ascorbic-acid and Anemia--Iron-Deficiency

Iron-deficiency anemia is the most frequent nutritional deficiency, with women of reproductive age being particularly at risk of its development. The aim of the systematic review was to assess the effectiveness of dietary interventions to treat iron-deficiency anemia in women based on the randomized controlled trials. The systematic review was conducted according to the PRISMA guidelines and registered in the PROSPERO database (CRD42021261235). The searching procedure was based on PubMed and Web of Science databases, while it covered records published until June 2021. It included all randomized controlled trials assessing effectiveness of various dietary interventions on treatment of iron-deficiency anemia in women of childbearing age. The total number of 7825 records were screened, while 14 of them were finally included in the systematic review. The studies were screened, included, and reported, and the risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials by two independent researchers. The included studies compared the effectiveness of various dietary interventions with supplementation, placebo, control, or any other dietary intervention, while the assessed dietary interventions were based either on increasing iron supply and/or on increasing its absorption (by increasing vitamin C or vitamin D or decreasing phytate intake). The duration of applied intervention was diversified from 3 months or less, through 4 or 5 months, to half of a year or more. Among the assessed biochemical measures, the following were analyzed in majority of studies: hemoglobin, ferritin, transferrin receptor, hematocrit, and transferrin. The majority of included studies supported the influence of dietary interventions on the treatment of iron-deficiency anemia, as the applied dietary intervention was not effective in only three studies. The majority of included studies were assessed as characterized by medium risk of bias, while the overall risk was high for only four studies, which resulted from the randomization process, deviations from the intended interventions, and selection of the reported result. The majority of included studies were conducted for increasing iron supply and/or increasing vitamin C supply; however, only for the interventions including increasing iron supply and simultaneously increasing its absorption by vitamin C supply were all results confirmed effective. Vitamin D also seems to be an effective dietary treatment, b

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Dietary Supplements; Female; Humans; Iron; Randomized Controlled Trials as Topic; Vitamin D; Vitamins

We report three cases of scurvy in previously healthy children referred to us for leg pain and refusal to walk. All children had no significant medical history, symptoms had started months before and subtly advanced. Two of them presented with gingival hyperplasia and petechiae, another one reported night sweats and gingival bleeding in the past few weeks. Two had vitamin D deficiency, and all had microcytic anaemia (in one case requiring transfusional support). A nutritional screening revealed low or undetectable levels of ascorbic acid. This, along with the clinical and radiological findings, led to a diagnosis of scurvy. Vitamin C supplementation was started with rapid improvement of the children's clinical condition. Scurvy is a rare disease in the 'first world', but there are anecdotal reports of scurvy in children without any of the known risk factors for this condition. In our cases, a selective diet was the only risk factor.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Child, Preschool; Diagnosis, Differential; Dietary Supplements; Humans; Male; Movement Disorders; Musculoskeletal Pain; Scurvy; Vitamin D; Vitamin D Deficiency; Vitamins; Walking

Oxidative stress is a common denominator in the pathogenesis of many chronic diseases. Therefore, antioxidants are often used to protect cells and tissues and reverse oxidative damage. It is well known that iron metabolism underlies the dynamic interplay between oxidative stress and antioxidants in many pathophysiological processes. Both iron deficiency and iron overload can affect redox state, and these conditions can be restored to physiological conditions using iron supplementation and iron chelation, respectively. Similarly, the addition of antioxidants to these treatment regimens has been suggested as a viable therapeutic approach for attenuating tissue damage induced by oxidative stress. Notably, many bioactive plant-derived compounds have been shown to regulate both iron metabolism and redox state, possibly through interactive mechanisms. This review summarizes our current understanding of these mechanisms and discusses compelling preclinical evidence that bioactive plant-derived compounds can be both safe and effective for managing both iron deficiency and iron overload conditions.

Topics: Anemia, Iron-Deficiency; Animals; Antioxidants; Ascorbic Acid; Disease Models, Animal; Homeostasis; Humans; Iron; Iron Deficiencies; Iron Overload; Oxidative Stress; Plant Extracts; Polyphenols; Reactive Oxygen Species; Vitamin A

Iron deficiency is a concern in both developing and developed (industrialized) countries; and young women are particularly vulnerable. This review investigates dietary determinants of and possible solutions to iron deficiency in young women living in industrialized countries. Dietary factors including ascorbic acid and an elusive factor in animal protein foods (meat; fish and poultry) enhance iron absorption; while phytic acid; soy protein; calcium and polyphenols inhibit iron absorption. However; the effects of these dietary factors on iron absorption do not necessarily translate into an association with iron status and iron stores (serum ferritin concentration). In cross-sectional studies; only meat intake has consistently (positively) been associated with higher serum ferritin concentrations. The enhancing effects of ascorbic acid and meat on iron absorption may be negated by the simultaneous consumption of foods and nutrients which are inhibitory. Recent cross-sectional studies have considered the combination and timing of foods consumed; with mixed results. Dietary interventions using a range of focused dietary measures to improve iron status appear to be more effective than dietary approaches that focus on single nutrients or foods. Further research is needed to determine optimal dietary recommendations for both the prevention and treatment of iron deficiency.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Calcium, Dietary; Developed Countries; Diet; Humans; Intestinal Absorption; Iron; Iron Deficiencies; Iron, Dietary; Meat; Phytic Acid; Polyphenols; Soybean Proteins

Uraemic patients are exposed either to iron deficiency due to impaired digestive n associated with various blood losses (particularly in dialysis patients) or iron verload related to blood transfusions in the pre-erythropoetin era or excessive intravenous iron supplementation. The central role of hepcidin in the regulation of oral iron absorption d its effects in uraemia have been recently evidenced. The increased haemoglobin synthesis induced by erythropoiesis stimulating agents (ESA) enhances iron requirements. In case of exhaustion of tissue reserves and/or insufficient exogenous supply, iron deficiency develops which is the major limiting factor for ESA efficacy. Careful biological follow-up is mandatory to detect early iron deficiency or overload, the latter being considered as possibly increasing the uraemic patients' susceptibility to bacterial or viral infections. Intravenous administration of Vitamin C, by enhancing the release of iron from the reticuloendothelial system towards transferrin increases the circulating iron available for erythropoiesis and contributes to the optimisation of ESA efficacy.

Topics: Anemia, Iron-Deficiency; Antimicrobial Cationic Peptides; Ascorbic Acid; Erythropoietin; Hepcidins; Humans; Intestinal Absorption; Iron; Iron Deficiencies; Uremia

Anemia is a common complication of chronic kidney disease, particularly in patients who are on dialysis. The use of recombinant human erythropoietin has led to the eradication of severe anemia in the dialysis population. Correction of anemia in these patients has been associated with better quality of life and clinical outcomes. Some hemodialysis patients have anemia that either is relatively refractory to epoetin therapy or requires very high doses of epoetin (i.e., hyporesponsiveness), despite having adequate iron stores, and are thus unable to achieve or maintain target hemoglobin levels. Several pharmacologic agents have been studied for effects on improving response to epoetin, either to counter hyporesponsiveness or simply to reduce epoetin use for purely economic reasons. This review examines the available literature regarding the efficacy of these potential pharmacologic adjuvants to epoetin in the treatment of anemia in patients on maintenance hemodialysis, with special emphasis on androgens, vitamin C (ascorbic acid), and L-carnitine. A review of published guidelines and recommendations for use of these agents in hemodialysis patients is provided.

Topics: Adjuvants, Pharmaceutic; Androgens; Anemia, Iron-Deficiency; Antioxidants; Ascorbic Acid; Carnitine; Erythropoietin; Female; Humans; Iron; Kidney Failure, Chronic; Male; Practice Guidelines as Topic; Renal Dialysis; Treatment Outcome

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Biomarkers; Drug Resistance; Erythropoietin; Ferritins; Humans; Iron; Kidney Failure, Chronic; Quality of Life; Recombinant Proteins; Renal Dialysis; Transferrin

Iron is one of the most important essential metal ions of which significance is well known for ages. This element is a key moiety of several enzymes in iron containing heme or nonheme form and transfer and storage protein, hemoglobin and myoglobin. Several membrane carriers of iron have already been identified. The redox state of iron is determined by xanthine oxidase, cytochromes and Hp or ceruloplasmin and ferroxidase activity of apo-ferritin, respectively. Some vitamins (C, B2-, B3-, B6-, B12) play also a role in the metabolism of iron. The iron content of cells of the organs is well regulated by the iron homeostasis. Iron has a significant role in the immune system by producing oxygen containing free radicals. Anaemia induced by iron deficiency may cause a challenge concerns for pregnant women, babies and adolescent, primarily.

Topics: Adolescent; Anemia, Iron-Deficiency; Ascorbic Acid; Female; Homeostasis; Humans; Infant, Newborn; Intestinal Absorption; Iron Compounds; Molecular Chaperones; Oxidation-Reduction; Pregnancy; Vitamin B Complex

Iron deficiency anemia is a hypochromic anemia in which hemoglobin poor synthesis is due to a decrease in the amount of iron in the body. The decrease of iron quantity has many causes: insufficient intake of aliments rich in iron (meat, viscera, green vegetables), increased necessities during growth period, pregnancy, erythrocytes hyperregeneration, high-performance sportsmen, increased loss by digestive way, genito-urinary way, respiratory, hemorrhagic syndromes. Clinically, symptoms and signs specific to all types of anemia and those specific to lack of iron occur besides the symptoms and signs of the underlying disease: atrophic glositis, angular stomatitis, sideropenic dysphagia, pica, skin and nails changes. Laboratory investigations useful for diagnosis are: microcytic, hypochromic anemia, decreased serum iron level, total capacity of iron binding increased, medullar iron store absent, good response to iron therapy. Ferro-Folgamma is one of the most indicated medicines in iron deficiency anemia. Due to its components this medicine has many indications: insufficient alimentary intake concerning iron, folic acid, B12 vitamin, vegetarian alimentation, increased needs during growth period, iron deficiency anaemia secondary to chronic hemorrhages, malnutrition, anemias associated with chronic alcohol intake, preventive treatment of iron deficiency anemia and megaloblastic anemia during pregnancy and lactation.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Drug Combinations; Ferrous Compounds; Folic Acid; Humans; Vitamin B 12

Increments of oxidative stress have been addressed as one potential cause for the accelerated atherosclerosis of chronic kidney disease patients. Ascorbate represents one of the most prominent antioxidants both in plasma as well as intracellulary, exerting beneficial effects by an inhibition of lipid peroxidation and by reducing endothelial dysfunction. However, in the presence of transition metals like iron, ascorbate may give rise to an increased generation of oxidants, and ascorbylation may impose additional carbonyl stress to uremic patients. Unsupplemented dialysis patients have reportedly lower plasma levels of ascorbate in comparison to healthy controls, mostly due to a loss into the dialysate or, in case of not dialyzed patients, increased urinary losses. Currently, 60 mg of ascorbate are recommended for chronic kidney disease patients, and 1-1.5 g of oral ascorbate/week in case of suspected subclinical ascorbate deficiency or 300 mg parenteral ascorbate/dialysis session, respectively. Ascorbate's role in modifying arterial blood pressure remains unclear, but anemic patients with functional iron deficiency might benefit from short-term, moderately dosed ascorbate supplements.

Topics: Anemia, Iron-Deficiency; Animals; Antioxidants; Ascorbic Acid; Blood Pressure; Endothelium, Vascular; Humans; Iron; Kidney Failure, Chronic; Renal Dialysis

Iron deficiency and iron deficiency anaemia (IDA) are common in young children. It has been suggested that the lack of iron may have important effects on children's psychomotor development and cognitive function.. To determine the effects of iron therapy on psychomotor development and cognitive function in iron deficient children less than 3 years of age.. The following databases were searched: COCHRANE LIBRARY (2000 ISSUE 4) MEDLINE (1966-August 2000) EMBASE (1980-August 2000) Latin American Database (LILACS) PsycLIT Journal articles (1974-August 2000) PsycLIT Chapters and Books (1987-August 2000) The references of identified trials and of important review articles were scrutinised. Citation searches on trials from the primary search were performed within the Science Citation Index. Key authors were contacted.. Studies were included if children less than 3 years of age with evidence of iron deficiency anaemia were randomly allocated to iron or iron and vitamin C versus a placebo or vitamin C alone and assessment of developmental status or cognitive function was carried out using standardised tests by observers blind to treatment allocation.. Abstracts and titles of studies identified on searches of electronic databases were read to determine whether they might meet the inclusion criteria. Full copies of those possibly meeting these criteria from electronic or other searches were assessed by two independent reviewers. Differences of opinion about suitability for inclusion were resolved by discussion. Data were analysed separately depending on whether participants had iron assessments were performed within one month of beginning iron therapy or later.. Five trials, including 180 children with IDA, examined the effects of iron therapy on measures of psychomotor development between 5 and 11 days of commencement of therapy. Data from four trials could be pooled. The pooled difference in pre to post treatment change in Bayley Scale PDI between iron treated and placebo groups was -3.2 (95%CI -7.24, 0.85) and in Bayley Scale MDI, 0.55 (95% CI -2.84, 1.75). Two studies, including 160 randomised children with IDA, examined the effects of iron therapy on measures of psychomotor development more than 30 days after commencement of therapy. Aukett et al reported the mean number of skills gained after two months of iron therapy, using the Denver test. The intervention group gained 0.8 (95% CI -0.18, 1.78) more skills on average than the control group. Idjrandinata et al reported that the difference in pre to post treatment change in Bayley Scale PDI between iron treated and placebo groups after 4 months was 18.40 (95%CI 10.16, 26.64) and in Bayley Scale MDI, 18.80 (95% CI 10.19, 27.41).. There is no convincing evidence that iron treatment of young children with IDA has an effect on psychomotor development discernable within 5-11 days. The effect of longer term treatment remains unclear but the data would be compatible with clinically significant benefit. There is urgent need for further randomised controlled trials with long term follow up.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Child, Preschool; Cognition; Humans; Infant; Iron; Psychomotor Performance; Randomized Controlled Trials as Topic; Time Factors; Treatment Outcome

In Europe, iron deficiency is considered to be one of the main nutritional deficiency disorders affecting large fractions of the population, particularly such physiological groups as children, menstruating women and pregnant women. Some factors such as type of contraception in women, blood donation or minor pathological blood loss (haemorrhoids, gynaecological bleeding...) considerably increase the difficulty of covering iron needs. Moreover, women, especially adolescents consuming low-energy diets, vegetarians and vegans are at high risk of iron deficiency. Although there is no evidence that an absence of iron stores has any adverse consequences, it does indicate that iron nutrition is borderline, since any further reduction in body iron is associated with a decrease in the level of functional compounds such as haemoglobin. The prevalence of iron-deficient anaemia has slightly decreased in infants and menstruating women. Some positive factors may have contributed to reducing the prevalence of iron-deficiency anaemia in some groups of population: the use of iron-fortified formulas and iron-fortified cereals; the use of oral contraceptives and increased enrichment of iron in several countries; and the use of iron supplements during pregnancy in some European countries. It is possible to prevent and control iron deficiency by counseling individuals and families about sound iron nutrition during infancy and beyond, and about iron supplementation during pregnancy, by screening persons on the basis of their risk for iron deficiency, and by treating and following up persons with presumptive iron deficiency. This may help to reduce manifestations of iron deficiency and thus improve public health. Evidence linking iron status with risk of cardiovascular disease or cancer is unconvincing and does not justify changes in food fortification or medical practice, particularly because the benefits of assuring adequate iron intake during growth and development are well established. But stronger evidence is needed before rejecting the hypothesis that greater iron stores increase the incidence of CVD or cancer. At present, currently available data do not support radical changes in dietary recommendations. They include all means for increasing the content of dietary factors enhancing iron absorption or reducing the content of factors inhibiting iron absorption. Increased knowledge and increased information about factors may be important tools in the prevention of iron defic

Topics: Adolescent; Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Child; Child, Preschool; Dietary Supplements; Europe; Female; Food, Fortified; Humans; Infant; Intestinal Absorption; Iron; Iron Deficiencies; Male; Menstruation; Pregnancy; Prevalence; Risk Factors

Iron deficiency is a major world health problem, that is, to a great extent, caused by poor iron absorption from the diet. Several dietary factors can influence this absorption. Absorption enhancing factors are ascorbic acid and meat, fish and poultry; inhibiting factors are plant components in vegetables, tea and coffee (e.g., polyphenols, phytates), and calcium. After identifying these factors their individual impact on iron absorption is described. Specific attention was paid to the effects of tea on iron absorption. We propose a calculation model that predicts iron absorption from a meal. Using this model we calculated the iron absorption from daily menus with varying amounts of enhancers and inhibitors. From these calculations we conclude that the presence of sufficient amounts of iron absorption enhancers (ascorbic acid, meat, fish, poultry, as present in most industrialized countries) overcomes inhibition of iron absorption from even large amounts of tea. In individuals with low intakes of heme iron, low intakes of enhancing factors and/or high intakes of inhibitors, iron absorption may be an issue. Depletion of iron stores enhances iron absorption, but this effect is not adequate to compensate for the inhibition of iron absorption in such an inadequate dietary situation. For subjects at risk of iron deficiency, the following recommendations are made. Increase heme-iron intake (this form of dietary iron present in meat fish and poultry is hardly influenced by other dietary factors with respect to its absorption); increase meal-time ascorbic acid intake; fortify foods with iron. Recommendations with respect to tea consumption (when in a critical group) include: consume tea between meals instead of during the meal; simultaneously consume ascorbic acid and/or meat, fish and poultry.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Biological Availability; Calcium; Diet; Dietary Proteins; Flavonoids; Humans; Intestinal Absorption; Iron; Iron Deficiencies; Iron, Dietary; Models, Biological; Phenols; Phytic Acid; Polymers; Polyphenols; Tea; Vitamin A

We report a child with an isolated complex III respiratory chain deficiency and global developmental delay who had severe pruritus with elevated plasma bile acid levels. A liver biopsy showed micronodular cirrhosis, and enzymologic evaluation demonstrated an isolated complex III deficiency in both liver and muscle. His pruritus improved and serum bile acid levels decreased after treatment with menadione and vitamin C.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Bile Acids and Salts; Child, Preschool; Developmental Disabilities; Drug Therapy, Combination; Electron Transport; Electron Transport Complex III; Humans; Male; Metabolism, Inborn Errors; Pruritus; Vitamin K

The contribution of vitamin C (ascorbic acid) to the prevention of iron deficiency anemia by promoting the absorption of dietary non-heme iron-especially in persons with low iron stores--is well established. But the question has been raised whether high-dose intakes of vitamin C might unduly enhance the absorption of dietary iron in persons with high iron stores or in patients with iron overload, possibly increasing the potential risk of iron toxicity. Extensive studies have shown that overall the uptake and storage of iron in humans is efficiently controlled by a network of regulatory mechanisms. Even high vitamin C intakes do not cause iron imbalance in healthy persons and probably in persons who are heterozygous for hemochromatosis. The uptake, renal tubular reabsorption and storage of vitamin C itself are also strictly limited after high-dose intake so that no excessive plasma and tissue concentrations of vitamin C are produced. The effect of high-dose vitamin C on iron absorption in patients with iron overload due to homozygous hemochromatosis has not been studied. Of special importance is the early identification of hemochromatosis patients, which is assisted by the newly developed PCR test for hereditary hemochromatosis. Specific treatment consists of regular phlebotomy and possibly iron-chelating therapy. These patients should moreover avoid any possibility of facilitated absorption of iron and need to limit their intake of iron. Patients with beta-thalassemia major and sickle cell anemia who suffer from iron overload due to regular blood transfusions or excessive destruction of red blood cells need specialized medical treatment with iron chelators and should also control their intake of iron. The serum of patients with pathological iron overload can contain non-transferrin-bound iron inducing lipid peroxidation with subsequent consumption of antioxidants such as vitamin E and vitamin C. The role of iron in coronary heart disease and cancer is controversial. Early suggestions that moderately elevated iron stores are associated with an increased risk of CHD have not been confirmed by later studies. In vitro, ascorbic acid can act as a prooxidant in the presence of transition metals such as iron or copper, but in the living organism its major functions are as an antioxidant. High intakes of vitamin C have thus not been found to increase oxidative damage in humans. Accordingly, the risk of CHD or cancer is not elevated. On the contrary, most studies

Topics: Anemia, Iron-Deficiency; Animals; Ascorbic Acid; Biological Availability; Humans; Iron, Dietary; Lipid Peroxidation; Risk Factors

One way to prevent iron deficiency anemia in developing countries is through the fortification of food products with iron. In addition to avoiding undesirable color and flavor changes, the main challenge is to protect the fortification iron from potential inhibitors of iron absorption present in commonly fortified foods.

Topics: Adult; Anemia, Iron-Deficiency; Animals; Ascorbic Acid; Biological Availability; Child; Developing Countries; Edetic Acid; Female; Food, Fortified; Hemoglobins; Humans; Iron; Iron Deficiencies; Iron, Dietary; Male; Prevalence; Rats

We investigated the effect of two dosing regimens of oral iron on iron status and hematological parameters in patients with CKD. In this single center, open label, randomized, active controlled clinical trial, stable adult patients with CKD stage G3-4 with percentage transferrin saturation (%TSAT) ≤ 30% and serum ferritin ≤ 500 ng/ml were eligible. Participants were randomized to receive either 100 mg of ferrous ascorbate once daily (OD group) or 100 mg of ferrous ascorbate twice daily (BD group, total daily dose 200 mg). The primary outcome was change in %TSAT between groups over 12 weeks. The secondary outcomes were changes in other iron status and hematological parameters, serum interleukin-6 (IL-6) and hepcidin. 80 participants were enrolled out of which 76 completed the study. Change in %TSAT was not significantly different between groups (β = - 1.43, 95% CI - 3.99 to 1.12, BD group as reference). The rise in serum ferritin was less in the OD group as compared to BD group (β = - 0.36, 95% CI - 0.61 to - 0.10) whereas MCHC increased in the OD group as compared to decrease in the BD group (β = 0.37, 95% CI 0.067-0.67). These observations need exploration to ascertain the impact of different oral iron dosing strategies in CKD.

Topics: Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Ferritins; Humans; Iron; Renal Insufficiency, Chronic

Anemia is one of the most frequent and earliest complications of chronic kidney disease (CKD), which impacts a patient’s quality of life and increases the risk of adverse clinical outcomes. Patients’ inflammatory status is strictly related to the occurrence of functional iron deficiency anemia (IDA) because this causes an increase in hepcidin levels with the consequent inhibition of iron absorption and release from cellular stores into blood circulation. The aim of this study was to evaluate the use of the new oral formulation based on ferric sodium EDTA in combination with vitamin C, folic acid, copper gluconate, zinc gluconate, and selenomethionine (Ferachel Forte®) in patients with moderate CKD and functional IDA, analyzing the inflammatory status in addition to iron blood parameters, in comparison with oral ferrous sulfate and liposomal iron therapies. Sixty-two elderly patients were randomly allocated to one of the following oral treatments for 6 months: ferrous sulfate (Group 1; N = 20), ferric sodium EDTA in combination (Group 2; N = 22), and ferric liposomal formulation (Group 3; N = 20). The evaluated parameters included iron profile parameters of hemoglobin (Hb), sideremia, ferritin, transferrin saturation, C-reactive protein (CRP), and hepcidin. The results showed that in Group 1, there were no improvements. In Group 2, there were statistically significant (p < 0.001) improvements in all evaluated parameters. Finally, in Group 3, there were significant improvements in all evaluated parameters except for hepcidin, which was less than that of Group 2 patients. In conclusion, the findings showed the superior efficacy of the formulation based on ferric sodium EDTA over the other oral iron sources, and that this formulation can contribute to reducing the systemic inflammatory status in patients with CKD.

Topics: Aged; Anemia, Iron-Deficiency; Antioxidants; Ascorbic Acid; Edetic Acid; Folic Acid; Gluconates; Hepcidins; Humans; Iron; Quality of Life; Renal Insufficiency, Chronic; Selenomethionine; Sodium; Vitamins

Iron-deficiency anaemia (IDA) is a common nutritional deficiency among pregnant women in India. It has a significant impact on the health of the mother as well as that of the foetus. IDA generally responds well to treatment with oral iron supplementation. However, oral iron supplements are toxic to the gastrointestinal mucosa and intolerance is common, resulting in poor compliance and failure of treatment. The iron salts such as iron hydroxide polymaltose complex (IPC) and ferrous ascorbate (FeA) are claimed to have low gastrointestinal intolerance, therefore better patient compliance than the conventionally used ferrous sulphate (FS). These preparations also claim to increase haemoglobin level faster as well as improve the iron storage better than FS. This study was done to compare the efficacy and safety of FS with IPC and FeA.. It was a randomized, parallel, open label, study among pregnant women of gestational age between 12 to 26 wk with moderate anaemia. Patients were randomly allocated to receive either FS, IPC or FeA. They were then followed up for 90 days to observe for improvement in the haemoglobin levels and other haematological parameters or any adverse drug reaction.. The haemoglobin levels were comparable in the three groups except at day 90 when FeA group had significantly higher haemoglobin level as compared to FS group (P<0.05). The overall adverse effect profiles were also comparable among the study groups except epigastric pain which was more commonly reported in the FS group.. The results of the study showed that FS, IPC and FeA have comparable efficacy and safety profile in the treatment of IDA of pregnancy.

Topics: Adolescent; Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Child; Female; Ferric Compounds; Ferrous Compounds; Humans; Pregnancy; Pregnant Women; Young Adult

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Biomarkers; Child Development; Child Nutritional Physiological Phenomena; Child, Preschool; Cucumis sativus; Female; Food, Fortified; Humans; India; Inflammation Mediators; Iron; Iron Deficiencies; Male; Micronutrients; Musa; Neuropsychological Tests; Nutritional Status; Prevalence; Psidium; Respiratory Tract Infections

Anaemia in young sub-Saharan African children may be due to the double burden of malaria and iron deficiency. Primary analysis of a double-blind, cluster randomized trial of iron containing micronutrient powder supplementation in Ghanaian children aged 6 to 35 months found no difference in malaria risk between intervention and placebo groups. Here, we performed a secondary analysis of the trial data to assess the impact of long-term prophylactic iron fortificant on the risk of iron deficiency and anaemia in trial subjects. This population-based randomized-cluster trial involved 1958 children aged between 6 to 35 months, identified at home and able to eat semi-solid foods. The intervention group (n = 967) received a daily dose containing 12.5 mg elemental iron (as ferrous fumarate), vitamin A (400 μg), ascorbic acid (30 mg) and zinc (5 mg). The placebo group (n = 991) received a similar micronutrient powder but without iron. Micronutrient powder was provided daily to both groups for 5 months. At baseline and endline, health assessment questionnaires were administered and blood samples collected for analysis. The two groups had similar baseline anthropometry, anaemia, iron status, demographic characteristics, and dietary intakes (p > 0.05). Of the 1904 (97.2%) children who remained at the end of the intervention, the intervention group had significantly higher haemoglobin (p = 0.0001) and serum ferritin (p = 0.0002) levels than the placebo group. Soluble transferrin receptor levels were more saturated among children from the iron group compared to non-iron group (p = 0.012). Anaemia status in the iron group improved compared to the placebo group (p = 0.03). Continued long-term routine use of micronutrient powder containing prophylactic iron reduced anaemia, iron deficiency and iron deficiency anaemia among pre-school children living in rural Ghana's malaria endemic area.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Child, Preschool; Dietary Supplements; Female; Ferrous Compounds; Ghana; Hemoglobins; Humans; Infant; Male; Placebo Effect; Trace Elements; Vitamin A; Vitamins; Zinc

Altered martial indices before orthopedic surgery are associated with higher rates of complications and greatly affect the patient's functional ability. Oral supplements can optimize the preoperative martial status, with clinical efficacy and the patient's tolerability being highly dependent on the pharmaceutical formula. Patients undergoing elective hip/knee arthroplasty were randomized to be supplemented with a 30-day oral therapy of sucrosomial ferric pyrophosphate plus L-ascorbic acid. The tolerability was 2.7% among treated patients. Adjustments for confounding factors, such as iron absorption influencers, showed a relevant response limited to older patients (≥ 65 years old), whose uncharacterized Hb loss was averted upon treatment with iron formula. Older patients with no support lost -2.8 ± 5.1%, while the intervention group gained +0.7 ± 4.6% of circulating hemoglobin from baseline (

Topics: Administration, Oral; Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Arthroplasty, Replacement; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Ascorbic Acid; Dietary Supplements; Diphosphates; Female; Ferric Compounds; Hematinics; Hematology; Hemoglobins; Humans; Iron; Male; Middle Aged; Preoperative Care

It remains uncertain whether vitamin C routinely used with oral iron supplements is essential for patients with iron deficiency anemia (IDA).. To compare the equivalence and assess the safety of oral iron supplements plus vitamin C or oral iron supplements alone in patients with IDA.. This single-center, open-label, equivalence randomized clinical trial was conducted from January 1, 2016, to December 30, 2017, in Huashan Hospital, Fudan University. Adult patients with newly diagnosed IDA were enrolled. Participants were randomly assigned (1:1) to the oral iron supplements plus vitamin C group or the oral iron supplements-only group. Data analysis was performed from March to December 2018.. Patients were randomized to receive a 100-mg oral iron tablet plus 200 mg of vitamin C or a 100-mg iron tablet alone every 8 hours daily for 3 months.. The primary outcome was the change in hemoglobin level from baseline to 2 weeks of treatment, and an equivalence margin of 1 g/dL in hemoglobin was chosen for the demonstration of comparable efficacy. Secondary outcomes included the change in the reticulocyte percentage after 2 weeks of treatment, the increase in hemoglobin level after 4 weeks of treatment, the increase in serum ferritin level after 8 weeks of treatment, and adverse events.. Among the 440 randomized patients (220 each in the oral iron supplements plus vitamin C group and iron-only group; 426 women [96.8%]; mean [SD] age, 38.3 [11.7] years), all were assessed for the primary outcome, and 432 (98.2%) completed the trial. From baseline to the 2-week follow-up, the mean (SD) change in hemoglobin level was 2.00 (1.08) g/dL in the oral iron supplements plus vitamin C group and 1.84 (0.97) g/dL in the oral iron supplements-only group (between-group difference, 0.16 g/dL; 95% CI, -0.03 to 0.35 g/dL), thus meeting the criteria for equivalence. The mean (SD) change in serum ferritin level from baseline to 8-week follow-up was 35.75 (11.52) ng/mL in the vitamin C plus iron group and 34.48 (9.50) ng/mL in the iron-only group (between-group difference, 1.27 ng/mL; 95% CI, -0.70 to 3.24 ng/mL; P = .21). There were no significant differences between the 2 groups regarding the rates of adverse events (46 [20.9%] vs 45 [20.5%]; difference, 0.4%; 95% CI, -6.7% to 8.5%; P = .82). No patient withdrew because of adverse events.. Among patients with IDA, oral iron supplements alone were equivalent to oral iron supplements plus vitamin C in improving hemoglobin recovery and iron absorption. These findings suggest that on-demand vitamin C supplements are not essential to take along with oral iron supplements for patients with IDA.. ClinicalTrials.gov Identifier: NCT02631668.

Topics: Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Dietary Supplements; Drug Therapy, Combination; Female; Ferrous Compounds; Hemoglobins; Humans; Male; Middle Aged; Vitamins

To compare the therapeutic efficacy of Ferrous ascorbate (FA) and Iron polymaltose complex (IPC) in Iron deficiency anemia (IDA) in children.. A randomized controlled trial (RCT) was conducted at a tertiary care hospital with 125 (1-12 y) children having clinical symptoms and signs of IDA. Participants were randomized into FA group and IPC group. Both the groups received iron salts (FA or IPC) randomly in a dose of 6 mg/kg elemental iron for 3 mo and followed up on day 3, day 7, at the end of 1 mo and 3 mo for Hemoglobin (Hb), Mean corpuscular volume (MCV), Red cell distribution width (RDW) and reticulocyte count.. Both groups had an improvement in hematological parameters at 3 mo of intervention. The difference in the rise of Hb (g%) at the end of 1 mo in FA group (3.13 ± 1.01) vs. IPC group (2.0 ± 0.85); p = 0.017 and at 3 mo in FA group (4.88 ± 1.28) vs. IPC group (3.33 ± 1.33); p = 0.001 was statistically significant. The difference in the rise of mean Hb was significantly better in FA than the IPC group F [3392] =1.79; p = 0.00 (ANOVA). The difference in the mean increase in MCV (fL) at day 7 in FA group (6.71 ± 8.32) vs. IPC group (2.91 ± 6.16); p = 0.011 and at 1 mo FA group (9.80 ± 8.56) vs. IPC group (5.35 ± 6.11); p = 0.004 was statistically significant. The mean decrease in RDW (%) at 1 mo in FA group (4.23 ± 3.27) vs. IPC group (2.67 ± 1.95); p = 0.005 and at 3 mo in FA group (5.74 ± 3.63) vs. IPC group (4.04 ± 2.17); p = 0.006 was statistically significant. The difference in the rise in mean reticulocyte count at day 3 in FA group (0.88 ± 0.50) vs. IPC group (0.43 ± 1.20); p = 0.017 and at day 7 in FA group (4.00 ± 1.69) vs. IPC group (2.19 ± 1.24); p = 0.001 was statistically significant. F [2294] = 29.2, p = 0.00 (ANOVA). During the study period, the FA group had minor adverse reactions whereas the IPC group had none.. Both the iron salts (FA and IPC) used in the treatment of IDA showed statistically significant improvement in the hematological parameters during the 3 mo of intervention. The improvement in hematological parameters was better in FA supplemented patients as compared to IPC.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Child; Child, Preschool; Dietary Supplements; Drug Combinations; Erythrocyte Indices; Female; Ferric Compounds; Hemoglobins; Humans; Infant; Iron; Iron Compounds; Male; Reticulocyte Count; Time Factors

Iron deficiency anemia (IDA) is a significant public health issue in India affecting nearly all vulnerable segments of the population. Causes of IDA include low consumption of iron-rich foods combined with poor iron bioavailability of nonheme iron sources. To date, interventions aimed at correcting IDA focus on increasing iron intake through iron supplementation or fortification strategies. In contrast, dietary diversification is a long-term sustainable approach to improve bioavailable iron intake. In this context, the inclusion of vitamin C-rich fruits in the regular diet has proven to improve iron absorption, but the effect on iron status is inconclusive. Considering the ongoing national program for preschoolers in India, we designed a cluster randomized controlled trial (RCT) to test the hypothesis that inclusion of vitamin C-rich fruit in a regular meal would improve iron absorption and lead to better child iron and micronutrient status, cognitive development, gut health, and growth while reducing morbidity. This paper illustrates a context-specific framework and activities to design and functionalize an open-label, three-arm cluster RCT to test a specific hypothesis. The results of this designed trial should generate evidence to inform policy on the effect of a food-based intervention on iron status.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Child, Preschool; Dietary Supplements; Food, Fortified; Fruit; Government Programs; Humans; India; Iron Deficiencies; Micronutrients; Nutritional Status; Psidium; Surveys and Questionnaires

Topics: Adolescent; Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Biological Availability; Biomarkers; Cohort Studies; Edible Grain; Erythrocytes; Feeding Behavior; Female; Humans; Intestinal Absorption; Iron; Iron Isotopes; Iron, Dietary; Meals; Postprandial Period; Reference Values; Tea; United Kingdom; Young Adult

The aim of the present investigation was to compare the efficacy and safety of oral ferrous asparto glycinate and ferrous ascorbate in pregnant women with iron deficiency anaemia (IDA). We performed a double blind, prospective, randomised, multicentre, parallel group comparative clinical study at three different centres in India. A total of 73 pregnant women at 12-26 weeks' gestation were divided into two arms. While one group received ferrous ascorbate, another group was treated with ferrous asparto glycinate for a period of 28 days. The mean rise in haemoglobin and ferritin levels on day 14 and 28 was evaluated. At both time points, significantly higher levels of haemoglobin and ferritin were noticed with ferrous asparto glycinate treatment as compared with ferrous ascorbate. Our results showed that ferrous asparto glycinate is an effective iron-amino acid chelate in the management of IDA in pregnant women as compared with ferrous ascorbate. Nevertheless, additional large scale prospective, randomised trials are warranted to confirm the findings of the present efficacy trial, and also to find out the anaemia eradication rate.

Topics: Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Aspartic Acid; Double-Blind Method; Female; Ferritins; Ferrous Compounds; Glycine; Hemoglobins; Humans; Pregnancy; Pregnancy Complications, Hematologic; Prospective Studies; Young Adult

Nutritional anemia is a public health problem among Ghanaian schoolchildren. There is need to employ dietary modification strategies to solve this problem through school and household feeding programs.. To evaluate the effectiveness of cowpea-based food containing fish meal served with vitamin C-rich drink to improve iron stores and hemoglobin concentrations in Ghanaian schoolchildren.. The study involved cross-sectional baseline and nutrition intervention phases. There were 150 participants of age 6 to 12 years. They were randomly assigned to 3 groups, fish meal -vitamin C (n = 50), vitamin C (n = 50), and control (n = 50), and given different cowpea-based diets for a 6-month period. Height and weight measurements were done according to the standard procedures, dietary data were obtained by 24-hour recall and food frequency questionnaire, hemoglobin concentrations were determined by Hemocue Hemoglobinometer, and serum ferritin and complement-reactive protein (CRP) were determined by enzyme-linked immunosorbent assay. Participants' blood samples were examined for malaria parasitemia and stools for helminthes using Giemsa stain and Kato-Katz techniques, respectively.. Mean ferritin concentration was not significantly different among groups. End line mean or change in hemoglobin concentrations between fish meal-vitamin C group (128.4 ± 7.2/8.3 ± 10.6 g/L) and control (123.1 ± 6.6/4.2 ± 10.4 g/L) were different, P < .05. Change in prevalence of anemia in fish meal-vitamin C group (19.5%) was different compared to those of vitamin C group (9.3%) and the control (12.2%). Levels of malaria parasitemia and high CRP among study participants at baseline and end line were 58% and 80% then 55% and 79%, respectively. Level of hookworm infestation was 13%.. Cowpea-based food containing 3% fish meal and served with vitamin C-rich drink improved hemoglobin concentration and minimized the prevalence of anemia among the study participants.

Topics: Anemia, Iron-Deficiency; Animals; Ascorbic Acid; Beverages; C-Reactive Protein; Child; Cross-Sectional Studies; Female; Ferritins; Fishes; Food, Fortified; Ghana; Hemoglobins; Humans; Malaria; Male; School Health Services; Surveys and Questionnaires; Treatment Outcome; Vegetables

Iron deficiency is common in overweight and obese individuals. This deficiency may be due to adiposity-related inflammation that increases serum hepcidin and decreases dietary iron absorption. Because hepcidin reduces iron efflux from the basolateral enterocyte, it is uncertain whether luminal enhancers of dietary iron absorption such as ascorbic acid can be effective in overweight and obese individuals.. In this study, we compared iron absorption from a meal with ascorbic acid (+AA) and a meal without ascorbic acid (-AA) in women in a normal-weight group (NW) with those in overweight and obese groups combined (OW/OB).. Healthy, nonanemic women [n = 62; BMI (in kg/m(2)): 18.5-39.9] consumed a stable-isotope-labeled wheat-based test meal -AA and a wheat-based test meal +AA (31.4 mg ascorbic acid). We measured iron absorption and body composition with the use of dual-energy X-ray absorptiometry, blood volume with the use of a carbon monoxide (CO)-rebreathing method, iron status, inflammation, and serum hepcidin.. Inflammatory biomarkers (all P < 0.05) and hepcidin (P = 0.08) were lower in the NW than in the OW/OB. Geometric mean (95% CI) iron absorptions in the NW and OW/OB were 19.0% (15.2%, 23.5%) and 12.9% (9.7%, 16.9%) (P = 0.049), respectively, from -AA meals and 29.5% (23.3%, 38.2%) and 16.6% (12.8%, 21.7%) (P = 0.004), respectively, from +AA meals. Median percentage increases in iron absorption for -AA to +AA meals were 56% in the NW (P < 0.001) and 28% in OW/OB (P = 0.006). Serum ferritin [R(2) = 0.22; β = -0.17 (95% CI: -0.25, -0.09)], transferrin receptor [R(2) = 0.23; β = 2.79 (95% CI: 1.47, 4.11)], and hepcidin [R(2) = 0.13; β = -0.85 (95% CI: -1.41, -0.28)] were significant predictors of iron absorption.. In overweight and obese women, iron absorption is two-thirds that in normal-weight women, and the enhancing effect of ascorbic acid on iron absorption is one-half of that in normal-weight women. Recommending higher intakes of ascorbic acid (or other luminal enhancers of iron absorption) in obese individuals to improve iron status may have a limited effect. This trial was registered at clinicaltrials.gov as NCT01884506.

Topics: Absorptiometry, Photon; Adiposity; Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Body Mass Index; Breakfast; Down-Regulation; Female; Food, Fortified; Hepcidins; Humans; Intestinal Absorption; Iron Isotopes; Iron, Dietary; Obesity; Overweight; Risk; Switzerland; Young Adult

In addition to phytate, polyphenols (PP) might contribute to low Fe bioavailability from sorghum-based foods. To investigate the inhibitory effects of sorghum PP on Fe absorption and the potential enhancing effects of ascorbic acid (AA), NaFeEDTA and the PP oxidase enzyme laccase, we carried out three Fe absorption studies in fifty young women consuming dephytinised Fe-fortified test meals based on white and brown sorghum varieties with different PP concentrations. Fe absorption was measured as the incorporation of stable Fe isotopes into erythrocytes. In study 1, Fe absorption from meals with 17 mg PP (8·5%) was higher than that from meals with 73 mg PP (3·2%) and 167 mg PP (2·7%; P< 0·001). Fe absorption from meals containing 73 and 167 mg PP did not differ (P= 0·9). In study 2, Fe absorption from NaFeEDTA-fortified meals (167 mg PP) was higher than that from the same meals fortified with FeSO₄ (4·6 v. 2·7%; P< 0·001), but still it was lower than that from FeSO₄-fortified meals with 17 mg PP (10·7%; P< 0·001). In study 3, laccase treatment decreased the levels of PP from 167 to 42 mg, but it did not improve absorption compared with that from meals with 167 mg PP (4·8 v. 4·6%; P= 0·4), whereas adding AA increased absorption to 13·6% (P< 0·001). These findings suggest that PP from brown sorghum contribute to low Fe bioavailability from sorghum foods and that AA and, to a lesser extent, NaFeEDTA, but not laccase, have the potential to overcome the inhibitory effect of PP and improve Fe absorption from sorghum foods.

Topics: Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Cross-Over Studies; Dietary Supplements; Edetic Acid; Edible Grain; Female; Ferric Compounds; Food, Fortified; Gastrointestinal Agents; Hematinics; Humans; Intestinal Absorption; Iron Chelating Agents; Iron, Dietary; Nutritive Value; Pigments, Biological; Polyphenols; Seeds; Sorghum; Switzerland; Young Adult

Assess drinking water fortification with iron and/or ascorbic acid as a strategy to control iron-deficiency anemia and iron deficiency.. Randomized blind clinical study, fortifying drinking water to 153 pre-school children during 3 months, with iron and ascorbic acid (A), ascorbic acid (B) or plain water (C). Hemoglobin (Hb), mean corpuscular volume (MCV) and ferritin were measured.. Within the groups, Hb raised in all three groups, MCV in A and B and ferritin in A. The difference between time points 0 and 1 was significant between A and B for Hb, when A and B were compared with C for MCV and when A was compared with either B or C for ferritin.. Water fortification is efficient in controlling iron deficiency and anemia. Iron stores' recovery depends on a more effective offer of iron. Water fortification must be preceded by a careful assessment of the previous nutritional status.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Brazil; Child Day Care Centers; Child, Preschool; Double-Blind Method; Drinking Water; Female; Food, Fortified; Hemoglobins; Humans; Iron; Iron Deficiencies; Male; Nutrition Assessment; Nutritional Status; Prevalence; Treatment Outcome; Vitamins

There is no study that assessed the effect of co-supplementation of iron and vitamin C on biomarkers of oxidative stress in non-anemic iron-deficient females. We investigated the effects of iron vs. iron + vitamin C co-supplementation on biomarkers of oxidative stress in iron-deficient girls. In a double-blind randomized controlled clinical trial, performed among 60 non-anemic iron-deficient girls, participants were randomly assigned to receive either 50 mg/day elemental iron supplements or 50 mg/day elemental iron + 500 mg/day ascorbic acid for 12 weeks. Fasting blood samples were taken at baseline, weeks 6 and 12 for assessment of biomarkers of oxidative stress. Compared with the baseline levels, both iron and iron + vitamin C supplementation resulted in a significant reduction in serum malondialdehyde (MDA) levels (P time < 0.001) and remarkable elevation in serum total antioxidant capacity (TAC; P time < 0.001) and vitamin C levels (P time = 0.001); however, comparing the two groups we failed to find an additional effect of iron + vitamin C supplementation to that of iron alone on serum TAC and MDA levels (P group was not statistically significant). Iron + vitamin C supplementation influenced serum vitamin C levels much more than that by iron alone (P group < 0.01). We also found a significant interaction term between time and group about serum vitamin C levels while this interaction was not significant about serum TAC and MDA levels. In conclusion, we found that iron supplementation with/without vitamin C improve biomarkers of oxidative stress among non-anemic iron-deficient females and may strengthen the antioxidant defense system by decreasing reactive oxygen species. Co-supplementation of iron + vitamin C has no further effect on oxidative stress compared with iron alone.

Topics: Adolescent; Anemia, Iron-Deficiency; Ascorbic Acid; Biomarkers; Double-Blind Method; Female; Humans; Iron; Oxidative Stress

Although a 40 % absorption of a standard reference dose corresponds to iron (Fe) absorption in borderline Fe-deficient subjects, this percentage is currently applied to all subjects independent of Fe status: (a) to assess the use of the 40 % of Fe absorption of the reference dose (FeRD%) for subjects with iron-depleted stores (IDS), normal Fe status (NIS), Fe deficiency without anemia (IDWA), and Fe deficiency anemia (IDA) and (b) to explore relationships between Fe status biomarkers and FeRD%. Six hundred forty-six participants (582 women and 64 men) were selected from multiple Fe bioavailability studies and classified into four groups based on Fe status: NIS, IDS, IDWA, and IDA. All men were classified as normal. The absorption from FeRD% was calculated in each group and correlated with Fe status biomarkers. (a) Women with IDS absorbed 40 (18.9-84.7) % of the reference dose; (b) for male subjects with NIS, the absorption of the reference dose was 19 (9.8-36.1) %, while for females, absorption was observed as to be 34 (16.7-68.6)%. In the case of subjects with IDWA, a 43 (19.7-92.5) % absorption was observed, while subjects with IDA demonstrated 67 (45.2-98.6) % absorption. Serum ferritin (SF) had the strongest inverse correlation with FeRD% (r = -0.41, p < 0.001). A transferrin saturation (TS) <15 % increases the probability that the FeRD% will be highly elevated (OR, 5.05; 95 % CI, 2.73, 9.31; p < 0.001). A 40 % absorption as reference dose is only appropriate to assess Fe absorption in subjects with IDS and IDWA. SF had an inverse correlation with FeRD%, and TS increases the probability that the FeRD% will be elevated by over fivefold.

Topics: Adolescent; Adult; Aged; Anemia, Iron-Deficiency; Ascorbic Acid; Female; Ferritins; Ferrous Compounds; Humans; Iron; Male; Middle Aged; Young Adult

To compare the efficacy of ferrous ascorbate and colloidal iron in the treatment of iron deficiency anemia in children.. Eighty one children, aged 6 mo to 12 y, were screened for iron deficiency anemia (IDA) and those diagnosed with IDA were randomized to receive ferrous ascorbate or colloidal iron for a period of 12 wk, such that each child received elemental iron 3 mg/kg body weight/d. Increase in hemoglobin (Hb) level was the primary outcome measure. Assessment was performed at baseline, wk 4, wk 8 and wk 12.. Of 81 children screened, 73 were included in the study. The mean rise in Hb at the end of the 12 wk was significantly higher in ferrous ascorbate group than the colloidal iron group [3.59 ± 1.67 g/dl vs. 2.43 ± 1.73 g/dl; P < 0.01]. Significantly higher proportion of children receiving ferrous ascorbate (64.86 % vs. 31.03 %; P < 0.01) became non-anemic in comparison to colloidal iron.. Ferrous ascorbate provides a significantly higher rise in hemoglobin levels in comparison to colloidal iron. The study supports the use of ferrous ascorbate in the pediatric age group, providing evidence for its role as an efficient oral iron supplement in the treatment of iron deficiency anemia.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Child; Child, Preschool; Colloids; Dietary Supplements; Drug Dosage Calculations; Drug Monitoring; Female; Hemoglobins; Humans; Infant; Iron Compounds; Male; Treatment Outcome; Vitamins

Habitual iron intakes during pregnancy are typically lower than dietary guidelines, a risk for iron deficiency. The aim of this study was to determine whether regular consumption of bread naturally rich in iron could help women to achieve dietary targets. Thirty-three primiparous mothers were randomized to eat 3-4 slices of iron-rich or control bread daily for 6 weeks. Two 24-h-prompted (multiple-pass) dietary recalls were completed, and validated algorithms were used to determine the amount of 'available iron' from the diet. Regular consumption of iron-rich bread helped pregnant women to achieve UK dietary recommendations; the quantity of bread consumed by the participants contributed 27% versus 9% UK Reference Nutrient Intake (RNI) (14.8 mg/d) in the intervention versus the control group. Levels of total 'available iron' were similar in both groups and correlated positively with total dietary iron (r = 0.78, P = 0.0001), vitamin C (r = 0.43, P = 0.017) and non-haem iron (r = 0.77, P = 0.0001). Findings from this study show that iron-rich staple foods can help women reach dietary targets for iron. This is an area of great potential that could be of particular benefit to low-income/ethnically diverse population groups who have some of the lowest iron intakes. Further research using fortified staple foods containing higher levels of iron is now warranted to establish physiological benefits.

Topics: Adult; Algorithms; Anemia, Iron-Deficiency; Ascorbic Acid; Biological Availability; Bread; Diet; Diet Records; Female; Heme; Humans; Iron; Iron, Dietary; Nutrition Policy; Nutritional Requirements; Pregnancy; Pregnancy Complications; Reference Values; Trace Elements; United Kingdom

Ascorbic acid, and more recently, the carotenoids lutein and zeaxanthin have been shown to enhance Fe absorption. However, it is not clear whether Fe status improves when foods high in ascorbic acid and carotenoids are consumed with Fe-fortified meals. The present study aimed to investigate whether consuming high v. low ascorbic acid-, lutein- and zeaxanthin-rich fruit (gold kiwifruit v. banana) with Fe-fortified breakfast cereal and milk improved Fe status in women with low Fe stores. Healthy women aged 18-44 years (n 89) with low Fe stores (serum ferritin ≤ 25 μg/l and Hb ≥ 115 g/l) were randomly stratified to receive Fe-fortified breakfast cereal (16 mg Fe as ferrous sulfate), milk and either two gold kiwifruit or one banana (164 mg v. not detectable ascorbic acid; 526 v. 22·90 μg lutein and zeaxanthin, respectively) at breakfast every day for 16 weeks. Biomarkers of Fe status and dietary intake were assessed at baseline and end in the final sample (n 69). Median serum ferritin increased significantly in the kiwifruit group (n 33) compared with the banana group (n 36), with 10·0 (25th, 75th percentiles 3·0, 17·5) v. 1·0 (25th, 75th percentiles - 2·8, 6·5) μg/l (P < 0·001). Median soluble transferrin receptor concentrations decreased significantly in the kiwifruit group compared with the banana group, with - 0·5 (25th, 75th percentiles - 0·7, - 0·1) v. 0·0 (25th, 75th percentiles - 0·3, 0·4) mg/l (P = 0·001). Consumption of an Fe-fortified breakfast cereal with kiwifruit compared with banana improved Fe status. Addition of an ascorbic acid-, lutein- and zeaxanthin-rich fruit to a breakfast cereal fortified with ferrous sulfate is a feasible approach to improve Fe status in women with low Fe stores.

Topics: Actinidia; Adult; Anemia, Iron-Deficiency; Antioxidants; Ascorbic Acid; Biomarkers; Carotenoids; Edible Grain; Female; Ferritins; Ferrous Compounds; Food, Fortified; Fruit; Humans; Iron, Dietary; Musa; Phytotherapy; Plant Extracts; Receptors, Transferrin; Young Adult

An experiment was conducted to evaluate the effects of laying hen diets supplemented with δ-aminolevulinic acid (ALA) and vitamin C (VC) on productive performance, iron status and egg quality. A total of 252 Hy-line brown commercial laying hens were fed two levels of VC (0 and 500 mg/kg) and three levels of ALA (0, 5 and 10 mg/kg) in a 2 × 3 factorial arrangement from 57 to 63 weeks of age. Each treatment contained seven replicates with six hens in each replicate. Supplementation of the diet with both ALA and VC resulted in a significant increase in egg production during 4-6 weeks (p < 0.05). The haematocrit (HCT), total iron-binding capacity (TIBC), white blood cell (WBC), total protein and albumin concentrations were not affected by the dietary treatments. However, ALA and interactive effect of ALA and VC were observed to increase the RBC, haemoglobin and serum iron concentrations (p < 0.05). In addition, inclusion of both ALA and VC increased blood lymphocyte percentage in relation to hens not supplemented with ALA (p < 0.05). Moreover, single effect of ALA or VC improved (p < 0.05) the yolk colour unit and albumin height from 3 to 6 weeks. The egg shell colour was increased (p < 0.05) by the effect of ALA. The addition of VC also led to an increase (p < 0.05) of the Haugh unit at the end of the experiment. However, neither ALA, nor VC exerted an effect on egg weight, egg shell breaking strength or egg shell thickness. The results demonstrate that dietary ALA and VC supplementation can improve the iron status and egg quality of laying hens.

Topics: Aminolevulinic Acid; Anemia, Iron-Deficiency; Animal Feed; Animal Nutritional Physiological Phenomena; Animals; Ascorbic Acid; Chickens; Diet; Dietary Supplements; Dose-Response Relationship, Drug; Drug Interactions; Drug Therapy, Combination; Eggs; Female; Iron; Oviposition

Micronutrient powders (MNP) are often added to complementary foods high in inhibitors of iron and zinc absorption. Most MNP therefore include high amounts of iron and zinc, but it is no longer recommended in malarial areas to use untargeted MNP that contain the Reference Nutrient Intake for iron in a single serving. The aim was to test the efficacy of a low-iron and -zinc (each 2.5 mg) MNP containing iron as NaFeEDTA, ascorbic acid (AA), and an exogenous phytase active at gut pH. In a double-blind controlled trial, South African school children with low iron status (n = 200) were randomized to receive either the MNP or the unfortified carrier added just before consumption to a high-phytate maize porridge 5 d/wk for 23 wk; primary outcomes were iron and zinc status and a secondary outcome was somatic growth. Compared with the control, the MNP increased serum ferritin (P < 0.05), body iron stores (P < 0.01) and weight-for-age Z-scores (P < 0.05) and decreased transferrin receptor (P < 0.05). The prevalence of iron deficiency fell by 30.6% (P < 0.01) and the prevalence of zinc deficiency decreased by 11.8% (P < 0.05). Absorption of iron from the MNP was estimated to be 7-8%. Inclusion of an exogenous phytase combined with NaFeEDTA and AA may allow a substantial reduction in the iron dose from existing MNP while still delivering adequate iron and zinc. In addition, the MNP is likely to enhance absorption of the high native iron content of complementary foods based on cereals and/or legumes.

Topics: 6-Phytase; Anemia, Iron-Deficiency; Ascorbic Acid; Body Weight; Child; Deficiency Diseases; Double-Blind Method; Edetic Acid; Edible Grain; Female; Ferric Compounds; Ferritins; Food, Fortified; Humans; Intestinal Absorption; Iron; Iron Chelating Agents; Iron Deficiencies; Male; Prevalence; Receptors, Transferrin; South Africa; Trace Elements; Zea mays; Zinc

The absorption profile of iron fortificants may be a determinant of their ability to generate nontransferrin-bound iron (NTBI) and, thus, their potential safety. Ferrous iron may be absorbed more rapidly than chelated ferric iron, but differences at the fortification level cannot be distinguished with nonisotopically labeled serum iron curves. Using stable isotope appearance curves (SIAC) in serum, we measured iron absorption profiles from FeSO(4) with ascorbic acid (AA) and from NaFeEDTA, as well as the serum hepcidin and NTBI response following the meals. Healthy women (n = 16) were given 6 mg oral iron as labeled FeSO(4) and NaFeEDTA with a maize porridge using a crossover design. SIAC, NTBI, and serum hepcidin were measured over 8 h after the meal. Iron from FeSO(4) plus AA was more rapidly absorbed, resulting in a 35% greater relative AUC during the first 2 h than for NaFeEDTA (P < 0.001). Median (95% CI) fractional iron absorption from the FeSO(4)- and NaFeEDTA-fortified meals was 15.2% (11.0-19.5) and 6.0% (5.0-9.2), respectively (P < 0.001). In response to the FeSO(4)-fortified meal, there was an ~60% increase in median serum hepcidin (P < 0.05) but no significant change in NTBI. There was no significant change in serum hepcidin or NTBI after the NaFeEDTA-fortified meal. SIAC are a useful new tool to compare iron absorption profiles from different iron compounds in fortified foods. Even with the use of a very well absorbed ferrous iron compound, iron fortification in this population does not increase NTBI, suggesting a low risk for adverse health consequences.

Topics: Adult; Algorithms; Anemia, Iron-Deficiency; Antimicrobial Cationic Peptides; Ascorbic Acid; Cross-Over Studies; Edetic Acid; Female; Ferric Compounds; Ferrous Compounds; Food, Fortified; Hemoglobins; Hepcidins; Humans; Intestinal Absorption; Iron Chelating Agents; Iron Isotopes; Iron, Dietary; Kinetics; Oxidation-Reduction; Protein Binding

Increasing the consumption of Fe-rich foods and thus improving Fe bioavailability without significantly increasing diet cost is the most sustainable intervention for improving Fe intake. We assessed the effect of supplementary food consisting of fermented soyabean (tempeh) and vitamin C-rich fruit consumed during pregnancy on maternal iron deficiency (ID).. Pregnant women were randomly allocated by village into optimized diet and control groups. Supplementary food was given 6 d/week at home. The average weekly food provided comprised 600 g of tempeh, 30 g of meat, 350 g of guava, 300 g of papaya and 100 g of orange. Hb, ferritin and transferrin receptor (TfR) concentrations were measured at 12-20 and at 32-36 weeks of gestation.. Thirty-nine villages in Indonesia.. Pregnant women (12-20 weeks of gestation, n 252).. At baseline, mean Hb, ferritin and TfR concentrations and body Fe concentration were within the normal range and did not differ between groups. At near term, mean Hb, ferritin and body Fe decreased, whereas mean TfR increased significantly in both groups. The mean changes in Fe status were similar in both groups. In Fe-deficient women, consumption of an optimized diet was associated with smaller decreases in Hb (1·02 (95% CI 0·98, 1·07) g/l; P = 0·058), ferritin (1·42 (95% CI 1·16, 1·75) μg/l; P = 0·046) and body Fe (2·57 (95% CI 1·71, 3·43) mg/kg; P = 0·073) concentrations, compared with a state of no intervention. Fe-deficient women at baseline benefited more from supplementary food compared with Fe-replete women.. Daily supplementary food containing tempeh and vitamin C-rich fruits during pregnancy might have positive effects on maternal ID.

Topics: Adolescent; Adult; Anemia, Iron-Deficiency; Antigens, CD; Ascorbic Acid; Diet; Dietary Supplements; Female; Fermentation; Ferritins; Fruit; Humans; Indonesia; Iron, Dietary; Middle Aged; Nutritional Status; Pregnancy; Receptors, Transferrin; Soy Foods; Young Adult

Assess the efficacy of a 10-week consumption of guava juice on the iron status of children with mild iron deficiency anemia.. Ninety-five boarding school children aged 6-9 years identified as anemic were randomly allocated to receive 300 mL of natural guava juice containing ∼200 mg of ascorbic acid (AA) or placebo (guava-flavored juice free of AA) with the main meal (5 d/wk). Information about dietary intake was collected at weeks 3, 5, and 7 at school and household levels. Changes in hemoglobin (Hb) and plasma ferritin (PF) among the subsample iron deficient at baseline (n = 33) were the main outcomes.. Iron and phytic acid intakes at school and at home did not differ between groups. Baseline Hb and PF were 11.9 ± 0.5 g/dL and 8.2 ± 3.6 ng/mL for the guava, and 11.4 ± 1.1 g/dL and 7.4 ± 4.6 ng/mL for the placebo group (Hb: p = 0.08; PF: p = 0.31); at week 10 of the study, corresponding values were 13.1 ± 0.9 g/dL and 17.9 ± 10.3 ng/mL (n = 16), and 12.3 ± 1.3 g/dL and 15.4 ± 5.8 ng/mL (n = 12) (Hb: p = 0.05; PF: p = 0.21). With analysis of variance (ANOVA) for repeated measures, the guava group had 0.64 g/dL higher Hb (CI(95), 0.18-1.11; p = 0.01) and 2.47 ng/mL higher PF (CI(95), -1.04 to 5.98; p = 0.12) compared with the placebo group.. Guava juice providing 200 mg AA at one meal on each school day had a marginal effect on Hb and PF concentrations in children consuming high-phytate diets fortified with iron.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Beverages; Child; Diet; Energy Intake; Female; Ferritins; Hemoglobins; Humans; Interviews as Topic; Iron, Dietary; Male; Mexico; Nutritional Status; Phytic Acid; Psidium; Surveys and Questionnaires

Dietary treatment is often recommended as the first line of treatment for women with mild iron deficiency. Although it is well established that ascorbic acid enhances iron absorption, it is less clear whether the consumption of ascorbic acid rich foods (such as kiwifruit) with meals fortified with iron improves iron status. The aim of this study is to investigate whether the consumption of ZESPRI(R) GOLD kiwifruit (a fruit high in ascorbic acid and carotenoids) with an iron fortified breakfast cereal meal increases iron status in women with low iron stores.. Eighty nine healthy women aged 18-44 years with low iron stores (serum ferritin (SF) or= 115 g/L) living in Auckland, New Zealand were randomised to receive an iron fortified breakfast cereal (16 mg iron per serve) and either two ZESPRI(R) GOLD kiwifruit or a banana (low ascorbic acid and carotenoid content) to eat at breakfast time every day for 16 weeks. Iron status (SF, Hb, C-reactive protein (CRP) and soluble transferrin receptor (sTfR)), ascorbic acid and carotenoid status were measured at baseline and after 16 weeks. Anthropometric measures, dietary intake, physical activity and blood loss were measured before and after the 16 week intervention.. This randomised controlled intervention study will be the first study to investigate the effect of a dietary based intervention of an iron fortified breakfast cereal meal combined with an ascorbic acid and carotenoid rich fruit on improving iron status in women with low iron stores.. ACTRN12608000360314.

Topics: Actinidia; Adolescent; Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Carotenoids; Edible Grain; Female; Food, Fortified; Fruit; Humans; Iron; Musa; Surveys and Questionnaires; Young Adult

Interventions to combat mild Fe deficiency in women of childbearing age may affect Zn nutriture. We used dietary and laboratory indices to assess change in Zn status during a 4-month partially blinded placebo-controlled Fe intervention in women with low Fe stores (serum ferritin < 20 microg/l and Hb > or = 120 g/l) from Dunedin, New Zealand. Subjects aged 18-40 years were randomly assigned to three groups: dietary advice (diet group; DG; n 29), daily Fe supplement with meals (supplement group; SG; n 23; 50 mg Fe as amino acid chelate) and placebo (placebo group; PG, n 26). A validated semi-quantitative FFQ (SFFQ) was administered at baseline, and at 4, 8 and 15 weeks; fasting morning blood samples were assayed for serum Zn, alkaline phosphatase (ALP) and C-reactive protein at baseline, and at 4, 8, 12 and 16 weeks; hair Zn and taste detection thresholds by electrogustometry were measured at baseline and at 16 weeks. Intakes of flesh foods and vitamin C but not Zn or Fe increased, whereas phytate and phytate:Zn molar ratios decreased (all P < or = 0.01) in the DG compared with the PG and SG, based on three SFFQ. Serum Zn increased in both the DG and PG (adjusted, P < or = 0.002), so the between-group difference was not significant; the lack of a parallel rise in the SG was significant when compared with the PG (P = 0.02). ALP activity (but not hair Zn or taste acuity) followed a similar trend. In conclusion, Zn status was not improved compared with placebo by an Fe-based dietary intervention. However, a daily moderate-dose Fe supplement with meals appeared to lower Zn status in these young adult women.

Topics: Adult; Alkaline Phosphatase; Anemia, Iron-Deficiency; Ascorbic Acid; Counseling; Diet Surveys; Dietary Supplements; Energy Intake; Female; Ferritins; Hair; Humans; Iron, Dietary; Meat; Phytic Acid; Single-Blind Method; Surveys and Questionnaires; Taste Threshold; Trace Elements; Young Adult; Zinc

In-home fortification of complementary foods with micronutrient powders containing low amounts of iron may be potentially safer than powders containing high amounts of iron. However, low iron doses have little nutritional effect, unless iron absorption is high.. The objective was to maximize iron absorption from a low-iron micronutrient powder for in-home fortification by testing combinations of iron as NaFeEDTA, ascorbic acid, and a microbial phytase active at gut pH. In addition, a recently proposed enhancer of iron absorption, L-alpha-glycerophosphocholine (GPC), was tested.. In 6 separate iron-absorption studies using a crossover design, women (n = 101) consumed whole-maize porridge fortified with 3 mg stable isotope-labeled FeSO4 or NaFeEDTA with different combinations of enhancers added to the meals at the time of consumption. Incorporation of iron isotopes into erythrocytes 14 d later was measured.. The addition of phytase when iron was present as either NaFeEDTA or FeSO4, with or without ascorbic acid, significantly increased iron absorption. The combined addition of phytase, ascorbic acid, and NaFeEDTA resulted in an absorption of 7.4%, compared with an absorption of 1.5% from FeSO4 without enhancers in the same meal (P < 0.001). The addition of ascorbic acid did not significantly increase iron absorption from NaFeEDTA, and the addition of calcium did not significantly inhibit iron absorption from NaFeEDTA in the presence of ascorbic acid. The addition of L-alpha-glycerophosphocholine did not significantly increase iron absorption.. Optimization of the micronutrient powder increased iron absorption from a highly inhibitory meal approximately 5-fold. This approach may allow for effective, untargeted in-home fortification of complementary foods with low amounts of highly bioavailable iron.

Topics: 6-Phytase; Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Biological Availability; Cross-Over Studies; Drug Synergism; Edetic Acid; Erythrocytes; Female; Ferric Compounds; Ferritins; Food, Fortified; Glycerylphosphorylcholine; Hemoglobins; Humans; Intestinal Absorption; Iron Isotopes; Iron, Dietary

Non-water-soluble iron compounds have been reported to be less well absorbed than ferrous sulfate in young children, and concern has been raised about their usefulness as food fortificants.. The objective was to evaluate the usefulness of ferrous fumarate and ferric pyrophosphate, compared with ferrous sulfate, in maintaining hemoglobin concentrations >105 g/L in Bangladeshi children.. Two hundred thirty-five children aged 7-24 mo (hemoglobin >105 g/L) were randomly assigned in a double-blind study to receive an infant cereal fortified with ferrous fumarate, ferric pyrophosphate, or ferrous sulfate. One serving of cereal (9.3 mg Fe; molar ratio of ascorbic acid to iron of 3:1) was consumed per day, 6 d/wk, for 9 mo. Blood samples were drawn at 4.5 and 9 mo.. Raw data were reformatted, and a "time to event" was calculated that corresponded to reaching the following thresholds: hemoglobin <105 g/L, plasma ferritin <12 microg/L, or plasma C-reactive protein >10 mg/L at baseline, 4.5 mo, or 9 mo. Data were censored when children did not reach the threshold or were lost to follow-up. A Kaplan-Meier approach was used to compare the 3 groups. No statistically significant differences were observed for hemoglobin <105 g/L (P = 0.943), plasma ferritin <12 microg/L (P = 0.601), or plasma C-reactive protein >10 mg/L (P = 0.508).. Contrary to earlier concerns, these results do not indicate differences in usefulness between water-soluble and non-water-soluble iron compounds in maintaining hemoglobin concentrations and preventing iron deficiency. These data will be important in the development of food-fortification strategies to combat anemia and iron deficiency in highly vulnerable population groups.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Bangladesh; C-Reactive Protein; Child, Preschool; Diphosphates; Female; Ferritins; Ferrous Compounds; Food, Fortified; Hemoglobins; Humans; Infant; Iron; Iron, Dietary; Male; Trace Elements

Ascorbic acid (AA) enhances and tea inhibits iron absorption. It is unclear whether iron status influences the magnitude of this effect.. We evaluated the influence of the iron status of young women on iron absorption from a rice meal with or without added tea or AA.. Two stable-isotope iron absorption studies were made in 2 groups of 10 subjects with iron deficiency anemia (IDA) and 10 subjects who were iron replete (control subjects). In study 1, the reference rice meal was fed alone or with 1 or 2 cups of black tea. In study 2, the reference meal was fed alone or with AA (molar ratio to iron, 2:1 or 4:1). Iron absorption was measured by the erythrocyte incorporation of (57)Fe and (58)Fe labels at 14 d.. Mean fractional iron absorption from the reference rice meal was approximately 2.5 times as great in the IDA group as in the control group (P < 0.05). The consumption of 1 or 2 cups of tea decreased iron absorption in the control subjects by 49% (P < 0.05) or 66% (P < 0.01), respectively, and in the IDA group by 59% or 67% (P < 0.001 for both), respectively. AA (molar ratio to iron, 2:1 or 4:1) increased iron absorption by 270% or 343%, respectively, in control subjects and by 291% or 350%, respectively, in subjects with IDA (P < 0.001).. The inhibitory effect of tea and the enhancing effect of AA on iron absorption were similar in the 2 groups. Overall differences in iron absorption in the 2 groups, however, continued to be dictated by iron status.

Topics: Adolescent; Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Biological Availability; Case-Control Studies; Cross-Over Studies; Erythrocytes; Female; Humans; Intestinal Absorption; Iron Isotopes; Iron, Dietary; Nutritional Status; Tea

Dietary fruits and vegetables may enhance iron status because of their high vitamin C content. The potential association between iron status and intakes of specific fruits and vegetables, according to sex and menopausal status, must be investigated.. The objective was to assess the relation between dietary fruits, vegetables, and juices (FVJ) according to their vitamin C and fiber contents and serum ferritin and hemoglobin concentrations.. A total of 4358 subjects, aged 35-60 y, of the Supplementation with Antioxidant Vitamins and Minerals (SU.VI.MAX) cohort were selected. Subjects had completed at least six 24-h-dietary records over 2 y. The relation between serum ferritin and hemoglobin, measured at inclusion, and dietary FVJ according to their vitamin C and fiber contents was assessed by multiple regression analysis.. In premenopausal women, serum ferritin was positively associated with intakes of fiber-poor FVJ (up to 10% higher serum ferritin in the third tertile compared with the first tertile). In the whole sample, hemoglobin was positively associated with fruits, vitamin C-rich FVJ, FVJ ascorbic acid, and fiber-poor FVJ categories (up to 1.5 g/L higher hemoglobin concentration).. Intakes of fiber-poor FVJ were associated with higher serum ferritin concentrations in premenopausal women and with higher hemoglobin concentrations in the whole sample. Our results suggest that the fiber content of fruits and vegetables influences iron stores in premenopausal women but has no influence in groups in whom nonheme-iron absorption is limited because of high iron stores. Other mechanisms are likely to be involved in the case of hemoglobin.

Topics: Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Beverages; Cohort Studies; Diet Records; Dietary Fiber; Double-Blind Method; Female; Ferritins; Fruit; Hemoglobins; Humans; Intrauterine Devices; Iron; Male; Menopause; Menstruation; Middle Aged; Nutritional Status; Regression Analysis; Vegetables

Infants in developing countries require early dietary interventions to prevent nutritional deficiencies, above all protein, energy, iron and zinc. To what extent these interventions may affect the fatty acid (FA) status is still unknown.. To examine and compare the effects of 2 micronutrient "sprinkles" supplementations (iron 12.5 mg + folic acid 150 microg, iron/folate and iron 12.5 mg + folic acid 150 microg + zinc 5 mg + vitamins A, C and D3, mineral/micronutrient [MMN]) versus placebo on the FA status of Cambodian infants.. A total of 204 infants age 6 mo and living in Kompong Chhnang Province, Cambodia, were randomly assigned to receive daily supplementation of MMN (n = 68) and iron/folate (n = 68) or placebo (n = 68) for a 12-mo period in powder form as sprinkles. At the end of the intervention period, FAs in the range of 16 to 24 C were determined in blood drops absorbed on a strip collected from 182 subjects, and values among the 3 intervention subgroups and those of 21 Italian 18-mo-old, normal-growing infants as the reference group were compared.. At the end of the supplementation trial, higher levels of the 2 essential FAs (EFAs) (linoleic acid, 18:2n-6, and alpha-linolenic acid, 18:3n-3) were found in the MMN group. No differences occurred for the major longer chain derivatives of both EFAs arachidonic acid (20:4n-6) and docosahexaenoic acid (22:6n-3). In MMN supplemented Cambodians, blood levels of linoleic acid approached those of Italian infants, and in addition their alpha-linolenic acid levels were improved. Cambodian infants, mostly still breast-fed through the second year of life, showed significantly higher levels of long-chain derivatives of both the n-6 and the n-3 series compared with Italians.. Supplementation with iron, folic acid, zinc and vitamins was associated with an increase of linoleic acid and alpha-linolenic acid levels in Cambodian infants versus placebo, without significant changes in the concentrations of their longer chain derivatives, resulting in a FA status closer to Italian counterparts for the essential polyunsaturated FA levels. The iron/folate-treated infants showed no differences compared with the other 2 groups. Studies are needed to differentiate the potential effects of the supplemented micronutrients on the FA status.

Topics: alpha-Linolenic Acid; Anemia, Iron-Deficiency; Ascorbic Acid; Cambodia; Child Development; Cholecalciferol; Dietary Supplements; Double-Blind Method; Female; Folic Acid; Fumarates; Gluconates; Humans; Infant; Iron Compounds; Italy; Linoleic Acid; Longitudinal Studies; Male; Micronutrients; Polysaccharides; Vitamin A

We measured iron bioavailability of meals based on wheat flour consumed by a vulnerable population in Latin America.. Bioavailability of iron (ferrous sulfate) from fortified noodles, noodle soup, noodle soup eaten with lemonade sweetened with panela (unrefined whole cane sugar), bread alone, and bread consumed with a chamomile infusion sweetened with panela was studied using the double isotopic method in 13 women.. Iron bioavailabilities from bread, noodles, and noodle soup were not significantly different (7.4%, 6.3%, and 6.0%, respectively). Iron absorption from noodle soup was significantly higher when given with lemonade (11.0%) compared with absorption of the same meal without lemonade (P < 0.02) or with the absorption of noodles (P < 0.04). Iron absorption of bread given alone or with chamomile infusion sweetened with panela (8%) was not significantly different.. Iron bioavailability of meals based on wheat flour, fortified with ferrous sulfate, is improved when given with lemonade. The consumption of this beverage may be an alternative to further increase the effectiveness of wheat flour fortification in preventing iron deficiency in low-income Latin American populations.

Topics: Acetic Acid; Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Beverages; Biological Availability; Chamomile; Cross-Over Studies; Female; Ferrous Compounds; Flour; Food, Fortified; Humans; Intestinal Absorption; Iron Radioisotopes; Iron, Dietary; Middle Aged; Plant Extracts; Triticum

We aimed to assess the efficacy of whole cow's milk fortified with ferrous gluconate and zinc oxide, along with ascorbic acid, in reducing the prevalence of anemia and improving iron status of low income children 10-30 mo of age. Healthy children were randomly assigned to drink 400 mL/d of cow's whole milk, either fortified milk (FM) with 5.8 mg/400 mL of iron as ferrous gluconate, 5.28 mg/400 mL of zinc as zinc oxide, and 48 mg/400 mL of ascorbic acid, or nonfortified milk (NFM) with 0.2 mg iron/400 mL, 1.9 mg zinc/400 mL, and 6.8 mg ascorbic acid/400 mL. Hemoglobin, serum ferritin, soluble transferrin receptors (TfR), and C-reactive protein concentrations were measured at baseline and 6 mo after intervention. The prevalence of anemia declined from 41.4 to 12.1% (P < 0.001), or 29 percentage points, in the FM group; there was no change in the NFM group. Hemoglobin (coefficient = 0.22, P < 0.01) was positively and TfR (coefficient = -0.29, P < 0.001) negatively associated with treatment, controlling for their respective baseline values, age, and gender. Treatment with FM was negatively associated with the likelihood of being anemic (pseudo R(2) = 0.085, P < 0.03) after 6 mo of intervention. Ferrous gluconate added to whole cow's milk as a fortificant along with ascorbic acid is efficacious in reducing the prevalence of anemia and in improving iron status of Mexican toddlers. The results of this study lead to broadening a subsidized FM distribution program to 4.2 million beneficiary children 1-11 y of age in Mexico.

Topics: Anemia, Iron-Deficiency; Animals; Ascorbic Acid; C-Reactive Protein; Child, Preschool; Female; Ferritins; Ferrous Compounds; Food, Fortified; Hemoglobins; Humans; Infant; Linear Models; Male; Mexico; Milk; Nutritional Status; Receptors, Transferrin; Zinc Oxide

One of the strategies to control iron deficiency anemia is the fortification of food with iron. A mechanism for improving the bioavailability of iron is to add an iron absorption promoter.. The objective was to determine the effect of ascorbyl palmitate (AP) on the bioavailability of iron in fortified bread made from refined wheat flour.. The iron bioavailability of wheat flour fortified with either ferrous sulfate alone or ferrous sulfate plus AP was studied with the use of double radio iron (55Fe and 59Fe) erythrocyte incorporation in 14 women.. Geometric mean (+/- range of 1 SD) iron absorption from the bread fortified with ferrous sulfate was 10.5% (4.1-27.0%). The addition of AP at molar ratios of AP to Fe of 2:1 and 4:1 significantly increased iron absorption [14.6% (5.9-36.1%) and 20.2% (10.6-38.6%), respectively; P < 0.001].. AP is a strong promoter of iron absorption from fortified bread because of its thermoresistant properties.

Topics: Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Biological Availability; Bread; Erythrocytes; Female; Food, Fortified; Humans; Iron; Iron Radioisotopes

The aim of this study was to determine whether iron deficiency anemia (IDA) in mothers alters their maternal cognitive and behavioral performance, the mother-infant interaction, and the infant's development. This article focuses on the relation between IDA and cognition as well as behavioral affect in the young mothers. This prospective, randomized, controlled, intervention trial was conducted in South Africa among 3 groups of mothers: nonanemic controls and anemic mothers receiving either placebo (10 microg folate and 25 mg vitamin C) or daily iron (125 mg FeS0(4), 10 microg folate, 25 mg vitamin C). Mothers of full-term normal birth weight babies were followed from 10 wk to 9 mo postpartum (n = 81). Maternal hematologic and iron status, socioeconomic, cognitive, and emotional status, mother-infant interaction, and the development of the infants were assessed at 10 wk and 9 mo postpartum. Behavioral and cognitive variables at baseline did not differ between iron-deficient anemic mothers and nonanemic mothers. However, iron treatment resulted in a 25% improvement (P < 0.05) in previously iron-deficient mothers' depression and stress scales as well as in the Raven's Progressive Matrices test. Anemic mothers administered placebo did not improve in behavioral measures. Multivariate analysis showed a strong association between iron status variables (hemoglobin, mean corpuscular volume, and transferrin saturation) and cognitive variables (Digit Symbol) as well as behavioral variables (anxiety, stress, depression). This study demonstrates that there is a strong relation between iron status and depression, stress, and cognitive functioning in poor African mothers during the postpartum period. There are likely ramifications of this poorer "functioning" on mother-child interactions and infant development, but the constraints around this relation will have to be defined in larger studies.

Topics: Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Cognition; Demography; Depression; Dietary Supplements; Educational Status; Emotions; Female; Ferric Compounds; Humans; Income; Placebos; Pregnancy; Pregnancy Complications; Puerperal Disorders; South Africa; Stress, Psychological

Topics: Adolescent; Anemia, Iron-Deficiency; Ascorbic Acid; Dietary Supplements; Double-Blind Method; Drug Therapy, Combination; Female; Folic Acid; Hemoglobins; Humans; India; Iron; Vitamin A

Iron-deficiency anemia currently is the most frequently occurring nutritional disorder world-wide. Previous Brazilian studies have demonstrated that drinking water fortified with iron and ascorbic acid is an adequate vehicle for improving the iron supply for children frequenting day-care centers.. The objective of this study was to clarify the role of ascorbic acid as a vehicle for improving iron intake in children in day-care centers in Brazil.. A six-month study was conducted on 150 children frequenting six day-care centers divided into two groups of three day-care centers by drawing lots: the iron-C group (3 day-care centers, n = 74), which used water fortified with 10 mg elemental iron and 100 mg ascorbic acid per liter, and the comparison group (3 day-care centers, n = 76), which used water containing only 100 mg ascorbic acid per liter. Anthropometric measurements and determinations of capillary hemoglobin were performed at the beginning of the study and after six months of intervention. The food offered at the day-care centers was also analyzed.. The food offered at the day-care center was found to be deficient in ascorbic acid, poor in heme iron, and adequate in non-heme iron. Supplementation with fortified drinking water resulted in a decrease in the prevalence of anemia and an increase in mean hemoglobin levels associated with height gain in both groups.. Fortification of drinking water with iron has previously demonstrated effectiveness in increasing iron supplies. This simple strategy was confirmed in the present study. The present study also demonstrated that for populations receiving an abundant supply of non-heme iron, it is possible to control anemia in a simple, safe, and inexpensive manner by adding ascorbic acid to drinking water.

Topics: Anemia, Iron-Deficiency; Anthropometry; Antioxidants; Ascorbic Acid; Brazil; Child Day Care Centers; Child, Preschool; Female; Food, Fortified; Fresh Water; Hemoglobins; Humans; Iron, Dietary; Male; Treatment Outcome

Maize-meal porridge is used for infant feeding in many African countries, including South Africa. A low-cost, finely milled, maize-meal porridge was fortified with beta-carotene, iron, and zinc (100% of recommended dietary allowance), as well as ascorbic acid, copper, selenium, riboflavin, vitamin B-6, vitamin B-12, and vitamin E.. We assessed whether the fortified porridge could reduce anemia and improve the micronutrient status and motor development of infants.. Infants aged 6-12 mo (n = 361) were randomly assigned to receive either the fortified or unfortified porridge for 6 mo. Primary outcomes were hemoglobin and serum retinol, zinc, and ferritin concentrations and motor development. Growth was assessed as a secondary outcome. Primary and secondary outcomes were assessed at baseline and 6 mo.. Two hundred ninety-two infants completed the study. The fortified-porridge group had an intervention effect of 9.4 microg/L (95% CI: 3.6, 15.1 microg/L) for serum ferritin and 9 g/L (95% CI: 6, 12 g/L) for hemoglobin concentrations. The proportion of infants with anemia decreased from 45% to 17% in the fortified-porridge group, whereas it remained >40% in the control group. The fortified-porridge group achieved on average 15.5 of the 25 motor development score items, whereas the control group achieved 14.4 items (P = 0.007). Serum retinol concentration showed an inconsistent effect, and no intervention effect was observed for serum zinc concentrations.. This low-cost fortified porridge can potentially have a significant effect in reducing anemia and improving iron status and motor development of infants in poor settings. The formulation needs some adjustment in terms of zinc fortification.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; beta Carotene; Child Development; Copper; Female; Food, Fortified; Humans; Infant; Infant Food; Infant Nutritional Physiological Phenomena; Iron, Dietary; Male; Micronutrients; Motor Skills; Nutritive Value; Selenium; Vitamin B Complex; Vitamin E; Vitamins; Weaning; Zea mays; Zinc

To study the effect of different therapeutical regimens of Ferro-Folgamma, in pregnant patients with iron deficiency anemia.. 22 pregnant patients between 20 and 35 week of gestation (mean 29 gestational week) with hemoglobin levels between 83.1-106 g/l were included. They were divided in two groups: group 1 included patients with hemoglobin levels up to 100g/l and group 2--with hemoglobin levels between 100 and 110. The dosage of the preparation in group 1 was 1 tablet Ferro-Folgamma tid for 40 days, and 1 tablet Ferro-Folgamma bid for the same period. Blood samples were taken four times during the study on day 0, 10th day, 20th day and in the week after the 40th completed day of therapy. The samples were tested for CBC, iron, transferine, feritine, folic acid. All patients were given complete information about the possible risks of iron deficiency anemia during pregnancy and parturition.. The mean hemoglobin level at initiation of treatment was 91.22 g/l (day 0). After initiation of treatment the the following rise in hemoglobin levels was detected 10th day - 103.8 g/l, 20th day - 112.6 g/l, after the 40th completed day - 136.0 g/l. The mean levels of the rest of hematological parameters were, day 0 - Er - 3.25 mln/microl, Fe - 7.53 micromol/l, transferine - 3.65 gr/l, feritine - 15.02 ngr/ml, folic acid - 14.08 ng/ml, vit. B12 - 219.68 pg/ml; 10th day - Er- 3.5 mln/microl, Fe - 14. 12 micromol/l; 20th day - Er - 4.10 mln/microl, Fe - 20.46 micromol/l; 40th completed day - Er- 4.69 mln/microl, Fe - 13.12 micromol/l, transferine - 3.82 gr/l, feritine - 27.42 ngr/ml, folic acid - 15.67 ng/ml, vit. B12 - 484.52 pg/ml respectively.. Oral treatment with Ferro-Folgamma, according the described dosage regimen, demonstrates its fast and stable effect in treatment of moderate iron deficiency and recovery of depleted iron pool in pregnant patients as well. It could be administered as a prophylactic preparation for borderline anemic states.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Drug Combinations; Female; Ferrous Compounds; Folic Acid; Gestational Age; Hemoglobins; Humans; Iron Metabolism Disorders; Pregnancy; Pregnancy Complications, Hematologic; Treatment Outcome

Despite efforts to improve iron supplements for iron deficiency anemia, there is no consensus on products that balance efficacy, safety and tolerability, and cost. Ferrous products are effective, but they are associated with more gastrointestinal side effects than ferric products. Ferric products tend to have lower absorption. We present results from a 12-week study that randomized 72 people with uncomplicated iron deficiency anemia to receive a ferrous iron supplement (Ferall, a combination of ferrous fumarate with ascorbic acid, folic acid, and cyanocobalamin) or a ferric iron polysaccharide complex (Niferex, ferro-glycine sulfate) plus ascorbic acid. The ferrous product was significantly more effective, the primary and secondary endpoints including changes in levels of hemoglobin and serum ferritin. There was a slightly higher frequency of gastrointestinal side effects in patients taking the ferrous product, but both supplements were well tolerated. No participant withdrew from the study because of side effects. We concluded that the ferrous product is safe and effective for use in uncomplicated iron deficiency anemia. The lack of direct comparison between single-agent ferrous fumarate and the combination ferrous product limited interpretation of results in terms of possible effects due to other components, such as ascorbic acid.

Topics: Administration, Oral; Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Female; Ferritins; Ferrous Compounds; Folic Acid; Hemoglobins; Humans; Intestinal Absorption; Iron; Iron, Dietary; Male; Middle Aged; Polysaccharides; Taiwan; Treatment Outcome

To investigate if oral use of Sorbifer Durules (EGIS Pharmaceutical Ltd, Budapest, Hungary) (1 tablet/d) is adequate for the maintenance of serum iron and vitamin C in normal range during recombinant human erythropoietin treatment in hemodialyzed patients. One tablet of Sorbifer Durules contains 100 mg of Fe(2+) and 60 mg of vitamin C.. Short-term, open-label clinical trial.. Hemodialysis units.. Twenty-four adult patients with end-stage renal disease on hemodialysis.. Four-week treatment period of Sorbifer Durules, preceded and followed by iron and vitamin C washout periods.. Fasting predialysis serum samples were collected on days 0, 28, 56, and 84 to determine hematocrit, blood hemoglobin, serum iron, total iron-binding capacity, transferrin saturation, ferritin, vitamin C, and plasma oxalate.. Four-week treatment in hemodialyzed patients by Sorbifer Durules led to significant increase of hematocrit, blood hemoglobin, serum iron and vitamin C. This treatment did not influence the level of plasma oxalate.. Oral dose of one tablet of Sorbifer Durules per day is adequate for the maintenance of serum iron in normal range during recombinant human erythropoietin treatment in hemodialyzed patients. This treatment simultaneously prevented the development of serum vitamin C deficiency and did not lead to further increase of plasma oxalate in these patients.

Topics: Administration, Oral; Anemia, Iron-Deficiency; Ascorbic Acid; Creatinine; Erythropoietin; Female; Ferritins; Hematocrit; Hemoglobins; Humans; Iron; Iron Deficiencies; Iron, Dietary; Kidney Failure, Chronic; Male; Middle Aged; Oxalates; Recombinant Proteins; Renal Dialysis; Transferrin

To compare the effectiveness of microencapsulated iron(II) fumarate sprinkles (with and without vitamin A), iron(II) sulfate drops, and placebo sprinkles in preventing recurrence of anaemia and to determine the long-term haematological outcomes in children at high risk of recurrence of anaemia 12 months after the end of supplementation.. A prospective, randomized, placebo-controlled design was used to study 437 Ghanaian children aged 8-20 months who were not anaemic (haemoglobin > or = 100 g/l). Four groups were given microencapsulated iron(II) fumarate sprinkles, microencapsulated iron(II) fumarate sprinkles with vitamin A, iron(II) sulfate drops or placebo sprinkles daily for six months. Primary outcome measures were change in haemoglobin and anaemic status at baseline and study end. Non-anaemic children at the end of the supplementation period were reassessed 12 months after supplementation ended.. Overall, 324 children completed the supplementation period. Among the four groups, no significant changes were seen in mean haemoglobin, ferritin or serum retinol values from baseline to the end of the supplementation period. During the trial, 82.4% (267/324) of children maintained their non-anaemic status. Sprinkles were well accepted without complications. At 12 months post-supplementation, 77.1% (162/210) of children with no intervention remained non-anaemic. This proportion was similar for children among the four groups.. In most children previously treated for anaemia, further supplementation was not needed to maintain their non-anaemic status. These results may have important implications for community intervention programmes in which initial high-dose treatment is needed because of a high prevalence of anaemia.

Topics: Administration, Oral; Anemia, Iron-Deficiency; Ascorbic Acid; Child, Preschool; Dietary Supplements; Ferrous Compounds; Ghana; Humans; Infant; Placebos; Prospective Studies; Risk Factors; Secondary Prevention

Although ascorbic acid (AA) increases dietary iron bioavailability, there has been no food-based community trial of its efficacy in improving iron status.. The objective was to assess the efficacy of 25 mg AA as agua de limón (limeade), consumed with each of 2 daily meals, in improving the iron status of iron-deficient women.. Two rural Mexican populations were randomly assigned to an AA or a placebo group, each with 18 iron-deficient women. The AA group was given 500 mL limeade containing 25 mg AA twice a day, 6 d/wk, for 8 mo. The placebo group was given a lime-flavored beverage free of AA or citric acid. Beverages were consumed within 30 min of 2 main daily meals. Data were collected on morbidity (3 times/wk), dietary intake (on 6 d), socioeconomic status, parasites (twice), medical history, and response to treatment. Blood samples at 0, 2, 4, 6, and 8 mo were analyzed for hemoglobin, plasma AA, plasma ferritin, transferrin receptors, and C-reactive protein.. AA intake was significantly (P < 0.0001) higher in the AA group, but nonheme iron, heme iron, and phytic acid intakes did not differ significantly. Plasma AA was significantly (P < 0.01) higher in the AA group at 2, 4, 6, and 8 mo. There were no final differences between groups in hemoglobin, plasma ferritin, or transferrin receptor concentrations or in the ratio of transferrin receptors to plasma ferritin after control for initial concentrations.. Increasing dietary AA by 25 mg at each of 2 meals/d did not improve iron status in iron-deficient women consuming diets high in phytate and nonheme iron.

Topics: Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Biological Availability; Citrus; Female; Health Status; Humans; Intestinal Absorption; Iron, Dietary; Mexico; Nutritional Status; Phytotherapy; Receptors, Transferrin; Rural Population

To measure iron absorption in children from meals containing apple juice or orange juice so as to determine if iron absorption will be greater with orange juice because of its higher ascorbic acid content than apple juice, a noncitrus fruit juice that US children reportedly prefer.. On 2 successive days, children consumed identical meals that included apple juice on one day and orange juice on the other, in random order. The meals were labeled with iron-57 on one day and iron-58 on the other. Iron absorption was measured from red blood cell incorporation of the iron stable isotopes 14 days later.. Nutrition research institute in a major metropolitan medical center.. A total of 25 healthy children, 3 to 6 years of age, were recruited, of whom 21 (11 male and 10 female) completed the study. Intervention Identical meals served with orange juice and apple juice were given on consecutive days, in a balanced randomized design.. Iron absorption measured by established stable isotope methods.. Median iron absorption from the meal ingested with apple juice was 7.17% (mean +/- SD, 9.48% +/- 9.68%). Median iron absorption from the meal ingested with orange juice was 7.78% (9.80% +/- 6.66%; P =.44). Iron absorption from the meal that included apple juice was significantly correlated with serum ferritin concentration (P =.02); iron absorption from the meal that included orange juice tended to correlate with serum transferrin receptor concentration (P =.051).. As children absorb iron well from a meal that includes either orange or apple juice, a preference for apple juice does not pose a concern with regard to the prospect of iron-deficiency anemia, which remains a significant health problem in the United States.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Beverages; Child; Child, Preschool; Citrus; Citrus sinensis; Female; Ferritins; Humans; Intestinal Absorption; Iron; Iron Isotopes; Male; Malus; Receptors, Transferrin; Risk Factors

Iron deficiency and iron-deficiency anemia are common in the developing world. We evaluated the feasibility of iron fortification of domestic drinking water to prevent and control iron deficiency and iron-deficiency anemia. Twenty-one families representing 88 persons, including children, were selected to participate in this study. Twelve families added an iron solution plus ascorbic acid to their domestic drinking water over a four months period and nine families added a placebo. Blood samples were collected, before and after the four months, for hemoglobin and serum ferritin measurements. Iron-fortified drinking water increased hemoglobin (children 10.9 +/- 1.1 g/dl to 11.7 +/- 1.1 g/dl p < .01, adults 12.9 +/- 1.7 g/dl to 13.7 +/- 1.7 g/dl p < .01) and ferritin (children 27.6 +/- 21.6 ng/dl to 33.8 +/- 22.1 ng/dl, adults 74.8 +/- 41.3 ng/dl to 106.2 +/- 93.9 ng/dl p < .05). No significant changes in hemoglobin and ferritin were found in the placebo group after 4 months. Preparation, distribution, and consumption of the solutions were successful. Iron fortification of household drinking water can be a simple and effective alternative to deal with iron deficiency and iron-deficiency anemia in less developed areas.

Topics: Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Brazil; Child; Child, Preschool; Drinking; Ferritins; Ferrous Compounds; Hemoglobins; Humans; Infant; Iron; Iron Deficiencies; Poverty; Single-Blind Method; Socioeconomic Factors; Water

Intravenous ascorbic acid administration (IVAA) could override recombinant human erythropoietin (rHuEPO) resistance in hemodialysis patients with iron overload. We investigated the hematopoietic response to IVAA in iron-overloaded hemodialysis patients. We included 36 patients whose ferritin levels were higher than 500 microg/L and who needed more than 100 U/kg/week of rHuEPO. The study included an initial phase (500 mg IVAA twice weekly was administered to all of the patients for 8 weeks) and a maintenance phase (patient groups were formed; Group 1 received IVAA 500 mg/week for 8 weeks and Group 2 received no therapy). We observed a significant increase in hematocrit and transferrin saturation and a decrease in the percentage of hypochromic red cells and ferritin levels at the end of the initial phase. The total weekly-required rHuEpo dose and rHuEpo/hemoglobin also fell significantly after the initial phase. The response remained stable in patient groups during the maintenance phase. In 6 nonresponders, the hypochromic red cells were <10%. In conclusion, IVAA effectively overrides rHuEPO resistance in iron-overloaded hemodialysis patients.

Topics: Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Drug Resistance; Erythropoietin; Female; Hematopoiesis; Humans; Iron Overload; Male; Middle Aged; Recombinant Proteins; Renal Dialysis

Iron-fortified school breakfasts have been introduced in Peru to combat childhood iron deficiency.. We evaluated whether iron absorption from a school breakfast meal was improved by increasing the ascorbic acid content or by adding an alternative enhancer of iron absorption, Na2EDTA.. In a crossover design, iron absorption from test meals was evaluated by erythrocyte incorporation of 58Fe and 57Fe. The test meals (wheat bread and a drink containing cereal, milk, and soy) contained 14 mg added Fe (as ferrous sulfate) including 2.0-2.6 mg 58Fe or 4.0-7.0 mg 57Fe.. Geometric mean iron absorption increased significantly from 5.1% to 8.2% after the molar ratio of ascorbic acid to fortification iron was increased from 0.6:1 to 1.6:1 (P < 0.01; n = 9). Geometric mean iron absorption increased significantly from 2.9% to 3.8%, from 2.2% to 3.5%, and from 2.4% to 3.7% after addition of Na2EDTA at molar ratios relative to fortification iron of 0.3:1, 0.7:1, and 1:1, respectively, compared with test meals containing no added enhancers (P < 0.01; n = 10 for all). Iron absorption after addition of ascorbic acid (molar ratio 0.6:1) was not significantly different from that after addition of Na2EDTA (molar ratio 0.7:1).. Ascorbic acid and Na2EDTA did not differ significantly in their enhancing effects on iron absorption at molar ratios of 0.6:1 to 0.7:1 relative to fortification iron. Additional ascorbic acid (molar ratio 1.6:1) increased iron absorption significantly. Increasing the molar ratio of Na2EDTA to fortification iron from 0.3:1 to 1:1 had no effect on iron absorption.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Biological Availability; Child; Child Nutritional Physiological Phenomena; Cross-Over Studies; Edetic Acid; Erythrocytes; Female; Food Additives; Food, Fortified; Humans; Intestinal Absorption; Iron, Dietary; Isotope Labeling; Male; Mass Spectrometry; Peru

Standard therapy for anemia in infants is ferrous sulfate drops administered 3 times/d. Adherence to treatment, however, is often poor. One likely reason for poor adherence is the unpleasant side effects associated with drops.. The objective was to evaluate the use of a new form of iron and a delivery system to treat anemia in infants that is likely to produce better adherence to treatment.. Using a prospective, randomized, controlled design, we studied 557 anemic children aged 6-18 mo (hemoglobin: 70-99 g/L) in rural Ghana. One group received a daily sachet of microencapsulated ferrous fumarate (80 mg elemental Fe) in powder form plus ascorbic acid to be sprinkled onto any complementary food eaten (sprinkles group); a control group received ferrous sulfate drops 3 times/d for 2 mo (total dose: 40 mg elemental Fe). Hemoglobin and serum ferritin concentrations were measured at baseline and at the end of treatment.. Successful treatment of anemia (hemoglobin > 100 g/L) occurred in 58% of the sprinkles group and in 56% of the drops group, with minimal side effects in both groups. Geometric mean ferritin concentrations increased significantly in each group from baseline to the end of treatment (P < 0.001).. Use of ferrous sulfate drops or a single daily dose of microencapsulated ferrous fumarate sprinkles plus ascorbic acid resulted in a similar rate of successful treatment of anemia without side effects. To our knowledge, this is the first demonstration of the use of microencapsulated iron sprinkles to treat anemia. Improved ease of use may favor the use of sprinkles to deliver iron.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Drug Administration Schedule; Drug Compounding; Drug Therapy, Combination; Female; Ferritins; Ferrous Compounds; Ghana; Hemoglobins; Humans; Infant; Infant Food; Male; Patient Compliance; Prospective Studies; Rural Population; Weaning

Iron deficiency anemia is a common complication of gastric bypass. The authors assessed the value of taking vitamin C with oral iron in correcting deficiencies in iron stores and anemia postoperatively.. Iron absorption tests were performed on 55 patients 3.2+/-2.0 years after isolated gastric bypass to identify those at higher risk for the late development of anemia. Twenty-nine of this group agreed to a therapeutic trial of iron alone or with vitamin C over a 2-month period. All 55 patients were followed up for 27.1+/-1.0 months following the study.. The iron absorption test identified patients with low iron stores, as indicated by low serum ferritin, and those with sufficient absorption surface to benefit from oral iron. The addition of vitamin C appears to enhance the therapeutic effect of iron by correcting ferritin deficits (P < 0.01) and anemia (P < 0.05). Differences in intestine length bypassed by the operation (10 vs. 100 cm) did not affect late ferritin and hemoglobin values.. This study suggests but does not prove that the addition of vitamin C to iron therapy after gastric bypass is more effective in restoring ferritin and hemoglobin than iron alone. These results are in contrast with the outcome 22.8 months later, when approximately 50% of study patients were again anemic. Closer follow-up of patients is urgently needed.

Topics: Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Dose-Response Relationship, Drug; Drug Interactions; Female; Ferrous Compounds; Follow-Up Studies; Gastric Bypass; Humans; Iron; Male; Middle Aged; Treatment Outcome

Different supplementation schemes to build iron stores in female Indonesian adolescents were investigated. Subjects were 273 high-school girls allocated randomly to four treatment groups. During a 3-mo period one group received 60 mg Fe, 750 micrograms retinol, 250 micrograms folic acid, and 60 mg vitamin C per day; a second group received 60 mg Fe, 6000 micrograms retinol, 500 mg folic acid, and 60 mg vitamin C once a week; a third group received 120 mg Fe and the same amount of the other three micronutrients as the second group once a week; and a fourth group received only placebos. All subjects were dewormed and supplement allocation was double blind. Blood samples were collected at baseline, after 2 and 3 mo of supplementation, and 6 mo after the last supplement. After 2 mo of supplementation, groups supplemented weekly and daily showed similar significant improvements (P < 0.001) in hemoglobin and retinol concentrations, and supplementation for 3 instead of 2 mo did not significantly increase these two indicators. After 3 mo, the increase in ferritin was approximately equal to 27 micrograms/L in the daily and 14-15 micrograms/L in the weekly groups (P < 0.001), the latter having a final concentration of 42-45 micrograms/L. At 6 mo postsupplementation there were no significant differences among daily and weekly groups, but the ferritin concentration was still approximately equal to 10-12-micrograms/L higher (P < 0.001) than in the placebo group. The group supplemented weekly with 60 mg Fe complained less about side effects than the other supplemented groups (P < 0.05). Weekly supplementation with 60 mg Fe and 6000 micrograms retinol for 3 mo was optimal for improving the iron status of the adolescents for approximately equal to 9 mo.

Topics: Adolescent; Anemia, Iron-Deficiency; Ascorbic Acid; Dose-Response Relationship, Drug; Double-Blind Method; Female; Ferritins; Folic Acid; Food, Fortified; Humans; Indonesia; Iron; Iron Deficiencies; Nutritional Status; Vitamin A; Vitamin A Deficiency

The purpose of the present study was to evaluate the efficacy of low dose iron supplementation with and without a heme component, prescribed for women in the second half of pregnancy.. A randomized, double-blind, placebo controlled trial. Thirty-one women received a daily dose of 27 mg elemental iron in a product containing both heme iron and non-heme iron (Hemofer), 30 women received the same dose as pure non-heme iron with vitamin C (Collets jern med vitamin C), and 29 women received placebo. A double dummy technique was used to mask tablets. The women were tested for red cell indices and iron status markers (s-ferritin, s-iron, Total Iron Binding Capacity and erythrocyte protoporphyrin) throughout pregnancy and 8 and 24 weeks postpartum. The results were analyzed according to the 'intention to treat' principle.. The hematological effects were equal in the two treatment groups. 25% of the supplemented women fell below 110 g/l in Hb vs 52% in the placebo group (p < 0.05); none fell below 100 g/l in the supplemented groups, 14% in the placebo group. Iron status was significantly better for all measured parameters in the heme iron group compared to placebo at the end of pregnancy. Differences between the other groups were only shown for some parameters, probably due to the small sample size. In the heme iron group there were fewer women with empty iron stores postpartum than at the start of pregnancy (from 14% to 8%), in the non-heme iron group there was a significant increase (from 3% to 27%), and in the placebo group the percentage of women with empty iron stores was more than doubled (from 21% to 52%).. A daily dose of 27 mg elemental iron, containing a heme component, given in the second half of pregnancy, prevents depletion of iron stores after birth in most women. An equivalent dose of pure inorganic iron seems less effective, but the sample size in this study was too small to demonstrate significant differences between the two treatment groups.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Dose-Response Relationship, Drug; Double-Blind Method; Female; Ferritins; Ferrous Compounds; Humans; Iron; Placebos; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Trimester, Second

Twenty-eight strict vegetarians were given 500 mg ascorbic acid twice daily after lunch and dinner for two months. Hemoglobin and certain iron status parameters were measured before and after the treatment. Ascorbate treatment increased mean hemoglobin by 8%, serum iron by 17% and transferrin saturation by 23% and decreased total iron binding capacity by 7%. All these changes were statistically significant. The rise in serum ferritin was 12%. The serum protein or copper level did not indicate their dietary deficiency, while initial serum ascorbate level were low which rose by 60% on therapy. It is concluded that ascorbate supplementation is a better method of improving hematologic and iron status than iron salt administration.

Topics: Adolescent; Adult; Anemia; Anemia, Iron-Deficiency; Ascorbic Acid; Diet, Vegetarian; Female; Ferritins; Hemoglobins; Humans; Iron; Male; Middle Aged

Efficacies of ferroplex, conferon, and feramide in the treatment of pregnant patients with iron-deficiency anemia were compared. Ferroplex proved to be the most effective. Therapy with this drug brought about the best correction of iron metabolism parameters. Feramide was the least effective agent. The efficacy of iron preparations depends on the ionic form of this metal and the combination of iron with the agents conducive to its better absorption in the gastrointestinal tract.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Delayed-Action Preparations; Drug Combinations; Female; Ferrous Compounds; Humans; Iron; Pregnancy; Pregnancy Complications, Hematologic; Reactive Oxygen Species

Guidelines generally recommend taking iron supplements in the morning away from meals and with ascorbic acid (AA) to increase iron absorption. However, there is little direct evidence on the effects of dietary factors and time of day on absorption from iron supplements. In iron-depleted women (n = 34; median serum ferritin 19.4 μg/L), we administered 100 mg iron doses labeled with

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Coffee; Dietary Supplements; Erythrocytes; Female; Humans; Iron; Iron, Dietary

Children living in resource-limited settings often suffer from multiple micronutrient deficiencies (MMD). However, there lacks evidence on the correlates of MMD in young children. We investigated the role of diets, water, sanitation and hygiene practice, enteric infections, and impaired gut health on MMD in children at 24 months of age using data from the multi-country MAL-ED birth cohort study. Co-existence of more than one micronutrient deficiency (e.g., anemia, iron, zinc, or retinol deficiency) was considered as MMD. We characterized intestinal inflammation by fecal concentrations of myeloperoxidase (MPO) and neopterin (NEO) measured in the non-diarrheal stool samples. Bayesian network analysis was applied to investigate the factors associated with MMD. A total of 1093 children were included in this analysis. Overall, 47.6% of the children had MMD, with the highest prevalence in Pakistan (90.1%) and lowest in Brazil (6.3%). MMD was inversely associated with the female sex [OR: 0.72, 95% CI: 0.54, 0.92]. A greater risk of MMD was associated with lower vitamin C intake [OR: 0.70, 95% CI: 0.48, 0.94] and increased fecal concentrations of MPO [OR: 1.31, 95% CI: 1.08, 1.51]. The study results imply the importance of effective strategies to ameliorate gut health and improve nutrient intake during the early years of life.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Bayes Theorem; Birth Cohort; Child; Child, Preschool; Cohort Studies; Female; Humans; Infant; Inflammation; Malnutrition; Micronutrients; Prevalence; Vitamin A Deficiency

In order to maintain an adequate iron status in young women, effective dietary interventions should provide sufficient amounts of iron in everyday meals and improve the bioavailability of non-heme iron by providing vitamin C. While some intervention studies administering products rich in vitamin C in conjunction with iron sources showed improved iron status, it is unknown whether a separate administration of products rich in iron and vitamin C may be a successful strategy as well. The aim of this study was to assess the effectiveness of dietary intervention with iron and vitamin C administered separately in improving iron status in young women to prevent iron deficiency anemia. The study was conducted in a group of 29 women aged 18-30, and an 8-week dietary intervention was performed. Study participants with an adequate iron status received 50 g of iron-fortified oat flakes (as a source of non-heme iron) with breakfast and 200 mL of orange juice (as a source of vitamin C) in the second part of the day. Iron status was analyzed based on red blood cells, hemoglobin, hematocrit, serum ferritin, and serum iron, and it was assessed at baseline, after 4 weeks, and after 8 weeks of the intervention. The intakes of iron, vitamin C, and folate were controlled throughout the study period, and menstrual blood loss was estimated. After 8 weeks of intervention, statistically significant differences compared with baseline were observed only for hematocrit, as its level after 8 weeks of intervention was higher than the baseline (

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Female; Ferritins; Folic Acid; Hemoglobins; Humans; Iron; Iron, Dietary; Nutritional Status; Vitamins

This study aimed to determine the effects of liposomal iron pyrophosphate/ascorbic acid on clinical and psychological outcomes in pregnant women. Women at the 11th-13th weeks of gestation with iron deficiency anaemia assuming Sideremil™ from April 2018 to May 2019 were recruited. Haematochemical, obstetric, neonatal and psychological outcomes were investigated at the enrolment, 21-23 weeks of gestation, 30-32 weeks of gestation and after 6 weeks from childbirth. Results showed significant positive effects on haemoglobin, ferritin, sideremia and transferrin levels, compared to baseline data. A significant improvement of anxiety and depression levels was also observed. Regarding the quality of life, all the domains significantly improved, especially the Physical Role domain. Our results indicate that Sideremil

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Dietary Supplements; Diphosphates; Female; Humans; Infant, Newborn; Iron; Iron Deficiencies; Pregnancy; Pregnant Women; Quality of Life

Iron deficiency anemia (IDA) in patients with heart disease is correlated with decreased exercise capacity and poor health-related quality of life, and predicts worse cardiovascular outcomes, especially for elderly patients. IDA can worsen cardiac function that can be monitored with Heart Rate Variability (HRV) analysis, providing important information about cardiac health. In a recent study we explored the effect and the tolerability of the administration of Ferric Sodium EDTA in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel Forte®) in "frailty" patients with secondary anemia and low kidney failure, by analysing the HRV frequency domain. The aim of the present study is the further confirmation of the safety of the already evaluated intervention, by analysing non-linear domain of HRV.. In this pilot study we enrolled 52 "frailty" elderly patients, with a recent diagnosis of secondary anemia due to iron deficiency, with Class II New York Heart Association (NYHA) hypertensive heart disease, low kidney failure, and atherosclerosis. The patients were divided in 2 groups: Group A (N=23 patients) received oral administration of Ferric Sodium EDTA in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel Forte®) 2 tabs/day, containing 60 mg of Fe3+, for 24 days; Group B (N=29 patients) received intravenous administration of ferrous gluconate 63 mg/day added to saline solution, while they were hospitalized (15±5 days). We evaluated laboratory values of hemoglobin (Hb) and sideremia levels. Furthermore, we measured ECG signals before and after treatment, using non-linear analysis techniques.. Both intravenous and oral treatments evaluated in this study, were effective and safe about the cardiovascular risk in "frailty" elderly patients, as resulted from non-linear HRV analysis. Efficacy results showed that hemoglobin and sideremia levels after treatments are significantly increased. The HRV non-linear analysis showed that all parameters evaluated, except for the SD1 values in the Group A, were not affected by treatments, confirming the absence of cardiovascular risk of the therapy.. Non-linear HRV evaluation confirmed that oral administration of Ferric Sodium EDTA, in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel forte®) did not impact the cardiovascular risk, without causing adverse events typically reported with other iron supplementation therapies, both oral and intravenous.

Topics: Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Ascorbic Acid; Drug Combinations; Edetic Acid; Female; Ferric Compounds; Folic Acid; Frail Elderly; Frailty; Gluconates; Heart Disease Risk Factors; Heart Diseases; Heart Rate; Humans; Iron Chelating Agents; Male; Pilot Projects; Renal Insufficiency; Risk Assessment; Selenomethionine; Time Factors; Treatment Outcome

Scurvy is a rare disease in developed nations. In the field of pediatrics, it primarily is seen in children with developmental and behavioral issues, malabsorptive processes, or diseases involving dysphagia. We present the case of an otherwise developmentally appropriate 4-year-old boy who developed scurvy after gradual self-restriction of his diet. He initially presented with a limp and a rash and was subsequently found to have anemia and hematuria. A serum vitamin C level was undetectable, and after review of the MRI of his lower extremities, the clinical findings supported a diagnosis of scurvy. Although scurvy is rare in developed nations, this diagnosis should be considered in a patient with the clinical constellation of lower-extremity pain or arthralgias, a nonblanching rash, easy bleeding or bruising, fatigue, and anemia. This case highlights the importance of carefully assessing a child's dietary and developmental status at well-child visits, which can help avoid a more invasive workup.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Child, Preschool; Diet; Exanthema; Hematuria; Humans; Lower Extremity; Magnetic Resonance Imaging; Male; Scurvy; Vitamin D Deficiency

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Child; Ferric Compounds; Humans; Iron

Treatment in IRIDA focuses on use of intravenous iron preparations to circumvent oral absorptive defect resulting from high levels of hepcidin due to TMPRSS6 gene variations. However, recent case reports and recommendations on atypical microcytic hypochromic anemias advocate use of oral iron and vitamin c trial before parenteral iron, as the same results in comparable improvement in haemoglobin. We prospectively evaluated our IRIDA cohort (n = 7) with oral iron and vitamin c dose over a period of 10 weeks and noted complete response in majority (6/7 = 86%) with >2 g/dL rise in Hb along with significant improvement of other iron related indices.

Topics: Administration, Oral; Adolescent; Anemia, Hypochromic; Anemia, Iron-Deficiency; Ascorbic Acid; Child; Child, Preschool; Drug Therapy, Combination; Female; Hemoglobins; Humans; Iron; Male; Phenotype

Anemia prevalence in India remains high despite preventive iron supplementation programs. Consequently, concurrent national policies of iron fortification of staple foods have been initiated.. This study evaluated the relation between dietary iron intake and anemia (hemoglobin <12 g/dL) in women of reproductive age (WRA; 15-49 y) with respect to iron fortification in India.. Data from 2 national surveys were used. Data on hemoglobin in WRA were sourced from the National Family Health Survey-4, whereas dietary intakes were sourced from the National Sample Survey. Adjusted odds for anemia with increasing iron intake were estimated, along with the effect of modulating nutrients such as vitamins B-12 and C, from statistically matched household data from the 2 surveys. The risks of inadequate (less than the Estimated Average Requirement for WRA) and excess (more than the tolerable upper limit for WRA) intakes of iron were estimated by the probability approach.. The relation between iron intake and the odds of anemia was weak (OR: 0.992; 95% CI: 0.991, 0.994); increasing iron intake by 10 mg/d reduced the odds of anemia by 8%. Phytate and vitamin B-12 and C intakes modified this relation by reducing the odds by 1.5% when vitamin B-12 and C intakes were set at 2 μg/d and 40 mg/d, respectively. The additional intake of 10 mg/d of fortified iron reduced the risk of dietary iron inadequacy from 24-94% to 9-39% across states, with no risk of excess iron intake. Approximately doubling this additional iron intake reduced the risk of inadequacy to 2-12%, but the risk of excess intake reached 22%.. Providing fortified iron alone may not result in substantial anemia reduction among WRA in India and could have variable benefits and risks across states. Geographically nuanced dietary strategies that include limited fortification and the intake of other beneficial nutrients should be carefully considered.

Topics: Adolescent; Adult; Anemia; Anemia, Iron-Deficiency; Ascorbic Acid; Diet; Energy Intake; Female; Food, Fortified; Health Surveys; Hemoglobins; Humans; India; Iron; Iron Overload; Iron, Dietary; Middle Aged; Phytic Acid; Risk Factors; Vitamin B 12; Young Adult

Vitamin C, an excellent reducing agent, aids in increasing absorbable ferrous iron in iron deficiency anemia. As an efficient antioxidant, it is still unknown whether vitamin C exerts protective effects against liver damage caused by iron excess and whether mitochondria are the target effectors of the above effects. In this study, 48 mice were randomly divided into a control group, iron-overload group, TAU-treated + iron-overload group and vitamin C-treated + iron-overload group with 12 mice per group. The mice were fed 4 months on pellet diets supplemented with iron in the form of ferrocene. The iron ratio in the diet was maintained at 0.2% (w/w) for 90 days and then 0.4% (w/w) for the remaining 30 days. Furthermore, 2 g kg-1 vitamin C and 20 mg kg-1 TAU were administered daily by oral gavage prior to iron-overload administration at 6 weeks and throughout the course of the experiments. We investigated the protective effects of vitamin C against liver damage by assessing the liver weight to body weight ratio (LW/BW), serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities, and histological changes. In addition, enzymatic and non-enzymatic antioxidants, reactive oxygen species (ROS) generation, mitochondrial swelling, and mitochondrial membrane potential (MMP) were evaluated to clarify the antioxidant effects of vitamin C. We found that vitamin C significantly attenuated impaired liver function in mice induced by iron overload via antioxidation, whereas no significant effect on iron uptake was observed. Vitamin C targeted the mitochondria, preventing mitochondrial swelling, MMP dissipation, and ROS burst, thus inhibiting hepatic apoptosis. Collectively, our results suggest that vitamin C acts as a "double agent" in iron supplementation therapy for iron deficiency anemia, boosting iron absorption for preventing iron deficiency and preventing liver damage due to excessive iron intake during treatment.

Topics: Alanine Transaminase; Anemia, Iron-Deficiency; Animals; Antioxidants; Ascorbic Acid; Aspartate Aminotransferases; Dietary Supplements; Ferrous Compounds; Glutathione Peroxidase; Humans; Iron; Iron Overload; Liver; Liver Diseases; Male; Malondialdehyde; Membrane Potential, Mitochondrial; Metallocenes; Mice; Oxidative Stress; Reactive Oxygen Species

The aim of this study was to assess the effect of vegetarian diet on iron metabolism parameters paying special attention to serum hepcidin and soluble transferrin receptor (sTfR) concentrations in 43 prepubertal children (age range 4.5-9.0 years) on vegetarian and in 46 children on omnivorous diets. There were no significant differences according to age, weight, height, and body mass index (BMI) between vegetarian and omnivorous children. Vegetarians had similar intake of iron and vitamin B

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Asymptomatic Diseases; Biomarkers; Child; Child Nutritional Physiological Phenomena; Child, Preschool; Dairy Products; Diet, Vegetarian; Eggs; Female; Ferritins; Hepcidins; Humans; Iron, Dietary; Male; Nutrition Assessment; Nutritional Status; Poland; Receptors, Transferrin; Solubility; Vitamin B 12

Strategies for preventing Fe deficiency include Fe supplementation and Fe fortification of foods. The absorption, metabolism and chemical characteristics of Fe multi-amino acid chelate (IMAAC) are not known. Absorption of IMAAC was compared with FeSO4 in Fe-depleted mice and in vitro chemical studies of the Fe supplement was performed in HuTu 80 cells. Hb repletion study was carried out in Fe-deficient CD1 mice that were fed for 10 d a diet supplemented with ferrous IMAAC or FeSO4. A control group of Fe-replete mice was fed a diet with adequate Fe concentrations throughout the study. Tissues were collected from the mice, and the expression of Fe-related genes was determined by quantitative PCR. Ferric reductase and Fe uptake were evaluated in HuTu 80 cells. Supplementation of the diet with FeSO4 or IMAAC significantly increased Hb levels (P<0·001) in Fe-deficient mice from initial 93·9 (SD 10·8) or 116·2 (SD 9·1) to 191 (SD 0·7) or 200 (SD 0·5) g/l, respectively. Initial and final Hb for the Fe-deficient control group were 87·4 (SD 6·7) and 111 (SD 11·7) g/l, respectively. Furthermore, the liver non-haem Fe of both supplement groups increased significantly (P<0·001). IMAAC was more effective at restoring Fe in the spleen compared with FeSO4 (P<0·005). Gene expression showed the IMAAC supplement absorption is regulated by the body's Fe status as it significantly up-regulated hepcidin (P<0·001) and down-regulated duodenal cytochrome b mRNA (P<0·005), similar to the effects seen with FeSO4. A significant proportion of Fe in IMAAC is reduced by ascorbic acid. Fe absorption in mice and cells was similar for both IMAAC and FeSO4 and both compounds induce and regulate Fe metabolism genes similarly in the maintenance of homeostasis in mice.

Topics: Amino Acids; Anemia, Iron-Deficiency; Animals; Ascorbic Acid; Biological Availability; Cell Line; Diet; Dietary Supplements; Duodenum; Gene Expression Regulation; Hemoglobins; Hepcidins; Humans; Intestinal Absorption; Iron; Iron Chelating Agents; Iron Deficiencies; Iron, Dietary; Liver; Male; Mice; Nutritional Status; Polymerase Chain Reaction; RNA, Messenger; Spleen

Iron deficiency is a major public health concern and nutritional approaches are required to reduce its prevalence. The aim of this study was to examine the iron bioavailability of a novel home fortificant, the "Lucky Iron Fish™" (LIF) (www.luckyironfish.com/shop, Guelph, Canada) and the impact of dietary factors and a food matrix on iron uptake from LIF in Caco-2 cells. LIF released a substantial quantity of iron (about 1.2 mM) at pH 2 but this iron was only slightly soluble at pH 7 and not taken up by cells. The addition of ascorbic acid (AA) maintained the solubility of iron released from LIF (LIF-iron) at pH 7 and facilitated iron uptake by the cells in a concentration-dependent manner. In vitro digestion of LIF-iron in the presence of peas increased iron uptake 10-fold. However, the addition of tannic acid to the digestion reduced the cellular iron uptake 7.5-fold. Additionally, LIF-iron induced an overproduction of reactive oxygen species (ROS), similar to ferrous sulfate, but this effect was counteracted by the addition of AA. Overall, our data illustrate the major influence of dietary factors on iron solubility and bioavailability from LIF, and demonstrate that the addition of AA enhances iron uptake and reduces ROS in the intestinal lumen.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Biological Availability; Biological Transport; Caco-2 Cells; Canada; Cell Survival; Ferritins; Ferrous Compounds; Humans; Hydrogen-Ion Concentration; Iron; Reactive Oxygen Species; Solubility; Tannins

To describe the prevalence and determinants of gestational night blindness in pregnant women receiving care in a hospital in Rio de Janeiro, Brazil.. Cross-sectional study of pregnant and postpartum women receiving care in a public hospital in Rio de Janeiro from 1999 to 2001 (group I; n 225) or from 2005 to 2008 (group II; n 381). Night blindness was identified through a standardized and validated interview (WHO, 1996). The determinants of gestational night blindness were identified through a hierarchical logistic regression model.. Public maternity hospital in Rio de Janeiro, RJ, Brazil.. Adult pregnant and postpartum women (n 606), aged ≥20 years.. The prevalence of gestational night blindness was 9·9 %. The final model revealed that not living in the South Zone of Rio de Janeiro (distal level: adjusted OR=1·846; 95 % CI 1·002, 3·401), belonging to group I (intermediate level: adjusted OR=2·183; 95 % CI 1·066, 4·471) and for the proximal level, having a history of abortion (adjusted OR=2·840; 95 % CI 1·134, 7·115) and having anaemia during the first and second trimesters of pregnancy (adjusted OR=3·776; 95 % CI 1·579, 9·029) were determinants of gestational night blindness.. Gestational night blindness should be assessed for during the prenatal care of all pregnant women, especially those living in deprived areas of the city and/or who have a history of abortion or anaemia. Nutritional monitoring is recommended during pregnancy to control gestational night blindness.

Topics: Abortion, Induced; Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Brazil; Cross-Sectional Studies; Dietary Supplements; Female; Folic Acid; Food, Fortified; Humans; Iron, Dietary; Logistic Models; Night Blindness; Postpartum Period; Pregnancy; Prenatal Care; Prevalence; Socioeconomic Factors; Vitamin A; Vitamin A Deficiency; Young Adult

Topics: Aged; Anemia, Iron-Deficiency; Ascorbic Acid; Female; Humans; Iron; Male

Scurvy is the classic and most severe form of vitamin C deficiency. This condition has become extremely rare among children in the industrialized countries.. We report the case of two boys presenting bone pain associated with haemorrhagic gingivitis, with perifollicular purpura of the lower limbs in one boy. The children had an unbalanced diet. Scurvy was associated with vitamin D and iron deficiency. The dermatological and radiological abnormalities seen were characteristic and a favourable outcome was rapidly obtained following supplementation.. The possibility of this forgotten historical illness should not be overlooked in the presence of these dermatological and rheumatologic signs, since this can help avoid unnecessary or excessively aggressive investigations.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Child; Diagnosis, Differential; Gingival Hemorrhage; Humans; Lower Extremity; Male; Purpura; Rare Diseases; Risk Factors; Scurvy; Severity of Illness Index; Treatment Outcome; Vitamin D Deficiency; Vitamins

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Auditory Diseases, Central; Auditory Pathways; beta Carotene; Cryptoxanthins; Diet; Female; Folic Acid; Hearing Loss; Humans; Infant, Premature, Diseases; Male; Maternal Nutritional Physiological Phenomena; Neurogenesis; Pregnancy; Pregnancy Complications

Iron deficiency anemia is one of the major causes of morbidity and mortality worldwide. Evidences from epidemiological and clinical studies suggest a possible correlation between antioxidant levels and the anemic disease risk. The present work is to investigate antioxidant levels and lipid peroxidation in anemic patients.. A number of 30 patients (15 males and 15 females) were selected for the study. Likewise, 30 age- and gender-matched healthy volunteers (15 males and 15 females) were selected with their informed consent. Patients and healthy subjects were supplemented with vitamins C and E for 15 days. The lipid peroxidation both in plasma and erythrocyte lysates was determined by thiobarbituric acid reactive substances and lipid peroxides. The antioxidant vitamins A, C, and E and total antioxidant activity were also analyzed. The antioxidant enzyme superoxide dismutase, catalase, and glutathione peroxidase were also determined.. Based on analysis, we found that the increase in lipid peroxidation was higher in the anemic subjects before vitamin supplementation, which was statistically significant at P<0.05. The antioxidant enzymes were higher in the patients before antioxidant supplementation when compared with patients after vitamin supplementation.. Our data revealed higher oxidative stress before vitamin supplementation in iron deficiency anemic patients and after supplementation, lower lipid peroxidation and increased antioxidant vitamins were achieved.

Topics: Adult; Anemia, Iron-Deficiency; Antioxidants; Ascorbic Acid; Dietary Supplements; Erythrocytes; Female; Humans; Lipid Peroxidation; Male; Middle Aged; Oxidative Stress; Vitamin E; Vitamins; Young Adult

Topics: Adult; Alopecia; Amines; Analgesics; Anemia, Iron-Deficiency; Ascorbic Acid; Cyclohexanecarboxylic Acids; Diagnosis, Differential; Drug Combinations; Female; Ferrous Compounds; Gabapentin; gamma-Aminobutyric Acid; Humans; Menorrhagia; Thyroid Diseases; Thyroid Function Tests

Mutations in TMPRSS6 gene cause iron-refractory iron deficiency anemia, a rare autosomal recessive disorder characterized by hypochromic microcytic anemia not responsive to oral iron therapy and partially responsive to parenteral iron administration. Here we report a female infant homozygous for a loss of function mutation in TMPRSS6 gene, who responded to oral iron therapy when supplemented with ascorbic acid.

Topics: Administration, Oral; Anemia, Iron-Deficiency; Ascorbic Acid; Erythrocyte Indices; Female; Humans; Infant; Iron; Membrane Proteins; Mutation; Serine Endopeptidases

We describe the case of a 40-year-old female patient who developed severe pulmonary hypertension and life-threatening right-sided heart failure in association with dietary scurvy and iron deficiency. Supplementation with oral vitamin C and iron very likely contributed to her complete cure. Scurvy-associated pulmonary arterial hypertension could result from impaired availability of endothelial nitric oxide, but inappropriate activation of the hypoxia-inducible family (HIF) of transcription factors could play an even more important role. HIF coordinates the body's responses to hypoxia, and its activity is regulated by oxygen-dependent prolyl hydroxylases, which need vitamin C and iron as cofactors. Deficiency of these cofactors could lead to uncontrolled HIF activity and pulmonary vasoconstriction responsive to vitamin C and iron administration.

Topics: Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Ascorbic Acid Deficiency; Dietary Supplements; Echocardiography; Female; Heart Failure; Humans; Hypertension, Pulmonary; Iron; Scurvy; Treatment Outcome; Vasoconstriction

A higher occurrence of iron deficiency anemia is present in rural Malaysia than urban Malaysia due to a lower socio-economic status of rural residents. This study was conducted in Tanah Merah, a rural district of Kelantan, Malaysia. Our objective was to investigate the impact of nutrition education alone, daily iron, folate and vitamin C supplementation or both on knowledge, attitudes and hemoglobin status of adolescent students. Two hundred eighty fourth year secondary students were each assigned by school to 1 of 4 different treatment groups. Each intervention was carried out for 3 months followed by 3 months without treatment. A validated self-reported knowledge and attitude questionnaire was administered; hemoglobin levels were measured before and after intervention. At baseline, no significant difference in hemoglobin was noted among the 4 groups (p = 0.06). The changes in hemoglobin levels at 3 months were 11, 4.6, 3.9 and -3.7% for the supplementation, nutrition education, combination and control groups, respectively. The changes at 6 months were 1.0, 6.8, 3.7 and -14.8%, respectively. Significant improvements in knowledge and attitude were evidenced in both the nutritional education and combination groups. The supplementation and control groups had no improvement in knowledge or attitudes. This study suggests nutritional education increases knowledge, attitudes and hemoglobin levels among Malaysian secondary school adolescents.

Topics: Adolescent; Analysis of Variance; Anemia, Iron-Deficiency; Ascorbic Acid; Dietary Supplements; Female; Folic Acid; Health Education; Humans; Iron; Malaysia; Male; Nutrition Therapy

In India < 90% of anaemia cases are estimated to be due to iron deficiency, because high iron requirements during pregnancy are not easily fulfilled by dietary intake. Ferrous ascorbate is widely prescribed iron salt in India but still no trial of ferrous ascorbate in Indian patients has been published. The study is to aim the evaluation of efficacy and tolerability of RB Tone forte tablet in the treatment of pregnancy anaemia. Fifty-five pregnant women (> 18 years) with haemoglobin value between 8 and 11 g/dl in 13th week of pregnancy were included in the study. The duration of study was 6 months. Study drug RB Tone forte tablet, (Medley pharmaceutical, Mumbai) containing ferrous ascorbate equivalent to elemental iron 100 mg + folic acid 1.5 mg + elemental zinc 22.5 mg was prescribed once daily to all pregnant women from 13th week of pregnancy for a duration of 6 months. Haemoglobin was assessed at the beginning of the therapy and at the end of the trial. Study included birth weight and gestational age as outcomes because of a need for more information on the functional consequences of iron supplementation during pregnancy. Tolerability was evaluated based on the global assessment by the investigator and patients on a 3-point scale marked as excellent/good/poor. Fifty patients were included for final analysis, 5 patients lost to follow-up. Haemoglobin levels increased from the mean baseline value of 8.950 +/- 0.1422 g/dl to 11.91 +/- 0.07840 g/dl, with mean increase of 2.964 +/- 0.1624 g/dl at the end of trial (p < 0.0001). Mean birth weight of infants (n = 50) was found to be 3079 +/- 25.10 g. Mean gestational age at the time of delivery was 38 weeks. No preterm delivery was reported, As per investigators assessment about tolerability of trial drug, 48% of patients reported good, 46% excellent and 6% reported poor tolerability. As per patient's assessment about tolerability 92% of patients reported good to excellent tolerability and 8% reported poor tolerability. All patients reported excellent gastro-intestinal tolerability of study drug. Positive effect on pregnancy outcome like gestational age and birth weight is mainly attributed to vasodilating property of ferrous ascorbate and beneficial effect of zinc. Ferrous ascorbate must be preferred as first choice of oral iron salt due to positive effect on haemoglobin value, vasodilating property and superior tolerability.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Drug Combinations; Female; Folic Acid; Humans; Pregnancy; Tablets; Vitamins; Zinc

Because of the high prevalence of iron-deficiency anemia in Brazil, individual control measures tend to be ineffective, and fortification of foods with iron is considered the most effective method to fight anemia.. To evaluate the effectiveness of fortification of drinking water with iron and vitamin C in the reduction of anemia in children in day-care centers in Belo Horizonte, Brazil.. This before-and-after study evaluated 318 children aged 6 to 74 months. Identification data and data on socioeconomic variables were collected; anthropometric and biochemical measurements were performed before and after 5 months of fortification of water with 5 mg of elemental iron and 50 mg of ascorbic acid per liter. The fortified water was used for drinking and cooking at the day-care center. Wilcoxon's nonparametric test was used to evaluate the differences in continuous variables, and McNemar's test was used to compare the prevalence rates of anemia.. The prevalence of anemia decreased significantly from 29.3% before fortification to 7.9% at the end of the study, with a significant increase in hemoglobin levels. Reductions in the prevalence rates of stunting and underweight were observed.. Fortification of water with iron and vitamin C significantly reduced the prevalence of anemia and improved nutritional status among children attending day-care centers.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Brazil; Child; Child Day Care Centers; Child, Preschool; Drinking Water; Female; Growth Disorders; Hemoglobins; Humans; Infant; Iron, Dietary; Longitudinal Studies; Male; Nutritional Status; Prevalence; Thinness; Urban Health; Water Supply

To determine the impact of an intervention that combined an increase in dietary and bioavailable iron intakes and an improvement in hygiene behaviors on the iron status of preschool children from Burkina Faso.. Thirty-three orphans and vulnerable children from 11 families who were 1-6 y old, were non-anemic, or had mild to moderate anemia were enrolled in an 18-wk trial. Using the probability approach for planning diets in an assisted-living facility, bioavailable iron intake was increased from 0.4 to 0.9 mg/d by increasing the amounts of meat and citrus fruits and by adding iron-rich condiments to the diet, for an estimated cost of U.S. $0.59/mo. Hygiene behaviors were modified by implementing hand-washing before meals and by the use of individual plates for meals. Iron status indicators were measured twice and means at enrollment and after intervention were compared.. After intervention, hemoglobin concentration increased from 98.7 to 103.8 g/L (P=0.006). There was a decrease in total iron binding capacity (107 to 91 micromol/L, P=0.05) and a marginal increase in transferrin saturation (13% to 17%, P=0.06). Significant improvement was not observed for serum ferritin concentration or prevalence of depleted iron stores, likely due to the confounding effect of infection. Anemia and iron-deficiency anemia were decreased from 64% to 30% and from 61% to 30%, respectively.. Dietary modification associated with adequate hygiene behaviors could be a relevant strategy to control iron deficiency and anemia in areas where infection is a major health problem.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Burkina Faso; Child; Child, Preschool; Condiments; Diet; Feeding Behavior; Female; Ferritins; Fruit; Hand Disinfection; Hemoglobins; Humans; Hygiene; Infant; Iron; Iron, Dietary; Male; Meat; Nutritional Status; Program Evaluation; Transferrin

To our knowledge, the impact of a nutrition education program combined with an increase in bioavailable dietary iron to treat iron-deficiency anemia has never been studied in adolescent girls.. To evaluate the impact of an intensive dietary program for the treatment of iron-deficiency anemia in 34 intervention and 34 control boarding-school girls aged 12 to 17 years from Benin.. A quasi-experimental design consisting of 4 weeks of nutrition education combined with an increase in the content and bioavailability of dietary iron for 22 weeks was implemented in the intervention school, but not in the control school. Data were obtained from both groups from a nutrition knowledge questionnaire, 24-hour dietary recalls, anthropometric measurements, measurement of iron status indices, and screening for malarial and intestinal parasitic infections.. Nutrition knowledge scores and mean intakes of nutrients, including dietary iron, absorbable iron, and vitamin C, were significantly higher in the intervention group (p < .05) than in the control group after 26 weeks. Mean hemoglobin and serum ferritin values were also significantly higher in the intervention group than in the control group (122 vs. 112 g/L [p = .0002] and 32 vs. 19 microg/L [p = .04], respectively), whereas the prevalence of anemia (32% vs. 85% [p = .005] and iron-deficiency anemia (26% vs. 56% [p = .04]) was significantly lower in the intervention group than in the control group. No significant differences between the groups were observed in intestinal parasitic infections or malaria status postintervention.. A multidietary strategy aiming to improve available dietary iron can reduce iron-deficiency anemia in adolescent girls.

Topics: Adolescent; Anemia, Iron-Deficiency; Ascorbic Acid; Benin; Biological Availability; Child; Diet; Diet Surveys; Energy Intake; Female; Ferritins; Health Education; Health Knowledge, Attitudes, Practice; Hemoglobins; Humans; Iron; Iron, Dietary; Malaria; Micronutrients; Trace Elements; Treatment Outcome; Vitamins

Iron deficiency and iron deficiency anemia are common in patients who undergo gastric bypass. The magnitude of change in iron absorption is not well known.. The objective was to evaluate the effects of Roux-en-Y gastric bypass (RYGBP) on iron status and iron absorption at different stages after surgery. We hypothesized that iron absorption would be markedly impaired immediately after surgery and would not improve after such a procedure.. Anthropometric, body-composition, dietary, hematologic, and iron-absorption measures were determined in 67 severe and morbidly obese women [mean age: 36.9 +/- 9.8 y; weight: 115.1 +/- 15.6 kg, body mass index (BMI: in kg/m(2)); 45.2 +/- 4.7] who underwent RYGBP. The Roux-en-Y loop length was 125-150 cm. Determinations were carried out before and 6, 12, and 18 mo after surgery. Fifty-one individuals completed all 4 evaluations.. The hemoglobin concentration decreased significantly throughout the study (repeated-measures analysis of variance). The percentage of anemic subjects changed from 1.5% at the beginning of the study to 38.8% at 18 mo. The proportion of patients with low serum ferritin increased from 7.5% to 37.3%. The prevalence of iron deficiency anemia was 23.9% at the end of the experimental period. Iron absorption from both a standard diet and from a standard dose of ferrous ascorbate decreased significantly after 6 mo of RYGBP to 32.7% and 40.3% of their initial values, respectively. No further significant modifications were noted.. Iron absorption is markedly reduced after RYGBP with no further modifications, at least until 18 mo after surgery.

Topics: Adolescent; Adult; Anastomosis, Roux-en-Y; Anemia, Iron-Deficiency; Ascorbic Acid; Diet; Female; Ferritins; Gastric Bypass; Hemoglobins; Humans; Intestinal Absorption; Iron; Iron, Dietary; Obesity, Morbid; Postoperative Complications; Prevalence; Young Adult

Food iron (Fe) fortification is an adequate approach for preventing Fe-deficiency anemia. Poorly water-soluble Fe compounds have good sensory attributes but low bioavailability. The reduction of the particle size of Fe fortificants and the addition of ascorbic acid might increase the bioavailability of low-soluble compounds. The present work aims to compare the Fe absorption and bioavailability of micronized dispersible ferric pyrophosphate (MDFP) (poorly soluble) to ferrous sufate (FS) (highly soluble) added to a fruit juice in presence or absence of ascorbic acid (AA) by using the hemoglobin repletion assay in rats.. After a hemoglobin depletion period, four fruit juices comprised of (1) FS, (2) MDFP, (3) FS + AA, (4) MDFP + AA were produced and administered to a different group of rats (n = 18) over 21 days. During the repletion period, Fe balance, hemoglobin regeneration efficiency (HRE), relative bioavailability (RBV) and Fe tissue content were determined in the short, medium and long term.. Fe absorption and bioavailability showed no significant differences between fortifying the fruit juice with FS or MDFP. The addition of AA to the juice enhanced Fe absorption during the long-term balance study within the same Fe source. HRE and Fe utilization increased after AA addition in both FS and MDFP groups in every period.. Fe absorption and bioavailability from MDFP were comparable to FS added to a fruit juice in rats. Further, the addition of AA enhanced Fe absorption in the long term, as well as Fe bioavailability throughout the repletion period regardless of the Fe source employed.

Topics: Anemia, Iron-Deficiency; Animals; Antioxidants; Ascorbic Acid; Beverages; Biological Availability; Dietary Supplements; Diphosphates; Food, Fortified; Hemoglobins; Intestinal Absorption; Iron; Iron, Dietary; Male; Particle Size; Random Allocation; Rats; Rats, Sprague-Dawley; Solubility

To measure the prevalence of transferrin saturation (TS) <12%, and iron-deficiency anemia (IDA) in Lebanese children, and their association with dietary habits, sociodemographic characteristics, and blood lead levels.. A cross-sectional study was performed over a period of 2 years. Of 268 children studied, 142 (53%) were boys and 126 (47%) were girls with an age range of 11 to 75 months. Information collected included nutritional status, blood counts, TS, and blood lead levels.. The total prevalence of TS<12% and IDA were 33.6% and 20.5%, respectively, and were associated with not having received iron supplements. IDA was more prevalent among males (P=0.04). TS<12% and IDA were significantly associated with elevated blood lead levels in the first age group (11 to 23 mo) (P=0.04, odds ratio=3.19) and (P=0.006, odds ratio=4.59), respectively.. IDA is common in Lebanese children and is associated with increased blood lead levels, lack of iron supplementation, and cultural dietary habits. Remedial measures such as iron fortification of commonly consumed food are needed on the national level. Lead exposure must be controlled and awareness must be raised about the potentially devastating consequences of combined iron deficiency and lead poisoning on young children.

Topics: Anemia, Iron-Deficiency; Animals; Ascorbic Acid; Child; Child, Preschool; Cross-Sectional Studies; Female; Humans; Infant; Lead; Lebanon; Male; Milk; Phlebotomy; Sepsis; Transferrin

We report the case of a 42-y-old morbidly obese woman who presented persistent anemia as result of Roux-en-Y gastric bypass.. The surgical procedure conducted in 1999 consisted of horizontal gastroplasty with truncular vagotomy, Roux-en-Y gastrojejunal anastomosis with an alimentary limb of 60 cm, and cholecystectomy. In 2000 a second surgery (subtotal gastrectomy, i.e., 90%, with a 50-mL gastric pouch) was performed because of failed gastroplasty. Anemia was detected approximately 1 y after the second surgery. This condition worsened significantly after an abdominal lipectomy performed in 2001. Since then, different oral iron compounds were used for treatment, but with unsatisfactory results. The subject was anemic for 4 y.. The condition was corrected only after intravenous iron administration. Iron absorptions from 3 mg of iron as ferrous ascorbate and from a standardized diet that also contained 3 mg of iron were 48.4% and 39.9%, respectively.. Iron absorption tests provided evidence that the reduction of intestinal iron absorption capacity was the most probable cause of the persistent anemia.

Topics: Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Female; Gastric Bypass; Humans; Intestinal Absorption; Obesity, Morbid; Treatment Outcome

Schoolchildren in developing countries often have inadequate intakes of iron, due primarily to poor bioavailability. Increasing meat in the diet could improve both the amount of iron consumed and its availability. The effect of increases in intakes of meat and ascorbic acid on absorbed iron was investigated by theoretically modifying the habitual diet of rural Kenyan schoolchildren. The projected changes in the amount of absorbed iron and prevalence of inadequate iron intakes were calculated for 78 children (6-9 years of age). The prevalence of inadequate iron intakes decreased from 77% to 54% through the theoretical addition of 50 g beef or 100 mg ascorbic acid and to 23% through the addition of both to dinner each day. To reduce the prevalence of inadequate iron intake to 5%, the addition of 100 g meat plus 150 mg ascorbic acid would be necessary. The combined addition of meat and ascorbic acid to a meal has the potential to reduce the projected prevalence of inadequate iron intakes among these schoolchildren.

Topics: Anemia, Iron-Deficiency; Animals; Ascorbic Acid; Biological Availability; Cattle; Child; Child Nutrition Disorders; Developing Countries; Diet; Diet Records; Dietary Supplements; Female; Heme; Humans; Iron; Iron Deficiencies; Iron, Dietary; Kenya; Male; Meat; Nutritional Status; Prevalence; Rural Population; Schools

Twenty-two percent of women in the United States are iron deficient. Iron deficiency adversely affects immune function as well as physical and cognitive performance. Although the risk of developing iron deficiency is high for female soldiers, this risk can be minimized with proper nutritional guidance. Recommended dietary modifications include (1) heme iron consumption, (2) ingestion of vitamin C and protein with meals, and (3) discontinued tea and coffee consumption with meals.

Topics: Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Dietary Supplements; Female; Humans; Iron; Military Medicine; Military Personnel; Risk Assessment; Risk Factors; Sex Factors; United States

Anemia is the most prevalent nutrition problem in young children. One possible strategy to prevent anemia is affordable fortification of drinking water.. The aim of this study was to evaluate the impact of iron-fortified drinking water of daycare facilities on the hemoglobin and anthropometric status of pre-school children.. Hemoglobin (Hb) status, weight and height measurements were assessed in 160 pre-school children aged 6 to 59 m before and after 8 m consumption of iron- (12 mg/L) and vitamin C- (90 mg/L) fortified drinking water.. Initially, 43.2% (69) of the children evaluated as being anemic decreased to 21% (37) at the end of study. At baseline, 42 (26.3%) children suffered from moderate anemia and 27 (16.9%) suffered severe anemia, but after iron fortification, total number of children suffering from moderate and severe anemia had decreased to 32 (20.7%) and 5 (3%), respectively. Weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ) Z-scores increased significantly from -0.84 +/- 1.03 to 0.06 +/- 1.10, -0.84 +/- 1.11 to 0.54 +/- 1.10 and -0.39 +/- 0.94 to -0.18 +/- 1.14, respectively (p < 0.05). Daycare personnel reported increased appetite and food consumption and decreased absenteeism during intervention.. Daily consumption of iron-fortified drinking water in daycare facilities is an effective, simple and inexpensive means of reducing and controlling for moderate and severe anemia in pre-school children.

Topics: Anemia, Iron-Deficiency; Anthropometry; Ascorbic Acid; Brazil; Child Day Care Centers; Child, Preschool; Drinking; Female; Food, Fortified; Hemoglobins; Humans; Infant; Infant Nutritional Physiological Phenomena; Iron, Dietary; Male; Nutritional Status; Treatment Outcome; Water

This report describes a patient with iron deficiency in bone marrow examination and iron-responsive restless legs syndrome (RLS), in whom serum ferritin levels were well above the conventional cutoff for considering iron deficiency. The predictive value of serum ferritin for iron deficiency in RLS depends on the cutoff employed, on the pre-test likelihood of iron deficiency and on coexisting inflammatory conditions. Bone marrow examination is helpful when ferritin levels are equivocal.

Topics: Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Ascorbic Acid; Ferritins; Humans; Iron, Dietary; Male; Restless Legs Syndrome; Severity of Illness Index

Topics: Adolescent; Adult; Aged; Anemia, Iron-Deficiency; Ascorbic Acid; Blood Donors; Double-Blind Method; Female; Ferritins; Ferrous Compounds; Hematinics; Humans; Male; Middle Aged; Receptors, Transferrin; Sex Factors; Solubility; Time Factors

Iron deficiency is the most common cause of nutritional anemia. During pregnancy there is a high risk of developing it, due to the increase of iron requirements for fetal and maternal tissues growth. The objective of this study was to determine the iron nutritional status in early pregnancy and to determine its relationship with the dietary intake. The study applied a cross-sectional and descriptive design in 419 pregnant women (13-41 y) from Valencia, Carabobo, Venezuela. Serum ferritin was determined by enzimoinmunoassay and hemoglobin by a semi-automated method. Dietary iron intake was assessed through two non-consecutive 24 hours recalls. Statistical analysis included basic descriptives, Fisher exact test, Chi-square, and Mann-Whitney tests; with a statistical significance of p < 0.05. The iron deficiency and anemia prevalence were 16.2% and 14.4%, respectively; corresponding 36.6% to ferropenic anemia. 10.4%, 29.0% and 24.2% of the women had deficient intake for iron, vitamin C and A, respectively. There were no significant differences by age. A nutritional risk was observed regarding the iron status, demonstrated by the percentage of ferropenic anemia and because the main dietary contribution came from non-heme iron, which has low bioavailability. Additionally, there was an important percentage of inadequate vitamin C and A intakes; hence, their contribution to iron absorption was limited.

Topics: Adolescent; Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Cross-Sectional Studies; Diet; Educational Status; Female; Ferritins; Hemoglobins; Humans; Iron; Iron Deficiencies; Malnutrition; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Trimester, First; Risk; Social Class; Venezuela; Vitamin A

The aim of the work was to study the level of vitamins C, B12 and folic acid in latent iron deficiency of different etiology (hipo- and anacid gastritis and menorrhagia). 81 patients with latent iron deficiency were investigated. Vitamin C levels were measured by refractometry, folic acid and vitamin B12 by radioimmune assay. The obtained results showed significant decrease of ascorbic acid and less apparent decrease of folic acid in the blood plasma. The content of vitamin B12 was unchanged. Decrease of vitamin C level is related to the changes of initial stages of iron metabolism and its further absorption. Less apparent changes of folic acid and vitamin B12 indicates, that such important stages of erithropoesis as DNA replication and cell proliferation are intact. Our results indicate to the development of metabolic disorders prior to revelation of iron deficiency anaemia, which need timely correction.

Topics: Adolescent; Adult; Aged; Anemia, Iron-Deficiency; Ascorbic Acid; Female; Folic Acid; Humans; Male; Middle Aged; Vitamin B 12

Helicobacter pylori has been established as a major cause of gastritis and peptic ulcer disease in adults and children. H. pylori infection may also have a role in the development of some extra-gastrointestinal diseases, including iron deficiency anemia. The aim of this study is to investigate H. pylori-related changes in gastric physiology and histology and the relationship of these changes to iron deficiency anemia in children.. Fifty-two patients with gastrointestinal complaints were studied. Hematologic parameters, 3-day vitamin C and iron consumption, serum gastrin levels, and gastric juice ascorbic acid levels were compared in patients with and without H. pylori infection. Dietary intake of vitamin C and iron, serum gastrin, gastric juice ascorbic acid content, and gastric histology were compared in patients with H. pylori infection and anemia and in patients with H pylori infection and no anemia. The CagA status of the H. pylori organisms was evaluated.. Twenty-eight of 52 patients had H. pylori. Thirty-one patients had iron deficiency anemia. H. pylori infection was associated with low serum iron levels. H. pylori gastritis was associated with a decrease in the gastric juice ascorbic acid level. Infection with CagA-positive strains was associated with a greater decrease in gastric juice ascorbic acid than infection with CagA-negative strains. However, the gastric juice ascorbic acid levels of patients with H. pylori and anemia were not different from those of non-anemic patients with H. pylori. Among patients with H. pylori infection, pangastritis was twice as common in those with anemia than in those without anemia.. H. pylori infection was associated with a decrease in gastric juice ascorbic acid concentration, and this effect was more pronounced in patients with the CagA-positive strain. Pangastritis was more common in patients whose H. pylori.infection was accompanied by anemia.

Topics: Anemia, Iron-Deficiency; Antigens, Bacterial; Ascorbic Acid; Bacterial Proteins; Child; Female; Gastric Acid; Gastric Acidity Determination; Gastrins; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Intestinal Absorption; Iron; Iron, Dietary; Male; Stomach; Virulence

Research conducted before genotyping was possible suggested that subjects heterozygous for the genetic mutation associated with hemochromatosis absorbed nonheme iron more efficiently than did control subjects when tested with a fortified meal. Heme-iron absorption in these subjects has not been reported.. We compared the absorption of heme and nonheme iron from minimally or highly fortified test meals between HFE C282Y-heterozygous and wild-type control subjects.. After prospective genotyping of 256 healthy volunteers, 11 C282Y-heterozygous and 12 wild-type control subjects were recruited, and their iron absorption was compared by using a hamburger test meal with or without added iron and ascorbic acid. After retrospective genotyping of 103 participants in previous iron-absorption studies, 5 C282Y-heterozygous subjects were compared with 72 wild-type control subjects.. HFE C282Y-heterozygous subjects did not differ significantly from wild-type control subjects in their absorption of either heme or nonheme iron from minimally or highly fortified test meals. No differences were detected in blood indexes of iron status (including serum ferritin, transferrin saturation, and non-transferrin-bound iron) or in blood lipids or transaminases, but heterozygotes had significantly greater, although normal, fasting glucose concentrations than did wild-type control subjects. Compound heterozygotes (those who had both HFE C282Y and H63D mutations) absorbed more nonheme (but not heme) iron from meals with high (but not low) iron bioavailability.. HFE C282Y-heterozygous subjects did not absorb dietary iron more efficiently, even when foods were highly fortified with iron from ferrous sulfate and ascorbic acid, than did control subjects. Iron fortification of foods should not pose an additional health risk to HFE C282Y heterozygotes.

Topics: Adult; Aged; Anemia, Iron-Deficiency; Ascorbic Acid; Case-Control Studies; Female; Ferritins; Food, Fortified; Genotype; Hemochromatosis; Hemochromatosis Protein; Heterozygote; Histocompatibility Antigens Class I; Homozygote; Humans; Intestinal Absorption; Ion Transport; Iron; Iron, Dietary; Male; Membrane Proteins; Middle Aged; Mutation; Prospective Studies; Retrospective Studies

The effect of intravenous ascorbic acid was compared with that of intravenous iron in the treatment of functional iron deficiency, as defined as serum ferritin levels over 300 ng/ml and serum iron levels below 50 microg/dl, in patients on chronic hemodialysis. Thirteen patients on chronic hemodialysis with functional iron deficiency received intravenous injections of ascorbic acid, 100 mg, three times a week, after hemodialysis. The therapy was continued until serum ferritin decreased to below 300 ng/ml (3 months at the maximum). The iron and control group were composed of patients who had serum iron levels below 50 microg/dl within 3 months after serum ferritin rose to over 300 ng/ml. Seven patients with the iron group received more than a total of 10 intravenous injections of saccharated ferric oxide (40 mg/dose) after hemodialysis, and seven patients with the control group received no iron preparation during the 3 months. In the ascorbic acid group, while hemoglobin did not change from 10.9 +/- 0.5 g/dl (mean +/- SE) during the three-month period, serum iron increased significantly from 37 +/- 4 microg/dl to 49 +/- 4 microg/dl after one month (p<0.01), and remained elevated until the end of the three-month period. Serum ferritin decreased significantly from 607 +/- 118 ng/ml to 354 +/- 30 ng/ml after 3 months (p<0.01). In the iron group, hemoglobin and serum iron increased significantly from the respective pre-treatment levels during the 2-month period, and serum ferritin rose significantly after 3 months. In the control group, hemoglobin, serum iron and ferritin levels decreased significantly from the respective pre-treatment levels during the 3 months. The recombinant erythropoietin dose remained stable for three months in the ascorbic acid, iron, and control groups, respectively. These results suggest that in hemodialysis patients with a functional iron deficiency, treatment with intravenous ascorbic acid can prevent iron overload due to treatment with intravenous iron, and provide a useful adjuvant means of maintaining hemoglobin and serum iron levels.

Topics: Aged; Anemia, Iron-Deficiency; Ascorbic Acid; Biomarkers; Female; Ferric Compounds; Ferric Oxide, Saccharated; Ferritins; Glucaric Acid; Humans; Iron; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Retrospective Studies; Treatment Outcome

The analysis of vitamin and iron indexes of 95 children sufficiently supplied with vitamin C and vitamin B2 and carotenoids deficiency has been carried out. Vitamin E deficit takes place among anemic children (with decreased hemoglobin blood level) 2 fold more often than among healthy children. From another side, decreased hemoglobin blood level, erythrocyte quantity and erythrocyte indexes have been determined 1.7-2.4 fold more often in insufficiently supplied with vitamin E children. Tocopherols serum level had tendency to the decrease and vitamin E deficit took place 2 fold more frequently in children suffering from iron deficiency anemia that is with decreased hemoglobin and serum ferritin concentrations. Marked positive linear correlation between these iron indexes and vitamin E serum level has been revealed. These results give evidence concerning significant role of this vitamin in the body iron supplying. The results obtained give evidence for multi-deficient anemia presence among children, which are not always caused by iron deficit. High frequency of vitamin E and B group vitamins deficiency proves expediency of these vitamins inclusion in complex therapy of iron deficiency.

Topics: Adolescent; Anemia; Anemia, Iron-Deficiency; Ascorbic Acid; Carotenoids; Child; Erythrocyte Count; Hemoglobins; Humans; Iron; Iron Deficiencies; Riboflavin; Tocopherols; Vitamin E Deficiency

Seroepidemiological and clinical studies suggest that Helicobacter pylori may cause iron deficiency anaemia (IDA) in the absence of peptic lesions by undefined mechanisms, which still remain to be fully elucidated. Gastric acidity and ascorbic acid (AA) promote iron absorption. AA is lowered in the presence of H pylori infection. H pylori can cause atrophic body gastritis with achlorhydria, decreased iron absorption, and consequent IDA. Whether alterations in intragastric acidity and AA concentrations play a role in IDA developing in patients with H pylori gastritis remains to be determined.. To evaluate gastric juice pH and gastric juice and plasma AA in patients with H pylori infection and unexplained IDA, compared with controls with IDA and a healthy stomach or with controls with H pylori infection and no IDA.. Patients with IDA and H pylori gastritis were characterised by concomitant increased intragastric pH (median value 7) and decreased intragastric AA (median value 4.4 micro g/ml) compared with controls with a healthy stomach (median pH 2; median intragastric AA 17.5 micro g/ml) and with H pylori positive controls without IDA (median pH 2.1; median intragastric AA 7.06 micro g/ml). Intragastric AA was inversely related to pH (r=-0.40, p=0.0059) and corporal degree of gastritis (r=-0.53, p=0.0039). Plasma AA concentrations were lower in all infected groups than in healthy controls.. Patients with unexplained IDA and H pylori gastritis present concomitant changes in intragastric pH and AA that may justify impaired alimentary iron absorption and consequent IDA.

Topics: Adult; Aged; Anemia, Iron-Deficiency; Ascorbic Acid; Female; Gastric Acidity Determination; Gastric Juice; Gastritis, Atrophic; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Hydrogen-Ion Concentration; Male; Middle Aged

After supplementation trials, vitamin C, iron and zinc levels were increased by 1789%, 59% and 30%, respectively. Partially supplemented pasteurized milk could be a new alternative with its high nutritive value, good sensory properties and low cost.

Topics: Anemia, Iron-Deficiency; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Biological Availability; Child; Child Nutritional Physiological Phenomena; Child, Preschool; Female; Food, Fortified; Humans; Infant; Iron; Male; Milk; Nutritional Status; Turkey; Zinc

Experiments with piglets showed good assimilation and metabolism of iron (II) in antianaemic powder Ferosol-1. In order to improve this drug, manganese, calcium (Ferosol-2, 1 composition) and ascorbic acid (Ferosol-2, 2 composition) were added. Manganese and ascorbic acid stimulate erythropoiesis and being strong reductants stabilize iron (II) on storage and in gastrointestinal tract. Components of Ferosol-2 were identified using colour, precipitation- and extraction tests, as well as paper chromatography and absorption spectroscopy. Quantitative analysis of microelements and ascorbic acid was performed using absorption spectroscopy, extraction photometry and iodometric titration methods. Ferosol-2 proved to be more stable than Ferosol-1. Lichfield and Wilkinson method modificated by Roth was used for detection of acute toxicity of Ferosol-2. A local action was estimated on quine pigs. Iron resorption was on 20 days old piglets. Antianaemic effectiveness of Ferosol-2 was evaluated on newborn piglets watching their weight. Experiments with white mice showed low toxicity of Ferosol-2 (LD50 = 4.3 g/kg, for 1 composition and 4.6 g/kg for 2 composition). It does not irritate mucosa of duodenum and ventriculus. Iron in Ferosol-2 was found to be well assimilated in gastrointestinal tract of piglets, easily gets into blood and joins albumen of plasma. After administration of Ferosol-2 to piglets increased iron concentration in blood serum was observed for 3 hours (1 composition) and 6 hours (2 composition). Experimental data showed increased resorption of iron in Ferosol-2, 2 composition due to ascorbic acid. Components of Ferosol-2 are well assimilated and join erythropoetic processes. Ferosol-2 leads to quicker weight gain as well as significantly higher amount of hemoglobin and red blood cells in piglets.

Topics: Administration, Oral; Anemia, Iron-Deficiency; Animals; Animals, Newborn; Ascorbic Acid; Calcium; Erythrocyte Count; Erythropoiesis; Ferrous Compounds; Guinea Pigs; Hemoglobins; Iron; Manganese; Mice; Oxalates; Photometry; Powders; Spectrophotometry; Spectrum Analysis; Swine; Time Factors

The objectives of this study were: (i) to investigate the energy, iron, zinc, calcium and vitamin C intakes of a group of healthy term Caucasian infants resident in Dunedin, New Zealand, prospectively from age 9 months to 2 years; and (ii) to determine the prevalence of iron deficiency anaemia among these infants. A self-selected sample of 74 Caucasian mothers and their infants born in Dunedin, New Zealand, between October 1995 and May 1996 were recruited. Dietary intake was determined using estimated diet records at 9, 12, 18 and 24 months of age. Haemoglobin concentration, mean corpuscular volume andzinc protoporphyrin concentration were determined at the same ages. The infants' zinc, calcium and vitamin C intakes appeared adequate. Their median iron intakes ranged from 4.3 mg (at 12 months) to 7.0 mg (at 9 months) per day and were below estimated requirements at all ages. At 9, 12 and 18 months of age, 7% (n = 4) of the infants had iron deficiency anaemia. None of the infants had iron deficiency anaemia at 24 months. The iron intakes of this group of Caucasian infants and young children appeared inadequate. However, their rate of iron deficiency anaemia was lower than has been reported in previous New Zealand studies.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Breast Feeding; Calcium, Dietary; Child, Preschool; Diet; Diet Records; Diet Surveys; Energy Intake; Erythrocyte Indices; Female; Hemoglobins; Humans; Infant; Infant Food; Iron; Iron, Dietary; Longitudinal Studies; Male; New Zealand; Prevalence; Prospective Studies; Protoporphyrins; Zinc

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Bacteremia; Chronic Disease; Drug Hypersensitivity; Erythropoietin; Ferritins; Humans; Injections, Intravenous; Iron; Kidney Diseases; Predictive Value of Tests; Recombinant Proteins; Renal Dialysis

This efficacy for both employers and employees (young working women 18 to 23 years of age) was undertaken to determine whether culturally acceptable dietary changes in lunches in the workplace and at home could bring about a behavioral change and improvement in their iron-deficiency anemia status. Maximum weight was given to increasing consumption of iddli, a popular cereal-based-fermented food, or of gooseberry juice. Four small factories were selected in periurban Bangalore, with a sample of 302 women. The 180-day interventions were supervised at the workplace. In unit 1 (72 women), the intervention consisted of iddli four times a week plus information, education, and communication (IEC) related to iron-deficiency anemia. Unit 2 (80 women) received 20 ml of gooseberry juice (containing 40 mg of vitamin C) three times a week plus IEC once a month. Women in unit 3 (70 women), the positive control, received 400 mg albendazole once plus ferrous sulfate tablets (60 mg elemental iron) two times a week. No IEC was given. Unit 4 (70 women) served as the negative control and received no intervention. The pre-post impact measures were dietary and nutrient intake, knowledge and practice, and hemoglobin status. In units 1, 2, and 3, the hemoglobin status of the women improved significantly from 11.10 to 12.30 g/dl, 11.20 to 12.70 g/dl, and 11.50 to 13.00 g/dl, respectively. In unit 4 there was no change: the values were 10.90 g/dl before and after intervention. The results show that the type of workplace lunch was of greater significance than IEC. Knowledge gains were impressive, but behavioral change was not sustained. It was concluded that the hemoglobin levels of the workers can easily be improved by cost-effective workplace lunches that also lead to better employer-employee relations.

Topics: Adolescent; Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Beverages; Diet Records; Dietary Supplements; Edible Grain; Female; Fermentation; Health Promotion; Humans; India; Nutritional Sciences; Severity of Illness Index; Women, Working

We used nationally representative data from the third National Health and Nutrition Examination Survey (NHANES III) to examine the relationship between low iron stores (serum ferritin < 12 microg/L) and dietary patterns that might affect iron status among Mexican American (MA) and non-Hispanic white (NHW) girls and women of reproductive age (12-39 y). Dietary data from the qualitative food-frequency questionnaire were used to classify subjects into three categories (using the 25th and 75th quartile values for NHW) for intake of heme iron, nonheme iron, iron absorption enhancers, and iron absorption inhibitors. The prevalence of low iron stores was 17.4% among MA (n = 1368) and 7.9% among NHW (n = 1473). Compared with high intake, the adjusted odds ratio (OR) for low iron stores was 1.80 [95% confidence interval (CI), 1.24-2.62] for medium intake of heme iron and 0.48 (95% CI, 0.25-0.91) for low intake of nonheme iron (plus iron supplement). Compared with no use, use of vitamin C supplements was associated with half the risk of low iron stores (OR = 0.50; 95% CI, 0.29-0.87). Similar results were found after income and parity were controlled for, except that the protective effect of vitamin C supplements was no longer significant. Even after adjustment for sociodemographic and dietary factors, MA women remained at increased risk for low iron stores (OR = 1.80; 95% CI, 1.30-2.49) indicating that the reasons for the higher prevalence of iron deficiency in MA women warrants further investigation.

Topics: Adolescent; Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Child; Contraceptives, Oral; Female; Ferritins; Humans; Iron; Iron, Dietary; Mexican Americans; Nutrition Surveys; Nutritional Status; Parity; Prevalence; Socioeconomic Factors; Surveys and Questionnaires; United States; White People

Strategies such as dietary diversification and food fortification have yielded significant results in controlling iron deficiency anaemia in developed countries. Reducing the prevalence of iron deficiency anaemia in developing countries is still a matter of importance. The major factors responsible for iron deficiency anaemia in the vulnerable segments of developing countries are reduced intake and poor bioavailability of dietary iron. Dietary diversification and food-based approaches pose considerable challenges before they can be implemented on a wide scale. Anaemia control programmes based on the administration of prophylactic doses of iron and folic acid tablets have been widely implemented. As the programmes were not effective in countries such as India, the dosage of iron was increased. The role of excess iron in causing intestinal oxidative stress has drawn attention to other approaches of iron supplementation. Prophylactic administration of iron along with antioxidants like vitamins E and C or foods rich in these vitamins is one such strategy. To reduce the intestinal oxidative stress, intermittent supplementation of iron is being considered. The potential benefits and shortcomings of these approaches are reviewed.

Topics: Anemia, Iron-Deficiency; Antioxidants; Ascorbic Acid; Developing Countries; Dietary Supplements; Food, Fortified; Health Policy; Humans; India; Intestinal Absorption; Intestinal Mucosa; Iron; Micronutrients; Oxidative Stress; Sodium Chloride

Poor compliance to oral medication and diet is common in hemodialysis (HD) patients and limits the ability of oral iron therapy to support erythropoiesis. Intravenous (i.v.) iron may be associated with undesirable and sometimes life-threatening complications.. We hypothesized that intradialytic oral iron therapy can overcome compliance problems and support effective maintenance erythropoiesis, which will keep Hct in the range of 33% to 36% and EPO requirements up to 50 units/week/kg. In a prospective observational study, SC EPO-treated hospital-based HD patients without conditions known to cause EPO resistance, were managed on intradialytic oral administration of iron and vitamin C. The primary endpoints were EPO requirements and resistance to EPO which standardized EPO requirements by the Hct level. Secondary endpoints included parameters that might affect the primary endpoints. Exclusion criteria were refusal to take oral medication, prestudy Hct < 27%, recent i.v. iron therapy or transfusions, bleeding, clinical conditions obligating Hct > 30% and known causes of EPO resistance. Twelve patients completed minimal follow-up period of 9 months.. Mean Hct was 34.4% (range: 31.8% - 40.2%). EPO requirements were 61.7 +/- 28.2 units/kg and below 52.5 units/kg in 50% of patients. Patients were classified into equal groups according to resistance to EPO, which was positively correlated (r = 0.71 p < 0.01) with body weight and Kt/V (r = -0.38, p < 0.05).. In conclusion, intradialytic oral iron therapy can support effective maintenance erythropoiesis in 50% of patients without known causes for EPO resistance. High response to EPO and low EPO requirement are correlated with lower body weight and possibly improved dialysis.

Topics: Administration, Oral; Anemia, Iron-Deficiency; Ascorbic Acid; Body Weight; Erythropoiesis; Humans; Iron; Middle Aged; Renal Dialysis

To determine the relative validity of an iron food frequency questionnaire (iron FFQ) designed to assess intakes of dietary iron and its absorption modifiers.. A computer-administered food frequency questionnaire was designed to estimate intake of total, non-haem, haem and meat iron as well as dietary components which influence iron absorption (vitamin C, phytate, calcium, grammes of meat/fish/poultry, tea and coffee) in women consuming a Western diet. The relative validity of the iron FFQ was assessed by comparing its results with those from weighed diet records collected over 11 days.. Dunedin, New Zealand.. Forty-nine women aged 19-31 y attending the University of Otago.. There was good agreement between the iron FFQ and the weighed diet records for median intakes of total iron, non-haem iron, calcium, tea and coffee. For dietary component intakes, correlations between the two methods ranged from 0.39 (for vitamin C) to 0.87 (for coffee) with 0.52 for total iron, and 0.61 for haem iron. In cross-classification with the weighed diet record, the iron FFQ correctly classified between 22% (for vitamin C) and 51% (for phytate) of participants into the same quartile. Actual values for surrogate categories indicated that the questionnaire can clearly differentiate between low and high intakes of all the dietary components assessed. The questionnaire also showed an acceptable level of agreement between repeat administrations (eg a correlation for total iron of 0.65).. The iron FFQ is appropriate for assessing group intakes of total iron, and iron absorption modifiers, in population studies to assess the aetiology and treatment of iron deficiency states in adult women consuming a Western diet.. This research was supported (in part) by a grant from the Health Research Council of New Zealand.

Topics: Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Biological Availability; Calcium, Dietary; Coffee; Computers; Diet Records; Female; Humans; Intestinal Absorption; Iron, Dietary; Meat; New Zealand; Phytic Acid; Reproducibility of Results; Statistics as Topic; Surveys and Questionnaires; Tea

Mexican American females have a higher prevalence of iron deficiency than do non-Hispanic white females.. The objective was to estimate the prevalence of iron deficiency anemia and examine potential reasons for this difference between Mexican American (n = 1194) and non-Hispanic white (n = 1183) females aged 12-39 y.. We used data from the third National Health and Nutrition Examination Survey (1988-1994). Iron deficiency anemia was defined as abnormal results from >/=2 of 3 tests (erythrocyte protoporphyrin, transferrin saturation, and serum ferritin) and a low hemoglobin concentration. We used multiple logistic regression to adjust for factors that were more prevalent in Mexican American females and significantly associated with iron deficiency anemia.. The prevalence of iron deficiency anemia was 6.2 +/- 0.8% (f1.gif" BORDER="0"> +/- SE) in Mexican American females and 2.3 +/- 0.4% in non-Hispanic white females. Mean dietary iron intake, mean serum vitamin C concentrations, and the proportion of females using oral contraceptives were similar in the 2 groups. Age <20 y and education were not associated with iron deficiency anemia. After adjustment for poverty level, parity, and iron supplement use, the prevalence of iron deficiency anemia was 2.3 times higher in Mexican American than in non-Hispanic white females (95% CI: 1.4, 3.9). In those with a poverty income ratio (based on household income) >3.0, however, the prevalence of iron deficiency anemia was 2.6 +/- 0.9% in Mexican American and 1.9 +/- 0.6% in non-Hispanic white females (NS).. Although much of the ethnic disparity in iron deficiency anemia remains unexplained, factors associated with household income may be involved.

Topics: Adolescent; Adult; Anemia, Iron-Deficiency; Ascorbic Acid; Child; Chromatography, High Pressure Liquid; Colorimetry; Contraceptives, Oral; Educational Status; Female; Ferritins; Fluorometry; Hemoglobins; Humans; Immunoradiometric Assay; Iron; Iron, Dietary; Mexican Americans; Nutrition Surveys; Parity; Prevalence; Protoporphyrins; Social Class; Transferrin

Recently we have shown the susceptibility of Fe-deficient rat intestine to oxidative damage during Fe repletion. The role of dietary antioxidants like ascorbic acid, alpha-tocopherol and a combination of both in counteracting the oxidative stress was tested in this study. Five groups of thirteen weanling WKY female rats were fed with an Fe-deficient diet for a period of 5 weeks. Another set of thirteen rats received an Fe-sufficient diet and served as the control group (Con). Oral administration of either vehicle (D), 8 mg Fe alone (D+) or in the presence of 24 mg ascorbic acid (D+ + C), 40 mg alpha-tocopherol (D+ + E) or a combination of both (D+ + C + E) per d for 15 d was carried out in Fe-depleted rats. The impact of this treatment protocol on Fe status, oxidative stress and antioxidant status at the site of Fe absorption was assessed. It was observed that though the indicators of Fe status were normalised on Fe supplementation, the oxidative stress as reflected by the levels of both thiobarbituric-acid reactive substances (TBARS) and protein carbonyls were significantly greater in D+ and D+ + C compared to D+ + E, D+ + C + E and Con groups. The mucosal cell DNA damage was seen in D+, D+ + C and D+ + E groups on electrophoresis. Functional integrity as assessed by the activities of alkaline phosphatase and lys-ala-dipeptidyl aminopeptidase were normalized in all the groups treated with the antioxidant(s). There were significant positive alterations in some of the endogenous antiperoxidative systems and in serum caeruloplasmin activity in D+ + E and D+ + C + E groups. Paradoxically, serum ascorbate levels were significantly lower in D+ + C than in D+ + E and D+ + C + E groups. This could be due to the protection offered by alpha-tocopherol in the presence of Fe. It is concluded that supplementation of alpha-tocopherol alone or in combination with ascorbic acid protects the gastrointestinal tract of Fe-deficient rats against Fe-mediated oxidative damage during Fe repletion. However, ascorbic acid alone does not protect the gastrointestinal tract against Fe-induced oxidative stress.

Topics: Administration, Oral; Anemia, Iron-Deficiency; Animals; Ascorbic Acid; Dietary Supplements; Female; Intestinal Absorption; Oxidative Stress; Rats; Rats, Inbred WKY; Vitamin E

To examine associations between breakfast cereal consumption and iron status and identify dietary patterns that might improve iron status in this vulnerable group.. Analysis of data from the UK National Diet and Nutrition Survey (NDNS) of children aged 1.5-4.5 years, including dietary intakes calculated from 4-day weighed records.. Data were used from 904 children with haematological measurements, excluding those taking iron supplements; 20% had low iron stores (ferritin < 10 microgl-1) while 8% were anaemic (Hb < 11 g dl-1).. High cereal consumers had significantly higher iron intakes than low cereal consumers (classified by tertiles) but the 10% difference in mean ferritin levels was not significant (P= 0.067). Lower intakes of vitamin C and meat among high consumers of cereal may have diluted the impact of cereal iron on iron status. When children were reclassified according to their intakes of vitamin C and iron from meat and breakfast cereals, the group with high (above median) intakes of two or more factors had a higher mean haemoglobin (Hb) level and a lower prevalence of anaemia compared with the group with low (below median) intakes of all three dietary constituents.. Nutritional advice that aims to improve iron status should emphasize not only rich sources of iron but also factors that may enhance or inhibit absorption. Strategies to optimize iron status in this vulnerable age group include consuming an iron-fortified breakfast cereal, vitamin C-rich fruit or drink at breakfast, and avoiding tea with (or after) meals.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Child Nutritional Physiological Phenomena; Child, Preschool; Diet; Edible Grain; Female; Ferritins; Hemoglobins; Humans; Infant; Iron, Dietary; Male; Meat; United Kingdom

Iron status was assessed in a representative sample of 188 adolescents living in a medium-sized city in Poland. Dietary intakes were evaluated using records of diet over a period of seven consecutive days. Subjects were considered to be iron deficient when two or more of the following parameters were abnormal: serum ferritin, transferrin saturation or mean corpuscular haemoglobin concentration. Based on this definition, the prevalence of iron deficiency in the investigated sample of children aged from ten to twelve years was 12.7%. Iron deficiency anaemia was defined using the following criteria: haemoglobin values less than 12.0 g. dl (-1) in girls or less than 12.2 g. dl(-1) in boys, combined with an iron deficiency. With such a definition, the prevalence of iron deficiency anaemia in all subjects was 6.3%. Four boys (3.9%) and six girls (6.8%) were diagnosed as anaemic. The values for Hb in the anaemic boys ranged from 10.9 to 12.2 g. dl (-1) and in anaemic girls from 8.7 to 12.0 g. (-1). It was found that the majority of the individuals studied had a dietary haem-iron intake lower than that recommended. No relationship was found between the level of serum ferritin and total iron and vitamin C dietary intake, but there was positive correlation between serum ferritin and intake of haem iron. A seven-day dietary history questionnaire correctly identified children at risk of iron deficiency anaemia.

Topics: Anemia, Iron-Deficiency; Ascorbic Acid; Child; Diet; Diet Records; Female; Ferritins; Hematologic Tests; Humans; Iron Deficiencies; Iron, Dietary; Male; Poland; Prevalence; Reference Values; Transferrin

We investigated the effect of Fe deficiency on the nutritive utilization of Fe, Ca, P and Mg in rats. Aside from the well known depletion of Fe in liver, femur and sternum with low values of Hb, Fe deficiency impaired Ca, P and Mg metabolism at different degrees. Iron deficiency altered Mg absorption, lowered the concentration of Ca in the liver, femur and sternum, raised the concentration of P and Mg in the liver, and decreased P in the femur. The altered status was not completely rectified by iron supplementation as the animals were still slightly anemic at the end of the study. The second purpose of the study was to evaluate the ability of three iron compounds (ferric citrate, ferrous sulfate and ferrous ascorbate) to correct the undesirable effects of Fe deficiency. Ten days after treatment with these diets, Fe-deficient rats still had reduced Mg absorption, especially those fed ferric citrate. The concentrations of hemoglobin approached normal values in all groups; however, serum Fe remained low, indicating that Fe reserves were still depleted. Hepatic and femoral Fe concentrations were also lower in all Fe-deficient groups regardless of the diet given, compared with their respective controls, whereas Fe concentrations in the sternum increased significantly with all three diets, suggesting an increase in erythropoiesis. The concentration of Ca, P and Mg in liver approached normal values, and appeared to normalize in the femur, except that Ca and P concentrations remained low with the citrate diet. In the sternum, a site assumed to have higher requirements for these minerals, the concentrations of Ca, P and Mg also increased. These findings indicate that Fe is involved in the bone mineralization, and that in physiological terms, Fe interacts favorably with Ca, P and Mg metabolism, since Fe deficiency altered the status of these metals. These findings also suggest that ferrous ascorbate and ferrous sulfate were more effectively absorbed than was ferric citrate.

Topics: Analysis of Variance; Anemia, Iron-Deficiency; Animal Feed; Animals; Ascorbic Acid; Body Weight; Calcium; Eating; Ferric Compounds; Ferrous Compounds; Food, Fortified; Hemoglobins; Iron; Iron Deficiencies; Magnesium; Male; Phosphorus; Random Allocation; Rats; Rats, Wistar; Tissue Distribution

This study was undertaken to verify the influence of the use of iron and Vitamin C fortified powdered whole milk on the hemoglobin levels of 238 children, aged 6 to 18 months, seen at a Basic Health Care Unit in the State of São Paulo. The powdered milk was fortified with 9 mg of iron (ferrous sulfate) and 65 mg of Vitamin C for each 100 g of powder. 4 kg/month were distributed to children under one year and 2 kg/month to those over one year of age. Clinical, anthropometric and hematological (hemoglobin level measurements) evaluations were performed at the onset of the study and at three month intervals after the beginning of the supplementation. At the end of the trial, there was still enough milk available to extend the intervention for a group of 39 children who had presented the worst evolution in the first six months. At the onset of the study, 72.6% of the children presented anemia. After 3 and 6 months, these percentages had decreased to 38.9% and 18.5%, respectively. Among the children that were followed-up for 9 months, their were only 2.5% who presented anemia at the end of the intervention. The highest prevalences were found in the 6 to 12 months age group and the best results in the 10 to 18 month group. There was intrafamilial dilution of the milk in 30.7% of the cases. With or without intrafamilial milk sharing, there were significant decreases in anemia occurrences with no differences between the two groups. The use of fortified milk did not affect the children nutritional condition. This study permitted the conclusion that the fortification of foodstuffs, besides being the method of election for the prevention of iron deficiency, is an excellent alternative for the treatment of and recovery from iron deficient anemia in children under two years of age.

Topics: Anemia, Iron-Deficiency; Animals; Ascorbic Acid; Food, Fortified; Health Facilities; Humans; Infant; Iron, Dietary; Longitudinal Studies; Milk; Nutritional Status; Prevalence; Time Factors

The impact of the use of fortified powdered whole milk (9 mg of iron and 65 mg of vitamin C/100 g of milk) on the hemoglobin levels of children under 2 years of age was evaluated, over a period of 6 months, in 107 children enrolled in municipal Day Care Centers (DCC) and in 228 seen at a Basic Health Care Unit (BHCU). Before the beginning of the intervention, 66.4% of the children in the DCC and 72.8% of those seen at the BHCU had hemoglobin levels under 11.0 g/dl. After 6 months of fortified milk intake, these percentages fell to 20.6% and 18.0% respectively. The average hemoglobin before the intervention was 10.3 g/dl in the DCC and 10.5 in the BHCU. After 6 months these increased to 11.6 g/dl in the populations studied. Concerning the nutritional condition, evaluated according to Gomez's criteria, 57% of the DCC children presented an improvement, 41.1% showed changes and only 1.9% became worse. In the BHCU, 11.4% presented better condition, 70.6% remained the same and 18% worsened, which demonstrated differences in response regarding improvement of nutritional condition, when fortified milk was used in closed and open environments. The authors conclude that the utilization of enriched foods is an excellent alternative in the treatment of iron deficiency in populations of children under 2 years of age.. The impact of the use of fortified powdered whole milk (9 mg of iron and 65 mg of vitamin C per 100 g of milk) on the hemoglobin levels of children under 2 years of age was evaluated, over a period of 6 months, in 107 children enrolled in municipal day care centers (DCC) and in 228 seen at a Basic Health Care Unit (BHCU). Before the beginning of the intervention, 66.4% of the children in the DCC and 72.8% of those seen at the BHCU had hemoglobin levels under 11.0 g/dl. After 6 months of fortified milk intake, these percentages fell to 20.6% and 18.0%, respectively. The average hemoglobin level before the intervention was 10.3 g/dl in the DCC and 10.5 g/dl in the BHCU. After 6 months these increased to 11.6 g/dl in the populations studied. Concerning the nutritional condition, evaluated according to Gomez's criteria, 57% of the DCC children showed improvement, 41.1% showed no change, and only 1.9% grew worse. In the BHCU, 11.4% showed improvement, 70.6% remained the same, and 18% worsened, which demonstrated differences in response regarding improvement of nutritional condition when fortified milk was used in closed and open environments. The authors conclude that the utilization of enriched foods is an excellent alternative in the treatment of iron deficiency in populations of children under 2 years of age. (author's)

Topics: Ambulatory Care Facilities; Analysis of Variance; Anemia, Iron-Deficiency; Animals; Anthropometry; Ascorbic Acid; Brazil; Child Day Care Centers; Food, Fortified; Hemoglobins; Humans; Infant; Iron; Longitudinal Studies; Milk; Nutritional Status; Prevalence; Reference Values; Socioeconomic Factors

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Ascorbic Acid; Blood Transfusion; Humans; USSR

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Ascorbic Acid; Blood Transfusion; Erythrocytes; Humans; Statistics as Topic; Vitamin B 12; Vitamin B Complex

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Ascorbic Acid; Humans; Iron; Peptic Ulcer; Vitamins

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Ascorbic Acid; Ferrous Compounds; Iron Compounds

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Ascorbic Acid; Iron; Iron Compounds; Vitamins