Железодефицитные новости

[Dr.Vad]

Recommendations for those who wish to follow a vegetarian diet:

• Since the digestibility of plant proteins is lower than that of animal proteins, it may be appropriate for vegetarians to consume more proteins than recommended for the general population
• Vegetarians should be encouraged to supplement their diets with a reliable source of vitamin B12 (vitamin-fortified foods or supplements)
• Vegetarians should be encouraged to regularly consume foods that are good sources of calcium
• Vegetarians should be encouraged to increase their iron intake above the population reference intake suggested for omnivores, by eating a variety of iron-rich plant foods that are low in phytate and oxalate
• Vegetarians should be encouraged to consume more dietary zinc than the population reference intake suggested for omnivores, especially when the dietary phytate:zinc ratio is high
• Vegetarians can improve their n-3 nutritional status by regularly consuming good sources of alpha-linolenic acid and limiting intake of sources of linoleic acid
---
Position paper on vegetarian diets from the working group of the Italian Society of Human Nutrition
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

У детей 3-4 лет с выраженным ранним кариесом чаще обнаруживается ЖДА в сочетании с дефицитом витамина Д: так гемоглобин менее 110 и витамин Д менее 20 нг/мл (50 нМ) был обнаружен в 11% случаев детей с кариесом, но ни у одного в контрольной группе; своеврем. коррекция ЖД и дефицита вит. Д может препятствовать развитию кариеса у дошкольников
---
Paediatr Child Health. 2018 May;23(3):e40-e45.
Combined deficiencies of 25-hydroxyvitamin D and anemia in preschool children with severe early childhood caries: A case-control study.
Deane S и соавт.

[Dr.Vad]

Помогает ли железо, принимаемое внутрь, улучшить спортивные достижения? помогает, особенно отчетливо это заметно, если изначальный уровень ферритина был ниже 20:

12 studies with a total of 283 participants were included. Supplementing IDNA athletes with iron improved performance in 6 studies (146 participants) and did not improve performance in the other 6 studies (137 participants). In the 6 studies that showed improved performance with iron supplementation, all used a ferritin level cutoff of ≤20 μg/L for treatment. Additionally, all studies that showed improved performance used oral iron as a supplement.
---
Sports Health. 2018 May 1:1941738118777488.
Does Iron Supplementation Improve Performance in Iron-Deficient Nonanemic Athletes?
Rubeor A, и соавт.

[Dr.Vad]

Французский опыт применения лечения дефицита железа у психиатрических пациентов:

Kassir A
[Iron deficiency: A diagnostic and therapeutic perspective in psychiatry].
Encephale. 2017 Feb;43(1):85-89.

OBJECTIVES:
The aim of this research study is to explore the percentage of psychiatric patients who have a deficiency in iron. In addition, the study investigates the efficacy of iron administered by oral treatment on psychiatric symptomatology among iron deficient patients. The research study utilized the martial biological results, which involved the observation of the level of iron deficiency among the outpatients of a local psychiatrist and assessor from the period of January 2012 until December 2013.

METHODS:
Out of 412 patients, 295 were women and 117 men. The age of the participants ranged from 16 to 89 years, with an average age of 45 years. The only exclusion criterion was a patient's refusal or inability to take the prescribed iron assessment test. We considered a transferrin saturation coefficient (TSC)<30% and/or a serum ferritin level ≤50 ng/mL to be "indicative" of obvious iron deficiency, and a ferritin level between 51 and 100 ng/mL to be "suggestive" of iron deficiency. A plasma ferritin assay was performed at least once on all of the participants prior to any proposed iron treatment. A calculation of the TSC in 138 patients was requested due to suspected iron deficiency despite a blood ferritin level of>100 ng/ml. A single method was utilized in the various laboratories to analyse the blood samples to determine whether there was a deficiency in iron. Only those patients with blood ferritin levels ≤100 ng/mL and/or a TSC of <30% (335 patients) were subsequently given exclusively an oral iron treatment prescribed on its own or as a supplement or simultaneously with psychotropic treatment. The daily administered dose of elemental iron varied between 50 and 200 mg a day.

RESULTS:
About half of the women - 145 (35.19% of the subjects) - and 15 men (3.64% of the subjects) certainly had a deficiency in iron (blood ferritin level ≤50 ng/mL). Ninety women and 24 men (27.6% of the subjects) had blood ferritin levels between 51 and 100ng/mL indicating iron deficiency, and 28 women and 33 men (14.8% of the subjects) had a TSC of <30% despite a blood ferritin level of >100 ng/mL. Overall, 335 patients (81.3% of the subjects) showed an iron deficiency based on the criteria we set. In the remaining 77 patients (18.7% of the subjects), all of them had blood ferritin levels >100 ng/mL and some had TSC≤30%, while the remaining patients' TSC was unknown because it was not measured. The results indicated that there is an iron deficiency in 198 out of 240 patients suffering mostly from mood and behavioural disorders, in 101 out of 126 patients suffering mostly from anxiety disorders, in 18 out of 27 patients suffering mostly from sleep disorders, in 14 out of 15 patients suffering mostly from delusions of persecution, and in the 4 patients suffering mostly from burn out. There was evidence of regression/remission of psychiatric symptoms in 193 responsive patients whereas the remaining 142 patients were considered non-responsive. In the responsive patient category, 37 participants were treated with just iron, 52 received iron supplemented to the initial psychotropic treatment which was not fully effective, and 104 patients were treated with iron and prescribed psychotropic drugs simultaneously. The iron treatment seems to bring about a reduction - particularly through its mono-aminergic neurotransmitter synthesis-promoting action - in hyperemotivity, anxiety, irritability, aggressiveness, sadness, anhedonia, apathy, asthenia, sleep disorders, dysautonomia symptoms, eating disorders, restless-leg syndrome, cognitive performance and the likelihood of resorting to psychiatric admission. A daily elemental iron dose intake between 50 and 200mg/day by deficient patients appears to likely enhance the effects of the psychotropic drugs and even to act as an actual antidepressant. Many patients who received a prescription for iron and antidepressants showed few side effects related to antidepressants and a small number required psychiatric hospitalization. Patients considered unresponsive to iron therapy were those who left the study, were not assessed because the study's timeframe ended, still had an iron deficiency because they did not continuously take the medication, or suffered from somatic diseases which explains their resistance to treat the low iron level (nutritional imbalance, digestive or urinary or gynecological or iatrogenic diseases, sleep apnea).

CONCLUSION:
Our clinical observation of two years in a local psychiatrist's clinic revealed that over 80% of patients had iron deficiency. Although the low iron level cannot explain all physical and psychiatric symptoms in patients, it is useful to note that more than half of the iron deficient patients responded favorably after an oral treatment of iron. This result leads to further investigation of the level of iron in psychiatric patients and to reconsider the iron range placed by the laboratories. In addition, it is crucial not to eliminate the possibility of iron deficiency in psychiatric patients.

[Dr.Vad]

Железа бисглицинат 27 мг для лечения анемии во время беременности за 8 недель повышает гемоглобин быстрее и с меньшими побочными действиями, чем железа глицин сульфат (ферросанол 100 мг железа), подробнее:

The study included 187 women in the final analysis. The mean increase in HB level after 8 weeks of treatment in ferrous bis-glycinate group was 24.8 ± 1.2 g/L versus 13.2 ± 1.8 g/L in ferrous glycine sulphate group (p ≤ 0.0001). The percentage of women with HB level more than 11 g/dL after 8 weeks of treatment was 89.2% in ferrous bis-glycinate group versus 71.3% in ferrous glycine sulphate group (p < 0.0001). The rate of adverse effects was significantly higher in ferrous glycine sulphate group (p = 0.001)
---
J Matern Fetal Neonatal Med. 2018 May 29:1-161.
Efficacy of ferrous bis-glycinate versus ferrous glycine sulphate in the treatment of iron deficiency anemia with pregnancy: a randomized double-blind clinical trial.
Abbas A и соавт.

[Dr.Vad]

Два кейса из Финляндии, где женщинам с тироидными проблемами и латентным железодефицитом именно коррекция дефицита железа снижала симптоматику, а снижение ферритина менее 100 сопровождалось рецидивами симптомов:

Iron deficiency without anemia–a clinical challenge
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Как незначительная недоношенность и железодефицит матери негативно влияют на запасы железа у плода: ферритин у плода был 96 при ЖД у матери и не особенно менялся на сроке 37-41 недели; тогда как ферритин был 116 у плода без дефицита железа и отмечался его рост с 37 до почти 39 недель беременности, после чего оставался таким же до 41 недели:

J Perinatol. 2018 Jun 8. doi: 10.1038/s41372-018-0140-9
Inadequate iron stores in early term neonates.
Hua Y и соавт.

[Dr.Vad]

ЖД, анемия и дефицит В12 негативно влияет на поведенческие реакции у мальчиков-подростков, но не у девочек:

We assessed whether ID (ferritin <15 µg/L), anemia (hemoglobin <12.7 g/dL), or blood concentrations of zinc, vitamins A and B12, and folate at ages 5-12 y were associated with externalizing or internalizing behavior problems in adolescence in 1042 schoolchildren from Bogotá, Colombia. Behavior problems were assessed with the Youth Self-Report questionnaire after a median 6.2 y of follow-up.
Mean ± SD externalizing and internalizing problems scores were 52.6 ± 9.6 and 53.8 ± 9.9, respectively. Among boys, middle-childhood ID, anemia, and low plasma vitamin B12 were associated with 5.9 (95% CI: 1.0, 10.7), 6.6 (95% CI: 1.9, 11.3), and 2.7 (95% CI: 0.4, 4.9) units higher mean externalizing problems scores in adolescence, respectively-after adjustment for baseline age, time spent watching television or playing video games, mother's height, and socioeconomic status. Also in boys, ID was related to an adjusted 6.4 (95% CI: 1.2, 11.6) units higher mean internalizing problems score. There were no associations among girls.
---
J Nutr. 2018 Apr 20.
Iron Deficiency, Anemia, and Low Vitamin B-12 Serostatus in Middle Childhood are Associated with Behavior Problems in Adolescent Boys: Results from the Bogotá School Children Cohort.
Robinson SL и соавт.

[Dr.Vad]

Ассоциация ЖДА с менструальной мигренью:

The migraine subgroups selected were as follows: (1) pure menstrual migraine (PMM) or menstrually related migraine (MRM) and (2) migraine not associated with menses (MNAM).
IDA was more common in patients with migraine than controls (21.7% vs 12.9%, P = 0.02). There was no association between IDA and tension-type headache (15.9% vs 12.9%, P = 0.43). Family history of migraine (P < 0.001) and IDA (P = 0.03) were significant factors in the model of migraine. Age (P = 0.009), family history of migraine (P < 0.001), and IDA (P = 0.018) were significant factors in the model of PMM/MRM. Only family history of migraine (P < 0.001) was significant in the model of MNAM.
---
Pain Med. 2016 Mar;17(3):596-605.
Iron Deficiency Anemia Is Associated with Menstrual Migraine: A Case-Control Study.

++++++++++++++++++++++++++

Of all IDA patients, 79.5 % defined headache at any time of their life. In addition, 36.2 % of all IDA patients defined the criteria for migraine. IDA patients with migraine were more frequently smokers and had significantly lower hemoglobin and mean corpuscular volume values (p values < 0.05). The IDA group with migraine had significantly higher mean anxiety score (p = 0.046) and headache-related QoL disturbance score (p = 0.021) than the IDA group without migraine. Migraine patients with aura had lower hemoglobin values (p = 0.02), higher depression scores (p = 0.005), and higher migraine-related QoL disturbance scores than others.
---
Wien Klin Wochenschr. 2016 Dec;128(Suppl 8):576-580.
Is iron-deficiency anemia associated with migraine? Is there a role for anxiety and depression?
Pamuk GE и соавт.

[Dr.Vad]

Стресс у матери во время беременности повышает риск ЖД у новорожденного в 3.5 раза:

Maternal recall of distress and health concerns during pregnancy correlated with cord blood ZnPP/H indices (r = 0.21, P < .01), even in the absence of major traumatic events... At 1 year, 24% of infants who were breastfed had moderate iron deficiency (plasma ferritin <12 µg/L). Higher cord blood ZnPP/H was predictive of this moderate iron deficiency (95% CI 1.26-1.47, P = .007). When coincident with maternal reports of gestational stress, the likelihood of low plasma ferritin at 1 year increased 3.6-fold in breastfed infants as compared with low-stress pregnancies (95% CI 1.33-6.83, P = .007).
---
J Pediatr. 2018 Jun 14.
Maternal Perceived Stress during Pregnancy Increases Risk for Low Neonatal Iron at Delivery and Depletion of Storage Iron at One Year.
Rendina DN, et al.

[Dr.Vad]

Если дошколятам готовить в железной/чугунной посуде на протяжении 4 мес., то их гемоглобин остается прежним, а у тех, у кого была анемия, она ликвидируется, тогда как готовка в дюралевой посуде ассоциируется со снижением уровня гемоглобина у детей:

Children (preschoolers aged 4-5 y for 16 wk.) were cluster randomized to either eating from iron pots (Group A) or aluminum pots (Group B). Primary outcome variables were change in hemoglobin concentration and anemia prevalence.
At baseline, for group A, mean hemoglobin concentration was 122.6 ± 10.2 g/dL and 122.9 ± 9.5 g/L after intervention, p = 0.78. In group B, mean baseline hemoglobin was 123.4 ± 10.4 g/L, and 121.3 ± 8.6 g/L after intervention, p = 0.07. All ten participants, who were anemic at baseline, were no longer anemic after intervention.
---
Indian J Pediatr. 2018 Jan 11.
Iron Pots for the Prevention and Treatment of Anemia in Preschoolers.

[Dr.Vad]

Риск бактериемии /сепсиса увеличен в полтора раза у людей с железодефицитом:

In age- and sex-adjusted analyses, BSI risk was increased among participants with indices of iron deficiency, serum iron ≤ 2.5th percentile (HR 1.72, 95% CI 1.34-2.21), Tsat ≤ 2.5th percentile (HR 1.48, 95% CI 1.12-1.96) or TIBC ≥ 97.5th percentile (HR 1.46, 95% CI 1.06-2.01). The associations remained similar after adjusting for comorbidities and exclusion of BSI related to cancer, rheumatic illnesses and inflammatory bowel disease. BSI mortality showed similar associations.
---
Intensive Care Med. 2018 Jul 23.
Association of iron status with the risk of bloodstream infections: results from the prospective population-based HUNT Study in Norway.
Mohus RM и соавт.

[Dr.Vad]

Тяга к поеданию сырого риса (рисовой крупы) как следствие ЖДА (гемоглобин 79 г/л) на фоне меноррагии из-за СПКЯ:
Med J Malaysia. 2018 Jun;73(3):170-171
Ryzophagia secondary to polycystic ovarian syndrome (PCOS) - related menorrhagia
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Преимущества лечение ЖДА во время беременности в/в железом по сравнению с пероральным: чаще удается достигнуть целевого уровня, через 4 недели лечения гемоглобин в среднем на 8.4 г/л выше, и в 3 раза снижена частота побочного действия:

...pregnant women receiving IV iron, compared with oral iron, had the following benefits:
(1) Achieved target hemoglobin more often, pooled OR 2.66 (95% confidence interval [CI]: 1.71-4.15), p < 0.001;
(2) Increased hemoglobin level after 4 weeks, pooled WMD 8.4 g/L (95% CI: 0.59-1.09), p < 0.001;
(3) Decreased adverse reactions, pooled OR 0.35 (95% CI: 0.18-0.67), p = 0.001.
---
Am J Perinatol. 2018 Aug 19.
Treatment of Iron Deficiency Anemia in Pregnancy with Intravenous versus Oral Iron: Systematic Review and Meta-Analysis.

[Dr.Vad]

Риск развития дефицита железа повышается в 3.5 раза у пациентов, постоянно принимающих празолы (ИПП), и в 1.5 раза - если их прием периодический, по сравнению с пациентами, которые никогда их не принимали:

Adjusted odds ratio of ID in PPI "full" user (PFU) /defined as a subject who had received PPIs for a continuous duration of at least one year prior to the index date/ and PPI "limited" users (PLU) was a subject who intermittently received PPI therapy compared to PPI non-user (PNU) was 3.60 (95%CI, [3.32 - 3.91]) and 1.51 (95% CI, [1.44 - 1.58]). Positive dose-response and time-response relationships were observed.
---
J Intern Med. 2018 Aug 23.
Use of proton pump inhibitor and risk of iron deficiency: a population-based case-control study.
Tran-Duy A и соавт.