Associations between serum ferritin, iron, and liver transaminases in adolescents: a large cross-sectional study / Asociaciones entre la ferritina sérica, el hierro y las transaminasas hepáticas en adolescentes: un amplio estudio transversal

Introduction: few previous studies suggest that serum iron status may be associated with liver function, but the relevant evidence remainslimited, especially in adolescents.Objective: we aimed to investigate the association between serum ferritin, iron, and liver transaminases in adolescents.Methods: a cross-sectional study including 3,404 adolescents aged 10-19 was performed based on the National Health and Nutrition ExaminationSurvey. Weighted multivariate regression, subgroup analysis, and sensitivity analysis were used.Results: a total of 3,404 adolescents were eventually included. Serum ferritin and iron were positively correlated to alanine aminotransferase(ALT) and aspartate aminotransferase (AST). The association between serum ferritin and ALT remained positive in all genders and races, but onlyremained positive in girls and several races between serum ferritin and AST. The positive correlations kept present among girls between serumiron and ALT, and also kept present among girls and non-Hispanic whites between serum iron and AST. Additionally, serum ferritin and iron werealso positively correlated to elevated ALT and elevated AST using binary logistic regression analysis. After excluding the subjects with serumferritin levels above the upper limit of normal, the main results remained the same basically.Conclusion: the present results add novel evidences about the associations between serum ferritin, iron, and liver transaminases, which requiresmore confirmatory studies. (AU)

Introducción: pocos estudios previos sugieren que el estado del hierro sérico pueda estar asociado con la función hepática, pero la evidenciarelevante sigue siendo limitada, especialmente en adolescentes.Objetivo: nuestro objetivo fue investigar la asociación entre la ferritina sérica, el hierro y las transaminasas hepáticas en adolescentes.Métodos: se realizó un estudio transversal que incluyó a 3,404 adolescentes de diez a 19 años de edad, basado en la Encuesta Nacional deExamen de Salud y Nutrición. Se utilizaron la regresión multivariada ponderada, el análisis de subgrupos y el análisis de sensibilidad.Resultados: finalmente, se incluyó un total de 3.404 adolescentes. La ferritina sérica y el hierro se correlacionaron positivamente con la alaninaaminotransferasa (ALT) y la aspartato aminotransferasa (AST). La asociación entre ferritina sérica y ALT se mantuvo positiva en todos los génerosy razas, pero solo se mantuvo positiva en niñas y en varias razas entre ferritina sérica y AST. Las correlaciones positivas siguieron presentesen las niñas entre el hierro sérico y la ALT, y también en las niñas y personas blancas no hispanas entre el hierro sérico y la AST. Además, laferritina sérica y el hierro también se correlacionaron positivamente con ALT elevada y AST elevada mediante análisis de regresión logísticabinaria. Después de excluir a los sujetos con niveles de ferritina sérica por encima del límite superior de la normalidad, los resultados principalesse mantuvieron básicamente iguales.Conclusión: los presentes resultados agregan evidencias novedosas sobre las asociaciones entre la ferritina sérica, el hierro y las transaminasashepáticas, lo que requiere más estudios confirmatorios. (AU)

Hemangioma capilar duodenal como causa atípica de ferropenia. Caso clínico / Duodenal capillary hemangioma as an atypical cause of iron deficiency. Case report

Los hemangiomas son tumores gastrointestinales de naturaleza vascular y benignos. Son infrecuentes, se localizan en la submucosa, y su presentación varía desde casos asintomáticos hasta casos con obstrucción intestinal, anemia o ferropenia. Su diagnóstico inicial suele ser endoscópico a pesar de no presentar características patognomónicas. Tradicionalmente su tratamiento ha sido quirúrgico, si bien en la actualidad es posible su resección endoscópica. Presentamos un caso de ferropenia resuelta tras resección endoscópica de un hemangioma capilar duodenal

Hemangiomas are benign vascular gastrointestinal tumours. They are infrequent, located in the submucosa, and can be asymptomatic or cause intestinal obstruction, anaemia or ferropenia. Their initial diagnosis is usually endoscopic despite the absence of pathognomonic features. Traditionally their treatment has been surgical although endoscopic resection is now possible. We present a case of ferropenia resolved after endoscopic resection of a capillary duodenal hemangioma

Evaluación y tratamiento del déficit de hierro con o sin anemia en rehabilitación multimodal de cirugía bariátrica / Evaluation and treatment of iron deficiency, with or without anemia, in enhanced recovery after bariatric surgery

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Qualidade nutricional de dietas e estado nutricional de vegetarianos de municípios do centro oeste paulista / Nutritional quality of diets and nutritional status of vegetarians from cities of the midwest region of São Paulo / Calidade nutricional de las dietas y estado nutricional de los vegetarianos de municipios del oeste de São Paulo

Introdução: A Sociedade Vegetariana Brasileira considera vegetariano aquele que exclui de sua alimentação todos os tipos de carne, aves, peixes e seus derivados, podendo ou não utilizar laticínios ou ovos. Vegetarianismo inclui o veganismo, prática de não utilizar produtos oriundos do reino animal para quaisquer fins. Diversas razões justificam o crescimento dessas dietas na atualidade - questões ligadas aos direitos dos animais, à ética, ao meio ambiente, à religião, entre outras. Objetivos: Identificar os riscos e benefícios associados à restrição alimentar presente na dieta vegetariana através das quantidades diárias de proteínas, vitamina B12, ferro e cálcio; determinar o índice de massa corporal dos voluntários, sua frequência alimentar, estado nutricional, tempo de prática da dieta, acompanhamento nutricional, suplementação e motivos e benefícios associados. Material e Método: Trata-se de um estudo transversal descritivo quali-quantitativo realizado por meio da aplicação de questionários. Resultados: As deficiências nutricionais predominantes foram as de vitamina B12 e cálcio, especialmente nos adeptos do vegetarianismo estrito. Além disso, uma tendência ao sobrepeso foi observada na população estudada, estando relacionada ao maior consumo de alimentos industrializados e ultraprocessados. Conclusão: Recomenda-se atenção especial a alimentos contendo proteínas, vitamina B12, ferro e cálcio no planejamento da alimentação dos adeptos ao vegetarianismo, sobretudo os adeptos ao vegetarianismo estrito.(AU)

Introduction: The Brazilian Vegetarian Society considers vegetarian who excludes all types of meat, poultry, fish and their derivatives from their diet, whether or not they can use dairy products or eggs. Vegetarianism includes veganism, the practice of not using products from the animal kingdom for any purpose. Several reasons justify the growth of these diets today - issues related to animal rights, ethics, the environment, religion, among others. Objectives: To identify the risks and benefits associated with the dietary restriction present in the vegetarian diet through the daily amounts of proteins, vitamin B12, iron and calcium; to determine the volunteers' body mass index, their food frequency, nutritional status, time on the diet, nutritional monitoring, supplementation and associated reasons and benefits. Material and Method: This is a cross-sectional qualitative and quantitative study carried out through the application of questionnaires. Results: The predominant nutritional deficiencies were those of vitamin B12 and calcium, especially in adherents of strict vegetarianism. In addition, a tendency to overweight was observed in the studied population, being related to the higher consumption of processed and ultra-processed foods. Conclusion: Special attention is recommended to foods containing proteins, vitamin B12, iron and calcium when planning food for those who adhere to vegetarianism, especially those who adhere to strict vegetarianism.(AU)

Introducción: La Sociedad Vegetariana Brasileña considera a los vegetarianos que excluyen todos los tipos de carne, pollo, pescado y sus derivados de su dieta, ya sea que puedan o no usar productos lácteos o huevos. El vegetarianismo incluye el veganismo, la práctica de no usar productos del reino animal para ningún propósito. Varias razones justifican el crecimiento de estas dietas hoy en día: cuestiones relacionadas con los derechos de los animales, la ética, el medio ambiente, la religión, entre otros. Objetivos: Identificar los riesgos y beneficios asociados con la restricción dietética presente en la dieta vegetariana a través de las cantidades diarias de proteínas, vitamina B12, hierro y calcio; determinar el indice de masa corporal de los voluntarios, su frecuencia de alimentos, estado nutricional, tiempo en la dieta, seguimiento con un nutricionista, suplementos y razones y beneficios asociados. Material y Método: Estudio transversal cualitativo y cuantitativo realizado mediante la aplicación de cuestionarios. Resultados: Las deficiencias nutricionales predominantes fueron las de vitamina B12 y calcio, especialmente en adherentes del vegetarianismo estricto. Además, se observó una tendencia al sobrepeso en la población estudiada, relacionada con el mayor consumo de alimentos procesados y ultraprocesados. Conclusión: Se recomienda prestar especial atención a los alimentos que contienen proteínas, vitamina B12, hierro y calcio al planificar los alimentos para aquellos que se adhieren al vegetarianismo, especialmente aquellos que se adhieren al vegetarianismo estricto.(AU)

Hipofosfatemia severa por hierro intravenoso en paciente intervenida de bypass gástrico / Intravenous iron induced severe hypophophatemia in a gastric bypass patient

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Is there a role for iron supplementation in critically ill patients? / Suplementos de hierro: ¿son útiles en el paciente crítico?

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Identificación de &-talasemia en anemias microcíticas hipocrómicas refractarias al tratamiento con hierro en Nicaragua / Identification of &-thalassemia in hypochromic microcytic anemias refractory to iron treatment in Nicaragua

Resumen Justificación y objetivo: gran parte de los casos descritos de anemias microcíticas-hipocrómicas corresponden a anemias ferropénicas y síndromes talasémicos. El diagnóstico diferencial se complementa con pruebas de laboratorio como el hierro sérico, ferritina, entre otras; sin embargo, estas son de baja disponibilidad en países en vías de desarrollo. En Nicaragua, el diagnóstico de estas patologías se basa en el historial clínico y análisis hematológicos de rutina. El objetivo de este trabajo fue la implementación de la técnica de cuantificación de hemoglobina A2 en el diagnóstico clínico de β-talasemia. Métodos: se realizó un estudio transversal con 30 pacientes que mostraban microcitosis e hipocromía después de 3 meses de tratamiento con sales de hierro. Se realizó electroforesis de hemoglobina y se utilizó el kit de la casa comercial Beta-Thal HbA2 Quik Column para cuantificar la hemoglobina A2 en cada paciente. El análisis estadístico utilizado fue la prueba de t de student. Se consideraron significativas las diferencias a p<0,05. Esta investigación respetó los principios éticos que conciernen. Se contó con la aprobación del Comité de Ética Institucional, UNAN-Managua. Los participantes dieron su consentimiento informado. Resultados: al aplicar el método para cuantificación de hemoglobina A2, se obtuvo que el 67 % de las muestras presentaron una concentración de hemoglobina A2 mayor al valor de referencia establecido (3,3 %), siendo pacientes diagnosticados para β-talasemia menor. El 33 % restante presentó valores normales de hemoglobina A2 con microcitosis e hipocromía. Se encontraron diferencias estadísticamente significativas entre las medias de glóbulos rojos, volumen corpuscular medio, hemoglobina corpuscular media y hemoglobina A2, entre ambos grupos. Conclusión: el diagnóstico diferencial de anemias microcíticas hipocrómicas refractarias al tratamiento con hierro, se realiza inicialmente por el historial clínico del paciente, pero es necesario contar con pruebas diagnósticas como la cuantificación de hemoglobina A2 que permitan identificar las diversas patologías que cursan con microcitosis e hipocromía.

Abstract Justification and objective: much of the described cases of microcytic-hypochromic anemias are ferropenic anemias and Thalassemia syndromes. The differential diagnosis is complemented by laboratory tests as serum iron, ferritin, among others; However, these are of low availability in developing countries. In Nicaragua, the diagnosis of these diseases is based on clinical history and routine blood analysis. The objective of this work was to implement a technique for quantification of hemoglobin A2 in the clinical diagnosis of β-Thalassemia. Methods: We conducted a cross-sectional study with 30 patients showing hypochromia and microcytosis after 3 months of treatment with iron salts. Hemoglobin electrophoresis was performed, a kit from Beta-Thal HbA2 Quik Column was used to quantify the hemoglobin A2 in each patient. The statistical analysis used was the student's t test. The differences were considered significant at p < 0.05. This research respected ethical principles that concern. It had the approval of the committee of ethics institutional, UNAN-Managua and the participants gave their informed consent. Results: when applying the method for quantification of hemoglobin A2, 67% of samples presented a concentration of hemoglobin A2 greater than the reference value set at 3.3%, these patients were diagnosed with β-Thalassemia minor. The remaining 33% presented normal values of hemoglobin A2 with hypochromia and microcytosis. Statistically significant differences between the averages of red blood cells, mean corpuscular volume, mean corpuscular hemoglobin and hemoglobin A2 between the two groups was observed. Conclusion: The differential diagnosis of microcytic hypochromic anemias refractory to treatment with iron, is initially performed by the clinical history of the patient, but it is necessary to have diagnostic tests such as the quantification of hemoglobin A2, which allow the identification of patients with β-Thalassemia minor within this group. In our study 67% of the studied samples were identified as β-Thalassemia minor.

¿Existe alguna asociación entre la concentración de vitamina D y la ferropenia en los niños? / Is there an association between vitamin D level and iron deficiency in children?

Introducción.La vitamina D afecta la eritropoyesis.Objetivo: evaluar, en niños de 6 meses a 5 años, la asociación entre concentraciones de 25-hidroxi vitamina D (25-OHD) en la madre/niño, ferropenia y anemia ferropénica (AF). Población y métodos. Se incluyeron los niños que asistieron a la consulta entre septiembre de 2014 y enero de 2016. Se excluyeron aquellos con infección aguda/crónica, desnutrición, enfermedades crónicas y prematuros. Se realizó hemograma, hierro sérico, capacidad fijación del hierro, ferritina y 25-OHD. Se investigó suplemento con hierro y vitamina D durante lactancia y embarazo.Resultados. Se incluyeron 117 niños: 67 tenían ferropenia/AF [Grupo 1, edad (años): 2,05 ± 1,24 (0,5-5)] y 50 niños sanos [Grupo 2, edad (años): 1,87 ± 1,12 (0,58-5)]. Más niños y madres tuvieron deficiencia de vitamina D en Grupo 1 que en Grupo 2 (niños, 49,3 % vs 20 %, p = 0,002, y madres: 94 % vs 64 %; p= < 0,001, respectivamente). Hubo correlación positiva entre la hemoglobina en niños y la 25-OHD en madres/niños. Factores independientes de riesgo de AF fueron más tiempo de lactancia (OR: 0,35; IC 95 % [0,155-0,789]; p = 0,011), más breve suplementación con hierro durante la lactancia (OR: 1,69; IC 95 % [1,148-2,508]; p = 0,008) y embarazo (OR: 1,39; IC 95 % [1,070-1,820]; p = 0,014) y concentraciones < 25-OHD en madres (OR: 1,16; IC del 95 % [1,034-1,292]; p = 0,011). Conclusiones. La deficiencia de vitamina D en madres/niños está asociada con ferropenia/AFen los niños.

Introduction. Vitamin D (VitD) affects the erythropoiesis. The aim of this study was to evaluate the association between maternal/child 25-OH VitD (25-OHD) levels and iron deficiency (ID) and anemia (IDA) in children aged 6 months-5 years. Population and methods. Between September 2014 and January 2016 children who were admitted to outpatient clinic were included to study. We excluded the children with acute or chronic infection, malnutrition, chronic disease and preterm birth history. Complete blood count, serum iron, total iron binding capacity, ferritin, 25-OHD levels were examined from children and their mothers. Iron and VitD supplementation during infancy and pregnancy and breastfeeding history were questioned.Results. The study included totally 117 children. There were 67 children with ID/IDA [Group 1, mean age (years):2.05±1.24 (0.5-5)] and 50 normal children [Group 2, mean age (years): 1.87±1.12 (0.58-5)]. There were more VitD deficient children and mothers in Group 1 than in Group 2 (respectively, children 49.3 % vs. 20 % p=0.002; mothers 94 % vs.64 %, p=<0.001). There was a positive correlation between hemoglobin levels of children and maternal/child 25-OHD. The independent risk factors for IDA in children were longer exclusively breastfeeding time (odds ratio [OR], 0.35; 95 % confidence interval [CI], 0.155-0.789; p=0.011), shorter duration of regular iron supplementation during infancy and pregnancy (infancy: OR,1.69; 95 % CI 1.148-2.508; p=0.008. pregnancy: OR,1.39; 95 % CI,1.070-1.820; p=0.014) and lower maternal 25-OHD level (OR,1.16; 95 % CI,1.034-1.292; p=0.011). Conclusions. Maternal/child VitD deficiency is associated with ID/IDA in children aged 6 months-5 years.

Anemia en la enfermedad renal crónica: protocolo de estudio, manejo y derivación a Nefrología / Anemia of chronic kidney disease: Protocol of study, management and referral to Nephrology

El objetivo del protocolo es conocer qué estudios deben solicitarse ante una anemia en un paciente con enfermedad renal crónica, el diagnóstico diferencial de la anemia renal, conocer y corregir otras anemias carenciales y los criterios de remisión del paciente anémico con enfermedad renal crónica a Nefrología u otras especialidades (AU)

The objective of this protocol is to know which test are needed to study an anaemia in a patient with chronic kidney disease, the differential diagnosis of renal anaemia, to know and correct other deficiency anaemias, and the criteria for referral to Nephrology or other specialties of the anaemic patient with chronic kidney disease (AU)

Insuficiencia cardíaca en la enfermedad renal y déficit de hierro: importancia de la ferroterapia / Heart failure in patients with kidney disease and iron deficiency; the role of iron therapy

La enfermedad renal crónica y la anemia son frecuentes en la insuficiencia cardíaca (IC) y su presencia se asocia con un peor pronóstico en estos pacientes. La ferropenia es frecuente en pacientes con IC y aumenta el riesgo de morbimortalidad, independientemente de la presencia o no de anemia. Mientras el tratamiento de la anemia con agentes estimuladores de la eritropoyesis en pacientes con IC no ha demostrado un beneficio sobre la morbimortalidad, el tratamiento con hierro intravenoso (iv) en pacientes con IC y fracción de eyección disminuida y déficit de hierro se asocia con una mejoría clínica. Además, en un análisis post hoc de un ensayo clínico, la ferroterapia mejoró la función renal en pacientes con IC y ferropenia. De hecho, las recientes guías clínicas sobre IC de la Sociedad Europea de Cardiología señalan que se debe considerar el tratamiento con hierro carboximaltosa iv en pacientes sintomáticos con fracción de eyección disminuida y déficit de hierro a fin de mejorar los síntomas, la capacidad de ejercicio y la calidad de vida. El hierro juega un papel importante en el almacenamiento de oxígeno (mioglobina) y en el metabolismo energético, y existen bases fisiopatológicas que explican el efecto beneficioso de la ferroterapia iv en pacientes con IC. Todo ello es revisado en el presente artículo (AU)

Chronic kidney disease and anaemia are common in heart failure (HF) and are associated with a worse prognosis in these patients. Iron deficiency is also common in patients with HF and increases the risk of morbidity and mortality, regardless of the presence or absence of anaemia. While the treatment of anaemia with erythropoiesis-stimulating agents in patients with HF have failed to show a benefit in terms of morbidity and mortality, treatment with IV iron in patients with HF and reduced ejection fraction and iron deficiency is associated with clinical improvement. In a posthoc analysis of a clinical trial, iron therapy improved kidney function in patients with HF and iron deficiency. In fact, the European Society of Cardiology's recent clinical guidelines on HF suggest that in symptomatic patients with reduced ejection fraction and iron deficiency, treatment with IV ferric carboxymaltose should be considered to improve symptoms, the ability to exercise and quality of life. Iron plays a key role in oxygen storage (myoglobin) and in energy metabolism, and there are pathophysiological bases that explain the beneficial effect of IV iron therapy in patients with HF. All these aspects are reviewed in this article (AU)

Potential of the physiological response of pea plants (Pisum sativum L. ) to iron deficiency (direct or lime- induced) / Potencial da resposta fisiológica das plantas de ervilha (Pisum sativum L. ) à deficiência de ferro (direta ou induzida pelo calcário)

Pea (Pisum sativum L.) is an important food crop in Tunisia, where calcareous soils represents the major limiting factor for agriculture production. In the present study a greenhouse experiment was conducted to assess the effects of direct and bicarbonate- induced iron deficiency on plant growth, chlorophyll fluorescence, photosynthesis, spad index and iron nutrition in two Tunisian pea genotypes (Pisum sativum L.). Plants were grown hydroponically and iron deficiency was induced for 3 weeks. Iron deficiency decreased all the above physiological parameters. The direct Fe deficiency is more drastic than bicarbonate- induced Fe deficiency. A close relationship between plant growth, photosynthesis and SPAD index was observed. Fe use efficiency for plant growth and Fe use efficiency for photosynthesis discriminates clearly the studied genotypes and seems to be the main reason of the tolerance of Kelvedon, as compared to Lincoln.

A ervilha (Pisum sativum L.) é uma cultura alimentar importante na Tunísia, onde os solos calcários representam o principal fator limitante para a produção agrícola. No presente estudo, foi conduzido um experimento em estufa para avaliar os efeitos da deficiência de ferro direta e induzida por bicarbonato sobre o crescimento de plantas, a fluorescência da clorofila, a fotossíntese, o índice SPAD e a nutrição de ferro em dois genótipos de ervilha da Tunísia (Pisum sativum L.). As plantas foram cultivadas hidroponicamente e a deficiência de ferro foi induzida durante 3 semanas. A deficiência de ferro diminuiu todos os parâmetros fisiológicos acima. A deficiência de Fe direta é mais drástica do que a deficiência de Fe induzida por bicarbonato. Observou-se uma estreita relação entre o crescimento das plantas, a fotossíntese e o índice SPAD. A eficiência de uso de Fe para o crescimento de plantas e a eficiência de uso de Fe para a fotossíntese discriminam claramente os genótipos estudados e parecem ser a razão principal da tolerância de Kelvedon, em comparação com a de Lincoln.

Relationships between umbilical vein and mother iron status / Las relaciones entre la vena umbilical y el estado de hierro en la madre

Introduction: Iron is an essential micronutrient in the growing fetus. Objective: The purpose of this study is to fi nd the possible correlations that may exist between maternal and fetal iron status and newborn weight. Material and methods: The study included 97 mothers scheduled to give birth by elective caesarean section in the central maternity of Tébessa (east of Algeria) between January and August 2014. The blood collection was sampled from the antecubital vein of the mother and the umbilical vein. The mean concentrations of parameters in maternal and fetal sides, respectively, were 10.64 ± 1.37 g/dl and 14.83 ± 1.79 g/ dl for hemoglobin, 51.57 ± 20.82 μg/dl and 112.47 ± 32.34 μg/dl for serum iron, and 12.37 ± 9.58 ng/ml and 109.64 ± 58.76 ng/ml for serum ferritin. Except for ferritin, other fetal parameters were correlated with those of mothers. Birth weight was only significantly correlated with maternal hemoglobin (r = 0.22, p = 0.02) and hematocrit (r = 0.2, p = 0.004). Conclusion: The fetal-maternal exchanges of iron were highlighted and iron status of the newborn was linked to that of the mother. The low maternal hemoglobin was associated with low newborn weight (AU)

Introducción: el hierro es un micronutriente esencial en el crecimiento del feto. Objetivo: el propósito de este estudio es conocer las posibles correlaciones que puedan existir entre el estado en hierro de la madre y del feto, y el peso del recién nacido. Material y métodos: el estudio incluyó a 97 madres programadas para dar a luz por cesárea electiva en la maternidad central de Tébessa (este de Argelia) entre enero y agosto de 2014. En la extracción de sangre se tomaron muestras de la vena antecubital de la madre y de la vena umbilical. Las concentraciones medias de los parámetros maternos y fetales, respectivamente, fueron 10,64 ± 1,37 g/dl y 14,83 ± 1,79 g/dl de hemoglobina, 51,57 ± 20,82 mg/dl y 112,47 ± 32,34 mg/dl para el hierro sérico y 12,37 ± 9,58 ng/ml y 109,64 ± 58,76 ng/ml para la ferritina sérica. A excepción de la ferritina, los otros parámetros fetales se correlacionaron con los de la madre. El peso al nacer solo se correlacionó signifi cativamente con la hemoglobina materna (r = 0,22; p = 0,02) y el hematocrito (r = 0,2; p = 0,004). Conclusión: se pusieron de relieve los intercambios materno-fetales de hierro y el estado de hierro en el recién nacido se mostró ligado al de la madre. La hemoglobina materna baja se asoció con un bajo peso del recién nacido (AU)

Encapsulación de hierro: Otra estrategia para la prevención o tratamiento de la anemia por deficiencia de hierro / Iron encapsulation: Another strategy for the prevention or treatment of iron deficiency anemia

RESUMEN La anemia por deficiencia de hierro afecta a un tercio de la población mundial, causando severos problemas de salud. Las estrategias de prevención y tratamiento se basan en la suplementación oral y fortificación de alimentos, pero su eficacia no ha sido la esperada. Una de las causas se debe a que los compuestos de hierro utilizados tienen baja biodisponibilidad y producen efectos indeseados. Por esto, se han buscado nuevas tecnologías que pudiesen evitar estos problemas, como la encapsulación. Esta tecnología mejora la biodisponibilidad del hierro, reduce alteraciones organolépticas de los productos fortificados, y disminuye los trastornos gastrointestinales del uso de suplementos, entre las principales ventajas. Estos productos de hierro encapsulados han sido estudiados in vitro, y también aplicados en estudios in vivo para determinar su eficacia contra la anemia por deficiencia de hierro, con promisorios resultados. Por tanto, el objetivo de esta revisión fue recopilar información acerca de las tendencias actuales de encapsulación de hierro como una herramienta para prevenir o tratar la anemia por deficiencia de hierro.

ABSTRACT Iron deficiency anemia affects one third of the world population, causing severe health problems. Prevention and treatment strategies are based on oral supplementation and fortification of foods, but the effectiveness of these strategies has not been as expected. One explanation is that the iron compounds used have low bioavailability and produce undesired effects. Therefore, new technologies that could avoid these problems, like the encapsulation, have been explored. This technology improves the bioavailability of iron, reduces organoleptic alterations of fortified products, and decreases gastrointestinal disorders related to supplement use. These encapsulated iron products have been studied in vitro and also applied in in vivo studies to determine their efficacy against iron deficiency anemia, with promising results. Therefore, the objective of this review was to gather information about current trends in iron encapsulation as a tool to prevent or treat iron deficiency anemia.

Identificação de transcritos diferencialmente expressos por Pasteurella multocida em condições de privação de ferro / Identification of differentially expressed transcripts by Pasteurella multocida iron-starved condition

Ferro (Fe) é um elemento essencial e a capacidade de adquiri-lo in vivo têm sido descrita em diversos agentes patogênicos através de fatores de virulência. Análises de transcritos durante a privação de Fe tem sido descritos através da técnica de "microarray", entretanto a técnica de RNA-seq recentemente tem demonstrado resultados superiores. Neste trabalho, o isolado de Pasteurella multocida (Pm 16759) altamente patogênico em suínos foi cultivado em duas condições com diferentes concentrações de Fe (controle e privação) com o objetivo de analisar transcritos diferencialmente expressos. O RNA total das duas condições foi extraído e sequenciado através da plataforma de nova geração Ion Torrent. Os dados foram analisados no Software Ion Reporter(tm) e processados no programa Rockhopper. Foram obtidas 1.341.615 leituras com tamanho médio de 81pb, com 96% de alinhamento com o genoma de Pasteurella multocida subsp. multocida 3480 e 98,8% de acurácia. No mapeamento das leituras das duas condições, observou-se 2,652 transcritos e destes, 177 (6,7%) foram diferencialmente expressos, sendo 93 na condição controle (Fe+) e 84 na condição de privação (Fe-). Na condição de privação de Fe, o perfil de transcritos foram associados a função de transporte celular (fbp ABC, permease de alta afinidade com Fe2+/Pb2+ e proteína periplasmática de alta afinidade com Fe2+ ), reguladores transcricionais e proteínas hipotéticas. O perfil na condição controle (Fe+) apresentou transcritos diferencialmente expressos associados ao RNAs anti-sense (asRNA) e genes do metabolismo energético (fructose-1,6-bisfosfatase). O estudo comprovou que a restrição de Fe aumenta a expressão de genes envolvidos no transporte celular, reguladores transcricionais, proteínas hipotéticas e desconhecidas e permitiu ainda a identificação de novos genes como a permease de alta afinidade com Fe2+/Pb2+ e proteina periplasmática de alta afinidade com Fe2+ , que configuram uma possível via alternativa de absorção de Fe.(AU)

Iron (Fe) is an essential element and the ability to acquire it in vivo has been described in several pathogens as virulence factors. Global analyses of transcripts during iron deprivation have been described by microarray studies, however recently RNA-seq analysis showed superior results. The high pathogenic swine strain of Pasteurella multocida (BRMSA 1113) was grown in two conditions with different concentrations of Fe (control and deprivation) in order to analyze the differentially expressed transcripts. The total RNA of the two conditions was extracted and sequenced by new generation Ion Torrent plataform. Data were analyzed in Ion Reporter(tm) Software and processed in Rockhopper software. Sequence analysis shows 1,341,615 readings with median length of 81pb, with 96% of alignment to the reference genome Pasteurella multocida strain 3489, and 98.8% accuracy. Reads mapping to genome of P. multocida in these two conditions detected 2,652 transcripts, which 177 (6.7%) were differentially expressed, with 93 in the control condition (Fe+) and 84 provided with iron deprivation condition (Fe-). In condition (Fe-), differential expressed transcript profile were associated to function of cellular transport (fbpABC, high-affinity Fe2+/Pb2+ permease and periplasmic protein probably involved in hight-affinity Fe2+ ), transcptional regulators and hypothetical proteins. The control condition (Fe+) shows differential expressed transcripts profile associated to RNA anti-sense (asRNA) energetic metabolism genes (fructose-1,6-bisphosphatase). The study showed that the Fe restriction increases the expression of genes involved in cellular transport, transcriptional regulators, hypothetical and unknown proteins, and also allowed the identification of High-affinity Fe2+/Pb2+ permease e Periplasmic protein probably involved in high-affinity Fe2+, that constitute a possible alternative route for Fe absorption.(AU)

Micronutrient supplementation adherence and influence on the prevalences of anemia and iron, zinc and vitamin A deficiencies in preemies with a corrected age of six months

OBJECTIVE: To analyze adherence to the recommended iron, zinc and multivitamin supplementation guidelines for preemies, the factors associated with this adherence, and the influence of adherence on the occurrence of anemia and iron, zinc and vitamin A deficiencies. METHODS: This prospective cohort study followed 58 preemies born in 2014 until they reached six months corrected age. The preemies were followed at a referral secondary health service and represented 63.7% of the preterm infants born that year. Outcomes of interest included high or low adherence to iron, zinc and multivitamin supplementation guidelines; prevalence of anemia; and prevalences of iron, zinc, and vitamin A deficiencies. The prevalence ratios were calculated by Poisson regression. RESULTS: Thirty-eight (65.5%) preemies presented high adherence to micronutrient supplementation guidelines. At six months of corrected age, no preemie had vitamin A deficiency. The prevalences of anemia, iron deficiency and zinc deficiency were higher in the low-adherence group but also concerning in the high-adherence group. Preemies with low adherence to micronutrient supplementation guidelines were 2.5 times more likely to develop anemia and 3.1 times more likely to develop zinc deficiency. Low maternal education level increased the likelihood of nonadherence to all three supplements by 2.2 times. CONCLUSIONS: Low maternal education level was independently associated with low adherence to iron, zinc and vitamin A supplementation guidelines in preemies, which impacted the prevalences of anemia and iron and zinc deficiencies at six months of corrected age.

Deficiências de micronutrientes em crianças brasileiras assistidas em creches: revisão da literatura / Micronutrient deficiencies in Brazilian children attending daycare centers: a review of the literature

Resumo Objetivos Revisar os artigos sobre o estado nutricional de ferro, vitamina A e zinco em crianças brasileiras assistidas em creches, enfocando métodos diagnósticos, prevalências das respectivas deficiências e fatores associados. Métodos A pesquisa de artigos foi efetuada nas bases PubMed, Lilacs e SciELO. Foram incluídos estudos observacionais com amostras representativas aleatórias que utilizaram indicadores bioquímicos para avaliar o estado nutricional de ferro, vitamina A e zinco de crianças assistidas em creches. Calcularam-se as prevalências médias ponderadas de anemia e de deficiência de vitamina A. Computaram-se as variáveis associadas à anemia. Resultados Foram incluídos 21 estudos, nos quais o estado nutricional de ferro, vitamina A e zinco foi analisado em 17, quatro e três, respectivamente. As prevalências médias ponderadas de anemia e de deficiência de vitamina A foram de 42,7% e 12,5%, respectivamente. Crianças de menor idade e de pior condição socioeconômica representaram as principais condições explicativas para a ocorrência de anemia. Conclusões Os resultados sugerem altas prevalências de anemia e de deficiência de vitamina A entre as crianças brasileiras assistidas em creches com perspectivas etiológicas centradas nas doenças infecciosas.

Abstract The scope of the study was to review the scientific publications on the nutritional status of iron, vitamin A and zinc among Brazilian children attending daycare centers, focusing on diagnostic methods, the prevalence of respective deficiencies and associated factors. A review of the literature was conducted in the PubMed, LILACS and SciELO databases. Observational studies with random representative samples using biochemical indicators to evaluate the nutritional status of iron, vitamin A and zinc of children attending public daycare centers were included. The average weighted prevalence for anemia and vitamin A deficiency was estimated. The variables associated with anemia were computed. Twenty-one observational studies were included, in which the nutritional status of iron, vitamin A and zinc were analyzed in 17, 4 and 3, respectively. The average weighted prevalence of anemia and vitamin A deficiency were 42.7% and 12.5%, respectively. Young children and children living in less favorable socioeconomic situations represented the main explanatory conditions predominantly associated with the occurrence of anemia. The results suggest a high prevalence of anemia, as well as vitamin A deficiency in Brazilian children attending daycare centers, with etiological prospects focused on infectious diseases.

Suplementos en gestación: últimas recomendaciones / Supplements in pregnancy: the latest recommendations

El embarazo representa un desafío desde el punto de vista nutricional, debido a que las necesidades de nutrientes están aumentadas y una alteración en su ingesta puede afectar la salud materno-fetal. Estados deficitarios en micronutrientes están relacionados con preeclampsia, retraso del crecimiento intrauterino, aborto y anomalías congénitas. Actualmente, la dieta de muchas madres gestantes es insuficiente en micronutrientes, siendo necesaria su suplementación. Se recomienda la suplementación con ácido fólico en dosis de 400 μg/día, y de 5 mg en embarazadas de riesgo, debiendo comenzar al menos 1 mes antes de la concepción y durante las primeras 12 semanas de gestación, y prolongarla durante todo el embarazo en madres con riesgo nutricional. Es importante vigilar la dosis adecuada de ácido fólico para prevenir los posibles efectos adversos derivados de su acumulación plasmática no metabolizada. Un elevado porcentaje de gestantes presenta anemia ferropénica, estando recomendado el uso intermitente de suplementos con hierro (menor alteración gastrointestinal y estrés oxidativo); no recomendándose en madres no anémicas (con hemoglobina > 13,5 g/L). Dado que la absorción de calcio está aumentada hasta un 40% en gestación, no se recomienda su suplementación en madres con ingestas adecuadas (3 lácteos/día), debiéndose reservar su uso a madres con ingestas insuficientes y/o que tengan alto riesgo de preeclampsia. Respecto al iodo, existen posicionamientos contradictorios por parte de distintos grupos de trabajo, estableciéndose la suplementación con yoduro potásico en mujeres que no alcanzan las ingestas recomendadas con su dieta (3 raciones de leche y derivados lácteos + 2 g de sal yodada). Dado que la vitamina A y D pueden ser tóxicas para la madre y el feto, no está recomendada su suplementación excepto en casos de deficiencia. Aunque la administración de suplementos con varios micronutrientes puede repercutir favorablemente en el resultado del embarazo, es necesaria una mayor evidencia científica para establecer el reemplazo de hierro y ácido fólico con un suplemento de micronutrientes múltiple (AU)

Pregnancy is a challenge from the nutritional point of view, because nutrient requirements are increased and alter its intake can affect maternal and fetal health. Micronutrient deficiency states are related to preeclampsia, intrauterine growth restriction, abortion and congenital anomalies. Currently, the diet of many expectant mothers is insufficient in micronutrients, in this cases supplementation is necessary. It is recommended supplementation with folic acid in doses of 400 mcg / day and 5 mg/day in risk pregnant, and should begin at least one month before conception and during the first 12 weeks gestation, and extend it throughout pregnancy in mothers with nutritional risk. It is important to keep watch the proper dose of folic acid to prevent possible adverse effects of unmetabolized accumulation in plasma. A high percentage of pregnant women presented iron deficiency anemia, being recommended intermittent use of iron supplements (with lower gastrointestinal alteration and oxidative stress); not recommended for mothers without anemia (hemoglobin> 13.5 g / L). Since calcium absorption is increased up to 40% in gestation, its supplementation is not recommended for mothers with adequate intakes (3 dairy / day), and its use must be reserved to women with inadequate intakes and / or high risk of preeclampsia. Regarding the iodine, there are conflicting positions by different working groups established potassium iodide supplementation in women who do not reach their recommended intake (3 servings of milk and dairy products + 2 g of iodized salt), with their diets. Given that vitamin A and D can be toxic to mother and fetus, it is not recommended its supplementation except in cases of deficiency. Although the use of multiple micronutrients supplements may favorably impact the outcome of pregnancy, more scientific evidence is needed to establish the replacement of iron and folic acid with a multiple micronutrient supplement (AU)

Anemia perniciosa: ferritina normal y un posible déficit de hierro oculto / Pernicious anemia: normal ferritin levels and possible hidden iron deficiency

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Optimización de la hemoglobina preoperatoria en pacientes no anémicos y/o sometidos a cirugía de elevada pérdida hemática / Optimization of preoperative hemoglobin levels in patients without anemia and/or patients who undergo surgery with high blood loss

Para minimizar la transfusión de sangre alogénica en cirugía compleja y con gran riesgo de pérdida hemática, es necesario disponer de varias técnicas de ahorro de sangre (abordaje multimodal). Todos los pacientes quirúrgicos deben ser evaluados con el tiempo suficiente para optimizar la hemoglobina y las reservas de hierro, para que la estrategia perioperatoria de transfusión establecida sea adecuada. En algunos casos, aunque el paciente no esté anémico, estará justificado mejorar el valor de hemoglobina para reducir el riesgo de transfusión de sangre alogénica, especialmente en los casos que por alguna razón la rechacen. También puede estar justificado tratar con hierro y/o agentes eritropoyéticos en los casos en que necesitemos una reserva de sangre autóloga importante para minimizar la transfusión de sangre alogénica en la cirugía de gran pérdida hemática (AU)

To minimize allogeneic blood transfusions (ABTs) during complex surgery and surgery with considerable blood loss risk, various blood-sparing techniques are needed (multimodal approach). All surgical patients should be assessed with sufficient time to optimize hemoglobin levels and iron reserves so that the established perioperative transfusion strategy is appropriate. Even if the patient does not have anemia, improving hemoglobin levels to reduce the risk of ABT is justified in some cases, especially those in which the patient refuses a transfusion. Treatment with iron and/or erythropoietic agents might also be justified for cases that need a significant autologous blood reserve to minimize ABT during surgery with considerable blood loss (AU)

Aproximación terapéutica a la anemia postoperatoria / Therapeutic approach to postoperative anemia

La anemia postoperatoria es un hallazgo común en los pacientes sometidos a cirugía mayor, y puede condicionar la rehabilitación precoz y la reincorporación a su actividad habitual. La transfusión de sangre alogénica sigue siendo el método comúnmente utilizado para la restauración de los valores de hemoglobina de manera rápida y eficaz. Sin embargo, los riesgos potenciales de la transfusión han llevado a la revisión de esta práctica transfusional y a la búsqueda de medidas alternativas para el tratamiento de la anemia postoperatoria. A este respecto parece que la administración precoz de hierro intravenoso puede mejorar la evolución de la hemoglobina postoperatoria y reducir la transfusión alogénica, sobre todo en pacientes con déficit de hierro o anemia importante. Lo que no está muy claro es si ello influye de manera muy relevante en la rehabilitación o calidad de vida en este contexto. Faltan estudios prospectivos aleatorizados bien diseñados y adecuadamente dimensionados para saber si el tratamiento con hierro intravenoso postoperatorio o perioperatorio, con o sin eritropoyetina recombinante, tiene un papel en la recuperación de la anemia postoperatoria, en la reducción de la transfusión y la morbilidad y en la mejoría de la capacidad de esfuerzo y la calidad de vida (AU)

Postoperative anemia is a common finding in patients who undergo major surgery, and it can affect early rehabilitation and the return to daily activities. Allogeneic blood transfusion is still the most widely used method for restoring hemoglobin levels rapidly and effectively. However, the potential risks of transfusions have led to the review of this practice and to a search for alternative measures for treating postoperative anemia. The early administration of intravenous iron appears to improve the evolution of postoperative hemoglobin levels and reduce allogeneic transfusions, especially in patients with significant iron deficiency or anemia. What is not clear is whether this treatment heavily influences rehabilitation and quality of life. There is a lack of well-designed, sufficiently large, randomized prospective studies to determine whether postoperative or perioperative intravenous iron treatment, with or without recombinant erythropoietin, has a role in the recovery from postoperative anemia, in reducing transfusions and morbidity rates and in improving exercise capacity and quality of life (AU)