Oral iron supplementation ameliorated alterations in iron uptake and utilization in copper-toxic female Wistar rats.

OBJECTIVE: Women are more susceptible to both iron deficiency and copper toxicity due to monthly flow and estrogen action, respectively. Oral iron is beneficial for menstruating women and enhances erythropoiesis, but both deficiency and excess of copper impact iron absorption and mobilization. The aim of this study was to investigate the possibility of mitigating copper toxicity in female Wistar rats while supplementing with iron. METHODS: 20 female rats (160-180g) were grouped into four: Groups 1 (Control) received 0.3mls normal saline, 2- copper-toxic (100m mg/kg Copper sulphate), 3- Copper-toxic+Iron (100 mg/kg Copper sulphate + 1 mg/kg Ferrous sulphate) and 4- Iron (1 mg/kg Ferrous sulphate). All treatment was administered orally for 5 weeks. Blood was collected retro-orbitally after light anesthesia into EDTA and plain bottles for hematological, serum copper, iron, ferritin and total iron binding capacity (TIBC) analysis. Liver was excised for copper and iron levels while bone marrow was harvested for myeloid/erythroid ratio. The data were analyzed by one-Way ANOVA and statistical significance was considered at p<0.05. RESULTS: Iron supplementation significantly increased packed cell volume, hemoglobin concentration, red blood cell count and myeloid/erythroid ratio, compared to the copper-toxic group. Serum iron and TIBC were significantly increased while liver copper and iron levels reduced significantly in iron supplemented group compared to the copper-toxic group. CONCLUSIONS: Oral iron supplementation mitigated alterations in iron absorption and mobilization following copper toxicity.

Iron Supplementation and Exercise During Pregnancy: Effects on Behavior and the Dopaminergic System.

Although it is known that regular physical activity is recommended as part of a healthy lifestyle, the number of data concerning efficacy of exercise and your relationship with a demand for iron during pregnancy is limited. The purpose of this study was to evaluate the relationship between iron supplementation and exercise during pregnancy on the behavior of rats. Molecular variables dopamine transporter (DAT) and dopamine receptor (D2) related to the locomotor behavior in response to the exercise and the iron supplemented diet were investigated. Sixty-day-old female Wistar rats were used. The pregnant rats were distributed into the following groups: standard diet (SD, n = 7), iron supplementation (IS, n = 9), exercise (EX, n = 10), and exercise + iron supplementation (EX + IS, n = 9). All rats in both the pregnant and non-pregnant groups were submitted to open-field tests. The iron supplementation diet was shown to reduce locomotor behaviors, with reduced central and peripheral ambulation, reduced rearing, and increased freezing. On the other hand, physical exercise caused an increase in central and peripheral ambulation, and in rearing. The expression of the D2 receptor protein and the dopamine transporter DAT did not show changes with the interventions over 21 days of pregnancy. In this context, the present study demonstrated that both iron supplementation and exercise exerted an influence during pregnancy on the behavior of rats, however, with different effects.

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)

Differences in iron intake during pregnancy influence in trainability response of male rat offspring / Diferenças na ingestão de ferro durante a gravidez influenciam na resposta à treinabilidade da prole de ratos machos

ABSTRACT Objective: To evaluate if different concentrations of iron in diets during pregnancy would interfere in the aerobic and anaerobic performance of the offspring, observed during 8-week swimming training and measured by lactate minimum test. Methods: Pregnant rats were divided into four groups with different dietary iron concentrations: standard (40mg/kg), supplementation (100mg/kg), restriction since weaning, and restriction only during pregnancy (4mg/kg). After birth, the offspring were assigned to their respective groups (Standard Offspring, Supplementation Offspring, Restriction Offspring or Restriction Offspring 2). The lactate minimum test was performed at three time points: before starting exercise training, after 4 weeks and after 8 weeks of exercise training. Results: The Restriction Offspring Group had a significant reduction in the concentration of lactate minimum and in swimming time to exhaustion, after 4 and 8 weeks of training as compared to before training. Therefore, the results showed the Restriction Offspring Group was not able to maintain regularity during training in lactate minimum tests. Conclusion: Our results suggested the Restriction Offspring Group showed a marked decrease in its performance parameters, which may have occurred due to iron restriction.

RESUMO Objetivo: Avaliar parâmetros aeróbios e anaeróbios da prole de ratas alimentadas com diferentes dietas de ferro durante a prenhez, por meio do teste de lactato mínimo. Métodos: As ratas prenhes foram divididas em quatro grupos com diferentes concentrações de ferro na dieta: padrão (40mg/kg), suplementação (100mg/kg), restrição desde o desmame e restrição apenas durante a gravidez (4mg/kg). Após o nascimento, os filhotes foram designados para seus respectivos grupos (Prole Padrão, Prole Suplementação, Prole Restrição ou Prole Restrição 2). O teste de lactato mínimo foi realizado em três momentos: antes de iniciar o treinamento físico, após 4 semanas e após 8 semanas de treinamento físico. Resultados: O Grupo Prole Restrição apresentou redução significativa na concentração do lactato mínimo e no tempo de natação até a exaustão, após 4 e 8 semanas de treinamento em relação ao período antes do início do treinamento. Assim, o Grupo Prole Restrição não foi capaz de manter regularidade durante o treinamento nos testes de lactato mínimo. Conclusão: Os resultados sugerem que o Grupo Prole Restrição apresentou diminuição acentuada nos parâmetros de desempenho, o que pode ter ocorrido devido à restrição de ferro.

Randomized Controlled Trial of Iron-Fortified versus Low-Iron Infant Formula: Developmental Outcomes at 16 Years.

OBJECTIVES: To test differences in cognitive outcomes among adolescents randomly assigned previously as infants to iron-fortified formula or low-iron formula as part of an iron deficiency anemia prevention trial. STUDY DESIGN: Infants were recruited from community clinics in low- to middle-income neighborhoods in Santiago, Chile. Entrance criteria included term, singleton infants; birth weight of ≥3.0 kg; and no major congenital anomalies, perinatal complications, phototherapy, hospitalization >5 days, chronic illness, or iron deficiency anemia at 6 months. Six-month-old infants were randomized to iron-fortified (12 mg/L) or low-iron (2.3 mg/L) formula for 6 months. At 16 years of age, cognitive ability, visual perceptual ability, visual memory, and achievement in math, vocabulary, and comprehension were assessed, using standardized measures. We compared differences in developmental test scores according to randomization group. RESULTS: At the follow-up assessment, the 405 participants averaged 16.2 years of age and 46% were male. Those randomized to iron-fortified formula had lower scores than those randomized to low-iron formula for visual memory, arithmetic achievement, and reading comprehension achievement. For visual motor integration, there was an interaction with baseline infancy hemoglobin, such that the iron-fortified group outperformed the low-iron group when 6-month hemoglobin was low and underperformed when 6-month hemoglobin was high. CONCLUSIONS: Adolescents who received iron-fortified formula as infants from 6 to 12 months of age at levels recommended in the US had poorer cognitive outcomes compared with those who received a low-iron formula. The prevention of iron deficiency anemia in infancy is important for brain development. However, the optimal level of iron supplementation in infancy is unclear. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01166451.

Iron Bisglycinate Chelate and Polymaltose Iron for the Treatment of Iron Deficiency Anemia: A Pilot Randomized Trial.

BACKGROUND: Iron Deficiency Anemia (IDA) is a major public health problem worldwide. Iron Bisglycinate Chelate (FeBC) and polymaltose iron (FeP) are used for the treatment of IDA and exhibit good tolerability with a low incidence of adverse effects. However, these compounds have important differences in their structures and bioavailability. OBJECTIVE: To compare the efficacy of oral supplementation with FeBC and FeP in anemic children. METHODS: In this double-blind study, children aged 1 to 13 years who were diagnosed with IDA were randomly divided into two groups: i) FeBC, supplemented with iron bisglycinate chelate, and ii) FeP, supplemented with polymaltose iron (3.0 mg iron/kg body weight/day for 45 days for both groups). RESULTS: Both treatments resulted in significant increases in hemoglobin levels, Mean Corpuscular Volume (MCV) and Cell Distribution Width (RDW) and in a reduction of transferrin levels, relative to initial values. However, only FeBC treatment significantly increased ferritin and Mean Corpuscular Hemoglobin (MCH) levels. A significant negative correlation was observed between the increase in ferritin and initial hemoglobin levels in the FeBC group, indicating that the absorption of FeBC is regulated by the body iron demand. CONCLUSION: These results provide preliminary evidence to suggest a greater efficacy of FeBC than FeP in increasing iron stores.

Iron supplementation for lambs experimentally infected by Haemonchus contortus: response to anemia and iron store in the bone marrow / Suplementação com ferro em cordeiros infectados experimentalmente por Haemonchus contortus: resposta a anemia e as reservas de ferro na medula óssea

To evaluate the effect of supplementation of iron dextran on blood variables and iron metabolism in lambs experimentally infected by Haemonchus contortus, four experimental groups were used: uninfected and non-supplemented animals (GI); infected animals supplemented with iron (GII); uninfected animals supplemented with iron (GIII); and infected non-supplemented animals (GIV). Groups II and IV received 10,000 larvae (L3) of Haemonchus contortus, and groups II and III received three doses of iron dextran (20mg/kg) intramuscularly with seven days of interval. Blood and faeces samples were collected on days 10 (D10), 17 (D17), 24 (D24), and 31 (D31), in order to determine red blood cell counts, iron metabolism, and EPG. Infected animals developed anemia from D24 and anemia was more severe on D31. Animals from GII had higher hematocrit and hemoglobin concentration compared to animals of GIV on D31. Iron stores in the bone marrow were higher in GII and GIII compared to GI and GIV. The GIV showed lower seric levels of iron on D24 compared to the other groups. The iron supplementation reduces the severity of the anemia caused by infection with Haemonchus contortus in lambs, improving erythropoietic response after blood loss.(AU)

Para avaliar o efeito da suplementação de ferro dextrano sobre variáveis sanguíneas e metabolismo do ferro em cordeiros experimentalmente infectados por Haemonchus contortus, foram utilizados quatro grupos experimentais: animais não infectados e não suplementados (GI); animais infectados e suplementados com ferro (GII); animais não infectados e suplementados com ferro (GIII); e animais não suplementados infectados (GIV). Os grupos II e IV receberam 10.000 larvas (L3) de Haemonchus contortus, e os grupos II e III receberam três doses de ferro dextrano (20mg/kg) por via intramuscular com sete dias de intervalo. As amostras de sangue e fezes foram coletadas nos dias 10 (D10), 17 (D17), 24 (D24) e 31 (D31), para determinar o eritrograma, o metabolismo do ferro e a quantidade de ovos por gramas de fezes (OPG). Os cordeiros infectados desenvolveram anemia no D24, sendo esta mais severa no dia 31. Os cordeiros do GII apresentaram maior hematócrito e concentração de hemoglobina em comparação com animais dd GIV no D31. Os estoques de ferro na medula óssea foram maiores no GII e GIII em comparação com o GI e GIV. O GIV mostrou menores níveis séricos de ferro no D24 em comparação com os outros grupos. A suplementação de ferro reduz a gravidade da anemia causada por infecção por Haemonchus contortus em cordeiros, melhorando a resposta eritropoietica após a perda de sangue.(AU)

Iron supplementation for lambs experimentally infected by Haemonchus contortus: response to anemia and iron store in the bone marrow / Suplementação com ferro em cordeiros infectados experimentalmente por Haemonchus contortus: resposta a anemia e as reservas de ferro na medula óssea

To evaluate the effect of supplementation of iron dextran on blood variables and iron metabolism in lambs experimentally infected by Haemonchus contortus, four experimental groups were used: uninfected and non-supplemented animals (GI); infected animals supplemented with iron (GII); uninfected animals supplemented with iron (GIII); and infected non-supplemented animals (GIV). Groups II and IV received 10,000 larvae (L3) of Haemonchus contortus, and groups II and III received three doses of iron dextran (20mg/kg) intramuscularly with seven days of interval. Blood and faeces samples were collected on days 10 (D10), 17 (D17), 24 (D24), and 31 (D31), in order to determine red blood cell counts, iron metabolism, and EPG. Infected animals developed anemia from D24 and anemia was more severe on D31. Animals from GII had higher hematocrit and hemoglobin concentration compared to animals of GIV on D31. Iron stores in the bone marrow were higher in GII and GIII compared to GI and GIV. The GIV showed lower seric levels of iron on D24 compared to the other groups. The iron supplementation reduces the severity of the anemia caused by infection with Haemonchus contortus in lambs, improving erythropoietic response after blood loss.(AU)

Para avaliar o efeito da suplementação de ferro dextrano sobre variáveis sanguíneas e metabolismo do ferro em cordeiros experimentalmente infectados por Haemonchus contortus, foram utilizados quatro grupos experimentais: animais não infectados e não suplementados (GI); animais infectados e suplementados com ferro (GII); animais não infectados e suplementados com ferro (GIII); e animais não suplementados infectados (GIV). Os grupos II e IV receberam 10.000 larvas (L3) de Haemonchus contortus, e os grupos II e III receberam três doses de ferro dextrano (20mg/kg) por via intramuscular com sete dias de intervalo. As amostras de sangue e fezes foram coletadas nos dias 10 (D10), 17 (D17), 24 (D24) e 31 (D31), para determinar o eritrograma, o metabolismo do ferro e a quantidade de ovos por gramas de fezes (OPG). Os cordeiros infectados desenvolveram anemia no D24, sendo esta mais severa no dia 31. Os cordeiros do GII apresentaram maior hematócrito e concentração de hemoglobina em comparação com animais dd GIV no D31. Os estoques de ferro na medula óssea foram maiores no GII e GIII em comparação com o GI e GIV. O GIV mostrou menores níveis séricos de ferro no D24 em comparação com os outros grupos. A suplementação de ferro reduz a gravidade da anemia causada por infecção por Haemonchus contortus em cordeiros, melhorando a resposta eritropoietica após a perda de sangue.(AU)

Parâmetros hematológicos e bioquímicos de bezerros neonatos da raça Holandesa tratados com ferro suplementar / Hematological and biochemical parameters of neonatal Holstein calves supplemented with iron

A deficiência de ferro em bezerros neonatos está associada ao desenvolvimento de anemia, que favorece o aparecimento de outras enfermidades como pneumonia e diarreia. Avaliou-se o efeito da suplementação de ferro sobre o eritrograma, teores séricos de ferro, ceruloplasmina e transferrina, bem como o potencial para toxicidade do protocolo utilizado por meio da avaliação dos teores de ureia, creatinina e enzimas hepáticas. Para tal avaliação foram utilizados 40 bezerros neonatos da raça Holandesa, alocados em cinco grupos experimentais com oito animais em cada grupo, que foram submetidos aos seguintes protocolos: administração intramuscular de 5mL de solução fisiológica estéril no 5º dia de idade (grupo controle G1), e administração intramuscular de 5mL de ferro dextrano 10% nos seguintes momentos: no 5º dia de idade (G2); no 5o e no 20º dias de idade (G3); no 5o e no 30º dias de idade (G4) e no 5o, 20o e 45º dias de idade (G5). Foram coletadas amostras de sangue até 8 horas após o nascimento e aos 5, 10, 20, 30, 60 e 90 dias de idade para realização do eritrograma, avaliação dos teores séricos de ferro, ceruloplasmina, transferrina, ureia, creatinina, bilirrubina total e direta, e das atividades das enzimas aspartato aminotransferase (AST), fosfatase alcalina (ALP) e gamaglutamiltransferase (GGT). Os animais que receberam ferro suplementar apresentaram menor oscilação nos parâmetros eritrocitários, embora os animais do grupo controle não tenham desenvolvido anemia. Notou-se também aumento, embora não significativo, nos teores séricos de ferro e das proteínas de fase aguda ceruloplasmina e transferrina, cuja atividade está relacionada ao metabolismo desse mineral. Os teores séricos de ureia, creatinina, bilirrubina total e direta e as atividades das enzimas GGT, AST e ALP não foram influenciados pelos protocolos de administração de ferro suplementar. Os protocolos de tratamento empregados não ocasionaram hepatoxidade ou nefrotoxidade aos animais...(AU)

Iron deficiency in newborn calves is associated with the development of anemia, which favors the development of other infirmities such as pneumonia and diarrhea. The present study evaluated the effect of iron supplementation on erythrogram, serum levels of iron, ceruloplasmin and tranferrin, as well as potential toxicity of the protocol used by means of evaluation of urea, creatinine and hepatic enzyme activities. 40 newborn Holstein calves were allocated into 5 experimental groups comprising 8 calves each, which were subjected to the following treatment protocols: intramuscular administration of 5mL of sterile saline on the 5th day of age (control group G1), intramuscular administration of 5mL of 10% dextran iron in the following moments: on the 5th day of age (G2); on the 5th and in the 20th day of age (G3); on the 5th and 30th day of age (G4); on the 5th, 20th and 45th days of age (G5). Blood samples were taken until 8 hours after birth and with 5, 10, 20, 30, 60, and 90 days of age, and subjected to hemogram, evaluation of serum levels of iron, ceruloplasmin, transferrin, urea, creatinine, total and direct bilirrubin, and serum activities of aspartate aminotransferase (AST), alcaline phosphatase (ALP), and gamma-glutamyltransferase (GGT). Calves that received iron supplementation at any time presented less variation in the erythrocyte parameters, although calves in the control group did not develop anemia. Serum concentration of iron and acute phase protein ceruloplasmin and transferrin, which activities are related to iron metabolism, also increased, although not significantly. Serum levels of urea, creatinine, bilirubins and activities of AST, ALP, and GGT were not influenced by the administration protocols used in this experiment. The results of the experiment led to the conclusion that the supplementation with parenteral dextran iron in calves that receive diets other than exclusive milk does not bring sufficient advantages to be indicated...(AU)

Parâmetros hematológicos e bioquímicos de bezerros neonatos da raça Holandesa tratados com ferro suplementar / Hematological and biochemical parameters of neonatal Holstein calves supplemented with iron

A deficiência de ferro em bezerros neonatos está associada ao desenvolvimento de anemia, que favorece o aparecimento de outras enfermidades como pneumonia e diarreia. Avaliou-se o efeito da suplementação de ferro sobre o eritrograma, teores séricos de ferro, ceruloplasmina e transferrina, bem como o potencial para toxicidade do protocolo utilizado por meio da avaliação dos teores de ureia, creatinina e enzimas hepáticas. Para tal avaliação foram utilizados 40 bezerros neonatos da raça Holandesa, alocados em cinco grupos experimentais com oito animais em cada grupo, que foram submetidos aos seguintes protocolos: administração intramuscular de 5mL de solução fisiológica estéril no 5º dia de idade (grupo controle G1), e administração intramuscular de 5mL de ferro dextrano 10% nos seguintes momentos: no 5º dia de idade (G2); no 5o e no 20º dias de idade (G3); no 5o e no 30º dias de idade (G4) e no 5o, 20o e 45º dias de idade (G5). Foram coletadas amostras de sangue até 8 horas após o nascimento e aos 5, 10, 20, 30, 60 e 90 dias de idade para realização do eritrograma, avaliação dos teores séricos de ferro, ceruloplasmina, transferrina, ureia, creatinina, bilirrubina total e direta, e das atividades das enzimas aspartato aminotransferase (AST), fosfatase alcalina (ALP) e gamaglutamiltransferase (GGT). Os animais que receberam ferro suplementar apresentaram menor oscilação nos parâmetros eritrocitários, embora os animais do grupo controle não tenham desenvolvido anemia. Notou-se também aumento, embora não significativo, nos teores séricos de ferro e das proteínas de fase aguda ceruloplasmina e transferrina, cuja atividade está relacionada ao metabolismo desse mineral. Os teores séricos de ureia, creatinina, bilirrubina total e direta e as atividades das enzimas GGT, AST e ALP não foram influenciados pelos protocolos de administração de ferro suplementar. Os protocolos de tratamento empregados não ocasionaram hepatoxidade ou nefrotoxidade aos animais. Concluiu-se que a suplementação com ferro dextrano por via parenteral em bezerros que recebem outras dietas que não apenas leite não traz benefícios que justifiquem sua indicação, embora sejam necessários mais estudos que avaliem a influência da suplementação com ferro sobre o tempo necessário para a recuperação, custos com o tratamento e impacto sobre a vida produtiva dos animais na idade adulta.(AU)

Iron deficiency in newborn calves is associated with the development of anemia, which favors the development of other infirmities such as pneumonia and diarrhea. The present study evaluated the effect of iron supplementation on erythrogram, serum levels of iron, ceruloplasmin and tranferrin, as well as potential toxicity of the protocol used by means of evaluation of urea, creatinine and hepatic enzyme activities. 40 newborn Holstein calves were allocated into 5 experimental groups comprising 8 calves each, which were subjected to the following treatment protocols: intramuscular administration of 5mL of sterile saline on the 5th day of age (control group G1), intramuscular administration of 5mL of 10% dextran iron in the following moments: on the 5th day of age (G2); on the 5th and in the 20th day of age (G3); on the 5th and 30th day of age (G4); on the 5th, 20th and 45th days of age (G5). Blood samples were taken until 8 hours after birth and with 5, 10, 20, 30, 60, and 90 days of age, and subjected to hemogram, evaluation of serum levels of iron, ceruloplasmin, transferrin, urea, creatinine, total and direct bilirrubin, and serum activities of aspartate aminotransferase (AST), alcaline phosphatase (ALP), and gamma-glutamyltransferase (GGT). Calves that received iron supplementation at any time presented less variation in the erythrocyte parameters, although calves in the control group did not develop anemia. Serum concentration of iron and acute phase protein ceruloplasmin and transferrin, which activities are related to iron metabolism, also increased, although not significantly. Serum levels of urea, creatinine, bilirubins and activities of AST, ALP, and GGT were not influenced by the administration protocols used in this experiment. The results of the experiment led to the conclusion that the supplementation with parenteral dextran iron in calves that receive diets other than exclusive milk does not bring sufficient advantages to be indicated, although more studies are necessary to evaluate the influence of iron supplementation on the outcome of infections in newborn calves, especially its influence on cost of treatment, time necessary for discharge and impact on its productive life.(AU)

Effect of iron supplementation on HbA1c levels in pregnant women with and without anaemia.

BACKGROUND: Iron deficiency anaemia has been associated with higher HbA1c levels. However, during and after iron supplementation there is a decrease in HbA1c results, causing a misinterpretation. Our aim was to analyse the effect of iron supplementation on HbA1c levels in nondiabetic pregnant women with and without anaemia. METHODS: Pregnant women in prenatal care, without gestational diabetes (GDM) or previous diabetes mellitus (DM) that performed an oral glucose tolerance test (OGTT) in the third trimester of pregnancy were invited to participate. Clinical and laboratorial analyses were performed, including standardized questionnaire, OGTT, full blood count and HbA1c. RESULTS: A total of 231 pregnant women without DM or GDM were included in the study. According to anaemia and/or iron supplementation, we divided women in: no iron and no anaemia - Group 1 (N=86); no iron and with anaemia - Group 2 (N=29); iron and no anaemia - Group 3 (N=87); iron and anaemia - Group 4 (N=29). There was statistically a significant, although no clinically relevant, difference between HbA1c values in pregnant women in Groups 1 and 4 [5.1±0.4% (32±4.4mmol/mol) and 4.8±0.3% (29±3.3mmol/mol), P<0.01; respectively]. HbA1c values in pregnant women in Groups 1, 2 and 3 were similar, independently of anaemia [5.1±0.4% (32±4.4mmol/mol); 5.0±0.4% (31±4.4mmol/mol) and 5.0±0.4% (31±4.4mmol/mol); p>0.05; respectively]. CONCLUSIONS: Iron supplementation during pregnancy does not affect HbA1c levels and has no clinical impact in the final interpretation of results in the absence of anaemia or presence of mild anaemia. Interpreting HbA1c results in pregnant women during iron therapy and with moderate or severe anaemia still requires caution.

Parâmetros hematológicos e bioquímicos de bezerros neonatos da raça Holandesa tratados com ferro suplementar

ABSTRACT: Iron deficiency in newborn calves is associated with the development of anemia, which favors the development of other infirmities such as pneumonia and diarrhea. The present study evaluated the effect of iron supplementation on erythrogram, serum levels of iron, ceruloplasmin and tranferrin, as well as potential toxicity of the protocol used by means of evaluation of urea, creatinine and hepatic enzyme activities. 40 newborn Holstein calves were allocated into 5 experimental groups comprising 8 calves each, which were subjected to the following treatment protocols: intramuscular administration of 5mL of sterile saline on the 5th day of age (control group G1), intramuscular administration of 5mL of 10% dextran iron in the following moments: on the 5th day of age (G2); on the 5th and in the 20th day of age (G3); on the 5th and 30th day of age (G4); on the 5th, 20th and 45th days of age (G5). Blood samples were taken until 8 hours after birth and with 5, 10, 20, 30, 60, and 90 days of age, and subjected to hemogram, evaluation of serum levels of iron, ceruloplasmin, transferrin, urea, creatinine, total and direct bilirrubin, and serum activities of aspartate aminotransferase (AST), alcaline phosphatase (ALP), and gamma-glutamyltransferase (GGT). Calves that received iron supplementation at any time presented less variation in the erythrocyte parameters, although calves in the control group did not develop anemia. Serum concentration of iron and acute phase protein ceruloplasmin and transferrin, which activities are related to iron metabolism, also increased, although not significantly. Serum levels of urea, creatinine, bilirubins and activities of AST, ALP, and GGT were not influenced by the administration protocols used in this experiment. The results of the experiment led to the conclusion that the supplementation with parenteral dextran iron in calves that receive diets other than exclusive milk does not bring sufficient advantages to be indicated, although more studies are necessary to evaluate the influence of iron supplementation on the outcome of infections in newborn calves, especially its influence on cost of treatment, time necessary for discharge and impact on its productive life.

RESUMO: A deficiência de ferro em bezerros neonatos está associada ao desenvolvimento de anemia, que favorece o aparecimento de outras enfermidades como pneumonia e diarreia. Avaliou-se o efeito da suplementação de ferro sobre o eritrograma, teores séricos de ferro, ceruloplasmina e transferrina, bem como o potencial para toxicidade do protocolo utilizado por meio da avaliação dos teores de ureia, creatinina e enzimas hepáticas. Para tal avaliação foram utilizados 40 bezerros neonatos da raça Holandesa, alocados em cinco grupos experimentais com oito animais em cada grupo, que foram submetidos aos seguintes protocolos: administração intramuscular de 5mL de solução fisiológica estéril no 5º dia de idade (grupo controle G1), e administração intramuscular de 5mL de ferro dextrano 10% nos seguintes momentos: no 5º dia de idade (G2); no 5o e no 20º dias de idade (G3); no 5o e no 30º dias de idade (G4) e no 5o, 20o e 45º dias de idade (G5). Foram coletadas amostras de sangue até 8 horas após o nascimento e aos 5, 10, 20, 30, 60 e 90 dias de idade para realização do eritrograma, avaliação dos teores séricos de ferro, ceruloplasmina, transferrina, ureia, creatinina, bilirrubina total e direta, e das atividades das enzimas aspartato aminotransferase (AST), fosfatase alcalina (ALP) e gamaglutamiltransferase (GGT). Os animais que receberam ferro suplementar apresentaram menor oscilação nos parâmetros eritrocitários, embora os animais do grupo controle não tenham desenvolvido anemia. Notou-se também aumento, embora não significativo, nos teores séricos de ferro e das proteínas de fase aguda ceruloplasmina e transferrina, cuja atividade está relacionada ao metabolismo desse mineral. Os teores séricos de ureia, creatinina, bilirrubina total e direta e as atividades das enzimas GGT, AST e ALP não foram influenciados pelos protocolos de administração de ferro suplementar. Os protocolos de tratamento empregados não ocasionaram hepatoxidade ou nefrotoxidade aos animais. Concluiu-se que a suplementação com ferro dextrano por via parenteral em bezerros que recebem outras dietas que não apenas leite não traz benefícios que justifiquem sua indicação, embora sejam necessários mais estudos que avaliem a influência da suplementação com ferro sobre o tempo necessário para a recuperação, custos com o tratamento e impacto sobre a vida produtiva dos animais na idade adulta.

Evaluation of Iron Deficiency Anemia in a Pediatric Clinic in the Dominican Republic.

BACKGROUND: Iron deficiency and iron deficiency anemia affect billions of people worldwide. Infants and young children are the most vulnerable. The Niños Primeros en Salud pediatric clinic aims to follow the American Academy of Pediatrics (AAP) recommendation to screen all children at 12 months of age, a vital period for development and the time of greatest risk. OBJECTIVES: To evaluate the clinic's performance screening for, diagnosing, and treating iron deficiency anemia; and to describe the prevalence and severity of anemia in infants and children attending a perirural clinic in the Dominican Republic. METHODS: A total of 293 charts were reviewed for hemoglobin tests performed between 9 and 15 months of age. If a hemoglobin screening was performed, then sociodemographic characteristics, medical history, and laboratory data were collected. If blood tests revealed anemia, then the presence or absence of documented anemia diagnosis as well as the presence or absence of documented provision of iron therapy were recorded. FINDINGS: Less than one-third (87, 29.7%) of patients had a documented hemoglobin test performed in this age range. Of these, 89.6% indicated anemia and nearly half (48.6%) revealed moderate anemia. One-third (34%) of hemoglobin results revealing anemia were not accompanied by a documented diagnosis. The vast majority (86.5%) of results indicated microcytosis, yet just more than half (50.8%) of anemic patients received iron therapy. CONCLUSIONS: Many children at the clinic were not screened for iron deficiency anemia during the period of highest risk. In the participants screened, iron deficiency anemia was underdiagnosed and often untreated. Anemia is a significant burden in this community-one demanding reliable screening and universal supplementation.

Prophylactic Iron Supplementation in Pregnancy: A Controversial Issue.

In our world today, iron deficiency (ID) is the most frequent nutritional deficiency and it is being considered as an epidemic public health crisis. Women of reproductive age and infants are at particular risk of ID, especially in underdeveloped countries. During pregnancy, iron deficiency anemia is a specific risk factor associated with negative maternal and perinatal outcomes. Many countries have iron supplementation (IS) programs-as recommended by the World Health Organization-during pregnancy; however, IS clinical benefits and risks are unclear. This review aims to discuss the threats and benefits of routine IS on maternal and infant outcomes.

Patterns of compliance with prenatal iron supplementation among Peruvian women.

Prenatal iron supplementation is recommended to control anaemia during pregnancy. Low compliance and side effects have been claimed as the main obstacles for adequate impact of the supplementation. As part of a double-blind supplementation study carried out in a hospital located in a shantytown in Lima, Peru, we monitored compliance throughout pregnancy and evaluated factors associated with variation in compliance over time. Overall, 985 pregnant women were enrolled in a supplementation study that was administered through their prenatal care from 10 to 24 weeks of gestation until 4 weeks postpartum. They received 60 mg iron and 250 µg folate with or without 15 mg zinc. Women had monthly care visits and were also visited weekly to query regarding compliance, overall health status, and potential positive and negative effects of supplement consumption. Median compliance was 79% (inter-quartile range: 65-89%) over pregnancy, and the median number of tablets consumed was 106 (81-133). Primpara had lower average compliance; positive health reports were associated with greater compliance, and negative reports were associated with lower compliance. There was no difference by type of supplement. Women with low initial compliance did achieve high compliance by the end of pregnancy, and women who reported forgetting to take the supplements did have lower compliance. Compliance was positively associated with haemoglobin concentration at the end of pregnancy. In conclusion, women comply highly with prenatal supplementation within a prenatal care model in which supplies are maintained and reinforcing messages are provided.

Eficácia do programa nacional de suplementação de ferro no controle de anemia em lactentes assistidos em centros de educaçao infantil / Efficacy of the national program of Iron supplementation in the anaemia control in infants assisted by child education centers

INTRODUÇÃO: a deficiência de ferro ocorre em proporção endêmica entre a população infantil e constitui um dos fatores causais do inadequado desenvolvimento cognitivo, social, motor e de redução da capacidade de aprendizado, colocando os lactentes como grupo prioritário para programas de intervenção nutricional visando o controle da deficiência de ferro. Assim, em 2005 o Ministério da Saúde implantou o Programa Nacional de Suplemento de Ferro (PNSF) disponível para o universo de crianças de 6-24 meses atendidas em Unidades Básicas de Saúde. OBJETIVO: verificar a prevalência de anemia e a eficácia da suplementação profilática com o sulfato ferroso fornecido pelo Programa Nacional de Suplementação de Ferro (PNSF) do Ministério da Saúde do Brasil. MÉTODO: trata-se de estudo prospectivo de intervenção, que foi desenvolvido no município de Guarujá-SP no universo de crianças de 6-24 meses frequentadoras de creches públicas cujos responsáveis autorizaram sua participação. O suplemento de ferro foi oferecido de acordo com as normas do PNSF e o diagnóstico de anemia foi realizado antes e seis meses após o período de intervenção. Como critério de anemia utilizou-se os padrões da Organização Mundial da Saúde que define anemia moderada para valores de hemoglobina (Hb) entre 11,0 e 9,5gHb/dL e anemia grave para valores inferiores a 9,5gHb/dL. RESULTADOS: do total das 136 crianças menores de 2 anos, 81% participou do estudo. Não foi encontrada diferença estatisticamente significativa entre a concentração média de Hb antes e após o período de intervenção (p = 0,684). A média inicial de Hb foi 11,6g/dL(D.p. = 1,82) e a final 11,5 g/dL (d.p.1,31). Embora apenas 11 dos 49 anêmicos atingissem os valores normais, 33 deles apresentaram um aumento na concentração de Hb. CONCLUSÃO: houve um aumento na concentração de hemoglobina entre as crianças com anemia grave. Não houve mudança na situação das crianças com anemia moderada. A suplementação com sulfato ferroso ...

INTRODUCTION: iron deficiency occurs in endemic proportion among children and is one of the causal factors of inappropriate cognitive, social, motor and reduced learning ability, putting infants as a priority group for nutritional intervention programs aiming to control iron deficiency. Thus, in 2005 the Ministry of Health established the National Program of Iron Supplementation (PNSF) available for the universe of children of 6-24 months old attended in Basic Health Units. OBJECTIVE: to estimate the prevalence of anaemia and analyse the efficacy of profilatic supplementation with ferrous sufate. METHODS: a prospective follow-up study intervention that was developed in the city of Guarujá - SP, Brazil in the universe of children between 6-24 months old attended in the Public Basic Health Units whose parents authorized their participation. The supplement was offered in accordance with the standards of PNSF and diagnosis of anaemia was performed before and 6 months after the intervention period. As a criterion for anaemia was used the standards of the World Health Organization that defines moderate anaemia to haemoglobin (Hb) between 11.0 and 9,5gHb/dL and severe anaemia to below 9,5gHb/dL. RESULTS: a total of 136 children under two years, (81% of total) participated in the study. No statistically significant difference was found between the mean Hb concentration before and after the intervention period (p=0.684). The initial mean Hb was 11,6g/dL (SD=1.82) and the final 11.5g/dL (SD=1.31). Although only 11 of the 49 anemic reached normal values, 33 of them showed an increase in Hb concentration. CONCLUSION: there was an increase in Hb concentration among children with severe anaemia. There was no change in the situation of children with moderate anaemia. Supplementation with ferrous sulphate...

Eficácia do programa nacional de suplementação de ferro no controle de anemia em lactentes assistidos em centros de educaçao infantil / Efficacy of the national program of Iron supplementation in the anaemia control in infants assisted by child education centers

INTRODUÇÃO: a deficiência de ferro ocorre em proporção endêmica entre a população infantil e constitui um dos fatores causais do inadequado desenvolvimento cognitivo, social, motor e de redução da capacidade de aprendizado, colocando os lactentes como grupo prioritário para programas de intervenção nutricional visando o controle da deficiência de ferro. Assim, em 2005 o Ministério da Saúde implantou o Programa Nacional de Suplemento de Ferro (PNSF) disponível para o universo de crianças de 6-24 meses atendidas em Unidades Básicas de Saúde. OBJETIVO: verificar a prevalência de anemia e a eficácia da suplementação profilática com o sulfato ferroso fornecido pelo Programa Nacional de Suplementação de Ferro (PNSF) do Ministério da Saúde do Brasil. MÉTODO: trata-se de estudo prospectivo de intervenção, que foi desenvolvido no município de Guarujá-SP no universo de crianças de 6-24 meses frequentadoras de creches públicas cujos responsáveis autorizaram sua participação. O suplemento de ferro foi oferecido de acordo com as normas do PNSF e o diagnóstico de anemia foi realizado antes e seis meses após o período de intervenção. Como critério de anemia utilizou-se os padrões da Organização Mundial da Saúde que define anemia moderada para valores de hemoglobina (Hb) entre 11,0 e 9,5gHb/dL e anemia grave para valores inferiores a 9,5gHb/dL. RESULTADOS: do total das 136 crianças menores de 2 anos, 81% participou do estudo. Não foi encontrada diferença estatisticamente significativa entre a concentração média de Hb antes e após o período de intervenção (p = 0,684). A média inicial de Hb foi 11,6g/dL(D.p. = 1,82) e a final 11,5 g/dL (d.p.1,31). Embora apenas 11 dos 49 anêmicos atingissem os valores normais, 33 deles apresentaram um aumento na concentração de Hb. CONCLUSÃO: houve um aumento na concentração de hemoglobina entre as crianças com anemia grave. Não houve mudança na situação das crianças com anemia moderada. A suplementação com sulfato ferroso ...(AU)

INTRODUCTION: iron deficiency occurs in endemic proportion among children and is one of the causal factors of inappropriate cognitive, social, motor and reduced learning ability, putting infants as a priority group for nutritional intervention programs aiming to control iron deficiency. Thus, in 2005 the Ministry of Health established the National Program of Iron Supplementation (PNSF) available for the universe of children of 6-24 months old attended in Basic Health Units. OBJECTIVE: to estimate the prevalence of anaemia and analyse the efficacy of profilatic supplementation with ferrous sufate. METHODS: a prospective follow-up study intervention that was developed in the city of Guarujá - SP, Brazil in the universe of children between 6-24 months old attended in the Public Basic Health Units whose parents authorized their participation. The supplement was offered in accordance with the standards of PNSF and diagnosis of anaemia was performed before and 6 months after the intervention period. As a criterion for anaemia was used the standards of the World Health Organization that defines moderate anaemia to haemoglobin (Hb) between 11.0 and 9,5gHb/dL and severe anaemia to below 9,5gHb/dL. RESULTS: a total of 136 children under two years, (81% of total) participated in the study. No statistically significant difference was found between the mean Hb concentration before and after the intervention period (p=0.684). The initial mean Hb was 11,6g/dL (SD=1.82) and the final 11.5g/dL (SD=1.31). Although only 11 of the 49 anemic reached normal values, 33 of them showed an increase in Hb concentration. CONCLUSION: there was an increase in Hb concentration among children with severe anaemia. There was no change in the situation of children with moderate anaemia. Supplementation with ferrous sulphate...(AU)

Iron supplementation among pregnant women: results from a population-based survey study / Suplementacao com sulfato ferroso entre gestantes: resultados de estudo transversal de base populacional

Objectives: To measure the prevalence and risk factors associated with iron supplementation among pregnant women in the municipality of Rio Grande, Southern Brazil. Methods: All mothers living in this municipality who had children in 2007 were surveyed for demographic, socioeconomic and health care received during pregnancy and childbirth. The statistical analysis consisted of Poisson regression with robust adjustment of variance, and the measure of effect was prevalence ratio (PR). Results: Among the 2,557 mothers interviewed (99% of total), 59% were supplemented with iron during pregnancy period. After adjusting for various confounding factors, a higher PR to iron supplementation was observed among teenagers, women with black skin color, primigravidae, who had six or more antenatal visits, who performed prenatal care in public sector and received vitamin during pregnancy. Conclusion: There is a clear need to increase the iron supplementation coverage of all pregnant women, especially among those currently considered with low gestational risk. .

Objetivos: Medir a prevalência e identificar fatores associados à suplementação com sulfato ferroso entre gestantes residentes no município de Rio Grande, RS. Métodos: Mães residentes neste município que tiveram filho em 2007 foram investigadas quanto a características demográficas, nível socioeconômico e assistência recebida durante a gestação e o parto. Na análise estatística, foi utilizada regressão de Poisson com ajuste robusto da variância, e a medida de efeito foi razão de prevalências (RP). Resultados: Dentre as 2.557 mães entrevistadas (99% do total), 59% foram suplementadas com sulfato ferroso durante a gestação. Após análise ajustando para diversos fatores de confusão, mostraram maior RP à suplementação com sulfato ferroso as gestantes adolescentes, de cor da pele preta, primigestas, que realizaram seis ou mais consultas de pré-natal, que fizeram essas consultas na rede pública e que receberam complexo vitamínico durante a gestação. Conclusão: Há evidente necessidade de aumentar a cobertura da suplementação com sulfato ferroso entre todas as gestantes, sobretudo entre aquelas tidas, em geral, como de menor risco gestacional. .

Anemia, insuficiência cardíaca e manejo clínico baseado em evidências / Anemia, heart failure and evidence-based clinical management

A anemia é uma comorbidade prevalente e marcadora de pior prognóstico em pacientes com insuficiência cardíaca (IC). Sua relevância clínica, bem como a fisiopatologia e abordagem terapêutica nesses pacientes são temas de destaque na literatura especializada. Nessa revisão são descritos os conceitos atuais sobre a fisiopatologia da anemia na IC, os critérios diagnósticos e as indicações da suplementação de ferro, ao mesmo tempo em que são analisados criticamente os principais estudos que ofereceram evidências sobre os benefícios dessa suplementação. São abordados os quatro componentes principais da anemia: doença crônica, dilucional, "renal" e disabsortiva. Nos pacientes com IC, os critérios para o diagnóstico são os mesmos utilizados na população geral: níveis de ferritina sérica inferiores a 30 mcg/L em pacientes não nefropatas e menores que 100 mcg/L ou ferritina sérica entre 100-299 mcg/L com saturação de transferrina menor que 20% em pacientes com doença renal crônica. Finalmente, são discutidas as possibilidades terapêuticas da anemia nessa população específica de pacientes.

Anemia is a prevalent comorbidity and marker of a poorer prognosis in patients with heart failure (HF). Its clinical relevance, as well as its pathophysiology and the clinical management of these patients are important subjects in the specialized literature. In the present review, we describe the current concepts on the pathophysiology of anemia in HF, its diagnostic criteria, and the recommendations for iron supplementation. Also, we make a critical analysis of the major studies showing evidences on the benefits of this supplementation. The four main components of anemia are addressed: chronic disease, dilutional, "renal" and malabsorption. In patients with HF, the diagnostic criteria are the same as those used in the general population: serum ferritin levels lower than 30 mcg/L in patients without kidney diseases and lower than 100 mcg/L or serum ferritin levels between 100-299 mcg/L with transferring saturation lower than 20% in patients with chronic kidney diseases. Finally, the therapeutic possibilities for anemia in this specific patient population are discussed.

Prevalencia y etiología de la anemia en Panamá

Desde 1998, el Ministerio de Salud de Panamá desarrolla un programa nacional de suplementación con hierro de forma preventiva en grupos de riesgo. El objetivo del estudio fue determinar las prevalencia total de anemia y de anemia ferropriva en una muestra representativa nacional de lactantes, preescolares, escolares y embarazadas, pertenecientes a distritos prioritarios y escolares de distritos prioritarios y no prioritarios. Se determinaron Hb, VCM, zinc-protoporfirina, ferritina sérica, proteína C reactiva (PCR) y solubilidad de hemoglobina. La Anemia ferropriva se definió como anemia con dos o más indicadores de nutrición de hierro alterados. Dado que un alto porcentaje de los sujetos presentó una PCR elevada, se utilizó un punto de corte para la ferritina de 50 ug/l. La prevalencia de anemia fue 66% en niños de 9 a 15 meses de edad, 41.8% en niños de 16 a 59 meses, 6.3% en escolares y 23.4% en embarazadas, mientras la prevalencia de anemia ferropriva fue 48.8%, 20.3%, 2.5% y 9.4%, respectivamente en embarazadas. La portación de drepanocitosis fue <2.5%. Conclusión: La anemia ferropriva tiene una alta prevalencia y es la principal causa de anemia en lactantes y preescolares. En embarazadas y escolares los procesos infecciosos constituirían la principal etiología de la anemia. La baja prevalencia de anemia ferropriva en escolares y embarazada es atribuible a la efectividad de la suplementación con hierro. Se requiere de la mejoría de la efectividad del programa nacional de suplementación y medidas destinadas a disminuir la incidencia de infecciones para reducir la prevalencia global de anemia en la población panameña.

From 1998, the Ministry of Health of Panama has a national program of prophylactic iron supplementation of risk groups. The objective of the study was to determine the prevalence anemia and of iron deficiency anemia (IDA) in a national representative sample of infants, preschool children and pregnant women from high-priority districts and scholar children from high-priority and not high-priority districts. Hb, MCV, zinc-protoporphyrin, serum ferritin, C reactive protein (CRP) and hemoglobin solubility were measured. IDA was defined as anemia plus two or more abnormal iron nutrition status. Since most of the subjects presented a high CRP, a 50 ug/l cutoff was used for serum ferritin. The prevalence of anemia was 66% in children from 9 to 15 months of age, 41.8% in children of 16 to 59 months, 6.3% in school children and 23.4% in pregnant women, whereas IDA prevalence was 48.8%, 20.3%, 2.5% and 9.4%, respectively. Sickle-cell trait was found in <2.5 % of the subjects. Conclusion, IDA was highly prevalent and the main cause of anemia in infants and preschool children. Infectious processes would constitute the main etiology of anemia in school children and pregnant women. The low prevalence of IDA in scholars and pregnant women is attributable to the effectiveness of the iron supplementation. The improvement of the effectiveness of the national iron supplementation program together with measures to diminish the incidence of infections are required to reduce the prevalence of anemia in the Panamanian population.