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![Associations between lifestyle behaviors [heme and non-heme iron intake and moderate-to-vigorous physical activity (MVPA)] and hemo- globin (Hb) levels and mediation by ferritin levels.](publication/337264236/figure/tbl1/AS:967105734266880@1607587383015/Associations-between-lifestyle-behaviors-heme-and-non-heme-iron-intake-and.png)
Associations between lifestyle behaviors [heme and non-heme iron intake and moderate-to-vigorous physical activity (MVPA)] and hemo- globin (Hb) levels and mediation by ferritin levels.
Source publication
Whole blood donors, especially frequently donating donors, have a risk of iron deficiency and low hemoglobin levels, which may affect their health and eligibility to donate. Lifestyle behaviors, such as dietary iron intake and physical activity, may influence iron stores and thereby hemoglobin levels. We aimed to investigate whether dietary iron in...
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Background
Frequent whole blood donors have an increased risk of developing iron deficiency. Iron deficiency can have detrimental health effects when left untreated. Donation intervals are commonly too short to replenish iron stores and extending these reduces donor availability. Oral iron supplementation is known to shorten iron store recovery tim...
Citations
... A dietary intake contains heme and non-heme iron [52]. Heme iron has high bioavailability (15-35%) respect Table 3 Dietary composition in children aged 6 to 59 months in the Puno region according to iron status, stratified in three categories of total body iron (TBI): TBI less than 0 mg/kg; between 0-5 mg/kg and more than 5 mg/kg Data are mean ± SEM. ...
Background
The anemia prevalence is higher in highlands populations. It is assumed that iron deficiency anemia (IDA) in children is mainly due to low dietary intake. However, other suggest that high prevalence of anemia is due to an inappropriate hemoglobin (Hb) adjustment for altitude.
Materials and methods
Cross-sectional study conducted in 338 preschoolers (PSC) from Puno-Peru. Hb was measured in whole blood, and ferritin, Soluble transferrin receptor, and Interleukin 6 in serum.The dietary iron intake was assessed by 24-h dietary recall, using NutriCap Software. Hb concentration was assessed as adjusted or unadjusted for altitude.
Results
With unadjusted Hb, the anemia prevalence was 4.7%, whereas after Hb correction, the prevalence raised-up to 65.6% (p < 0.001). Reciprocally, erythrocytosis proportion decreased from 20.35 to 0.30% (p < 0.001). Total Body Iron (TBI) showed that 7.44% had ID and 0.32% had IDA. PSC with normal unadjusted Hb levels have more protein and micronutrients intake than anemic ones. PSC with erythrocytosis consumed less fat, and more niacin and ascorbic acid than anemics. Total iron intake was lower in anemic than the other groups, but without statistical significance due to the standard deviation of the data in a small number of anemic PSC (n = 16). TBI, unadjusted Hb, and adjusted Hb were not different between groups consuming or not multimicronutrients.
Conclusions
The consumption of iron and iron status in children who live at high altitude is adequate, and that anemia could be due to other micronutrient deficiencies and/or that the adjustment of Hb by altitude is inappropriate.
... The reason for this is that the polysaccharide iron complex is absorbed into the patient's gastrointestinal tract in the form of intact molecules after oral administration and act rapidly to increase the iron content and hemoglobin level in the blood [18]. The vast majority of dietary iron intake (80 %, as indicated by a previous study) is non-ferritin [22], which is non-absorbable by the duodenum. Vitamin C, as a strong reducing agent, complex with trivalent iron ions in ferritin to unstable ferrous ascorbate and use its solubility to promote the absorption of non-hemoglobin in the duodenum and proximal jejunum, thus better relieving the symptoms of iron deficiency anemia [19]. ...
Purpose: To evaluate the clinical efficacy of polysaccharide iron complexes (PIC) plus vitamin C in treating iron deficiency anemia (IDA) during pregnancy and its effect on iron metabolism.Methods: Ninety pregnant women with IDA in their second trimester admitted into the Department of Gynaecology and Obstetrics, Nanchang Third Hospital, Jiangxi Province, China between June 2019 and June 2021 were randomly and equally assigned to receive either PIC (two 500 mg capsules daily) alone (control group) or PIC plus vitamin C (0.1 g daily) (study group) for 4 weeks. Efficacy was determined by changes in clinical symptoms and blood indices and iron metabolism indices (serum ferritin, serum iron, hepcidin, transferrin saturation) pre- and post-treatment. Adverse pregnancy outcomes were also recorded.Results: Both groups were comparable at baseline. Post-treatment, study group showed significantly higher red blood cell (RBC), hemoglobin (Hb), mean red blood cell volume (MCV) and mean corpuscular hemoglobin (MCH) compared to control group (p < 0.05). Iron metabolism indices also significantly improved in study group with serum ferritin (SF), serum iron (SI), hepcidin (Hepc), and transferrin saturation (TSAT) (p < 0.05). The total clinical efficacy was higher in study group (p < 0.05), and the incidence of adverse pregnancy outcomes was lower (p < 0.05).Conclusions: The combination of PIC with vitamin C significantly improves the hematological indices, enhances iron metabolism, and reduces adverse pregnancy outcomes compared to PIC alone in pregnant women with IDA. Further studies with larger sample sizes are warranted to validate these results.
... Although knowledge of donation-induced iron deficiency was limited, most donors did know about iron store recovery through dietary iron intake. Donors were able to name iron-rich dietary products, and some were even aware of the inhibitory and stimulating effect on iron uptake of other dietary products such as dairy and vitamin C [22]. Although providing dietary advice is not part of Sanquin's standard policy, many of the collection staff members indicated that they provide donors with dietary advice. ...
Background and Objectives
Iron supplementation is an effective strategy to mitigate donation‐induced iron deficiency in blood donors. However, evidence on the perception of individuals involved in blood donation on iron supplementation as a blood service policy is lacking. This study aimed to evaluate the knowledge and perception of whole blood donors (donors), blood collection staff (collection staff) and donor physicians (physicians) regarding donation‐induced iron loss and iron supplementation.
Materials and Methods
Online focus group discussions had four to six participants and followed a structured questioning approach. All participants had to be fluent in Dutch to participate, and donors had donated at least five times. Sixteen donors, eight collection staff members and four physicians participated in this study. Recordings were transcribed, coded and analysed using a grounded theory approach.
Results
Awareness of donation‐induced iron loss was limited in donors. Donors and physicians were predominantly positive towards iron supplementation; the primary motivator for donors was to prevent deferral and reduce iron‐deficiency‐related symptoms. Improving donor health was the main argument for physicians to advocate iron supplementation. Staff had a critical view on iron supplementation as a policy, as they perceived it as unethical and possibly ineffective. A knowledge gap might underlie their concerns.
Conclusion
Most individuals involved in blood donation are positive towards iron supplementation as a blood service policy. If implemented, guidance and monitoring is desired and adequate education of all stakeholders is required.
... Donation-induced iron deficiency (ID) is an established phenomenon among blood donors, with a growing recognition in poor resource settings. Published literature confirms that regular blood donors experience a progressive decline in iron reserves as the frequency of donation increases [1,2]. This results in the depletion of the body ferritin first, followed by red blood cells (RBCs), ultimately resulting in decreased haemoglobin (Hb) only in the last stage of ID. ...
Background and Objectives
Repeated blood donation is a well‐known cause of iron deficiency among donors. However, present scientific literature lacks comprehensive evidence regarding the impact of regular plateletpheresis procedures on body iron reserves. In this study, we aimed to detect and correlate iron deficiency (using iron indices) with the frequency of platelet donations. Additionally, we also analysed the correlation between other iron and haematological indices with serum ferritin to determine cost‐effective parameters that may serve as an initial screening approach to determine which donors should be subjected to serum ferritin testing.
Materials and Methods
A total of 180 male participants from our platelet donor registry were enrolled in this observational cross‐sectional study. Enrolment questionnaires were administered to eligible donors, and biological samples were collected during plateletpheresis donation. Biological tests such as complete blood count, reticulocyte indices, iron indices, vitamin B12 and folate were performed.
Results
Donors with ≥12 donations per year showed the highest prevalence of low ferritin (serum ferritin: 15–30 ng/mL) and absent iron stores (serum ferritin <15 ng/mL) (41.3% and 26.7%, respectively). Ferritin showed a significant negative correlation with recent ( r = −0.346) and lifetime donations ( r = −0.196). The efficacy of other indices for identifying iron depletion was much better using a serum ferritin value <15 ng/mL.
Conclusion
Regular plateletpheresis donations can lead to varying severities of non‐anaemic iron deficiency. Blood centres must regularly monitor frequent plateletpheresis donors (especially donors with more than 11 donations in a calendar year) and ideally maintain their serum ferritin above 30 ng/mL.
... Hemoglobins (Hbs) are large and complex protein molecules, and the Hb level is related to nutrients from dietary intakes (12). Animal experiments have shown that lower Hb level is related to the impaired bone turnover and poor bone strength (13)(14)(15). ...
Introduction
In the elder population, both low hemoglobin (Hb)/anemia and osteoporosis (OP) are highly prevalent. However, the relationship between Hb and OP is still poorly understood. This study was to evaluate the correlation between Hb and OP in Chinese elderly population.
Methods
One thousand and sisty-eight individuals aged 55–85 years were enrolled into this cross-sectional study during June 2019–November 2019. Data on the demographics and clinical characteristics were recorded. Detections of complete blood count, liver/kidney function, glucose metabolism and lipid profile, and thoracolumbar X-ray were performed, and bone mineral density (BMD) at lumbar spine 1–4, femur neck, and total hip was measured by dual-energy X-ray absorptiometry (DXA). Univariate and multivariate linear regression analyses were employed to evaluate the correlation between Hb with BMD T-score. Logistic regression analysis was performed to access the correlation between different Hb levels and the odds ratio (OR) for OP.
Results
Compared with non-OP group, OP patients had lower level of Hb. Univariate linear regression analysis indicated Hb level was positively related to the BMD of lumbar spine 1–4, femur neck and total hip, and this relationship remained after adjusting confounding variables [gender, age, body mass index (BMI), diabetes mellitus (DM) and morphological vertebral fracture]. Logistic regression analysis showed the ORs for OP decreased with the increase of Hb. Compared with the subjects with the lowest quartile of Hb, the OR for OP in the highest quartile group was 0.60 (0.41–0.89) after adjusting for gender, age and BMI, and the OR for OP was 0.62 (0.41–0.92) after further adjustment for gender, age, BMI, DM, and lipid indexes.
Discussion
In conclusion, Lower Hb level is related to lower BMD in the elderly population. However, whether Hb level could be used to predict the risk of OP needs to be further determined in more longitudinal clinical studies.
... 29 A Dutch study also showed a positive association between heme iron intake and ferritin levels. 30 Smoking • Cigarette use was associated with odds for ID that were 35-40% lower for current smokers than for nonsmokers in two US studies. 1,8,11 Two European studies showed higher ferritin levels for smokers but only in female donors. ...
... 4,6,7 Higher body mass index (BMI) is associated with higher ferritin levels. 8 In recent decades, many other factors that affect iron status have been identified: diet, 9,10 genetics, 11,12 ethnicity, 13 and iron supplementation, which is mostly studied among blood donors. 14,15 Ferritin is also a known acute-phase protein that is elevated in inflammatory conditions, complicating its diagnostic value in individuals with conditions such as inflammatory bowel disease or chronic heart failure. ...
... 12,[35][36][37] Dietary behaviour, and in particular heme iron intake, is also a determinant of iron status in donors. 9,15 Information on iron supplementation was also not available for this study. Sanquin does not prescribe oral supplementation of iron to donors, and only a small minority (8.7%) uses iron supplements. ...
... Sanquin does not prescribe oral supplementation of iron to donors, and only a small minority (8.7%) uses iron supplements. 9 Information on donors' smoking status is also expected to add value to the model. Had these determinants been available for our analysis, the In most software packages parameter estimates are obtained by a maximum likelihood estimator by default, but alternative estimators can be chosen as well. ...
Background and Objectives
Serum ferritin levels are increasingly being used to assess iron stores. Considerable variation in ferritin levels within and between individuals has been observed, but our current understanding of factors that explain this variation is far from complete. We aim to combine multiple potential determinants in an integrative model, and investigate their relative importance and potential interactions.
Methods
We use ferritin measurements collected by Sanquin Blood Bank on both prospective (N = 59 596) and active blood donors (N = 78 318) to fit a structural equation model with three latent constructs (individual characteristics, donation history, and environmental factors). Parameters were estimated separately by sex and donor status.
Results
The model explained 25% of ferritin variance in prospective donors, and 40% in active donors. Individual characteristics and donation history were the most important determinants of ferritin levels in active donors. The association between environmental factors and ferritin was smaller but still substantial; higher exposure to air pollution was associated with higher ferritin levels, and this association was considerably stronger for active blood donors than for prospective donors.
Discussion
In active donors, individual characteristics explain 20% (17%) of ferritin variation, donation history explains 14% (25%) and environmental factors explain 5% (4%) for women (men). Our model presents known ferritin determinants in a broader perspective, allowing for comparison with other determinants as well as between new and active donors, or between men and women.
... Notably, the variation was linked to the local interdonation intervals rather than local hemoglobin cut-offs [57 & ]. Timmer et al. [58] examined the effect of dietary iron on hemoglobin in 2323 Dutch donors, finding that hemoglobin increased 0.16 mmol/L for each additional gram of heme iron intake and decreased 0.014 mmol/L for each additional gram of nonheme iron intake. However, a study of 2000 Finish donors found that donation frequency was the most important determinant of donor iron stores, far more important than red meat consumption or iron supplementation [59], a finding consistent with earlier studies showing that full recovery of iron stores following blood donation takes over 100 days in those taking daily iron supplements and over 180 days in nonsupplemented donors [ This suggests plasma ferritin of 25.4 ng/ml represents a physiological point below, which there is exhaustion of available iron stores signaled by rising sTfR and declining hemoglobin. ...
Purpose of review:
This review examines recent research on the prevalence and importance of iron deficiency in blood donors, and on efforts to mitigate it.
Recent findings:
Premenopausal females, teenagers, and high-frequency donors are at the highest risk for donation-induced iron deficiency, in both high-resource and low-resource settings. The physiology relating iron stores to hemoglobin levels and low hemoglobin deferral is well elucidated in blood donor populations, yet the clinical effects attributable to iron loss in the absence of anemia are challenging to identify. Expanded adoption of ferritin testing is improving donor management but may cause decreases in the blood supply from temporary donor loss. The potential for personalized donor management is emerging with development of computational models that predict individual interdonation intervals that aim to optimize blood collected from each donor while minimizing low hemoglobin deferrals.
Summary:
Measures to reduce iron deficiency are available that can be deployed on a standardized or, increasingly, personalized basis. Blood centers, regulators, and donors should continue to evaluate different tactics for addressing this problem, to obtain a balanced approach that is optimal for maintaining adequate collections while safeguarding donor health.
... In this way, making use of the Hallberg et al. 25 estimate for iron absorption, we calculated the corresponding iron intake. Using these calculated values of iron intake as a likelihood function, and the iron intake observed in a previous study among blood donors in the Netherlands as an informative prior, 26 we made use of Bayes' theorem to obtain a posterior estimate of iron intake by taking the mode of the product of prior and likelihood. Subsequently, using the posterior estimate of iron intake, we calculated the difference between obligate loss and iron absorption. ...
Blood donors are at risk of iron deficiency anaemia. While this risk is decreased through ferritin‐based deferral, ideally ferritin monitoring should also aid in optimising donation frequencies. We extended an existing model of haemoglobin (Hb) synthesis with iron homeostasis and validated the model on a cohort of 300 new donors whose ferritin levels were measured from stored blood samples collected over a 2‐year period. We then used the donor's gender, body weight, height, and baseline Hb and ferritin levels to predict subsequent Hb and ferritin levels. The prediction error was within measurement variability in 88% of Hb level predictions and 64% of ferritin level predictions. A sensitivity analysis of the model revealed that baseline ferritin level was the most important in predicting future ferritin levels. Finally, we used the model to calculate the annual donation frequency at which donors would keep their ferritin level >15 ng/ml when measured after donating for 2 years. The mean annual donation frequency would then be 1.9 for women and 4.1 for men. The computational model, requiring baseline values only, can predict future Hb and ferritin levels remarkably well. This enables determination of optimal donation frequencies for individual donors at the start of their donation career.
... Optimal donation intervals may differ between donors, depending on the decrease in ferritin levels after a whole blood donation and an individual's capability of restoring ferritin to pre-donation levels. This may be influenced by dietary and supplemental iron intake and other lifestyle behaviors, as well as by genetic traits that affect iron absorption and release [6]. ...
Background:
Depending on post-donation erythropoiesis, available iron stores, and iron absorption rates, optimal donation intervals may differ between donors. This project aims to define subpopulations of donors with different ferritin trajectories over repeated donations.
Methods:
Ferritin levels of 300 new whole blood donors were measured from stored (lookback) samples from each donation over two years in an observational cohort study. Latent classes of ferritin level trajectories were investigated separately using growth mixture models for male and female donors. General linear mixed models assessed associations of ferritin levels with subsequent iron deficiency and/or low hemoglobin.
Results:
Two groups of donors were identified using group-based trajectory modeling in both genders. Ferritin levels showed rather linear reductions among 42.9% of male donors and 87.7% of female donors. For the remaining groups of donors, steeper declines in ferritin levels were observed. Ferritin levels at baseline and the end of follow-up varied greatly between groups.
Conclusions:
Repeated ferritin measurements show depleting iron stores in all-new whole blood donors, the level at which mainly depends on baseline ferritin levels. Tailored, less intensive donation strategies might help to prevent low iron in donors, and could be supported with ferritin monitoring and/or iron supplementation.
