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Online Library: Anaemia

The following pages provide an overview of the most recent research and clinical studies about the health benefits of micronutrients in fighting anaemia. This collection of scientific facts proves that anyone who privately or publicly questions the health value of micronutrients does not serve YOUR health, or the health of the people, but rather the multi-billion dollar investment 'business with disease' based on patented pharmaceutical drugs.

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Agriculture-related anaemias.

Source: British journal of biomedical science 1994;51(4):345-57.

Author: Fleming AF.

Affiliation: Department of Haematology, School of Pathology of the South African Institute for Medical Research, Johannesburg.

Abstract: Man evolved as a hunter-gatherer, and the invention and spread of agriculture was followed by changes in diet, the environment and population densities which have resulted in globally high prevalences of anaemias due to nutritional deficiencies of iron, folate and (locally) vitamin B12, to infestations by hookworm and schistosomes, to malaria, and to the natural selection for the genes for sickle-cell diseases, beta-thalassaemias, alpha-thalassaemias, glucose-6-phosphate dehydrogenase deficiency, ovalocytosis and possibly (locally) elliptocytosis. The present explosion of population is driving an expansion of agriculture, especially the cultivation of rice, and this has led often to disastrous increases of transmission of malaria, schistosomiasis and other diseases, to widespread chemical pollution, and to degradation of the environment. Anaemia, as the commonest manifestation of human disease, is a frequent consequence. The urgent need for increased food production is matched by the urgent need for assessment and control of the health impact of agricultural development.

Anaemia among the inhabitants of a rural area in northern Natal.

Source: S Afr Med J. 1985 Mar 23;67(12):458-62.

Author: Mayet FG, Schutte CH, Reinach SG.

Affiliation:

Abstract: Haematological and parasitological investigations were carried out on apparently healthy subjects in a rural area of Natal. Anaemia was highly prevalent and of a moderate to severe degree (haemoglobin value less than 11,0 g/dl) in 42% of males and 52,5% of females. In 50% of subjects the anaemia was hypochromic and iron deficiency appeared to be the major contributing factor. However, failure to utilize iron, giving rise to hypo-chromia, was not excluded as a complicating factor. Subnormal serum vitamin B12 levels were found in some subjects, and this frequently coexisted with iron deficiency. The presence of parasites was not considered to have contributed to the production of anaemia. It was concluded that the anaemia was to a large extent nutritional in origin.

Correcting a marginal riboflavin deficiency improves hematologic status in young women in the United Kingdom (RIBOFEM)

Source: The American Journal of Clinical Nutrition 2011; 93 (6): 1274-1284

Author: Powers HJ, Hill MH, Mushtaq S, Dainty JR, et al.

Affiliation: The Human Nutrition Unit, University of Sheffield, United Kingdom and The Institute of Food Research, Norwich, United Kingdom.

Abstract: Moderate riboflavin deficiency is prevalent in certain population groups in affluent countries, but the functional significance of this deficiency is not clear. Studies have indicated a role for riboflavin in the absorption and use of iron. The authors investigated the effect of riboflavin supplementation on hematologic status in a group of moderately riboflavin-deficient women aged 19–25 y in the United Kingdom. 123 women with biochemical evidence of riboflavin deficiency [erythrocyte glutathione reductase activation coefficient (EGRAC) >1.40] were randomly assigned to receive 2 or 4 mg riboflavin or a placebo for 8 wk. Measurements of hematologic status were made pre- and postsupplementation, and dietary intakes were also assessed; iron absorption was measured in a subgroup of women. 119 women completed the intervention. The use of a riboflavin supplement for 8 wk elicited a significant improvement in riboflavin status with a dose response (P < 0.0001). For women who received supplemental riboflavin, an increase in hemoglobin status correlated with improved riboflavin status (P < 0.02). Women in the lowest tertile of riboflavin status at baseline (EGRAC >1.65) showed a significantly greater increase in hemoglobin status in response to the supplement than did women in the first and second tertiles (P < 0.01). Dietary iron intake and iron absorption did not change during the study. Conclusions: Moderately poor riboflavin status can affect iron status: the lower the riboflavin status, the greater the hematologic benefits of improving status. The results also suggest that consideration should be given to raising the currently accepted EGRAC threshold for deficiency.

Riboflavin (vitamin B-2) and health.

Source: The American journal of clinical nutrition 2003;77(6):1352-60

Author: Powers HJ.

Affiliation: Centre for Human Nutrition, University of Sheffield, United Kingdom.

Abstract: Riboflavin is unique among the water-soluble vitamins in that milk and dairy products make the greatest contribution to its intake in Western diets. Meat and fish are also good sources of riboflavin, and certain fruit and vegetables, especially dark-green vegetables, contain reasonably high concentrations. Biochemical signs of depletion arise within only a few days of dietary deprivation. Poor riboflavin status in Western countries seems to be of most concern for the elderly and adolescents, despite the diversity of riboflavin-rich foods available. However, discrepancies between dietary intake data and biochemical data suggest either that requirements are higher than hitherto thought or that biochemical thresholds for deficiency are inappropriate. This article reviews current evidence that diets low in riboflavin present specific health risks. There is reasonably good evidence that poor riboflavin status interferes with iron handling and contributes to the etiology of anemia when iron intakes are low. Various mechanisms for this have been proposed, including effects on the gastrointestinal tract that might compromise the handling of other nutrients. Riboflavin deficiency has been implicated as a risk factor for cancer, although this has not been satisfactorily established in humans. Current interest is focused on the role that riboflavin plays in determining circulating concentrations of homocysteine, a risk factor for cardiovascular disease. Other mechanisms have been proposed for a protective role of riboflavin in ischemia reperfusion injury; this requires further study. Riboflavin deficiency may exert some of its effects by reducing the metabolism of other B vitamins, notably folate and vitamin B-6.

Correcting a marginal riboflavin deficiency improves hematologic status in young women in the United Kingdom (RIBOFEM)

Source: The American journal of clinical nutrition 2011; 93(6): 1274-1284

Author: Powers HJ, Hill MH, Mushtaq S, Dainty JR et al.

Affiliation: Human Nutrition Unit, University of Sheffield, United Kingdom

Abstract: Moderate riboflavin deficiency is prevalent in certain population groups in affluent countries, but the functional significance of this deficiency is not clear. Studies have indicated a role for riboflavin in the absorption and use of iron. The authors investigated the effect of riboflavin supplementation on hematologic status in a group of moderately riboflavin-deficient women aged 19–25 y in the United Kingdom. One hundred nineteen women completed the intervention. The use of a riboflavin supplement for 8 wk elicited a significant improvement in riboflavin status with a dose response. For women who received supplemental riboflavin, an increase in hemoglobin status correlated with improved riboflavin status. Dietary iron intake and iron absorption did not change during the study. Conclusions: Moderately poor riboflavin status can affect iron status: the lower the riboflavin status, the greater the hematologic benefits of improving status. The results also suggest that consideration should be given to raising the currently accepted EGRAC threshold for deficiency.

Iron availability increases the pathogenic potential of Salmonella typhimurium and other enteric pathogens at the intestinal epithelial interface

Source: PLoS One. 2012;7(1):e29968. Epub 2012 Jan 17.

Author: Kortman GA, Boleij A, Swinkels DW, Tjalsma H

Affiliation: Department of Laboratory Medicine, Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

Abstract: Recent trials have questioned the safety of untargeted oral iron supplementation in developing regions. Excess of luminal iron could select for enteric pathogens at the expense of beneficial commensals in the human gut microflora, thereby increasing the incidence of infectious diseases. The objective of the current study was to determine the effect of high iron availability on virulence traits of prevalent enteric pathogens at the host-microbe interface. A panel of enteric bacteria was cultured under iron-limiting conditions and in the presence of increasing concentrations of ferric citrate to assess the effect on bacterial growth, epithelial adhesion, invasion, translocation and epithelial damage in vitro. Translocation and epithelial integrity experiments were performed using a transwell system in which Caco-2 cells were allowed to differentiate to a tight epithelial monolayer mimicking the intestinal epithelial barrier. Growth of Salmonella typhimurium and other enteric pathogens was increased in response to iron. Adhesion of S. typhimurium to epithelial cells markedly increased when these bacteria were pre-incubated with increasing iron concentration, whereas this was not the case for the non-pathogenic Lactobacillus plantarum. Cellular invasion and epithelial translocation of S. typhimurium followed the trend of increased adhesion. Epithelial damage was increased upon incubation with S. typhimurium or Citrobacter freundii that were pre-incubated under iron-rich conditions. In conclusion, the data of this study fit with the consensus that oral iron supplementation is not without risk as iron could, in addition to inducing pathogenic overgrowth, also increase the virulence of prevalent enteric pathogens.

Anemia, iron and vitamin B12 deficiencies after sleeve gastrectomy compared to Roux-en-Y gastric bypass: a meta-analysis.

Source: http://www.ncbi.nlm.nih.gov/pubmed/24582411

Author: Kwon Y, et al.

Affiliation: Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea.

Abstract: The effective treatment of postoperative anemia and nutritional deficiencies is critical for the successful management of bariatric patients. However, the evidence for nutritional risk or support of bariatric patients remains scarce. The aims of this study were to assess current evidence of the association between 2 methods of bariatric surgery, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), and postoperative anemia and nutritional deficiencies. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for English-language studies using a list of keywords. Reference lists from relevant review articles were also searched. In the authors' meta-analysis, they included studies with a duration of>12 months, those comparing SG with RYGB, and those with available outcome data for postoperative anemia and iron and vitamin B12 deficiencies. Of 36 potentially relevant studies, 9 met the inclusion criteria. Data were combined by means of a fixed-effects model or random-effects model. Compared with the SG group, the odds ratio for postoperative vitamin B12 deficiency in the RYGB group was 3.55. In the subgroup analysis, studies in which prophylactic iron or vitamin B12 was administered lost significance in the odds ratio for postoperative vitamin B12 deficiency. The authors' findings suggest that SG is more beneficial than RYGB with regard to postoperative vitamin B12 deficiency risk, whereas the 2 methods are comparable with regard to the risk of postoperative anemia and iron deficiency. Postoperative prophylactic iron and B12 supplementation, in addition to general multivitamin and mineral supplementation, is recommended based on the comparable deficiency risk of the 2 methods as indicated by subgroup Analysis.

Effects of daily iron supplementation in primary-school-aged children: systematic review and meta-analysis of randomized controlled trials.

Source: http://www.ncbi.nlm.nih.gov/pubmed/24130243

Author: Low M, Farrell A, Biggs BA, Pasricha SR.

Affiliation: Department of Clinical Haematology (Low), The Alfred Hospital, Prahran; Thalassaemia Service (Farrell, Pasricha), Southern Health, Clayton; Department of Medicine (Biggs, Pasricha), The Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton; Nossal Institute for Global Health (Pasricha), Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia.

Abstract: Anemia is an important public health and clinical problem. Observational studies have linked iron deficiency and anemia in children with many poor outcomes, including impaired cognitive development; however, iron supplementation, a widely used preventive and therapeutic strategy, is associated with adverse effects. Primary-school-aged children are at a critical stage in intellectual development, and optimization of their cognitive performance could have long-lasting individual and population benefits. In this study, the authors summarize the evidence for the benefits and safety of daily iron supplementation in primary-school-aged children. The authors searched electronic databases (including MEDLINE and Embase) and other sources (July 2013) for randomized and quasi-randomized controlled trials involving daily iron supplementation in children aged 5-12 years. They combined the data using random effects meta-analysis. The authors identified 16 501 studies; of these, they evaluated 76 full-text papers and included 32 studies including 7089 children. Of the included studies, 31 were conducted in low- or middle-income settings. Iron supplementation improved global cognitive scores, intelligence quotient among anemic children and measures of attention and concentration. Iron supplementation also improved age-adjusted height among all children and age-adjusted weight among anemic children. Iron supplementation reduced the risk of anemia by 50% and the risk of iron deficiency by 79%. Adherence in the trial settings was generally high. Safety data were limited. Conclusion: The authors’ analysis suggests that iron supplementation safely improves hematologic and non-hematologic outcomes among primary-school-aged children in low- or middle-income settings and is well tolerated.