Iron status of Filipino infants and preschoolers using plasma ferritin and transferrin receptor levels.

Iron status of 1,861 Filipino infants and preschoolers was evaluated by measurements of plasma ferritin (PF), transferrin receptor (TR) and hemoglobin (Hb). One group of subjects (Group I) consisted of all anemic subjects together with a systematic subsample from the Fourth National Nutrition Survey-Biochemical Phase. Results showed that depleted iron stores based on PF (< 12.0 ng/ml) was present in 70.0% of infants and 60.5% of preschoolers. Tissue iron deficiency based on TR (> 8.5 mg/l) was present in higher proportion (80.0% and 73.7% for infants and preschoolers) which was comparable to the proportion of anemia (80.3%). In a subgroup of subjects from the Country Program for Children IV (Group 2) elevated TR was present in 61.4% of infants and 46.5% of preschoolers. A lower proportion of depleted iron stores of 22.7% in infants and 15.2% in preschoolers was observed. Correlation test showed that there was a closer relationship between Hb and TR (r = -0.42) than Hb and PF (r = 0.20) even if PF was expected to give a higher proportion of values below normal. The occurrence of anemia in the presence of elevated TR without any decrease in PF values suggest that the diagnostic ability of PF could be limited in the presence of infection. Therefore, future studies should include biochemical tests such as C-reactive proteins (CRP) to determine the extent of association between anemia and infection.

Iron status of pregnant Filipino women as measured by serum ferritin.

Iron status of pregnant women at different stages of pregnancy was evaluated by comparing values for hemoglobin (Hb), red cell indices, serum iron (SI), transferrin saturation (TS) and serum ferritin (SF) values with those of a group of non-pregnant women of comparable age and socio-economic status. Mean SF values on the second and third trimesters (9.3 +/- 2.60 ng/ml and 7.1 +/- 2.19 ng/ml) were significantly lower compared to that in the first trimester (22.6 +/- 2.20 ng/ml). These levels were also lower than that found in the non-pregnant controls. The trend was the same for TS. Hemoglobin levels of the pregnant subjects were significantly lower than those of the non-pregnant women. Prevalence of iron deficiency based on SF < 12.0 ng/ml and TS < 16.0% was highest at term and lowest during the first trimester indicating a decrease in iron stores as pregnancy progressed. Sensitivity for each of the iron parameters was computed, and it was found that for the diagnosis of iron deficiency in pregnant women, SF has a greater sensitivity than TS, SI, MCV and MCH.

Menstrual blood loss and iron nutrition in Filipino women.

Menstrual blood loss was measured in 80 apparently healthy women aged 15-44 years. The study showed a median menstrual blood loss of 37.1 ml per period and the range was from 5.4-169.0 ml. With an average menstrual cycle of 29 days and a mean hemoglobin content of 12.8 g/dl the average iron loss was estimated to be about 0.55 mg/day. The simultaneous effects of menstrual iron loss and dietary iron intake on the iron status of menstruating women were examined using multiple regression analysis. The parameters used to measure iron status were serum iron, transferrin saturation index (TSI), hemoglobin and mean corpuscular hemoglobin concentration (MCHC). Among these parameters, TSI was found to be the most sensitive indicator of changes in factors affecting iron balance moreover, it was found that with greater menstrual loss and decreasing iron intake, there was a marked fall in TSI. However, the decline of TSI did not reach a level at which deficiency of iron transport would have occurred. These results suggest that iron intake was enough to replenish the iron lost in menstruation. Results of statistical analysis showed that the upper limit of menstrual blood loss should be about 80 ml per period. Any loss above this level for continuously long period of time may lead to anemia. This condition is further aggravated by insufficient iron intake. The data from this study are useful in estimating the recommended dietary allowance (RDA) for iron for menstruating Filipino women. They will also serve as a basis of management of patients in medical practice in terms of evaluating risk of and treatment of iron-deficiency anemia.

Assessment of iron status of Filipino pregnant women.

Plasma ferritin (PF), erythrocyte protoporphyrin (EP) and hemoglobin (Hb) were used to assess the iron status of 158 Filipino pregnant women included as subjects in the third national nutrition survey conducted by the Food and Nutrition Research Institute in 1987. The prevalence of iron depletion was 39.9% based on PF (less than 12 ng/ml). Iron deficient erythropoiesis was present in 36.1% based on EP of greater than 28 micrograms/dl whole blood and 40.5% based on EP/Hb ratio of greater than 2.4. When the criterion of iron deficiency was that both PF and EP were abnormal, the prevalence of deficiency was lower and only 16.4%. Iron deficiency anemia was present in 14.6% based on Hb less than 11 g/dl in addition to abnormal PF and EP. Significantly lower mean values for PF were obtained in women on the 2nd and 3rd trimesters of pregnancy indicating decreasing iron stores and the need for iron therapy to prevent anemia during those periods. The iron status of 38 women who reported taking iron supplements was not significantly different from those who did not take supplements.

Assessment of the iron status of Filipino adolescents.

The iron nutritional status of 1,153 Filipino adolescents from low, medium and high socio-economic groups was assessed by determination of hemoglobin, FEP, serum ferritin and transferrin saturation. Prevalence rates of iron deficiency based on FEP and serum ferritin were higher for females than for males. Iron deficiency was more prevalent among adolescents from low socio-economic families. The high prevalence of iron deficiency (24.4%) based on FEP among females from the low socio-economic group may be due to inadequate iron intake and low availability of dietary iron since 79.7% came from vegetable sources. Compared to FEP and transferrin saturation, serum ferritin determination appeared to be more sensitive as an indicator of iron status.

Hemoglobin levels in normal Filipino pregnant women.

The hemoglobin concentrations during pregnancy in Filipinos belonging to the upper income group, who were prescribed 105 mg elemental iron daily, and who had acceptable levels of transferrin saturation, were examined in an attempt to define normal levels. The hemoglobin concentrations for each trimester followed a Gaussian distribution. The hemoglobin values equal to the mean minus one standard deviation were 11.4 gm/dl for the first trimester and 10.4 gm/dl for the second and third trimesters. Using these values as the lower limits of normal, in one group of pregnant women the prevalence of anemia during the last two trimesters was found lower than that obtained when WHO levels for normal were used. Groups of women with hemoglobin of 10.4 to 10.9 gm/dl (classified anemic by WHO criteria but normal in the present study) and those with 11.0 gm/dl and above could not be distinguished on the basis of their serum ferritin levels nor on the degree of decrease in their hemoglobin concentration during pregnancy. Many subjects in both groups, however, had serum ferritin levels less than 12 ng/ml which indicate poor iron stores. It might be desirable in future studies to determine the hemoglobin cut-off point that will delineate subjects who are both non-anemic and adequate in iron stores using serum ferritin levels as criterion for the latter.

Hematological effects of prenatal iron supplementation on mothers and their infants.

Infants born to mothers who served an subjects of an iron supplementation study among pregnant women were followed-up for one year to assess the benefits derived by the infants from the iron treatment of the mothers. Hemoglobin and hematocrit levels at one to three months after birth were not statistically different between infants of iron-treated and untreated mothers. Infants aged six to twelve months who have not received any dietary iron supplement and were born from iron-treated mothers tended to have slightly higher hemoglobin levels than infants born to mothers not treated with iron during pregnancy but differences were not statistically significant. Mean hemoglobin levels for the infants aged six to twelve months who received daily iron supplement were significantly higher compared to hemoglobin levels of infants with either no iron or with intermittent iron supplement. Initial hemoglobin and hematocrit levels of pregnant mothers before supplementation and at one month postpartum, which were included in the report, showed higher gains in hemoglobin levels for the anemic mothers treated with iron compared to the gain found for the placebo group.

Iron supplementation studies among pregnant women.

The effect of iron supplementation alone or in combination with ascorbic acid as a preventive and or corrective measure against anemia were tested using pregnant women seeking pre-natal consultation at various health centers in Greater Manila Area. One tablet containing 65 mg iron alone or in combination with ascorbic acid per day during a supplementation period which varied from 16.5 to 17.8 weeks maintained initial hemoglobin and hematocrit levels in non-anemic women. Three tablets of the same iron preparation (total of 195 mg iron) daily resulted in significant increases in hemoglobin and hematocrit in anemic women. Ascorbic acid had no apparent beneficial effect. Considering the positive response to iron treatment, it is recommended that a nationwide program of iron supplementation of pregnant Filipinos be undertaken.