Iron deficiency in patients with cancer: a prospective cross-sectional study

BackgroundDespite the deleterious consequences of iron deficiency (ID) in patients with cancer, underdiagnosis is frequent. The CARENFER study aimed to assess the prevalence of ID using both serum ferritin concentration and transferrin coefficient saturation (iron-saturation of transferrin, TSAT) index, as well as ID anaemia in patients with cancer.MethodsThis prospective cross-sectional study was conducted in 15 oncology units in France in 2019. All patients present in the medical unit during the 2-week study period, regardless of the type of tumour (solid or haematological) and treatment, were eligible. Serum ferritin concentration, TSAT index and haemoglobin level were determined. ID and ID-associated anaemia were defined according to European Society of Medical Oncology 2018 Guidelines: ID was defined either as ferritin <100 µg/L (absolute ID) or as ferritin ≥100 µg/L and TSAT <20% (functional ID).ResultsA total of 1221 patients with different types of solid malignant tumours were analysed: median age 64 years; 89.4% under treatment for their cancer, mainly by chemotherapy (75.4%). Overall, ID was found in 57.9% (55.1–60.6) of patients. Among them, functional ID accounted for 64% of cases. ID anaemia was reported in 21.8% (19.6–24.2) of all patients with cancer. ID was highly prevalent in untreated (75/130, 57.4%) and non-anaemic (419/775, 54.1%) patients.ConclusionThis study highlights the high prevalence of ID in patients with cancer, whether or not associated with anaemia or treatment. These results emphasise the need to a better detection and management of ID in cancer, thereby optimising overall patient care.Trial registration numberClinicalTrials.gov Identifier: NCT03924271.

Association of High Serum Ferritin Level in Early Pregnancy with Development of Gestational Diabetes Mellitus- A Prospective Observational Study

Introduction: Gestational Diabetes Mellitus (GDM) has a negative impact on maternal and perinatal outcome and several long-term complications. The evidence from different experimental studies have shown that high serum ferritin concentration can lead to pancreatic β-cell dysfunction and impaired glucose metabolism leading to GDM. Aim: To determine the association of increased serum ferritin level in first trimester and GDM in course of pregnancy. Materials and Methods: A prospective observational study was conducted in 204 women in Institute of Post Graduate Medical Education and Research and SSKM Hospital, West Bengal, India, during the period from January 2015 to December 2015. The blood samples were collected and screened for GDM by Oral Glucose Tolerance Test (OGTT) at the beginning of the study and then assayed for serum ferritin level who were screened negative. The women were divided into four groups by quartiles of serum ferritin levels (Q1 to Q4). Then they were followed-up with OGTT at 24-28 weeks and again at 32-34 weeks. Statistical analysis was done by using paired t-test, Chi-square test and Fisher’s- exact test. Results: The participants had an average serum ferritin concentration of 77.44 ng/mL. GDM prevalence within each serum ferritin quartile was 7.84%, 11.76%, 19.61% and 23.53% respectively (p-value=0.016). The odds ratio for GDM in the ferritin Q2-Q4 was 1.57 (CI=0.41-5.92), 2.87 (CI=0.84-9.83) and 3.62 (CI=1.08-12.11) compared with Q1, respectively. In addition, primigravida and women with high Haemoglobin (Hb) level (>13 gm%) have an increased risk of developing GDM. Conclusion: Elevated serum ferritin level is associated with increased incidence of GDM irrespective of other risk factors. Iron supplementation should therefore be individualised based on serum ferritin in early pregnancy to minimise the risk of GDM.

Evaluation of Serum Ferritin and Anti-Thyroid Peroxidase Antibody Status in Newly Diagnosed Subclinical Cases of Hypothyroidism

Background:: Serum ferritin concentrations are altered in hypothyroidism, but there is no available literature regarding the status of serum ferritin in anti-thyroid peroxidase (anti-TPO) positive hypothyroidism. The objectives: of our study were to evaluate the titer of anti-TPO and serum ferritin in newly diagnosed hypothyroid patients and to find out any difference of serum ferritin concentration between antibody-positive and antibody-negative patients. Methods:: A total of 143 subjects above the age of 18 years were recruited, and serum Thyroid Stimulating Hormone (TSH), free T3, free T4, anti-TPO, and ferritin were assayed by chemiluminescence method. According to their serum analysis findings, three groups were made as Group 1 of 49 subjects with hypothyroidism and anti-TPO positive, Group 2 of 47 subjects with hypothyroidism and anti-TPO negative, and Group 3 of 47 euthyroid and anti-TPO negative controls. Results: : Kruskal Wallis H test was applied, and the difference in concentration of TSH, FT3, FT4, Ferritin, anti-TPO amongst the three groups was found to be significant. The relationship between anti-TPO levels and serum ferritin concentration was further studied by multinomial logistic regression. We have found that there is a significant difference between the concentrations of ferritin; hence, it is highly likely that those with a high level of anti-TPO antibody shall have a higher concentration of serum ferritin. Conclusion:: ferritin concentrations were decreased in anti-TPO negative hypothyroidism, but in case of anti-TPO positive hypothyroidism the ferritin concentrations are raised. Hence, hypothyroidism should not always be considered as an iron deficiency state.

Effect of calcium intake on iron absorption and hematologic status: A systematic review and dose-response meta-analysis of randomized trials and case-cross-over studies

Background: The interaction between dietary (and supplementary) divalent ions has been a long-standing issue in human nutrition research. Developing optimal calcium and iron supplementation recommendation needs detailed knowledge of the potential trade-offs between: a) the clinical effects of concurrent intake on iron absorption and hematological indices, and b) the potentially negative effects of separated ingestion on adherence to either or both iron and calcium supplements. Human clinical studies have examined the effects of calcium intake on iron status, but there are no meta-analyses or recent reviews summarizing the findings. Objective: We aimed to summarize the literature on the effect of calcium consumption from meals and supplements on iron indices in humans, and quantify the pooled effects. Design: Peer-reviewed randomized and case-cross-over studies were included in this review. Result: The negative effect of calcium intake was statistically significant in short-term iron absorption studies but the effect magnitude was low (weighted mean difference (WMD) = -5.57%, (95% CI: -7.09, -4.04)). The effect of calcium on iron status was mixed. There was a quadratic dose-response relationship between calcium intake and serum ferritin concentration. Higher daily calcium intake was associated with a modest reduction in serum ferritin concentration. There was, however, no reduction in hemoglobin concentration (WMD = 1.22g/L, 95% CI: 0.37, 2.07). Conclusion: The existing body of studies is insufficient to make recommendations with high confidence due to heterogeneity in design, limitations of ferritin as an iron biomarker and lack of intake studies in pregnant women. Prescribing separation of prenatal calcium and iron supplements in free living individuals is unlikely to affect the anemia burden. There is a need for effectiveness trials comparing the effects of prescribing separated intake to concurrent intake, with functional end-points as primary outcomes, and adherence to each supplement as intermediate outcomes.