RESUMO
Iron deficiency (ID) has been shown to affect central nervous system (CNS) development and induce hypomyelination. Previous work from our laboratory in a gestational ID model showed that both oligodendrocyte (OLG) and astrocyte (AST) maturation was impaired. To explore the contribution of AST iron to the myelination process, we generated an in vitro ID model by silencing divalent metal transporter 1 (DMT1) in AST (siDMT1 AST) or treating AST with Fe3+ chelator deferoxamine (DFX; DFX AST). siDMT1 AST showed no changes in proliferation but remained immature. Co-cultures of oligodendrocyte precursors cells (OPC) with siDMT1 AST and OPC cultures incubated with siDMT1 AST-conditioned media (ACM) rendered a reduction in OPC maturation. These findings correlated with a decrease in the expression of AST-secreted factors IGF-1, NRG-1, and LIF, known to promote OPC differentiation. siDMT1 AST also displayed increased mitochondrial number and reduced mitochondrial size as compared to control cells. DFX AST also remained immature and DFX AST-conditioned media also hampered OPC maturation in culture, in keeping with a decrease in the expression of AST-secreted growth factors IGF-1, NRG-1, LIF, and CNTF. DFX AST mitochondrial morphology and number showed results similar to those observed in siDMT1 AST. In sum, our results show that ID, induced through two different methods, impacts AST maturation and mitochondrial functioning, which in turn hampers OPC differentiation.
Assuntos
Astrócitos , Diferenciação Celular , Deficiências de Ferro , Oligodendroglia , Astrócitos/metabolismo , Astrócitos/efeitos dos fármacos , Oligodendroglia/metabolismo , Oligodendroglia/efeitos dos fármacos , Animais , Diferenciação Celular/efeitos dos fármacos , Diferenciação Celular/fisiologia , Células Cultivadas , Proteínas de Transporte de Cátions/metabolismo , Técnicas de Cocultura , Meios de Cultivo Condicionados/farmacologia , Ratos , Células Precursoras de Oligodendrócitos/efeitos dos fármacos , Células Precursoras de Oligodendrócitos/metabolismo , Desferroxamina/farmacologia , Proliferação de Células/efeitos dos fármacos , Proliferação de Células/fisiologia , Ferro/metabolismoRESUMO
BACKGROUND: Despite the emergence of diverse programs in Mexico to address anemia and micronutrient deficiencies in disadvantaged groups, progress on reducing their prevalence has stagnated. In Mexico, anemia surveillance at the population level is conducted through the National Health and Nutrition Survey ENSANUT (for its acronym in Spanish). OBJECTIVE: To overview the trends in anemia and iron deficiency (ID) from 1999 to 2018-19 in the Mexican population before COVID-19 pandemic. METHODS: Data from five nationwide surveys in Mexico were used. Where available, data on anemia, ID, and ID anemia (IDA) were extracted from ENSANUTs 1999, 2006, 2012, 2016, and 2018-19 in participants from 1 to 99 years old. Blood sample collection methods were similar across surveys (1999-2018) where capillary drop blood was used to estimate Hb using a HemoCue and serum blood samples to measure ferritin and C-reactive protein concentration. RESULTS: The trend in anemia prevalence shows a U-shape from 1999 to 2018-19 in <60 years old. In older adults (≥60 years), an increasing trend was observed. Anemia declined progressively from 1999 to 2012 but increased from 2016 to 2018-19 in comparison with 2012. In contrast, ID declined from 2006 to 2018-19, mainly in children, while IDA did not change over this period. In older adults, ID prevalence remained constant over time. CONCLUSIONS: The shifting trend in anemia prevalence across ENSANUTs 1999 through 2018-19 did not mimic the decreasing trend of ID over the same period of time. Other noncausal factors seem to play an important role in the variability of hemoglobin measurements.
Plain language titleOverview of Trends in the Prevalence of Anemia and Iron Deficiency in the Mexican Population From 1999 to 2018-19Plain language summaryIn Mexico, anemia surveillance has been monitored through the National Health and Nutrition Survey since 1999. Nonetheless, progress on reducing their prevalence seems to be stagnated despite the emergence of diverse social programs in Mexico to tackle micronutrient deficiencies in children and women. The main cause of anemia in children and women is iron deficiency (ID). Any progress in tackling ID should be reflected in anemia prevalence. To investigate the prevalence trend, we used information about anemia (based on hemoglobin concentration) and ID (based on serum ferritin levels) where available, from 5 nationwide surveys in Mexico among participants from 1 to 99 years old, to discuss some of the potential factors behind anemia and ID trends. From 1999 to 2018-19, we observed an ¨U" shape in the prevalence of anemia in all age groups <60 years old, contrasting with the prevalence of ID, which trend is in decline. No major changes in terms of social programs can explain the trend in anemia. In fact, other nutritional indicators seem to have improved in Mexican children. A major difference in the measurement of anemia and ID is that hemoglobin was measured in situ using drop of capillary blood in HemoCue, a portable photometer, while ferritin was measured in venous blood in the central laboratory. While many external factors might influence the hemoglobin measurement in the field setting, it seems that the technique of finger prick capillary introduces more errors to the measurement of hemoglobin than other techniques (e.g., pool capillary or venous blood using HemoCue). This difference, in turn, affects anemia diagnosis. Since the drop of capillary blood has been widely acceptable, we did not perform any validation of hemoglobin measurement in those past surveys, so we cannot role out the contribution of other factors that affected hemoglobin measurement. Future studies should use venous blood to improve anemia classification; otherwise, validation studies should be carried out to improve hemoglobin measurement when using capillary blood.
Assuntos
Anemia Ferropriva , Anemia , Inquéritos Nutricionais , Humanos , México/epidemiologia , Pré-Escolar , Adulto , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/sangue , Pessoa de Meia-Idade , Adolescente , Criança , Lactente , Adulto Jovem , Masculino , Feminino , Idoso , Prevalência , Idoso de 80 Anos ou mais , Anemia/epidemiologia , Anemia/sangue , Deficiências de Ferro , COVID-19/epidemiologia , Ferritinas/sangueRESUMO
La anemia por deficiencia de hierro es un problema prevalente a nivel global que aparece en niños, adolescentes y mujeres en edad fértil, son los más afectados. La hemoglobina reticulocitaria es un nuevo biomarcador prometedor para el diagnóstico temprano. Objetivo. Evaluar la hemoglobina reticulocitaria para el diagnóstico precoz de anemia por deficiencia de hierro. Metodología. Se realizó una revisión sistemática en bases de datos biomédicas como PubMed, Scielo, Researchgate, Base, Cochrane Library y DOAJ; se incluyeron 24 estudios observacionales (2018-2023) sobre el uso de la hemoglobina reticulocitaria en el diagnóstico de anemia por deficiencia de hierro; se extrajeron datos sobre las características de los estudios, los valores de sensibilidad y especificidad de este biomarcador. Resultados. La hemoglobina reticulocitaria presentó una sensibilidad agrupada de 90% y una especificidad de 89,5% en los estudios analizados. También mostró una diferencia de medias significativa de -2,88 (IC 95%: -3,36 a -2,40) entre grupos con y sin anemia por deficiencia de hierro. Se encontró una heterogeneidad sustancial entre los resultados de los diferentes estudios (I2=95%; p<0,00001). Conclusión. La hemoglobina reticulocitaria demostró elevada sensibilidad y especificidad, así como una diferencia significativa entre grupos con y sin la condición, lo que evidencia su utilidad como prueba para la detección temprana de la anemia por deficiencia de hierro.
Iron deficiency anemia is a prevalent global health problem that appears in children, adolescents and women of childbearing age, who are the most affected. Reticulocyte hemoglobin is a promising new biomarker for early diagnosis. Objective. To evaluate reticulocyte hemoglobin for the early diagnosis of iron deficiency anemia. Methodology. A systematic review was conducted searching biomedical databases including PubMed, Scielo, Researchgate, Base, Cochrane Library and DOAJ; 24 observational studies (2018-2023) were included on the use of reticulocyte hemoglobin in the diagnosis of iron deficiency anemia; data were extracted on the characteristics of the studies and the sensitivity and specificity values of this biomarker. Results. Reticulocyte hemoglobin showed a pooled sensitivity of 90% and a specificity of 89.5% in the studies analyzed. It also showed a significant mean difference of -2.88 (95% CI: -3.36 to -2.40) between groups with and without iron deficiency anemia. Substantial heterogeneity was found among the results of the different studies (I2=95%; p<0.00001). Conclusion. Reticulocyte hemoglobin demonstrated high sensitivity and specificity, as well as a significant difference between groups with and without the condition, which shows its usefulness as a test for the early detection of iron deficiency anemia.
A anemia por deficiência de ferro é um problema de saúde global prevalente que aparece em crianças, adolescentes e mulheres em idade fértil, sendo os mais afetados. A hemoglobina reticulocitária é um novo biomarcador promissor para o diagnóstico precoce. Objetivo. Avaliar a hemoglobina reticulocitária para o diagnóstico precoce da anemia por deficiência de ferro. Metodologia. Foi realizada uma revisão sistemática com busca em bases de dados biomédicas incluindo PubMed, Scielo, Researchgate, Base Cochrane Library e DOAJ; foram incluídos 24 estudos observacionais (2018-2023) sobre o uso da hemoglobina reticulocitária no diagnóstico de anemia por deficiência de ferro; foram extraídos dados sobre as características dos estudos e os valores de sensibilidade e especificidade deste biomarcador. Resultados. A hemoglobina reticulocitária apresentou sensibilidade agrupada de 90% e especificidade de 89,5% nos estudos analisados. Também mostrou uma diferença média significativa de -2,88 (IC 95%: -3,36 a -2,40) entre grupos com e sem anemia por deficiência de ferro. Encontrou-se heterogeneidade substancial entre os resultados dos diferentes estudos (I2=95%; p<0,00001). Conclusão. A hemoglobina reticulocitária demonstrou elevada sensibilidade e especificidade, bem como uma diferença significativa entre grupos com e sem a condição, o que evidencia a sua utilidade como teste para a detecção precoce da anemia por deficiência de ferro.
Assuntos
Deficiências de FerroRESUMO
El presente manual, ofrece al facilitador, y/o personal de salud, una metodología y orientaciones para seguir fortaleciendo las capacidades, habilidades y destrezas de los actores sociales, en el uso del rotafolio en los temas priorizados, para el desarrollo de visitas domiciliarias con calidad, logrando en los padres de familia o gestantes, una cultura de cuidado y protección para sus niñas y niños hasta 12 meses de edad, con énfasis en la prevención de la anemia
Assuntos
Anemias Nutricionais , Cuidado da Criança , Desenvolvimento Infantil , Distúrbios do Metabolismo do Ferro , Desnutrição , Nutrição da Gestante , Deficiências de Ferro , Promoção da SaúdeRESUMO
OBJECTIVE: This study aimed to describe the prevalence and predictors of childhood anemia in an Amazonian population-based birth cohort study. METHODS: Prevalence of maternal anemia was estimated at delivery (hemoglobin [Hb] concentration < 110 g/L) in women participating in the MINA-Brazil birth cohort study and in their children, examined at ages one, two (Hb < 110 g/L), and five (Hb < 115 g/L). Moreover, ferritin, soluble transferrin receptor, and C-reactive protein concentrations were measured in mothers at delivery and in their 1- and 2-year-old children to estimate the prevalence of iron deficiency and its contribution to anemia, while adjusting for potential confounders by multiple Poisson regression analysis (adjusted relative risk [RRa]). RESULTS: The prevalence 95% confidence interval (CI) of maternal anemia, iron deficiency, and iron-deficiency anemia at delivery were 17.3% (14.0-21.0%), 42.6% (38.0-47.2%), and 8.7% (6.3-11.6)%, respectively (n = 462). At one year of age (n = 646), 42.2% (38.7-45.8%) of the study children were anemic, 38.4% (34.6-42.3%) were iron-deficient, and 26.3 (23.0-29.9) had iron-deficiency anemia. At two years of age (n = 761), these values decreased to 12.8% (10.6-15.2%), 18.1% (15.5-21.1%), and 4.1% (2.8-5.7%), respectively; at five years of age (n = 655), 5.2% (3.6-7.2%) were anemic. Iron deficiency (RRa = 2.19; 95%CI: 1.84-2.60) and consumption of ultra-processed foods (UPF) (RRa = 1.56; 95%CI: 1.14-2.13) were significant contributors to anemia at 1 year, after adjusting for maternal schooling. At 2 years, anemia was significantly associated with maternal anemia at delivery (RRa: 1.67; 95%CI: 1.17-2.39), malaria since birth (2.25; 1.30-3.87), and iron deficiency (2.15; 1.47-3.15), after adjusting for children's age and household wealth index. CONCLUSIONS: Anemia continues to be highly prevalent during pregnancy and early childhood in the Amazon. Public health policies should address iron deficiency, UPF intake, maternal anemia, and malaria to prevent and treat anemia in Amazonian children.
Assuntos
Anemia Ferropriva , Anemia , Deficiências de Ferro , Malária , Gravidez , Humanos , Feminino , Pré-Escolar , Anemia Ferropriva/epidemiologia , Estudos de Coortes , Prevalência , Brasil/epidemiologia , Hemoglobinas/análise , Hemoglobinas/metabolismo , Anemia/epidemiologiaRESUMO
El presente manual contiene el desarrollo de temas sobre el Desarrollo Infantil Temprano saludable como un derecho de las niñas y niños; el actor social y su papel en el cuidado infantil, la prevención y reducción de la anemia; la visita domiciliaria y las sesiones temáticas para desarrollar durante la visita a los niños hasta los 12 meses de edad o a las gestantes; las que deberás revisar y aprender, para así motivar y persuadir a la madre, padre o cuidador de la niña o niño o a la gestante a mejorar las prácticas de cuidado
Assuntos
Anemias Nutricionais , Distúrbios do Metabolismo do Ferro , Cidade Saudável , Desnutrição , Prevenção de Doenças , Nutrição da Gestante , Deficiências de Ferro , Promoção da SaúdeRESUMO
INTRODUCTION: Iron has different physiological processes and is regulated by hepcidin that is also an acute phase reactant, which increases with inflammation. Obesity produces a pro-inflammatory state, affecting directly the normal regulation of iron, causing ferritin (FER) deficiency. FER is used as the only indicator of the status of iron in patients with obesity, so the majority of them would be underdiagnosed, leading to a high prevalence of iron deficiency (ID) and anemia. The aim of this study is to evaluate the diagnostic tests: transferrin saturation (TS), FER, and C-reactive protein (CRP) vs. FER with the objective of analyzing the most accurate variable for the diagnosis of ID. MATERIALS AND METHODS: We present a cross-sectional, analytical, and retrospective study, evaluating the diagnostic tests in 96 patients, to whom two methods were applied for the diagnosis of ID: method 1 (FER < 30 ng/mL) and method 2 divided into 2A (FER < 30 ng/mL), 2B (FER 30-100 ng/mL + CRP ≥ 5 mg/L), 2C (FER 100-300 ng/mL + CRP ≥ 5 mg/L + TS < 20%), and 2D (TS < 20%). RESULTS: The prevalence of ID obtained using method 1 was 30.2% while 69.8% presented ID using total method 2, confirming an underdiagnosis of 39.6%. CONCLUSION: The inflammatory state in patients with obesity must be considered in the diagnosis of ID. The use of TS, FER, and CRP has greater validity than the use of serum FER for the diagnosis of ID in patients with obesity.
Assuntos
Anemia Ferropriva , Cirurgia Bariátrica , Deficiências de Ferro , Obesidade Mórbida , Transferrina , Humanos , Biomarcadores , Proteína C-Reativa/análise , Proteína C-Reativa/metabolismo , Estudos Transversais , Ferritinas/análise , Ferritinas/sangue , Ferro , Obesidade/complicações , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Transferrina/análise , Transferrina/metabolismo , Transferrinas , Inflamação/sangue , Inflamação/metabolismoRESUMO
Fe-deficiency anaemia is a major public health concern in children under 5 years of age. TMPRSS6 gene, encoding matriptase-2 protein, is implicated in Fe homoeostasis and has been associated with anaemia and Fe status in various populations. The aim of this cross-sectional study was to investigate the associations between the single nucleotide polymorphism (SNP) TMPRSS6 rs855791 and biomarkers of anaemia and Fe deficiency in Brazilian children attending day care centres. A total of 163 children aged 6-42 months were evaluated. Socio-economic, demographic, biochemical, haematological, immunological and genotype data were collected. Multiple logistic and linear regressions with hierarchical selection were used to assess the effects of independent variables on categorised outcomes and blood marker concentrations. Minor allele (T) frequency of rs855791 was 0·399. Each copy of the T allele was associated with a 4·49-fold increased risk of developing anaemia (P = 0·005) and a 4·23-fold increased risk of Fe deficiency assessed by serum soluble transferrin receptor (sTfR) (P < 0·001). The dose of the T allele was associated with an increase of 0·18 mg/l in sTfR concentrations and reductions of 1·41 fl and 0·52 pg in mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH), respectively. In conclusion, the T allele of SNP TMPRSS6 rs855791 was significantly associated with anaemia and Fe deficiency assessed by sTfR in Brazilian children attending day care centres. The effect was dose dependent, with each copy of the T allele being associated with lower MCV and MCH and higher concentrations of sTfR.
Assuntos
Anemia Ferropriva , Anemia , Deficiências de Ferro , Pré-Escolar , Humanos , Anemia/epidemiologia , Anemia/genética , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/genética , Brasil/epidemiologia , Estudos Transversais , Hospital Dia , Proteínas de Membrana/genética , Polimorfismo de Nucleotídeo Único , Receptores da Transferrina , Serina Endopeptidases/genética , Serina Endopeptidases/metabolismoRESUMO
OBJECTIVES: This paper aims to review data on the association of obesity and iron deficiency in children and adolescents, exposing the possible involvement of hepcidin and interleukin-6 (IL-6), obesity's inflammation biomarkers. DATA SOURCE: Articles from PUBMED and WEB OF SCIENCE database with no chronological limit were reviewed to write this systematic review. Keywords such as children, obesity, iron deficiency, and hepcidin were used. After deleting duplicated and review articles, 91 were screened, and 39 were selected as eligible. Sixteen articles were included because they involved serum hepcidin levels in obese children and adolescents as outcomes. SUMMARY OF FINDINGS: Finally, those 16 articles were organized in two tables: one includes therapeutic interventions, and the other does not. As hepcidin was discovered in 2000, the first articles that presented serum hepcidin's quantification in obese children and adolescents, homeostasis iron markers, and their possible association with obesity's inflammatory environment began to be published in 2008. CONCLUSIONS: Obesity's chronic inflammation state leads to the production of IL-6, which acts as a signaling molecule for hepcidin synthesis, resulting in iron deficiency, which is common in obese children and adolescents who respond inadequately to iron supplementation. On the other hand, that population responds adequately to therapeutic intervention programs that lead to weight loss, guaranteeing iron homeostasis improvement. Therefore, perhaps it is time to discuss serum hepcidin level quantification as part of evaluating children and adolescents with iron deficiency, which could guide clinical choices that might lead to better therapeutic outcomes.