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Defining optimal body iron

Published online by Cambridge University Press:  28 February 2007

James D. Cook
James D. Cook*
Affiliation:
Department of Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, Kansas 66160, USA
*
Corresponding author: Professor James D. Cook, fax +1 913 588 3996, email [email protected]
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Abstract

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The major liabilities of Fe lack include defects in psychomotor development in infants, impaired educational performance in schoolchildren, increased perinatal morbidity, and impaired work capacity. Few if any of the relevant investigations have demonstrated these abnormalities in the absence of anaemia. Consequently, adequate Fe nutrition can be defined as a normal haemoglobin concentration. On the other hand, optimal Fe nutrition should be regarded as sufficient body Fe to avoid any limitation in tissue Fe supply, termed Fe-deficient erythropoiesis. A variety of laboratory measurements have been used to identify this milder form of Fe deficiency, including serum ferritin, transferrin saturation, erythrocyte protoporphyrin, mean corpuscular volume, and more recently the concentration of the soluble fragment of transferrin receptor in serum. Recent studies indicate that the serum transferrin receptor is the preferred measurement, because enhanced synthesis of the transferrin receptor represent the initial cellular response to a declining Fe supply. Moreover, unlike other methods, it is not affected by chronic inflammation or infection which are often confused with Fe deficiency. In an otherwise normal healthy population the transferrin receptor: ferritin value provides a useful quantitative index of body Fe over a wide spectrum of Fe status, ranging from Fe repletion to Fe-deficiency anaemia. It is concluded that optimal Fe nutrition is best defined as a normal haemoglobin, serum ferritin and transferrin receptor concentration.

Keywords

Iron deficiencySerum transferrin receptor
Type
‘Optimal nutrition’
Information
Proceedings of the Nutrition Society , Volume 58 , Issue 2 , May 1999 , pp. 489 - 495
Copyright
Copyright © The Nutrition Society 1999

References

Addison, GM, Beamish, MR, Hales, CN, Hodgkins, M, Jacobs, A & Llewellin, P (1972) An immunoradiometric assay for ferritin in the serum of normal subjects and patients with iron deficiency and iron overload. Journal of Clinical Pathology 25, 326–329.Google Scholar
Allen, LH (1997) Pregnancy and iron deficiency: unresolved issues. Nutrition Reviews 55, 91–101.Google Scholar
Basta, SS, Soekirman, MS, Karyadi, D & Scrimshaw, NS (1979) Iron deficiency anemia and the productivity of adult males in Indonesia. American Journal of Clinical Nutrition 32, 916–925.Google Scholar
Baynes, RD, Skikne, BS & Cook, JD (1994) Circulating transferr in receptors and assessment of iron status. Journal of Nutritional Biochemistry 5, 322–330.CrossRefGoogle Scholar
Beguin, Y (1992) The soluble transferrin receptor: Biological aspects and clinical usefulness as quantitative measure of erythropoiesis. Haematologica 77, 1–10.Google Scholar
Beguin, Y, Grek, V, Weber, G, Sautois, B, Paquot, N, Pereira, M, Scheen, A, Lefebvre, P & Fillet, G (1997) Acute functional iron deficiency in obese subjects during a very-low-energy all-protein diet. American Journal of Clinical Nutrition 66, 75–79.Google Scholar
Bruner, AB, Joffe, A, Duggan, AK, Casella, JF & Brandt, J (1996) Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls. Lancet 348, 992–996.Google Scholar
Chwang, LC, Soemantri, AG & Pollitt, E (1988) Iron supplementation and physical growth of rural Indonesian children. American Journal of Clinical Nutrition 47, 496–501.Google Scholar
Cook, JD (1994) The effect of endurance training on iron metabolism. Seminars in Hematology 31, 146–154.Google Scholar
Cook, JD, Alvarado, J, Gutniskey, A, Jamra, M, Labardini, J, Layrisse, M, Linares, J, Loria, A, Maspes, V, Restrepo, A, Reynafarje, C, Sanchez-Medal, L, Velez, H & Viteri, F (1971) Nutritional deficiency and anemia in Latin America: a collaborative study. Blood 38, 591–603.Google Scholar
Cook, JD, Finch, CA & Smith, NJ (1976) Evaluation of the iron status of a population. Blood 48, 449–455.Google Scholar
Cook, JD, Flowers, CH & Skikne, BS (1998) An assessment of dried blood spot technology for identifying iron deficiency. Blood 92, 1807–1813.CrossRefGoogle ScholarPubMed
Cook, JD, Skikne, BS & Baynes, RD (1993) Serum transferrin receptor. Annual Review of Medicine 44, 63–74.Google Scholar
Cook, JD, Skikne, B & Baynes, R (1996) The use of the serum transferrin receptor for the assessment of iron status. In Iron Nutrition in Health and Disease, pp. 49–58 [Hallberg, L and Asp, NG, editors]. London: John Libbey & Company Ltd.Google Scholar
Davies, KJA, Donovan, CM, Refino, CJ, Brooks, GA, Packer, L & Dallman, PR (1984) Distinguishing effects of anemia and muscle iron deficiency on exercise bioenergetics in the rat. American Journal of Physiology 246, E535–E543.Google Scholar
De Andraca, I, Castillo, M & Walter, T (1997) Psychomotor development and behavior in iron-deficient anemic infants. Nutrition Reviews 55, 125–132.Google Scholar
Doyle, W, Crawford, MA, Wynn, AHA & Wynn, SW (1990) The association between maternal diet and birth dimensions. Journal of Nutrition in Medicine 1, 9–17.Google Scholar
Edgerton, VR, Gardner, GW, Ohira, Y, Gunawardena, KA & Senewiratne, B (1979) Iron-deficiency anaemia and its effect on worker productivity and activity patterns. British Medical Journal 2, 1546–1549.CrossRefGoogle ScholarPubMed
Ekblom, B (1996) Iron deficiency, anemia and physical performance. In Iron Nutrition in Health and Disease, pp. 195–203 [Hallberg, L and Asp, NG, editors]. London: John Libbey & Company Ltd.Google Scholar
Ferguson, BJ, Skikne, BS, Simpson, KM, Baynes, RD & Cook, JD (1992) Serum transferrin receptor distinguishes the anemia of chronic disease from iron deficiency anemia. Journal of Laboratory and Clinical Medicine 119, 385–390.Google Scholar
Finch, CA, Bellotti, V, Stray, S, Lipschitz, DA, Cook, JD, Pippard, MJ & Huebers, HA (1986) Plasma ferritin determination as a diagnostic tool. Western Journal of Medicine 145, 657–663.Google Scholar
Finch, CA, Miller, LR, Inamdar, AR, Person, R, Seiler, K & Mackler, B (1976) Iron deficiency in the rat. X Physiological and biochemical studies of muscle dysfunction. Journal of Clinical Investigation 58, 447–453.Google Scholar
Fleming, AF (1982) Iron deficiency in the tropics. Clinics in Haematology 11, 365–388.CrossRefGoogle ScholarPubMed
Fordy, J & Benton, D (1994) Does low iron influence psychological functioning? Journal of Human Nutrition and Dietetics 7, 127–133.Google Scholar
Garn, SM, Ridella, SA, Tetzold, AS & Falkner, F (1981) Maternal haematological levels and pregnancy outcomes. Seminars in Perinatology 5, 155–162.Google Scholar
Guyatt, GH, Patterson, C, Ali, M, Singer, J, Levine, M, Turpie, I & Meyer, R (1990) Diagnosis of iron-deficiency anemia in the elderly. American Journal of Medicine 88, 205–209.Google Scholar
Hathirat, P, Valyasevi, A, Kotchabhakdi, NJ, Rojroongwasinkul, N & Pollitt, E (1992) Effects of an iron supplementation trial on the Fe status of Thai schoolchildren. British Journal of Nutrition 68, 245–252.Google Scholar
Hemminki, E & Merilainen, J (1995) Long-term follow-up of mothers and their infants in a randomized trial on iron prophylaxis during pregnancy. American Journal of Obstetrics and Gynecology 173, 205–209.Google Scholar
Hemminki, E & Starfield, B (1978) Routine administration of iron and vitamins during pregnancy: review of controlled clinical trials. British Journal of Obstetrics and Gynaecology 85, 404–410.Google Scholar
Himes, JH, Walker, SP, Williams, S, Bennett, F & Grantham-McGregor, SM (1997) A method to estimate prevalence of iron deficiency and iron deficiency anemia in adolescent Jamaican girls. American Journal of Clinical Nutrition 65, 831–836.Google Scholar
Idjradinata, P & Pollitt, E (1993) Reversal of developmental delays in iron-deficient anaemic infants treated with iron. Lancet 341, 1–4.Google Scholar
Isah, HS, Fleming, AF, Ujah, IA & Ekwempu, CC (1985) Anaemia and iron status of pregnant and non-pregnant women in the guinea savanna of Nigeria. Annals of Tropical Medicine and Parasitology 79, 485–493.Google Scholar
Klebanoff, MA, Shiono, PH, Selby, JV, Trachtenberg, AI & Graubard, BI (1991) Anemia and spontaneous preterm birth. American Journal of Obstetrics and Gynecology 164, 59–63.Google Scholar
Kohgo, Y, Nishisato, T, Kondo, H, Tsushima, N, Niitsu, Y & Urushizaki, I (1986) Circulating transferrin receptor in human serum. British Journal of Haematology 64, 277–281.Google Scholar
Krantz, SB (1994) Pathogenesis and treatment of the anemia of chronic disease. American Journal of the Medical Sciences 307, 353–359.Google Scholar
Layrisse, M, Chaves, JF, Mendez-Castellano, , Bosch, V, Tropper, E, Bastardo, B & Gonzalez, E (1996) Early response to the effect of iron fortification in the Venezuelan population. American Journal of Clinical Nutrition 64, 903–907.Google Scholar
Leggett, BA, Brown, NN, Bryant, SJ, Duplock, L, Powell, LW & Halliday, JW (1990) Factors affecting the concentrations of ferritin in serum in a healthy Australian population. Clinical Chemistry 36, 1350–1355.Google Scholar
Levin, HM (1986) A benefit-cost analysis of nutritional programs for anaemia reduction. Research Observations 1, 219–245.Google Scholar
Lipschitz, DA (1990) The anemia of chronic disease. Journal of the American Geriatric Society 38, 1258–1264.CrossRefGoogle ScholarPubMed
Looker, AC, Dallman, PR, Carroll, MD, Gunter, EW & Johnson, CL (1997) Prevalence of iron deficiency in the United States. Journal of the American Medical Association 277, 973–976.Google Scholar
Lozoff, B, Brittenham, GM, Wolf, AW, McClish, DK, Kuhnert, PM, Jimenez, E, Jimenez, R, Mora, LA, Gomez, I & Krauskoph, D (1987) Iron deficiency anemia and iron therapy: Effects on infant developmental test performance. Pediatrics 79, 981–995.Google Scholar
Lozoff, B, Wolf, AW & Jimenez, E (1996) Iron-deficiency anemia and infant development: effects of extended oral iron therapy. Journal of Pediatrics 129, 382–389.Google Scholar
Lu, ZM, Goldenberg, R, Cliver, S, Cutter, G & Blankson, M (1991) The relationship between maternal hematocrit and pregnancy outcome. Obstetrics and Gynecology 77, 190–194.Google ScholarPubMed
Pollitt, E (1997) Iron deficiency and educational deficiency. Nutrition Reviews 55, 133–141.Google Scholar
Pollitt, E, Hathirat, P, Kotchabhakdi, NJ, Missell, L & Valyasevi, A (1989) Iron deficiency and educational achievement in Thailand. American Journal of Clinical Nutrition 50, 687–697.CrossRefGoogle ScholarPubMed
Punnonen, K, Irjala, K & Rajamaki, A (1997) Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood 89, 1052–1057.CrossRefGoogle ScholarPubMed
Scholl, TO, Hediger, ML, Fischer, RL & Shearer, JW (1992) Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study. American Journal of Clinical Nutrition 55, 985–988.Google Scholar
Shih, YJ, Baynes, RD, Hudson, BG, Flowers, CH, Skikne, BS & Cook, JD (1990) Serum transferrin receptor is a truncated form of tissue receptor. Journal of Biological Chemistry 265, 19077–19081.Google Scholar
Skikne, BS, Flowers, CH & Cook, JD (1990) Serum transferrin receptor: A quantitative measure of tissue iron deficiency. Blood 75, 1870–1876.CrossRefGoogle ScholarPubMed
Soemantri, AG, Pollitt, E & Kim, I (1985) Iron deficiency anemia and educational achievement. American Journal of Clinical Nutrition 42, 1221–1228.CrossRefGoogle ScholarPubMed
US Preventive Services Task Force (1993) Routine iron supplementation during pregnancy. Journal of the American Medical Association 270, 2846–2854.Google Scholar
Walter, T, De Andraca, I, Chadud, P & Perales, CG (1989) Iron deficiency anemia: Adverse effects on infant psychomotor development. Pediatrics 84, 7–17.Google Scholar
Worwood, M (1982) Ferritin in human tissues and serum. Clinics in Haematology 11, 275–307.Google Scholar
Zhu, YI & Haas, JD (1998) Response of serum transferrin receptor to iron supplementation in iron-depleted, nonanemic women. American Journal of Clinical Nutrition 67, 271–275.CrossRefGoogle ScholarPubMed