pica and Anemia--Iron-Deficiency

Pica is defined by the American Psychiatric Association's Diagnostic and Statistical Manual, 5th edition (DSM 5) as the ongoing ingestion of materials with no nutritive or food value. More specifically such ingestions must be unremitting for at least 1 month and occur at a developmentally inconsistent age for such behavior. This article reviews the association of pica with pregnancy, micronutrient deficiencies, psychiatric disorders, dementia, and developmental disorders with emphasis on autism spectrum disorders (ASD).. Some variants of non-nutritive consumption are prevalent behavioral norms in non-western cultures, so not all picas should be considered pathological. However, the strong association of pica with iron deficiency anemia (IDA) lends credence to the hypothesis that dopamine transmission may be disrupted in this disorder. Picas associated with ASD are resistant to medications but can be treated with applied behavioral analysis therapy (ABA). Etiological hypotheses for pica are explored with a focus on neurobiological, neuroimaging, and psychiatric correlations. Pharmacological management and behavior modification strategies are also discussed. The possibility that pica is a form of addiction analogous to food cravings is introduced and suggested as an area for further research pursuits.

Topics: Anemia, Iron-Deficiency; Autism Spectrum Disorder; Female; Humans; Neurology; Pica; Pregnancy; United States

Pica is a common condition in childhood that is commonly missed.. To familiarize physicians with the clinical evaluation and management of children with pica.. A PubMed search was completed in Clinical Queries using the key term "pica" OR "dirteating". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.. Pica refers to the persistent, compulsive craving for and the ingestion of substances usually considered inedible and the behavior is discordant with cultural practices and continues beyond the normal developmental phase of occasional indiscriminate and experimental mouthing and swallowing over a period of at least one month. The condition is more common among children in lower socioeconomic classes and those who are mentally handicapped or emotionally deprived. Pica is a significant cause of anemia and lead poisoning. Pica generally resolves in children of normal intelligence after they have been trained to discriminate between edible and inedible items and proper supervision is provided. While relief of family economic and housing difficulties is an adjunct, attention to the individual's emotional needs and stresses is of paramount importance. Children with iron deficiency anemia should be treated with iron replacement therapy. Complications such as gastrointestinal obstruction and lead poisoning should be promptly recognized and treated.. Pica is often an overlooked phenomenon and its association with iron deficiency and lead poisoning has been known for centuries. The underlying cause and complications should be treated if possible. Primary care physicians should be aware of pica and proactively seek information about pica in patients that belong to the high-risk groups.

Topics: Anemia, Iron-Deficiency; Animals; Child; Disease Management; Global Health; Humans; Intellectual Disability; Lead Poisoning; Malnutrition; Morbidity; Pica; Risk Assessment; Risk Factors

Pica is the compulsive eating of non-nutritive substances. It is often associated with iron deficiency but its pathophysiology is unknown. Areas covered: We searched the literature using the keywords listed below. Our aim was to describe the phenomenon in its various aspects, to touch briefly on the historical and cultural background, and to examine in more detail the studies that tried to analyze the relative roles of iron deficiency and pica. Expert commentary: Pica is an intriguing symptom known for centuries. Pregnant women and preadolescents are at the highest risk of pica. Iron absorption is reduced in the presence of non-nutritive substances. Iron therapy usually cures the pica behavior. There are different forms of pica, one caused directly by iron deficiency probably due to the lack of iron in some areas of the brain and one more culturally driven and including mostly geophagy.

Topics: Anemia, Iron-Deficiency; Female; Humans; Mental Disorders; Nervous System Diseases; Phenotype; Pica; Pregnancy; Pregnancy Complications, Hematologic; Prevalence; Risk Factors

Topics: Anemia, Iron-Deficiency; Child; Child, Preschool; Developmental Disabilities; Diagnosis, Differential; Epithelium; Humans; Infant; Infant, Newborn; Intestinal Absorption; Italy; Pica; Respiration; Restless Legs Syndrome; Risk Factors; Stroke

Topics: Anemia, Iron-Deficiency; Calcium Sulfate; Female; Humans; Middle Aged; Pica

Pica is the compulsive intake of non-nutritive substances such as earth, clay, chalk, soap and ice. The most common forms of pica are geophagia or the intake of earth and pagophagia or the intake of ice. The description of this peculiar phenomenon dates back to the Greco-Roman civilization. Its prevalence during pregnancy is generally underestimated. Published data reveal a prevalence of between 8% and 65%. Investigations from Latin America indicate a prevalence of 23% to 44%. It is not clear yet which are the causes that predispose to pica, but they are frequently associated with anemia or iron deficiency during pregnancy. Its diagnosis, which only consists in questioning pregnant women, is generally omitted during prenatal care, probably because health professionals have no knowledge about this disorder. The identification of pica in pregnant women could contribute to the detection of a risk group where it is necessary to implement strategies as regards both the evaluation and the nutritional education.

Topics: Anemia, Iron-Deficiency; Female; Humans; Pica; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Prevalence

Topics: Anemia, Iron-Deficiency; Animals; Dwarfism; Egypt; Hepatomegaly; Humans; Hypogonadism; Iran; Male; Pica; Splenomegaly; Syndrome; Zinc

Pica (pica = magpie) is an eating disorder that is manifested by a craving for oral ingestion of a given substance that is unusual in kind (nonfood items) or quantity (food items). Pica has been described as a world wide phenomenon, but there are more frequent occurrences of selected substances among selected groups--especially young children and black pregnant and nonpregnant women in the southern part of the USA. In Central Europe and Germany this syndrome has not been described in the moderne literature. For this reason, we report a case of pica for starch associated with severe iron deficiency anemia in Germany. Iron deficiency anemia and--less often-potassium and zinc deficiency are the main complications of an excessive starch or clay ingestion, followed by gastrointestinal obstructions due to gastroliths or impaction. Additionally, naphtalene poisoning (in pica for toilet air-freshener blocks), phosphorus poisoning (in matches pica), mercury poisoning (in paper pica), and lead poisoning (in dried paint pica) have been described.

Topics: Adult; Anemia, Iron-Deficiency; Child; Diagnosis, Differential; Female; Germany; Humans; Male; Middle Aged; Pica; Pregnancy; Starch

Topics: Anemia, Iron-Deficiency; Celiac Disease; Child; Diagnosis, Differential; Female; Humans; Pica

We describe two new forms of pica associated with iron deficiency and a new variant of a third. Previous reports on pica are tabulated. The value of a sympathetic, nonjudgmental approach to eliciting the medical history is emphasized.

Topics: Adult; Anemia, Iron-Deficiency; Female; Humans; Male; Medical History Taking; Pica

Pica and restless legs syndrome (RLS) are associated with iron depletion and deficiency. The presence of pica and RLS was prospectively assessed in blood donors.. During a 39-month period, 1236 donors deferred for fingerstick hemoglobin (Hb) level of less than 12.5 g/dL and 400 nondeferred "control" donors underwent health screening and laboratory testing (complete blood count, ferritin, iron, transferrin). Pica and RLS were assessed by direct questioning. Deferred donors and iron-deficient control donors were given 325 mg of ferrous sulfate daily for 60 days. Reassessments were performed and additional iron tablets dispensed at subsequent visits.. Pica was reported in 11% of donors with iron depletion or deficiency, compared with 4% of iron-replete donors (p < 0.0001). Pagophagia (ice pica) was most common and often of extraordinary intensity. Female sex, younger age, and lower mean cell volume and transferrin saturation values were strongly associated with pica. Donors with pica given iron reported a marked reduction in the desire to consume the nonnutritive substance by Days 5 to 8 of therapy, with disappearance of symptoms by Days 10 to 14. RLS was reported in 16% of subjects with iron depletion or deficiency compared with 11% of iron-replete donors (p = 0.012). Iron replacement generally resulted in improvement of RLS symptoms; however, at least 4 to 6 weeks of iron therapy was necessary.. The presence of pica is associated with a high probability of iron depletion or deficiency in blood donors; however, RLS lacks a strong correlation in this population. Screening questions for pagophagia may be useful in the ascertainment of iron deficiency in donors and may identify those who would benefit from oral iron.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Biomarkers; Blood Donors; Case-Control Studies; Drug Administration Schedule; Female; Ferritins; Ferrous Compounds; Hematinics; Hemoglobins; Humans; Logistic Models; Male; Mass Screening; Middle Aged; Pica; Prevalence; Prospective Studies; Restless Legs Syndrome; Surveys and Questionnaires; Transferrin; Young Adult

This study aimed to determine the relationship between pagophagia (compulsive ice eating) and H. pylori infection in patients with iron-deficiency anemia. We identified H. pylori infection using the (13)C-urea breath test in 45 patients with iron-deficiency anemia (group 1) and 55 patients with iron-deficiency anemia and pagophagia (group 2). Subgroups for testing oral intestinal iron absorption were randomly assigned from both groups. These subgroups consisted of (a) 10 patients with iron-deficiency anemia, (b) 10 patients with iron-deficiency anemia and pagophagia, (c) 10 patients with iron-deficiency anemia, pagophagia, and H. pylori infection before the eradication of H. pylori and (d) subgroup c after eradication therapy. There was no difference in the rate of H. pylori infection in the iron-deficiency anemia groups, with or without pagophagia. Furthermore, oral intestinal iron absorption was not influenced by pagophagia and/or H. pylori infection. Pagophagia did not increase the risk of H. pylori infection in patients with iron-deficiency anemia. Pagophagia and H. pylori infection do not synergistically affect the development of intestinal iron absorption abnormalities.

Topics: Adult; Aged; Anemia, Iron-Deficiency; Breath Tests; Female; Helicobacter Infections; Helicobacter pylori; Humans; Ice; Intestinal Absorption; Iron; Male; Middle Aged; Pica

Geophagy has been associated with iron deficiency and anaemia, but no causal relationship has been established. To clarify this, we conducted a two-by-two factorial randomised, controlled trial on the effect of iron and multimicronutrient supplementation on geophagy in Zambian schoolchildren in Lusaka, from February to December 2001. Of the 406 children, 212 (52.2%) were girls and the mean (range) age was 10.2 (7-15) years. Geophagy was reported by 302 (74.4%) and more often in girls than in boys (80.2 vs. 67.7%, P = 0.007). The mean (range) daily earth intake was 25.2 (1-200) g. Geophageous children had more often geophageous relatives than non-geophageous children (79.5 vs. 1.9%, P < 0.001). Geophageous children had lower serum ferritin (20.5 vs. 25.0 microg/l, P = 0.032) but not haemoglobin (Hb) (129.2 vs. 130.4 g/l, P = 0.59), than non-geophageous. Among those with Hb < 130 g/l, geophageous children had significantly higher prevalence (53.7 vs. 30.6%, P = 0.024) of Ascaris lumbricoides infection than non-geophageous. The prevalence of geophagy (74.4 to 51.6%) and the intake of earth (25.3 to 15.0 g/day) declined (P = 0.001 and P < 0.001, respectively) among the 220 (54.2%) children followed-up. In bivariate analysis, non-iron supplementation reduced the prevalence of geophagy more than iron supplementation did, but this was not confirmed in the multiple logistic regression analysis. Multimicronutrients had no effect on either geophagy prevalence or earth intake. Geophagy was prevalent and associated with iron deficiency, but iron supplementation had no effects on geophageous behaviour. Geophagy could be a copied behaviour and the association between geophagy and iron deficiency due to impaired iron absorption following earth eating.

Topics: Adolescent; Adult; Aged; Anemia, Iron-Deficiency; Child; Child, Preschool; Dietary Supplements; Double-Blind Method; Female; Follow-Up Studies; Humans; Iron; Male; Micronutrients; Middle Aged; Pica; Zambia

A pregnant woman in her 20s presented with an excessive desire to smell a specific household cleaning product. She was found to have severe iron deficiency anaemia and her symptoms resolved following intravenous iron supplementation. She described symptoms of fatigue, shortness of breath and olfactory cravings. The specific scent could not be replicated with other smells and the woman had to significantly modify her lifestyle to accommodate the excessive desire. She had a similar experience during her prior pregnancy which resolved after the correction of severe iron deficiency anaemia. This unique symptom has been described as desiderosmia: iron deficiency manifesting as olfactory cravings. This underappreciated but useful symptom is defined as a separate entity to pica, as there is an absence of desire to ingest the product. Desiderosmia can harm mother and baby through inhalation of potentially harmful fumes; hence, women who describe this symptom should be assessed for iron deficiency anaemia.

Topics: Administration, Intravenous; Anemia, Iron-Deficiency; Female; Humans; Iron; Iron Deficiencies; Pica; Pregnancy; Pregnancy Complications, Hematologic

Frequent blood donors who contribute multiple times annually are important for maintaining an adequate blood supply. However, repeated donations exacerbate iron deficiency, which can lead to pica, a condition characterised as repeated eating or chewing of a non-nutritious substance such as ice, clay and dirt. Understanding characteristics of frequent donors that are associated with increased risk for developing pica will help to identify them and prevent this adverse consequence of blood donation.. Demographic, clinical, haematological, and biochemical factors associated with pica were investigated using univariable and multivariable logistic regression analysis in a cohort of 1693 high-intensity donors who gave nine or more units of whole blood in the preceding 2 years. Pica was classified by questionnaire responses as consuming at least 8 oz of ice daily and/or consumption of non-ice substances regardless of the amount and frequency.. Pica was present in 1.5% of the high-intensity donors, and only occurred in those with ferritin <50 ng/ml. Of 16 candidate variables, only haematocrit (OR = 0.835, p = 0.020) was independently associated with pica. Although severe iron deficiency was more prevalent in high-intensity donors, pica behaviours were less prevalent than in less frequent donors (2.2%).. We have uncovered predictors of pica in high-intensity donors, which further emphasises the need to continue to implement iron replacement programs to reduce the prevalence of pica and maintain a robust pool of frequent donors.

Topics: Anemia, Iron-Deficiency; Blood Donors; Ferritins; Humans; Iron Deficiencies; Pica; Prevalence

Topics: Anemia, Iron-Deficiency; Hemoglobins; Humans; Pica

Topics: Adult; Anemia, Iron-Deficiency; Craving; Female; Humans; Pica

Topics: Adult; Anemia, Iron-Deficiency; Depression; Feeding and Eating Disorders; Female; Fluoxetine; Humans; Obsessive-Compulsive Disorder; Pica; Recurrence; Selective Serotonin Reuptake Inhibitors; Spain

Pica is a poorly understood psychiatric disorder that presents with the ingestion of non-nutritious substances for unclear reasons. A high index of suspicion for unusual toxin exposure aids in the diagnosis of pica patients presenting with unexplained neurodegenerative features.. We present a 47-year-old female with worsening gait over the past year. Prior to this, she was fully independent with activities of daily living, but is now mostly housebound due to frequent falls. Past medical history is significant for menorrhagia, iron deficiency anemia and pica. CBC and iron studies revealed iron deficiency with microcytic hypochromic anemia. MRI brain demonstrated symmetrical T2 hyperintensities within the middle cerebellar peduncles.. Differential diagnoses for her clinical deficits and imaging, including Spinocerebellar Ataxia, Multiple System Atrophy and Fragile X Tremor-Ataxia Syndrome, were excluded based on neurological assessment, family history and genetic PCR testing. Collateral history revealed a regular habit of mothball ingestion and serum paradichlorobenzene levels were elevated to 15mcg/mL. The patient was treated with iron replacement therapy and her symptoms gradually improved over several months.. Iron deficiency anemia is commonly associated with pica, which can lead to toxin ingestion. A high index of suspicion for toxin ingestion in pica patients can immensely aid in the diagnosis. Mothball abuse secondary to pica may affect the CNS and can present with nonspecific neurodegenerative changes. To our knowledge, there have been no reported cases in the literature with paradichlorobenzene neurotoxicity predominantly affecting the middle cerebellar peduncles.

Topics: Anemia, Iron-Deficiency; Chlorobenzenes; Female; Humans; Insect Repellents; Magnetic Resonance Imaging; Middle Aged; Middle Cerebellar Peduncle; Neurotoxicity Syndromes; Pica

Geophagy is widespread among women from Sub-Saharan Africa, South America and the Caribbean and may persist in western countries. This practice may be associated with adverse effects such as anaemia, constipation or intestinal occlusion. We aimed to determine the prevalence of geophagy and the level of knowledge about its health effects among healthy adults originating from these countries and attending a travel medicine and international vaccination consultation in France. Among 101 travellers enrolled in the study, 83 (82.1%) were born in Sub-Saharan Africa and 13 (12.8%) in South America or the Caribbean. The mean duration of residence in France was 15.6 ± 10.4 years. Previous or current geophagy was present in 42 travellers [previous geophagy in 31 (30.7%) and current consumption in 11 (10.9%)]; 38 (90.5%) were women. The rate of awareness of harmful effects of geophagy as the risk of iron-deficient anaemia (18.8%) and soil-transmitted intestinal parasitic infections (11.9%) was low overall. Women with previous or current geophagy more often had history of iron therapy compared to those who never consumed, both during pregnancy (50.0 versus 14.3%; p = 0.0009) and outside pregnancy (47.4 versus 2.8%; p < 0.0001). Despite a long period of residence in France, geophagy was still a current practice among 10.9% of Sub-Saharan, South American and Caribbean travellers, who are poorly informed of its harmful effects. Therefore, specific information tailored to Sub-Saharan, South American and Caribbean about the risks of geophagy should be implemented in western countries.Level of evidence Level V, descriptive cross-sectional survey.

Topics: Adult; Africa South of the Sahara; Anemia, Iron-Deficiency; Caribbean Region; Constipation; Emigrants and Immigrants; Female; France; Health Knowledge, Attitudes, Practice; Heavy Metal Poisoning; Humans; Intestinal Diseases, Parasitic; Intestinal Obstruction; Male; Middle Aged; Pica; Prevalence; Soil; South America

Topics: Aged; Anemia, Iron-Deficiency; Humans; Hypercalcemia; Male; Pica

Collagenous gastritis is an uncommon gastrointestinal disease in children. Its cause remains uncertain. It may present as severe hypoproteinaemia manifesting as generalized oedema. We report a 15 months old female who presented with pica, generalized body oedema and diarrhoea. Diagnostic workup revealed gastric replacement of the lamina propria by hyalinized collagen on histology. This case seeks to highlight the need for early paediatric gastroenterology referral including oesophagogastroduodenoscopy with multiple tissue biopsies as part of a broad diagnostic workup in children with non-specific gastrointestinal symptoms to improve diagnostic yield and enable accurate histologic diagnosis, so that appropriate therapy can be timeously applied.

Topics: Albumins; Anemia, Iron-Deficiency; Azathioprine; Biopsy; Collagen; Diarrhea; Edema; Endoscopy, Gastrointestinal; Female; Gastric Mucosa; Gastritis; Humans; Hypoalbuminemia; Hypoproteinemia; Infant; Pica; Prednisone; Treatment Outcome; Water-Electrolyte Balance

Kaolin eating is an ancestral and worldwide tradition, particularly in women in order to relieve nauseas and abdominal troubles. Nevertheless, damaging effects such as anemia and intestinal troubles are well documented. However, compulsive disorders associated with kaolin intake are less known.. We reported in this paper a severe craving observed in a young woman consuming kaolin for several years, associated with a microcytic iron-deficiency non-regenerative anemia.. This paper allows to draw attention among physicians who are rarely informed of this practice imported from abroad and have consequently a limited role in informing patients of the potential deleterious side effects of geophagia.

Topics: Anemia, Iron-Deficiency; Craving; Female; Humans; Kaolin; Pica; Young Adult

Few case series of pagophagia and iron deficiency include men. We performed a retrospective study of non-Hispanic white men with iron-deficiency anemia whose anemia and pagophagia, thrombocytosis, and thrombocytopenia (if present) resolved after iron replacement. Iron-deficiency anemia was defined as transferrin saturation (TS) <15%, serum ferritin (SF) <30 μg/L, and hemoglobin (Hb) <13.0 g/dL. We excluded men with: anemia, thrombocytosis, or thrombocytopenia due to non-iron-deficiency causes; malignancy; chronic inflammatory conditions; hemochromatosis; or creatinine >1.1 mg/dL. We computed univariate and multivariable pagophagia associations with: age; gastrointestinal bleeding; TS; SF; Hb; red blood cell (RBC) count; mean corpuscular volume (MCV); RBC distribution width (RDW); and platelet count. Median age of 41 men was 54 y (range 18-81). Fourteen men (34.1%) had pagophagia. Thirty-six men (87.8%) had gastrointestinal bleeding. Mean Hb was 9.4 ± 2.2 g/dL. Six men (14.6%) had thrombocytosis; two (4.9%) had thrombocytopenia. Logistic regression on pagophagia revealed: age (p = 0.0158; odds ratio 0.92 [95% confidence interval: 0.85, 0.99]) and platelet count (p = 0.0187; 0.98 [0.97, 1.00]) (41.4% of pagophagia occurrence; ANOVA p = 0.0053). We conclude that pagophagia occurred in 34% of men with iron-deficiency anemia and was negatively associated with age and platelet count, after adjustment for other variables.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Erythrocyte Indices; Humans; Male; Middle Aged; Pica; Sex Factors; Symptom Assessment; Young Adult

A 50-year-old woman presented with worsening fatigue and shortness of breath. For 2 months, she has been having increased craving for unpeeled lemons and was seen in clinic about a month prior to presentation at the emergency room. At that time, she was asymptomatic except for endorsing craving for lemons. Physical exam findings at presentation noted obesity, sinus tachycardia, pallor, mild scleral jaundice and no other stigmata for chronic liver disease. Her labs suggested iron-deficiency anaemia (IDA), elevated liver enzymes and positive antimitochondrial antibody titre. Abdominal ultrasound and CT scan showed mild scarring. She was diagnosed with primary biliary cholangitis with portal hypertension complicated by oesophageal varices and IDA. Interventions included blood transfusion, oesophageal banding and treatment with ursodeoxycholic acid. Her craving for lemons, shortness of breath and fatigue resolved within 1 week. With ongoing outpatient follow-up and oesophageal variceal surveillance, she continues to do well.

Topics: Administration, Oral; Anemia, Iron-Deficiency; Blood Transfusion; Cholagogues and Choleretics; Diagnosis, Differential; Digestive System Surgical Procedures; Esophageal and Gastric Varices; Female; Humans; Hypertension, Portal; Iron; Liver Cirrhosis, Biliary; Middle Aged; Pica; Ultrasonography; Ursodeoxycholic Acid

Geophagy, the craving and purposive consumption of earth, is commonly reported during pregnancy. To date, most studies of geophagy have been cross-sectional and have not assessed its relationship with HIV infection. Therefore, to concurrently examine proposed etiologies of geophagy, a cohort of 371 women with mixed HIV status from Nyanza region, Kenya were recruited in late pregnancy and interviewed about pica at nine time points, through 21 months postpartum. Nutritional status (hemoglobin concentration and food insecurity), physical health (HIV infection and gastrointestinal distress), and psychosocial health (depression and perceived stress) were also repeatedly assessed. Prevalence of geophagy was greatest during pregnancy and decreased significantly postpartum. In a two-level hierarchical linear model, a one-unit increase in average hemoglobin (g/dL) was associated with a 35% decrease in the odds of geophagy. The adjusted odds ratios (CI) of geophagy were 3.98 (2.99, 5.29), 2.54 (1.13, 5.69), and 1.68 (1.15, 2.44) times higher if a woman was pregnant, reported diarrhea in the prior 24 hours, or was HIV positive, respectively. The adjusted odds ratio of geophagy was 1.61 (1.06, 2.45) times higher if a woman reported geophagy during childhood. Our results lend greatest plausibility to the protection hypothesis (i.e., that geophagy occurs in response to compromised immunity and/or infection). Given the high prevalence of geophagy, clinicians should regularly screen for the behavior and measure inflammatory biomarkers before treating geophagy with iron supplements, which can exacerbate some infections.

Topics: Adult; Anemia, Iron-Deficiency; Cohort Studies; Cross-Sectional Studies; Female; Hemoglobins; HIV Infections; Humans; Iron; Kenya; Longitudinal Studies; Odds Ratio; Pica; Postpartum Period; Pregnancy; Pregnancy Complications; Prevalence

Topics: Abdominal Pain; Adult; Anemia, Iron-Deficiency; Depressive Disorder; Diagnosis, Differential; Female; Hemoglobins; Humans; Lead; Lead Poisoning; Menorrhagia; Pica; Vomiting

Anecdotal evidence suggests that pica occurs among Hispanic women in the United States, especially during pregnancy. However, the prevalence and socio-demographic and biological factors associated with pica in this population have not been adequately identified.. Trained, bilingual study personnel conducted structured interviews at public health clinics in Salinas Valley, California with 187 pregnant Hispanic women in their 2nd or 3rd trimesters of pregnancy. Hemoglobin was measured using Hemocue; concentrations of transferrin receptor (TfR) and alpha-1 acid glycoprotein (AGP) were measured in dried blood spots. Multivariable stepwise regression analyses were conducted with pica during pregnancy as the dependent variable and individual- and family-level factors as independent variables to identify significant associations. Additionally, multivariable models were built to explore the associations between pica and iron status (iron deficiency and anemia).. Half of all participants (51.3%) had ever engaged in pica, and 37.6% had done so during the current pregnancy. Pica substances included large quantities of ice, frost, raw starches, and various earthen items. Pica during the current pregnancy was significantly associated with higher TfR concentrations [OR: 1.29; 95% CI: 1.11, 1.51] indicative of low iron stores and greater food insecurity [OR: 1.20, 95% CI: 1.03, 1.40]. Women who engaged in pica during the current pregnancy were more likely to be iron deficient [adjusted OR: 2.58; 95% CI: 1.19, 5.60], but not anemic [adjusted OR: 1.40; 0.60, 3.23].. Among pregnant Hispanic women, pica was prevalent and strongly associated with iron deficiency and food insecurity. Clinicians should screen for pica during pregnancy in Hispanic populations, and future studies should elucidate the underlying etiology and consequences of engaging in pica during pregnancy.

Topics: Adult; Anemia, Iron-Deficiency; California; Cross-Sectional Studies; Female; Hemoglobins; Hispanic or Latino; Humans; Iron; Orosomucoid; Pica; Pregnancy; Pregnancy Complications; Prevalence; Receptors, Transferrin; Socioeconomic Factors; Young Adult

Iron deficiency anemia (IDA) and abdominal pain are commonly seen in a pediatric emergency department (8 and 18% incidence respectively in our center). They are manifestations of a wide variety of diseases ranging from benign to immediately life-threatening. Trichobezoar is an under-diagnosed entity that has to be considered in children and adolescents, expecially female, suffering from trichotillomania (compulsion to pull hair) and trichophagy (compulsion to swallow hair). When undiagnosed, gastric bezoars may cause gastric ulceration, perforation, haemorrhage and obstruction.. To underline the importance of including this pathology in the differential diagnosis of IDA and abdominal pain, we present the case of a 14 year-old girl with a huge trichobezoar which completely filled the stomach and extended into the small bowel. Since trichobezoar has an extension to the small bowel, it is classified as Rapunzel syndrome. As the bezoar couldn't be removed by endoscopy, the girl underwent surgical intervention. The patient passed through a gradual re-feeding, with iron and vitamins supplementation, and through a psychiatric counselling.. The Rapunzel syndrome is a rare entity that may be complicated by life-threatening events. A prompt diagnosis and an appropriate therapy can reduce comorbidities. Gradual re-feeding with supplementation of micronutrients allows adequate catch-up weight with normalization of haematochemical nutritional parameters. Since many of these patients suffer from psychiatric pathology such as PICA with emotional problems and mental retardation, psychological/psychiatric counselling plays an important role in order to prevent bezoar recurrence.

Topics: Abdominal Pain; Adolescent; Anemia, Iron-Deficiency; Bezoars; Diagnosis, Differential; Duodenum; Emergency Service, Hospital; Female; Humans; Pica; Stomach; Syndrome; Tomography, X-Ray Computed; Trichotillomania; Ultrasonography

To investigate the relationship between prenatal geophagy, maternal prenatal haematological indices, malaria, helminth infections and cognitive and motor development among offspring.. At least a year after delivery, 552 of 863 HIV-negative mothers with singleton births who completed a clinical trial comparing the efficacy of sulfadoxine-pyrimethamine and mefloquine during pregnancy in Allada, Benin, responded to a nutrition questionnaire including their geophagous habits during pregnancy. During the clinical trial, helminth infection, malaria, haemoglobin and ferritin concentrations were assessed at 1st and 2nd antenatal care visits (ANV) and at delivery. After the first ANV, women were administered daily iron and folic acid supplements until three what? post-delivery. Singleton children were assessed for cognitive function at age 1 year using the Mullen Scales of Early Learning.. The prevalence of geophagy during pregnancy was 31.9%. Pregnant women reporting geophagy were more likely to be anaemic (AOR = 1.9, 95% CI [1.1, 3.4]) at their first ANV if they reported geophagy at the first trimester. Overall, prenatal geophagy was not associated with maternal haematological indices, malaria or helminth infections, but geophagy during the third trimester and throughout pregnancy was associated with poor motor function (AOR = -3.8, 95% CI [-6.9, -0.6]) and increased odds of geophagous behaviour in early childhood, respectively.. Prenatal geophagy is not associated with haematological indices in the presence of micronutrient supplementation. However, it may be associated with poor child motor function and infant geophagy. Geophagy should be screened early in pregnancy.

Topics: Adolescent; Adult; Anemia, Iron-Deficiency; Child Development; Child, Preschool; Dietary Supplements; Female; Folic Acid; Humans; Infant, Newborn; Maternal Exposure; Maternal Health; Pica; Pregnancy; Pregnancy Complications; Soil; Young Adult

We report the peculiar case of a patient who consumed raw rice daily and had iron-deficiency anaemia secondary to menorrhagia with underlying polycystic ovarian syndrome. A 32-year-old lady of Asian descent presented with symptoms of fatigue, lethargy and prolonged, irregular periods for the last two months. There was noticeable increase in body weight, male pattern alopecia and facial acne. In addition, she experienced sudden, unexplained predilection towards consumption of raw rice (up to 300- 400g/day). The patient was treated with oral iron and cyclical progestin. After three weeks, her haemoglobin improved and her ryzophagia subsided. Gynaecologists should be vigilant of pica, which can occur outside of the context of pregnancy and also poses potential health risks including tooth attrition, electrolyte imbalance, intestinal obstruction and poisoning.

Topics: Adult; Anemia, Iron-Deficiency; Female; Humans; Menorrhagia; Oryza; Pica; Polycystic Ovary Syndrome

Pica, the eating of non-foods, occurs particularly in children and pregnant women. It has been observed in communities all over the world. Pica is associated with iron deficiency and, in some environments, lead poisoning. This is the first time a study has assessed the prevalence of pica in Australia.. The study assessed the prevalence of pica in an Australian rural community, using a questionnaire given to parents of 223 children aged 2-10 years attending the five general practice surgeries in the shire.. The prevalence of non-ice pica in the study group was 9.4%, and 3.6% of this group ate soil.. The presence of pica should alert the treating clinician to consider iron deficiency and, in the case of polluted environments, lead exposure.

Topics: Adult; Anemia, Iron-Deficiency; Australia; Child; Child, Preschool; Female; Humans; Male; Pica; Pregnancy; Prevalence; Rural Population; Soil; Surveys and Questionnaires

Iron deficiency can occur in patients after Roux-en-y gastric bypass due to altered absorption. Pica, the compulsive craving and intake of non-nutritive substances, is a rare and poorly understood presentation of iron deficiency. To our knowledge, the rate of pica after RYGB has never been reported.. The medical records of patients who underwent laparoscopic RYGB from 2001 to 2011 were reviewed. Patients with pica or other abnormal cravings were identified.. Pica was identified in 16/959 (1.7%) patients who underwent RYGB during the study period. The most common presenting sign was pagophagia. All patients with pica were female and had multiple risk factors for iron deficiency with 13/16 being premenopausal and 7/16 non-compliant with oral iron supplementation. Pica symptoms presented at a mean of 3.9 ± 1.9 years after RYGB. Iron deficiency was identified in all 16 patients, with a median ferritin level of 5.0 ng/mL (range 2-27). All 16 patients received intravenous iron and pica symptoms resolved.. Pica is a rare phenomenon associated with iron deficiency and can occur despite oral iron supplementation. In our experience, intravenous iron can relieve symptoms. Patients considering bariatric surgery should be counseled on pica. Patients with unusual cravings should be evaluated for iron deficiency.

Topics: Adult; Anemia, Iron-Deficiency; Craving; Female; Gastric Bypass; Humans; Ice; Incidence; Iron; Laparoscopy; Male; Middle Aged; Pica; Risk Factors; Sex Factors

The aim of this case-control study was to determine the frequency of pica and its relationship with iron deficiency in children in Zanjan. We selected 872 children and determined the frequency of pica. We selected students who did not have pica of the same age and sex, and in the same class as our cases as a control group. Both groups were evaluated for iron deficiency anaemia. Among the 57 students (6.7%) who had pica, there was no significant relationship with sex (P > 0.05). The most common types of pica were soil (62.3%) and paper (31.2%). The frequency of anaemia among cases was greater than in controls, although the difference was not statistically significant. The serum iron/total iron binding capacity ratio ≤ 0.15 did not differ significantly between the 2 groups. We did not find any association between pica and anaemia and/or iron deficiency (P > 0.05).. العلاقة بين البيكا ونقص الحديد في الأطفال في محافظة زانجان، جمهورية إيران الإسلامية: دراسة حالة ضابطة.. منصور صادق زاده، بريسا خوشنويس اصل، سينا صادق زاده.. تمثَّل الهدف من دراسة الحالة الضابطة هذه في تحديد معدل انتشار البيكا وعلاقتها بنقص الحديد في الأطفال في محافظة زانجان. وقد اخترنا عينة عشوائية من 872 طفاً وحددنا معدل انتشار البيكا. فاخترنا بشكل جزافي أطفالاً يتمتعون بالصحة من نفس العمر والجنس ومن نفس الصف المدرسي كالحالات لاستخدامهم كمجموعة ضابطة. وجرى تقييم الحالات والحالات الضابطة عى أساس فقر الدم الناجم عن نقص الحديد. ومن بن الطاب المصابن بمرض البيكا والبالغ عددهم 57 طالباً (6.7%)، لم تثبت أي علاقة ذات دلالة بجنس المريض (0.05 0,05). Les types les plus connus de pica étaient la géophagie (62,3 %) et l’ingestion de papier (31,2 %). La fréquence de l’anémie parmi les cas était plus élevée que chez les témoins, mais la différence n’était pas statistiquement significative. Le ratio de la capacité de fixation du fer sérique/fer total, inférieur ou égal à 0,15, ne différait pas significativement entre les deux groupes. Nous n’avons trouvé aucune association entre le pica et l’anémie et/ou les carences en fer (p > 0,05).

Topics: Adolescent; Anemia, Iron-Deficiency; Case-Control Studies; Child; Female; Humans; Iran; Iron; Male; Pica; Prevalence

Pica is common in pregnancy and is often felt to be benign. The following case of severe pica presenting without anemia is unusual in its presentation, laboratory findings, and treatment.. A 31-year-old multiparous woman at 37 0/7 weeks of gestation presented with esophagitis and gastritis secondary to laundry detergent consumption. She had borderline anemia (hemoglobin of 11 g/dL and hematocrit of 37%, mean corpuscular volume 80%) but was severely iron-deficient (serum ferritin 7 micrograms/dL). Parenteral iron infusion was associated with dramatic resolution of her cravings within 36 hours of treatment.. Pica may be related to deficient iron stores in the absence of anemia and can result in serious morbidity. Parenteral iron may be associated with rapid pica resolution in symptomatic pregnant patients.

Topics: Adult; Anemia, Iron-Deficiency; Chemically-Induced Disorders; Detergents; Esophagitis; Female; Gastritis; Humans; Iron; Iron Deficiencies; Noxae; Pica; Pregnancy; Pregnancy Complications; Trace Elements; Treatment Outcome

Iron deficiency anemia is a common finding in women of child-bearing age. Pica, or the ingestion of non-food or non-nutritive items, is a well-known manifestation of iron deficiency. A high sodium diet increases risk for nephrolithiasis. We describe the case of a 31-year-old woman with recurrent calcium nephrolithiasis and anemia who ate ice chips as well as spoons of salt daily. Treatment of pica may prove effective in preventing recurrent nephrolithiasis.. A 31-year-old white woman with a past medical history of menorrhagia, anemia, and recurrent calcium nephrolithiasis presented for preoperative evaluation prior to ureterolithotomy. She described a daily pattern of eating continually from a cup of ice chips accompanied by multiple spoons of salt directly out of a salt shaker. These cravings had been present for many years, were bothersome to her, and interfered with her daily life. Laboratory findings revealed hemoglobin of 10.9 g/dL with ferritin of 3 ng/mL. History, physical, and laboratory data were consistent with pica secondary to iron deficiency anemia. She was prescribed orally administered ferrous sulfate 325 mg three times a day with meals. She continues to struggle with the symptoms of pica and orally administered supplementation.. It is important that clinicians consider the possible diagnosis of sodium chloride pica in patients with iron deficiency anemia and recurrent nephrolithiasis. Treatment of anemia and resolution of pica may prove effective in preventing future nephrolithiasis. Specific questioning about pica symptoms in patients with iron deficiency anemia and recurrent nephrolithiasis may be helpful diagnostically and therapeutically.

Topics: Adult; Anemia, Iron-Deficiency; Diagnosis, Differential; Female; Ferritins; Ferrous Compounds; Humans; Nephrolithiasis; Pica; Recurrence; Sodium Chloride, Dietary

Geophagy, or the ingestion of earth or clay, is widespread among women of Sub-Saharan African, Caribbean or French Guiana origin. Little is known about this practice among HIV patients native of these countries and who are followed-up in France. The aims of this study were to determine (i) the prevalence and factors associated with geophagy among HIV patients native of these countries, (ii) patients' knowledge about the harmful effects of geophagy, and (iii) the association of geophagy with iron deficiency, or a history of anemia or constipation. Among the 119 included patients, current geophagy and previous geophagy were present in 11/119 (9%) and 47/119 (40%) patients, respectively. Female gender was the only factor associated with consumption (OR 5.37; 95% CI 2.07-15.92 p = 0.001). Awareness about the risk of iron-deficient anemia was low (24%). Preventive education should be integrated into the care of HIV adults from countries in which geophagy is a culture and widely accepted practice.

Topics: Adult; Africa South of the Sahara; Anemia, Iron-Deficiency; Caribbean Region; Ethnicity; Feeding and Eating Disorders; Female; France; French Guiana; Health Knowledge, Attitudes, Practice; HIV Infections; Humans; Male; Pica; Prevalence; Soil

Topics: Adult; Anemia, Iron-Deficiency; Charcoal; Coffee; Craving; Female; Gasoline; Humans; Meat Products; Menorrhagia; Middle Aged; Olfaction Disorders; Paper; Pica; Pregnancy; Pregnancy Complications, Hematologic; Rain

The study aims to review a condition defined by the desire to consume ice in order to satisfy an addictive-like compulsion, rather than for purposes of hydration or pain relief. This condition is called ice pica, or pagophagia. Associations between ice pica and iron deficiency, suggestions for clinical screening of at risk populations, and recommendations for treatment and follow-up care are provided.. An extensive literature review of original research articles, reviews, clinical practice manuscripts, and scientific publications on pica and pagophagia.. A compulsion or craving for the consumption of ice is often overlooked in clinical practice. It is therefore important for clinicians to include ice pica as part of the review of systems for certain patient populations. Ice pica is frequently associated with iron deficiency, and iron supplementation is an effective therapy in most cases.. Knowledge gained from screening for ice pica can generate valuable patient information and lead to the diagnosis and treatment of iron deficiency. The populations at risk include young women and blood donors of either sex.

Topics: Anemia, Iron-Deficiency; Female; Humans; Ice; Iron; Male; Pica

Iron deficiency anemia (IDA) is a major public health problem especially in underdeveloped and developing countries. Zinc is the co-factor of several enzymes and plays a role in iron metabolism, so zinc deficiency is associated with IDA. In this study, it was aimed to investigate the relationship of symptoms of IDA and zinc deficiency in adult IDA patients. The study included 43 IDA patients and 43 healthy control subjects. All patients were asked to provide a detailed history and were subjected to a physical examination. The hematological parameters evaluated included hemoglobin (Hb); hematocrit (Ht); red blood cell (erythrocyte) count (RBC); and red cell indices mean corpuscular volume (MCV), mean corpuscular hemoglobin (МСН), mean corpuscular hemoglobin concentration (МСНС), and red cell distribution width (RDW). Anemia was defined according to the criteria defined by the World Health Organization (WHO). Serum zinc levels were measured in the flame unit of atomic absorption spectrophotometer. Symptoms attributed to iron deficiency or depletion, defined as fatigue, cardiopulmonary symptoms, mental manifestations, epithelial manifestations, and neuromuscular symptoms, were also recorded and categorized. Serum zinc levels were lower in anemic patients (103.51 ± 34.64 μ/dL) than in the control subjects (256.92 ± 88.54 μ/dL; <0.001). Patients with zinc level <99 μ/dL had significantly more frequent mental manifestations (p < 0.001), cardiopulmonary symptoms (p = 0.004), restless leg syndrome (p = 0.016), and epithelial manifestations (p < 0.001) than patients with zinc level > 100 μ/dL. When the serum zinc level was compared with pica, no statistically significant correlation was found (p = 0.742). Zinc is a trace element that functions in several processes in the body, and zinc deficiency aggravates IDA symptoms. Measurement of zinc levels and supplementation if necessary should be considered for IDA patients.

Topics: Adolescent; Adult; Anemia, Iron-Deficiency; Case-Control Studies; Cognition Disorders; Dyspnea; Erythrocyte Indices; Fatigue; Female; Humans; Male; Middle Aged; Pica; Restless Legs Syndrome; Skin Diseases; Spectrophotometry, Atomic; Symptom Assessment; Turkey; Young Adult; Zinc

The causes and consequences of geophagy, the craving and consumption of earth, remain enigmatic, despite its recognition as a behavior with public health implications. Iron deficiency has been proposed as both a cause and consequence of geophagy, but methodological limitations have precluded a decisive investigation into this relationship. Here we present a novel in vivo model for assessing the impact of geophagic earth on iron status: Gallus gallus (broiler chicken). For four weeks, animals were gavaged daily with varying dosages of geophagic material or pure clay mineral. Differences in haemoglobin (Hb) across treatment groups were assessed weekly and differences in liver ferritin, liver iron, and gene expression of the iron transporters divalent metal transporter 1 (DMT1), duodenal cytochrome B (DcytB) and ferroportin were assessed at the end of the study. Minimal impact on iron status indicators was observed in all non-control groups, suggesting dosing of geophagic materials may need refining in future studies. However, this model shows clear advantages over prior methods used both in vitro and in humans, and represents an important step in explaining the public health impact of geophagy on iron status.

Topics: Aluminum Silicates; Anemia, Iron-Deficiency; Animal Feed; Animals; Biological Availability; Cation Transport Proteins; Chickens; Clay; Diet; Ferritins; Hemoglobins; Iron; Liver; Models, Biological; Pica

Topics: Adult; Anemia, Iron-Deficiency; Craving; Female; Humans; Pica; Talc

Topics: Adult; Anemia, Iron-Deficiency; Brain; Diagnosis, Differential; Female; Headache; Humans; Hypereosinophilic Syndrome; Magnetic Resonance Imaging; Pica; Pregnancy; Pregnancy Complications; Stroke; Toxocariasis; Vision Disorders

To provide an overview of the current state of knowledge concerning the determinants and consequences of geophagy during pregnancy.. Bibliographic searching of articles published in English or French and included in the Scopus database, and reporting of our experience with the management of geophagic pregnant women at the maternity unit of Saint-Laurent-du-Maroni (French Guiana).. Geophagy is a little known practice initiated by various stimuli, including nausea and iron deficiency. Sustained geophagy during pregnancy has many consequences, due to complex ionic interactions with the digestive tract. Clay consumption may lead to iron deficiency, which may even be life-threatening in cases of post-partum haemorrhage in severely anaemic women. For the foetus, in addition to the known risk of preterm birth associated with maternal anaemia, maternal geophagy may lead to overexposure to heavy metals, including aluminium in particular. This practice should therefore be considered potentially damaging to the neurological development of the child. The ionic imbalances caused by the ingestion of clay over a long period should be systematically evaluated and corrected, given the secondary malabsorption they may cause, often necessitating parenteral feeding.

Topics: Adult; Anemia, Iron-Deficiency; Female; French Guiana; Heavy Metal Poisoning; Humans; Pica; Poisoning; Pregnancy; Pregnancy Complications

The relationship between pagophagia (ice pica) and iron deficiency anemia was studied. All 81 patients with iron deficiency anemia defined as hemoglobin <12.0 g/dl and ferritin level <12 ng/ml were interviewed about their habits of eating ice or other non-food substances. Pagophagia was defined as compulsive and repeated ingestion of at least one tray of ice or ice eating which was relieved after iron administration. Pagophagia was present in 13 patients (16.0%). All patients who received oral iron were periodically assessed employing a questionnaire on pagophagia and laboratory data. Iron therapy can cure the pagophagia earlier than hemoglobin recovery and repair of tissue iron deficiency. Although the pathogenesis of pagophagia is unclear, a biochemical approach involving the central nervous system might elucidate the mechanism underlying these abnormal behaviors.

Topics: Adult; Aged; Anemia, Iron-Deficiency; Biomarkers; Cholestyramine Resin; Female; Ferritins; Hemoglobins; Humans; Ice; Japan; Male; Pica; Prevalence

Bezoar is defined as the accumulation of organic or nonbiological substances inside the gastrointestinal system. Trichobezoars are the most frequently detected ones and are mostly present in patients with neuropsychiatric disorders. The continuance of the trichobezoar tail-shaped extension over the duodenum and jejunum is described in Rapunzel syndrome. Both conditions are rarely reported in children. The present case submitted here is related to a 5-year-old girl referred with an abdominal mass and anemia, diagnosed with Rapunzel syndrome and developing trichobezoar due to iron deficiency and pica.

Topics: Anemia, Iron-Deficiency; Bezoars; Child, Preschool; Female; Humans; Jejunum; Pica; Stomach; Syndrome; Treatment Outcome

Chronic, severe iron-deficiency anemia (IDA) in the first years of life increases the risk of irreversibly compromised cognitive, affective, and motor development. While IDA in infants has decreased because of dietary changes (iron-fortified formula and delaying cow's milk), toddlers (13-36 months) are equally vulnerable to the adverse effects of IDA. We aimed to show that despite public health efforts, severe IDA remains a problem in toddlers and is associated with excess milk consumption.. Retrospective chart review of children 6 to 36 months admitted to or evaluated by hematology at a children's hospital from January 1, 2005 to December 31, 2010 with a severe microcytic anemia (hemoglobin [Hb] <9 g/dL and mean corpuscular volume (MCV) <75 fL).. We identified 68 infants and toddlers with severe IDA; most (84%) were 13 to 36 months old. The mean Hb and MCV were 6.0 g/dL (range = 2.2-8.9 g/dL) and 54.0 fL (range = 45.5-69.8 fL), respectively. Fatigue, poor appetite, and pica were the most common symptoms, found in 43%, 29%, and 22% of patients, respectively. Only 41% of parents reported pale skin while 77% of physicians recorded it on physical exam. Daily cow's milk consumption surpassed 24 ounces for 47 of 48 children with reported intake; 11 consumed more than 64 ounces per day.. Despite current screening recommendations, severe IDA continues to be a problem in toddlers and strongly correlates with excess cow's milk consumption. This reiterates the importance of screening for IDA into routine toddler care.

Topics: Age Factors; Anemia, Iron-Deficiency; Animals; Appetite; Child, Preschool; Diet; Erythrocyte Indices; Fatigue; Female; Humans; Infant; Male; Milk; Pica; Retrospective Studies; Risk Factors

A relation between pica (the craving and purposive consumption of nonfood items) during pregnancy and anemia is observed frequently. However, few studies related pica behaviors to biomarkers of iron status, and little is known about pica prevalence in U.S. pregnant adolescents. To address this, we undertook a longitudinal study examining iron status and pica behaviors among a group of 158 pregnant adolescents (aged ≤18 y). Approximately two-thirds of the participants were African American and 25% were Hispanic. Maternal iron status indicators [hemoglobin, soluble transferrin receptor, serum ferritin (SF), total body iron (TBI), and serum hepcidin] were assessed during pregnancy (18.5-37.3 wk) and at delivery. Pica behavior was assessed up to 3 times across gestation. Among the 158 adolescents, 46% reported engaging in pica behavior. Substances ingested included ice (37%), starches (8%), powders (4%), and soap (3%). During pregnancy, mean SF [geometric mean: 13.6 μg/L (95% CI: 11.0, 17.0 μg/L)], TBI (mean ± SD: 2.5 ± 4.2 mg/kg), and hepcidin [geometric mean: 19.1 μg/L (95% CI: 16.3, 22.2 μg/L)] concentrations were significantly lower (P < 0.05) in the pica group (n = 72) than values observed among the non-pica group [SF, geometric mean: 21.1 μg/L (95% CI: 18.0, 25.0 μg/L); TBI, mean ± SD: 4.3 ± 3.5 mg/kg; hepcidin, geometric mean: 27.1 μg/L (95%: 23.1, 32.1 μg/L); n = 86]. Although additional studies must address the etiology of these relations, this practice should be screened for, given its association with low iron status and because many of the substances ingested may be harmful. This trial was registered at clinicaltrials.gov as NCT01019902.

Topics: Adolescent; Anemia, Iron-Deficiency; Cross-Sectional Studies; Dietary Supplements; Feeding Behavior; Female; Ferritins; Hemoglobins; Hepcidins; Humans; Iron; Iron Deficiencies; Iron, Dietary; Longitudinal Studies; Nutritional Status; Pica; Pregnancy; Prevalence; Receptors, Transferrin

Pagophagia (compulsive ice chewing) has long been associated with iron deficiency anemia, but prior attempts to account for this craving have been unsatisfactory. We hypothesize that chewing ice triggers vascular changes that lead to preferential or increased perfusion of the brain. This would result in increased alertness and processing speed in anemic patients, but not in healthy controls who are already at ceiling, and would explain why anemic individuals crave ice. Preliminary support for this hypothesis was found in two studies. In Study 1, non-anemic subjects reported very low rates of pagophagia (only 4%) while anemic subjects reported significantly higher rates (56%). In Study 2, chewing ice dramatically improved response time on a neuropsychological test, but only for anemic individuals. In a small randomized controlled trial, iron deficient anemic subjects and healthy controls were assigned to chew ice or drink tepid water and then took a continuous performance test that measures response time, response time variability, errors of impulsivity and errors of inattention. In the water condition, anemic subjects performed significantly worse than healthy controls. Chewing ice had no effect on the performance of healthy controls, but significantly improved the performance of anemic patients. Potential explanations include activation of the dive reflex, which would lead to peripheral vasoconstriction and preferential perfusion of the brain or, alternatively, sympathetic nervous system activation, which would also increase blood-flow to the brain.

Topics: Adolescent; Adult; Aged; Anemia, Iron-Deficiency; Female; Humans; Ice; Male; Middle Aged; Pica; Young Adult

Topics: Anemia, Iron-Deficiency; Bezoars; Female; Humans; Jejunum; Pica; Stomach

Topics: Anemia, Iron-Deficiency; Bezoars; Female; Humans; Jejunum; Pica; Stomach

This study investigated the prevalence of iron-deficiency anaemia, glucose-6-phosphate dehydrogenase (G6PD) deficiency and β-thalassaemia trait among Arab migrating nomad children in southern Islamic Republic of Iran. Blood samples were analysed from 134 schoolchildren aged < 18 years (51 males, 83 females). Low serum ferritin (< 12 ng/dL) was present in 17.9% of children (21.7% in females and 11.8% in males). Low haemoglobin (Hb) correlated significantly with a low serum ferritin. Only 1 child had G6PD deficiency. A total of 9.7% of children had HbA2 ≥ 3.5 g/dL, indicating β-thalassaemia trait (10.8% in females and 7.8% in males). Mean serum iron, serum ferritin and total iron binding capacity were similar in males and females. Serum ferritin index was as accurate as Hb index in the diagnosis of iron-deficiency anaemia. A high prevalence of β-thalassaemia trait was the major potential risk factor in this population.. انتشار الثلاسيميَّة، وفقر الدم بعوز الحديد، وعوز نازعة هيدْرُجين الغلوكوز -6- فُسْفات بين أطفال البدو المهاجرين العرب، جنوب جمهورية إيران الإسلامية. مهدي باسالار، داوود مهرباني، عبد الرضا أفراسيابي، زهرة مهرآور، إيرما ريحاني، رقية حميدي، مهران كريمي. لقد تم في هذه الدراسة الاستقصاءُ عن انتشار فقر الدم بعوز الحديد، وعوز نازعة هيدْرُجين الغلوكوز –6– فُسْفات (G6PD)، وخَلَّة الثلاسيمية بيتا بين أطفال البدو المهاجرين العرب في جنوب جمهورية إيران الإسامية. حيث تم تحليل عينات دم من 134 طفاً من أطفال المدارس الذين تقل أعمارهم عن 18 عاماً (51 ذكور، 83 إناث). فوُجد انخفاض في فيرِّيتين المصل (<12 نانوغرام/دل) لدى 17.9% من الأطفال (21.7% لدى الإناث و 11.8% لدى الذكور). وكان انخفاض خضاب الدم (الهيموغلوبين) مرتبطاً – بشكل كبير – مع انخفاض فيرِّيتين المصل. وكان لدى طفل واحد فقط عوز في عوز نازعة هيدروجين الغلوكوز –6– فوسفات. وكان الخضاب 3.5 ≥ HbA2 غ/دل لدى 9.7% من مجموع الأطفال، مما يدل على وجود خلة الثلاسيمية بيتا (10.8% لدى الإناث و 7.8% لدى الذكور). وكان هناك تشابه بين الخضاب في متوسط حديد المصل وفيرِّيتن المصل والسعة الإجمالية الرابطة للحديد لدى الذكور والإناث. وكان لمؤشر فيرِّيتن المصل نفس دقة مؤشر الهيموغلوبين في تشخيص فقر الدم بعوز الحديد. وكان ارتفاع معدل انتشار خلة الثلاسيمية بيتا يمثّل عاملَ الخطر المحتمل الرئيي لدى هذه الفئة من السكان.. Prévalence de la thalassémie, de l'anémie ferriprive et du déficit en glucose-6-phosphate déshydrogénase chez des enfants nomades et migrants arabes (sud de la République islamique d'Iran).. La présente étude a évalué la prévalence de l'anémie ferriprive, du déficit en glucose-6-phosphate déshydrogénase et de la bêta-thalassémie mineure chez des enfants nomades et migrants arabes dans le sud de la République islamique d'Iran. Des échantillons de sang de 134 écoliers de moins de 18 ans ont été analysés (51 garçons, 83 filles). Des taux de ferritine sérique faibles (< 12 ng/dL) ont été observés chez 17,9 % des enfants (21,7 % chez les filles et 11,8 % chez les garçons). Un faible taux d'hémoglobine (Hb) était significativement corrélé à un faible taux de ferritine sérique. Seul un enfant était atteint de déficit en glucose-6-phosphate déshydrogénase. Au total, 9,7 % des enfants présentaient un taux d’HbA2 supérieur ou égal à 3,5 g/dL, signe d'une bêta-thalassémie mineure (10,8 % des filles et 7,8 % des garçons). Le taux moyen de fer sérique, de la ferritine sérique et la capacité de liaison du fer total étaient similaires chez les deux sexes. Le taux de ferritine sérique était aussi précis que le taux d’Hb pour le diagnostic de l'anémie ferriprive. La forte prévalence de la bêta-thalassémie mineure représentait le principal facteur de risque dans cette population.

Topics: Adolescent; Anemia, Iron-Deficiency; Anorexia; Arabs; beta-Thalassemia; Child; Cross-Sectional Studies; Female; Ferritins; Genetic Predisposition to Disease; Glucosephosphate Dehydrogenase Deficiency; Hemoglobin A2; Humans; Iran; Iron; Male; Pica; Prevalence; Risk Factors; Transients and Migrants; Water Supply

Topics: Abdomen; Anemia, Iron-Deficiency; Celiac Disease; Child, Preschool; Female; Foreign Bodies; Humans; Lactulose; Pica; Radiography

Pica is defined as developmentally inappropriate consumption of nonnutritive substances for at least 1 month. There are a few studies on serum trace element levels of patients with pica. The literature contains contracting data on the levels of oxidative stress and antioxidant levels in patients with iron-deficiency anemia (IDA). The effect of pica on oxidative stress and antioxidant capacity has not been investigated yet. The present study evaluated the effects of pica and IDA on oxidative stress and antioxidant capacity as well as on the levels of trace elements including serum zinc and selenium in 47 children with IDA plus pica, 22 children with IDA only and 21 nonanemic children as controls. The results demonstrated significantly lower levels of serum selenium and zinc in pica and IDA groups compared to the control group. Total oxidant levels were highest in the pica group and consistently, the lowest total antioxidant capacity was observed again in the pica group. Comparison of pica and IDA groups yielded significantly lower levels of total antioxidant levels and significantly higher oxidative stress index in the pica group. Consequently, it is thought that the detrimental effects of pica within the organism were mediated by adverse impacts on antioxidant capacity and oxidative stress. These effects should be kept in mind while managing patients with pica.

Topics: Adolescent; Anemia, Iron-Deficiency; Antioxidants; Case-Control Studies; Celiac Disease; Child; Child, Preschool; Duodenum; Gastroscopy; Humans; Infant; Oxidative Stress; Pica; Selenium; Trace Elements; Zinc

The association of blood donation-related iron deficiency with pica or restless legs syndrome (RLS) remains poorly elucidated. This study evaluated the prevalence of RLS and pica in blood donors completing the REDS-II Iron Status Evaluation (RISE) study.. RISE enrolled 2425 blood donors in a prospective cohort study; 1334 donors provided blood samples to characterize iron status and answered a questionnaire inquiring into symptoms of RLS and pica at a final visit after 15 to 24 months of follow-up. Associations between both conditions and iron status were evaluated.. There were 9 and 20% of donors reporting symptoms of probable or probable/possible RLS, respectively. Iron depletion and donation intensity were not predictive of RLS. Pica was reported by 65 donors (5.5%), half of whom reported daily cravings. Prevalence of pica increased with degree of iron depletion in women (2% in iron-replete females, 13% in those with ferritin < 12 ng/mL), but not in men. Probable RLS and pica coexpressed in eight individuals, but no more frequently than expected by chance.. RLS and pica have been associated with iron deficiency in nondonor populations. This study indicates a potentially high prevalence of RLS in frequent blood donors but shows no association with iron status or donation intensity. Low iron stores were associated with higher prevalence of pica, but only in females. Furthermore, the results are incompatible with RLS and pica sharing a common pathophysiology.

Topics: Adult; Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Blood Donors; Female; Follow-Up Studies; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Pica; Prevalence; Prospective Studies; Restless Legs Syndrome; Risk Factors; Self Report

Topics: Anemia, Iron-Deficiency; Blood Donors; Female; Humans; Male; Mass Screening; Pica; Restless Legs Syndrome

Topics: Adult; Anemia, Iron-Deficiency; Female; Food; Food-Drug Interactions; Humans; Iron; Pica; Polyphenols; Trace Elements; Vitis

TMPRSS6 A736V is associated with lower transferrin saturation (TS), hemoglobin (Hb), and mean corpuscular volume (MCV) levels in general adult populations. We sought to identify relationships of TMPRSS6 K253E, A736V, and Y739Y to iron, erythrocyte, and pica phenotypes in women with iron deficiency or depletion.. We tabulated observations on 48 outpatient non-pregnant women who had iron deficiency (serum ferritin (SF) <14pmol/L and TS <10%) or iron depletion (SF<112pmol/L). We performed direct sequencing of TMPRSS6 exons 7 and 17 in each patient. We used age, TS, SF, Hb, MCV, pica, and TMPRSS6 allele positivity (dichotomous) or mutation genotypes (trichotomous) as variables for analyses.. Forty-six women were white; two were black. 58.3% had iron deficiency. 45.8% had pica (pagophagia, each case). Allele frequencies were 41.7% (K253E), 36.5% (A736V), and 39.6% (Y739Y). K253E frequency was greater in women with TS ≥10% (p=0.0001). Y739Y was more frequent in women with TS <10% (p=0.0135). Mean TS was also lower in women positive for Y739Y (6±4% vs. 13±16%, respectively; p=0.0021). In multiple regressions, neither K253E, A736V, nor Y739Y genotypes were significantly associated with other variables.. TMPRSS6 K253E frequency was greater in women with TS ≥10%. Frequency of Y739 was greater in women with TS <10%. Mean TS was lower in women with Y739Y. We observed no other significant relationship of TMPRSS6 K253E, A736V, or Y739Y with iron, erythrocyte, or pica phenotypes.

Topics: Adult; Aged; Anemia, Iron-Deficiency; Erythrocyte Indices; Female; Gene Frequency; Humans; Iron; Membrane Proteins; Middle Aged; Mutation; Pica; Serine Endopeptidases

Geophagia, eating of earth, is a relative frequent practice in several countries and especially in the African and South American mainlands. In some cases, migrant people continue this practice in the host country. Geophagia has some positive effects, presumed or real, and several harmful effects with significant health impacts. We relate the history of young patient of Cameroonian origin who consults for chonic fatigue, abdominal pain and menorrhagia. Laboratory tests show a severe aneamia with iron deficiency.

Topics: Abdominal Pain; Adult; Anemia, Iron-Deficiency; Cameroon; Fatigue; Female; Ferric Compounds; Hematinics; Humans; Injections, Intravenous; Menorrhagia; Pica; Poverty; Risk Factors; Switzerland; Treatment Outcome

Topics: Adult; Anemia; Anemia, Iron-Deficiency; Animals; Female; Humans; Pica; Porifera; Young Adult

Topics: Abdomen, Acute; Adolescent; Anemia, Iron-Deficiency; Female; Humans; Pica

Topics: Anemia, Iron-Deficiency; Food Preferences; Health Knowledge, Attitudes, Practice; Health Status; Humans; Ice; Pica

Topics: Anemia, Iron-Deficiency; Calcium Sulfate; Celiac Disease; Humans; Male; Pica; Young Adult

Topics: Aged, 80 and over; Anemia, Iron-Deficiency; Anemia, Macrocytic; Dementia; Female; Human Coprophagia; Humans; Pica; Severity of Illness Index

In order to examine whether symptoms of iron deficiency anemia are due to the iron deficiency itself or the associated anemia, 34 patients with polycytemia vera (PV) treated with venesectio, who had iron deficiency but normal hemoglobin (Hb) levels, were given a questionnaire covering symptoms of iron deficiency including the international RLS-scale and the Fact-fatigue quality of life scale (QoL). We found a prevalence of pica of 11.7%, mouth paresthesias of 5.8% and rest-less legs 29.6% (RLS "normal" prevalence 10%). Thus, the prevalence of RLS is significantly higher in our population. We also saw a significant difference in QoL between patients with and without RLS (P = 0.015) and QoL correlated with the severity of RLS (R = 0.85). In conclusion, RLS seems to be a frequent and serious problem for PV patients treated with venesectio according to standard guidelines.

Topics: Anemia, Iron-Deficiency; Health Surveys; Humans; Iron Deficiencies; Mouth; Paresthesia; Phlebotomy; Pica; Polycythemia Vera; Prevalence; Quality of Life; Restless Legs Syndrome; Surveys and Questionnaires

The etiology of pica, the purposive consumption of non-food substances, is not understood, despite its ubiquity among gravidae. We examined correlates of pica in a representative obstetric population (n = 2,368) on Pemba Island, Zanzibar, Tanzania to examine proposed etiologies. Cross-sectional data were collected on socioeconomic characteristics, food intake, geophagy (earth consumption), amylophagy (raw starch consumption), anthropometry, iron status, parasitic burden, and gastrointestinal morbidities. Amylophagy was reported by 36.3%, geophagy by 5.2%, and any pica by 40.1%. There was a strong additive relationship of geophagy and amylophagy with lower hemoglobin (Hb) concentration and iron deficiency anemia. By multivariate logistic regression, any pica was associated with Hb level (odds ratio [OR] = 0.76, 95% confidence interval [CI] = 0.72-0.81), nausea (OR = 1.45, 95% CI = 1.20-1.73), and abdominal pain (OR = 1.22, 95% CI = 1.01-1.48). These striking results indicate that the nature of the relationship between pica, pregnancy, gastrointestinal distress, and iron deficiency anemia merits further investigation.

Topics: Anemia; Anemia, Iron-Deficiency; Female; Hemoglobins; Humans; Iron, Dietary; Pica; Pregnancy; Pregnancy Complications, Hematologic; Tanzania

Topics: Anemia, Iron-Deficiency; Citrus; Female; Hematinics; Humans; Infusions, Intravenous; Iron-Dextran Complex; Middle Aged; Pica

Topics: Anemia, Iron-Deficiency; Diagnosis, Differential; Female; Gastric Bypass; Humans; Ice; Middle Aged; Obesity, Morbid; Pica

Anemia affects almost two-thirds of pregnant women in developing countries and contributes to maternal morbidity and mortality and to low birthweight.. To determine the prevalence of anemia and the dietary and socioeconomic factors associated with anemia in pregnant women living in an urban community setting in Hyderabad, Pakistan.. This was a prospective, observational study of 1,369 pregnant women enrolled at 20 to 26 weeks of gestation and followed to 6 weeks postpartum. A blood sample was obtained at enrollment to determine hemoglobin levels. Information on nutritional knowledge, attitudes, and practice and dietary history regarding usual food intake before and during pregnancy were obtained by trained interviewers within 1 week of enrollment.. The prevalence of anemia (defined by the World Health Organization as hemoglobin < 11.0 g/dL) in these subjects was 90.5%; of these, 75.0% had mild anemia (hemoglobin from 9.0 to 10.9 g/dL) and 14.8% had moderate anemia (hemoglobin from 7.0 to 8.9 g/dL). Only 0.7% were severely anemic (hemoglobin < 7.0 g/ dL). Nonanemic women were significantly taller, weighed more, and had a higher body mass index. Multivariate analysis after adjustment for education, pregnancy history, iron supplementation, and height showed that drinking more than three cups of tea per day before pregnancy (adjusted prevalence odds ratio [aPOR], 3.2; 95% confidence interval [CI], 1.3 to 8.0), consumption of clay or dirt during pregnancy (aPOR, 3.7; 95% CI, 1.1 to 12.3), and never consuming eggs or consuming eggs less than twice a week during pregnancy (aPOR, 1.7; 95% CI, 1.1 to 2.5) were significantly associated with anemia. Consumption of red meat less than twice a week prior to pregnancy was marginally associated with anemia (aPOR, 1.2; 95% CI, 0.8 to 1.8) but was significantly associated with lower mean hemoglobin concentrations (9.9 vs. 10.0 g/dL, p = .05) during the study period. A subanalysis excluding women with mild anemia found similar associations to those of the main model, albeit even stronger.. A high percentage of women at 20 to 26 weeks of pregnancy had mild to moderate anemia. Pica, tea consumption, and low intake of eggs and red meat were associated with anemia. Women of childbearing age should be provided nutritional education regarding food sources of iron, especially prior to becoming pregnant, and taught how food choices can either enhance or interfere with iron absorption.

Topics: Adult; Anemia, Iron-Deficiency; Beverages; Body Mass Index; Cohort Studies; Cross-Sectional Studies; Diet; Eggs; Female; Health Knowledge, Attitudes, Practice; Hemoglobins; Humans; Iron, Dietary; Meat; Nutritional Requirements; Nutritional Sciences; Nutritional Status; Pakistan; Pica; Pregnancy; Prevalence; Prospective Studies; Risk Factors; Socioeconomic Factors; Tea; Urban Population; Women's Health

Topics: Adolescent; Anemia, Iron-Deficiency; Female; Ferrous Compounds; Humans; Pica; Restless Legs Syndrome

Topics: Anemia, Iron-Deficiency; Breast Feeding; Dietary Supplements; Humans; Infant; Infant, Newborn; Iron; Lead Poisoning; Pica; Vitamin D

In this study, we evaluated the prevalence of fibromyalgia (FM) in iron deficiency anemia (IDA) and thalassemia minor (TM) patients and associated factors. In addition, we investigated the prevalence of IDA in outpatients with fibromyalgia, and its effect on clinical findings. The study included 205 IDA, 40 TM patients and 100 healthy controls. FM was diagnosed according to 1990 ACR criteria. Whole blood count, biochemical tests, and serum iron parameters were determined. Pain, fatigue, and FM Impact Questionnaire (FIQ) functional item scores were assessed in FM subjects. In addition, the prevalence of IDA in FM patients diagnosed at the Rheumatology Outpatient Clinic was determined. The prevalences of FM in IDA (17.6%) and TM (20%) groups were higher than in controls (6%; p values 0.006 and 0.025, respectively). When IDA patients with FM were compared to those without FM, it was seen that a higher percentage were females, married, and a higher percentage had history of pica (all p values < 0.05). Serum hemoglobin and iron parameters did not differ between IDA patients with and without FM. IDA was detected in 48 (24.5%) of 196 FM patients. FM patients without IDA had higher sleep disturbance scores (p = 0.012) and longer duration of FM (p = 0.045). FM was a common finding in patients with IDA and TM. FM was associated with female sex and history of pica in IDA patients, and not associated with serum hemoglobin and selected iron parameters. The presence of FM in TM had no association with any of the above-mentioned parameters.

Topics: Adult; Anemia, Iron-Deficiency; beta-Thalassemia; Female; Fibromyalgia; Hemoglobins; Humans; Male; Pica; Prevalence; Sex Factors

Topics: Anemia, Iron-Deficiency; Celiac Disease; Child; Diagnostic Errors; Glutens; Humans; Male; Obsessive-Compulsive Disorder; Pica

Topics: Anemia, Iron-Deficiency; Argentina; Case-Control Studies; Female; Humans; Iron; Pica; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Outcome; Retrospective Studies

Topics: Adult; Anemia, Iron-Deficiency; Anorexia Nervosa; Depressive Disorder, Major; Female; Humans; Pica

Association of pica, iron deficiency anaemia (IDA) and celiac disease (CD) have been reported in the literature. An unusual but completely reversible form of pica in the form obsessive compulsive sponge eating (pervasive disorder) was reported as an odd manifestation of IDA and CD.. The medical practice is full of challenges and complexity; and clinicians need to be vigilant all the time in their practice to appreciate unusual and rare manifestations of common clinical conditions like IDA and CD.

Topics: Anemia, Iron-Deficiency; Celiac Disease; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Iron; Male; Obsessive-Compulsive Disorder; Pica

Topics: Adult; Anemia, Iron-Deficiency; Female; Humans; Ice; Pica

Topics: Adult; Anemia, Iron-Deficiency; Case-Control Studies; Female; France; Geography; Humans; Male; Middle Aged; Pica; Prevalence

Topics: Anemia, Iron-Deficiency; Humans; Ice; Pica

Topics: Anemia, Iron-Deficiency; Humans; Ice; Pica

Pagophagia, or the practice of consuming ice, is a particular expression of the more general phenomenon of pica. Pagophagia is a complex behavioral phenomenon arising from the interplay of biochemical, hematological, psychological, and cultural factors. This compulsive dietary aberration is observed in many children and pregnant women worldwide. The authors report 3 cases of severe iron deficiency anemia with a serum ferritin level of 2-3 ng/mL, in which the patients were consuming 2 trays and many bags of ice per day. Following treatment with iron therapy, pagophagia spontaneously resolved within 2 weeks. It is a commonly missed problem. Pediatricians should be alert to this phenomena and its association with iron-deficiency anemia.

Topics: Adult; Anemia, Iron-Deficiency; Appetite; Child; Chronic Disease; Female; Humans; Ice; Iron; Male; Pica

Topics: Adult; Anemia, Iron-Deficiency; Coffee; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Pica

Pica, the compulsive eating of non edible substances, is known by the medical profession for centuries. In the novel by Miguel de Cervantes "Adventures of the famous knight Don Quixote de la Mancha'', there is a history in which "women that by caprice eat soil, plaster coal and other disgusting substances'' are mentioned. This description configures the clinical diagnosis of pica. This fact has not attracted the attention of the critics of Cervantes' novel, up to now. This unequivocal reference of pica suggests that iron deficiency anemia, caused by chronic hemorrhages in adults, was frequent in 1605, when the book was first published.

Topics: Anemia, Iron-Deficiency; History, 16th Century; Humans; Medicine in Literature; Pica

Topics: Anemia, Iron-Deficiency; Female; Humans; Hypokalemia; Intestinal Absorption; Iron; Paralysis; Pica; Potassium; Soil

Abstract Pica, the compulsive ingestion of nonnutritive substances, has been a fascinating and poorly understood phenomenon for centuries. Pagophagia, or ice eating, is one of the most common forms of pica and is closely associated with the development of iron-deficiency anemia. Although this condition has been well described among pregnant women and malnourished children, particularly in developing countries, it has not been previously reported to occur following gastric bypass surgery for treatment of severe obesity. This article presents two cases of women who experienced a recurrence of pagophagia following gastric bypass surgery, along with an updated review of the literature.

Topics: Adult; Anemia, Iron-Deficiency; Female; Gastric Bypass; Humans; Ice; Iron; Obesity, Morbid; Pica; Recurrence

Topics: Albendazole; Anemia, Iron-Deficiency; Animals; Anthelmintics; Antibodies, Helminth; Celiac Disease; Child, Preschool; Female; Humans; Iron; Liver Diseases, Parasitic; Lung Diseases, Parasitic; Pica; Risk Factors; Tomography, X-Ray Computed; Toxocara canis; Toxocariasis; Ultrasonography

Topics: Abortion, Spontaneous; Adolescent; Anemia, Iron-Deficiency; Diagnosis, Differential; Female; Humans; Pica; Pregnancy

Topics: Anemia, Iron-Deficiency; Australia; Child, Preschool; Female; Humans; Pica; Turkey

Topics: Aged; Anemia, Iron-Deficiency; Clothing; Female; Humans; Pica

Topics: Adult; Anemia, Iron-Deficiency; Animals; Egg Shell; Female; Ferrous Compounds; Humans; Pica; Treatment Outcome

Iron-deficiency anemia (IDA) is a public health problem in the developing and even industrialized countries. Pregnant women and children under 5 years of age are among the high-risk population. Our main objectives in this study were to obtain the prevalence of IDA in pregnant women by routine methods and by serum ferritin.. We analysed the blood of 270 healthy pregnant mothers, 16 weeks of gestational age. A series of determinations were conducted to determine haemoglobin concentration (Hb); red blood cells count (RBC); serum ferritin and other indexes. Then a questionnaire for epidemiological data, type of diet, level of education, laboratory data, etc. was filled.. The mean values (SD) of haematological indexes were as follows: Hb 12.07I1.5 g/dl; serum ferritin 24.87I19.32 ng/ml; mean corpuscular haemoglobin concentration (MCHC) 31.9I1.4 g/dl; mean corpuscular volume (MCV) 82.2I9 fl and mean corpuscular haemoglobin (MCH) 26.4I3.2 pg. 28.5 % of the subjects were anaemic at the time of the study according to serum ferritin (SF < 12 ng/ml) and 16.7% of the mothers had low serum Haemoglobin (Hb<11 g/dl) (P=0.005). There was a positive correlation (r=0.76; P=0.01) between Hb concentration and serum ferritin levels.. The prevalence of IDA was 28.5%, which is the same as the prevalence found in other developing countries (25-35%). This shows that in southern Iran we are still far behind the health status in the industrialized countries (5-8%).

Topics: Adolescent; Adult; Anemia, Iron-Deficiency; Child, Preschool; Erythrocyte Indices; Female; Ferritins; Hemoglobins; Humans; Iran; Iron; Male; Nutritional Status; Pica; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Trimesters; Surveys and Questionnaires

Topics: Adult; Anemia, Iron-Deficiency; Celiac Disease; Female; Humans; Pica

This is a case report of an otherwise healthy 2-year-old boy with a history of pica, associated with iron deficiency anemia. This boy was referred to our department for a neurologic evaluation because of an acute episode of sialorrhea, difficulty in speaking, dysphagia, and repeated swallowing movements. An uncertain episode of a brief-duration still gaze was also reported. In addition, the history revealed that the child had earlier ingested a leaf from a poisonous houseplant called Colocasia esculenta, also known as "elephant's ear." The habit of pica subsided after treatment with iron supplements. A 9-month follow-up period was uneventful. Neurologic manifestations can accompany accidental intoxications of some non-nutrient substances. Thus, pica must be suspected in children with acute behavior alterations.

Topics: Anemia, Iron-Deficiency; Aphasia; Child, Preschool; Colocasia; Deglutition Disorders; Humans; Iron; Male; Pica; Plant Poisoning; Sialorrhea

Pica is an eating disorder characterized by the irrepressible and elective craving for food and non-food substances. Pagophagia is a particular form characterized by an ingestion of ice, often associated with iron deficiency. We report a case of intense and prolonged pagophagia. We also analyse literature about the nature of the link between pica and iron deficiency.. A forty-two year old woman was admitted for severe anaemia secondary to iron deficiency possibly related to chronic gynaecological bleeding. A diet investigation revealed a pagophagia of about eighty ice cubes per day developing over five years. Iron supplement corrected the anaemia and the pagophagia disappeared in less than fifteen days without recurrence in the following year.. The disappearance of pagophagia after the correction of iron deficiency supports the theory that pagophagia could well be a symptom of iron deficiency.

Topics: Adult; Anemia, Iron-Deficiency; Female; Humans; Ice; Iron; Pica

Topics: Adult; Anemia, Iron-Deficiency; Aspirin; Carbonated Beverages; Female; Humans; Menorrhagia; Pica; Terminology as Topic

After a clinical study at Kilifi District hospital had shown a high prevalence of geophagy among pregnant women, and a strong association of geophagy, anaemia and iron depletion, 52 pregnant women from the same hospital, and 4 traditional healers from the surroundings of Kilifi in Kenya were interviewed on the topic of soil-eating and its perceived causes and consequences. The findings were substantiated by results from an earlier anthropological study on maternal health and anaemia in the same study area. Most of the pregnant women (73%) ate soil regularly. They mainly ate the soil from walls of houses, and their estimated median daily ingestion was 41.5 g. They described soil-eating as a predominantly female practice with strong relations to fertility and reproduction. They made associations between soil-eating, the condition of the blood and certain bodily states: pregnancy, lack of blood (upungufu wa damu), an illness called safura involving "weak" blood, and worms (minyolo). The relationships the women described between soil-eating and illness resemble to some extent the causalities explored in biomedical research on soil-eating, anaemia and intestinal worm infections. However the women did not conceptualise the issue in terms of the single causal links characteristic of most scientific thought. Instead, they acknowledged the existence of multiple links between phenomena which they observed in their own and other women's bodies. The women's ideas about soil-eating and their bodies shows the significance of both social and cultural context on the ways in which women derive knowledge from, and make sense of their bodily states. The cultural associations of soil-eating with blood, fertility and femininity exist alongside knowledge of its links to illness. Our findings show that soil-eating is more than just a physiologically induced behaviour; it is a rich cultural practice.

Topics: Anemia, Iron-Deficiency; Attitude to Health; Culture; Ethnopsychology; Female; Humans; Pica; Pregnancy; Pregnancy Complications; Soil

Topics: Aged; Anemia, Iron-Deficiency; Carotenoids; Female; Humans; Pica; Solanum lycopersicum

Topics: Anemia, Iron-Deficiency; Child Development; Child, Preschool; Humans; Infant; Infant Nutritional Physiological Phenomena; Iron; Iron Deficiencies; Pica

We describe a Black female who has suffered for many years from an (often) severe anemia (Hb 5-9 g/dl) with iron deficiency (serum Fe 8 microg/dl; TIBC 462 microg/dl; ferritin 7 ng/ml or less) and folate deficiency. The patient had hypermenorrhea which was appropriately treated resulting in an increase in hemoglobin level but not affecting the Fe deficiency. Splenomegaly was present, perhaps resulting from a clay-eating habit, although this was consistently denied. The patient had an alpha-thalassemia-2 (-3.7 kb) trait and a deletional hereditary persistence of fetal hemoglobin (HPFH) (type II) which were inherited from her father. Over the last six years the level of Hb F varied between 8.5 and 16% (25-29% in the father), while the G gamma value was also low (15-22% versus 32-34% in the father). Comparable reductions were seen in the relative levels of gamma-mRNA and G gamma-mRNA. These data support results published by Adams et al who showed a severe reduction in Hb F level in another HPFH heterozygote with Fe deficiency; these investigations suggested that a reduction in alpha-globin synthesis resulted in preferential formation of alpha beta dimers rather than alpha gamma dimers. Our data suggest that the decrease of Hb F and G gamma levels is due to a reduction in gamma-mRNA formation, mainly of the G gamma type, rather than through a posttranslational mechanism alone.

Topics: Adult; alpha-Thalassemia; Anemia, Iron-Deficiency; Female; Fetal Hemoglobin; Folic Acid Deficiency; Gene Deletion; Genetic Carrier Screening; Globins; Humans; Pica; RNA, Messenger

This study examined prevalence and correlates of anemia in the Muynak District of Uzbekistan, an area of rapidly changing social and economic conditions following the collapse of the Soviet Union.. Questionnaire data and blood samples were collected on a random sample of 433 children aged 1 through 4 years.. The prevalence of anemia ranged from 89% in 1-year-olds to 48% in 4-year-olds. Correlates for anemia included younger age, a communal water source, and a history of pica.. Anemia is a widespread problem in young children in this district. An aggressive attempt to reverse this problem is needed.

Topics: Anemia; Anemia, Iron-Deficiency; Child, Preschool; Female; Humans; Infant; Logistic Models; Male; Pica; Prevalence; Surveys and Questionnaires; Uzbekistan; Water Supply

Topics: Abdominal Neoplasms; Anemia, Iron-Deficiency; Child; Diagnosis, Differential; Female; Foreign Bodies; Humans; Intestine, Large; Pica; Radiography

Topics: Adolescent; Anemia, Iron-Deficiency; Bezoars; Female; Humans; Pica; Plastics; Stomach

Topics: Aged; Anemia, Iron-Deficiency; Fecal Impaction; Humans; Male; Pica; Zea mays

Topics: Adult; Anemia, Iron-Deficiency; Child; Female; Humans; Pica; Pregnancy; Pregnancy Complications, Hematologic

The incidence of pica during pregnancy has been reported to range from 0% to 68% depending on the patient population. This study was designed to define characteristics and factors influencing the practice of pica in a rural obstetric population. Our study group was 125 consecutive pregnant women who were interviewed at their initial antenatal visit about attitudes and behavior regarding pica practices. The prevalence of anemia was determined. Chi-square and t tests were used when appropriate. A pica was found in 18 (14.4%) patients. There were no significant differences between patients with a pica and those with none with respect to age, race, weight, or anemia. Substances ingested included white and red dirt, ice, cornstarch, laundry starch, soap, ashes, chalk, paint, and burnt-matches. Characteristics of patients with pica included cravings (6 of 18 or 33.3%), pica before pregnancy (10 of 18 or 56.6%), childhood pica (6 of 18 or 33.3%), and the presence of other household members with pica (56.6%). Our study data suggest that pica is frequently associated with similar practices during childhood and nonpregnant states. These patients also may be at risk for lead toxicity or other environmental toxin exposures.

Topics: Adolescent; Adult; Anemia, Iron-Deficiency; Child; Female; Georgia; Humans; Ice; Pica; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Rural Population

Generalized or localized itch without primary skin manifestations may be the presenting symptom of serious internal diseases. Five characteristic cases of pruritus are discussed: Hodgkin's disease, primary sclerosing cholangitis, polycythemia vera, iron deficiency (with pica), and uremia. Other important causes must be considered; all forms of cholestasis, including primary biliary cirrhosis, drug-induced, pregnancy-related, and extrahepatic cholestasis; other hematologic and malignant disorders such as non-Hodgkin's lymphoma, leukemia, multiple myeloma, solid tumors, and myelodysplastic syndromes; metabolic and endocrine diseases, most notably diabetes mellitus, hyperthyroidism, hypothyroidism, and carcinoid syndrome; focal neurologic diseases such as brain tumors, cerebral infarctions and multiple sclerosis; adverse drug reactions without rash; infectious diseases, especially parasitic and HIV infections. A diagnostic laboratory screening for pruritus of undetermined origin is suggested.

Topics: Adult; Aged; Anemia, Iron-Deficiency; Cholangitis, Sclerosing; Diagnosis, Differential; Female; Hematologic Diseases; Hodgkin Disease; Humans; Liver Diseases; Male; Metabolic Diseases; Middle Aged; Pica; Polycythemia Vera; Pruritus; Uremia

Topics: Acute Disease; Adult; Anemia, Iron-Deficiency; Bezoars; Clothing; Female; Humans; Pancreatic Pseudocyst; Pancreatitis; Pica; Stomach

Topics: Anemia, Hypochromic; Anemia, Iron-Deficiency; Dwarfism; Hepatomegaly; Humans; Hypogonadism; Liver Diseases; Medical Records; Pica; Splenomegaly

Topics: Anemia, Hypochromic; Anemia, Iron-Deficiency; Dwarfism; Feeding and Eating Disorders; Hepatomegaly; Humans; Hypogonadism; Liver Diseases; Pica; Splenomegaly

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Feeding and Eating Disorders; Humans; Pica

Topics: Anemia; Anemia, Iron-Deficiency; Child; Cobalt; Humans; Infant; Infant, Newborn; Iron; Pica