Salivary cystatin SN is a factor predicting iron bioavailability after phytic acid rich meals in female participants.

Phytic acid is an inhibitor of iron bioavailability, but it has been suggested that individuals may adapt to phytic acid over time, and that the salivary protein, cystatin SN, may be involved. This study evaluated the relationship between human cystatin SN levels and iron bioavailability after a phytic acid rich meal. Three groups of ten women consumed meals with: (1) 500 mg phytate sprinkles, (2) 500 mg phytate capsules, or (3) no phytic acid. Iron bioavailability was measured by the mealtime percentage of maximum iron recovery; cystatin SN was measured pre-and post-meal by enzyme-linked immunosorbent assay. Pre-to-post meal cystatin SN was positively correlated with improved iron bioavailability in group 1. Pre-to-post meal cystatin SN was correlated with improved iron absorption in groups 1 and 2. Cystatin SN recovery after phytic acid rich meals may be a physiological factor predicting iron bioavailability.

Dental Caries Are Associated with Anemia in Pediatric Patients: A Systematic Literature Review.

BACKGROUND: Dental caries (cavities) and anemia are among the most common chronic diseases seen by health professionals and experienced globally. However, the quality, and current evidence linking pediatric dental caries to anemia, is not well established. Moreover, it is not well known whether anemia seen with dental caries is due to iron deficiency or other causes. OBJECTIVE: This systematic literature review was designed to analyze the relationship between anemia and pediatric dental caries and examine the strength of evidence in current research. METHODS: Articles were sourced from PubMed, the American Dental Association database, American Dental Hygienist's Association database, Science Direct, Cochrane Library, CINAHL, Google Scholar, and Medline ProQuest. Outcomes were pooled for statistical effect size. RESULTS: Nineteen articles were selected from 351 identified. There was a 4.5-fold incidence in anemia diagnosis among children with, compared to without, dental caries. While ferritin and mean corpuscular volume were not significantly different among children with and without dental caries, the average serum iron was nearly 30 ug/dL greater in caries-free children, suggesting that iron deficiency may be more common among children with caries. Studies in the future may benefit from methodological improvements and more specific study questions to further investigate this question.

Food Pattern Modeling as an Alternative Assessment Method to Multiday Dietary Recalls for Iron-Related Nutrients: A Proof-of-Concept Study.

There are barriers to in-depth memory-based dietary assessment techniques in community-based research. Food pattern modeling may be an alternative method to traditional assessment techniques. The objective of this study was to pilot a comparison of food pattern modeling to 24 h diet recalls for predicting hematological outcomes of iron status. Data from 3-24 h dietary recalls in 27 women were analyzed by two methods: mean dietary intake estimates or food pattern modeling. Food pattern modeling was used to determine the total inventory of foods consumed with iron, phytate, or ascorbic acid or iron-phytate ratios. Each variable was analyzed for its relationship to hemoglobin, ferritin, and acute iron absorption from a meal challenge study by creating receiver operating characteristic (ROC) curves. There were no differences in ROC curves or diagnostic accuracies between food pattern modeling or mean dietary intake estimates for iron, vitamin C, phytate, or phytate-iron ratios for estimating hemoglobin or ferritin values (p > 0.05). Food pattern modeling was inferior to mean dietary estimates for acute iron absorption, suggesting that more detailed methods may be necessary for studies with sensitive or acute dietary measurement outcomes. Food pattern modeling for total iron, vitamin C, phytate, and phytate-iron ratios may be comparable to detailed memory-based recalls for larger studies assessing the impact of foods on iron status.

Optimizing Discharge Opioid Prescribing Practices After Mastectomy With Immediate Reconstruction.

A quality improvement initiative was conducted to provide guidelines for opioid prescribing following mastectomy with immediate reconstruction. Patients undergoing mastectomy with concurrent tissue expander reconstruction were surveyed at their first postoperative visit to determine use of pain medication, satisfaction, and refill rates. Opioid prescriptions were converted to total oral morphine milligram equivalents (MMEs). Guidelines for postdischarge prescriptions were developed. During phase I, 16 patients were surveyed to determine baseline prescribed MMEs and rate of satisfaction. A guideline was subsequently developed to standardize postdischarge prescribing (550 MMEs prescribed average risk vs 900 MMEs high risk), and the survey was repeated (phase II). Median 210 MMEs were used. Of the 23 patients, 1 required a refill, 83% were highly satisfied, and 77% of opioids were unused. Guidelines were further revised to limit prescribed opioids (290 MME average risk vs 450 MME high risk), and the survey was repeated (phase III). A median of 118 MMEs was used. Of the 22 patients, 5 required refills, 73% were highly satisfied, and 53% of opioids were unused. Phase IV included 27 patients. A median of 98 MMEs was used. Two patients required refills, 93% were highly satisfied, and 58% of opioids were unused. Our finding showed that there is significant overprescription of opioids after elective breast surgery. Practice guidelines can reduce the amount of opioids prescribed. Reducing excess opioids available in the community is a noble goal; however, it must be done cautiously, as decreased patient satisfaction can be an unintended consequence.