Refractory iron-deficiency anemia and gluten intolerance - Response to gluten-free diet.

INTRODUCTION: refractory iron-deficiency anemia has a multifactorial origin related to various gastrointestinal conditions, with celiac disease plus malabsorption and IBD together with isolated gluten intolerance being most common. OBJECTIVES: to determine the prevalence of serum, genetic, and histological markers for gluten intolerance, and to analyze the response to gluten withdrawal from the diet in these patients. METHODS: a number of patients with refractory anemia were prospectively and consecutively enrolled. A protocol to measure serum (TGt-2), genetic (HLA-DQ2/DQ8), and histological markers for celiac disease was applied. All followed a gluten-free diet for a median 3.6 years. Sustained remission of anemia during follow-up was interpreted as positive response. RESULTS: ninety-eight patients (84% females) with a mean age of 54 years were studied. Anti-TGt2 antibodies were positive in 5% of cases. A total of 67 cases (68%) were haplotype HLA-DQ2 or -DQ8 (+). We found villous atrophy (Marsh III) in 13% of patients, and an inflammatory pattern (Marsh I or II) in 13%. All remaining 72 patients (74%) had no histological duodenal changes.Age, anemia duration, number of transfusions, number of parenteral iron doses, and time on a gluten-free diet were all compared according to the presence or absence of villous atrophy and HLA-DQ2/8 positivity, and no significant differences were found for any of the analyzed variables. Response was positive in 92% of subjects. CONCLUSIONS: celiac disease with villous atrophy is rarely a cause of refractory anemia. Gluten intolerance with no histological lesions is seen in almost 75% of patients, and therefore plays a relevant role in its development.

Consumo de alimentos fontes de ferro e de estimulantes de sua absorção por crianças menores de um ano / Consumption of iron sources and iron absorption stimulating foods by under year old infants

O objetivo deste trabalho foi verificar se a prática alimentar de 400 crianças menores de um ano de vida, atendidas em duas Unidades Básicas de Saúde-Escola do Município de Mogi das Cruzes, pode favorecer o desenvolvimento da anemia ferropriva. As informaçöes sobre alimentaçäo foram obtidas em entrevistas com as mäes. Verificou-se que 26,8 por cento das crianças se encontravam em aleitamento materno exclusivo ou predominante, aos 90 dias de idade. Observou-se a introduçäo de outros tipos de leite, bem como de alimentos näo lácteos, no esquema alimentar das crianças que näo estavam em aleitamento materno exclusivo ou predominante. Para as que já consumiam alimentos näo lácteos, levantou-se a frequência de consumo de alimentos que fornecem ferro e vitamina C, nutrientes encontrados em quantidades insuficientes no leite. Houve adequaçäo tanto da época de introduçäo da fruta quanto da frequência semanal de consumo. A frequência de consumo de leguminosas foi considerada regular. O consumo de verduras foi restrito, apesar da frequencia semanal ser adequada. Houve uma baixa frequência semanal de consumo de carne. Conclui-se que a alimentaçäo das crianç deste estudo provavelmente näo cobre as necessidades de ferro, podendo favorecer o desenvolvimento de anemia ferropriva.

Iron supplementation moderates but does not cure the Belgrade anemia.

Belgrade rats inherit microcytic, hypochromic anemia as an autosomal recessive trait (gene symbol b). Erythrocytes and tissue are iron deficient in the face of elevated TIBC (total iron binding capacity) and percent iron saturation; iron injections increased the number of erythrocytes but their appearance remained abnormal. We have investigated iron supplements to improve husbandry of b/b rats and to learn more about the underlying defect and its tissue distribution. Weekly i.m. (intramuscular) injections of iron-dextran (Imferon at 30 mg kg-1) improved the anemia but did not alter the red cell morphology. Certain diets also improved the health of b/b rats when compared to standard rat chows by the criteria of weight, survival to adulthood, hematology and reproduction. The critical nutritional factor turned out to be iron bioavailability, with ferrous iron added to the diet improving the health of Belgrade rats without affecting the underlying erythroid defect. Tissue iron measurements after dietary or parenteral supplementation confirmed the iron deficient status of untreated b/b rats and established that dietary ferrous iron partially relieved this deficiency, with injections leading to greater amounts of tissue iron. Serum iron and TIBC were also found to be elevated in untreated b/b rats, with dietary supplementation decreasing but not eliminating the elevation in TIBC. These studies indicate that iron supplements can improve the health of b/b rats without altering the underlying defect and also suggest that the mutation could alter iron uptake in the GI (gastrointestinal) tract.

Iron deficiency: contemporary scientific issues and international programmatic approaches.

Iron deficiency is a common nutritional disorder in developing countries and contributes significantly to reduced work productivity and economic output as well as to increased morbidity and mortality. There are well established biochemical tests for assessing iron status in developed countries. However, cost and interference from infectious conditions make it difficult to assess iron status in many developing country settings. Examination of the hemoglobin distribution in the population and assessment of the hemoglobin response to supplementation are alternative approaches to defining iron status and the nature of anemia. Prevention and control of iron deficiency requires the combined approach of dietary improvement, fortification of a common staple food when feasible, and appropriate iron supplementation for infants and pregnant women. In all these intervention activities, operational research is needed to improve effectiveness. In addition, controlling iron deficiency requires coordination with other nutrition and primary health care programs as part of an integrated approach to improved health and nutrition of the population.

Determinants of compliance with iron supplementation: supplies, side effects, or psychology?

Iron deficiency anemia affects over 2 billion people. Particularly at risk are pregnant women and young children. Although distribution of iron supplements is practised in many antenatal care programs in developing countries, it has often been alleged that pregnant women do not take them. Poor compliance arises not only because of patient behavior but also from factors out of the patient's control. This paper presents the results of a review of the literature on medical compliance to determine whether iron supplementation is different from other medications, to assess the known levels of compliance, and to synthesize recommendations for improving compliance relevant to iron supplementation. The review showed that compliance with iron therapy is a specific case of medical compliance. Reasons for non-compliance with iron deficiency treatment include: inadequate program support (lack of political commitment and financial support); insufficient service delivery (poor provider-user dynamics; lack of supplies, access, training, and motivation of health care professionals); and patient factors (misunderstanding instructions, side effects, frustration about the frequency and number of pills taken, migration, fear of having big babies, personal problems, nausea that accompanies pregnancy, and the subtlety of anemia which makes demand for treatment low). Much has been made about the side effects (nausea, constipation, etc.) that women might experience during iron therapy as the cause of poor compliance with iron supplementation without justification according to this review. Instead, unavailability of iron supplements was the most common reason why women did not take iron supplements. Women bear a disproportionate burden from iron deficiency anemia even though the technology exists to address the problem at low cost. Governments and health care professionals must renew their commitment to iron therapy by monitoring and improving compliance. We can significantly improve compliance by: making sure that iron supplements are available at all times; providing advanced warning about the possibility of side effects; involving the patient in the therapeutic strategy; and providing reminders, such as posters and calendars, about taking supplements.

Severe iron deficiency anaemia in Fiji children.

AIMS: A prospective study to determine the magnitude of the problem of severe iron deficiency anaemia in Fiji children with intercurrent illnesses and their response to the interventions with dietary modifications and iron therapy. METHODS: A total of 2136 consecutive children between 6 months and 12 years of age, who attended a hospital and a health centre in Fiji, for intercurrent illness, during a 9 months period, were screened for severe iron deficiency anaemia (haemoglobin < 70 g/L). RESULTS: Eighty children (3.7%) had severe iron deficiency anaemia. Majority (75%) of children with severe anaemia were younger than 2 years. Dietary and iron therapy were successful in correcting anaemia in all 80 children. CONCLUSIONS: Severe iron deficiency anaemia was common in Fiji children seeking medical attention for intercurrent illness. Simple therapeutic measures, which included dietary advice and iron therapy, were successful in correcting this severe debility in those children.

Supplementation with vitamin A and iron for nutritional anaemia in pregnant women in West Java, Indonesia.

Nutritional anaemia, thought to be caused by iron deficiency, affects 50-70% of pregnant women in the developing world. The influence of vitamin A and iron supplementation was studied in anaemic pregnant women in West Java, in a randomised, double-masked, placebo-controlled field trial. 251 women aged 17-35 years, parity 0-4, gestation 16-24 weeks, and haemoglobin between 80 and 109 g/L were randomly allocated to four groups: vitamin A (2.4 mg retinol) and placebo iron tablets; iron (60 mg elemental iron) and placebo vitamin A; vitamin A and iron; or both placebos, all daily for 8 weeks. Maximum haemoglobin was achieved with both vitamin A and iron supplementation (12.78 g/L, 95% Cl 10.86 to 14.70), with one-third of the response attributable to vitamin A (3.68 g/L, 2.03 to 5.33) and two-thirds to iron (7.71 g/L, 5.97 to 9.45). After supplementation, the proportion of women who became non-anaemic was 35% in the vitamin-A-supplemented group, 68% in the iron-supplemented group, 97% in the group supplemented with both, and 16% in the placebo group. Improvement in vitamin A status may contribute to the control of anaemic pregnant women.

[Efficacy and tolerance of a dietary iron supplement (Bio-fer) in pregnancy anemia]. / Efficacité et tolérance d'un complément au fer alimentaire (Bio-fer) dans l'anémie gravidique.

Fifty pregnant women with a hemoglobin between > 10 and < or = 12 g/100 ml during the second three months of pregnancy participated in a non-comparative clinical trial intended to evaluate, during a one month treatment period, the acceptability and effectiveness of an iron supplement (Bio-fer), combined with a high iron diet. Gastric discomfort regressed (present in 11 and 3 women before and after treatment) (p < 0.05), the same applying to constipation (p < 0.05) (present in 17 and 8 women before and after treatment). Reasons for abandoning treatment were nausea (n = 2) and vertigo (n = 1). Anemia or deficiency, evaluated on the basis of hemoglobin and iron-binding capacity levels, improved or stabilised in 34 patients out of 47 (72.3%). Hemoglobin increased (p < 0.0001) on average from 11.4 +/- 0.6 to 11.7 +/- 0.8 g/100 ml.

Effect of chlorella on rats with iron deficient anemia.

In order to determine effects of iron deficiency on the living body, rats were given the iron deficient diet (Group 1, iron content, 0.32mg/100g), the complete diet added with iron (Group 5, iron content, 32.5mg/100g), the diet added with 1% chlorella (Group 2, iron content, 2.2mg/100g), the diet added with 5% chlorella (Group 3, iron content, 7.4mg/100g), or the diet added with 10% chlorella (Group 4, iron content, 13.9mg/100g). For the first 30 days, rats of all groups were given the iron deficiency diet to make them iron deficient, and were subsequently given the respective diet during the next 30 days to observe various changes in the conditions of rats. Following results were obtained. 1) When rats were reared for 30 days with the iron deficient diet, rats of these groups became anemic and their hemoglobin concentrations and hematocrit values lowered. Rats of Groups 3, 4 and 5 fed with the diets containing certain amounts of iron rapidly recovered, while the recovery of those of Group 2 fed with less iron content diet was delayed. Group 1 fed with the iron deficient diet showed no recovery. 2) Examination of effects of these diets on the rats body weight gains revealed that the growth of Groups 1 and 2 with iron deficiency was delayed notably (p less than 0.01) as compared with Group 5 and that of Group 3 was likewise restrained (p less than 0.05). The relative organ weights of all rats were examined. The liver weight in Groups 1, 2, 3, 4 was lower than that in Group 5, while that of the spleen in Groups 1 and 2 was higher than that in Group 5. 3) The Numbers of erythrocyte decreased in Groups 1 and 2 (p less than 0.01) and increased in Groups 3 and 4 (p less than 0.01) as compared with Group 5. There was no direct relation between the iron content in the diet and the number of leukocytes and their compositions. 4) Serum iron decreased remarkably in Groups 1 and 2 (p less than 0.01) but there were no intergroup differences in blood glucose value. 5) When osmotic fragility of erythrocyte membranes was expressed in term of NaCl concentration to indicate 50% hemolysis, Groups 1, 2 and 3 apparently increased their resistance as compared with Group 5 (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[The use of the pasty "Zdorov'e" ("Health") in the treatment of iron deficiency anemia]. / Ispol'zovanie pashteta "Zdorov'e" pri lechenii zhelezodefitsitnoi anemii.

Paste "Zdorovie", a product with high content of protein and assimilable iron, developed at the Moscow Institute of Applied Biotechnology, has been proved to be effective in the combined antianemia therapy. Improved hemograms and biochemical parameters were recorded in 60 pregnant women and nursing mothers suffering from iron-deficiency anemia (IDA). The data obtained have permitted the authors to recommend paste "Zdorovie" for combined treatment of IDA in pregnant women and to consider it promising in prevention of IDA in nursing mothers.

Iron deficiency in coeliac disease is mild and it is detected and corrected by gluten-free diet.

In 54 children with coeliac disease, mild iron deficiency anaemia or evidence of iron deficiency without anaemia were common at the time of diagnosis. Treatment with a gluten-free diet without iron medication eliminated all evidence of iron deficiency and completely normalized laboratory values. Subsequent challenge with gluten resulted in the rapid reappearance of suboptimal iron balance as evidenced by a decrease in serum ferritin concentration.

Iron requirements of pregnancy.

To maintain the necessary maternal iron stores, the pregnant patient needs to receive iron supplements during the last half of pregnancy. These needs are particularly great during the last trimester, increasing from the usual requirement of 3-4 mg/day to 5-6 mg/day. Dietary and oral supplementation therapies are the most efficient methods of supplementing iron in normal pregnant women and those experiencing iron deficiency.

[Evaluation of the effects of specialized therapeutic canned food on the course of iron-deficiency anemia in young children]. / Otsenka vliianiia spetsializirovannykh lechebnykh konservov na techenie zhelezodefitsitnykh anemii u detei rannego vozrasta.

A total of 25 normal children and 131 children with iron-deficiency anemia (IDA) were investigated, 53 out of 131 IDA patients served as controls and received a standard food ration for children suffering from IDA, the rest received nutrition containing medicinal canned food. The following paraclinical parameters were evaluated in all the children investigated: red blood cell and hemoglobin content, calcium concentration, the content of ascorbic acid and vitamin B1, iron metabolism indices (serum iron, general and latent iron-binding capacity of the blood serum, coefficient of transferrin saturation with iron, serum ferritin). The results of the study have shown a favourable effect of the special-purpose medicinal canned food on IDA course in young children that necessitates their wide production and practical use.

Nutritional anemias.

Prevention of nutritional deficiencies should be attained by the consumption of a good diet. Unfortunately, in the case of iron, this is not always possible, and it is advantageous to fortify food with iron. Milk-based formulas and cereals are the most commonly used iron-fortified products in infancy and early childhood. Bioavailability of iron from cereals is low and more clinical studies on the field are necessary to demonstrate the effectiveness of iron-fortified cereals in infants and children of developing countries. Infections and excessive blood loss in infancy related to the use of fresh, pasteurized or powdered cow milk result in much of the anemia we currently see in industrialized countries. Vitamin A deficiency interacts with iron metabolism and recent intervention studies have shown that anemia in Vitamin A deficient children can be successfully treated with oral supplements.

Anemia ferropriva en el lactante: erradicación con leche fortificada con hierro / Control on infant iron deficiency anemia: use of iron supplemented milk

We evaluated the effect of iron supplemented milk on 86 healthy infants who were followed from 3 to 12 months of age. Whole milk was supplemented with 15 mg elementary iron as ferrous sulphate and 100 mg ascorvic acid per 100 g powder. 104 infants received the same mulk with no supplement and served as control. All iron nutritional paramenters were higher in the supplemented group at 9 and 12 months of treatment (p < 0.01). Iron deficiency anemia was shown in 34% of the control as compared to 0% of the treatment group. The product exhibited excellent tolerance and could therefore be used to erradicate iron deficiency anemia of the infant

[A clinical and experimental study of the food and biological value of dietetic canned chicken meat for children]. / Kliniko-éksperimental'noe izuchenie pishchevoi i biologicheskoi tsennosti detskikh dieteticheskikh konservov iz miasa tsypliat.

The results are presented of clinico-experimental investigations of 4 different variants of dietetic canned chicken meat for children. The products were enriched with blood stimulants. Certain clinical and hematological parameters were used for the evaluation of the effectiveness of the canned chicken meat. The results obtained have evidenced that the products studied are tolerated well and produce a pronounced antianemic effect.