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Objectives: The acute phase response (APR) influences indicators of iron status. A recent WHO/CDC consultation recommended concurrent measurement of [alpha]-1-acid-glycoprotein (AGP) in surveys to control for the APR, and aid in interpreting iron status. They proposed further exploratory analyses using AGP. We examined whether the APR (measured by AGP) influences the expected relationships between iron status indicators in an HIV-infected population. Subjects: We measured hemoglobin (Hb), serum ferritin (SF), transferrin receptor (TfR), erythropoietin (EPO) and AGP in a cross-sectional survey of 643 HIV-positive Zimbabwean women. Results: SF was significantly higher in APR-positive (AGP> 1 g/l) women (P Conclusions: AGP captured the influence of the APR on iron indicators and their relationships with each other. The APR influenced SF and its relationship with Hb as expected. TfR behaved unexpectedly. Although TfR has been promoted as an iron indicator that is uninfluenced by the APR, TfR concentrations were depressed among anemic APR-positive women. Because TfR reflects iron deficiency and erythropoietic activity, pro-inflammatory cytokines associated with the APR may be inhibiting erythropoeisis, which is reflected by lower TfR concentrations. We support the WHO/CDC recommendation that AGP is a useful indicator to assess the influence of the APR on iron status indicators. doi:10.1038/ejcn.2008.33; published online 28 May 2008 Keywords: acute phase response; AGP; iron status; SF; TfR; HIV, Introduction Despite considerable national, regional and global efforts targeted at the prevention of iron deficiency (ID), it remains among the most common nutritional problem in the world (WHO, 2001). In [...]

Matriptase-2 is a recently identified membrane-bound, cell-surface serine protease expressed primarily in liver. Mutations in matriptase-2 in mice and humans cause iron-deficiency anemia that responds poorly to iron therapy. The poor response results from an inability to decrease hepcidin production during iron deficiency. Cell culture studies reveal that matriptase-2 inhibits hepcidin induction by cleaving membrane hemojuvelin, a potent activator of hepcidin transcription. As a novel suppressor of hepcidin expression, matriptase-2 emerges as a possible candidate for therapeutic interventions aimed at treating disorders of iron metabolism.

Iron-deficiency anaemia (IDA) is a common problem all over the world, which mainly attacks pregnant women, infants and children. The main objectives were to assess the prevalence of IDA in children 12 24 months old in the area of Thessalia located in the central part of Greece and to identify, by means of a simple questionnaire, its nutritional risk factors. The research was applied as a cross-sectional and case control study. In the first part of the study, the haemoglobin (Hb) levels were estimated by a mobile photometer analyser in 938 children (approximately one-third of the total children population). In the second part, children with Hb < 11 g/dl were compared with their random selected healthy controls in haematological, anthropometric and nutritional parameters. The estimated laboratory values were Hb, haematocrit, mean corpuscular volume, mean corpuscular Hb, mean corpuscular Hb concentration, zinc protoporphyrin, serum iron, serum ferritin, transferring saturation, total iron binding capacity and Hb electrophoresis. Finally, 75 children (34 boys, 41 girls; mean age 17.51 [+ or -] 3.5 months), who were found to have IDA, constituted the case group while 75 healthy children constituted the control group. The studied nutritional variables through the application of a standardized food frequency questionnaire were: duration of breast feeding, milk that the child drinks during the research, age of solid food introduction, child's health status according to the mother's point of view, child's appetite and frequency of bread, cereals, meat, fish, egg, legumes, chocolate, marmalade, vegetables, fruit and tea intake. The prevalence of IDA in the region was 7.99%. The carriers of b-thalassaemia (2.13%) were excluded from the study. Significant statistical difference has been observed between the two groups (P < 0.001) in all haematological and anthropometric parameters except head circumference (P= 0.85). Concerning the nutritional indices the two groups were statistically different (P< 0.001) in the following: the cases were breastfed less, were drinking fresh cow's milk and tea, were eating meat, vegetables and fruit less often, had a bad appetite and were more likely to get sick. In conclusion, the prevalence of IDA in this area of Greece is approximately similar to other areas in the developed world. The application of simple food frequency questionnaires for the detection of the nutritional IDA risk factors could prognose and prevent anaemia. Keywords: Nutritional risk factors, iron deficiency anemia, children, Greece, food frequency questionnaire, mobile Hb estimation

Background: Iron stores and haemoglobin iron deficits in menstruating women can be calculated from body iron losses and absorption of dietary iron using recently developed methods. Objective: To examine iron balance (iron status) expressed as body iron stores or haemoglobin iron deficites in menstruating women from amounts of iron lost (iron requirements) and amounts of dietary iron absorbed. Calculations are made both of stationary states and of the rate of changes in iron stores (iron status) when any of the two main factors determining iron balance are changed. Design: The study is based on (1) previous and new equations describing relationships between iron absorption, iron requirements (losses), iron stores and/or haemoglobin deficits and (2) published data on iron requirements and their variation in menstruating adult women. Results: Both iron stores and haemoglobin iron deficits are strongly related to iron requirements and absorption of dietary iron and follow the same equations during states of iron repletion and iron deficiency. When, for example, increasing or decreasing the bioavailability of the dietary iron, about 90% of the change in iron stores will occur within 1 y. Conclusions: There are strong relationships between iron requirements, bioavailability of dietary iron and amounts of stored iron. The observations that a reduction in iron stores and a calculated decrease of haemoglobin iron had the same increasing effect on iron absorption suggest that the control of iron absorption is mediated from a common cell, that may register both size of iron stores and hemoglobin iron deficit, eg the hepatocyte. Sponsorship: The Swedish Medical Research Council (project B96-19X-04721-21A), the Swedish Council for Forestry and Agriculture Research (50.0120/95 and 997/881, 113:3), the Swedish Dairy Association and The Danone International Prize for Nutrition 1999 (LH). Descriptors: iron absorption; diet; bioavailability; iron requirements; iron stores; iron deficiency; haemoglobin iron deficit; women; iron balance; serum ferritin; menstruation, Introduction Maintenance of iron balance, when absorption equals losses, is achieved by control of iron absorption since the body has no mechanisms to control iron losses. This was pointed out [...]

Chronic gastrointestinal infection with the bacterium Helicobacter pylori may be responsible for the chronic iron deficiency seen in many Alaska natives. Researchers studying the Yupik eskimos found that many had anemia even though their diet is rich in iron. In a detailed study of 140 adults, 90% had blood in their stool. Among 70 who had endoscopy, 97% had evidence of severe Helicobacter pylori infection that caused ulcers and hemorrhages. They also had evidence of gastritis, which is an inflammation of the stomach. This could account for their gastrointestinal bleeding., Objective.--To confirm prevalent iron deficiency among Yupik Eskimos living in Alaska and to explore the frequency of and potential lesions accounting for occult gastrointestinal bleeding. Design.--Descriptive survey. Setting.--Rural Arctic community. Subjects.--A total of 140 adult volunteers from 3 villages in the Yukon-Kuskokwim Delta region of western Alaska. Main Outcome Measures.--Daily iron intake, hematologic and biochemical indexes of iron status, fecal hemoglobin levels, stool parasites, and endoscopic findings. Results.--While dietary iron intake by Yupiks was similar to that of a reference population, iron deficiency prevalence was increased 13-fold in Yupik men and 4-fold in Yupik women. Fecal hemoglobin levels were elevated in 90% of subjects contrasted with only 4% of a reference group; median levels were 5.9 and 0.5 mg of hemoglobin per gram of stool, respectively. Among 70 Yupik subjects with elevated fecal hemoglobin levels who had endoscopy performed, 68. (97%) had an abnormal gastric appearance consisting of erythema, mucosal thickening, diffuse mucosal hemorrhages, erosions, or ulcerations. Gastric biopsies revealed chronic active gastritis with associated Helicobacter pylori in 68 (99%) of 69. No other hemorrhagic gastrointestinal disease was detected. Conclusions.--Based on this study sample, occult gastrointestinal bleeding appears to be pervasive in the Yupik population and likely underlies the prevalent iron deficiency. An atypical hemorrhagic gastritis associated with H pylori infection is present almost universally and may represent the bleeding source. JAMA. 1997;277:1135-1139

Injury to gastrointestinal tissue may be a cause of hidden bleeding in patients with iron-deficiency anemia. Damage to the stomach, intestines, colon or other parts of the gastrointestinal system was found in 62 of 100 anemic patients using either endoscopy or colonoscopy. Possible bleeding sites were found in the colons of 25 patients, the gastrointestinal tracts of 36 patients and both in one patient. Cancer was the most common injury to the colon, occurring in 11 of the 26 patients. Nineteen of the 37 patients with identified gastrointestinal bleeding sites had peptic ulcers. The remaining 38 patients with negative results of endoscopy were tested for possible injury using radiography and bowel follow-through studies. Gastrointestinal lesions found in these patients were unlikely to cause bleeding and included small polyps, hemorrhoids, enlarged esophageal veins and inflammation of the esophagus. This group responded well to treatment with iron supplements taken by mouth.

A complex interaction between impaired cardiac performance, activation of neurohormonal and inflammatory responses, renal dysfunction, drug effects, and bone marrow hyporesponsiveness which contribute to the development of anemia is reported. The findings from the study might have merit in patients with moderately symptomatic heart failure and documented iron deficiency.

One-third to two-thirds of patients with cystic fibrosis have iron deficiency. It has been reported that patients with cystic fibrosis who had been receiving pancreatic enzyme supplements for at least one year showed impaired ability to absorb iron. In this study, 13 young adults with cystic fibrosis and 9 controls of similar ages were compared concerning their ability to absorb an oral iron supplement. A preparation of pancreatic enzymes was given to both the cystic fibrosis and control groups. There was significant impairment of the ability to absorb iron in both groups after the administration of the pancreatic enzymes; there had been no difference in iron absorption before the pancreatic enzymes were given. The mechanism by which pancreatic enzymes impair iron absorption is not known, but it appears that long-term use of pancreatic enzymes may contribute to iron deficiency. It is concluded that the iron status of cystic fibrosis patients should be monitored carefully. If supplemental iron is given, it should not be given around the time that pancreatic enzyme supplementation is given. (Consumer Summary produced by Reliance Medical Information, Inc.)