Железодефицитные новости

[Dr.Vad]

У женщин с ЖДА синдром дефицита внимания/гиперактивности встречается в 6 раз чаще (почти у каждой пятой):

83 newly diagnosed iron deficiency anemia patients and 70 healthy controls were included in this study. All participants were assessed using a sociodemographic form, Structured Clinical Interview I (SCID-I), Wender Utah Rating Scale (WURS); Moreover, participants having WURS scores 36 and above were also assessed using the Adult ADD/ADHD Evaluation Scale and interviewed according to DSM-5 criteria. In the study, 22.9% of patients with iron deficiency anemia and 12.9% of healthy controls were found to have WURS scores 36 and above. Fifteen patients (18.1%) in iron deficiency anemia group and two patients (2.9%) in control group had adult ADHD, when they were evaluated with Adult ADD/ADHD Evaluation Scale and interviewed according to DSM-5 criteria (p=0.007). The patients with iron deficiency anemia had significantly higher WURS scores compared to controls (p=0.002).
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Noro Psikiyatr Ars. 2017 Mar;54(1):72-77.
The Investigation of Symptoms and Diagnoses of Adult-Attention Deficit/ Hyperactivity Disorder in Women with Iron Deficiency Anemia.

[Dr.Vad]

Железа сульфат против мальтофера для лечения ЖДА у детей 1-3 летнего возраста:

Of 80 randomized infants and children (median age, 22 months; 55% male; 61% Hispanic white; 40 per group), 59 completed the trial (28 [70%] in ferrous sulfate group; 31 [78%] in iron polysaccharide complex group). From baseline to 12 weeks, mean hemoglobin increased from 7.9 to 11.9 g/dL (ferrous sulfate group) vs 7.7 to 11.1 g/dL (iron complex group), a greater difference of 1.0 g/dL (95% CI, 0.4 to 1.6 g/dL; P < .001) with ferrous sulfate (based on a linear mixed model). Proportion with a complete resolution of IDA was higher in the ferrous sulfate group (29% vs 6%; P = .04). Median serum ferritin level increased from 3.0 to 15.6 ng/mL (ferrous sulfate) vs 2.0 to 7.5 ng/mL (iron complex) over 12 weeks, a greater difference of 10.2 ng/mL (95% CI, 6.2 to 14.1 ng/mL; P < .001) with ferrous sulfate. Mean total iron-binding capacity decreased from 501 to 389 μg/dL (ferrous sulfate) vs 506 to 417 μg/dL (iron complex) (a greater difference of -50 μg/dL [95% CI, -86 to -14 μg/dL] with ferrous sulfate; P < .001). There were more reports of diarrhea in the iron complex group than in the ferrous sulfate group (58% vs 35%, respectively; P = .04).

JAMA. 2017 Jun 13;317(22):2297-2304.
Effect of Low-Dose Ferrous Sulfate vs Iron Polysaccharide Complex on Hemoglobin Concentration in Young Children With Nutritional Iron-Deficiency Anemia: A Randomized Clinical Trial.
Powers JM и соавт.

[Dr.Vad]

Железодефицит без анемии как причина хр. повышенной усталости - мета-анализ:

Fe deficiency is a prevalent nutritional disease, and fatigue is a common complaint in the general and patient population. The association between Fe deficiency without anaemia (IDNA) and fatigue is unclear. Here, we performed a meta-analysis to evaluate the therapeutic effect of Fe on fatigue in patients with IDNA and the association between IDNA and fatigue in the population. Articles from the PubMed database up to 19 January 2016 were systematically searched. A total of six relevant randomised controlled trials (RCT) and six relevant cross-sectional studies were identified. All outcomes were converted into effect sizes. In the meta-analysis of the six RCT, we identified a significant therapeutic effect of Fe in fatigue patients with IDNA (pooled effect size 0·33; 95 % CI 0·17, 0·48; I 2=0·0 %; P<0·0001). A sensitivity analysis found that the overall results (i.e. significant association) were robust. In the meta-analysis of the six cross-sectional studies, the association between IDNA and fatigue was not significant (pooled effect size 0·10; 95 % CI -0·11, 0·31; I 2=57·4 %; P=0·362). A sensitivity analysis found that the overall results (i.e. no significant association) were not robust; removal of one study made the outcomes significant. These meta-analyses suggest that improving Fe status may decrease fatigue. Further research is necessary to identify diagnostic criteria for selecting fatigue patients who might benefit from Fe therapy and to assess the prevalence of IDNA with fatigue in the general population.
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Br J Nutr. 2017 Jun 19:1-10.
Iron deficiency without anaemia is a potential cause of fatigue: meta-analyses of randomised controlled trials and cross-sectional studies.
Yokoi K, Konomi A.

[Dr.Vad]

ЖДА как риск фактор для остеопороза - повышен на 75%, если в лечении ЖДА использовали в/в введение железа, то риск повышался на 120%, а если трансфизию эритромассы, то на 50%, по сравнению с людьми без ЖДА, подробнее:

Osteoporosis occurred more often among patients with IDA compared to individuals without IDA (2.27% vs. 1.32%, p < 0.001). Cox proportional hazard analysis revealed that the risk for osteoporosis was significantly higher in the case than the control group (hazard ratio (HR) = 1.74; 95% CI = 1.61-1.88) and remained similar after adjustment for covariates (adjusted HR = 1.81; 95% CI = 1.67-1.97). Compared with individuals without IDA, the risk for osteoporosis was even higher for patients with IDA who received intravenous ferrum therapy (adjusted HR = 2.21; 95% CI = 1.85-2.63). In contrast, the risk for osteoporosis was reduced for patients with IDA who received a blood transfusion (adjusted HR = 1.47; 95% CI = 1.20-1.80).
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Nutrients. 2017 Jun 16;9(6).
Iron Deficiency Anemia as a Risk Factor for Osteoporosis in Taiwan: A Nationwide Population-Based Study.

[Dr.Vad]

Лечение железодефицита без анемии - полный текст 17 страничной статьи в ПДФ доступен по ссылке внизу для своб. скачивания:

Swiss Med Wkly. 2017 Jun 21;147:w14434. eCollection 2017 Jun 21.
The treatment of iron deficiency without anaemia (in otherwise healthy persons).
Clénin GE.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Однократное в/в введение 1000 мг железа пациентам с с-мом беспокойных ног и ферритином менее 75 незначительно улучшило симптоматику через 1 месяц по сравнению с плацебо, существенные различия были замечены спустя 3 месяца:

Ferric carboxymaltose treatment (n = 59) led to nonsignificant improvement over placebo (n = 51) in International Restless Legs Syndrome Severity Scale score at week 4 (difference [95% confidence interval], -2.5 [-5.93 to 1.02], P = 0.163), reaching significance by week 12 (-4.66 [-8.59 to -0.73], P = 0.021).
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Mov Disord. 2017 Jun 23. Ferric carboxymaltose in patients with restless legs syndrome and nonanemic iron deficiency: A randomized trial.

[Dr.Vad]

Детям с низким весом при рождении (менее 2.5 кг) назначение железа в первые месяцы жизни ассоциировалось с более низким риском обнаружения систолической гипертензии в 7 лет:

Am J Clin Nutr. 2017 Jun 28.
Lower systolic blood pressure at age 7 y in low-birth-weight children who received iron supplements in infancy: results from a randomized controlled trial.
Lindberg J и соавт.

Background: Low birth weight (LBW) (≤2500 g) is associated with iron deficiency in infancy and high blood pressure (BP) later in life.
Objective: We investigated the effect of iron supplementation that was given to LBW infants on midchildhood BP.
Design: The study was a randomized, double-blind, controlled trial that included 285 marginally LBW (2000-2500-g) infants at 2 Swedish centers between May 2004 and November 2007. The infants were randomly assigned to receive a placebo or 1 or 2 mg Fe · kg-1 · d-1 from 6 wk to 6 mo of age. In secondary analyses at the age of 7 y, systolic blood pressure (SBP), diastolic blood pressure (DBP), and the prevalence of children with BP within the hypertensive range (>90th percentile) were compared between the groups.
Results: BP was analyzed via intention to treat in 189 children (66%). The mean ± SD SBP was 103 ± 8.1, 101 ± 7.5, and 101 ± 7.8 mm Hg in children who had received the placebo (n = 70), 1 mg Fe · kg-1 · d-1 (n = 54), or 2 mg Fe · kg-1 · d-1 (n = 65), respectively. When the iron-supplemented groups were combined in covariate-adjusted analyses, the mean SBP in LBW children who had received iron supplementation in infancy was 2.2 mm Hg (95% CI: 0.3, 4.2 mm Hg) lower than in those who were unsupplemented (P = 0.026). Multivariate logistic regression showed that iron supplementation in infancy reduced the odds of having an SBP within the hypertensive range at 7 y of age (OR: 0.32; 95% CI: 0.11, 0.96). For DBP, there were no significant differences between the intervention groups.
Conclusions: LBW children who receive iron supplementation (1 or 2 mg Fe · kg-1 · d-1) in infancy have lower SBP at 7 y.

[Dr.Vad]

Сочетанный дефицит цинка и железа у детей 9-12 лет - дети с сочетанным дефицитом были в среднем на полтора см ниже и их ферритин был менее 15:
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Int J Vitam Nutr Res. 2017 Jul 14:1-9.
The Prevalence of Zinc Deficiency and its Correlation with Iron Status and Economical Living Area in 9 - 12-Year-Old Children.

[Dr.Vad]

Опять двухвалентное железо оказалось лучше трехвалентного теперь уже и для профилактики ЖДА у детей первого года жизни - были выше показалели гемоглобина и ниже частота лат. ЖД или ЖДА:

J Pediatr Hematol Oncol. 2017 Sep 1.
Comparison of Different Iron Preparations in the Prophylaxis of Iron-deficiency Anemia.
Aydin A, Gur E, Erener-Ercan T, Can G, Arvas A.
We compared the efficacy of ferrous sulfate (divalent) and ferric polymaltose (trivalent) compounds for the prophylaxis of iron-deficiency anemia (IDA). Study infants included exclusively breast milk-fed term infants. Subjects were divided randomly into 2 groups at 4 months of age and group 1 (n=56) received divalent and group 2 (n=56) received trivalent iron (Fe) preparation at a dose of 2 mg/kg/d for 5 months. At 9 months of age, after a 5-month prophylaxis, a significant increase was observed in hemoglobin (Hb), hematocrit, serum Fe levels, and transferrin saturation in both groups. However, group 1 had significantly higher Hb, hematocrit, mean corpuscular volume, Fe, and transferrin saturation than group 2 (11.7±0.6 g/dL, 34.6%±1.7%, 76.2±2.9 fL, 55.5±1.8 mcg, 20.8±3.9 g/L, respectively in group 1 vs. 11.3±0.5 g/dL, 33.5%±1.5%, 74.7±3.2 fL, 42.5±1.8 mcg, 14.1±7.5 g/L, respectively in group 2). No significant difference was found in ferritin values between the groups. Fe deficiency was found in 17 (30.3%) of the subjects in group 1, and 23 (41%) of subjects in group 2 whereas 5 (8.9%) subjects had IDA in group 1 and 12 (12%) in group 2 which were insignificant between groups.

[Dr.Vad]

Blood Transfus. 2017 Sep;15(5):422-437.
Current misconceptions in diagnosis and management of iron deficiency.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Иллюзорный паразитоз как следствие железодефицитной анемии - коррекция ЖДА полностью избавила от недуга:

Delusional parasitosis secondary to severe iron deficiency anemia [Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Микроцитоз (MCV менее 74) и ферритин менее 18 у детей на втором году жизни ассоциируется с более низким когнитивным развитием ребенка:

Five children (from n=83) had Fe deficiency (ferritin <12 µg/l) and no child had Fe deficiency anaemia (Hb<110 g/l+ferritin<12 µg/l). Children with microcytosis (MCV<74 fl, n=13) had significantly lower mean cognitive composite scores (88·5 (sd 13·3) v. 97·0 (sd 7·8), P=0·04, Cohen's d effect size=0·8) than those without microcytosis. The ferritin concentration which best predicted microcytosis was calculated as 18·4 µg/l (AUC=0·87 (95% CI 0·75, 0·98), P<0·0001, sensitivity 92 %, specificity 75 %). Using 18·5 µg/l as a threshold, children with concentrations <18·5 µg/l had significantly lower mean cognitive composite scores (92·3 (sd 10·5) v. 97·8 (sd 8·1), P=0·012, Cohen's d effect size=0·6) compared with those with ferritin ≥18·5 µg/l.
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Br J Nutr. 2017 Sep;118(5):360-367.
Microcytosis is associated with low cognitive outcomes in healthy 2-year-olds in a high-resource setting.
McCarthy EK и соавт.

[Dr.Vad]

эффективность и безопасность в/в железа для лечения ЖДА во время беременности:

A total of 47 studies were eligible (21 RCTs and 26 observational studies), investigating IS (n = 2635; 41 studies), FCM (n = 276; four studies) and IPM (n = 164; three studies). All IV preparations resulted in significant improvements in haematological parameters, with a median increase of 21.8 g/L at 3-4 weeks and 30.1 g/L by delivery, but there was no evidence of any associated improvements in clinical outcomes. A greater median increase in Hb was observed with a high (25 g/L; range: 20-39.6 g/L) compared with low dose (20 g/L; range: 6.2-50.3 g/L). The median prevalence of adverse drug reactions for IPM (2.2%; range: 0-4.5%) was lower than FCM (5.0%; range: 0-20%) and IS (6.7%; range: 0-19.5%).

-ferric carboxymaltose (FCM), iron polymaltose (IPM), iron sucrose (IS)-

Aust N Z J Obstet Gynaecol. 2017 Sep 18.
Safety and efficacy of intravenous iron polymaltose, iron sucrose and ferric carboxymaltose in pregnancy: A systematic review.

[Dr.Vad]

Профилактика дефицита железа (с 6 недель до 6 мес. возраста) у детей с низким весом (2000-2500 г) при рождении снижает риск их агрессивного/антисоциального поведения и к 7 годам после рождения (равно как и к 3 годам, что было показано ранее):
Pediatr Res. 2017 Sep 27. doi: 10.1038/pr.2017.235.
Effects of iron supplementation of low birth weight infants on cognition and behavior at 7 years-a randomized controlled trial.
Berglund SK и соавт.

[Dr.Vad]

Фебрильные судороги у детей и ЖДА: показатель ферритина показывает наилучшую ассоциативную связь между ними, а не уровень гемоглобина:

A total of 17 studies enrolling 2416 children with FS and 2387 controls were included in the meta-analysis. The results indicated that IDA was significantly associated with FS (OR, 1.98; 95% CI, 1.26-3.13; P=0.003). Subgroup analyses evaluated the diagnostic indices for IDA including serum iron, plasma ferritin, and mean corpuscular volume (MCV). The results indicated that IDA diagnosed on the basis of plasma ferritin (OR, 3.78; 95% CI, 1.80-7.94; P<0.001) or MCV (OR, 2.08; 95% CI, 1.36-3.17; P=0.001) was modestly associated with FS, whereas IDA diagnosed on the basis of two serum iron studies was not associated with FS (OR, 0.57; 95% CI, 0.24-1.37; P=0.210).
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Seizure. 2017 Sep 15;52:27-34.
Relationship between iron deficiency anemia and febrile seizures in children: A systematic review and meta-analysis.
Kwak BO, Kim SN, Lee R.