001; female: p = 0.008). The prevalence of ID in female regular donors with a high frequency was significantly higher than that in new donors (33.1% vs. 24.6%; odds ratio = 1.209 [95% CI: 1.035-1.412]). Donation frequency, age, Hb, body mass index and being pre-menopausal were identified as independent risk factors for ID (p < 0.05). The developed model exhibited good discrimination ability (area under the receiver operating characteristic curve >0.7) and calibration (p > 0.05) in development, internal validation cohorts and external validation cohorts. CONCLUSION A higher donation frequency has been associated with reduced SF levels and an increased risk of ID in women. The developed ID risk prediction model demonstrates moderate discriminative power and good model fitting, suggesting its potential clinical utility.
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Affiliation(s)
- Guanglin Xiao
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Changqing Li
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Yongjun Chen
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Peizhe Zhao
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Wan Li
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Hanzu Xiao
- Nanyue Biopharmaceutical Corporation Ltd, Hengyang, Hunan, China
| | - Yating Yang
- Sichuan Yuanda Shuyang Pharmaceutical Company Limited, Chengdu, Sichuan, China
| | - Yu Zhang
- Hualan Biological Engineering Inc, Xinxiang, Henan, China
| | - Rong Zhou
- Beijing Tiantan Biological Products Company Limited, Beijing, China
| | - Aying Liu
- Linwu Plasmapheresis Station, Nanyue Biopharming Corporation Ltd, Hengyang, Hunan, China
| | - Lili Liu
- Changyuan Plasmapheresis Station, Hualan Biological Engineering Inc, Xinxiang, Henan, China
| | - Linzhi Du
- Jiange Plasmapheresis Station, Sichuan Yuanda Shuyang Pharmaceutical Company Limited, Chengdu, Sichuan, China
| | - Qian Xiang
- Xinhua Plasmapheresis Station, Nanyue Biopharming Corporation Ltd, Hengyang, Hunan, China
| | - Jing Yang
- Xundian Plasmapheresis Station, Sichuan Yuanda Shuyang Pharmaceutical Company Limited, Chengdu, Yunnan, China
| | - Ya Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
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11
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Chimhashu TL, Verhoef H, Symington EA, Zandberg L, Baumgartner J, Malan L, Smuts CM, Feskens EJM, Melse-Boonstra A. Comparison of test performance of two commonly used multiplex assays to measure micronutrient and inflammatory markers in serum: results from a survey among pregnant women in South Africa. Br J Nutr 2024; 131:248-255. [PMID: 37560803 PMCID: PMC10751947 DOI: 10.1017/s0007114523001782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/07/2023] [Accepted: 08/07/2023] [Indexed: 08/11/2023]
Abstract
The combined sandwich-ELISA (s-ELISA; VitMin Lab, Germany) and the Quansys Q-Plex™ Human Micronutrient Array (7-Plex) are multiplex serum assays that are used to assess population micronutrient status in low-income countries. We aimed to compare the agreement of five analytes, α-1-acid glycoprotein (AGP), C-reactive protein (CRP), ferritin, retinol-binding protein 4 (RBP4) and soluble transferrin receptor (sTfR) as measured by the 7-Plex and the s-ELISA. Serum samples were collected between March 2016 and December 2017. Pregnant women (n 249) were recruited at primary healthcare clinics in Johannesburg, and serum samples were collected between March 2016 and December 2017. Agreement between continuous measurements was assessed by Bland-Altman plots and concordance measures. Agreement in classifications of deficiency or inflammation was assessed by Cohen's kappa. Strong correlations (r > 0·80) were observed between the 7-Plex and s-ELISA for CRP and ferritin. Except for CRP, the 7-Plex assay gave consistently higher measurements than the s-ELISA. With the exception of CRP (Lin's ρ = 0·92), there was poor agreement between the two assays, with Lin's ρ < 0·90. Discrepancies of test results difference between methods increased as the serum concentrations rose. Cohen's kappa for all the five analytes was < 0·81 and ranged from slight agreement (vitamin A deficiency) to substantial (inflammation and Fe deficiency) agreement. The 7-Plex 1.0 is a research and or surveillance tool with potential for use in low-resource laboratories but cannot be used interchangeably with the s-ELISA. Further optimising and validation is required to establish its interchangeability with other validated methods.
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Affiliation(s)
- Tsitsi Letwin Chimhashu
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Hans Verhoef
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Elizabeth A. Symington
- Department of Life and Consumer Sciences, University of South Africa, Johannesburg, South Africa
| | - Lizelle Zandberg
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Jeannine Baumgartner
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
- Department of Nutritional Sciences, King’s College, London, UK
| | - Linda Malan
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | | | - Edith J. M. Feskens
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Alida Melse-Boonstra
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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12
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Von Holle A, O'Brien KM, Sandler DP, Janicek R, Karagas MR, White AJ, Niehoff NM, Levine KE, Jackson BP, Weinberg CR. Toenail and serum levels as biomarkers of iron status in pre- and postmenopausal women: correlations and stability over eight-year follow-up. Sci Rep 2024; 14:1682. [PMID: 38242893 PMCID: PMC10798942 DOI: 10.1038/s41598-023-50506-5] [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: 02/24/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024] Open
Abstract
Iron status is often assessed in epidemiologic studies, and toenails offer a convenient alternative to serum because of ease of collection, transport, and storage, and the potential to reflect a longer exposure window. Very few studies have examined the correlation between serum and toenail levels for trace metals. Our aim was to compare iron measures using serum and toenails on both a cross-sectional and longitudinal basis. Using a subset of the US-wide prospective Sister Study cohort, we compared toenail iron measures to serum concentrations for iron, ferritin and percent transferrin saturation. Among 146 women who donated both blood and toenails at baseline, a subsample (59%, n = 86) provided specimens about 8 years later. Cross-sectional analyses included nonparametric Spearman's rank correlations between toenail and serum biomarker levels. We assessed within-woman maintenance of rank across time for the toenail and serum measures and fit mixed effects models to measure change across time in relation to change in menopause status. Spearman correlations at baseline (follow-up) were 0.08 (0.09) for serum iron, 0.08 (0.07) for transferrin saturation, and - 0.09 (- 0.17) for ferritin. The within-woman Spearman correlation for toenail iron between the two time points was higher (0.47, 95% CI 0.30, 0.64) than for serum iron (0.30, 95% CI 0.09, 0.51) and transferrin saturation (0.34, 95% CI 0.15, 0.54), but lower than that for ferritin (0.58, 95% CI 0.43, 0.73). Serum ferritin increased over time while nail iron decreased over time for women who experienced menopause during the 8-years interval. Based on cross-sectional and repeated assessments, our evidence does not support an association between serum biomarkers and toenail iron levels. Toenail iron concentrations did appear to be moderately stable over time but cannot be taken as a proxy for serum iron biomarkers and they may reflect physiologically distinct fates for iron.
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Affiliation(s)
- Ann Von Holle
- Biostatistics and Computational Biology Branch National Institute of Environmental Health Sciences, Mail Drop A3-03, P.O. Box 12233, Research Triangle Park, Durham, NC, 27709, USA
| | - Katie M O'Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Robert Janicek
- Advanced Research and Diagnostic Laboratory, University of Minnesota, Minneapolis, MN, USA
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA
| | - Alexandra J White
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Nicole M Niehoff
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
- Ontada, Durham, NC, USA
| | | | - Brian P Jackson
- Department of Earth Sciences, Dartmouth College, Hanover, NH, USA
| | - Clarice R Weinberg
- Biostatistics and Computational Biology Branch National Institute of Environmental Health Sciences, Mail Drop A3-03, P.O. Box 12233, Research Triangle Park, Durham, NC, 27709, USA.
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13
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Liu Y, Chen H, Zhou Y, Lin X, Yang L, Zhan B, Wei Y, Sun R, Yang H, Zhang Z, Deng G. The association of serum toxic metals and essential elements during early pregnancy with body mass index trajectory of infants during the first years: A prospective study. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 269:115766. [PMID: 38039855 DOI: 10.1016/j.ecoenv.2023.115766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023]
Abstract
To the best of our knowledge, prior research has yet to delve into the combined and interactive relationships between maternal exposure to essential elements and toxic metals and infancy's continuous growth and trajectories. This study aims to discern infant growth trajectories in the first year of life and to determine the associations of maternal serum levels of essential elements and toxic metals with growth trajectory. Within a Chinese prospective cohort in 2019 - 2021, 407 mother-infant pairs were included, and the serum levels of five essential elements (zinc, calcium, copper, magnesium and iron) and two toxic metals (cadmium and lead) in early pregnancy were assessed. The growth trajectory of infants was followed until age one year. Raw BMI and height values were transformed to age- and sex-specific BMI and height standard deviation (SD) scores. Latent-class group-based trajectory models and piecewise linear mixed regression were estimated to determine infant growth trajectories and growth velocity, respectively. The individual relationship between maternal metallic element levels and infant growth trajectory was examined using multinomial logistic regression models and linear mixed regression, while joint associations and interactive relationships were explored using Bayesian kernel machine regression (BKMR) following confounder adjustments. Four distinct trajectory patterns based on BMI-z score (low-rapid BMI gain group, normal-stable BMI group, very low-rapid BMI gain group and normal-rapid BMI gain group) and length-for-age (high-stable length group, low-stable length group, normal-rapid length gain group, very low-rapid length gain group) were identified during the first year post-birth, respectively. In single-metal and multiple-metal models, infants born to mothers with higher serum Zn and lower serum Cu levels were associated with a normal-rapid BMI gain trajectory during the first year. Serum Cu exhibited a positive correlation with the rate of BMI change solely in infants aged 6-12 months. Further, the BKMR analysis revealed a statistically significant and negative joint effect of the five essential elements on the likelihood of normal-rapid BMI/length gain trajectory when serum levels of these elements fell below the 70th percentile compared to median levels. In addition, high levels of serum copper and calcium interactively affect the rates of BMI change during 6-12 months old (β: -0.21, 95% CI: -0.44, -0.03, P = 0.04, P-interaction=0.04). In conclusion, maternal trace elements at early pregnancy are linked to infant growth patterns and growth velocity in the first year of life.
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Affiliation(s)
- Yao Liu
- Department of Clinical Nutrition, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen 518000, People's Republic of China
| | - Hengying Chen
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
| | - Yingyu Zhou
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510080, People's Republic of China
| | - Xiaoping Lin
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510080, People's Republic of China
| | - Lanyao Yang
- School of Public Health, Ningxia Medical University, Yinchuan 750004, Ningxia, People's Republic of China
| | - Bowen Zhan
- School of Public Health, Ningxia Medical University, Yinchuan 750004, Ningxia, People's Republic of China
| | - Yuanhuan Wei
- Department of Clinical Nutrition, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen 518000, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou 510000, People's Republic of China
| | - Ruifang Sun
- Department of Clinical Nutrition, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen 518000, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou 510000, People's Republic of China
| | - Hongguang Yang
- Department of Clinical Nutrition, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen 518000, People's Republic of China
| | - Zheqing Zhang
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou 510080, People's Republic of China
| | - Guifang Deng
- Department of Clinical Nutrition, Union Shenzhen Hospital of Huazhong University of Science and Technology, Shenzhen 518000, People's Republic of China.
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14
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Liang Y, Luo S, Wong THT, He B, Schooling CM, Au Yeung SL. Association of iron homeostasis biomarkers in type 2 diabetes and glycaemic traits: a bidirectional two-sample Mendelian randomization study. Int J Epidemiol 2023; 52:1914-1925. [PMID: 37400992 DOI: 10.1093/ije/dyad093] [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: 11/21/2022] [Accepted: 06/14/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Mendelian randomization (MR) studies show iron positively associated with type 2 diabetes (T2D) but included potentially biasing hereditary haemochromatosis variants and did not assess reverse causality. METHODS We assessed the relation of iron homeostasis with T2D and glycaemic traits bidirectionally, using genome-wide association studies (GWAS) of iron homeostasis biomarkers [ferritin, serum iron, total iron-binding capacity (TIBC), transferrin saturation (TSAT) (n ≤ 246 139)], T2D (DIAMANTE n = 933 970 and FinnGen n = 300 483), and glycaemic traits [fasting glucose (FG), 2-h glucose, glycated haemoglobin (HbA1c) and fasting insulin (FI) (n ≤ 209 605)]. Inverse variance weighting (IVW) was the main analysis, supplemented with sensitivity analyses and assessment of mediation by hepcidin. RESULTS Iron homeostasis biomarkers were largely unrelated to T2D, although serum iron was potentially associated with higher T2D [odds ratio: 1.07 per standard deviation; 95% confidence interval (CI): 0.99 to 1.16; P-value: 0.078) in DIAMANTE only. Higher ferritin, serum iron, TSAT and lower TIBC likely decreased HbA1c, but were not associated with other glycaemic traits. Liability to T2D likely increased TIBC (0.03 per log odds; 95% CI: 0.01 to 0.05; P-value: 0.005), FI likely increased ferritin (0.29 per log pmol/L; 95% CI: 0.12 to 0.47; P-value: 8.72 x 10-4). FG likely increased serum iron (0.06 per mmol/L; 95% CI: 0.001 to 0.12; P-value: 0.046). Hepcidin did not mediate these associations. CONCLUSION It is unlikely that ferritin, TSAT and TIBC cause T2D although an association for serum iron could not be excluded. Glycaemic traits and liability to T2D may affect iron homeostasis, but mediation by hepcidin is unlikely. Corresponding mechanistic studies are warranted.
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Affiliation(s)
- Ying Liang
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Shan Luo
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Tommy Hon Ting Wong
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Baoting He
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - C Mary Schooling
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
- School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Shiu Lun Au Yeung
- School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
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15
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Zhao Y, Ray A, Broberg K, Kippler M, Lill CM, Vineis P, Katzke VA, Rodriguez‐Barranco M, Chirlaque M, Guevara M, Gómez J, Hansen J, Panico S, Middleton LT, Masala G, Pala V, Vinagre‐Aragon A, Zibetti M, Vermeulen R, Peters S. Prediagnostic Blood Metal Levels and the Risk of Parkinson's Disease: A Large European Prospective Cohort. Mov Disord 2023; 38:2302-2307. [PMID: 37675653 PMCID: PMC10946475 DOI: 10.1002/mds.29602] [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: 05/26/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Metals have been postulated as environmental concerns in the etiology of Parkinson's disease (PD), but metal levels are typically measured after diagnosis, which might be subject to reverse causality. OBJECTIVE The aim of this study was to investigate the association between prediagnostic blood metal levels and PD risk. METHODS A case-control study was nested in a prospective European cohort, using erythrocyte samples collected before PD diagnosis. RESULTS Most assessed metals were not associated with PD risk. Cadmium has a suggestive negative association with PD (odds ratio [95% confidence interval] for the highest quartile, 0.70 [0.42-1.17]), which diminished among never smokers. Among current smokers only, lead was associated with decreased PD risk (0.06 [0.01-0.35]), whereas arsenic showed associations toward an increased PD risk (1.85 [0.45-7.93]). CONCLUSIONS We observe no strong evidence to support a role of metals in the development of PD. In particular, smoking may confound the association with tobacco-derived metals. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Yujia Zhao
- Institute for Risk Assessment SciencesUtrecht UniversityUtrechtthe Netherlands
| | - Anushree Ray
- Institute for Risk Assessment SciencesUtrecht UniversityUtrechtthe Netherlands
- Institute for Stroke and Dementia ResearchLudwig‐Maximilians‐University of MunichMunichGermany
| | - Karin Broberg
- Institute of Environmental Medicine, Karolinska InstituteStockholmSweden
| | - Maria Kippler
- Institute of Environmental Medicine, Karolinska InstituteStockholmSweden
| | - Christina M. Lill
- Institute of Epidemiology and Social MedicineUniversity of MünsterMünsterGermany
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College LondonLondonUnited Kingdom
| | - Paolo Vineis
- MRC Centre for Environment and Health, School of Public Health, Imperial College LondonLondonUnited Kingdom
| | - Verena A. Katzke
- Division of Cancer EpidemiologyGerman Cancer Research CenterHeidelbergGermany
| | - Miguel Rodriguez‐Barranco
- Escuela Andaluza de Salud PúblicaGranadaSpain
- Instituto de Investigación Biosanitaria ibs.GRANADAGranadaSpain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud PúblicaMadridSpain
| | - María‐Dolores Chirlaque
- Centro de Investigación Biomédica en Red de Epidemiología y Salud PúblicaMadridSpain
- Department of EpidemiologyRegional Health Council, IMIB‐Arrixaca, Murcia UniversityMurciaSpain
| | - Marcela Guevara
- Centro de Investigación Biomédica en Red de Epidemiología y Salud PúblicaMadridSpain
- Instituto de Salud Pública y Laboral de NavarraPamplonaSpain
- Navarra Institute for Health ResearchPamplonaSpain
| | - Jesús‐Humberto Gómez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud PúblicaMadridSpain
- Department of EpidemiologyRegional Health Council, IMIB‐Arrixaca, Murcia UniversityMurciaSpain
| | - Johnni Hansen
- Danish Cancer Institute, Danish Cancer SocietyCopenhagenDenmark
| | | | - Lefkos T. Middleton
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College LondonLondonUnited Kingdom
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical NetworkFlorenceItaly
| | - Valeria Pala
- Epidemiology and Prevention UnitFondazione IRCCS Istituto Nazionale dei Tumori di MilanoMilanItaly
| | - Ana Vinagre‐Aragon
- Movement Disorders Unit, Department of NeurologyUniversity Hospital DonostiaSan SebastianSpain
- Neurodegenerative Diseases AreaBioDonostia Health Research InstituteSan SebastiánSpain
| | - Maurizio Zibetti
- Department of Neuroscience “Rita Levi Montalcini”University of TurinTurinItaly
| | - Roel Vermeulen
- Institute for Risk Assessment SciencesUtrecht UniversityUtrechtthe Netherlands
- Julius Center for Health Sciences and Primary CareUniversity Medical Centre UtrechtUtrechtthe Netherlands
| | - Susan Peters
- Institute for Risk Assessment SciencesUtrecht UniversityUtrechtthe Netherlands
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16
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O'Callaghan KM, Qamar H, Gernand AD, Onoyovwi AK, Zlotkin S, Mahmud AA, Ahmed T, Keya FK, Roth DE. Maternal prenatal, with or without postpartum, vitamin D3 supplementation does not improve maternal iron status at delivery or infant iron status at 6 months of age: secondary analysis of a randomised controlled trial. BMJ Nutr Prev Health 2023; 6:282-292. [PMID: 38264359 PMCID: PMC10800272 DOI: 10.1136/bmjnph-2023-000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/31/2023] [Indexed: 01/25/2024] Open
Abstract
Background Vitamin D may modify iron status through regulation of hepcidin and inflammatory pathways. This study aimed to investigate effects of maternal vitamin D supplementation on iron status in pregnancy and early infancy. Methods In a trial in Dhaka, Bangladesh, women (n=1300) were randomised to one of five vitamin D3 regimens from 17 to 24 weeks' gestation until 26 weeks postpartum (prenatal; postpartum doses): 0;0, 4200;0, 16 800;0, 28 000;0 or 28 000;28 000 IU/week. All participants received standard iron-folic acid supplementation. In this secondary analysis (n=998), we examined effects of prenatal;postpartum vitamin D on serum ferritin and other biomarkers of maternal iron status (transferrin saturation, total iron binding capacity, soluble transferrin receptor and hepcidin) at delivery, and infant ferritin and haemoglobin at 6 months of age. Using linear regression, we estimated per cent mean differences between each intervention group and placebo with 95% CIs, with and without adjustment for baseline ferritin or inflammatory biomarkers (C reactive protein and α-1-acid glycoprotein (AGP)). Results At delivery, ferritin concentrations were similar between each intervention group and placebo in unadjusted (n=998) and baseline ferritin-adjusted analyses (n=992; p>0.05). Compared with placebo, AGP was lower in each intervention group (per cent difference (95% CI) = -11% (-21 to -1.0), -14% (-23 to -3.5) and -11% (-19 to -2.0) in the 4200 IU/week, 16 800 IU/week and 28 000 IU/week groups, respectively; n=779). In the subgroup of women with baseline 25-hydroxyvitamin D < 30 nmol/L, ferritin was lower in each intervention group versus placebo (-23% (-37 to -5.0), -20% (-35 to -1.9) and -20% (-33 to -4.1) in the 4200 IU/week, 16 800 IU/week and 28 000 IU/week groups, respectively; n=645); effects were slightly attenuated after adjustment for inflammation (n=510). There were no effects of vitamin D on other iron biomarkers among women at delivery or infants aged 6 months. Conclusion These findings do not support improvement of iron status by vitamin D. The effect of prenatal vitamin D supplementation on ferritin may reflect an anti-inflammatory mechanism.
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Affiliation(s)
- Karen M O'Callaghan
- Department of Nutritional Sciences, King's College London, London, UK
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Huma Qamar
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - AK Onoyovwi
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stanley Zlotkin
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Abdullah A Mahmud
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Farhana K Keya
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Daniel E Roth
- Centre for Global Child Health and SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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17
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Fonseca Ó, Ramos AS, Gomes LTS, Gomes MS, Moreira AC. New Perspectives on Circulating Ferritin: Its Role in Health and Disease. Molecules 2023; 28:7707. [PMID: 38067440 PMCID: PMC10708148 DOI: 10.3390/molecules28237707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
The diagnosis of iron disturbances usually includes the evaluation of serum parameters. Serum iron is assumed to be entirely bound to transferrin, and transferrin saturation-the ratio between the serum iron concentration and serum transferrin-usually reflects iron availability. Additionally, serum ferritin is commonly used as a surrogate of tissue iron levels. Low serum ferritin values are interpreted as a sign of iron deficiency, and high values are the main indicator of pathological iron overload. However, in situations of inflammation, serum ferritin levels may be very high, independently of tissue iron levels. This presents a particularly puzzling challenge for the clinician evaluating the overall iron status of the patient in the presence of an inflammatory condition. The increase in serum ferritin during inflammation is one of the enigmas regarding iron metabolism. Neither the origin, the mechanism of release, nor the effects of serum ferritin are known. The use of serum ferritin as a biomarker of disease has been rising, and it has become increasingly diverse, but whether or not it contributes to controlling the disease or host pathology, and how it would do it, are important, open questions. These will be discussed here, where we spotlight circulating ferritin and revise the recent clinical and preclinical data regarding its role in health and disease.
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Affiliation(s)
- Óscar Fonseca
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (Ó.F.); (A.S.R.); (L.T.S.G.); (M.S.G.)
| | - Ana S. Ramos
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (Ó.F.); (A.S.R.); (L.T.S.G.); (M.S.G.)
- FCUP—Faculdade de Ciências, Universidade do Porto, 4169-007 Porto, Portugal
- ICBAS—Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
| | - Leonor T. S. Gomes
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (Ó.F.); (A.S.R.); (L.T.S.G.); (M.S.G.)
- FCUP—Faculdade de Ciências, Universidade do Porto, 4169-007 Porto, Portugal
- ICBAS—Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
| | - Maria Salomé Gomes
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (Ó.F.); (A.S.R.); (L.T.S.G.); (M.S.G.)
- ICBAS—Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
| | - Ana C. Moreira
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (Ó.F.); (A.S.R.); (L.T.S.G.); (M.S.G.)
- ICBAS—Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
- IBMC—Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto, Portugal
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Silva CSS, Bensenor IM, Goulart AC, Lotufo PA, Santos IS. Anaemia and its causes at the Brazilian Longitudinal Study of Adult Health: a cross-sectional analysis of baseline data. Fam Pract 2023:cmad102. [PMID: 37951231 DOI: 10.1093/fampra/cmad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Most anaemia studies focus on children and women of childbearing age. We assessed the frequency and main aetiologies of anaemia according to sociodemographic characteristics at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort of middle-aged adults. METHODS The primary analyses included 15,051 participants aged 35-74 years with a valid blood cell count. We built logistic models to analyse the association between socioeconomic characteristics and anaemia diagnosis. We also described the main aetiologies in a subset (n = 209) of participants with anaemia. RESULTS Anaemia was present in 3.0% (95% confidence interval [95%CI]: 2.6-3.4%) of men and 7.4% (95%CI: 6.9-8.0%) of women. The frequency of anaemia diagnosis was higher in women in all subgroups except for the oldest age stratum (65-74 years). The frequency of anaemia was particularly high in Blacks (6.0% and 15.5% in men and women, respectively). The most common causes of anaemia were iron deficiency (in women), chronic kidney disease, and chronic inflammation (in men). The frequency of unexplained anaemia was respectively 33.3% and 34.2% for men and women, and this condition was more frequent among participants of Black or Mixed races. CONCLUSIONS Anaemia was associated with age, female sex, Black race, and low socioeconomic status. Unexplained anaemia was common and more frequent in individuals of Black and Mixed races. ELSA-Brasil follow-up data may provide further insight into the relevance of unexplained anaemia in this setting.
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Affiliation(s)
- Cássia S S Silva
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil
| | - Isabela M Bensenor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alessandra C Goulart
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil
- Departamento de Epidemiologia, Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Itamar S Santos
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Zhang X, Jia R, Zheng Z, Jiang L, Xu Y, Raj A, Sun D. Effect of roxadustat on iron metabolism in patients with peritoneal dialysis: a real-world 24-week study. Eur J Med Res 2023; 28:489. [PMID: 37936193 PMCID: PMC10629011 DOI: 10.1186/s40001-023-01465-0] [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: 08/15/2023] [Accepted: 10/21/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Roxadustat is an oral hypoxia inducing factor-prolyl hydroxylase inhibitor (HIF-PHI) that regulates iron metabolism in patients with chronic kidney disease (CKD) primarily by reducing hepcidin levels and mobilizing internal iron stores. More data are needed to demonstrate the efficacy of roxadustat in regulating iron metabolism in patients with peritoneal dialysis (PD) compared with erythropoiesis stimulating agents (ESAs). METHODS This prospective cohort study enrolled PD patients with a mean hemoglobin level of 60-100 g/L. All subjects were randomized into two groups at a ratio of 2:1 the roxadustat group (106 cases), and the ESA group (53 cases). The primary endpoint was the change in the iron biomarker levels and the proportion of patients with absolute iron deficiency and functional iron deficiency. RESULTS Compared with ESAs, roxadustat significantly decreased hepcidin level (difference, - 20.09 ng/mL; 95% CI, - 30.26 to - 9.92), attenuated the increase in serum soluble transferrin receptor (sTFR) level (difference, - 7.87 nmol/L; 95% CI, - 12.11 to - 3.64), and reduced the proportion of patients with functional iron deficiency (roxadustat, 11.43%; ESA, 33.33%). There was no significant difference in safety of the two groups over the duration of the study. CONCLUSIONS Compared with ESA group, roxadustat group showed significant differences in all iron biomarker levels except serum ferritin (sFt) and transferrin saturation (TSAT). These results suggest that roxadustat was superior to ESAs as a therapy for iron metabolism in PD patients. TRIAL REGISTRATION This study completed Chinese Clinical Trial Registration on March 4, 2022 (registration number: ChiCTR2200057231).
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Affiliation(s)
- Xuejie Zhang
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, 99 West Huai-Hai Road, Xuzhou, 221002, Jiangsu, China
- Department of Nephrology, Jintan Hospital,Affiliated Hospital of Jiangsu University, Changzhou, China
| | - Ruoyu Jia
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zhifang Zheng
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, 99 West Huai-Hai Road, Xuzhou, 221002, Jiangsu, China
| | - Luhua Jiang
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, 99 West Huai-Hai Road, Xuzhou, 221002, Jiangsu, China
| | - Yizhou Xu
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, 99 West Huai-Hai Road, Xuzhou, 221002, Jiangsu, China
| | - Ashok Raj
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, 99 West Huai-Hai Road, Xuzhou, 221002, Jiangsu, China
- Department of Urology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Dong Sun
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, 99 West Huai-Hai Road, Xuzhou, 221002, Jiangsu, China.
- Department of Internal Medicine and Diagnostics, Xuzhou Medical University, Xuzhou, China.
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20
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Fujisawa H, Nakayama M, Haruyama N, Fukui A, Yoshitomi R, Tsuruya K, Nakano T, Kitazono T. Association between iron status markers and kidney outcome in patients with chronic kidney disease. Sci Rep 2023; 13:18278. [PMID: 37880328 PMCID: PMC10600187 DOI: 10.1038/s41598-023-45580-8] [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: 08/02/2023] [Accepted: 10/21/2023] [Indexed: 10/27/2023] Open
Abstract
Several studies conducted in patients with various stages of chronic kidney disease (CKD) have investigated the association of iron status markers, such as transferrin saturation (TSAT) and serum ferritin, with kidney outcomes. However, the associations were inconsistent and remain strongly debated. Therefore, we aimed to investigate whether TSAT and serum ferritin levels were associated with kidney outcome in such a population. In this study, 890 patients who were admitted for the evaluation of and education for CKD were prospectively followed. Primary kidney outcome was a composite of doubling of serum creatinine, end-stage kidney disease, or death due to kidney failure. Participants were divided into quartiles (Q1-Q4) according to TSAT or serum ferritin levels. During a median follow-up period of 2.8 years, kidney events occurred in 358 patients. In the multivariable Cox analyses, compared with Q3 of TSAT, the hazard ratios (95% confidence intervals) for Q1, Q2, and Q4 were 1.20 (0.87, 1.66), 1.38 (1.01, 1.87), and 1.14 (0.82, 1.59), respectively. Compared with Q2 of serum ferritin, lower and higher quartiles had a significantly increased risk for kidney outcome; hazard ratios (95% confidence intervals) for Q1, Q3, and Q4 were 1.64 (1.18, 2.27), 1.71 (1.24, 2.37), and 1.52 (1.10, 2.10), respectively. A Fine-Gray model with death before kidney events as a competing risk showed results similar to the above. In CKD, lower and higher ferritin levels were independent risk factors for kidney disease progression.
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Affiliation(s)
- Hironobu Fujisawa
- Division of Nephrology, Department of Internal Medicine, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, 810-8563, Japan
| | - Masaru Nakayama
- Division of Nephrology, Department of Internal Medicine, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, 810-8563, Japan.
| | - Naoki Haruyama
- Division of Nephrology, Department of Internal Medicine, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, 810-8563, Japan
| | - Akiko Fukui
- Division of Nephrology, Department of Internal Medicine, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, 810-8563, Japan
| | - Ryota Yoshitomi
- Division of Nephrology, Department of Internal Medicine, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, 810-8563, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, Kashihara City, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan
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21
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Ye Q, Devarshi PP, Grant RW, Higgins KA, Mitmesser SH. Lower Intakes of Key Nutrients Are Associated with More School and Workplace Absenteeism in US Children and Adults: A Cross-Sectional Study of NHANES 2003-2008. Nutrients 2023; 15:4356. [PMID: 37892431 PMCID: PMC10609412 DOI: 10.3390/nu15204356] [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: 07/22/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
The influence of individual macro- and micronutrients on absenteeism in the United States is largely unknown. The objective of this study was to determine whether nutritional status or nutrient intake were associated with absenteeism from school and work due to illness or injury. Data from NHANES 2003-2008 were used to assess nutrient intake from food and food plus supplements, nutritional biomarker levels, and school and work absenteeism per year in children and adults. Negative binomial regression models were used to predict mean days of missed work per year and to estimate incidence rate ratios (IRRs) of absenteeism by nutrient biomarker status. Of 7429 children, 77% reported missing school days (mean 4.0 days). Of 8252 adults, 51% reported missing work days (mean 4.9 days). Children and adults who reported more absent days had a significantly lower intake of protein and several essential micronutrients from the diet. When nutrients from supplements were included, this negative association was retained for protein, selenium, choline, and DHA in children and for protein, selenium, vitamin K, choline, potassium, fiber, octadecatrienoic acid, and lycopene in adults. Future studies are needed to ascertain whether dietary interventions, such as access to healthier food options and/or dietary supplements, can reduce absenteeism.
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Affiliation(s)
- Qian Ye
- Science & Technology, Pharmavite LLC, West Hills, CA 91304, USA; (P.P.D.); (R.W.G.)
| | - Prasad P. Devarshi
- Science & Technology, Pharmavite LLC, West Hills, CA 91304, USA; (P.P.D.); (R.W.G.)
| | - Ryan W. Grant
- Science & Technology, Pharmavite LLC, West Hills, CA 91304, USA; (P.P.D.); (R.W.G.)
| | - Kelly A. Higgins
- Food Components and Health Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, US Department of Agriculture, Beltsville, MD 20705, USA
| | - Susan H. Mitmesser
- Science & Technology, Pharmavite LLC, West Hills, CA 91304, USA; (P.P.D.); (R.W.G.)
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22
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Lyle AN, Budd JR, Kennerley VM, Smith BN, Danilenko U, Pfeiffer CM, Vesper HW. Assessment of WHO 07/202 reference material and human serum pools for commutability and for the potential to reduce variability among soluble transferrin receptor assays. Clin Chem Lab Med 2023; 61:1719-1729. [PMID: 37071928 DOI: 10.1515/cclm-2022-1198] [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: 11/22/2022] [Accepted: 04/04/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVES The clinical use of soluble transferrin receptor (sTfR) as an iron status indicator is hindered by a lack of assay standardization and common reference ranges and decision thresholds. In 2009, the WHO and National Institute for Biological Standards and Controls (NIBSC) released a sTfR reference material (RM), 07/202, for assay standardization; however, a comprehensive, formal commutability study was not conducted. METHODS This study evaluated the commutability of WHO 07/202 sTfR RM and human serum pools and the impacts of their use as common calibrators. Commutability was assessed for six different measurement procedures (MPs). Serum pools were prepared according to updated CLSI C37-A procedures (C37) or non-C37 procedures. The study design and analyses were based on Parts 2 and 3 of the 2018 IFCC Commutability in Metrological Traceability Working Group's Recommendations for Commutability Assessment. WHO 07/202 and serum pools were used for instrument/assay and mathematical recalibration, respectively, to determine if their use decreases inter-assay measurement variability for clinical samples. RESULTS The WHO 07/202 RM dilutions were commutable for all 6 MPs assessed and, when used for instrument calibration, decreased inter-assay variability from 208 to 55.7 %. Non-C37 and C37 serum pools were commutable for all 6 MPs assessed and decreased inter-assay variability from 208 to 13.8 % and 4.6 %, respectively, when used for mathematical recalibration. CONCLUSIONS All materials evaluated, when used as common calibrators, substantially decreased inter-assay sTfR measurement variability. MP calibration to non-C37 and C37 serum pools may reduce the sTfR IMPBR to a greater extent than WHO 07/202 RM.
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Affiliation(s)
- Alicia N Lyle
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Victoria M Kennerley
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Uliana Danilenko
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christine M Pfeiffer
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hubert W Vesper
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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23
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Porter JB, Scrimgeour A, Martinez A, James L, Aleku M, Wilson R, Muckenthaler M, Boyce M, Wilkes D, Schaeper U, Campion GV. SLN124, a GalNAc conjugated 19-mer siRNA targeting tmprss6, reduces plasma iron and increases hepcidin levels of healthy volunteers. Am J Hematol 2023; 98:1425-1435. [PMID: 37497888 DOI: 10.1002/ajh.27015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/04/2023] [Accepted: 06/12/2023] [Indexed: 07/28/2023]
Abstract
SLN124, an N-acetylgalactosamine conjugated 19-mer short interfering RNA, is being developed to treat iron-loading anemias (including beta-thalassemia and myelodysplastic syndromes) and myeloproliferative neoplasms (polycythemia vera). Through hepatic targeting and silencing of the TMPRSS6 gene, SLN124 increases endogenous hepcidin synthesis. This is the first clinical report of an siRNA targeting a component of iron homeostasis. This first-in-human, phase 1 study assessed the safety, tolerability, pharmacokinetics, and pharmacodynamics of single ascending doses of SLN124 (1.0, 3.0, and 4.5 mg/kg) in healthy volunteers. Twenty-four participants were randomized in three sequential cohorts of eight subjects, each to receive a single dose of either SLN124 or placebo (6:2 randomization), administered subcutaneously. There were no serious or severe adverse events, or discontinuations due to adverse events, and most treatment-emergent adverse events were mild, including transient mild injection site reactions, resolving without intervention. SLN124 was rapidly absorbed, with a median tmax of 4-5 h across all treatment groups, and largely eliminated from plasma by 48 h. Plasma concentrations increased in a greater than dose proportional fashion between treatment groups. In all SLN124 groups, a dose-related effect was observed across iron metabolism markers, and across erythroid markers, SLN124 resulted in increased plasma hepcidin levels, peaking around Day 29, and consequent dose-related sustained reductions in plasma iron and transferrin saturation with decreased reticulocyte production, MCHC, and MCV. Results suggest duration of action lasting up to 56 days after a single SLN124 dose, on hepcidin and hematological parameters of iron metabolism (serum iron and TSAT).
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24
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Gayathri S, Gunasekaran D, Basu S. Iron Status of Preadolescents Without Clinical Pallor Attending a Tertiary Care Hospital in South India- A Cross-Sectional Analytical Study. Indian J Pediatr 2023:10.1007/s12098-023-04773-9. [PMID: 37558812 DOI: 10.1007/s12098-023-04773-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/10/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVES To determine the prevalence of Iron Deficiency (ID) in children without clinical pallor using serum ferritin and the new parameters, soluble transferrin receptor (sTfR) & the ratio of sTfR/log10 serum ferritin (sTfR-F index), as suggested by WHO. Also to assess whether these new parameters could individually predict the presence of ID. METHODS Consecutive 230 healthy children aged 9-11 y without clinical pallor underwent estimation of Hemoglobin (Hb), C-Reactive Protein (CRP), serum ferritin, sTfR, and sTfR-F index levels in their blood. The abilities of the sTfR and sTfR-F index in predicting ID were determined by comparing with the gold standard (normal CRP and less serum ferritin), plotting Receiver-operating characteristic (ROC) curve, and noting the area under the curve (AUC). RESULTS The blood reports of 114 boys and 106 girls (total = 220) were available for analysis. Overall, 57 (31 girls, 26 boys) children had ID; among children with low CRP, 45 had ID, as suggested by low serum ferritin levels. Among children with high CRP, 12 had evidence of ID as evidenced by elevated sTfR and/or sTfR-F index. The positive predictive values of both sTfR and sTfR-F were low (32.9% and 35.9%, respectively) than the negative predictive values (85.6% and 95.3%, respectively). CONCLUSIONS The proportion of children identified to have ID using serum ferritin, sTfR, and sTfR-index was 25.9%. sTfR and/or sTfR-F index are unlikely to be ideal individual predictors of ID.
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Affiliation(s)
- S Gayathri
- Department of Pediatrics, Women & Children's Hospital, JIPMER, Puducherry, India
| | | | - Sharbari Basu
- Department of Biochemistry, JIPMER, Puducherry, India
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25
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Butler-Laporte G, Farjoun Y, Chen Y, Hultström M, Liang KYH, Nakanishi T, Su CY, Yoshiji S, Forgetta V, Richards JB. Increasing serum iron levels and their role in the risk of infectious diseases: a Mendelian randomization approach. Int J Epidemiol 2023; 52:1163-1174. [PMID: 36773317 PMCID: PMC10396421 DOI: 10.1093/ije/dyad010] [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: 06/14/2022] [Accepted: 02/02/2023] [Indexed: 02/13/2023] Open
Abstract
OBJECTIVES Increased iron stores have been associated with elevated risks of different infectious diseases, suggesting that iron supplementation may increase the risk of infections. However, these associations may be biased by confounding or reverse causation. This is important, since up to 19% of the population takes iron supplementation. We used Mendelian randomization (MR) to bypass these biases and estimate the causal effect of iron on infections. METHODS As instrumental variables, we used genetic variants associated with iron biomarkers in two genome-wide association studies (GWASs) of European ancestry participants. For outcomes, we used GWAS results from the UK Biobank, FinnGen, the COVID-19 Host Genetics Initiative or 23andMe, for seven infection phenotypes: 'any infections', combined, COVID-19 hospitalization, candidiasis, pneumonia, sepsis, skin and soft tissue infection (SSTI) and urinary tract infection (UTI). RESULTS Most of our analyses showed increasing iron (measured by its biomarkers) was associated with only modest changes in the odds of infectious outcomes, with all 95% odds ratios confidence intervals within the 0.88 to 1.26 range. However, for the three predominantly bacterial infections (sepsis, SSTI, UTI), at least one analysis showed a nominally elevated risk with increased iron stores (P <0.05). CONCLUSION Using MR, we did not observe an increase in risk of most infectious diseases with increases in iron stores. However for bacterial infections, higher iron stores may increase odds of infections. Hence, using genetic variation in iron pathways as a proxy for iron supplementation, iron supplements are likely safe on a population level, but we should continue the current practice of conservative iron supplementation during bacterial infections or in those at high risk of developing them.
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Affiliation(s)
- Guillaume Butler-Laporte
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
| | - Yossi Farjoun
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Yiheng Chen
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Michael Hultström
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Integrative Physiology, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Kevin Y H Liang
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Tomoko Nakanishi
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, QC, Canada
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- Kyoto-McGill International Collaborative School in Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Chen-Yang Su
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Satoshi Yoshiji
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, QC, Canada
- Kyoto-McGill International Collaborative School in Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Vincenzo Forgetta
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - J Brent Richards
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
- Department of Human Genetics, McGill University, Montréal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
- Department of Twin Research, King’s College London, London, UK
- 5 Prime Sciences Inc., Montreal, QC, Canada
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26
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Larsen B, Baller EB, Boucher AA, Calkins ME, Laney N, Moore TM, Roalf DR, Ruparel K, Gur RC, Gur RE, Georgieff MK, Satterthwaite TD. Development of Iron Status Measures during Youth: Associations with Sex, Neighborhood Socioeconomic Status, Cognitive Performance, and Brain Structure. Am J Clin Nutr 2023; 118:121-131. [PMID: 37146760 PMCID: PMC10375461 DOI: 10.1016/j.ajcnut.2023.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Iron is essential to brain function, and iron deficiency during youth may adversely impact neurodevelopment. Understanding the developmental time course of iron status and its association with neurocognitive functioning is important for identifying windows for intervention. OBJECTIVES This study aimed to characterize developmental change in iron status and understand its association with cognitive performance and brain structure during adolescence using data from a large pediatric health network. METHODS This study included a cross-sectional sample of 4899 participants (2178 males; aged 8-22 y at the time of participation, M [SD] = 14.24 [3.7]) who were recruited from the Children's Hospital of Philadelphia network. Prospectively collected research data were enriched with electronic medical record data that included hematological measures related to iron status, including serum hemoglobin, ferritin, and transferrin (33,015 total samples). At the time of participation, cognitive performance was assessed using the Penn Computerized Neurocognitive Battery, and brain white matter integrity was assessed using diffusion-weighted MRI in a subset of individuals. RESULTS Developmental trajectories were characterized for all metrics and revealed that sex differences emerged after menarche such that females had reduced iron status relative to males [all R2partial > 0.008; all false discovery rates (FDRs) < 0.05]. Higher socioeconomic status was associated with higher hemoglobin concentrations throughout development (R2partial = 0.005; FDR < 0.001), and the association was greatest during adolescence. Higher hemoglobin concentrations were associated with better cognitive performance during adolescence (R2partial = 0.02; FDR < 0.001) and mediated the association between sex and cognition (mediation effect = -0.107; 95% CI: -0.191, -0.02). Higher hemoglobin concentration was also associated with greater brain white matter integrity in the neuroimaging subsample (R2partial = 0.06, FDR = 0.028). CONCLUSIONS Iron status evolves during youth and is lowest in females and individuals of low socioeconomic status during adolescence. Diminished iron status during adolescence has consequences for neurocognition, suggesting that this critical period of neurodevelopment may be an important window for intervention that has the potential to reduce health disparities in at-risk populations.
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Affiliation(s)
- Bart Larsen
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA, United States; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States; Penn/Children's Hospital of Philadelphia Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, United States.
| | - Erica B Baller
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA, United States; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States; Penn/Children's Hospital of Philadelphia Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, United States
| | - Alexander A Boucher
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Minnesota, Minneapolis, MN, United States
| | - Monica E Calkins
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States; Penn/Children's Hospital of Philadelphia Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, United States
| | - Nina Laney
- Penn/Children's Hospital of Philadelphia Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, United States
| | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States; Penn/Children's Hospital of Philadelphia Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, United States
| | - David R Roalf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States; Penn/Children's Hospital of Philadelphia Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, United States
| | - Kosha Ruparel
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States; Penn/Children's Hospital of Philadelphia Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, United States
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States; Penn/Children's Hospital of Philadelphia Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, United States; Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States; Penn/Children's Hospital of Philadelphia Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, United States; Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael K Georgieff
- Department of Pediatrics, Division of Neonatology, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Theodore D Satterthwaite
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA, United States; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States; Penn/Children's Hospital of Philadelphia Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, United States
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27
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Næss-Andresen ML, Jenum AK, Berg JP, Falk RS, Sletner L. The impact of recommending iron supplements to women with depleted iron stores in early pregnancy on use of supplements, and factors associated with changes in iron status from early pregnancy to postpartum in a multi-ethnic population-based cohort. BMC Pregnancy Childbirth 2023; 23:350. [PMID: 37179290 PMCID: PMC10182636 DOI: 10.1186/s12884-023-05668-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND We aimed to evaluate the impact of recommending supplementation to pregnant women with serum ferritin (SF) < 20 µg/L in early pregnancy on use of supplements, and to explore which factors were associated with changes in iron status by different iron indicators to 14 weeks postpartum. METHODS A multi-ethnic population-based cohort study of 573 pregnant women examined at mean gestational week (GW) 15 (enrolment), at mean GW 28 and at the postpartum visit (mean 14 weeks after delivery). Women with SF < 20 µg/L at enrolment were recommended 30-50 mg iron supplementation and supplement use was assessed at all visits. Change of SF, soluble transferrin receptor and total body iron from enrolment to postpartum were calculated by subtracting the concentrations at the postpartum visit from that at enrolment. Linear and logistic regression analyses were performed to assess associations between use of supplements in GW 28 and changes in iron status and postpartum iron deficiency/anaemia. Change of iron status was categorized into 'steady low', 'improvement', 'deterioration', and 'steady high' based on SF status at enrolment and postpartum. Multinomial logistic regression analyses were performed to identify factors associated with change of iron status. RESULTS At enrolment, 44% had SF < 20 µg/L. Among these women (78% non-Western European origin), use of supplements increased from 25% (enrolment) to 65% (GW 28). Use of supplements in GW 28 was associated with improved iron levels by all three indicators (p < 0.05) and with haemoglobin concentration (p < 0.001) from enrolment to postpartum, and with lower odds of postpartum iron deficiency by SF and TBI (p < 0.05). Factors positively associated with 'steady low' were: use of supplements, postpartum haemorrhage, an unhealthy dietary pattern and South Asian ethnicity (p ≤ 0.01 for all); with 'deterioration': postpartum haemorrhage, an unhealthy dietary pattern, primiparity and no use of supplements (p < 0.01 for all), and with 'improvement': use of supplements, multiparity and South Asian ethnicity (p < 0.03 for all). CONCLUSIONS Both supplement use and iron status improved from enrolment to the postpartum visit among women recommended supplementation. Dietary pattern, use of supplements, ethnicity, parity and postpartum haemorrhage were identified as factors associated with change in iron status.
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Affiliation(s)
- Marthe-Lise Næss-Andresen
- Department of General Practice, Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1130, 0318, Oslo, Norway.
| | - Anne Karen Jenum
- General Practice Research Unit, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jens Petter Berg
- Department of Medical Biochemistry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ragnhild Sørum Falk
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Line Sletner
- Department of Paediatric and Adolescents Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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28
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Aguree S, Owora A, Hawkins M, Reddy MB. Iron Deficiency and Iron Deficiency Anemia in Women with and without Obesity: NHANES 2001-2006. Nutrients 2023; 15:nu15102272. [PMID: 37242155 DOI: 10.3390/nu15102272] [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: 04/14/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Obesity has been linked to numerous health and nutritional problems, including impaired iron metabolism, a common cause of anemia. We aimed to determine the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) among women aged 20-49 years based on body mass index (BMI) status. We used measures of iron status and body mass index from the 2001-2006 National Health and Nutrition Examination Survey (NHANES). Mean serum ferritin, erythrocyte protoporphyrin, and soluble transferrin receptor were higher, while those of serum iron, percent transferrin saturation, and mean cell volume (MCV) were lower in women with obesity than those with normal weight (all p < 0.016). ID based on the ferritin model was 12.5 ± 1.0% vs. 22.9 ± 1.6% (p < 0.001); 9.0 ± 0.9% vs. 20.0 ± 1.3% (p < 0.001) based on the MCV model; and 8.1 ± 1.0% vs. 10.5 ± 1.2% (p > 0.05) based on the BII model for women with normal weight and women with obesity, respectively. Anemia prevalence was 5.5 ± 0.8% (normal) vs. 9.3 ± 1.0% (obese) (p = 0.005). The IDA estimates based on the ferritin and MCV models were similar but higher than that from the BII model (p < 0.001). Generally, the prevalence rates of ID and anemia (and IDA) were higher for women with obesity, but the method used to define deficiency mattered. The choice of iron indices is important for estimating ID and IDA in populations with obesity.
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Affiliation(s)
- Sixtus Aguree
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405, USA
| | - Arthur Owora
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN 47405, USA
| | - Misty Hawkins
- Department of Health and Wellness Design, School of Public Health, Indiana University, Bloomington, IN 47405, USA
| | - Manju B Reddy
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA 50011, USA
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29
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Das A, Bai CH, Chang JS, Huang YL, Wang FF, Chen YC, Chao JCJ. Associations of Dietary Patterns and Vitamin D Levels with Iron Status in Pregnant Women: A Cross-Sectional Study in Taiwan. Nutrients 2023; 15:nu15081805. [PMID: 37111023 PMCID: PMC10143533 DOI: 10.3390/nu15081805] [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: 02/21/2023] [Revised: 03/17/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Vitamin D is involved in the pathophysiology of anemia. This cross-sectional study was conducted using the Nationwide Nutrition and Health Survey in Pregnant Women in Taiwan database. We investigated associations among dietary patterns (DPs), vitamin D, and iron-related biomarkers in pregnant women. The principal component analysis revealed four DPs. Linear and logistic regression analyses were performed to investigate the association of DPs with anemia-related biomarkers. Plant-based, carnivore, and dairy and nondairy alternatives DPs were positively associated with serum vitamin D levels. After adjusting covariates, the pregnant women consuming plant-based DPs at the mid-tertile (T2) were associated with reduced risks of low serum folate and vitamin D levels, and those consuming carnivore DPs at higher tertiles (T2 and/or T3) were correlated with an increased risk of low serum iron levels but decreased risks of low serum transferrin saturation, vitamin B12, and vitamin D levels. The pregnant women consuming dairy and nondairy alternatives DPs at the highest tertile (T3) were associated with reduced risks of low serum folate and vitamin B12 levels. However, the processed food DP was not correlated with anemia-related biomarkers. Thus, plant-based, carnivore, and dairy and nondairy alternatives DPs were associated with the risk of low-serum-anemia-related variables.
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Affiliation(s)
- Arpita Das
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110301, Taiwan
| | - Chyi-Huey Bai
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110301, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110301, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei 110301, Taiwan
| | - Jung-Su Chang
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110301, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei 110301, Taiwan
- Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110301, Taiwan
| | - Ya-Li Huang
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110301, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110301, Taiwan
| | - Fan-Fen Wang
- Department of Metabolism, Yangming Branch, Taipei City Hospital, 105 Yusheng Street, Taipei 111024, Taiwan
| | - Yi-Chun Chen
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110301, Taiwan
| | - Jane C-J Chao
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110301, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, 252 Wu-Hsing Street, Taipei 110301, Taiwan
- Master Program in Global Health and Health Security, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110301, Taiwan
- TMU Research Center for Digestive Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110301, Taiwan
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30
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Naveed K, Goldberg N, Shore E, Dhoot A, Gabrielson D, Goodarzi Z, Lin Y, Pai M, Pardy NA, Robinson S, Andreou R, Sood M, Price V, Storm S, Verduyn A, Parker ML, Fralick M, Beriault D, Sholzberg M. Defining ferritin clinical decision limits to improve diagnosis and treatment of iron deficiency: A modified Delphi study. Int J Lab Hematol 2023; 45:377-386. [PMID: 36602151 DOI: 10.1111/ijlh.14016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Iron deficiency is highly prevalent worldwide and is an issue of health inequity. Despite its high prevalence, uncertainty on the clinical applicability and evidence-base of iron-related lab test cut-offs remains. In particular, current ferritin decision limits for the diagnosis of iron deficiency may not be clinically appropriate nor scientifically grounded. METHODS A modified Delphi study was conducted with various clinical experts who manage iron deficiency across Canada. Statements about ferritin decision limits were generated by a steering committee, then distributed to the expert panel to vote on agreement with the aim of achieving consensus and acquiring feedback on the presented statements. Consensus was reached after two rounds, which was defined as 70% of experts rating their agreement for a statement as 5 or higher on a Likert scale from 1 to 7. RESULTS Twenty-six clinical experts across 10 different specialties took part in the study. Consensus was achieved on 28 ferritin decision limit statements in various populations (including patients with multiple comorbid conditions, pediatric patients, and pregnant patients). For example, there was consensus that a ferritin <30 μg/L rules in iron deficiency in all adult patients (age ≥ 18 years) and warrants iron replacement therapy. CONCLUSION Consensus statements generated through this study corresponded with current evidence-based literature and guidelines. These statements provide clarity to facilitate clinical decisions around the appropriate detection and management of iron deficiency.
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Affiliation(s)
- Kanza Naveed
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicola Goldberg
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Eliane Shore
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Arti Dhoot
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Denise Gabrielson
- Division of Hematology/Oncology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Zahra Goodarzi
- Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yulia Lin
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Menaka Pai
- Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences and St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Natasha A Pardy
- Department of Hematology, Eastern Health, St. John's, Newfoundland and Labrador, Canada
| | - Sue Robinson
- Division of Hematology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Roseann Andreou
- Division of Hematology/Oncology, Toronto East Health Network Michael Garron Hospital, Toronto, Ontario, Canada
| | - Manish Sood
- Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Vicky Price
- Division of Pediatric Hematology/Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sherri Storm
- Academic Family Health Team & Women's and Children's Health Program, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ashley Verduyn
- Department of Rehabilitative Care, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle L Parker
- DynaLIFE Medical Labs and Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Fralick
- Department of Internal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Daniel Beriault
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michelle Sholzberg
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, Toronto, Ontario, Canada
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31
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A Review of the Risk Factors for Iron Deficiency Anaemia among Adolescents in Developing Countries. Anemia 2023; 2023:6406286. [PMID: 36636253 PMCID: PMC9831712 DOI: 10.1155/2023/6406286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/15/2022] [Accepted: 12/24/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction Identifying the root causes of iron deficiency anaemia is a prerequisite for effective management and prevention in adolescents. This systematic review assessed risk factors of iron deficiency anaemia among adolescents living in developing countries. Method Electronic databases such as PubMed, Cochrane Library, Science Direct, Google Scholar, and SCOPUS were comprehensively searched for studies published between 1990 and 2020 that involved risk factors of iron deficiency anaemia among adolescents living in developing countries. The quality of the included studies was assessed using the American Dietetic Association Quality Criteria Checklist. Results A total of 2,252 publications were reviewed, and only fifteen cross-sectional studies were eligible for inclusion, eight of which focused on female adolescents and seven on both genders. Direct risk factors contributing to anaemia among adolescents included food intake practices (n = 10 studies), female adolescents (n = 8 studies), menstruation (n = 5 studies), and parasitic infection (n = 6 studies). Indirect risk factors found to be associated with anaemia among adolescents included low educational status (n = 4 studies) and low socioeconomic status (n = 3 studies). All fifteen studies were of good quality. Conclusion Food intake practices, female adolescents, menstruation, parasitic infection, and low educational status were the leading risk factors of iron deficiency anaemia among adolescents. Further research should concentrate on assessing the effectiveness and efficacy of existing interventions aimed at preventing iron deficiency among vulnerable groups in developing countries.
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32
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Evaluation of RET-He values as an early indicator of iron deficiency anemia in pregnant women. Hematol Transfus Cell Ther 2023; 45:52-57. [PMID: 34266811 PMCID: PMC9938494 DOI: 10.1016/j.htct.2021.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION During pregnancy, women are at an increased risk of developing iron-deficiency anemia. OBJECTIVE The objective of this study was to assess the diagnostic performance of the reticulocyte hemoglobin equivalent (RET-He) in the early detection of iron-deficiency anemia in a group of pregnant women and to establish a reference range for this parameter in a group of control individuals. METHOD A total of 60 patients and 130 control subjects were included in the study. Blood samples collected from the subjects were submitted to a complete blood count and a serum ferritin test and the data were analyzed by comparing the groups and ROC curves. RESULTS The reference range found for the RET-He was between 29.75pg and 38.24pg, with a median of 35pg. The receiver operating characteristic (ROC) curve analysis for the ferritin parameter showed an area under the curve of 0.732 for the RET-He, 0.586 for hemoglobin, 0.551 for the mean corpuscular hemoglobin concentration and 0.482 for the mean corpuscular volume. CONCLUSION Early diagnosis of iron deficiency anemia in pregnancy is essential to prevent damage to both maternal and fetal health. The RET-He presents an excellent potential as an auxiliary tool for the diagnosis of iron deficiency in pregnant women.
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33
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Yadav D, Pvsn KK, Tomo S, Sankanagoudar S, Charan J, Purohit A, Nag V, Bhatia P, Singh K, Dutt N, Garg MK, Sharma P, Misra S, Purohit P. Association of iron-related biomarkers with severity and mortality in COVID-19 patients. J Trace Elem Med Biol 2022; 74:127075. [PMID: 36174458 PMCID: PMC9472468 DOI: 10.1016/j.jtemb.2022.127075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 09/02/2022] [Accepted: 09/12/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Nutritional deficiency is associated with weaken immune system and increased susceptibility to infection. Among other nutrients, several trace elements have been shown to regulate immune responses. Iron is one of the most abundant trace elements present in our body, which is required in various biological processes. Iron has an immunomodulatory function and thus influence the susceptibility to the course and outcome of a variety of viral infections. So, this present study was aimed to study relations of different iron-related biomarkers in association to severity and mortality in SARS-CoV-2 patients. MATERIALS AND METHODS A total of 150 individuals infected with COVID-19 and 50 healthy individuals were recruited. Cases were divided based on severity (mild, moderate, and severe) and outcome (discharged or deceased). Serum iron, TIBC, ferritin, transferrin, transferrin saturation levels were analyzed by the direct colourimetric method. RESULTS In cases the median levels of serum iron, TIBC, transferrin, transferrin saturation and ferritin are 29 µg/dL, 132.53 µg/dL, 106.3 mg/dL, 17.74 % and 702.9 ng/dL respectively. Similarly, in controls the median levels of serum iron, TIBC, transferrin, transferrin saturation and ferritin are 53 µg/dL, 391.88 µg/dL, 313.51 mg/dL, 12.81 % and 13.52 ng/dL respectively. On comparing the cases with the controls, a significant lower level of iron, TIBC, and transferrin were found in the cases along with the significant higher levels of ferritin and transferrin saturation. On comparing the Receiver operating characteristic (ROC) curves of Iron, Ferritin, Transferrin, Transferrin sat % and TIBC in relation to survival in COVID-19 patients it was found that iron, followed by transferrin and ferritin has the highest area under the curve (AUC) with 74 %, 63 % and 61 % respectively. Further, in pairwise analysis of ROC curve, a significant difference was found between the Iron-transferrin (p < 0.01), iron-TIBC (p < 0.001) and transferrin-ferritin (P < 0.01). The multiple regression model based on Iron and transferrin outperformed any other combination of variables via stepwise AIC selection with an AUC of 98.2 %. The cutoff point according to Youden's J index is characterized with a sensitivity of 98 % and a specificity of 96.8 %, indicating that iron along with transferrin can be a useful marker that may contribute to a better assessment of survival chances in COVID-19. CONCLUSION Our study demonstrated a significantly decreased levels of iron, TIBC, & transferrin and a significantly increased levels of ferritin and transferrin saturation in COVID-19 patients when compared with controls. Further, Iron and transferrin were observed to be a good predictor of mortality in patients with COVID-19. From the above analysis we confirm that iron-related biomarkers play an important role in the development of oxidative stress and further lead to activation of the cytokine storm. So, continuous monitoring of these parameters could be helpful in the early detection of individuals developing the severe disease and can be used to decrease mortality in upcoming new waves of COVID-19.
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Affiliation(s)
- Dharamveer Yadav
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Kiran Kumar Pvsn
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Sojit Tomo
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Jayakaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Abhishek Purohit
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, India
| | - Vijaylakshami Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Pradeep Bhatia
- Department of Anaesthesia, All India Institute of Medical Sciences, Jodhpur, India
| | - Kuldeep Singh
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Mahendra Kumar Garg
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Sanjeev Misra
- Department of Surgical Oncology, Director and CEO, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Purvi Purohit
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India.
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34
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Brooker PG, Rebuli MA, Williams G, Muhlhausler BS. Effect of Fortified Formula on Growth and Nutritional Status in Young Children: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:5060. [PMID: 36501090 PMCID: PMC9737957 DOI: 10.3390/nu14235060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/19/2022] [Accepted: 11/19/2022] [Indexed: 11/29/2022] Open
Abstract
Previous reviews of the effect of young child formulas on health outcomes in infants and toddlers have been inconclusive. In this study, we undertook a contemporary synthesis of studies investigating the effects of consuming fortified milk beverages (compared to cow’s milk or unfortified comparator formula) on growth and/or nutritional status in children 1−3 years of age. Five electronic databases were searched (PubMed, Web of Science, Scopus, ProQuest, and Cochrane Library) for randomised controlled trials comparing fortified milk against control milk in young children (9−48 months), published between January 1990 and June 2022. Outcomes were growth, body composition, biochemical markers, and/or nutritional status. Mean differences (MD) were pooled using random-effects meta-analysis where there were ≥3 studies. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Nineteen articles (12 studies; n = 4795) met the inclusion criteria. Heterogeneity was substantial, likely attributable to considerable variation in study characteristics. Fortified milk was associated with increased weight gain (MD = 0.14 kg [95% CI 0.06, 021], p = 0.0003) compared with control milk. Subgroup analyses demonstrated increases in weight in lower-income countries, and in studies with intervention periods > 6 months. There were no effects of fortified milks on other anthropometric measures. Haemoglobin (MD = 3.76 g/L [95% CI 0.17, 7.34], p = 0.04) and ferritin (MD = 0.01 nmol/L [95% CI 0.00, 0.02], p = 0.02) concentrations were increased in infants consuming fortified milks. Fortified milk beverages appear to offer a safe and acceptable source of complementary nutrition as a short-term strategy for addressing nutritional deficits and may modestly promote weight gain in vulnerable populations when provided for periods > 6 months. This study was prospectively registered with PROSPERO (CRD42022339920) and funded by the Infant Nutrition Council.
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Affiliation(s)
- Paige G. Brooker
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, BC 5000, Australia
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35
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Yamane T, Kanamori Y, Sawayama H, Yano H, Nita A, Ohta Y, Hinokuma H, Maeda A, Iwai A, Matsumoto T, Shimoda M, Niimura M, Usuki S, Yasuda-Yoshihara N, Niwa M, Baba Y, Ishimoto T, Komohara Y, Sawa T, Hirayama T, Baba H, Moroishi T. Iron accelerates Fusobacterium nucleatum-induced CCL8 expression in macrophages and is associated with colorectal cancer progression. JCI Insight 2022; 7:156802. [PMID: 36136589 PMCID: PMC9675438 DOI: 10.1172/jci.insight.156802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 09/20/2022] [Indexed: 12/15/2022] Open
Abstract
Accumulating evidence suggests that high levels of Fusobacterium nucleatum in colorectal tumor tissues can be associated with poor prognosis in patients with colorectal cancer (CRC); however, data regarding distinct prognostic subgroups in F. nucleatum-positive CRC remain limited. Herein, we demonstrate that high-iron status was associated with a worse prognosis in patients with CRC with F. nucleatum. Patients with CRC presenting elevated serum transferrin saturation exhibited preferential iron deposition in macrophages in the tumor microenvironment. In addition, F. nucleatum induced CCL8 expression in macrophages via the TLR4/NF-κB signaling pathway, which was inhibited by iron deficiency. Mechanistically, iron attenuated the inhibitory phosphorylation of NF-κB p65 by activating serine/threonine phosphatases, augmenting tumor-promoting chemokine production in macrophages. Our observations indicate a key role for iron in modulating the NF-κB signaling pathway and suggest its prognostic potential as a determining factor for interpatient heterogeneity in F. nucleatum-positive CRC.
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Affiliation(s)
- Taishi Yamane
- Department of Cell Signaling and Metabolic Medicine, Faculty of Life Sciences,,Department of Gastroenterological Surgery, Graduate School of Medical Sciences
| | - Yohei Kanamori
- Department of Cell Signaling and Metabolic Medicine, Faculty of Life Sciences
| | - Hiroshi Sawayama
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences
| | - Hiromu Yano
- Department of Cell Pathology, Graduate School of Medical Sciences, and
| | - Akihiro Nita
- Department of Cell Signaling and Metabolic Medicine, Faculty of Life Sciences
| | - Yudai Ohta
- Department of Cell Signaling and Metabolic Medicine, Faculty of Life Sciences
| | - Hironori Hinokuma
- Department of Cell Signaling and Metabolic Medicine, Faculty of Life Sciences
| | - Ayato Maeda
- Department of Cell Signaling and Metabolic Medicine, Faculty of Life Sciences
| | - Akiko Iwai
- Department of Cell Signaling and Metabolic Medicine, Faculty of Life Sciences
| | - Takashi Matsumoto
- Department of Cell Signaling and Metabolic Medicine, Faculty of Life Sciences,,Department of Gastroenterological Surgery, Graduate School of Medical Sciences
| | - Mayuko Shimoda
- Department of Cell Signaling and Metabolic Medicine, Faculty of Life Sciences
| | - Mayumi Niimura
- Department of Cell Signaling and Metabolic Medicine, Faculty of Life Sciences
| | - Shingo Usuki
- Liaison Laboratory Research Promotion Center, Institute of Molecular Embryology and Genetics, Kumamoto University, Kumamoto, Japan
| | | | - Masato Niwa
- Laboratory of Pharmaceutical and Medicinal Chemistry, Gifu Pharmaceutical University, Gifu, Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences
| | - Takatsugu Ishimoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences,,Gastrointestinal Cancer Biology, International Research Center for Medical Sciences
| | - Yoshihiro Komohara
- Department of Cell Pathology, Graduate School of Medical Sciences, and,Center for Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, and
| | - Tomohiro Sawa
- Department of Microbiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tasuku Hirayama
- Laboratory of Pharmaceutical and Medicinal Chemistry, Gifu Pharmaceutical University, Gifu, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences,,Center for Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, and
| | - Toshiro Moroishi
- Department of Cell Signaling and Metabolic Medicine, Faculty of Life Sciences,,Center for Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, and
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Belhomme N, Morcet J, Lescoat A, Robin F, Deugnier Y, Bardou-Jacquet E, Lainé F. Patient-reported outcomes and their relation with iron parameters in HFE haemochromatosis during maintenance therapy: A prospective cohort study. Liver Int 2022; 42:2473-2481. [PMID: 35727816 DOI: 10.1111/liv.15341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS The standard of care for haemochromatosis is regular phlebotomy in order to maintain low ferritin levels. Many patients report fatigue or joint pain despite serum ferritin within the therapeutic targets. We evaluated Patient-Reported Outcomes, and their relation with iron parameters, in C282Y homozygous patients undergoing maintenance phlebotomy. METHODS Patients were prospectively enrolled in a French referral care centre. At each phlebotomy, patients completed a numeric fatigue scale, a joint pain questionnaire and SF-36 Mental Component Score (MCS) and Physical Component Score (PCS). Haemoglobin, iron, TS and ferritin were collected concomitantly. RESULTS About 701 visits were performed in 259 patients. The median fatigue score was 3/10; 171 (66%) patients reported joint pain. Age and worsening of joint pain were associated with fatigue (p < .0001 for both). Female gender (p < .037), age (p < .003), and a decrease of TS (p = .050) were associated with joint pain. Main features associated with PCS <50 were worsening of joint pain and age (p < .001 for both) and TS <20% (p < .02). CONCLUSIONS Fatigue was independent from iron parameters. The main factor impacting quality of life was joint pain, which was more severe in patients with low TS values. Then, a more precise monitoring of TS should be proposed during haemochromatosis maintenance therapy; while less stringent monitoring of serum ferritin levels could be tested.
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Affiliation(s)
- Nicolas Belhomme
- Service de Médecine Interne et Immunologie Clinique, CHU de Rennes, Rennes, France.,Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France.,Unité d'Investigation Clinique, CHU de Rennes, Rennes, France
| | - Jeff Morcet
- Unité d'Investigation Clinique, CHU de Rennes, Rennes, France
| | - Alain Lescoat
- Service de Médecine Interne et Immunologie Clinique, CHU de Rennes, Rennes, France.,Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France.,Faculté de médecine, Université Rennes 1, Rennes, France
| | - François Robin
- Faculté de médecine, Université Rennes 1, Rennes, France.,Service de Rhumatologie, CHU de Rennes, Rennes, France.,INSERM UMR 991, Rennes, France
| | - Yves Deugnier
- Unité d'Investigation Clinique, CHU de Rennes, Rennes, France.,Centre de référence des surcharges génétiques en fer, service des maladies du foie, CHU de Rennes, France
| | - Edouard Bardou-Jacquet
- Unité d'Investigation Clinique, CHU de Rennes, Rennes, France.,Faculté de médecine, Université Rennes 1, Rennes, France.,Centre de référence des surcharges génétiques en fer, service des maladies du foie, CHU de Rennes, France
| | - Fabrice Lainé
- Unité d'Investigation Clinique, CHU de Rennes, Rennes, France.,Centre de référence des surcharges génétiques en fer, service des maladies du foie, CHU de Rennes, France
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37
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Jefferds MED, Mei Z, Addo Y, Hamner HC, Perrine CG, Flores-Ayala R, Pfeiffer CM, Sharma AJ. Iron Deficiency in the United States: Limitations in Guidelines, Data, and Monitoring of Disparities. Am J Public Health 2022; 112:S826-S835. [PMID: 36288529 PMCID: PMC9612197 DOI: 10.2105/ajph.2022.306998] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 11/04/2022]
Abstract
Iron deficiency and the more severe sequela, iron deficiency anemia, are public health problems associated with morbidity and mortality, particularly among pregnant women and younger children. The 1998 Centers for Disease Control and Prevention recommendations for prevention and control of iron deficiency in the United States is old and does not reflect recent evidence but is a foundational reference for many federal, clinical, and program guidelines. Surveillance data for iron deficiency are sparse at all levels, with critical gaps for pregnant women and younger children. Anemia, iron deficiency, and iron deficiency anemia are often conflated but should not be. Clinical guidelines for anemia, iron deficiency, and iron deficiency anemia give inconsistent recommendations, causing nonsystematic assessment of iron deficiency. Screening for iron deficiency typically relies on identifying anemia, despite anemia's low sensitivity for iron deficiency. In the National Health and Nutrition Examination Survey, more than 70% of iron deficiency is missed among pregnant women and children by relying on hemoglobin for iron deficiency screening. To improve assessment and diagnosis and strengthen surveillance, better and more complete data and updated foundational guidance on iron deficiency and anemia are needed that consider new evidence for measuring and interpreting laboratory results. (Am J Public Health. 2022;112(S8):S826-S835. https://doi.org/10.2105/AJPH.2022.306998).
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Affiliation(s)
- Maria Elena D Jefferds
- At the time of writing, Maria Elena D. Jefferds, Zuguo Mei, Yaw Addo, Heather C. Hamner, Cria G. Perrine, Rafael Flores-Ayala, and Andrea J. Sharma were with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Christine M. Pfeiffer was with the Nutritional Biomarkers Branch, National Center for Environmental Health, CDC, Atlanta
| | - Zuguo Mei
- At the time of writing, Maria Elena D. Jefferds, Zuguo Mei, Yaw Addo, Heather C. Hamner, Cria G. Perrine, Rafael Flores-Ayala, and Andrea J. Sharma were with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Christine M. Pfeiffer was with the Nutritional Biomarkers Branch, National Center for Environmental Health, CDC, Atlanta
| | - Yaw Addo
- At the time of writing, Maria Elena D. Jefferds, Zuguo Mei, Yaw Addo, Heather C. Hamner, Cria G. Perrine, Rafael Flores-Ayala, and Andrea J. Sharma were with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Christine M. Pfeiffer was with the Nutritional Biomarkers Branch, National Center for Environmental Health, CDC, Atlanta
| | - Heather C Hamner
- At the time of writing, Maria Elena D. Jefferds, Zuguo Mei, Yaw Addo, Heather C. Hamner, Cria G. Perrine, Rafael Flores-Ayala, and Andrea J. Sharma were with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Christine M. Pfeiffer was with the Nutritional Biomarkers Branch, National Center for Environmental Health, CDC, Atlanta
| | - Cria G Perrine
- At the time of writing, Maria Elena D. Jefferds, Zuguo Mei, Yaw Addo, Heather C. Hamner, Cria G. Perrine, Rafael Flores-Ayala, and Andrea J. Sharma were with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Christine M. Pfeiffer was with the Nutritional Biomarkers Branch, National Center for Environmental Health, CDC, Atlanta
| | - Rafael Flores-Ayala
- At the time of writing, Maria Elena D. Jefferds, Zuguo Mei, Yaw Addo, Heather C. Hamner, Cria G. Perrine, Rafael Flores-Ayala, and Andrea J. Sharma were with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Christine M. Pfeiffer was with the Nutritional Biomarkers Branch, National Center for Environmental Health, CDC, Atlanta
| | - Christine M Pfeiffer
- At the time of writing, Maria Elena D. Jefferds, Zuguo Mei, Yaw Addo, Heather C. Hamner, Cria G. Perrine, Rafael Flores-Ayala, and Andrea J. Sharma were with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Christine M. Pfeiffer was with the Nutritional Biomarkers Branch, National Center for Environmental Health, CDC, Atlanta
| | - Andrea J Sharma
- At the time of writing, Maria Elena D. Jefferds, Zuguo Mei, Yaw Addo, Heather C. Hamner, Cria G. Perrine, Rafael Flores-Ayala, and Andrea J. Sharma were with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Christine M. Pfeiffer was with the Nutritional Biomarkers Branch, National Center for Environmental Health, CDC, Atlanta
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Ntenda PAM, Chirambo AC, Nkoka O, El-Meidany WM, Goupeyou-Youmsi J. Implication of asymptomatic and clinical Plasmodium falciparum infections on biomarkers of iron status among school-aged children in Malawi. Malar J 2022; 21:278. [PMID: 36183114 PMCID: PMC9526385 DOI: 10.1186/s12936-022-04297-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background Iron status is considered as a continuum from an iron deficiency with anaemia, without anaemia, varying amounts of stored iron to iron overload. The burden of Plasmodium falciparum infections is typically high among school-aged children (SAC). Nonetheless, SAC are often less likely to be covered by malaria interventions, making them a group with an untreated reservoir of parasite transmission. This study aimed to assess the effects of asymptomatic and clinical malaria infections on biochemical markers of iron status among SAC in Malawi. Methods Data from the 2015–2016 Malawi Micronutrient Survey (MNS) was used and multivariable logistic regression models using a generalized estimating equation to account for the complex cluster survey design were constructed. Blood samples of 684 children aged 5 to 14 years old were evaluated for clinical and asymptomatic malaria infections. Furthermore, blood samples were used to estimate haemoglobin (Hb), serum ferritin (SF) and, soluble transferrin receptors (sTfR) concentrations. Results Of the 684 SAC analysed, approximately 42% had asymptomatic malaria, while 41.0% had clinical malaria. Anaemia (low Hb levels), iron deficiency (low SF concentration), and functional iron deficiency (high sTfR levels) were found in 20%, 5%, and 30% of the children, respectively. School-aged children with asymptomatic malaria had increased odds of being anaemic (adjusted odds ratio [aOR]: 3.71, 95% confidence interval [CI]: 2.29–5.99) and increased levels of sTfR (aOR: 3.00, 95% CI 2.01–4.47). Similarly, SAC with clinical malaria had increased odds of being anaemic (aOR: 3.54, 95% CI 2.19–5.72) and increased levels of sTfR (aOR: 3.02, 95% CI 2.02–4.52). Conclusions Both asymptomatic and clinical malaria were independent risk factors for anaemia and functional iron deficiency (FID). The notion that asymptomatic and clinical malaria were associated with both anaemia and FID underscores the need for public health programmers to consider adding mass screening and treatment for malaria to existing school-based health programmes. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04297-1.
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Affiliation(s)
- Peter A M Ntenda
- Malaria Alert Centre, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi.
| | - Angeziwa C Chirambo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, P.O. Box 30096, Mahatma Ghandhi Road, Chichiri, Blantyre, Malawi
| | - Owen Nkoka
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Walaa M El-Meidany
- Department of Nutrition, High Institute of Public Health, Alexandria University, Hiph 65 El-Horreya Avenue, El-Ibrahimia, Alexandria, Egypt
| | - Jessy Goupeyou-Youmsi
- Malaria Alert Centre, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi
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Positive or U-Shaped Association of Elevated Hemoglobin Concentration Levels with Metabolic Syndrome and Metabolic Components: Findings from Taiwan Biobank and UK Biobank. Nutrients 2022; 14:nu14194007. [PMID: 36235661 PMCID: PMC9572591 DOI: 10.3390/nu14194007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
Iron overnutrition has been implicated with a higher risk of developing metabolic and cardiovascular diseases, including metabolic syndrome (MetS), whereas iron deficiency anemia exacerbates many underlying chronic conditions. Hemoglobin (Hb) concentration in the blood, which reflects a major functional iron (i.e., heme iron) in the body, may serve as a surrogate of the nutritional status of iron. We conducted sex-specific observational association studies in which we carefully titrated the association between Hb deciles and MetS and its components among the Taiwanese Han Chinese (HC) from the Taiwan Biobank and Europeans of White ancestry from the UK Biobank, representing two large ethnicities. Our data show that at higher-than-normal levels of Hb, increasing deciles of Hb concentration were significantly associated with MetS across all sex subgroups in both ethnicities, with the highest deciles resulting in up to three times greater risk than the reference group [Taiwanese HC: OR = 3.17 (95% CI, 2.75-3.67) for Hb ≥ 16.5 g/dL in men, OR = 3.11 (2.78-3.47) for Hb ≥ 14.5 g/dL in women; European Whites: OR = 1.89 (1.80-1.98) for Hb ≥ 16.24 g/dL in men, OR = 2.35 (2.24-2.47) for Hb ≥ 14.68 g/dL in women]. The association between stronger risks and increasing Hb deciles was similarly observed with all metabolic components except diabetes. Here we found that both the highest Hb decile groups and contrarily the lowest ones, with respect to the reference, were associated with higher odds of diabetes in both ethnic groups [e.g., Taiwanese HC men: OR = 1.64 (1.33-2.02) for Hb ≥ 16.5 g/dL, OR = 1.71 (1.39-2.10) for Hb ≤ 13.5 g/dL; European Whites women: OR = 1.39 (1.26-1.45) for Hb ≥ 14.68 g/dL, OR = 1.81 (1.63-2.01) for Hb ≤ 12.39 g/dL]. These findings confirm that elevated Hb concentrations, a potential indicator of iron overnutrition, may play a role in the pathophysiology of MetS and metabolic components.
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40
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Prevalence of and Risk Factors for Iron Deficiency in Twin and Singleton Newborns. Nutrients 2022; 14:nu14183854. [PMID: 36145230 PMCID: PMC9500937 DOI: 10.3390/nu14183854] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Iron deficiency (ID) in utero and in infancy can cause irreversible neurocognitive damage. Iron status is not routinely tested at birth, so the burden of neonatal ID in the United States is unknown. Infants born from twin or higher-order pregnancies may be at elevated risk of inadequate nutrient endowment at birth. The present study sought to compare the burden of neonatal ID in cord blood serum samples from twin (n = 54) and singleton pregnancies (n = 24). Iron status (serum ferritin (SF), soluble transferrin receptor (sTfR), hepcidin) and inflammation (C-reactive protein (CRP) and interleukin-6 (IL-6)) biomarker concentrations were measured by immunoassay. The prevalence of ID (SF < 76 ng/mL) among twins was 21% (23/108) and among singletons 20% (5/24). Gestational age at birth, maternal race and infant sex predicted SF levels. Maternal anemia (hemoglobin < 11 g/dL) was observed in 40% of mothers but was not associated with neonatal iron biomarkers. More research is needed to identify risk factors and regulatory mechanisms for inadequate fetal iron accrual to identify higher risk pregnancies and neonates for screening and intervention.
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41
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An Improved Method for Quick Quantification of Unsaturated Transferrin. BIOSENSORS 2022; 12:bios12090708. [PMID: 36140091 PMCID: PMC9496074 DOI: 10.3390/bios12090708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022]
Abstract
Blood iron levels play a vital role in oxygen metabolism and energy generation whilst transporter protein, transferrin, binds and delivers iron to the transferrin receptor of endosomal compartments of cells. Consequently, the iron-binding capacity of transferrin is an important indicator for many diseases, and its measurements are used in the diagnosis and treatment of anaemias. Various assays, including Total Iron Binding Capacity (TIBC), Unsaturated Iron-Binding Capacity (UIBC) and Transferrin Saturation (TS), were developed to assess the iron-binding capacity of transferrin. Clinically, UIBC is measured in serum by a multi-step liquid ferrozine method and subjected to interference from conditions such as haemolysis and lipemia. Here, we report a quick method that directly measures the concentration of apotransferrin in EDTA-treated plasma, theoretically equivalent to UIBC. Importantly, this supramolecular assembly-based method is more time-efficient, cost-effective and insensitive to serum cation fluctuations. With additional colorimetric property, this method also provides a visual indicator for abnormal health conditions with extreme transferrin statuses such as those found in cancers. Its minimal requirement for equipment would be particularly useful for diagnosis in remote and under-developed regions.
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Mahant H, Jain S, Patel A, Lapani B. Appropriate Method of TIBC Estimation in Reference to Serum Transferrin Levels. J Lab Physicians 2022; 15:25-30. [PMID: 37064980 PMCID: PMC10104694 DOI: 10.1055/s-0042-1750065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Abstract
Background The currently available various methods of estimation of total iron binding capacity (TIBC) show marked variation in reference range. Although serum transferrin (TF) level is a sensitive indicator of iron status, its measurement requires immunoassay equipment which may not be available in many routine biochemistry laboratories. So, this study was planned to find the most appropriate method to estimate TIBC.
Objectives This study aimed to compare different methods of TIBC estimation and to corelate the TIBC values obtained by different methods with serum TF concentration.
Material and Methods This analytical cross-sectional study was performed in the clinical chemistry laboratory of the Biochemistry Department of Medical College Baroda & SSG Hospital, Vadodara, Gujarat, on 250 leftover serum samples destined to be discarded. In all these samples, serum TIBC was estimated by direct method, indirect method, as well as calculated method (iron + unsaturated iron binding capacity [UIBC]) along with the measurement of serum TF level.
Statistical Analysis Among the different methods, repeated analysis of variance (ANOVA) analysis and Bland–Altman plot were used to find out significance of difference. Correlation coefficients were found between different methods of TIBC estimation and serum TF levels.
Results The means of TIBC by calculated, indirect, and direct methods were 344.51, 342.23, and 378.24 µg/dL, respectively. The mean of serum TF was 295.3 mg/dL. There was statistically significant difference between TIBC by direct and indirect methods and between direct and calculated methods. There was a strong positive correlation between TIBC by direct method and serum TF (r = 0.888, p < 0.0001), but there was moderate correlation between TIBC by indirect method and serum TF (r = 0.748, p < 0.04), and between TIBC by calculated method and serum TF (r = 0.725, p < 0.05).
Conclusion Among different methods of estimation of TIBC, direct method is more reliable in reference to serum TF levels.
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Affiliation(s)
- Hardik Mahant
- Department of Biochemistry, Medical College Baroda, Vadodara, Gujarat, India
| | - Shilpa Jain
- Department of Biochemistry, Medical College Baroda, Vadodara, Gujarat, India
| | - Arpita Patel
- Department of Biochemistry, Gujarat Medical Education and Research Society (GMERS) Medical College, Vadodara, Gujarat, India
| | - Bhumi Lapani
- Department of Biochemistry, Medical College Baroda, Vadodara, Gujarat, India
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Sharawy N, Imam AAA, Aboulhoda BE, Khalifa MM, Morcos GNB, Abd Algaleel WA, Moustafa PE, Abdelbaset MA, Shoukry T. Iron dyshomeostasis and time-course changes in iron-uptake systems and ferritin level in relation to pro-inflammatory microglia polarization in sepsis-induced encephalopathy. Front Physiol 2022; 13:953206. [PMID: 36035473 PMCID: PMC9413069 DOI: 10.3389/fphys.2022.953206] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Encephalopathy is a frequent and lethal consequence of sepsis. Recently, a growing body of evidence has provided important insights into the role of iron dyshomeostasis in the context of inflammation. The molecular mechanisms underlying iron dyshomeostasis and its relationship with macrophage phenotypes are largely unknown. Here, we aimed to characterize the changes in iron-transporter and storage proteins and the microglia phenotype that occur during the course of sepsis, as well as their relationship with sepsis-induced encephalopathy. We used a cecal ligation and puncture (CLP) murine model that closely resembles sepsis-induced encephalopathy. Rats were subjected to CLP or sham laparotomy, then were neurologically assessed at 6 h, 24 h, and 3 days after sepsis induction. The serum and brain were collected for subsequent biochemical, histological, and immunohistochemical assessment. Here, an iron excess was observed at time points that followed the pro-inflammatory macrophage polarization in CLP-induced encephalopathy. Our results revealed that the upregulation of non-transferrin-bound iron uptake (NTBI) and ferritin reduction appeared to be partially responsible for the excess free iron detected within the brain tissues. We further demonstrated that the microglia were shifted toward the pro-inflammatory phenotype, leading to persistent neuro-inflammation and neuronal damage after CLP. Taken together, these findings led us to conclude that sepsis increased the susceptibility of the brain to the iron burden via the upregulation of NTBI and the reduction of ferritin, which was concomitantly and correlatively associated with dominance of pro-inflammatory microglia and could explain the neurological dysfunction observed during sepsis.
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Affiliation(s)
- Nivin Sharawy
- Department of Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmad Abdel-Aliem Imam
- Preclinical Sciences, College of Osteopathic Medicine, William Carey University, Hattiesburg, MS, United States
- Faculty of Medicine, Cairo University, Cairo, Egypt
- *Correspondence: Ahmad Abdel-Aliem Imam, ; Basma Emad Aboulhoda,
| | - Basma Emad Aboulhoda
- Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, Cairo, Egypt
- *Correspondence: Ahmad Abdel-Aliem Imam, ; Basma Emad Aboulhoda,
| | - Mohamed Mansour Khalifa
- Department of Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of Human Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - George N. B. Morcos
- Department of Biochemistry, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of Basic Medical Sciences, Faculty of Medicine, King Salman International University, El-Tor, Egypt
| | | | | | | | - Tarek Shoukry
- Department of Physiology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Prevalence of postpartum anaemia and iron deficiency by serum ferritin, soluble transferrin receptor and total body iron, and associations with ethnicity and clinical factors: a Norwegian population-based cohort study. J Nutr Sci 2022; 11:e46. [PMID: 35754987 PMCID: PMC9201879 DOI: 10.1017/jns.2022.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Worldwide, there are limited data on the prevalence of postpartum anaemia and iron status. The aims of the present study were to assess the prevalence of anaemia and iron deficiency (ID) by three iron indicators 14 weeks postpartum, their relations to haemoglobin (Hb) and associations with ethnicity and clinical factors in a multi-ethnic population. We conducted a population-based cohort study of 573 women followed from early pregnancy. The prevalence of postpartum anaemia (Hb <12·0 g/dl) was 25 %. ID prevalence varied from 39 % by serum ferritin (SF <15 μg/l), to 19 % by soluble transferrin receptor (sTfR >4·4 mg/l) and 22 % by total body iron (TBI < 0 mg/kg). The mean Hb concentration was 12·8 g/dl in women with no ID, 12·6 g/dl in those with ID by SF only and 11·6 g/dl in those with ID by SF, sTfR and TBI. ID by sTfR and TBI defined by the current threshold values probably identified a more severe iron-deficient population compared with ID assessed by SF. Compared with Western Europeans, the prevalence of anaemia was at least the double in ethnic minorities (26–40 % v. 14 %; P < 0·01–0·05), and the prevalence of ID by sTfR and TBI, but not of ID by SF < 15 μg/l, was significantly higher in some minority groups. After adjustment for covariates, only South Asians had lower Hb and higher sTfR concentration. Insufficient iron intake, gestational anaemia or ID, and postpartum haemorrhage were associated with lower postpartum Hb concentration and poorer iron status.
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Influences of Vitamin D and Iron Status on Skeletal Muscle Health: A Narrative Review. Nutrients 2022; 14:nu14132717. [PMID: 35807896 PMCID: PMC9268405 DOI: 10.3390/nu14132717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open
Abstract
There is conflicting evidence of the roles vitamin D and iron have in isolation and combined in relation to muscle health. The purpose of this narrative review was to examine the current literature on the roles that vitamin D and iron have on skeletal muscle mass, strength, and function and how these nutrients are associated with skeletal muscle health in specific populations. Secondary purposes include exploring if low vitamin D and iron status are interrelated with skeletal muscle health and chronic inflammation and reviewing the influence of animal-source foods rich in these nutrients on health and performance. PubMed, Scopus, SPORT Discus, EMBAE, MEDLINE, and Google Scholar databases were searched to determine eligible studies. There was a positive effect of vitamin D on muscle mass, particularly in older adults. There was a positive effect of iron on aerobic and anaerobic performance. Studies reported mixed results for both vitamin D and iron on muscle strength and function. While vitamin D and iron deficiency commonly occur in combination, few studies examined effects on skeletal muscle health and inflammation. Isolated nutrients such as iron and vitamin D may have positive outcomes; however, nutrients within food sources may be most effective in improving skeletal muscle health.
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46
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Genome-wide meta-analysis of iron status biomarkers and the effect of iron on all-cause mortality in HUNT. Commun Biol 2022; 5:591. [PMID: 35710628 PMCID: PMC9203493 DOI: 10.1038/s42003-022-03529-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 05/24/2022] [Indexed: 01/19/2023] Open
Abstract
Iron is essential for many biological processes, but iron levels must be tightly regulated to avoid harmful effects of both iron deficiency and overload. Here, we perform genome-wide association studies on four iron-related biomarkers (serum iron, serum ferritin, transferrin saturation, total iron-binding capacity) in the Trøndelag Health Study (HUNT), the Michigan Genomics Initiative (MGI), and the SardiNIA study, followed by their meta-analysis with publicly available summary statistics, analyzing up to 257,953 individuals. We identify 123 genetic loci associated with iron traits. Among 19 novel protein-altering variants, we observe a rare missense variant (rs367731784) in HUNT, which suggests a role for DNAJC13 in transferrin recycling. We further validate recently published results using genetic risk scores for each biomarker in HUNT (6% variance in serum iron explained) and present linear and non-linear Mendelian randomization analyses of the traits on all-cause mortality. We find evidence of a harmful effect of increased serum iron and transferrin saturation in linear analyses that estimate population-averaged effects. However, there was weak evidence of a protective effect of increasing serum iron at the very low end of its distribution. Our findings contribute to our understanding of the genes affecting iron status and its consequences on human health. A GWAS on the four major iron-related biomarkers is conducted using data from the Trøndelag Health Study (HUNT), Michigan Genomics Initiative (MGI), and SardiNIA study, to identify 123 loci associated with iron homeostasis and effect on all-cause mortality.
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The Impact of Iron Dyshomeostasis and Anaemia on Long-Term Pulmonary Recovery and Persisting Symptom Burden after COVID-19: A Prospective Observational Cohort Study. Metabolites 2022; 12:metabo12060546. [PMID: 35736479 PMCID: PMC9228477 DOI: 10.3390/metabo12060546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is frequently associated with iron dyshomeostasis. The latter is related to acute disease severity and COVID-19 convalescence. We herein describe iron dyshomeostasis at COVID-19 follow-up and its association with long-term pulmonary and symptomatic recovery. The prospective, multicentre, observational cohort study “Development of Interstitial Lung Disease (ILD) in Patients With Severe SARS-CoV-2 Infection (CovILD)” encompasses serial extensive clinical, laboratory, functional and imaging evaluations at 60, 100, 180 and 360 days after COVID-19 onset. We included 108 individuals with mild-to-critical acute COVID-19, whereas 75% presented with severe acute disease. At 60 days post-COVID-19 follow-up, hyperferritinaemia (35% of patients), iron deficiency (24% of the cohort) and anaemia (9% of the patients) were frequently found. Anaemia of inflammation (AI) was the predominant feature at early post-acute follow-up, whereas the anaemia phenotype shifted towards iron deficiency anaemia (IDA) and combinations of IDA and AI until the 360 days follow-up. The prevalence of anaemia significantly decreased over time, but iron dyshomeostasis remained a frequent finding throughout the study. Neither iron dyshomeostasis nor anaemia were related to persisting structural lung impairment, but both were associated with impaired stress resilience at long-term COVID-19 follow-up. To conclude, iron dyshomeostasis and anaemia are frequent findings after COVID-19 and may contribute to its long-term symptomatic outcome.
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Cochrane KM, Hutcheon JA, Karakochuk CD. Iron-Deficiency Prevalence and Supplementation Practices Among Pregnant Women: A Secondary Data Analysis From a Clinical Trial in Vancouver, Canada. J Nutr 2022; 152:2238-2244. [PMID: 35687377 PMCID: PMC9535446 DOI: 10.1093/jn/nxac135] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND North American public health guidelines recommend supplementation with an iron-containing prenatal multivitamin throughout pregnancy to meet the RDA of 27 mg of elemental iron daily. However, whether supplementation with standard prenatal multivitamins is sufficient to prevent maternal iron deficiency is unclear, as needs increase substantially with advancing gestation. OBJECTIVES This study aimed to assess iron status in early and late pregnancy among 60 pregnant women receiving 27 mg/day of elemental iron as part of a randomized trial in Vancouver, Canada. METHODS Study visits were conducted at 8-21 (baseline) and 24-38 (endline) weeks of gestation. Venous blood specimens were collected for a complete blood count and measurement of iron and inflammatory biomarkers. Supplementation with any additional iron (beyond 27 mg/day) was reported by participants (treatment with additional iron is recommended if ferritin is <30 μg/L). Quantile regression was used to explore predictors of endline ferritin concentrations, including ethnicity, education, income, and baseline ferritin measurement. RESULTS Overall, 60 and 54 women participated in baseline and endline visits, respectively. Rates of probable iron deficiency (ferritin <30 μg/L) at baseline and endline were 17 (28%) and 44 (81%), respectively. Less than half (n = 18; 41%) of participants with probable iron deficiency at endline reported supplementation with additional iron. Ethnicity was the only significant modifier of endline ferritin, with higher concentrations in those of South, East, and Southeast Asian ethnicity compared to those of European ethnicity (β: 10.4 μg/L; 95% CI: 0.3-20.5). CONCLUSIONS Pregnant individuals may require additional supplemental iron beyond 27 mg to meet requirements in later pregnancy, given the high rates of iron deficiency observed in this clinical trial, despite consumption meeting 100% of the RDA. This trial was registered at clinicaltrials.gov as NCT04022135.
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Affiliation(s)
- Kelsey M Cochrane
- Food Nutrition and Health Faculty of Land and Food Systems University of British Columbia, Vancouver, Canada,BC Children's Hospital Research Institute University of British Columbia, Vancouver, Canada
| | - Jennifer A Hutcheon
- BC Children's Hospital Research Institute University of British Columbia, Vancouver, Canada,Obstetrics and Gynaecology Faculty of Medicine University of British Columbia, Vancouver, Canada
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Zimmermann P, Antonelli MC, Sharma R, Müller A, Zelgert C, Fabre B, Wenzel N, Wu HT, Frasch MG, Lobmaier SM. Prenatal stress perturbs fetal iron homeostasis in a sex specific manner. Sci Rep 2022; 12:9341. [PMID: 35662279 PMCID: PMC9167276 DOI: 10.1038/s41598-022-13633-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/18/2022] [Indexed: 11/09/2022] Open
Abstract
The adverse effects of maternal prenatal stress (PS) on child's neurodevelopment warrant the establishment of biomarkers that enable early interventional therapeutic strategies. We performed a prospective matched double cohort study screening 2000 pregnant women in third trimester with Cohen Perceived Stress Scale-10 (PSS-10) questionnaire; 164 participants were recruited and classified as stressed and control group (SG, CG). Fetal cord blood iron parameters of 107 patients were measured at birth. Transabdominal electrocardiograms-based Fetal Stress Index (FSI) was derived. We investigated sex contribution to group differences and conducted causal inference analyses to assess the total effect of PS exposure on iron homeostasis using a directed acyclic graph (DAG) approach. Differences are reported for p < 0.05 unless noted otherwise. Transferrin saturation was lower in male stressed neonates. The minimum adjustment set of the DAG to estimate the total effect of PS exposure on fetal ferritin iron biomarkers consisted of maternal age and socioeconomic status: SG revealed a 15% decrease in fetal ferritin compared with CG. Mean FSI was higher among SG than among CG. FSI-based timely detection of fetuses affected by PS can support early individualized iron supplementation and neurodevelopmental follow-up to prevent long-term sequelae due to PS-exacerbated impairment of the iron homeostasis.
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Affiliation(s)
- Peter Zimmermann
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marta C Antonelli
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Instituto de Biología Celular y Neurociencias "Prof. E. De Robertis," Facultad de Medicina, UBA, Buenos Aires, Argentina
| | - Ritika Sharma
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Helmholtz Zentrum Munich, Neuherberg, Germany
| | - Alexander Müller
- Innere Medizin I, Department of Cardiology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Camilla Zelgert
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bibiana Fabre
- Facultad de Farmacia y Bioquímica, Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Natasha Wenzel
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Hau-Tieng Wu
- Department of Mathematics, Duke University, Durham, NC, USA
- Department of Statistical Science, Duke University, Durham, NC, USA
- Mathematics Division, National Center for Theoretical Sciences, Taipei, Taiwan
| | - Martin G Frasch
- Department of Obstetrics and Gynecology and Center on Human Development and Disability (CHDD), University of Washington, Seattle, WA, USA.
| | - Silvia M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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Charmila A, Natarajan S, Chitra TV, Pawar N, Kinjawadekar S, Firke Y, Murugesan U, Yadav P, Ohri N, Modgil V, Rodge A, Swami OC. Efficacy and Safety of Ferric Carboxymaltose in the Management of Iron Deficiency Anemia: A Multi-Center Real-World Study from India. J Blood Med 2022; 13:303-313. [PMID: 35706850 PMCID: PMC9189149 DOI: 10.2147/jbm.s361210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Parenteral iron preparations, like ferric carboxymaltose (FCM), are commonly used to manage moderate-to-severe iron deficiency anemia (IDA). Real-world data on efficacy and safety of FCM is limited in India. Methods A retrospective, observational and real-world study was conducted to assess the efficacy and safety of FCM in adolescents and adults with IDA across 269 centers in India. Data was retrieved from medical records of patients who received FCM for management of IDA. Physicians’ clinical assessment of efficacy and safety of FCM was also assessed. Data were analyzed for hematological parameters at baseline and at 4 ± 1 week for study population, and for severity of anemia. Results In 1800 patients with IDA, intravenous FCM resulted in a significant increase in hemoglobin (Hb) of 2.76 g/dL, serum ferritin of 35.85 µg/L, red blood cell (RBC) count, hematocrit, mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) (P < 0.001 for all) at 4 ± 1 week as compared to baseline. In subjects with severe IDA, an increase in Hb was of 3.31 g/dL, serum ferritin increased of 35.84 µg/L, RBC count, hematocrit and MCH improved significantly (P < 0.001 for all). In subjects with moderate IDA, Hb (increase of 2.63 g/dL), serum ferritin (increase of 35.92 µg/L), RBC count, hematocrit, MCV, and MCH improved significantly (P < 0.001 for all). In subjects with mild IDA, only the mean Hb values at 4 weeks were significantly higher (P < 0.001; increased by 1.89 g/dL). Physicians rated efficacy of FCM as very good to good in 97.5% of patients. Similarly, safety of FCM was rated very good to good in 97.2% subjects. Conclusion FCM efficiently, safely and quickly corrects moderate-to-severe anemia in Indian patients in a short span of 4 weeks. Physicians’ positive clinical impression of efficacy and safety supports clinical usage of FCM in real-world scenario. ![]()
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Affiliation(s)
- Ayyavoo Charmila
- Obstetrics and Gynecology, Aditi Hospital, Tiruchirappalli, Tamil Nadu, India
| | - Suma Natarajan
- Obstetrics and Gynecology, Ganga Medical Centre & Hospitals, Coimbatore, Tamil Nadu, India
| | | | - Nivedita Pawar
- Obstetrics and Gynecology, Nivedita Maternity Home, Nashik, Maharashtra, India
| | - Sucheta Kinjawadekar
- Obstetrics and Gynecology, Kamalesh Mother and Child Hospital, New Mumbai, Maharashtra, India
| | - Yogini Firke
- Obstetrics and Gynecology, Dhanvantari Hospital, Mumbai, Maharashtra, India
| | - Umaiyal Murugesan
- Obstetrics and Gynecology, Sri Kumaran A Speciality Hospital, Chennai, Tamil Nadu, India
| | - Poonam Yadav
- Obstetrics and Gynecology, SDMH Hospital, Jaipur, Rajasthan, India
| | - Neelam Ohri
- Obstetrics and Gynecology, New Life Hospital, Varanasi, Uttar Pradesh, India
| | - Vidhu Modgil
- Obstetrics and Gynecology, Suman Hospital, Ludhiana, Punjab, India
| | - Ajinkya Rodge
- Medical Services, Emcure Pharmaceuticals Ltd., Pune, Maharashtra, India
| | - Onkar C Swami
- Medical Services, Emcure Pharmaceuticals Ltd., Pune, Maharashtra, India
- Correspondence: Onkar C Swami, Emcure Pharmaceuticals Ltd., Pune, Maharashtra, 411 057, India, Tel +91-93724 23101, Email
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