Riesgos y beneficios de la profilaxis con sulfato ferroso en lactantes nacidos a término con niveles de hemoglobina y ferremia desconocidos / Risks and benefits of iron supplementation in full-term infants with unknown hemoglobin and ferritin levels

La seguridad y eficacia de los programas de suplementación con hierro a lactantes, está actualmente en discusión. El objetivo de esta revisión fue identificar estudios sobre riesgos y beneficios de la suplementación con hierro profiláctico en lactantes menores de un año, nacidos a término, con niveles de hemoglobina (Hb) y ferremia desconocidos. Se realizó una búsqueda en Pubmed y Cochrane, identificando 3 revisiones sistemáticas y metaanálisis. Estos estudios arrojaron resultados que indican mejoras en los niveles séricos de hierro y hemoglobina como resultado de la suplementación con hierro. Sin embargo, no se observó un beneficio significativo en el desarrollo cognitivo de los lactantes. Los efectos adversos más reportados son los gastrointestinales, efectos en el crecimiento (menor ganancia de talla y peso) y menor absorción de zinc. En resumen, la evidencia en cuanto a la profilaxis con hierro en lactantes es limitada, lo que nos lleva a recomendar un seguimiento cercano de los lactantes que reciben suplementos de hierro, con el objetivo de detectar posibles eventos adversos. Es fundamental evaluar cuidadosamente los riesgos y beneficios de esta intervención antes de su implementación (AU)

The safety and efficacy of iron supplementation programs for infants are currently under discussion. The objective of this review was to identify studies on the risks and benefits of prophylactic iron supplementation in infants under one year of age, born at term, with unknown hemoglobin (Hb) and serum iron levels. The search was conducted on Pubmed and Cochrane, identifying three systematic reviews and meta-analyses. The results indicate improvements in serum iron and hemoglobin levels as a result of iron supplementation. However, a significant benefit in infant cognitive development was not observed. The most reported adverse effects were gastrointestinal, effects on growth (reduced height and weight gain), and reduced zinc absorption. In summary, the evidence regarding iron prophylaxis in infants is limited, leading us to recommend close monitoring of infants receiving iron supplements to detect potential adverse events. It is crucial to carefully assess the risks and benefits of this intervention before implementation (AU)

Anemia no diabetes mellitus gestacional: implicações na instabilidade genômica / Anemia in gestational diabetes mellitus: implications for genomic instability

Introdução: Evidências têm mostrado uma associação entre anemia e Diabetes Mellitus. Contudo, a relação entre anemia e Diabetes Mellitus Gestacional (DMG) ainda não está bem estabelecida, bem como sua repercussão na instabilidade genômica. Portanto, objetivou-se verificar a associação entre anemia e instabilidade genômica em mulheres com DMG atendidas em um hospital universitário. Métodos: Estudo transversal com mulheres apresentando diagnóstico de DMG que realizaram pré-natal no Hospital Universitário de Santa Maria (RS). Informações referentes ao DMG, anemia e suplementação de ferro foram obtidas nos prontuários. A instabilidade genômica foi avaliada pelo ensaio de citoma em micronúcleos em células bucais (BMCyt). Resultados: Das 44 gestantes avaliadas, 28,6% apresentaram anemia e 79,5% foram suplementadas com ferro. Das gestantes que realizaram suplementação, 75,0% não apresentaram anemia gestacional. Níveis de hemoglobina não se associaram com a instabilidade genomica (p > 0,05), mas foi observada uma associação entre brotos nucleares e os níveis de glicemia (r = 0,977; p = 0,003). Conclusão: Não foi verificado associação entre anemia e instabilidade genômica em mulheres com DMG.(AU)

Introduction: There is evidence of an association between anemia and diabetes mellitus. However, the relationship between anemia and gestational diabetes mellitus (GDM) remains to be established, as well as its impact on genomic instability. Therefore, we aimed to examine the association between anemia and genomic instability in women with GDM treated at a university hospital. Methods: A cross-sectional study of women with a diagnosis of GDM who received prenatal care at the University Hospital of Santa Maria, southern Brazil. Data on GDM, anemia, and iron supplementation were obtained from medical records. Genomic instability was assessed by the buccal micronucleus cytome (BMCyt) assay. Results: Of 44 pregnant women evaluated, 28.6% had anemia and 79.5% received iron supplementation; of the latter, 75.0% did not have gestational anemia. Hemoglobin levels were not associated with genomic instability (p > 0.05), but an association was found between nuclear buds and blood glucose levels (r = 0.977; p = 0.003). Conclusion: There was no association between anemia and genomic instability in women with GDM.(AU)

Elaboración de productos panificados a partir de premezcla de harinas aptas para celíacos enriquecidas con hierro y vitaminas del complejo B y su aceptabilidad / Preparation of bakery products from premix of flours suitable for celiac people and enriched with iron and vitamin B complex and their acceptability

La Ley 20.830/98 reglamenta el enriquecimiento de la harina, sin embargo, no contempla a la premezcla de harinas aptas para celíacos. Aproximadamente 50% de los celíacos presenta anemia, por lo es necesario elaborar productos cuyas características nutricionales, sensoriales y funcionales sean óptimas. El objetivo del trabajo fue enriquecer con hierro y vitaminas del complejo B (mix) la premezcla de harinas apta para celíacos y evaluar la aceptabilidad de dos panificados de alta demanda poblacional elaborados a partir de la premezcla. En cocinas especializadas para celíacos se elaboraron panes y palitos, cada uno en dos versiones (con mix y sin mix), se presentaron en envases individuales y etiquetados forma numérica para la degustación. Se evaluó la aceptabilidad de los panificados utilizando una escala hedónica de 9 puntos a través de un cuestionario autoadministrado. Se utilizó la prueba t de Student para la comparación de promedios obtenidos. Participaron 105 celíacos (81% mujeres), el promedio de edad fue 34,5±10,9 años Según auto-reporte el 60% cursó con anemia. La puntuación global promedio de aceptabilidad fue: pan sin mix 7,42±1,33puntos; pan con mix 8,00±1,06 puntos; palito sin mix 7,91±1,05 puntos y palito con mix 7,86±1,17 puntos. Se realizó el análisis de la premezcla apta para celíacos y se constató que la misma cumple con el aporte de micronutrientes (hierro, B1, B2, B3 y ácido fólico). En este estudio, los panes con mix tuvieron mayor aceptabilidad que aquellos sin mix. En el caso de los palitos no se observaron diferencias en la aceptabilidad entre productos (con mix vs sin mix)(AU)

Validade do autorrelato de anemia e do uso terapêutico de sais de ferro durante a gestação: coorte de nascimentos de 2015 de Pelotas, Rio Grande do Sul, Brasil / Validity of patient-reported anemia and therapeutic use of iron supplements during pregnancy: 2015 Pelotas (Brazil) birth cohort / Validez del autoinforme de anemia y uso terapéutico de sales de hierro durante la gestación: cohorte de nacimientos de 2015 en Pelotas, Río Grande do Sul, Brasil

O objetivo deste estudo é investigar a validade do autorrelato de anemia e de uso terapêutico de sais de ferro, frente à informação de hemoglobina da carteira da gestante. O estudo utiliza dados da coorte de nascimentos de 2015 de Pelotas, Rio Grande do Sul, Brasil. Para a validação do autorrelato de anemia, foram incluídas todas as mães que tinham registro de hemoglobina na carteira da gestante (N = 3.419), ao passo que, para a validação do autorrelato de uso terapêutico de sais de ferro, foram incluídas as que tinham registro de exames de hemoglobina na carteira da gestante e que relataram haver utilizado algum medicamento com sulfato ferroso em sua composição durante a gestação. Anemia foi definida como, pelo menos, um registro de hemoglobina ≤ 11g/dL na carteira da gestante (padrão-ouro). A prevalência de anemia conforme padrão-ouro foi 35,9% (34,3-37,5), ao passo que a de anemia autorrelatada foi 42,2% (40,8-43,7), e o autorrelato de uso terapêutico de sais de ferro, 43,2% (41,3-45,1). A sensibilidade do autorrelato de anemia foi 75,2% (72,8-77,6) e a especificidade, 75,1% (73,3-76,9). Para o autorrelato de uso terapêutico de sais de ferro, a sensibilidade foi 66,4% (63,5-69,2) e a especificidade, 71,9% (69,7-74,0). A especificidade do autorrelato de anemia e do autorrelato de uso terapêutico de sais de ferro entre mães com ≥ 12 anos de escolaridade foi 78,4% (75,4-81,4) e 79,5% (76,1-82,9). Na população estudada, com alta prevalência de anemia, de cada cinco puérperas que relataram anemia ou uso terapêutico de sais de ferro, três relatavam a verdade. A especificidade de ambos os autorrelatos foi mais elevada entre mães com ≥ 12 anos de escolaridade.

This study aimed to investigate the validity of patient-reported anemia and therapeutic use of iron supplements, compared to hemoglobin values recorded on the patient's prenatal card. The study used data from the 2015 Pelotas (Brazil) birth cohort. For validation of self-reported anemia, we included all mothers with hemoglobin values recorded on their prenatal card (N = 3,419), while validation of self-reported therapeutic use of iron supplements included those who had hemoglobin values recorded on their prenatal care and who reported having used medicines containing ferrous sulfate during pregnancy. Anemia was defined as at least one record of hemoglobin ≤ 11g/dL on the prenatal card (gold standard). Prevalence of anemia according to the gold standard was 35.9% (34.3-37.5), while patient-reported anemia was 42.2% (40.8-43.7), and patient-reported therapeutic use of iron supplements was 43.2% (41.3-45.1). Sensitivity of patient-reported anemia was 75.2% (72.8-77.6) and specificity was 75.1% (73.3-76.9). For patient-reported therapeutic use of iron supplements, sensitivity was 66.4% (63.5-69.2) and specificity was 71.9% (69.7-74.0). Specificity of patient-reported anemia and patient-reported therapeutic use of iron supplements in mothers with ≥ 12 years of schooling was 78.4% (75.4-81.4) and 79.5% (76.1-82.9), respectively. In the study population, for every five postpartum women that reported anemia or therapeutic use of iron supplements, three were telling the truth. The specificity of both self-reports was high in mothers with ≥ 12 years of schooling.

El objetivo de este estudio es investigar la validez del autoinforme de anemia y uso terapéutico de sales de hierro, respecto a la información sobre la hemoglobina, presente la cartilla de la embarazada. El estudio utiliza datos de la cohorte de nacimientos en Pelotas, Rio Grande ddo Sul, Brasil, 2015. Para la validación del autoinforme de anemia, se incluyeron a todas las madres que tenían un registro de hemoglobina en la cartilla de la embarazada (N = 3.419), al mismo tiempo que, para la validación del autoinforme del uso terapéutico de sales de hierro, se incluyeron a quienes tenían registro de exámenes de hemoglobina en la cartilla de la embarazada, y que informaron haber utilizado algún medicamento con sulfato ferroso en su composición durante la gestación. La anemia se definió como, por lo menos, un registro de hemoglobina ≤ 11g/dL en la cartilla de la embarazada (patrón ideal). La prevalencia de anemia, según el patrón ideal, fue de un 35,9% (34,3-37,5), mientras que la de la anemia autoinformada fue de un 42,2% (40,8-43,7), y el autoinforme de uso terapéutico de sales de hierro, 43,2% (41,3-45,1). La sensibilidad del autoinforme de anemia fue de un 75,2% (72,8-77,6) y la especificidad, 75,1% (73,3-76,9). Para el autoinforme de uso terapéutico de sales de hierro, la sensibilidad fue 66,4% (63,5-69,2) y la especificidad, 71,9% (69,7-74,0). La especificidad del autoinforme de anemia y del autoinforme de uso terapéutico de sales de hierro entre madres con ≥ 12 años de escolaridad fue 78,4% (75,4-81,4) y 79,5% (76,1-82,9). En la población estudiada, con una alta prevalencia de anemia, de cada cinco puérperas que informaron anemia o uso terapéutico de sales de hierro, tres relataban la verdad. La especificidad de ambos autoinformes fue más elevada entre madres con ≥ 12 años de escolaridad.

Effect of the Brazilian iron fortification of wheat and corn flour on the nutritional iron status in adolescents, 6 years after its implementation

BACKGROUND: As it is difficult to know the content of iron added in the Brazilian iron fortification of wheat and corn flour, and if the compound has good or poor bioavailability, the objective was to assess the effect of the Brazilian iron fortification program, as it was carried out, on iron nutritional status of adolescents, 6 years after its implementation. METHODS: A cross-sectional retrospective study was conducted with adolescents aged 10 to 17 years, both sexes, treated at a primary health care center. Data were collected from medical records of patients and compared with those of a previous survey conducted at the same center in 2004. Anthropometry, iron biochemical indicators, food intake, pubertal stage, and transferrin saturation were assessed, with pubertal stage and transferrin saturation being the last two variables compared between 2004 and 2010. Mann-Whitney and chi-square tests were also used. RESULTS: In 2010, mean hemoglobin values and serum ferritin levels were within normal ranges for both sexes, and adolescents who consumed diets with low iron bioavailability constituted more than half of the sample (52.7%). In2004, a 10.3 and 18.6% prevalence of iron deficiency was observed, based on low transferrin saturation, in females and males, respectively. It was noted that during the 6-year period, this prevalence decreased significantly, 4 and10.4%. CONCLUSIONS: Anemia and iron deficiency are not prevalent in this population, probably due to the implementation of flour fortification with iron; it is not possible, however, to attribute such a result only to the implementation of this strategy.

Efecto del consumo de casabe venezolano sobre la absorción de minerales en un modelo experimental con ratas / Effect of consumption of Venezuelan casabe on mineral absorption in a experimental model with rats

El principal producto derivado de la yuca en Venezuela es el casabe, el cual es valorado por su contenido calórico, riqueza en Fibra Dietética (FD) y minerales. En este estudio se determinó el efecto del consumo de diferentes variedades de casabe venezolano sobre la absorción de hierro, cobre y zinc, en un modelo experimental, con 20 ratas machos adultas, cepa Sprague Dawley, las cuales fueron divididas en 4 grupos: un control sin fibra y tres grupos experimentales en los que se sustituyó el almidón de maíz por una variedad de casabe, identificados por su procedencia como: “Casabe Miranda”, “Casabe Sucre” y “Casabe Amazonas”. Las dietas con inclusión de casabe tuvieron un mayor contenido mineral, en comparación con la dieta control. El contenido de FD total y su fracción soluble fueron significativamente mayores en las variedades de casabe Sucre y Amazonas (p<0,05). La inclusión de casabe a las dietas produjo un incremento significativo en la excreción fecal de hierro y cobre(p<0,05). La absorción de los minerales se incrementó para el hierro en las variedades Miranda (3,5%) y Sucre (6%); para el cobre en el grupo Amazonas (32%); mientras que el Zinc fue menos afectado en su absorción a lo largo del ensayo. Los resultados de este estudio señalan que el efecto de la adición de casabe a las dietas sobre la absorción de hierro, cobre y zinc, fue diferente para cada mineral y estuvo relacionado con la dieta que consumieron los animales, dependiendo de la variedad de casabe utilizada.

The main product from cassava in Venezuela is the Casabe, which is valued for its caloric content, and rich in dietary fiber (DF) and minerals. This study determined the effect of consumption of different varieties of Venezuelan cassava on absorption of iron, cooper and zinc, in an experimental model, with 20 adult males rats, strain Sprague Dawley, which were divided into 4 groups: a control without fiber and three experimental groups with substitution of cornstarch by a variety of casabe, identified by their origin as:“ Casabe Miranda”, “Casabe Sucre” y “Casabe Amazonas”. Casabe diets had a higher mineral content, compared to the control diet. Total and soluble dietary fiber content were significantly higher in Sucre and Amazonas casabe varieties(p<0,05). The inclusion of casabe to diets resulted in a significant increase in the fecal excretion of iron and copper (p<0,05).The mineral absorption increased for iron in Miranda (3.5%) and Sucre (6%) varieties; for copper in the Amazonas group (32%); while the zinc absorption was less affected throughout the trial. The results of this study indicates that the effect of adding casabe to diets on absorption of iron, copper and zinc, was different for each mineral and was related to the diet consumed by the animals, depending of casabe variety used.

Potencial evocado auditivo cortical, análise bioquímica e morfológica em cérebro de ratos submetidos a tratamento subcrônico com chumbo: efeito protetor da suplementação com ferro / Cortical Auditory Evoked Potential, biochemical and morphological analysis in brain of rats treated with subchronic lead: protective effect of supplementation with iron

O chumbo (Pb) é um metal pesado que pode ocasionar alterações nos sistemas nervoso central (SNC) e auditivo. Faltam estudos que demonstrem tais alterações clínicas, em conjunto com as alterações bioquímicas e morfológicas em cérebro de ratos expostos ao Pb. Tem sido relatado que o ferro (Fe) tem um efeito protetor na toxicidade cerebral causada pelo Pb. O objetivo deste estudo foi avaliar a atividade elétrica cerebral, analisar a concentração de Pb no sangue e tecido cerebral, e observar o aspecto morfológico do cérebro de ratos intoxicados por Pb, submetidos à suplementação com Fe ou não. Foi realizado um projeto piloto utilizando 20 ratos machos recém-desmamados (Rattus norvegicus, variedade Wistar), que foram divididos em 5 grupos, sendo um controle e 4 experimentais (n=4/grupo). Nos grupos experimentais, os animais receberam por 6 semanas acetato de chumbo em água de beber nas concentrações de 100 mg/L e 400 mg/L de Pb, e em dois destes grupos houve administração simultânea de 20 mg/Kg de FeSO4 a cada 2 dias, por gavagem gástrica, e no outro não. O grupo controle recebeu, água deionizada. Após estabelecida a relação entre o Pb administrado e a dosagem deste no sangue (10 μgPb/dL e 30 μgPb/dL para as dosagens 100 e 400 mg/L de Pb, respectivamente), o experimento foi realizado com 30 ratos recém-desmamados divididos em 6 grupos (n=5/grupo). Os cinco primeiros foram idênticos aos empregados no estudo piloto, incluindo um grupo no qual os animais receberam água deionizada e 20 mg/Kg FeSO4 por gavagem gástrica a cada 2 dias, por 6 semanas. Após o período experimental, foi realizado o Potencial Evocado Auditivo Cortical (PEAC) com a análise da latência dos componentes P1, N1 e P2. Após a eutanásia, o cérebro dos animais foi removido, submetido ao processamento histológico (hematoxilina e eosina) e analisado ao microscópio óptico. Os dados foram analisados por ANOVA/Tukey, Kruskal-Wallis/Dunn e regressão linear (p<0,05). Foi observada uma dose-resposta...

Lead (Pb) is a heavy metal that may cause alterations in the central nervous system (CNS) and auditory system. There is lack of studies demonstrating these clinical alterations, combined to the biochemical and morphological alterations in the brain of rats exposed to Pb. It has been reported that iron (Fe) has a protective effect on the brain toxicity caused by Pb. This study evaluated the electrical brain activity, analyzed the Pb concentration in blood and brain tissue, and observed the morphological aspect of the brain in rats intoxicated by Pb, submitted or not to Fe supplementation. A pilot study was conducted on 20 recently weaned male rats (Rattus norvegicus, Wistar type) divided in 5 groups, being one control and 4 experimental (n=4/group). In the experimental groups, the animals received lead acetate in drinking water for 6 weeks at concentrations of 100 mg/L and 400 mg/L of Pb, and in two of these groups there was simultaneous administration of 20 mg/Kg of FeSO4 at every 2 days, by gastric gavage. The control group received deionized water. After establishing the relationship between the administered Pb and its concentration in blood (10 μgPb/dL and 30 μgPb/dL for concentrations of 100 and 400 mg/L of Pb, respectively), the study was conducted on 30 recently weaned rats divided in 6 groups (n=5/group). The five first groups were identical to those used in the pilot study, including one group in which the animals received deionized water and 20 mg/Kg FeSO4 by gastric gavage at every 2 days, for 6 weeks. After the study period, the Cortical Auditory Evoked Potential (CAEC) was applied for analysis of latency of the components P1, N1 and P2. The animals were killed, their brains were removed and submitted to histological processing (hematoxylin and eosin) for light microscopy analysis. Data were analyzed by the ANOVA/Tukey, Kruskal-Wallis/Dunn and linear regression tests (p<0.05). A dose- response relationship was observed in the Pb concentration...

Potencial evocado auditivo cortical, análise bioquímica e morfológica em cérebro de ratos submetidos a tratamento subcrônico com chumbo: efeito protetor da suplementação com ferro / Cortical auditory evoked potential, biochemical and morphological analysis in brain of rats treated with subchronic lead: protective effect of supplementation with iron

O chumbo (Pb) é um metal pesado que pode ocasionar alterações nos sistemas nervoso central (SNC) e auditivo. Faltam estudos que demonstrem tais alterações clínicas, em conjunto com as alterações bioquímicas e morfológicas em cérebro de ratos expostos ao Pb. Tem sido relatado que o ferro (Fe) tem um efeito protetor na toxicidade cerebral causada pelo Pb. O objetivo deste estudo foi avaliar a atividade elétrica cerebral, analisar a concentração de Pb no sangue e tecido cerebral, e observar o aspecto morfológico do cérebro de ratos intoxicados por Pb, submetidos à suplementação com Fe ou não. Foi realizado um projeto piloto utilizando 20 ratos machos recém-desmamados (Rattus norvegicus, variedade Wistar), que foram divididos em 5 grupos, sendo um controle e 4 experimentais (n=4/grupo). Nos grupos experimentais, os animais receberam por 6 semanas acetato de chumbo em água de beber nas concentrações de 100 mg/L e 400 mg/L de Pb, e em dois destes grupos houve administração simultânea de 20 mg/Kg de FeSO4 a cada 2 dias, por gavagem gástrica, e no outro não. O grupo controle recebeu, água deionizada. Após estabelecida a relação entre o Pb administrado e a dosagem deste no sangue (10 μgPb/dL e 30 μgPb/dL para as dosagens 100 e 400 mg/L de Pb, respectivamente), o experimento foi realizado com 30 ratos recém-desmamados divididos em 6 grupos (n=5/grupo). Os cinco primeiros foram idênticos aos empregados no estudo piloto, incluindo um grupo no qual os animais receberam água deionizada e 20 mg/Kg FeSO4 por gavagem gástrica a cada 2 dias, por 6 semanas. Após o período experimental, foi realizado o Potencial Evocado Auditivo Cortical (PEAC) com a análise da latência dos componentes P1, N1 e P2. Após a eutanásia, o cérebro dos animais foi removido, submetido ao processamento histológico (hematoxilina e eosina) e analisado ao microscópio óptico. Os dados foram analisados por ANOVA/Tukey, Kruskal-Wallis/Dunn e regressão linear (p<0,05). Foi observada uma dose-resposta...

Lead (Pb) is a heavy metal that may cause alterations in the central nervous system (CNS) and auditory system. There is lack of studies demonstrating these clinical alterations, combined to the biochemical and morphological alterations in the brain of rats exposed to Pb. It has been reported that iron (Fe) has a protective effect on the brain toxicity caused by Pb. This study evaluated the electrical brain activity, analyzed the Pb concentration in blood and brain tissue, and observed the morphological aspect of the brain in rats intoxicated by Pb, submitted or not to Fe supplementation. A pilot study was conducted on 20 recently weaned male rats (Rattus norvegicus, Wistar type) divided in 5 groups, being one control and 4 experimental (n=4/group). In the experimental groups, the animals received lead acetate in drinking water for 6 weeks at concentrations of 100 mg/L and 400 mg/L of Pb, and in two of these groups there was simultaneous administration of 20 mg/Kg of FeSO4 at every 2 days, by gastric gavage. The control group received deionized water. After establishing the relationship between the administered Pb and its concentration in blood (10 μgPb/dL and 30 μgPb/dL for concentrations of 100 and 400 mg/L of Pb, respectively), the study was conducted on 30 recently weaned rats divided in 6 groups (n=5/group). The five first groups were identical to those used in the pilot study, including one group in which the animals received deionized water and 20 mg/Kg FeSO4 by gastric gavage at every 2 days, for 6 weeks. After the study period, the Cortical Auditory Evoked Potential (CAEC) was applied for analysis of latency of the components P1, N1 and P2. The animals were killed, their brains were removed and submitted to histological processing (hematoxylin and eosin) for light microscopy analysis. Data were analyzed by the ANOVA/Tukey, Kruskal-Wallis/Dunn and linear regression tests (p<0.05). A dose- response relationship was observed in the Pb concentration...

Estrategias para la prevención y el tratamiento de la anemia ferropriva / Strategies for the prevention and treatment of iron deficienciy anemia

La anemia ferropriva se asocia con una elevada prevalencia en la infancia. Se presenta una revisión de la epidemiología, el diagnóstico y el tratamiento de esta afección en la población pediátrica

Effect of Helicobacter pylori eradication therapy in iron deficiency anaemia of pregnancy – A pilot study.

Background & objectives: Despite routine iron supplementation and promotion of diet modification, iron deficiency anaemia (IDA) remains widely prevalent in our antenatal population. Recent studies in pediatric population have highlighted the role of Helicobacter pylori infection in IDA. This study was undertaken to study the effect of eradication therapy in H. pylori infected pregnant women with IDA. Methods: Randomized placebo-controlled double blind clinical trial was done on 40 antenatal women between 14-30 wk gestation, with mild to moderate IDA and having H. pylori infection, as detected by stool antigen test. These women were randomly divided into group I (n=20): H. pylori treatment group (amoxicillin, clarithromycin, omeprazole for 2 wk) and group II (n=20): placebo group. Both groups received therapeutic doses of iron and folic acid. Outcome measures were improvement in haematological parameters and serum iron profile after 6 wk of oral iron therapy. Results: The prevalence of iron deficiency in pregnant women with mild to moderate anaemia was 39.8 per cent (95% CI 35.7, 44.3); and 62.5 per cent (95% CI 52, 73) of these pregnant women with IDA were infected with H. pylori. After 6 wk of therapeutic oral iron and folic acid supplementation, the rise in haemoglobin, packed cell volume, serum iron and percentage transferrin saturation was significantly (P<0.05) higher in the group given H. pylori eradication therapy as compared to the placebo group. Interpretation & conclusions: Our results showed a high occurrence of H. pylori infection in pregnant women with IDA. Eradication therapy resulted in significantly better response to oral iron supplementation among H. pylori infected pregnant women with IDA.

A suplementação de ferro na gravidez: orientações atuais / Iron supplementation in pregnancy: current guidelines

O ferro é um dos minerais mais abundantes na crosta terrestre e nos organismos. Participa da síntese da hemoglobina, mioglobina, além de ser co-fator de uma série de reações enzimáticas. Durante a gravidez, vários processos fisiológicos fazem com que a demanda desse micronutriente tenha um incremento significativo, o que torna necessárias maiores ingestão e absorção de ferro. Sabe-se que, durante a gestação, a quantidade de ferro absorvida nos intestinos aumenta, mas, mesmo assim, a maioria das gestantes não ingere quantidade satisfatória desse mineral, o que torna explicável a suplementação oral da dieta com ferro. Vários autores advogam que essa suplementação não deva ser feita de maneira rotineira, mas individualizada, devido a possíveis efeitos deletérios do ferro durante a gestação, dentre eles o aumento nas taxas de Diabetes Mellitus Gestacional e pré-eclâmpsia. O objetivo desse estudo é realizar uma revisão na literatura médica que versa sobre o assunto, criando uma análise crítica sobre a suplementação oral rotineira de ferro e seus possíveis riscos durante a gestação

Iron is one of the most abundant mineral on the Earth's crust and organisms. It is essential for the synthesis of hemoglobin and myoglobin; besides, it acts as a co-factor in a series of enzymatic reactions. During pregnancy, multiple physiological adaptations cause an increase in the demand of micro-nutrients, which makes further ingestion and absorption of iron necessary. It is known that, during pregnancy, the amount of iron absorbed in the intestines increases, but even so, most pregnant women do not have an adequate iron intake, which makes the oral supplementation of diet with iron a reasonable action. A considerable number of authors advocate that this supplementation should not be made as a routine, but individualized, due to the possible deleterious effects of iron during pregnancy, among them the increased risk of Gestational Diabetes and pre-eclampsia. The aim of this study is to perform a review in the medical literature about the subject, creating a critical analysis of routine iron supplementation and its possible risks during pregnancy

Involvement of Splenic Hemangioma and Rectal Varices in a Patient with Klippel - Trenaunay Syndrome / 대한소화기학회지

Klippel - Trenaunay syndrome (KTS) is characterized by a cutaneous vascular nevus of the involved extremity, bone and soft tissue hypertrophy of the extremity and venous malformations. We present a case of KTS with splenic hemangiomas and rectal varices. A 29-year-old woman was referred for intermittent hematochezia for several years. She had history with a number of operations for cutaneous and soft tissue hamangiomas since the age of one year old and for increased circumference of her left thigh during the last few months. Abdominal CT revealed multiple hemangiomas in the spleen, fusiform aneurysmal dilatation of the deep veins and soft tissue hemangiomas. There was no evidence of hepatosplenomegaly or liver cirrhosis. Colonoscopy revealed hemangiomatous involvement in the rectum. There were rectal varices without evidence of active bleeding. Upon venography of the left leg, we also found infiltrative dilated superficial veins in the subcutaneous tissue and aneurysmal dilatation of the deep veins. The patient was finally diagnosed with KTS, and treated with oral iron supplementation only, which has been tolerable to date. Intervention or surgery is not required. When gastrointestinal varices or hemangiomatous mucosal changes are detected in a young patient without definite underlying cause, KTS should be considered.

Anemia em pré-escolares atendidos em creches de Sâo Paulo (SP): perspectivas decorrentes da fortificação das farinhas de trigo e de milho / Anemia in pre-school children attending day care centers of São Paulo: perspectives of the wheat and maize flour fortification

Pre-school children are one of the most vulnerable groups to iron-defi ciencyanemia. The objective of this study was to measure the hemoglobin concentration and to diagnose the prevalence of anemia in children from 24 to 60 months old attending child day care centers. The diagnosis of anemiain 465 pre-school children from six child day care centers in Butantã,S.Paulo/Brasil, was carried out with peripheral hemoglobin measurementsand analysed by HemoCue employing 11,0g/dL as the cut-off for anemia.The nutritional status was calculated through weight/age, height/age, weight/height with cut-off values of -2.0 and +2.0 for malnutrition and obesity, respectively. The pre-school children had presented 20.9% anemia, 2.4% of the children were shown to be stunting, 0.9% wasting and 5.1% obesity. The childrenïs anthropometric features, as well as socio-economic and family conditions, were not associated with anemia. The prevalence of anemia,signifi cantly lower than the described in the totality of studies developedamong preschool children before the publication of Resolution 344/2002,that it determined the fortifi cation of wheat and maize fl ours with iron,allows to suggest that the supplemental iron, propagated through fortifi edfoods, positively played the role it was assigned to strategy of intervention forthe control of the iron defi ciency.

Los niños en edad preescolar son uno delos grupos más vulnerables a la anemiaferropriva. El objetivo del estudio fue medir la concentración de hemoglobina y diagnosticar la prevalencia de anemia en niños de 24 meses a 60 meses que frecuentan Jardines Infantiles.El diagnostico de anemia en 465 preescolares de seis unidades del barrio Butantã, municipio de São Paulo, Brasil, fue realizado por medio de la determinación de la concentración dehemoglobina periférica, utilizando punto de corte de 11,0g/dl. El estado nutricional fue calculado utilizando el puntajeûZ para peso/ edad, estatura/edad y peso/estaturacon niveles de corte -2,0 + 2,0 para desnutrición y obesidad, respectivamente. Fue diagnosticada anemia en 20,9% de los preescolares, desnutrición anterior en 2,4%, desnutrición actual en 0,9% y obesidad en 5,1%. No se encontró relación entre la anemia y las características antropométricas de los niños ni con las variables socio-económicas y domiciliares de las familias. La prevalencia de anemia encontrada es signifi cativamente menor que la descrita en estudios realizados en las mismas poblaciones de preescolares anteriormente a la publicación de la resolución 344/2002, eso que determinó el fortificación de las harinas de trigo y maíz con hierro. Esto permite sugerir que el suplemento de hierro, aportado por medio de los alimentos fortificados ejerció positivamente el papel que le fue conferido en el estratégia de la intervención para controlar su deficiencia.

A criança em idade pré-escolar é um dos grupos mais vulneráveis à anemia ferropriva. O objetivo do estudo foi medir a concentração de hemoglobinae diagnosticar a prevalência de anemia em crianças com 24 meses a 60 meses de idade que frequentam Centros de Educação Infantil. O diagnóstico de anemia de 465 pré-escolaresde seis unidades da regional do Butantã,município de São Paulo, foi realizado com determinação da concentração de hemoglobina periférica utilizando ponto de corte de 11,0g/dL. O estado nutricional foi calculado utilizando os escores-Z de peso/idade, estatura/idade e peso/estatura com níveis de corte -2,0 e +2,0para desnutrição e obesidade, respectivamente. Os pré-escolares apresentaram 20,9% deanemia; 2,4% de crianças foram diagnosticadas como tendo desnutrição pregressa, 0,9% desnutrição atual e 5,1% obesidade. Não houveassociação da anemia com as características antropométricas das crianças e com as variáveissocioeconômicas e domiciliares das famílias. A prevalência de anemia, significativamente menor do que a descrita na totalidade deestudos desenvolvidos entre pré-escolares antes da publicação da Resolução 344/2002, quedeterminou a fortifi cação das farinhas de trigo e de milho com ferro, permite sugerir que o ferro suplementar, veiculado pelos alimentosfortificados, exerceu positivamente o papel que lhe foi conferido na estratégia de intervenção para o controle da deficiência de ferro.

Fact of low hemoglobin and packed cell volume in pregnant women are at a stand still.

A cross sectional descriptive type of study was done in 98 women of reproductive age. Among them 25 were in control group of non pregnant women and 73 were pregnant women of 1st, 2nd and 3rd trimester of pregnancy with and without iron supplementation. The period of study was July 2004 to June 2005. The main objective of our study was to compare hemoglobin percent and packed cell volume (PCV) in pregnant and non pregnant women. In present study hemoglobin percent and packed cell volume was significantly decreased in 2nd and 3rd trimester of pregnancy when compared with the control group and same category of women who were not supplemented with iron. It is evident that the significantly low hemoglobin percent and packed cell volume (PCV) in pregnant women is due in part to dietary iron deficiency. Therefore, iron therapy in pregnancy is helpful to maintain the hemoglobin percent and packed cell volume nearer to that of non pregnant normal women.

Persistence of low serum iron and high total iron binding capacity in pregnant women.

A cross sectional descriptive type of study was done in 98 women of reproductive age. Among them 25 were in control group of non pregnant women and 73 were pregnant women of 1st, 2nd and 3rd trimester of pregnancy with and without iron supplementation. The period of study was July 2004 to June 2005. The main objective of our study was to compare serum iron and total iron binding capacity in pregnant and non pregnant women. In present study serum iron was significantly increased in 2nd and 3rd trimester of pregnancy that was supplemented with iron when compared with the same category of women who were not supplemented with iron. On the other hand serum total iron binding capacity (TIBC) was significantly increased in 3rd trimester of pregnancy that was not supplemented with iron when compared with the same category of women who were supplemented with iron. It is evident that the significantly low serum iron and high TIBC in pregnant women is due in part to dietary iron deficiency. Therefore, iron therapy in pregnancy is helpful to maintain the serum iron and TIBC nearer to that of non pregnant normal women.

Effect of herbo-mineral formulation EHb in experimental anaemia in rodents.

EHb-a herbo-mineral formulations of iron (ferrous form) produced a significantly higher and dose dependent increase in the haemoglobin level, as compared to Fefol (a non-complex-chelated iron preparation). Also, EHb did not produce any overt toxicity or gastric irritation at these dose levels. The results suggest that EHb can be of a better choice in the treatment of anaemia than any other commercially available chelated iron preparations.

Comparaçäo do desempenho de pré-escolares, mediante teste de desenvolvimento de Denver, antes e após intervençäo nutricional / Comparison of preschool children's performance through Denver develomental test, before and after nutritional supplement

A analise de performance psicomotora dde crianças institucionalizadas é de fundamental importância no planejamento de atividades educativas. Estudos anteriores têm mostrado prejuízos desta funçao em crianças de creches. Objetivo. Comparar o desempenho no teste de triagem de Denver em crianças de 2 a 6 anos de idade, de creches conveniadas com a Prefeitura de Sao Paulo, antes e após seis meses de intervençao nutricional com suplemento alimentar enriquecido com ferro. Método. Foram analisadas 130 crianças de 2 a 6 anos de idade, em três creches municipais de Sao Paulo, aplicando-se o teste de Denver, por psicólogas treinadas, comparando-se os resultados de acordo com o sexo, faixa etaria e estado nutricional, antes e após período de suplementaçao alimentar. Resultados. A maior parte das crianças teve desempenho normal, tanto na primeira aplicaçao (70,80 por cento), como na segunda (80,80 por cento), sem modificaçao do estado nutricional. Na comparaçao dos resultados, 76,92 por cento nao modificaram o desempenho e 18,46 por cento melhoraram significativamente. Em relaçao ao sexo, nao foram encontradas diferenças significantes, enquanto que, para a faixa etaria, houve melhora significante entre as crianças de 4 a 6 anos. Conclusoes. Além do aspecto nutricional, fatores como prontidao para aprendizagem, organizaçao familiar e orientaçao psicopedagógica das creches devem estar favorecendo o desenvolvimento, mesmo considerando-se o baixo nível socioeconomico da populaçao estudada.