Железодефицитные новости

[Dr.Vad]

еще из прежних публикаций, которые стали доступны в свободной версии недавно:

IRON: HOW TO MANAGE WHEN THERE IS TOO MUCH OR TOO LITTLE OF IT
DECEMBER 6, 2019
Management of iron deficiency
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

В подтверждение предыдущей статьи где ЖДА ассоциировалась с повышением риска деменции, эта публикация показывает, что и дефицит железа по низкому ферритину снижает когнитивные способности людей средних лет и пожилых:

SF is significantly and positively associated with cognition. In older people with low SF levels, iron supplementation may be a promising therapy to improve cognition.
---
J Nutr Health Aging. 2024 Feb 17;28(4):100190.
Lower serum ferritin levels are associated with worse cognitive performance in aging

[Dr.Vad]

оценка железа бисглицината 25 мг (аля-Солгар) каждый день или через день у спортсменок с жд по ферритину менее 35 (около 20 в среднем), ежедневный прием чуть лучше повышал ферритин за 8 недель (2 мес. лечения), и становился более 35 у 60%, но он чаще сопровождался тошнотой и запорами; прием через день переносился легче, но ферритин более 35 повысился у 17% (у каждой шестой), при ферритине менее 15 ни у кого не было достигнуто повышение более 35 вне зависимости от режима; возраст 18-22 года, ИМТ 22-23, все подробности по ссылке на оригинал:

Daily versus three times weekly dosing for treatment of iron deficiency nonanemia in NCAA Division 1 female athletes

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Oral iron supplementation: new formulations, old questions. 2024

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

некоторые моменты про усвоение железа у человека:

Iron Absorption: Molecular and Pathophysiological Aspects

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

сравнение пациентов с В12 дефицитной анемией и комбинированной в12-железодефицитной - пациенты с комби-анемией были моложе (42-66 лет), преимущественно женщины, Витамин В12 был 200-308 или низконормальный, гемоглобин 121-131 или тоже низконормальный, гомоцистеин 11-18 или пограничный; жд как ферритин менее 30 или менее 100 и Ж/ОЖСС менее 0.2, ответ на лечение жд препаратами внутрь у трети пациентов и у 7/8 после в/в введения железа:

Iron deficiency in pernicious anemia: Specific features of iron deficient patients and preliminary data on response to iron supplementation.
Rogez J, Urbanski G, Vinatier E, Lavigne C, Emmanuel L, Dupin I, Ravaiau C, Lacombe V.
Clin Nutr. 2024 Apr;43(4):1025-1032.

[Dr.Vad]

боли роста в общей практике педиатра: были диагностированы у 333 детей в возрасте 7-8 лет что составило 73% от всех детей с хроническими болями в ногах, длились около 11 мес до диагностики; 267 детей выполнили назначенное лечение в течение 3 мес. и вернулись на повторный прием; тем, у кого была анемия (гемоглобин менее 110 г/л) был назначен препарат железа-2 к витамину д и препарату кальция, симптомы прошли у 67% детей после курса железа и у 29% без железа

72 out of 107 (67%) children, who received iron became symptom-free.
Only 43 out of 160 (29%) patients became symptom-free, who received only calcium and vitamin D3 and did not receive iron.

Prevalence of growing pains in a general paediatric OPD: A descriptive, observational and cross-sectional study
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

как достаток железа в организме по гемоглобину и ферритину положительно влияет на структуру кости голени и маркеры обмена костной ткани:

Higher ferritin was associated with higher total, trabecular, and cortical volumetric bone mineral density, trabecular volume, cortical area and thickness, stiffness, and failure load (all p ≤ 0.037).

Higher soluble transferrin receptor (sTfR) was associated with lower trabecular number, and higher trabecular thickness and separation, cortical thickness, and cortical pore diameter (all p ≤ 0.033).

Higher haemoglobin was associated with higher cortical thickness (p = 0.043).

Higher ferritin was associated with lower βCTX, PINP, total 25(OH)D, and total 24,25(OH)2D, and higher 1,25(OH)2D:24,25(OH)2D ratio (all p ≤ 0.029).

Higher sTfR was associated with higher PINP, total 25(OH)D, and total 24,25(OH)2D (all p ≤ 0.025).

The greater density, size, and strength of the tibia, and lower circulating concentrations of markers of bone resorption and formation with better iron stores (higher ferritin) are likely as a result of the direct role of iron in collagen synthesis.
---
Bone. 2024 Jun 3:186:117145.
Iron status is associated with tibial structure and vitamin D metabolites in healthy young men

[Dr.Vad]

ВEST PRACTICE ADVICE 1: No single formulation of oral iron has any advantages over any other. Ferrous sulfate is preferred as the least expensive iron formulation.
BEST PRACTICE ADVICE 2: Give oral iron once a day at most. Every-other-day iron dosing may be better tolerated for some patients with similar or equal rates of iron absorption as daily dosing.
BEST PRACTICE ADVICE 3: Add vitamin C to oral iron supplementation to improve absorption.
BEST PRACTICE ADVICE 4: Intravenous iron should be used if the patient does not tolerate oral iron, ferritin levels do not improve with a trial of oral iron, or the patient has a condition in which oral iron is not likely to be absorbed.
BEST PRACTICE ADVICE 5: Intravenous iron formulations that can replace iron deficits with 1 or 2 infusions are preferred over those that require more than 2 infusions.
BEST PRACTICE ADVICE 6: All intravenous iron formulations have similar risks; true anaphylaxis is very rare. The vast majority of reactions to intravenous iron are complement activation-related pseudo-allergy (infusion reactions) and should be treated as such.
BEST PRACTICE ADVICE 7: Intravenous iron therapy should be used in individuals who have undergone bariatric procedures, particularly those that are likely to disrupt normal duodenal iron absorption, and have iron-deficiency anemia with no identifiable source of chronic gastrointestinal blood loss.
BEST PRACTICE ADVICE 8: In individuals with inflammatory bowel disease and iron-deficiency anemia, clinicians first should determine whether iron-deficiency anemia is owing to inadequate intake or absorption, or loss of iron, typically from gastrointestinal bleeding. Active inflammation should be treated effectively to enhance iron absorption or reduce iron depletion.
BEST PRACTICE ADVICE 9: Intravenous iron therapy should be given in individuals with inflammatory bowel disease, iron-deficiency anemia, and active inflammation with compromised absorption.
BEST PRACTICE ADVICE 10: In individuals with portal hypertensive gastropathy and iron-deficiency anemia, oral iron supplements initially should be used to replenish iron stores. Intravenous iron therapy should be used in patients with ongoing bleeding who do not respond to oral iron therapy.
BEST PRACTICE ADVICE 11: In individuals with portal hypertensive gastropathy and iron-deficiency anemia without another identified source of chronic blood loss, treatment of portal hypertension with nonselective β-blockers can be considered.
BEST PRACTICE ADVICE 12: In individuals with iron-deficiency anemia secondary to gastric antral vascular ectasia who have an inadequate response to iron replacement, consider endoscopic therapy with endoscopic band ligation or thermal methods such as argon plasma coagulation.
BEST PRACTICE ADVICE 13: In patients with iron-deficiency anemia and celiac disease, ensure adherence to a gluten-free diet to improve iron absorption. Consider oral iron supplementation based on the severity of iron deficiency and patient tolerance, followed by intravenous iron therapy if iron stores do not improve.
---
Clin Gastroenterol Hepatol. 2024 Jun 11:S1542-3565(24)00410-5.
AGA Clinical Practice Update on Management of Iron Deficiency Anemia: Expert Review