Effect of Nutrition Education and Diet Modification in Iron Depleted Preschool Children in Nurseries in Tehran: a Pilot Study

In view of the high prevalence of iron deficiency in preschool children and its consequences, this study was carried out to examine the effect of nutrition education and dietary modification on 438 two- to six-year-old nursery school children in Tehran in 1999. Sixty-two children who were judged anemic, iron-depleted, or having low iron stores were randomly allocated to "control", "dietary modification" (consuming one additional citrus fruit after lunch), and "nutrition education" (teaching the mothers proper eating patterns based on the food pyramid) groups. Food habits were surveyed, including 24-hour dietary recall and food frequency, as well as timing of consumption of special items; this survey was carried out for each child before and after intervention. After three months, blood samples were taken from the subjects. The prevalence of anemia, iron depletion, and low iron stores was 11.4, 62.8, and 15.1% respectively, with no significant differences observed in hemoglobin and percent transferrin saturation (%TS) between the groups. Mean ± SD serum ferritin concentrations in "control", "diet modification", and "nutrition education" groups were 8.9 ± 3.1, 9.5 ± 3.7, and 6.9 ± 2.3 mug/dL. The same figures at the end of intervention were 6.9 ± 3.5, 11.2 ± 5, and 10.7 ± 5.9 mug/dL, respectively. Analysis of variance showed ferritin concentrations to be significantly different, in that there was a reduction in the control and elevation in the nutrition education groups. There was no significant difference in %TS before and after the intervention. During three months of intervention, changes in frequency of fruit and fruit juice intake after the meals in nutrition education and diet modification groups were significantly correlated to serum ferritin alteration. Frequency of fruit juice intake (rich in vitamin C) after meals (at least five times a week) can significantly increase serum ferritin within three months. Therefore, educating mothers of iron-deficient children while increasing the iron stores in children can prevent the recurrence of iron deficiency and result in general child wellbeing.

Download Full-text

Correlation between Diagnostic 59Fe2+-Absorption and Serum Ferritin Concentration in Man

Zeitschrift für Naturforschung C ◽

10.1515/znc-1977-11-1227 ◽

1977 ◽

Vol 32 (11-12) ◽

pp. 1023-1025 ◽

Cited By ~ 20

Author(s):

H. C. Heinrich ◽

J. Brüggemann ◽

E. E. Gabbe ◽

M. Gläser ◽

Fatima Icagic ◽

...

Keyword(s):

Bone Marrow ◽

Iron Deficiency ◽

Correlation Coefficient ◽

Serum Ferritin ◽

Inverse Relationship ◽

Sensitive Indicator ◽

Ferritin Concentration ◽

Iron Stores ◽

Serum Ferritin Concentration ◽

The Relationship

Abstract A high correlation coefficient r = -0.832 (Pr≠0 <0.0001) was estimated in man for the inverse relationship between the diagnostic 59Fe2+-absorption and the serum ferritin concentration which is very close to the correlation r = - 0.88 as described for the relationship between the diagnostic 59Fe2+-absorption and the diffuse cytoplasmic storage iron in the bone marrow macrophages. The increase of the diagnostic 59Fe2+-absorption seems to be an earlier and more sensitive indicator of depleted iron stores whereas the serum ferritin decreases somewhat later during the development of iron deficiency.

Download Full-text

Enzyme-linked Immunosorbent Assay to Measure Serum Ferritin and the Relationship between Serum Ferritin and Nonheme Iron Stores in Cats

Veterinary Pathology ◽

10.1177/030098589403100607 ◽

1994 ◽

Vol 31 (6) ◽

pp. 674-678 ◽

Cited By ~ 29

Author(s):

G. A. Andrews ◽

P. S. Chavey ◽

J. E. Smith

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Immunosorbent Assay ◽

Serum Iron ◽

Nonheme Iron ◽

Enzyme Linked Immunosorbent Assay ◽

Ferritin Concentration ◽

Iron Stores ◽

Tissue Iron ◽

Serum Ferritin Concentration

Serum ferritin concentration correlates with tissue iron stores in humans, horses, calves, dogs, and pigs but not in rats. Because serum iron and total iron-binding capacity can be affected by disorders unrelated to iron adequacy (such as hypoproteinemia, chronic infection, hemolytic anemia, hypothyroidism, and renal disease), serum ferritin is probably the most reliable indicator of total body iron stores in larger species. To test the hypothesis that serum ferritin might be correlated with tissue iron levels in cats, we developed a quantitative enzyme-linked immunosorbent assay that uses two monoclonal antibodies in a sandwich arrangement to measure feline serum ferritin. The recovery of purified ferritin added to feline sera ranged from 94% to 104%; the within-assay coefficient of variability was 8.4%, and the assay-to-assay variability was 13.2%. Mean serum ferritin from 40 apparently healthy cats was 76 ng ml (SD = 24 ng/ml). Serum ferritin concentration was significantly correlated ( P < 0.001, n = 101, r = 0.365) with the nonheme iron in the liver and spleen (expressed as milligrams of iron per kilogram of body weight), as determined by Pearson product-moment correlation analysis. Because serum iron can decrease in diseases other than iron deficiency, the combination of serum iron and serum ferritin should provide sufficient evidence to differentiate anemia of chronic inflammation from anemia of iron deficiency in the cat.

Download Full-text

Relationship Between Iron Indices and Iron Responsiveness Following IV Ferumoxytol or Oral Iron In Patients with CKD Not on Dialysis

Blood ◽

10.1182/blood.v116.21.5149.5149 ◽

2010 ◽

Vol 116 (21) ◽

pp. 5149-5149

Author(s):

John Adamson ◽

Zhu Li ◽

Paul Miller ◽

Annamaria Kausz

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Iron Status ◽

Oral Iron ◽

Iron Therapy ◽

Deficiency Anemia ◽

Functional Iron Deficiency ◽

Iron Stores ◽

Iv Iron ◽

Definition Of

Abstract Abstract 5149 BACKGROUND Iron deficiency anemia (IDA) is associated with reduced physical functioning, cardiovascular disease, and poor quality of life. The measurement of body iron stores is essential to the management of IDA, and the indices most commonly used to assess iron status are transferrin saturation (TSAT) and serum ferritin. Unfortunately, serum ferritin is not a reliable indicator of iron status, particularly in patients with chronic kidney disease (CKD), because it is an acute phase reactant and may be elevated in patients with iron deficiency in the presence of inflammation. Recent clinical trials have shown that patients with iron indices above a strict definition of iron deficiency (TSAT >15%, serum ferritin >100 ng/mL), do have a significant increase in hemoglobin (Hgb) when treated with iron. These results are consistent with recent changes to the National Cancer Comprehensive Network (NCCN) guidelines, which have expanded the definition of functional iron deficiency (relative iron deficiency) to include a serum ferritin <800 ng/mL; previously, the serum ferritin threshold was <300 ng/mL. Additionally, for patients who meet this expanded definition of functional iron deficiency (TSAT <20%, ferritin <800 ng/mL), it is now recommended that iron replacement therapy be considered in addition to erythropoiesis-stimulating agent (ESA) therapy. Ferumoxytol (Feraheme®) Injection, a novel IV iron therapeutic agent, is indicated for the treatment of IDA in adult patients with CKD. Ferumoxytol is composed of an iron oxide with a unique carbohydrate coating (polyglucose sorbitol carboxymethylether), is isotonic, has a neutral pH, and evidence of lower free iron than other IV irons. Ferumoxytol is administered as two IV injections of 510 mg (17 mL) 3 to 8 days apart for a total cumulative dose of 1.02 g; each IV injection can be administered at a rate up to 1 mL/sec, allowing for administration of a 510 mg dose in less than 1 minute. METHODS Data were combined from 2 identically designed and executed Phase III randomized, active-controlled, open-label studies conducted in 606 patients with CKD stages 1–5 not on dialysis. Patients were randomly assigned in a 3:1 ratio to receive a course of either 1.02 g IV ferumoxytol (n=453) administered as 2 doses of 510 mg each within 5±3 days or 200 mg of oral elemental iron (n=153) daily for 21 days. The main IDA inclusion criteria included a Hgb ≤11.0 g/dL, TSAT ≤30%, and serum ferritin ≤600 ng/mL. The mean baseline Hgb was approximately 10 g/dL, and ESAs were use by approximately 40% of patients. To further evaluate the relationship between baseline markers of iron stores and response to iron therapy, data from these trials were summarized by baseline TSAT and serum ferritin levels. RESULTS Overall, results from these two pooled trials show that ferumoxytol resulted in a statistically significant greater mean increase in Hgb relative to oral iron. When evaluated across the baseline iron indices examined, statistically significant (p<0.05) increases in Hgb at Day 35 were observed following ferumoxytol administration, even for subjects with baseline iron indices above levels traditionally used to define iron deficiency. Additionally, at each level of baseline iron indices, ferumoxytol produced a larger change in Hgb relative to oral iron. These data suggest that patients with CKD not on dialysis with a wide range of iron indices at baseline respond to IV iron therapy with an increase in Hgb. Additionally, ferumoxytol consistently resulted in larger increases in Hgb relative to oral iron across all levels of baseline iron indices examined. Disclosures: Adamson: VA Medical Center MC 111E: Honoraria, Membership on an entity's Board of Directors or advisory committees. Li:AMAG Pharmaceuticals, Inc.: Employment. Miller:AMAG Pharmaceuticals, Inc.: Employment. Kausz:AMAG Pharmaceuticals, Inc.: Employment.

Download Full-text

Comparative study of efficacy and safety of parenteral iron sucrose versus ferric carboxymaltose in treatment of postpartum iron deficiency anaemia

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20215083 ◽

2021 ◽

Vol 11 (1) ◽

pp. 100

Author(s):

Ganesh N. Dakhle ◽

Mrunalini V. Kalikar ◽

Rujuta P. Fuke ◽

Anisha S. Parmarthi ◽

Mrunalini K. Chokhandre

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Iron Deficiency Anaemia ◽

Maximum Dose ◽

Iron Sucrose ◽

Ferric Carboxymaltose ◽

Care Hospital ◽

Deficiency Anaemia ◽

Iron Stores ◽

Parenteral Iron

Background: Postpartum anaemia often leads to multiple clinical complications in mother as well as infant and iron supplementation with parenteral iron is the preferred treatment modality. The present study was planned to compare the efficacy and tolerability of IV iron sucrose and IV ferric carboxymaltose in treatment of postpartum iron deficiency anaemia.Methods: This randomized, parallel, open label, prospective 4-weeks study was conducted from June 2019 to December 2020 in women with postpartum anaemia admitted to obstetrics and gynaecology inpatient department of a tertiary care hospital. Women with postpartum iron deficiency anaemia (N=60) were randomly divided into two groups; receiving Injection iron sucrose (N=30, maximum dose 500 mg) or Injection ferric carboxymaltose (N=30, maximum dose 500 mg). Change in haemoglobin and serum ferritin levels from baseline to the end of 2 and 4 weeks of treatment were evaluated.Results: The results showed early, sustained and significant increase in the haemoglobin levels in both the groups. However, the difference was not significant between groups (p=0.2). Evaluation of replenishment of iron stores (serum ferritin) showed improvement in both the groups, however in FCM group the rise was found to be significant (p<0.05).Conclusions: FCM in a lower dose of 500mg was found to be safe and effective in significantly improving haemoglobin concentration as well as in replenishing iron stores in patients with postpartum anaemia.

Download Full-text

Effect of blood donation on iron stores as evaluated by serum ferritin

Blood ◽

10.1182/blood.v50.3.441.bloodjournal503441 ◽

1977 ◽

Vol 50 (3) ◽

pp. 441-447 ◽

Cited By ~ 7

Author(s):

CA Finch ◽

JD Cook ◽

RF Labbe ◽

M Culala

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Blood Donors ◽

Serum Ferritin Level ◽

Blood Donation ◽

Ferritin Level ◽

Geometric Mean ◽

Iron Stores ◽

High Incidence ◽

First Time

Serum ferritin was measured in 2982 blood donors. First-time male donors had a geometric mean of 127 microgram/liter and female donors 46 microgram/liter. While values were essentially constant in the women between the ages of 18 and 45, there was a rapid increase in the men between 18 and 30 years of age consistent with the establishment of iron stores during that time. Blood donation was associated with a decrease in serum ferritin. One unit per year, equivalent to an increased requirement of 0.65 mg/day, halved the serum ferritin level in the male. More frequent donations were associated with further decreases. From the data obtained it would appear that male donors, while depleting their iron stores, were able to donate 2–3 U/yr without an appreciable incidence of iron deficiency. Women could donate only about half that amount, and more frequent donations were associated with a high incidence of iron deficiency and donor dropout. These data have provided information on the effect of graded amounts of iron loss through bleeding on iron balance.

Download Full-text

Serum transferrin receptor: a quantitative measure of tissue iron deficiency

Blood ◽

10.1182/blood.v75.9.1870.1870 ◽

1990 ◽

Vol 75 (9) ◽

pp. 1870-1876 ◽

Cited By ~ 446

Author(s):

BS Skikne ◽

CH Flowers ◽

JD Cook

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Transferrin Receptor ◽

Iron Status ◽

Serum Transferrin ◽

Mean Cell Volume ◽

Functional Iron Deficiency ◽

Iron Stores ◽

Serum Transferrin Receptor ◽

Tissue Iron

Abstract This study was undertaken to evaluate the role of serum transferrin receptor measurements in the assessment of iron status. Repeated phlebotomies were performed in 14 normal volunteer subjects to obtain varying degrees of iron deficiency. Serial measurements of serum iron, total iron-binding capacity, mean cell volume (MCV), free erythrocyte protoporphyrin (FEP), red cell mean index, serum ferritin, and serum transferrin receptor were performed throughout the phlebotomy program. There was no change in receptor levels during the phase of storage iron depletion. When the serum ferritin level reached subnormal values there was an increase in serum receptor levels, which continued throughout the phlebotomy program. Functional iron deficiency was defined as a reduction in body iron beyond the point of depleted iron stores. The serum receptor level was a more sensitive and reliable guide to the degree of functional iron deficiency than either the FEP or MCV. Our studies indicate that the serum receptor measurement is of particular value in identifying mild iron deficiency of recent onset. The iron status of a population can be fully assessed by using serum ferritin as a measure of iron stores, serum receptor as a measure of mild tissue iron deficiency, and hemoglobin concentration as a measure of advanced iron deficiency.

Download Full-text

Cystic Fibrosis Study Questioned

PEDIATRICS ◽

10.1542/peds.74.1.169a ◽

1984 ◽

Vol 74 (1) ◽

pp. 169-169

Author(s):

JOANN ATER

Keyword(s):

Cystic Fibrosis ◽

Iron Deficiency ◽

Serum Ferritin ◽

Plasma Volume ◽

Clinical Observation ◽

Good Evidence ◽

Iron Therapy ◽

Iron Stores ◽

Oral Iron Therapy ◽

Low Serum

In Reply.— Wagener and colleagues make a valid point that increase in plasma volume can be an appropriate response to hypoxia, without the development of polycythemia. This probably is a factor contributing to the inappropriately low hemoglobin values we found in our patients with cystic fibrosis. However, as in anything in medicine, there is rarely a single reason for any clinical observation. Our finding that some of our patients with low iron stores, as reflected by low serum ferritin values, had a significant increase in hemoglobin values with oral iron therapy, provides good evidence that iron deficiency may be one factor limiting the development of polycythemia in these patients.

Download Full-text

Utility of serum ferritin as a measure of iron deficiency in normal males undergoing repetitive phlebotomy

Blood ◽

10.1182/blood.v56.5.786.786 ◽

1980 ◽

Vol 56 (5) ◽

pp. 786-791 ◽

Cited By ~ 32

Author(s):

RA Jacob ◽

HH Sandstead ◽

LM Klevay ◽

LK Johnson

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Iron Absorption ◽

Iron Status ◽

Normal Male ◽

Controlled Environment ◽

Mixed Diet ◽

Iron Stores ◽

Normal Males ◽

Normal Men

Abstract Hematologic indices and iron balance data were obtained on 22 normal male volunteers who were subjected to a mean +/- SD phlebotomy of 164 +/- 34 ml whole blood/mo while living in a controlled environment. Over an average stay of 5 mo, volunteers did not develop anemia, but did display a reduction in iron stores that was quantitated by measurement of serum ferritin and iron balance. The percent saturation of transferrin and the usual erythrocyte parameters did not reflect changes in iron status. Loss of iron, which was calculated from quantitative phlebotomy and iron balance data, showed that a decrease of 1 ng of serum ferritin represented a loss of 4.5 +/- 5.3 mg of iron in 10 men whose initial serum ferritins were greater than 25 ng/ml, and 25.3 +/- 58.8 mg of iron in 7 men whose initial serum ferritins were less than 25 ng/ml. The period required for 3 volunteers who consumed a self-selected mixed diet at home to replace their depleted iron stores to prephlebotomy levels was about 4.5 mo. The sensitivity of serum ferritin as an index of iron stores was affirmed. In addition it was found that normal men who were consuming a mixed diet containing about 15 mg of iron daily and losing blood at a rate of 164 +/- 34 ml/mo did not increase their iron absorption sufficiently to compensate for the iron loss.

Download Full-text

The role of blood loss and diet in the aetiology of mild iron deficiency in premenopausal adult New Zealand women

Public Health Nutrition ◽

10.1079/phn200054 ◽

2001 ◽

Vol 4 (2) ◽

pp. 197-206 ◽

Cited By ~ 51

Author(s):

Anne-Louise M Heath ◽

C Murray Skeaff ◽

Sheila Williams ◽

Rosalind S Gibson

Keyword(s):

New Zealand ◽

Iron Deficiency ◽

Blood Loss ◽

Serum Ferritin ◽

Menstrual Blood ◽

Adult Women ◽

Menstrual Blood Loss ◽

Iron Stores ◽

Supplement Use

AbstractObjectiveTo investigate the role of blood loss and diet in the aetiology of mild iron deficiency (MID) in premenopausal New Zealand women. Mild iron deficiency was defined as low, but not necessarily exhausted, iron stores (i.e. serum ferritin <20 μg/L) in the absence of anaemia (i.e. haemoglobin ≥120 g/L).DesignCross-sectional study of a volunteer sample of premenopausal adult women. Information on habitual dietary intakes (using a specially designed and validated computerised iron food frequency questionnaire), health and demographic status, sources of blood loss (including menstrual blood loss estimated using a validated menstrual recall method), contraceptive use, height and weight, haemoglobin, serum ferritin and C-reactive protein were collected.SettingDunedin, New Zealand during 1996/1997.ParticipantsThree hundred and eighty-four women aged 18–40 years.ResultsThe characteristics that were associated with an increased risk of MID were: low meat/fish/poultry intake, high menstrual blood loss, recent blood donation, nose bleeds, and low body mass index. The protective factors included shorter duration of menstrual bleeding, and multivitamin–mineral supplement use in the past year.ConclusionsThere are a number of potentially modifiable factors that appear to influence risk of MID. Women with low menstrual blood loss may be able to decrease their risk of MID by increasing their meat/fish/poultry intake, while those with a higher menstrual blood loss may be able to decrease their risk by decreasing their menstrual blood loss, perhaps by changing their method of contraception. Women should be encouraged to maintain a healthy body weight, and those who choose to donate blood, or who experience nose bleeds, should have their iron stores monitored.

Download Full-text

Utility of serum ferritin as a measure of iron deficiency in normal males undergoing repetitive phlebotomy

Blood ◽

10.1182/blood.v56.5.786.bloodjournal565786 ◽

1980 ◽

Vol 56 (5) ◽

pp. 786-791

Author(s):

RA Jacob ◽

HH Sandstead ◽

LM Klevay ◽

LK Johnson

Keyword(s):

Iron Deficiency ◽

Serum Ferritin ◽

Iron Absorption ◽

Iron Status ◽

Normal Male ◽

Controlled Environment ◽

Mixed Diet ◽

Iron Stores ◽

Normal Males ◽

Normal Men

Hematologic indices and iron balance data were obtained on 22 normal male volunteers who were subjected to a mean +/- SD phlebotomy of 164 +/- 34 ml whole blood/mo while living in a controlled environment. Over an average stay of 5 mo, volunteers did not develop anemia, but did display a reduction in iron stores that was quantitated by measurement of serum ferritin and iron balance. The percent saturation of transferrin and the usual erythrocyte parameters did not reflect changes in iron status. Loss of iron, which was calculated from quantitative phlebotomy and iron balance data, showed that a decrease of 1 ng of serum ferritin represented a loss of 4.5 +/- 5.3 mg of iron in 10 men whose initial serum ferritins were greater than 25 ng/ml, and 25.3 +/- 58.8 mg of iron in 7 men whose initial serum ferritins were less than 25 ng/ml. The period required for 3 volunteers who consumed a self-selected mixed diet at home to replace their depleted iron stores to prephlebotomy levels was about 4.5 mo. The sensitivity of serum ferritin as an index of iron stores was affirmed. In addition it was found that normal men who were consuming a mixed diet containing about 15 mg of iron daily and losing blood at a rate of 164 +/- 34 ml/mo did not increase their iron absorption sufficiently to compensate for the iron loss.

Download Full-text