Железодефицитные новости

[Dr.Vad]

Физическая активность (5 дней в неделю по 25 минут) у железодефицитных женщин замедляет коррекцию ферритина по сравнению с теми, кто не нагружает себя таковыми упражнениями: через 8 недель приема 42 мг железа в день ферритин у первых был в полтора раза ниже (32 против 48 мкг/л), подробнее:

72 iron-depleted, nonanemic Chinese women [serum ferritin (sFer) <25 μg/L and hemoglobin >110 g/L] were included in an 8-wk, partially blinded, randomized controlled trial with a 2 × 2 factorial design including iron supplements (42 mg elemental Fe/d) or placebo and aerobic training (five 25-min sessions/wk at 75-85% of maximum heart rate) or no training. Linear mixed models were used to evaluate the relation between supplement type, training, and changes in iron status over time, measured by sFer, hemoglobin, soluble transferrin receptor (sTfR), and estimated total body iron.Results: After treatment, both the iron-supplemented trained and untrained groups showed significantly improved sFer, sTfR, and body iron values compared with either of the placebo groups. Similarly, trained participants had significantly higher aerobic fitness measures than untrained participants. Training modified the sFer response to supplementation (training by supplement interaction, P = 0.07), with the iron-supplemented trained group having significantly lower sFer than the iron-supplemented untrained group at week 8 (mean ± SD: 31.8 ± 13.5 and 47.6 ± 15.7 μg/L, respectively; P = 0.042), whereas there was no significant difference between the placebo trained and untrained groups (21.3 ± 12.2 and 20.3 ± 7.0 μg/L, respectively; P = 1.00).
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Am J Clin Nutr. 2017 Nov 1.
Efficacy of iron supplementation may be misinterpreted using conventional measures of iron status in iron-depleted, nonanemic women undergoing aerobic exercise training.

[Dr.Vad]

Однократное введение монофера после родов снижало усталость и депрессивное настроение лучше, чем пероральный прием железа:

Participants received intravenous iron (n = 97) or oral iron (n = 99), and completed the Multidimensional Fatigue Inventory and Edinburgh Postnatal Depression Scale, and haematological and iron parameters were measured. Primary outcome was the aggregated change in physical fatigue score from baseline to 12 weeks postpartum.

The difference in physical fatigue score was -0·97 (95% CI: -1·65; -0·28, P = 0·006) in favour of intravenous iron, but did not meet the predefined difference of 1·8. Across visits, we found statistically significant differences in fatigue and depression scores, as well as in haematological and iron parameters, all in favour of intravenous iron.

Vox Sang. 2017 Apr;112(3):219-228.
Single-dose intravenous iron infusion or oral iron for treatment of fatigue after postpartum haemorrhage: a randomized controlled trial.
Holm C et al.

[Dr.Vad]

Пpием железа после родов способствовал снижению послеродовой депрессии, слабый ответ на лечение был у тех, у кого ферритин не поднимался выше 45-50:

his randomized, double-blind, placebo-controlled trial evaluated 70 mothers with PPD. One week after delivery, the mothers were randomly allocated in the iron-treated (50 mg elemental iron/daily) and placebo-treated groups. After 6 weeks, the improvement of PPD symptoms was compared between the groups.

Ferritin significantly increased in the iron-treated group (p < 0.001), but not in the placebo group (p = 0.09). After intervention, ferritin was higher in the iron-treated group (medians: 78.2 vs. 37 mg/dl, p = 0.01). The rate of iron deficiency significantly decreased in the iron-treated group (p = 0.009), but not in the placebo group (p = 0.4). After intervention, the rate of iron deficiency was higher in the placebo group (31.4 vs. 8.5 %, p = 0.01). The Edinburgh Postnatal Depression Scale (EPDS) score significantly decreased in the iron-treated group (p < 0.001), but not in the placebo group (p = 0.13). After intervention, the EPDS score was lower in the iron-treated group (medians 9 vs. 12, p = 0.01). The improvement rate for PPD was significantly higher in the iron-treated group (42.8 vs. 20 %, p = 0.03). After intervention, mothers with continued PPD had lower ferritin than the improved mothers (41.8 vs. 67 mg/dl, p = 0.03). Mothers with continued depression had higher rate of iron deficiency compared to the improved mothers (27.1 vs. 4.5 %, p = 0.02).
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Eur J Nutr. 2017 Mar;56(2):901-908.
The efficacy of early iron supplementation on postpartum depression, a randomized double-blind placebo-controlled trial.
Sheikh M. et al.

[Dr.Vad]

Необычная пика у беременной - страсть к употреблению стирального порошка/жидкости, которая вызвала эзофагит и гастрит, несмотря на пограничные значения в общем анализе, дефицит железа был очень выражен - ферритин 7 мкг/дл; в/в введение железа за 36 ч убрало эту тягу:

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.
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Obstet Gynecol. 2017 Nov 3.
Pica in Pregnancy: An Unusual Presentation.
Epler KE, и соавторы

[Dr.Vad]

Как дефицит железа потенциально может способствовать аллергическим заболеваниям - подробности в полной версии:
Metallomics. 2017 Nov 9.
Linking iron-deficiency with allergy: role of molecular allergens and the microbiome.
Roth-Walter F, Pacios LF, Bianchini R, Jensen-Jarolim E.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Что будет, если спортсменам с ферритином 30-100 ввести 3 раза по 100 мг венофера в течение 4 недель?

4 weeks of IV ferric carboxymaltose supplementation doubled serum ferritin, and decreased feelings of fatigue and mood disturbance in non-anemic athletes with initial ferritin levels in the clinically normal range of 30–100 µg/L without associated changes in Hbmass. Running performance was not acutely affected by iron supplementation, but there was some evidence from self-reported training diaries that participants felt more able to train. [Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Еще один редкий случай поваренно-солевой пики у пациентки с ЖДА, которая привела к нефролитиазу:

Sodium chloride pica causing recurrent nephrolithiasis in a patient with iron deficiency anemia: a case report
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

треть причин ЖДА можно выявить у пациентов младше 50 лет при помоши капсульной видеоскопии (если ничего не было обнаружено на ФГДС и колоноскопии) - только 4.5% из них опухолевые, подробнее:
Capsule endoscopy in young patients with iron deficiency anaemia and negative bidirectional gastrointestinal endoscopy.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Причины дефицита железа (ферритин менее 20) у женшин 18-35 лет в Австралии (26% ЖД и 6% ЖДА + гемоглобин менее 120) скрываются за банальным недоеданием мясной еды и недопиванием алкоголя (воздержание):

...intakes of all nutrients (with the exception of calcium and vitamin C), meat, red meat, and grains and cereals, were significantly higher for iron replete (IR) participants... intakes of meat, red meat and alcohol were significantly higher in IR participants than those with ID/IDA.

Association between Haem and Non-Haem Iron Intake and Serum Ferritin in Healthy Young Women.
Nutrients. 2018 Jan 12;10(1). pii: E81.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

ферритин менее 12 у беременных женщин после 20 недель беременности ассоциируется с 2.5-кратным повышением риска антенатальной депрессии и постнатальная депрессия была в среднем 10.1 ± 5.7 баллов по эдинбургской шкале:

Iron Deficiency and Risk of Maternal Depression in Pregnancy: An Observational Study.
Dama M. и соавт.
J Obstet Gynaecol Can. 2018 Jan 4. pii: S1701-2163(17)30570-4.

[Dr.Vad]

Effectiveness and safety of ferric carboxymaltose compared to iron sucrose in women with iron deficiency anemia: phase IV clinical trials
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

У пациентов с низким уровнем витамина А в крови, особенно у беременных и кормящих, добавление витамина А в рацион может снизить риск развития ЖД(А) и способствовать повышению гемоглобина:

vitamin A supplementation reduces the risk of anemia by 26% and raises hemoglobin levels, compared to non-treated group, independent of the life stage; vitamin A supplementation did not alter the prevalence of iron deficiency among the clinical trials conducted with children and teenagers (RR 0.82, 95% CI 0.60 to 1.12, p = 0.204), whereas a significant increase in serum ferritin levels was observed in trials conducted with pregnant and lactating women (WMD 6.61 μg/L; 95% CI 6.00 to 7.21 μg/L; p < 0.001);
vitamin A supplementation alone may reduce the risk of anemia, by improving hemoglobin and ferritin levels in individuals with low serum retinol levels.
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Crit Rev Food Sci Nutr. 2018 Jan 16:0.
Effect of vitamin A supplementation on iron status in humans: a systematic review and meta-analysis.

[Dr.Vad]

Treatment of Anemia of Chronic Disease with True Iron Deficiency in Pregnancy
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Анемия повышает риск деменции и чем тяжелее анемизация, тем выше ее риск:

we found a significant association between anemia and dementia incidence (adjusted HR 1.24; 95% CI 1.02-1.51). The adjusted HRs for incidence of dementia according to the severity of anemia were 1.19 (95% CI 0.98-1.45) for those with mild anemia, 1.47 (95% CI 0.97-2.21) for those with moderate anemia, and 5.72 (95% CI 1.84-17.81) for those with severe anemia, showing a significant p value for trend (p = 0.003).
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Anemia is associated with incidence of dementia: a national health screening study in Korea involving 37,900 persons.
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Низкий ферритин после родов ассоциируется с повышенным риском депрессии и прием железа после родов снижает его риск развития согласно обзору опубликованных исследований:

Eight out of ten studies found higher risk for postpartum depression (PPD) (r - 0.19 to -0.43 and ORs 1.70-4.64) in anaemic women. Low ferritin in the postpartum period but not during pregnancy was associated with increased risk of PPD. Iron supplementation in the postpartum period decreased risk of PPD in four out of five studies, whereas it did not protect from PPD if given during pregnancy.
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J Psychosom Obstet Gynaecol. 2018 Jan 24:1-10.
Anaemia and depletion of iron stores as risk factors for postpartum depression: a literature review.