RESUMEN
PURPOSE: We assessed the association of total meat, processed, and unprocessed red meat and iron intake with the risk of developing gestational diabetes mellitus (GDM) in pregnant women. METHODS: We conducted a prospective study among 3298 disease-free Spanish women participants of the SUN cohort who reported at least one pregnancy between December 1999 and March 2012. Meat consumption and iron intake were assessed at baseline through a validated, 136-item semi-quantitative, food frequency questionnaire. We categorized total, red, and processed meat consumption and iron intake into quartiles. Logistic regression models were used to adjust for potential confounders. RESULTS: We identified 172 incident cases of GDM. In the fully adjusted analysis, total meat consumption was significantly associated with a higher risk of GDM [OR = 1.67 (95% CI 1.06-2.63, p-trend 0.010)] for the highest versus the lowest quartile of consumption. The observed associations were particularly strong for red meat consumption [OR = 2.37 (95% CI 1.49-3.78, p-trend < 0.001)] and processed meat consumption [OR = 2.01 (95% CI 1.26-3.21, p-trend 0.003)]. Heme iron intake was also directly associated with GDM [OR = 2.21 (95% CI 1.37-3.58, p-trend 0.003)], although the association was attenuated and lost its statistical significance when we adjusted for red meat consumption [OR = 1.57 (95% CI 0.91-2.70, p-trend 0.213)]. No association was observed for non-heme and total iron intake, including supplements. CONCLUSIONS: Our overall findings suggest that higher pre-pregnancy consumption of total meat, especially red and processed meat, and heme iron intake, are significantly associated with an increased GDM risk in a Mediterranean cohort of university graduates.
Asunto(s)
Diabetes Gestacional/etiología , Dieta/efectos adversos , Hemo/efectos adversos , Hierro de la Dieta/efectos adversos , Fenómenos Fisiologicos Nutricionales Maternos , Productos de la Carne/efectos adversos , Carne/efectos adversos , Adulto , Estudios de Cohortes , Diabetes Gestacional/epidemiología , Diabetes Gestacional/etnología , Diabetes Gestacional/prevención & control , Dieta/etnología , Suplementos Dietéticos/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Fenómenos Fisiologicos Nutricionales Maternos/etnología , Atención Preconceptiva , Embarazo , Estudios Prospectivos , Factores de Riesgo , Autocuidado , Autoinforme , España/epidemiología , Adulto JovenRESUMEN
BACKGROUND: An iron overload may induce pancreatic islet damage and increase risk of diabetes. Women with a history of gestational diabetes mellitus (GDM) are at high risk of developing type 2 diabetes mellitus (T2DM) after pregnancy. OBJECTIVE: We aimed to examine the association of habitual iron intake with long-term risk of T2DM in this high-risk population. DESIGN: We included 3976 women with a history of GDM from the Nurses' Health Study II cohort as part of the ongoing Diabetes & Women's Health Study. The women were followed up through 2009. Iron intake was assessed with the use of a validated food-frequency questionnaire in 1991 and every 4 y thereafter. We used Cox proportional hazards models to estimate HRs and 95% CIs. RESULTS: We documented 641 incident T2DM cases during 57,683 person-years of observation. Adjusted HRs for T2DM for the highest quartile compared with the lowest quartile were 1.64 (95% CI: 1.20, 2.25; P-trend = 0.02) for total iron intake and 1.80 (95% CI: 1.18, 2.74; P-trend = 0.005) for dietary heme iron intake. In addition, women who consumed ≥30.0 mg supplemental Fe/d, compared with nonusers, had an adjusted HR of 1.83 (95% CI: 1.25, 2.70; P-trend = 0.002). CONCLUSION: In women with a history of GDM, greater intakes of total iron, dietary heme iron, and supplemental iron were associated with higher risk of T2DM.
Asunto(s)
Diabetes Mellitus Tipo 2/etiología , Diabetes Gestacional/fisiopatología , Suplementos Dietéticos/efectos adversos , Sobrecarga de Hierro/fisiopatología , Hierro de la Dieta/efectos adversos , Carne/efectos adversos , Adulto , Estudios de Cohortes , Diabetes Mellitus Tipo 2/epidemiología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Hemo/efectos adversos , Humanos , Incidencia , Sobrecarga de Hierro/etiología , Hierro de la Dieta/envenenamiento , Enfermeras y Enfermeros , Encuestas Nutricionales , Embarazo , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Riesgo , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND AND AIMS: Iron is thought to play a fundamentally important role in the development of cardiovascular disease (CVD). This meta-analysis was performed to investigate the dose-response association between dietary intake of iron (including heme and non-heme iron) and the risk of CVD. METHODS AND RESULTS: We performed a search of the PubMed and Embase databases for prospective cohort studies of the association between dietary iron intake and CVD risk. Thirteen articles comprising 252,164 participants and 15,040 CVD cases were eligible for inclusion. Heme iron intake was associated significantly with increased risk of cardiovascular disease, and the pooled relative risk (RR) for each 1 mg/day increment was 1.07 (95% confidence interval: 1.01 to 1.14, I² = 59.7%). We also found evidence of a curvilinear association (P < 0.05 for non-linearity). In contrast, we found no association between CVD risk and dietary non-heme (0.98, 0.96 to 1.01, I² = 15.8%) or total iron (1.00, 0.94 to 1.06, I² = 30.4%). Subgroup analyses revealed that the association between heme iron intake and CVD risk was stronger among non-fatal cases (1.19, 1.07-1.33) and American patients (1.31, 1.11-1.56). CONCLUSIONS: Higher dietary intake of heme iron is associated with an increased risk of cardiovascular disease, whereas no association was found between CVD and non-heme iron intake or total iron intake. These findings may have important public health implications with respect to preventing cardiovascular disease.
Asunto(s)
Enfermedades Cardiovasculares/etiología , Medicina Basada en la Evidencia , Hemo/efectos adversos , Hierro de la Dieta/efectos adversos , Enfermedades Cardiovasculares/epidemiología , Suplementos Dietéticos/efectos adversos , Hemo/administración & dosificación , Humanos , Hierro de la Dieta/administración & dosificación , Carne/efectos adversos , Factores de RiesgoRESUMEN
BACKGROUND: Injection therapies are widely used for muscle injuries. As there is only limited evidence of their efficacy, physicians should be aware of the potential harmful effects of these injected preparations. OBJECTIVES: The purpose of this review was to systematically review the literature on the myotoxic effects of intramuscular injection preparations commonly used for acute muscle injuries. DATA SOURCES: The databases of PubMed, Embase, Web of Science, Cochrane Library, CINAHL and SportDiscus were searched in March 2013. STUDY ELIGIBILITY CRITERIA: Studies reporting histological evaluation or creatine kinase activity after intramuscular injection with local anaesthetics, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), platelet-rich plasma (PRP), Traumeel(®) and Actovegin(®), or combination preparations were eligible for inclusion. DATA ANALYSIS: Two authors independently screened the search results and assessed the risk of bias. A best-evidence synthesis was used to identify the level of evidence. RESULTS: Forty-nine studies were included in this systematic review. There is strong to moderate evidence that intramuscularly injected local anaesthetics and NSAIDs are myotoxic, and there is conflicting evidence of the myotoxicity of PRP. There is limited evidence that single corticosteroid injections are not myotoxic but have a synergistic myotoxic effect when used together with local anaesthetics. There is no information to assess whether Actovegin(®) and Traumeel(®) are myotoxic. CONCLUSION: Local anaesthetics and NSAID injections are not recommended for the treatment of muscle injuries in athletes, as they are myotoxic. The possible myotoxic effects of corticosteroids, PRP, Traumeel(®) and Actovegin(®) should be assessed in future research.
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Anestésicos Locales/efectos adversos , Antiinflamatorios no Esteroideos/efectos adversos , Músculo Esquelético/efectos de los fármacos , Músculo Esquelético/lesiones , Corticoesteroides/administración & dosificación , Corticoesteroides/efectos adversos , Anestésicos Locales/administración & dosificación , Animales , Antiinflamatorios no Esteroideos/administración & dosificación , Creatina Quinasa/metabolismo , Hemo/administración & dosificación , Hemo/efectos adversos , Hemo/análogos & derivados , Homeopatía/efectos adversos , Humanos , Inyecciones Intramusculares , Minerales/administración & dosificación , Minerales/efectos adversos , Músculo Esquelético/enzimología , Extractos Vegetales/administración & dosificación , Extractos Vegetales/efectos adversos , Plasma Rico en PlaquetasRESUMEN
BACKGROUND: A low supply of iron in the diet may result in iron deficiency and mild iron-deficiency anaemia in healthy individuals. Women are more susceptible than men because of menstrual iron loss. We compared the effect of a low dose of iron, administered as a dietary supplement, with a high pharmacological dose of iron to otherwise healthy individuals with iron deficiency and mild iron deficiency anaemia. MATERIAL AND METHOD: In a randomised, double-blind trial conducted in 2000-2001, 73 women and three men with iron deficiency received either 27.6 mg of iron consisting of ferrous fumarate enriched with 13% haem iron, or 100 mg ferrosulphate daily for 12 weeks. Blood samples were analysed four times in the course of the treatment. RESULTS: The median ferritin value rose by 13 and 7 µg/l in the high-dose and low-dose group, respectively. The increase in ferritin was significantly higher in the high-dose than in the low dose group ( < 0.001). There was no statistically significant difference between the groups in the change in Hb, serum-iron or serum-iron binding capacity. The median haemoglobin value increased by 0.4 g/100 ml in both groups. Gastrointestinal side effects were experienced by 58% in the high-dose group and 35% in the low-dose group. Four subjects in the high-dose group and one in the low-dose group broke off the treatment because of side effects. INTERPRETATION: A supplement of low-dose iron is enough to increase iron stores in cases of nutritional iron deficiency in healthy individuals and to optimise haemoglobin. High-dose iron caused the largest increase in iron stores. Low-dose iron resulted in the least side effects.
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Anemia Ferropénica/tratamiento farmacológico , Compuestos Ferrosos/administración & dosificación , Hemo/administración & dosificación , Hierro/administración & dosificación , Administración Oral , Adulto , Anciano , Estreñimiento/inducido químicamente , Diarrea/inducido químicamente , Suplementos Dietéticos , Método Doble Ciego , Combinación de Medicamentos , Femenino , Ferritinas/sangre , Compuestos Ferrosos/efectos adversos , Compuestos Ferrosos/sangre , Compuestos Ferrosos/uso terapéutico , Hemo/efectos adversos , Hemo/uso terapéutico , Humanos , Hierro/sangre , Hierro/uso terapéutico , Deficiencias de Hierro , Masculino , Persona de Mediana Edad , ComprimidosRESUMEN
OBJECTIVE: Conventional iron deficiency treatment with pharmacologic iron doses often causes side effects. Heme iron has high bioavailability and a low capacity to cause gastrointestinal side effects. This study investigated the possibility of using heme iron in the form of blood-based crisp bread as a diet-based treatment program to improve the iron status of women of reproductive age. METHODS: In a 12-wk intervention study, 77 women (mean age 24 y) were assigned to one of four groups: blood-based crisp bread (35 mg of iron [Fe], 27 mg of which was heme Fe), iron supplementation consisting of 35 mg of non-heme iron/day (Fe35), iron supplementation consisting of 60 mg of non-heme iron/day (Fe60), and controls (iron-free tablets). RESULTS: Body iron increased significantly in the crisp bread group by a median of 2.7 mg/kg (interquartile range 3.1, n = 18), in the Fe35 group by 2.7 mg/kg (interquartile range 2.8, n = 11), and in the Fe60 group by 4.1 mg/kg (interquartile range 3.6, n = 13), whereas no change was observed in the control group. No statistically significant difference in iron status increase was observed between the crisp bread group compared with the two iron-supplemented groups. CONCLUSION: Dietary-based treatment containing heme iron has few side effects and can be used efficiently to improve the iron status of women of reproductive age.
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Hemo/administración & dosificación , Deficiencias de Hierro , Hierro de la Dieta/administración & dosificación , Hierro/sangre , Pan/efectos adversos , Suplementos Dietéticos/efectos adversos , Femenino , Tracto Gastrointestinal/efectos de los fármacos , Hemo/efectos adversos , Hemo/farmacocinética , Humanos , Hierro de la Dieta/efectos adversos , Hierro de la Dieta/farmacocinética , Adulto JovenAsunto(s)
Antioxidantes/economía , Antioxidantes/uso terapéutico , Neoplasias de la Mama/economía , Neoplasias de la Mama/terapia , Hemo/análogos & derivados , Cobertura del Seguro/economía , Cobertura del Seguro/legislación & jurisprudencia , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/legislación & jurisprudencia , Terapia Ortomolecular/economía , Anciano , Antioxidantes/efectos adversos , Aprobación de Drogas/legislación & jurisprudencia , Medicina Basada en la Evidencia/legislación & jurisprudencia , Femenino , Alemania , Hemo/efectos adversos , Hemo/economía , Hemo/uso terapéutico , Humanos , Infusiones Intravenosas , Terapia Ortomolecular/efectos adversos , Terapia Ortomolecular/legislación & jurisprudencia , Prevención SecundariaRESUMEN
In a cohort study of 49,654 Canadian women, we assessed the association of colorectal cancer with total iron and heme iron intake, excluding iron supplements. Among women aged 40-59 years, followed for an average of 16.4 years, we identified 617 incident colorectal cancer cases. Data from a food frequency questionnaire administered at baseline were used to calculate red meat intake and intake of total dietary iron, iron from meat, and heme iron. Analyses were carried out for all cases and for the proximal colon, distal colon, and rectum, using Cox proportional hazards models. We found no association of intake of iron, heme iron, or iron from meat with risk of colorectal cancer overall or with any of the subsites, nor was there effect modification by alcohol consumption or hormonal replacement therapy.
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Neoplasias Colorrectales/epidemiología , Hemo/efectos adversos , Hierro de la Dieta/efectos adversos , Adulto , Consumo de Bebidas Alcohólicas , Estudios de Cohortes , Neoplasias Colorrectales/etiología , Conducta Alimentaria , Femenino , Estudios de Seguimiento , Terapia de Reemplazo de Hormonas , Humanos , Carne , Persona de Mediana Edad , Estudios Prospectivos , RiesgoRESUMEN
The intake of a Western diet with a high amount of red meat is associated with a high risk for colon cancer. We hypothesize that heme, the iron carrier of red meat, is involved in diet-induced colonic epithelial damage, resulting in increased epithelial proliferation. Rats were fed purified control diets, or purified diets supplemented with 1.3 micromol/g of hemin (ferriheme), protoporphyrin IX, ferric citrate, or bilirubin (n = 8/group) for 14 days. Feces were collected for biochemical analyses. Fecal cytotoxicity was determined from the degree of lysis of erythrocytes by fecal water. Colonic epithelial proliferation was measured in vivo using [3H]thymidine incorporation into colonic mucosa. The colonic epithelial proliferation in heme-fed rats was significantly increased compared to control rats [55.2 +/- 5.8 versus 32.6 +/- 6.3 dpm/microg DNA (mean +/- SE); P < 0.05]. The fecal water of the heme group was highly cytotoxic compared to the controls (90 +/- 2% versus 2 +/- 1%; P < 0.001), although the concentrations of cytotoxic bile acids and fatty acids were significantly lower. Organic iron was significantly increased compared to the controls (257 +/- 26 versus 80 +/- 21, microM; P < 0.001). Spectrophotometric analyses suggest that this organic iron is heme-associated. Thiobarbituric acid-reactive substances were greatly increased in the fecal water of heme-fed rats compared to the controls (177 +/- 12 versus 59 +/- 7 microM; P < 0.05). Heme itself could not account for the increased cytotoxicity because the addition of heme to the fecal water of the control group, which was equimolar to the organic iron content of the fecal water of the heme group, did not influence the cytotoxicity. Hence, an additional heme-induced cytotoxic factor is involved, which may be modulated by the generation of luminal-reactive oxygen species. Protoporphyrin IX, ferric citrate, and bilirubin did not increase proliferation and cytotoxicity. In conclusion, dietary heme leads to the formation of an unknown, highly cytotoxic factor in the colonic lumen. This suggests that, in heme-fed rats, colonic mucosa is damaged by the intestinal contents. This results in a compensatory hyperproliferation of the epithelium, which supposedly increases the risk for colon cancer.