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Fe Deficiency, Dietary Bioavailbility and Absorption

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A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (15 February 2018) | Viewed by 101171

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Special Issue Editor

Dr. Elad Tako

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Guest Editor

USDA-ARS, Robert W. Holley Center for Agriculture and Health, Cornell University, Ithaca, NY 14853, USA
Interests: dietary micronutrients; Fe and Zn deficiencies; anemia; Zn status biomarkers; bioactive compounds; prebiotics; microbiome; nutrigenomics; intestinal functionality and development; polyphenols; in vivo models of human nutrition
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The World Health Organization estimates that approximately one-third of worldwide infant deaths, and one half in developing countries, can be attributed to malnutrition. More specifically, iron (Fe) deficiency is the most common nutritional deficiency worldwide and a major cause of infant mortality. Fe deficiency is particularly widespread in low-income countries because of a general lack of consumption of animal products (which can promote non-heme Fe absorption and contain highly bioavailable heme Fe) coupled with a high consumption of a monotonous diet of cereal grains and legumes. Such diets are low in bioavailable Fe due to the presence of phytic acid and certain polyphenols that are inhibitors of Fe bioavailability. Diets with chronically poor Fe bioavailability which result in high prevalence of Fe deficiency and anemia, increase the risk of all-cause child mortalities and also may lead to many pathophysiological consequences including stunted growth, low birth weight, delayed mental development and motor functioning and others. Thus, a crucial step in alleviating Fe deficiency anemia is through understanding how specific dietary practices and components contribute to the Fe status in a particular region where Fe deficiency is prevalent. The aim of this Special Issue is to report on the recent advances and research developments in related to the improvements of dietary Fe bioavailability and absorption and in effort to alleviate dietary Fe deficiency.

Assis. Prof. Elad Tako
Guest Editor

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Keywords

Iron
Deficiency
Diet
Bioavailability
Absorption
Transport
Brush Border Membrane functionality;
Biomarkers
Prebiotics
Intestinal Microbial Population

Published Papers (12 papers)

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Research

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9 pages, 280 KiB

Open AccessArticle

Serum Hepcidin Concentration in Individuals with Sickle Cell Anemia: Basis for the Dietary Recommendation of Iron

by Juliana Omena, Cláudia Dos Santos Cople-Rodrigues, Jessyca Dias do Amaral Cardoso, Andrea Ribeiro Soares, Marcos Kneip Fleury, Flávia Dos Santos Barbosa Brito, Josely Correa Koury and Marta Citelli

Nutrients 2018, 10(4), 498; https://doi.org/10.3390/nu10040498 - 17 Apr 2018

Cited by 10 | Viewed by 5044

Abstract

Dietary iron requirements in patients with sickle cell disease (SCD) remain unclear. SCD is a neglected hemoglobinopathy characterized by intense erythropoietic activity and anemia. Hepcidin is the hormone mainly responsible for iron homeostasis and intestinal absorption. Intense erythropoietic activity and anemia may reduce hepcidin transcription. By contrast, iron overload and inflammation may induce it. Studies on SCD have not evaluated the role of hepcidin in the presence and absence of iron overload. We aimed to compare serum hepcidin concentrations among individuals with sickle cell anemia, with or without iron overload, and those without the disease. Markers of iron metabolism and erythropoietic activity such as hepcidin, ferritin, and growth differentiation factor 15 were evaluated. Three groups participated in the study: the control group, comprised of individuals without SCD (C); those with the disease but without iron overload (SCDw); and those with the disease and iron overload (SCDio). Results showed that hepcidin concentration was higher in the SCDio > C > SCDw group. These data suggest that the dietary iron intake of the SCDio group should not be reduced as higher hepcidin concentrations may reduce the intestinal absorption of iron. Full article

(This article belongs to the Special Issue Fe Deficiency, Dietary Bioavailbility and Absorption)

16 pages, 5848 KiB

Open AccessArticle

Optimal Serum Ferritin Levels for Iron Deficiency Anemia during Oral Iron Therapy (OIT) in Japanese Hemodialysis Patients with Minor Inflammation and Benefit of Intravenous Iron Therapy for OIT-Nonresponders

by Kazuya Takasawa, Chikako Takaeda, Takashi Wada and Norishi Ueda

Nutrients 2018, 10(4), 428; https://doi.org/10.3390/nu10040428 - 29 Mar 2018

Cited by 8 | Viewed by 7777

Abstract

Background: We determined optimal serum ferritin for oral iron therapy (OIT) in hemodialysis (HD) patients with iron deficiency anemia (IDA)/minor inflammation, and benefit of intravenous iron therapy (IIT) for OIT-nonresponders. Methods: Inclusion criteria were IDA (Hb <120 g/L, serum ferritin <227.4 pmol/L). Exclusion criteria were inflammation (C-reactive protein (CRP) ≥ 5 mg/L), bleeding, or cancer. IIT was withheld >3 months before the study. ΔHb ≥ 20 g/L above baseline or maintaining target Hb (tHB; 120–130 g/L) was considered responsive. Fifty-one patients received OIT (ferrous fumarate, 50 mg/day) for 3 months; this continued in OIT-responders but was switched to IIT (saccharated ferric oxide, 40 mg/week) in OIT-nonresponders for 4 months. All received continuous erythropoietin receptor activator (CERA). Hb, ferritin, hepcidin-25, and CERA dose were measured. Results: Demographics before OIT were similar between OIT-responders and OIT-nonresponders except low Hb and high triglycerides in OIT-nonresponders. Thirty-nine were OIT-responders with reduced CERA dose. Hb rose with a peak at 5 months. Ferritin and hepcidin-25 continuously increased. Hb positively correlated with ferritin in OIT-responders (r = 0.913, p = 0.03) till 5 months after OIT. The correlation equation estimated optimal ferritin of 30–40 ng/mL using tHb (120–130 g/L). Seven OIT-nonresponders were IIT-responders. Conclusions: Optimal serum ferritin for OIT is 67.4–89.9 pmol/L in HD patients with IDA/minor inflammation. IIT may be a second line of treatment for OIT-nonreponders. Full article

(This article belongs to the Special Issue Fe Deficiency, Dietary Bioavailbility and Absorption)

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11 pages, 555 KiB

Open AccessArticle

Relative Bioavailability of Iron in Bangladeshi Traditional Meals Prepared with Iron-Fortified Lentil Dal

by Rajib Podder, Diane M. DellaValle, Robert T. Tyler, Raymond P. Glahn, Elad Tako and Albert Vandenberg

Nutrients 2018, 10(3), 354; https://doi.org/10.3390/nu10030354 - 15 Mar 2018

Cited by 13 | Viewed by 4558

Abstract

Due to low Fe bioavailability and low consumption per meal, lentil must be fortified to contribute significant bioavailable Fe in the Bangladeshi diet. Moreover, since red lentil is dehulled prior to consumption, an opportunity exists at this point to fortify lentil with Fe. Thus, in the present study, lentil was Fe-fortified (using a fortificant Fe concentration of 2800 µg g⁻¹) and used in 30 traditional Bangladeshi meals with broad differences in concentrations of iron, phytic acid (PA), and relative Fe bioavailability (RFeB%). Fortification with NaFeEDTA increased the iron concentration in lentil from 60 to 439 µg g⁻¹ and resulted in a 79% increase in the amount of available Fe as estimated by Caco-2 cell ferritin formation. Phytic acid levels were reduced from 6.2 to 4.6 mg g⁻¹ when fortified lentil was added, thereby reducing the PA:Fe molar ratio from 8.8 to 0.9. This effect was presumably due to dephytinization of fortified lentil during the fortification process. A significant (p ≤ 0.01) Pearson correlation was observed between Fe concentration and RFeB% and between RFeB% and PA:Fe molar ratio in meals with fortified lentil, but not for the meal with unfortified lentil. In conclusion, fortified lentil can contribute significant bioavailable Fe to populations at risk of Fe deficiency. Full article

(This article belongs to the Special Issue Fe Deficiency, Dietary Bioavailbility and Absorption)

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4086 KiB

Open AccessArticle

Dietary Factors Modulate Iron Uptake in Caco-2 Cells from an Iron Ingot Used as a Home Fortificant to Prevent Iron Deficiency

by Ildefonso Rodriguez-Ramiro, Antonio Perfecto and Susan J. Fairweather-Tait

Nutrients 2017, 9(9), 1005; https://doi.org/10.3390/nu9091005 - 12 Sep 2017

Cited by 12 | Viewed by 6090

Abstract

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

(This article belongs to the Special Issue Fe Deficiency, Dietary Bioavailbility and Absorption)

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5850 KiB

Open AccessArticle

Iron Fortification of Lentil (Lens culinaris Medik.) to Address Iron Deficiency

by Rajib Podder, Bunyamin Tar’an, Robert T. Tyler, Carol J. Henry, Diane M. DellaValle and Albert Vandenberg

Nutrients 2017, 9(8), 863; https://doi.org/10.3390/nu9080863 - 11 Aug 2017

Cited by 17 | Viewed by 7652

Abstract

Iron (Fe) deficiency is a major human health concern in areas of the world in which diets are often Fe deficient. In the current study, we aimed to identify appropriate methods and optimal dosage for Fe fortification of lentil (Lens culinaris Medik.) dal with FeSO₄·7H₂O (ferrous sulphate hepta-hydrate), NaFeEDTA (ethylenediaminetetraacetic acid iron (III) sodium salt) and FeSO₄·H₂O (ferrous sulphate mono-hydrate). We used a colorimetric method to determine the appearance of the dal fortified with fortificants at different Fe concentrations and under different storage conditions. Relative Fe bioavailability was assessed using an in vitro cell culture bioassay. We found that NaFeEDTA was the most suitable fortificant for red lentil dal, and at 1600 ppm, NaFeEDTA provides 13–14 mg of additional Fe per 100 g of dal. Lentil dal sprayed with fortificant solutions, followed by shaking and drying at 75 °C, performed best with respect to drying time and color change. Total Fe and phytic acid concentrations differed significantly between cooked unfortified and fortified lentil, ranging from 68.7 to 238.5 ppm and 7.2 to 8.0 mg g⁻¹, respectively. The relative Fe bioavailability of cooked fortified lentil was increased by 32.2–36.6% compared to unfortified cooked lentil. We conclude that fortification of lentil dal is effective and could provide significant health benefits to dal-consuming populations vulnerable to Fe deficiency. Full article

(This article belongs to the Special Issue Fe Deficiency, Dietary Bioavailbility and Absorption)

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1382 KiB

Open AccessArticle

Iron Supplementation during Three Consecutive Days of Endurance Training Augmented Hepcidin Levels

by Aya Ishibashi, Naho Maeda, Akiko Kamei and Kazushige Goto

Nutrients 2017, 9(8), 820; https://doi.org/10.3390/nu9080820 - 30 Jul 2017

Cited by 19 | Viewed by 5555

Abstract

Iron supplementation contributes an effort to improving iron status among athletes, but it does not always prevent iron deficiency. In the present study, we explored the effect of three consecutive days of endurance training (twice daily) on the hepcidin-25 (hepcidin) level. The effect of iron supplementation during this period was also determined. Fourteen male endurance athletes were enrolled and randomly assigned to either an iron-treated condition (Fe condition, n = 7) or a placebo condition (Control condition; CON, n = 7). They engaged in two 75-min sessions of treadmill running at 75% of maximal oxygen uptake on three consecutive days (days 1–3). The Fe condition took 12 mg of iron twice daily (24 mg/day), and the CON condition did not. On day 1, both conditions exhibited significant increases in serum hepcidin and plasma interleukin-6 levels after exercise (p < 0.05). In the CON condition, the hepcidin level did not change significantly throughout the training period. However, in the Fe condition, the serum hepcidin level on day 4 was significantly higher than that of the CON condition (p < 0.05). In conclusion, the hepcidin level was significantly elevated following three consecutive days of endurance training when moderate doses of iron were taken. Full article

(This article belongs to the Special Issue Fe Deficiency, Dietary Bioavailbility and Absorption)

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754 KiB

Open AccessArticle

Iron Bioavailability Studies of the First Generation of Iron-Biofortified Beans Released in Rwanda

by Raymond Glahn, Elad Tako, Jonathan Hart, Jere Haas, Mercy Lung’aho and Steve Beebe

Nutrients 2017, 9(7), 787; https://doi.org/10.3390/nu9070787 - 21 Jul 2017

Cited by 27 | Viewed by 5948

Abstract

This paper represents a series of in vitro iron (Fe) bioavailability experiments, Fe content analysis and polyphenolic profile of the first generation of Fe biofortified beans (Phaseolus vulgaris) selected for human trials in Rwanda and released to farmers of that region. The objective of the present study was to demonstrate how the Caco-2 cell bioassay for Fe bioavailability can be utilized to assess the nutritional quality of Fe in such varieties and how they may interact with diets and meal plans of experimental studies. Furthermore, experiments were also conducted to directly compare this in vitro approach with specific human absorption studies of these Fe biofortified beans. The results show that other foods consumed with beans, such as rice, can negatively affect Fe bioavailability whereas potato may enhance the Fe absorption when consumed with beans. The results also suggest that the extrinsic labelling approach to measuring human Fe absorption can be flawed and thus provide misleading information. Overall, the results provide evidence that the Caco-2 cell bioassay represents an effective approach to evaluate the nutritional quality of Fe-biofortified beans, both separate from and within a targeted diet or meal plan. Full article

(This article belongs to the Special Issue Fe Deficiency, Dietary Bioavailbility and Absorption)

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706 KiB

Open AccessArticle

Iron Fortified Complementary Foods Containing a Mixture of Sodium Iron EDTA with Either Ferrous Fumarate or Ferric Pyrophosphate Reduce Iron Deficiency Anemia in 12- to 36-Month-Old Children in a Malaria Endemic Setting: A Secondary Analysis of a Cluster-Randomized Controlled Trial

by Dominik Glinz, Rita Wegmüller, Mamadou Ouattara, Victorine G. Diakité, Grant J. Aaron, Lorenz Hofer, Michael B. Zimmermann, Lukas G. Adiossan, Jürg Utzinger, Eliézer K. N’Goran and Richard F. Hurrell

Nutrients 2017, 9(7), 759; https://doi.org/10.3390/nu9070759 - 14 Jul 2017

Cited by 22 | Viewed by 9031

Abstract

Iron deficiency anemia (IDA) is a major public health problem in sub-Saharan Africa. The efficacy of iron fortification against IDA is uncertain in malaria-endemic settings. The objective of this study was to evaluate the efficacy of a complementary food (CF) fortified with sodium iron EDTA (NaFeEDTA) plus either ferrous fumarate (FeFum) or ferric pyrophosphate (FePP) to combat IDA in preschool-age children in a highly malaria endemic region. This is a secondary analysis of a nine-month cluster-randomized controlled trial conducted in south-central Côte d’Ivoire. 378 children aged 12–36 months were randomly assigned to no food intervention (n = 125; control group), CF fortified with 2 mg NaFeEDTA plus 3.8 mg FeFum for six days/week (n = 126; FeFum group), and CF fortified with 2 mg NaFeEDTA and 3.8 mg FePP for six days/week (n = 127; FePP group). The outcome measures were hemoglobin (Hb), plasma ferritin (PF), iron deficiency (PF < 30 μg/L), and anemia (Hb < 11.0 g/dL). Data were analyzed with random-effect models and PF was adjusted for inflammation. The prevalence of Plasmodium falciparum infection and inflammation during the study were 44–66%, and 57–76%, respectively. There was a significant time by treatment interaction on IDA (p = 0.028) and a borderline significant time by treatment interaction on iron deficiency with or without anemia (p = 0.068). IDA prevalence sharply decreased in the FeFum (32.8% to 1.2%, p < 0.001) and FePP group (23.6% to 3.4%, p < 0.001). However, there was no significant time by treatment interaction on Hb or total anemia. These data indicate that, despite the high endemicity of malaria and elevated inflammation biomarkers (C-reactive protein or α-1-acid-glycoprotein), IDA was markedly reduced by provision of iron fortified CF to preschool-age children for 9 months, with no significant differences between a combination of NaFeEDTA with FeFum or NaFeEDTA with FePP. However, there was no overall effect on anemia, suggesting most of the anemia in this setting is not due to ID. This trial is registered at clinicaltrials.gov (NCT01634945). Full article

(This article belongs to the Special Issue Fe Deficiency, Dietary Bioavailbility and Absorption)

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Review

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33 pages, 1506 KiB

Open AccessReview

Impact of Inflammation on Ferritin, Hepcidin and the Management of Iron Deficiency Anemia in Chronic Kidney Disease

by Norishi Ueda and Kazuya Takasawa

Nutrients 2018, 10(9), 1173; https://doi.org/10.3390/nu10091173 - 27 Aug 2018

Cited by 109 | Viewed by 16718

Abstract

Iron deficiency anemia (IDA) is a major problem in chronic kidney disease (CKD), causing increased mortality. Ferritin stores iron, representing iron status. Hepcidin binds to ferroportin, thereby inhibiting iron absorption/efflux. Inflammation in CKD increases ferritin and hepcidin independent of iron status, which reduce iron availability. While intravenous iron therapy (IIT) is superior to oral iron therapy (OIT) in CKD patients with inflammation, OIT is as effective as IIT in those without. Inflammation reduces predictive values of ferritin and hepcidin for iron status and responsiveness to iron therapy. Upper limit of ferritin to predict iron overload is higher in CKD patients with inflammation than in those without. However, magnetic resonance imaging studies show lower cutoff levels of serum ferritin to predict iron overload in dialysis patients with apparent inflammation than upper limit of ferritin proposed by international guidelines. Compared to CKD patients with inflammation, optimal ferritin levels for IDA are lower in those without, requiring reduced iron dose and leading to decreased mortality. The management of IDA should differ between CKD patients with and without inflammation and include minimization of inflammation. Further studies are needed to determine the impact of inflammation on ferritin, hepcidin and therapeutic strategy for IDA in CKD. Full article

(This article belongs to the Special Issue Fe Deficiency, Dietary Bioavailbility and Absorption)

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14 pages, 248 KiB

Open AccessReview

Approaches for Reducing the Risk of Early-Life Iron Deficiency-Induced Brain Dysfunction in Children

by Sarah E. Cusick, Michael K. Georgieff and Raghavendra Rao

Nutrients 2018, 10(2), 227; https://doi.org/10.3390/nu10020227 - 17 Feb 2018

Cited by 56 | Viewed by 8121

Abstract

Iron deficiency is the most common micronutrient deficiency in the world. Women of reproductive age and young children are particularly vulnerable. Iron deficiency in late prenatal and early postnatal periods can lead to long-term neurobehavioral deficits, despite iron treatment. This may occur because screening and treatment of iron deficiency in children is currently focused on detection of anemia and not neurodevelopment. Anemia is the end-stage state of iron deficiency. The brain becomes iron deficient before the onset of anemia due to prioritization of the available iron to the red blood cells (RBCs) over other organs. Brain iron deficiency, independent of anemia, is responsible for the adverse neurological effects. Early diagnosis and treatment of impending brain dysfunction in the pre-anemic stage is necessary to prevent neurological deficits. The currently available hematological indices are not sensitive biomarkers of brain iron deficiency and dysfunction. Studies in non-human primate models suggest that serum proteomic and metabolomic analyses may be superior for this purpose. Maternal iron supplementation, delayed clamping or milking of the umbilical cord, and early iron supplementation improve the iron status of at-risk infants. Whether these strategies prevent iron deficiency-induced brain dysfunction has yet to be determined. The potential for oxidant stress, altered gastrointestinal microbiome and other adverse effects associated with iron supplementation cautions against indiscriminate iron supplementation of children in malaria-endemic regions and iron-sufficient populations. Full article

(This article belongs to the Special Issue Fe Deficiency, Dietary Bioavailbility and Absorption)

22 pages, 708 KiB

Open AccessReview

Effects of an Acute Exercise Bout on Serum Hepcidin Levels

by Raúl Domínguez, Antonio Jesús Sánchez-Oliver, Fernando Mata-Ordoñez, Adrián Feria-Madueño, Moisés Grimaldi-Puyana, Álvaro López-Samanes and Alberto Pérez-López

Nutrients 2018, 10(2), 209; https://doi.org/10.3390/nu10020209 - 14 Feb 2018

Cited by 42 | Viewed by 7657

Abstract

Iron deficiency is a frequent and multifactorial disorder in the career of athletes, particularly in females. Exercise-induced disturbances in iron homeostasis produce deleterious effects on performance and adaptation to training; thus, the identification of strategies that restore or maintain iron homeostasis in athletes is required. Hepcidin is a liver-derived hormone that degrades the ferroportin transport channel, thus reducing the ability of macrophages to recycle damaged iron, and decreasing iron availability. Although it has been suggested that the circulating fraction of hepcidin increases during early post-exercise recovery (~3 h), it remains unknown how an acute exercise bout may modify the circulating expression of hepcidin. Therefore, the current review aims to determine the post-exercise expression of serum hepcidin in response to a single session of exercise. The review was carried out in the Dialnet, Elsevier, Medline, Pubmed, Scielo and SPORTDiscus databases, using hepcidin (and “exercise” or “sport” or “physical activity”) as a strategy of search. A total of 19 articles were included in the review after the application of the inclusion/exclusion criteria. This search found that a single session of endurance exercise (intervallic or continuous) at moderate or vigorous intensity (60–90% VO_2peak) stimulates an increase in the circulating levels of hepcidin between 0 h and 6 h after the end of the exercise bout, peaking at ~3 h post-exercise. The magnitude of the response of hepcidin to exercise seems to be dependent on the pre-exercise status of iron (ferritin) and inflammation (IL-6). Moreover, oxygen disturbances and the activation of a hypoxia-induced factor during or after exercise may stimulate a reduction of hepcidin expression. Meanwhile, cranberry flavonoids supplementation promotes an anti-oxidant effect that may facilitate the post-exercise expression of hepcidin. Further studies are required to explore the effect of resistance exercise on hepcidin expression. Full article

(This article belongs to the Special Issue Fe Deficiency, Dietary Bioavailbility and Absorption)

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25 pages, 1082 KiB

Open AccessReview

Rational Management of Iron-Deficiency Anaemia in Inflammatory Bowel Disease

by Ole Haagen Nielsen, Christoffer Soendergaard, Malene Elbaek Vikner and Günter Weiss

Nutrients 2018, 10(1), 82; https://doi.org/10.3390/nu10010082 - 13 Jan 2018

Cited by 51 | Viewed by 15763

Abstract

Anaemia is the most frequent, though often neglected, comorbidity of inflammatory bowel disease (IBD). Here we want to briefly present (1) the burden of anaemia in IBD, (2) its pathophysiology, which mostly arises from bleeding-associated iron deficiency, followed by (3) diagnostic evaluation of anaemia, (4) a balanced overview of the different modes of iron replacement therapy, (5) evidence for their therapeutic efficacy and subsequently, (6) an updated recommendation for the practical management of anaemia in IBD. Following the introduction of various intravenous iron preparations over the last decade, questions persist about when to use these preparations as opposed to traditional and other novel oral iron therapeutic agents. At present, oral iron therapy is generally preferred for patients with quiescent IBD and mild iron-deficiency anaemia. However, in patients with flaring IBD that hampers intestinal iron absorption and in those with inadequate responses to or side effects with oral preparations, intravenous iron supplementation is the therapy of choice, although information on the efficacy of intravenous iron in patients with active IBD and anaemia is scare. Importantly, anaemia in IBD is often multifactorial and a careful diagnostic workup is mandatory for optimized treatment. Nevertheless, limited information is available on optimal therapeutic start and end points for treatment of anaemia. Of note, neither oral nor intravenous therapies seem to exacerbate the clinical course of IBD. However, additional prospective studies are still warranted to determine the optimal therapy in complex conditions such as IBD. Full article

(This article belongs to the Special Issue Fe Deficiency, Dietary Bioavailbility and Absorption)

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