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FIG.\t31.2\nFingernails\twith\tcup-like\tdepressions\t(koilonychia)\tare\ta\tsign\tof\tiron\tdeficiency\tin\tadults.\n\tSource:\t(From\nHeitz\tC.\tKoilonychia.\tIn:\tFlickr\t[website].\t\t\nhttps://www.flickr.com/photos/coreyheitzmd/15023020192\n.\tApril\t14,\t2014.)\nProgressive,\tuntreated\tanemia\tresults\tin\tcardiovascular\tand\trespiratory\tchanges\tthat\tcan | [
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eventually\tlead\tto\tcardiac\tfailure.\tSome\tsocial\tand\temotional\tbehavioral\n\tsymptoms\trespond\tto\tiron\ntherapy\tbefore\tthe\tanemia\tis\tcured,\tsuggesting\tthey\tmay\tbe\tthe\tresult\tof\ttissue\tdepletion\tof\tiron-\ncontaining\tenzymes\trather\tthan\ta\tdecreased\tlevel\tof\themoglobin\t(\nsee\n\t\nPathophysiology\tand\tCare\nManagement\tAlgorithm:\n\tIron\tDeficiency\tAnemia\n). | [
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Management\tAlgorithm:\n\tIron\tDeficiency\tAnemia\n).\nAssessment\nA\tdefinitive\tdiagnosis\tof\tiron\tdeficiency\tanemia\trequires\tmore\tthan\tone\tmethod\tof\tiron\tevaluation;\nserum\tferritin,\tiron,\tand\ttransferrin\tare\tthe\tmost\tuseful.\tThe\tevaluation\talso\tshould\tinclude\tan | [
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values\tmay\tbe\twithin\tthe\tnormal\trange\tdespite\tiron\tdeficiency.\nAfter\tabsorption,\tiron\tis\ttransported\tby\tplasma\t\ntransferrin\n—a\tbeta-1\tglobulin\t(protein)\tthat\tbinds\niron\tderived\tfrom\tthe\tgastrointestinal\ttract,\tiron\tstorage\tsites,\tor\themoglobin\tbreakdown—to\tthe\nbone\tmarrow | [
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Transferrin\tmolecules\tare\tgenerated\ton\tthe\tsurface\tof\tRBCs\tin\tresponse\tto\tthe\tneed\tfor\tiron.\tWith\niron\tdeficiency,\tso\tmany\t\ntransferrin\treceptors\n\tare\ton\tthe\tcell\tsurface\tunbound\tto\tiron\tthat\tsome\tof\nthem\tbreak\toff\tand\tfloat\tin\tthe\tserum.\tTheir\tpresence\tis\tan\tearly\tsign\tof\tdeveloping\tiron\tdeficiency;\ta\nhigher\tquantity\n\tof | [
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higher\tquantity\n\tof\t\nsoluble\tserum\ttransferrin\treceptors\t(STFRs)\n\tmeans\tgreater\tdeficiency\tof\tiron.\nProgressive\tstages\tof\tiron\tdeficiency\tcan\tbe\tevaluated\tby\tmeasurements,\tas\tshown\tin\t\nTable\t31.2\n.\nTABLE\t31.2\nBiochemical\tEvaluation\tof\tIron\tDeficiency\nMeasure\nReference\nRange\nDeficiency\nSerum\tor\nplasma\nferritin\nNewborn\t25-200\nng/mL;\t25-\n200\tmcg/dL | [
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] |
Serum\tor\nplasma\nferritin\nNewborn\t25-200\nng/mL;\t25-\n200\tmcg/dL\nNeonate\t–\t5\nmos\n50-200\nng/mL;\n50-200\nmcg/dL\n6\tmos-15\tyr\n7-142\nng/mL;\t7-\n142\nmcg/dL\nF\t15\tyr\t+\t10-\n150\nng/mL;\n10-150\nmcg/dL\nM\t15\tyr\t+\n12-300\nng/mL;\n12-300\nmcg/dL\nThe\tmost\tsensitive\tindicator\tof\tiron\tdeficiency.\tLow\tlevels\tof\tferritin\nare\talso\tseen\tin\tsevere\tprotein\tdepletion. | [
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are\talso\tseen\tin\tsevere\tprotein\tdepletion.\nFemales\t–\t<\t10\tmcg/dL\nMales\t–\t<\t12\tmcg/dL\nSerum\tor\nplasma\tiron\nF\t40-150\nmcg/dL;\t7.2-\n26.9\tmmol/L\nM\t50-160\nmcg/dL;\n8.9-28.7\nmmol/L\nA\tgood\tmeasure\tof\tquantity\tof\tiron\tbound\tto\ttransferrin.\nFemales\t–\t<\t40\tmcg/dL\nMales\t–\t<50\tmcg/dL\nTotal\tiron-\nbinding\ncapacity\n(TIBC)\n250-460\tmcg/dL;\n45-82\tmmol/L | [
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0.021363064646720886,
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-0.035579614341259,
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-4.993158006905385e-33,
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0.07336843758821487,
0.04899042844772339,
0.0430937334895134,
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0.0050363256596028805,
0.03135976567864418,
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0.07294239103794098,
0.06321857869625092,
0.13675455749034882,
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0.0147261843085289,
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0.035686053335666656,
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0.049582675099372864,
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0.08967646956443787,
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0.002275957027450204,
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0.029904380440711975,
0.005662631709128618,
0.02982260286808014,
-0.018963484093546867,
0.006441797129809856,
0.006169337313622236,
0.041636500507593155,
0.05202470347285271,
0.09900540113449097,
0.04216211289167404,
0.11130417883396149,
0.1007600948214531,
0.10099196434020996,
0.040359675884246826,
-5.43350289206046e-8,
-0.025827646255493164,
0.021105578169226646,
-0.028682881966233253,
0.004479854367673397,
0.0026704201009124517,
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0.02640070579946041,
0.02712356112897396,
0.009043673053383827,
-0.03416895866394043,
0.10311953723430634,
-0.007795779965817928,
-0.0728776603937149,
-0.0368754006922245,
0.011753314174711704,
-0.014133058488368988,
-0.07872430235147476,
0.09021063148975372,
-0.020904870703816414,
-0.06936421990394592,
0.007264592684805393,
0.04979759082198143,
0.051173266023397446,
0.02076118066906929,
0.007124550174921751,
-0.05345157906413078,
-0.08853857219219208,
-0.027315793558955193,
0.017454219982028008,
0.04605266824364662,
-0.00454985536634922,
-0.060130663216114044,
0.014387397095561028,
0.025344563648104668,
0.01104857586324215,
0.0012875576503574848,
-0.06610909104347229,
0.00622093491256237,
-0.009476128965616226,
0.1426953673362732,
-0.003519912716001272,
-0.04473571479320526,
-0.047275397926568985,
0.068695068359375,
0.09948679059743881,
-0.05310337245464325,
-0.06755606830120087,
0.050236400216817856,
-0.003545904066413641,
-0.013573388569056988,
0.01206300314515829,
0.09134051948785782,
0.017397422343492508,
-0.04024498537182808,
-0.02761721797287464,
-0.008382251486182213,
-0.07912253588438034,
0.027561809867620468,
0.0035066097043454647,
0.04245837405323982,
-0.05365375801920891,
0.033392392098903656,
0.029755961149930954,
-0.05298107862472534
] |
Total\tiron-\nbinding\ncapacity\n(TIBC)\n250-460\tmcg/dL;\n45-82\tmmol/L\nTIBC\tprimarily\treflects\tliver\tfunction\tand\tis\tan\tindirect\tmeasurement\nof\ttransferrin.\nIncreases\twith\tiron-deficiency\tanemia.\nTransferrin\nsaturation\nF\t15%-50%\nM\t20%-50%\nMeasures\tthe\tiron\tsupply\tto\tthe\ttissues.\nCalculated\tby\tdividing\tserum\tiron\tby\tthe\tTIBC\tmultiplied\tby\t100. | [
-0.01897479221224785,
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0.011428424157202244,
0.011508860625326633,
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0.06235407665371895,
0.09381067007780075,
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0.01590150222182274,
0.07540509849786758,
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0.012314621359109879,
0.0488235242664814,
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0.07481127977371216,
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0.018380189314484596,
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0.00804466474801302,
0.05134602636098862,
0.09392211586236954,
0.022031795233488083,
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0.01757078617811203,
0.06641142070293427,
0.013456065207719803,
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0.12612757086753845,
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0.04159558191895485,
0.08027627319097519,
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0.11779438704252243,
0.046102505177259445,
0.07675842195749283,
0.0124670946970582,
0.06680744886398315,
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0.11359991878271103,
-0.015426709316670895,
0.007633809931576252,
0.02028932049870491,
0.04967918619513512,
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0.06473800539970398,
0.028449375182390213,
-0.06902797520160675,
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0.03165806457400322,
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0.0031500537879765034,
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0.004382715560495853,
0.03963826224207878,
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0.05416261404752731,
0.02343650348484516,
0.001178779755719006,
-0.07698008418083191,
0.005099749658256769,
0.03030235692858696,
0.09865322709083557,
0.05536048486828804,
0.045391540974378586,
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0.013448805548250675,
0.05677830055356026,
-0.04135764390230179,
-0.04046931117773056,
-0.018922150135040283,
5.427422354297601e-33,
0.05505013465881348,
0.028626343235373497,
0.018016036599874496,
0.06473810225725174,
0.030392112210392952,
0.013611741364002228,
-0.0607941709458828,
-0.0559951551258564,
0.014469022862613201,
0.07115989178419113,
-0.11413983255624771,
0.033012714236974716,
0.040131956338882446,
0.030420199036598206,
-0.00969765242189169,
-0.02127678506076336,
-0.026931481435894966,
0.04060487821698189,
-0.006949764210730791,
0.021251216530799866,
-0.012227998115122318,
0.13246747851371765,
0.022188866510987282,
0.0027570356614887714,
-0.05980487912893295,
0.04465556889772415,
-0.04905903711915016,
0.024170469492673874,
-0.039509765803813934,
0.0016672166530042887,
0.02860341966152191,
0.01880618929862976,
0.021458419039845467,
-0.06769352406263351,
-0.017565006390213966,
-0.048616718500852585,
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0.03491542115807533,
0.056246623396873474,
0.044760867953300476,
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0.07264549285173416,
0.014333369210362434,
0.07231564819812775,
0.01585983671247959,
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0.040622152388095856,
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0.039880525320768356,
0.06411240994930267,
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0.18282368779182434,
0.015468578785657883,
0.05546724423766136,
0.006708915811032057,
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0.015343879349529743,
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0.0027762935496866703,
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0.08421408385038376,
0.021449854597449303,
0.018996674567461014,
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0.029954547062516212,
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0.007947886362671852,
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0.007595655508339405,
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0.0010291730286553502,
0.02042984962463379,
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0.06104247272014618,
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0.024988243356347084,
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0.030935928225517273,
0.016745291650295258,
0.07236195355653763,
0.019607631489634514,
0.1379101723432541,
0.03620542585849762,
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0.060529835522174835,
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0.05771113187074661,
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0.09077795594930649,
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0.0012705771951004863,
0.027196234092116356,
0.09271975606679916,
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0.044748902320861816,
0.011987504549324512,
0.006435060407966375,
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0.008276506327092648,
0.025257647037506104,
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0.08965625613927841,
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0.07573600113391876,
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0.072846420109272,
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0.05311795696616173,
0.014403066597878933,
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0.05001914128661156,
0.06954164803028107,
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0.08239352703094482,
0.018606435507535934,
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0.03790770843625069,
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0.05601219832897186,
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0.04680989310145378,
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0.024020912125706673,
0.019210131838917732,
0.046005621552467346,
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0.0663987323641777,
0.009613431058824062,
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0.01733996719121933,
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0.0684841200709343,
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0.004970193840563297,
0.022823164239525795,
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0.006480403710156679,
0.006901198532432318,
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0.02622338756918907,
0.013501548208296299,
0.057908639311790466,
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0.02978341653943062,
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0.06574920564889908,
0.10424719005823135,
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0.0294253621250391,
0.0058369687758386135,
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0.01309981569647789,
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0.011196655221283436,
0.06317629665136337,
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-0.03098226711153984,
0.04395613446831703,
0.05764756351709366,
-0.07255934923887253,
-0.0977160781621933,
0.04338718205690384,
0.07144515961408615,
0.014320929534733295,
0.11749352514743805,
-0.015490196645259857,
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0.039441924542188644,
0.01791864074766636,
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-0.07712440192699432,
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0.010816209018230438,
0.03952617943286896,
-0.003610706189647317,
0.00968471821397543,
0.032137081027030945,
-0.0816509798169136,
0.05035141482949257,
-0.02343578450381756,
0.01722663827240467,
0.025070900097489357,
-0.03643089160323143,
-0.001390029676258564,
0.021390212699770927,
0.0902368500828743,
-0.10486753284931183,
-0.02598441392183304,
-0.04956097900867462,
0.09599000960588455,
0.09775210916996002,
-0.11694805324077606,
-0.02353338897228241,
0.0338410958647728,
0.03960045427083969,
-0.09136784821748734,
0.010223393328487873,
0.07082110643386841,
-0.0011448643635958433,
-0.0321633517742157,
-0.06342566758394241,
0.06948668509721756,
0.040277060121297836,
-0.019725076854228973,
-0.0018174184951931238,
0.050803281366825104,
0.004174806643277407,
0.049437981098890305,
0.03582706302404404,
-0.04897960647940636
] |
Calculated\tby\tdividing\tserum\tiron\tby\tthe\tTIBC\tmultiplied\tby\t100.\nLevels\tless\n\tthan\t16%\tare\tconsidered\tinadequate\tfor\terythropoiesis.\nSoluble\tserum\ntransferrin\nreceptor\n(STFR)\nF\t1.9-4.4\tmg/L\nM\t2.2-5\tmg/L\nSTFR\treflects\tthe\trate\tof\tred\tblood\tcell\t(RBC)\tproduction\tin\tbone\nmarrow.\tOrdered\tto\tdifferentiate\tbetween\tiron\tdeficiency\tanemia | [
0.005179535131901503,
-0.08979802578687668,
-0.019184544682502747,
-0.0025411893147975206,
-0.055662624537944794,
-0.017417481169104576,
-0.013917289674282074,
0.14410735666751862,
-0.029312269762158394,
0.032692570239305496,
0.06414365023374557,
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0.003285726998001337,
0.04772351682186127,
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0.07180346548557281,
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0.07995016127824783,
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0.011361579410731792,
0.006176966708153486,
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0.058120157569646835,
0.027185050770640373,
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0.010084674693644047,
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0.05859729275107384,
0.023541033267974854,
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0.010840043425559998,
0.04788607731461525,
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0.08426190167665482,
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marrow.\tOrdered\tto\tdifferentiate\tbetween\tiron\tdeficiency\tanemia\nand\tanemia\tof\tchronic\tdisease.\nMore\tsensitive\tthan\tserum\tferritin\tbecause\tit\tis\televated\twith\tiron\ndeficiency,\tis\twithin\tnormal\tlimits\t(WNL)\n\tin\tchronic\tdisease\tor\ninflammation,\tand\tis\tlow\twith\tiron\toverload.\nCreated\twith\tassistance\tby\tMary\tLitchford,\tPhD,\tRDN,\tLDN.\nProtoporphyrin | [
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levels\tare\taffected\tby\nchronic\tinfection\tand\tother\tfactors\tthat\tcan\tproduce\ta\tcondition\tthat\tmimics\tiron\tdeficiency\tanemia\nwhen,\tin\tfact,\tiron\tis\tadequate.\nAt\thigher\taltitudes,\twhere\tthere\tis\ta\tlower\tavailability\tof\toxygen,\thematocrit\tand\themoglobin\tlevels\nincrease\tto\tadapt\t(\nRyan\tet\tal,\t2014 | [
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increase\tto\tadapt\t(\nRyan\tet\tal,\t2014\n).\tThis\tmust\tbe\tconsidered\twhen\tassessing\tanemia.\tHigh\taltitude\nis\t4900\tto\t11,500\tfeet;\tvery\thigh\taltitude\n\tis\t11,500\tto\t18,000\tfeet;\textreme\taltitude\tis\tabove\t18,000\nfeet.\nMedical\tmanagement\nTreatment\tof\tiron\tdeficiency\tanemia\tshould\tfocus\tprimarily\ton\tthe\tunderlying\tcause,\talthough\tthis\tis | [
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same\tamount\twere\tgiven\tin\tthe\tferric\tform.\nIron\tis\tbest\tabsorbed\twhen\tthe\tstomach\tis\tempty.\tHowever,\tunder\tthese\tconditions\tit\ttends\tto\ncause\tgastric\tirritation,\twhich\tis\ta\tdirect\tresult\tof\tthe\thigh\tquantity\n\tof\tfree\tferrous\tiron\tin\tthe\nstomach.\tGastrointestinal\tside\teffects\tcan\tinclude\tnausea,\tepigastric\tdiscomfort\tand\tdistention, | [
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heartburn,\tdiarrhea,\tor\tconstipation.\tIf\tthese\tside\teffects\toccur,\tthe\tpatient\tis\ttold\tto\ttake\tthe\tiron\nwith\tmeals\tinstead\tof\ton\tan\tempty\tstomach;\thowever,\tthis\tsharply\treduces\tthe\tabsorbability\tof\tthe\niron.\tChelated\tforms\tof\tiron\t(combined\twith\tamino\tacids\tor\tKrebs\tcycle\n\tintermediaries)\tare\tmore | [
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intermediaries)\tare\tmore\nbioavailable\tthan\tnonchelated\tiron.\tChelated\tiron\tis\tless\taffected\tby\tinhibitors\tof\tiron\tabsorption,\nincluding\tphytate,\toxalate,\tphosphate,\tand\tcalcium.\tChelated\tiron,\tparticularly\tferrous\tbis\tglycinate,\ncauses\tless\tgastrointestinal\tdisturbances\tthan\telemental\tiron\tand\tit\tcan\tbe\tgiven\tin\ta\tlower\tdose\n(\nFerrari\tet\tal,\t2012 | [
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-0.03763841465115547,
-0.13208657503128052,
0.07626727968454361,
-0.021797187626361847,
0.048836272209882736,
-0.028924860060214996,
-0.03973789140582085,
0.0007690076599828899,
-0.05112509801983833,
0.049092572182416916,
0.04365723952651024,
-0.006749070715159178,
0.026205845177173615,
0.01798565499484539,
-0.016198160126805305,
0.050639353692531586,
0.047931574285030365,
0.03501961752772331,
-0.003997296094894409,
0.025560347363352776,
0.03651591017842293,
0.09810742735862732,
0.15049655735492706,
-4.288720134582036e-8,
0.041701026260852814,
-0.038990311324596405,
-0.034697506576776505,
-0.02328321523964405,
0.023092515766620636,
-0.041016217321157455,
0.036639805883169174,
0.04132483899593353,
-0.008947936818003654,
-0.055652134120464325,
0.019094349816441536,
0.09232655167579651,
-0.04459550976753235,
-0.055422015488147736,
0.11135359853506088,
0.06917315721511841,
-0.030162176117300987,
0.04430820047855377,
-0.03520302474498749,
-0.0322040319442749,
-0.03933233395218849,
0.03948044404387474,
-0.010151115246117115,
0.03355925530195236,
-0.054231125861406326,
-0.006363207474350929,
-0.03075503371655941,
-0.02003292366862297,
0.016542138531804085,
0.0015544821508228779,
0.043638940900564194,
-0.03881234675645828,
-0.006446317303925753,
-0.0461338646709919,
-0.02875417098402977,
0.046324100345373154,
-0.058620572090148926,
-0.017814477905631065,
0.002936172764748335,
0.11300338804721832,
-0.022017063573002815,
-0.03154454007744789,
-0.05227495729923248,
0.06311886012554169,
0.054496653378009796,
-0.04558827728033066,
-0.036819975823163986,
0.09532369673252106,
0.035073328763246536,
-0.08254816383123398,
-0.004623814485967159,
0.10707979649305344,
-0.004228798672556877,
-0.07169055193662643,
-0.02778114192187786,
0.03959505259990692,
0.06563839316368103,
0.023125896230340004,
-0.00016280160343740135,
0.017272839322686195,
0.06052623689174652,
0.0765749141573906,
0.10636124759912491,
-0.04264746978878975
] |
(\nFerrari\tet\tal,\t2012\n;\t\nMilman\tet\tal,\t2013\n).\tMicronutrient\tpowders\t(MNPs)\n\tcontaining\tiron\tmay\tbe\nuseful\tmethods\tof\thome\tfood\tfortification\tfor\tchildren\tunder\tage\t2\t(\nDe-Regil\tet\tal,\t2013\n).\tThe\tMNPs\ncan\tbe\tadded\tto\tsemisolid\tfoods\twithout\taffecting\tthe\tsensory\tappeal\tof\tthe\tfoods.\tVarious\tforms\tof\niron\tsupplements\tare\tdiscussed\tin\t\nTable\t31.3\n. | [
-0.04694890230894089,
-0.030616674572229385,
0.02633672207593918,
-0.027976814657449722,
-0.06249435618519783,
-0.0005267685046419501,
0.09795212000608444,
-0.005201057996600866,
-0.0018796693766489625,
0.02583914063870907,
0.14523959159851074,
-0.0658051073551178,
0.0629386305809021,
0.0214155875146389,
-0.03735712915658951,
0.012548414058983326,
0.006025776267051697,
-0.015577100217342377,
-0.04173055663704872,
-0.060029108077287674,
0.011454514227807522,
0.08005043864250183,
0.05126141384243965,
-0.02482462115585804,
0.03002997301518917,
0.04974347725510597,
-0.061202287673950195,
-0.028593871742486954,
-0.014957078732550144,
-0.037301938980817795,
-0.07007656246423721,
0.06610926240682602,
0.01828855834901333,
-0.02204023115336895,
0.09337922185659409,
0.05589820444583893,
-0.06353424489498138,
0.023499591276049614,
0.05629634112119675,
0.022310594096779823,
0.015238218009471893,
-0.10987604409456253,
-0.018160808831453323,
-0.029165763407945633,
0.056117117404937744,
-0.01488894410431385,
-0.019790489226579666,
-0.001695143524557352,
-0.026102760806679726,
-0.030991151928901672,
-0.06243368983268738,
0.02497074194252491,
-0.04338363930583,
0.08543435484170914,
0.04078403115272522,
-0.03181631863117218,
-0.021247796714305878,
-0.05671112611889839,
-0.0538768507540226,
0.009052645415067673,
-0.008567928336560726,
-0.02604639157652855,
-0.07631305605173111,
0.012996230274438858,
0.005366818979382515,
0.039487019181251526,
-0.09107793867588043,
0.01967642270028591,
-0.0028827213682234287,
0.06162913516163826,
-0.09657569974660873,
0.02663225308060646,
-0.06113022565841675,
0.12526331841945648,
-0.061649806797504425,
0.023142648860812187,
0.08049929887056351,
-0.07632956653833389,
0.019379865378141403,
-0.04485594481229782,
-0.09505978226661682,
0.05015040934085846,
0.032909076660871506,
-0.011513739824295044,
-0.029714934527873993,
0.027712684124708176,
-0.027148311957716942,
0.05602329224348068,
0.0457049123942852,
0.0058585056103765965,
0.002894500270485878,
-0.014366082847118378,
0.014359256252646446,
-0.051847003400325775,
-0.04929833114147186,
-0.05035944655537605,
-0.002728619845584035,
-0.03333958610892296,
-0.02883880026638508,
0.05159439891576767,
-0.017064224928617477,
0.00941913016140461,
-0.04426634684205055,
-0.02737160585820675,
-0.08757201582193375,
-0.017581963911652565,
-0.02647499367594719,
-0.04204666614532471,
0.07758349925279617,
0.004022980574518442,
-0.061896827071905136,
0.023333070799708366,
0.03743317350745201,
-0.07953231036663055,
-0.05044691637158394,
-0.041575316339731216,
-0.015414770692586899,
-0.008353200741112232,
0.1645662933588028,
0.050871092826128006,
0.007542245555669069,
0.01495250966399908,
-0.04952163249254227,
0.050818558782339096,
-0.03635052591562271,
0.0020771867129951715,
-0.009158246219158173,
2.8760671508065133e-33,
0.024122709408402443,
0.06591390073299408,
0.022039271891117096,
0.04731987416744232,
0.041505202651023865,
0.021331505849957466,
-0.06633098423480988,
-0.03044617734849453,
-0.028682231903076172,
0.047547996044158936,
-0.09614833444356918,
-0.053304523229599,
-0.04850415512919426,
0.06754160672426224,
-0.012816088274121284,
-0.12640966475009918,
-0.01746080443263054,
0.07449593394994736,
0.003734339727088809,
-0.001609093975275755,
-0.041605979204177856,
0.13435959815979004,
0.030681192874908447,
0.014291947707533836,
-0.07295972853899002,
-0.03881596401333809,
-0.009685076773166656,
-0.023214122280478477,
0.0513598769903183,
0.036893393844366074,
0.06084876507520676,
-0.05022231489419937,
-0.07734094560146332,
-0.02060123346745968,
-0.060418322682380676,
-0.031656015664339066,
-0.03066493384540081,
-0.024990303441882133,
0.019759895280003548,
-0.027691030874848366,
-0.06359412521123886,
0.04242587462067604,
0.006521100644022226,
0.0820685401558876,
-0.01601690612733364,
-0.003412851830944419,
0.031159786507487297,
0.0018227195832878351,
0.0004093479074072093,
-0.02646803855895996,
-0.005169741343706846,
-0.028716279193758965,
0.05753134936094284,
-0.012908725067973137,
-0.05490977689623833,
-0.00004517169145401567,
-0.008181236684322357,
0.01508354302495718,
0.0005626330384984612,
0.07651551812887192,
-0.015428557060658932,
0.0720292255282402,
0.013135302811861038,
-0.07605402171611786,
0.05613119527697563,
0.004135378170758486,
-0.09286634624004364,
-0.05140524357557297,
0.06190483272075653,
0.013326629064977169,
-0.019639011472463608,
0.032622262835502625,
0.04740893095731735,
0.006979729514569044,
0.07308060675859451,
0.004528909921646118,
0.03781542554497719,
-0.0563691109418869,
0.017769278958439827,
-0.06512444466352463,
-0.021555816754698753,
-0.05090522766113281,
-0.003469947725534439,
-0.029081914573907852,
-0.046442631632089615,
-0.02631271630525589,
0.02302311733365059,
-0.08905618637800217,
0.019725263118743896,
-0.0002049725007964298,
-0.03532261401414871,
0.03590768948197365,
-0.01039843074977398,
-0.0590328611433506,
-0.08285846561193466,
-3.028475870862377e-33,
-0.029459567740559578,
-0.01808318682014942,
-0.026968488469719887,
0.008933636359870434,
-0.037861213088035583,
-0.08054330199956894,
-0.008439787663519382,
-0.014580531045794487,
0.09791046380996704,
-0.019236041232943535,
0.062148820608854294,
0.0072162761352956295,
-0.011864504776895046,
-0.1194634661078453,
-0.03594629094004631,
0.04179548844695091,
0.02366778627038002,
0.09741796553134918,
-0.01648729480803013,
-0.05192543938755989,
-0.08041699230670929,
0.05348314717411995,
-0.0794709324836731,
0.1041683480143547,
-0.0010058763436973095,
0.06904114037752151,
0.005002064164727926,
0.023068059235811234,
0.029651327058672905,
0.01625082455575466,
0.018644869327545166,
-0.12245774269104004,
-0.041823480278253555,
0.07411743700504303,
0.01268780417740345,
0.020758749917149544,
-0.024167992174625397,
0.012817678041756153,
-0.008242876268923283,
0.012403199449181557,
0.0544557087123394,
0.00646284269168973,
0.07177206128835678,
0.03214457258582115,
-0.03931155055761337,
-0.043051883578300476,
-0.07463954389095306,
-0.06494826078414917,
-0.005017127841711044,
0.02194511890411377,
0.04621037840843201,
0.020634949207305908,
-0.06911872327327728,
-0.005413363687694073,
0.020413778722286224,
0.020298706367611885,
0.03454751893877983,
-0.06856009364128113,
-0.0487724170088768,
-0.08778316527605057,
-0.031006021425127983,
0.01980454847216606,
0.07393519580364227,
0.0420556403696537,
0.11583629250526428,
-0.07614745199680328,
-0.07756131142377853,
-0.05147594213485718,
0.012176305055618286,
-0.045837149024009705,
0.03091423213481903,
0.03336118161678314,
-0.04566149786114693,
-0.12943430244922638,
0.06202225759625435,
-0.052622903138399124,
0.042225416749715805,
-0.014117415994405746,
-0.004502193070948124,
-0.029829053208231926,
-0.07396551966667175,
-0.022010648623108864,
0.06116694211959839,
0.021295495331287384,
-0.03046538680791855,
-0.04120814427733421,
0.060743022710084915,
0.06934323161840439,
0.04971736669540405,
0.07553841173648834,
0.004428267013281584,
0.06735125184059143,
0.07974829524755478,
0.09950729459524155,
0.09864405542612076,
-5.437338401748093e-8,
-0.006554447580128908,
-0.0933438241481781,
-0.023477662354707718,
0.034623973071575165,
0.09069196879863739,
-0.028807053342461586,
0.03306709602475166,
0.013726315461099148,
0.004729379899799824,
-0.02817394770681858,
0.05213629826903343,
0.08834106475114822,
-0.08099132776260376,
-0.056152764707803726,
0.08773741871118546,
-0.03428660333156586,
0.006753131747245789,
0.07212018221616745,
-0.041838422417640686,
-0.06315692514181137,
-0.010326428338885307,
0.08155983686447144,
-0.03868279978632927,
-0.007066498044878244,
-0.012376883998513222,
0.01954275369644165,
-0.040725819766521454,
-0.01197504810988903,
0.05147719010710716,
0.05316139757633209,
0.060159824788570404,
-0.05127860605716705,
-0.020844368264079094,
-0.029269928112626076,
0.00597219355404377,
0.04826010763645172,
-0.08671620488166809,
-0.02984919771552086,
-0.03185904026031494,
0.12098637223243713,
-0.027783486992120743,
-0.027548110112547874,
-0.028654919937253,
0.08639545738697052,
0.04323715344071388,
-0.042045269161462784,
-0.08373519033193588,
0.09881920367479324,
0.0008732943679206073,
-0.04370000213384628,
-0.0069526489824056625,
0.06530589610338211,
0.036158960312604904,
-0.030174920335412025,
-0.023237207904458046,
-0.007753095589578152,
0.06434445083141327,
-0.009992288425564766,
0.04909249395132065,
0.042007096111774445,
0.05179852619767189,
0.08105523139238358,
0.0641857162117958,
-0.02143336646258831
] |
iron\tsupplements\tare\tdiscussed\tin\t\nTable\t31.3\n.\nTABLE\t31.3\nForms\tof\tIron\tSupplements\nIron\tSupplement\nAdvantages\nDisadvantages\nFerrous\tsulfate\nMost\tcommonly\tstudied\nLeast\texpensive\nMost\tconstipating\nFerrous\tgluconate\nGenerally\twell\ttolerated\twith\nfew\tgastrointestinal\tside\neffects\nCarbonyl\tiron\t(slow\tiron)\nGenerally\twell\ttolerated\twith | [
-0.010333011858165264,
-0.09681373834609985,
0.021206839010119438,
0.08489187806844711,
-0.040568575263023376,
0.026022575795650482,
0.07227471470832825,
0.006405618507415056,
-0.08604540675878525,
0.04939470440149307,
0.025625722482800484,
-0.0000797856118879281,
0.002007139613851905,
0.008628311567008495,
-0.052977364510297775,
-0.05091695860028267,
0.06477205455303192,
-0.005117554683238268,
-0.04296913743019104,
0.027535121887922287,
0.01210763305425644,
0.036514103412628174,
0.07608255743980408,
-0.004863530397415161,
-0.005292292218655348,
0.04861655458807945,
-0.055480875074863434,
-0.014547702856361866,
-0.011302953585982323,
-0.05721335858106613,
-0.1106792613863945,
0.03302847594022751,
0.044136445969343185,
-0.042355794459581375,
0.03614604100584984,
-0.004279867745935917,
-0.019681351259350777,
-0.005856812931597233,
-0.002826201729476452,
0.01913192681968212,
-0.05085388198494911,
-0.05290776491165161,
-0.006463193334639072,
0.046138279139995575,
0.03728196397423744,
-0.0727628692984581,
-0.03567960858345032,
-0.1059643104672432,
-0.013544616289436817,
0.059810273349285126,
-0.08529436588287354,
-0.033665891736745834,
-0.10615236312150955,
0.08747590333223343,
0.06848903745412827,
-0.04938313737511635,
-0.028665587306022644,
-0.06375516206026077,
-0.0767897441983223,
-0.004543558228760958,
-0.02537013217806816,
-0.046924129128456116,
-0.053495246917009354,
-0.008137914352118969,
-0.0024833546485751867,
0.10240583121776581,
-0.01680794544517994,
-0.018382173031568527,
-0.006808801554143429,
0.07274936884641647,
-0.01437344215810299,
0.036443691700696945,
-0.06844821572303772,
0.10070011764764786,
0.022742122411727905,
0.028396470472216606,
0.13113100826740265,
-0.08312857151031494,
0.017050668597221375,
0.000319873244734481,
-0.11059104651212692,
0.07663010060787201,
-0.006457395851612091,
0.041971370577812195,
-0.0022527810651808977,
0.0218290314078331,
-0.03744640201330185,
0.045132845640182495,
-0.020572690293192863,
-0.009625297971069813,
0.030650123953819275,
-0.03265271335840225,
0.034847162663936615,
-0.07782605290412903,
-0.001839456264860928,
0.02368924580514431,
-0.005303098354488611,
-0.07348235696554184,
-0.009189778007566929,
-0.028678573668003082,
-0.011892929673194885,
0.025131888687610626,
0.006184326950460672,
0.02351541444659233,
-0.04504818469285965,
-0.009685207158327103,
0.02403389848768711,
0.00139757024589926,
0.02546386420726776,
0.02917860448360443,
-0.013701745308935642,
-0.01353068370372057,
0.02641463465988636,
-0.029514309018850327,
-0.03281893581151962,
-0.03100467287003994,
-0.00874167587608099,
-0.02062203176319599,
0.12495635449886322,
0.05454638972878456,
0.0378703847527504,
-0.01587950438261032,
0.04938586428761482,
-0.006984753999859095,
-0.04783701151609421,
-0.03319459408521652,
-0.03092757798731327,
2.9789094985210243e-33,
0.030268942937254906,
0.06272456794977188,
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effects\nCarbonyl\tiron\t(slow\tiron)\nGenerally\twell\ttolerated\twith\nfew\tgastrointestinal\tside\neffects\nSlow\trate\tof\tsolubilization,\nwhich\tslows\tthe\trate\tof\nabsorption\nChelated\tiron\t(ferrous\tfumarate,\nsuccinate,\taspartate,\tand\tbis\nglycinate)\nBetter\tabsorbed\nFewer\tside\teffects\nLeast\tconstipating\nMore\texpensive | [
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Better\tabsorbed\nFewer\tside\teffects\nLeast\tconstipating\nMore\texpensive\nHealth\tprofessionals\tusually\tprescribe\toral\tiron\tthree\ttimes\tdaily\tfor\t3-6\tmonths\tto\ttreat\tiron\ndeficiency.\tDepending\ton\tthe\tseverity\tof\tthe\tanemia\tand\tthe\tpatient’s\ttolerance,\tthe\tdaily\tdose\tof | [
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elemental\tiron\trecommended\tis\t50\tto\t100\tmg\tthree\ttimes\tdaily\tfor\tadults\tand\t2-6\tmg/kg\tof\tbody\nweight\tdivided\tinto\tthree\tdoses\tper\tday\tfor\tchildren\t(\nShort\tand\tDomagalski,\t2013\n;\t\nWang,\t2016\n).\nVitamin\tC\tgiven\twith\tthe\tiron\tgreatly\tincreases\tiron\tabsorption,\tbut\tat\thigher\tdoses\tit\tmay\talso | [
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improvements\tin\tmood\tand\tappetite\tsooner.\tThe\themoglobin\tlevel\twill\tbegin\tto\tincrease\tby\tday\t4.\nIron\ttherapy\tshould\tbe\tcontinued\tfor\t4-6\n\tmonths,\teven\tafter\trestoration\tof\tnormal\themoglobin\tlevels,\nto\tallow\tfor\trepletion\tof\tbody\tiron\treserves.\tCoordination\tof\tcare\twith\ta\tphysician\tis\tessential\twith\ntherapeutic\tiron\tsupplementation. | [
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hormone\tthat\tstimulates\tblood\tcell\tproduction.\tIt\tis\tmost\toften\tgiven\tas\tiron\tdextran\n\tbut\tcan\talso\tbe\ngiven\tas\tiron\tsucrose\tor\tferric\tgluconate.\tAlthough\treplenishment\tof\tiron\tstores\tby\tthis\troute\tis\nfaster,\tit\tis\tmore\texpensive\tand\tintravenous\ttherapy\tcarries\tadditional\trisk.\nMedical\tnutrition\ttherapy | [
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Medical\tnutrition\ttherapy\nNutrition\tassessments\tand\tinterventions\tshould\tconsider\tthe\tamount\tof\tabsorbable\tdietary\tiron\nconsumed.\tA\tgood\tsource\tof\tiron\tcontains\ta\tsubstantial\tamount\tof\tiron\tin\trelation\n\tto\tits\tcalorie\ncontent\tand\tcontributes\tat\tleast\t10%\tof\tthe\trecommended\tdietary\tallowance\t(RDA)\tfor\tiron.\tLiver; | [
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kidney;\tbeef;\tdried\tfruits;\tdried\tpeas\tand\tbeans;\tnuts;\tdark\tgreen\tleafy\tvegetables;\tand\tfortified\nwhole-grain\tbreads,\tmuffins,\tcereals,\tand\tnutrition\tbars\tare\tamong\tthe\tfoods\tthat\trank\thighest\tin\niron\tcontent\t(see\t\nAppendix\t42\n).\tIt\tis\testimated\tthat\t1.8\tmg\tof\tiron\tmust\tbe\tabsorbed\tdaily\n\tto\tmeet | [
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to\tmeet\nthe\tneeds\tof\t80%\tto\t90%\tof\tadult\twomen\tand\tadolescent\tboys\tand\tgirls.\nForm\tof\tiron.\nHeme\tiron\n\t(approximately\t15%\tof\twhich\tis\tabsorbable)\tis\tthe\torganic\tform\tin\tmeat,\tfish,\tand\npoultry,\tand\tis\tknown\tas\tthe\t\nmeat-fish-poultry\t(MFP)\tfactor\n.\tIt\tis\tmuch\tbetter\tabsorbed\tthan\nnonheme\tiron.\t\nNonheme\tiron | [
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] |
.\tIt\tis\tmuch\tbetter\tabsorbed\tthan\nnonheme\tiron.\t\nNonheme\tiron\n\tcan\talso\tbe\tfound\tin\tMFP,\tas\twell\tas\tin\tlegumes,\tgrains,\tvegetables,\nherbs\tand\tfruits,\tbut\n\tit\tis\tnot\tpart\tof\tthe\theme\tmolecule.\tThe\tabsorption\trate\tof\tnonheme\tiron\tvaries\nbetween\t3%\tand\t8%\tdepending\ton\tthe\tpresence\tof\tdietary\tenhancing\tfactors,\tspecifically\tvitamin\tC | [
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Bioavailability\tof\tdietary\tiron.\nBecause\ttypical\tWestern\tdiets\tgenerally\tcontain\t6\tmg/1000\tkcal\tof\tiron,\tthe\tbioavailability\tof\tiron\tin\nthe\tdiet\tis\tmore\timportant\tin\tcorrecting\tor\tpreventing\tiron\tdeficiency\tthan\tthe\ttotal\tamount\tof\ndietary\tiron\tconsumed.\tThe\trate\tof\tabsorption\tdepends\n\ton\tthe\tiron\tstatus\tof\tthe\tindividual,\tas | [
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] |
on\tthe\tiron\tstatus\tof\tthe\tindividual,\tas\nreflected\tin\tthe\tlevel\tof\tiron\tstores.\tThe\tlower\tthe\tiron\tstores,\tthe\tgreater\tthe\trate\tof\tiron\tabsorption.\nIndividuals\twith\tiron\tdeficiency\tanemia\tabsorb\tapproximately\t20%\tto\t30%\tof\tdietary\tiron\tcompared\nwith\tthe\t5%\tto\t10%\tabsorbed\tby\tthose\twithout\tiron\tdeficiency.\nIron\toverload | [
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] |
Iron\toverload\nExcess\tiron\tis\tstored\tas\tferritin\tand\themosiderin\tin\tthe\tmacrophages\n\tof\tthe\tliver,\tspleen,\tand\tbone\nmarrow.\tThe\tbody\thas\ta\tlimited\tcapacity\tto\texcrete\tiron\tand\tis\tefficient\tat\trecycling\tit.\tApproximately\n1\tmg\tof\tiron\tis\texcreted\tdaily\tthrough\tthe\tgastrointestinal\ttract,\turinary\ttract,\tand\tskin.\tWhen\tred | [
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blood\tcells\tare\tno\tlonger\tfunctional\t(after\tabout\t120\tdays),\tthey\tare\tre-absorbed\tby\tthe\tspleen.\tIron\nfrom\tthese\tcells\tcan\tbe\trecycled\tby\tthe\tbody.\tTo\tmaintain\ta\tnormal\n\tiron\tbalance,\tthe\tdaily\tobligatory\nloss\tmust\tbe\treplaced\tby\tthe\tabsorption\tof\theme\tand\tnonheme\tfood\tiron.\tPersons\twith\tiron\toverload | [
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excrete\tincreased\tamounts\tof\tiron,\tespecially\tin\tthe\tfeces,\tto\tcompensate\tpartially\tfor\tthe\tincreased\nabsorption\tand\thigher\tstores.\nExcessive\tiron\tintake\tusually\tstems\tfrom\taccidental\tincorporation\tof\tiron\tinto\tthe\tdiet\tfrom\nenvironmental\tsources.\tIn\tthe\tUnited\n\tStates\tiron-containing\tsupplements\tremain\ta\tcommon\tsource | [
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States\tiron-containing\tsupplements\tremain\ta\tcommon\tsource\nof\texcessive\tiron\tingestion,\tespecially\tamong\tchildren\t(\nChang\tand\tRangan,\t2011\n).\tIn\tother\tparts\tof\nthe\tworld,\texcessive\tiron\tintake\tmay\tresult\tfrom\tconsumption\tof\tbeverages\tor\tfoods\tprepared\tin\tiron-\ncontaining\tcooking\tvessels\t(\nNational\tLibrary\tof\tMedicine,\t2019\n). | [
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containing\tcooking\tvessels\t(\nNational\tLibrary\tof\tMedicine,\t2019\n).\nUncommon\tdisorders\tassociated\twith\tiron\toverload\tinclude\themochromatosis,\n\tthalassemias,\nsideroblastic\tanemia,\tchronic\themolytic\tanemia,\tineffective\terythropoiesis,\ttransfusional\tiron\noverload\t(secondary\tto\tmultiple\tblood\ttransfusions),\tporphyria\tcutanea\ttarda,\taplastic\tanemia,\tand | [
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alcoholic\tcirrhosis.\t\nAplastic\tanemia\n\tis\ta\tnormochromic-normocytic\tanemia\taccompanied\tby\ta\ndeficiency\tof\tall\tthe\tformed\telements\tin\tthe\tblood;\tit\tcan\tbe\tcaused\tby\texposure\tto\ttoxic\tchemicals,\nionizing\tradiation,\tand\tmedications,\talthough\tthe\tcause\tis\toften\tunknown. | [
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Brain\tiron\tincreases\twith\tage\tand\tis\tabnormally\televated\tin\tneurodegenerative\tdiseases,\tincluding\nAlzheimer’s\tdisease\tand\tParkinson’s\tdisease\t(\nWard\tet\tal,\t2014\n).\tSeveral\tgene\tvariants\taffect\tiron\nmetabolism\tand\tmay\tcontribute\tto\tearly\tonset\tof\tthese\tconditions.\nHemochromatosis\nHereditary\themochromatosis\n\tis\ta\tgeneral | [
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age.\tMen\tare\tusually\tdiagnosed\tearlier\tthan\twomen\tbecause\tthey\thave\tno\tphysiologic\tmechanisms\nfor\tlosing\tiron\tsuch\tas\tmenstruation,\tpregnancy,\tor\tlactation.\tSymptoms\tinclude\tfatigue,\tjoint\tpain,\nand\tenlarged\tliver\tand\tspleen.\tThe\texact\tprevalence\tof\tthis\tdisorder\tis\tunknown,\n\tbut\tit\tis\tthought\tto | [
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but\tit\tis\tthought\tto\nbe\tthe\tmost\tcommon\tautosomal\trecessive\tdisorder\tin\tCaucasian\tpopulations.\tIn\tindividuals\tof\nNorthern\tEuropean\tdescent,\tit\tis\testimated\tto\thave\tan\tincidence\tof\t1\tin\t227\tpeople.\tPeople\twith\tthis\ncondition\tabsorb\tthree\ttimes\tmore\tiron\tfrom\ttheir\tfood\tthan\tthose\twithout\themochromatosis.\tThose | [
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who\thave\ttwo\taffected\tgenes\t(homozygous)\twill\tlikely\tdie\tof\tiron\toverload\tunless\tthey\tdonate\n\tblood\nfrequently.\tOtherwise,\tthe\texcessive\tiron\tabsorption\tcontinues\tunabated.\nThe\tHemochromatosis\tand\tIron\tOverload\tScreening\tStudy\t(HEIRS)\tnotes\tthat\tnon-Hispanic\twhites | [
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have\tthe\thighest\tprevalence\tof\tthe\tC282Y\tmutation\tof\tthe\thereditary\tiron\t(HFE)\tgene\tand\tthus\nhemochromatosis,\tfollowed\tby\tNative\tAmericans,\tHispanics,\tAfrican\tAmericans,\tPacific\tIslanders,\nand\tAsians\t(\nAdams,\t2015\n).\tAsians\tand\n\tPacific\tIslanders\thave\tthe\thighest\tlevels\tof\tiron\tin\ttheir\tblood | [
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Pacific\tIslanders\thave\tthe\thighest\tlevels\tof\tiron\tin\ttheir\tblood\nof\tall\tracial\tand\tethnic\tgroups,\tbut\tthey\thave\tthe\tlowest\tprevalence\tof\tthe\tgene\tmutation\tfound\twith\nthe\ttypical\tform\tof\themochromatosis.\tResults\tfrom\tthe\tHEIRS\tstudy\tsuggest\tthat\tincreased\tiron\nvalues\tin\tnon-Caucasian\tpopulations\tmay\tbe\tassociated\twith\tnon-HFE\themochromatosis\tand | [
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secondary\tiron\toverload.\nPathophysiology\nHepcidin\n\tis\ta\tpeptide\tsynthesized\tin\tthe\tliver\tthat\tfunctions\tas\tthe\tprincipal\tregulator\tof\tsystemic\niron\thomeostasis.\tIt\tregulates\tiron\ttransport\tfrom\tiron-exporting\ttissues\tinto\tplasma.\tHepcidin\ndeficiency\tunderlies\tmost\tknown\tforms\tof\thereditary\themochromatosis.\tHepcidin\tinhibits\tthe\tcellular | [
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hepatic\tstores\t(\nGanz,\t2011\n).\nHepcidin\tsynthesis\tis\tincreased\tby\tiron\tloading\tand\tdecreased\tby\tanemia\tand\thypoxia.\tIts\nsynthesis\tis\talso\tgreatly\tincreased\tduring\tinflammation,\ttrapping\tiron\tin\tmacrophages,\tdecreasing\nplasma\tiron\tconcentrations,\tand\tcausing\tiron-restricted\terythropoiesis\tthat\tis\tcharacteristic\tof | [
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hepatomegaly,\tskin\tpigmentation,\tarthritis,\theart\tdisease,\thypogonadism,\tdiabetes\tmellitus,\tand\ncancer.\tIndividuals\twith\tabnormally\thigh\tiron\tlevels\tare\tmore\tlikely\tto\tdevelop\tcancer\tof\n\tthe\tcolon.\nIron\tis\ta\tprooxidant\tthat\tcan\tbe\tused\tfor\ttumor\tcell\tgrowth\tand\tproliferation.\tThere\talso\tseems\tto\tbe | [
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increased\trisk\tfor\tage-related\tmacular\tdegeneration,\tAlzheimer’s\tdisease,\tand\tParkinson’s\tdisease\nbecause\tof\tthe\toxidative\tdamage\tassociated\twith\tiron\toverload\t(\nBelaidi\tand\tBush,\t2016\n;\t\nFleming\tand\nPonka,\t2012\n).\nAssessment\nIf\tan\tiron\toverload\tis\tsuspected,\tserum\tferritin\tlevel\t(storage\n\tiron)\tand\tpercent\tof\ttransferrin | [
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iron)\tand\tpercent\tof\ttransferrin\nsaturation\t([serum\tiron/TIBC]\t×\t100)\tshould\tbe\tperformed\t(\nBacon\tet\tal,\t2011\n).\tIron\toverload\tmay\tbe\npresent\tif\tthe\ttransferrin\tsaturation\tis\tgreater\tthan\tor\tequal\tto\t45%\tand\tif\tthe\tserum\tferritin\tlevel\tis\nelevated.\tIf\ttransferrin\tsaturation\tand\tferritin\tlevels\tare\televated,\tHFE\tmutation\tanalysis\tis\nrecommended. | [
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recommended.\nMedical\tmanagement\nThe\tpatient\twith\tiron\toverload\n\tmay\tsimultaneously\tbe\tanemic\tas\ta\tresult\tof\tdamage\tto\tthe\tbone\nmarrow,\tan\tinflammatory\tdisorder,\tcancer,\tinternal\tbleeding,\tor\tchronic\tinfection.\tIron\tsupplements\nshould\tnot\tbe\ttaken\tuntil\tthe\tcause\tis\tknown. | [
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should\tnot\tbe\ttaken\tuntil\tthe\tcause\tis\tknown.\nFor\tpatients\twith\tsignificant\tiron\toverload,\tweekly\tphlebotomy\tfor\t2\tto\t3\tyears\tmay\tbe\trequired\tto\neliminate\tall\texcess\tiron\t(\nBacon\tet\tal,\t2011\n).\tTreatment\tfor\tnoninherited\tforms\tof\tsecondary\n\tiron\noverload\talso\tmay\tinvolve\tiron\tdepletion\twith\tintravenous\tdeferoxamine\tor\toral\tdeferasirox, | [
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chelating\tagents\tthat\tare\texcreted\tby\tthe\tkidneys,\tor\twith\tcalcium\tdisodium\nethylenediaminetetraacetic\tacid\t(EDTA).\tMorbidity\tand\tmortality\tare\treduced\tif\texcess\tbody\tiron\tis\nremoved\tby\tphlebotomy\ttherapy\tbefore\thepatic\tcirrhosis\tor\tdiabetes\tdevelops.\nMedical\tnutrition\ttherapy\nIndividuals\twith | [
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Medical\tnutrition\ttherapy\nIndividuals\twith\n\tiron\toverload\tshould\treduce\tmeat,\tfish\tand\tpoultry\tand\tconsume\tmore\tof\ta\tplant\nbased\tor\tvegetarian\tdiet.\tReduced\tvitamin\tC\tis\trecommended\tas\twell\tas\tavoidance\tof\tvitamin\tC\nsupplements,\tas\tthis\tcan\tincrease\tabsorption\tof\tiron. | [
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supplements,\tas\tthis\tcan\tincrease\tabsorption\tof\tiron.\nAffected\tpersons\tshould\tavoid\tfoods\tthat\tare\tfortified\twith\tiron\t(i.e.,\tbreakfast\tcereals,\tenergy\tor\nsports\tbars,\tand\tmeal-replacement\tdrinks\tor\tshakes).\tThey\tshould\talso\n\tavoid\tiron\tsupplements\tor\nmultiple\tvitamin\tand\tmineral\tsupplements\tthat\tcontain\tiron.\tThe\tRDA\tfor\tiron\tshould\tnot\tbe | [
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and\ttheir\tprecursors\tin\tthe\tblood\tand\nbone\tmarrow.\tThis\tanemia\tis\tcharacterized\tby\tthe\tpresence\tof\tlarge,\timmature,\tabnormal,\tRBC\nprogenitors\tin\tthe\tbone\tmarrow;\t95%\tof\tcases\tare\tattributable\tto\tfolate\tor\tvitamin\tB\n12\n\tdeficiency.\nTwo\tdisorders\tof\tcobalamin\tmetabolism\tarise\tfrom\tmutations\tof\tthe\tmethionine\tsynthase\tand | [
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] |
methionine\tsynthase\treductase\tgenes;\tthese\tdisorders\tfeature\tmegaloblastic\tanemia\n\tand\tneurologic\nmanifestations\t(see\t\nChapter\t6\n).\nBoth\tvitamins\tare\tessential\tto\tthe\tsynthesis\tof\tnucleoproteins.\tHematologic\tchanges\tare\tthe\tsame\nfor\tboth;\thowever,\tthe\tfolic\tacid\tdeficiency\tis\tthe\tfirst\tto\tappear.\tNormal\tbody\tfolate\tstores\tare | [
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] |
depleted\twithin\t2\tto\t4\tmonths\tin\tindividuals\tconsuming\tfolate-deficient\tdiets.\tBy\tcontrast,\tvitamin\nB\n12\n\tstores\tare\tdepleted\tonly\tafter\tseveral\tyears\tof\n\ta\tvitamin\tB\n12\n–deficient\tdiet.\tIn\tpersons\twith\nvitamin\tB\n12\n\tdeficiency,\tfolic\tacid\tsupplementation\tcan\tmask\tB\n12\n\tdeficiency\t(\nFig.\t31.3\n). | [
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FIG.\t31.3\nSequential\tstages\tof\tvitamin\tB\n12\n\tstatus.\n\tSource:\t(From\tHerbert\tV:\tStaging\tvitamin\tB\n12\n.\tIn\tZiegler\tEE,\tFiler\tLJ,\neditors:\t\nPresent\tknowledge\tin\tnutrition,\n\ted\t7,\tWashington,\tDC,\t1996,\tInternational\tLife\tSciences\tInstitute\tPress.)\nIn\tcorrecting\tthe\tanemia,\tthe\tvitamin\tB\n12\n\tdeficiency\tmay\tremain\tundetected,\tleading\tto\tthe | [
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12\n\tdeficiency\tmay\tremain\tundetected,\tleading\tto\tthe\nirreversible\tneuropsychiatric\tdamage\tthat\tis\tcorrected\tonly\twith\n\tB\n12\n\tsupplementation\t(see\t\nChapter\n41\n).\nFolate-deficiency\tanemia\nEtiology\nFolate\tis\ta\tnaturally\toccurring\tB\tvitamin\tfound\tin\tfoods\tin\tthe\ttetrahydrofolate\t(THF)\tform.\tFolic\tacid | [
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and\tincreased\trequirements\tresulting\tfrom\tpregnancy\tor\tgrowth.\tFolate-deficiency\tanemia\tcan\taffect\npregnant\twomen\tand\toccurs\tin\tinfants\tborn\tto\tmothers\twith\tfolate\tdeficiency.\tFolate\tdeficiency\tin\nearly\tpregnancy\tcan\tresult\tin\tan\tinfant\tborn\twith\ta\tneural\ttube\tdefect\t(see\t\nChapter\t14\n).\tOther\ncauses\tare\tintestinal | [
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] |
Chapter\t14\n).\tOther\ncauses\tare\tintestinal\n\tdisorders\tresulting\tin\tmalabsorption\t(celiac\tdisease,\ttropical\tsprue,\tand\ninflammatory\tbowel\tdisease),\tuse\tof\tcertain\tdrugs\t(anticonvulsants,\tbarbiturates,\tcycloserine,\nsulfasalazine,\tcholestyramine,\tand\tmetformin),\tamino\tacid\texcess\t(glycine\tand\tmethionine),\tand\nalcohol. | [
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] |
alcohol.\nBecause\talcohol\tinterferes\twith\tthe\tfolate\tenterohepatic\tcycle,\tmost\tpeople\twith\talcoholism\thave\ta\nnegative\tfolate\tbalance\n\tor\ta\tfolate\tdeficiency.\tAlcoholics\tconstitute\tthe\tonly\tgroup\tthat\tgenerally\thas\nall\tsix\tcauses\tof\tfolate\tdeficiency\tsimultaneously:\tinadequate\tingestion,\tabsorption,\tand\tuse,\tand | [
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] |
increased\texcretion,\trequirement,\tand\tdestruction\tof\tfolate\t(see\t\nChapter\t28\n).\t\nBox\t31.2\n\tdescribes\tthe\ncauses\tof\tfolate\tdeficiency.\nBOX\t31.2\nCauses\tof\tFolate\tDeficiency | [
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Inadequate\nIngestion\nPoor\tdiet\t(lack\tof\n\tor\tovercooked\tfruits\tand\tvegetables),\tvitamin\tB\n12\n\tor\tvitamin\tC\ndeficiency,\tchronic\talcoholism\nInadequate\nAbsorption\nCeliac\tdisease,\ttropical\tsprue,\tdrug\tinteractions,\tcongenital\tdefects\nInadequate\nUtilization\nAntagonists,\tanticonvulsants,\tenzyme\tdeficiency,\tvitamin\tB\n12\n\tand\tvitamin\tC\tdeficiency, | [
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12\n\tand\tvitamin\tC\tdeficiency,\nchronic\talcoholism,\texcess\tglycine\tand\tmethionine\nIncreased\nRequireme\nnt\nExtra\ttissue\tdemand,\tinfancy,\n\tincreased\thematopoiesis,\tincreased\tmetabolic\tactivity,\nLesch-Nyhan\tsyndrome,\tdrugs\nIncreased\nExcretion\nVitamin\tB\n12\n\tdeficiency,\tliver\tdisease,\tkidney\tdialysis,\tchronic\texfoliative\tdermatitis\nIncreased\nDestruction | [
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] |
Increased\nDestruction\nDietary\toxidants\nModified\tfrom\tHerbert\tV,\tDas\tKC:\tFolic\tacid\tand\tvitamin\tB\n12\n.\tIn\tShils\tME\tet\tal,\teditors:\t\nModern\tnutrition\nin\thealth\tand\tdisease\n,\ted\t8,\tvol\t1,\tPhiladelphia,\n\t1994,\tLea\t&\tFebiger.\nBOX\t31.3\nCauses\tof\tVitamin\tB\n12\n\t\nDeficiency\nInadequate\ningestion | [
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0.007718352135270834,
0.10129061341285706,
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0.05009011924266815,
0.016960350796580315
] |
BOX\t31.3\nCauses\tof\tVitamin\tB\n12\n\t\nDeficiency\nInadequate\ningestion\nPoor\tdiet\tresulting\tfrom\ta\tvegan\tdiet\tand\tlack\tof\tsupplementation,\tchronic\talcoholism,\npoverty\nInadequate\nabsorption\nGastric\tdisorders,\tsmall\tintestinal\tdisorders,\tcompetition\tfor\tabsorption\tsites,\tpancreatic\ndisease,\tHIV,\tor\tAIDS,\tgastritis,\tgastric\tsurgery\nInadequate\nuse\nVitamin\tB | [
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0.004540266003459692,
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0.09348776936531067,
0.009277626872062683,
0.016339074820280075,
0.011302076280117035,
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0.031989529728889465,
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0.01441981177777052,
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0.08412150293588638,
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] |
Inadequate\nuse\nVitamin\tB\n12\n\tantagonists,\n\tcongenital\tor\tacquired\tenzyme\tdeficiency,\tabnormal\tbinding\nproteins\nIncreased\nrequiremen\nt\nHyperthyroidism,\tincreased\thematopoiesis\nIncreased\nexcretion\nInadequate\tvitamin\tB\n12\n\tbinding\tprotein,\tliver\tdisease,\trenal\tdisease\nIncreased\ndestruction | [
0.03617841377854347,
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0.05387106165289879,
0.023573003709316254,
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0.08246459066867828,
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binding\tprotein,\tliver\tdisease,\trenal\tdisease\nIncreased\ndestruction\nPharmacologic\tdoses\tof\tascorbic\tacid\twhen\tit\tfunctions\tas\ta\tprooxidant\nMedication\ninduced\nDrugs\tthat\tsuppress\tgastric\tacid\tand\tmetformin\thave\tbeen\n\tassociated\twith\tB\n12\ndeficiency\nAIDS,\n\tAcquired\timmune\tdeficiency\tsyndrome;\t\nHIV,\n\thuman\timmunodeficiency\tvirus. | [
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HIV,\n\thuman\timmunodeficiency\tvirus.\nFolate\tabsorption\ttakes\tplace\tin\tthe\tsmall\tintestine.\tEnzyme\tconjugases\t(e.g.,\tpteroylpolyglutamate\nhydrolase,\tthe\tfolate\tconjugase),\tfound\tin\tthe\tbrush\tborder\tof\tthe\tsmall\tintestine,\thydrolyze\tthe\npolyglutamates\tto\tmonoglutamates\tand\treduce\tthem\tto\tdihydrofolate\tand\ttetrahydrofolic\n\tacid | [
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acid\n(THFA)\tin\tthe\tsmall\tintestinal\tepithelial\tcells\t(enterocytes).\tFrom\tthe\tenterocytes\tthese\tforms\tare\ntransported\tto\tthe\tcirculation,\twhere\tthey\tare\tbound\tto\tprotein\tand\ttransported\tas\tmethyl\tTHFA\tinto\nthe\tcells\tof\tthe\tbody.\nIn\tthe\tabsence\tof\tvitamin\tB\n12\n,\t5-methyl\tTHFA,\tthe\tmajor\tcirculating\tand\tstorage\tform\tof\tfolic\tacid, | [
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] |
deoxyuridylate\tto\tthymidylate,\twhich\tis\tnecessary\tfor\tDNA\tsynthesis.\nMTHFR\tallele.\nA\tgenetic\tdefect\tfound\tin\t25%\tof\tHispanics,\t10%\tof\tCaucasians\tand\tAsians,\tand\t1%\tof\tAfrican\nAmericans\n\tis\tthe\tmethylenetetrahydrofolate\treductase\t(MTHFR)\tdeficiency\t(National\tInstitutes\tof\nHealth,\tOffice\tof\tDietary\tSupplements,\t2018)\t(see\t\nChapter\t6 | [
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] |
Health,\tOffice\tof\tDietary\tSupplements,\t2018)\t(see\t\nChapter\t6\n).\tThe\tallele\tis\tproblematic\tin\tpregnancy\nand\tmay\tcontribute\tto\tmiscarriages,\tanencephaly,\tor\tneural\tdefects\t(see\t\nChapter\t14\n).\tBecause\nMTHFR\tirreversibly\treduces\t5,10-methylenetetrahydrofolate\tto\t5-methyltetrahydrofolate,\tits\ndeficiency\tmay\tresult\tin | [
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metabolically\tuseless\tform\tof\t5-methyl\tTHFA\t(\nFig.\t31.4\n).\tThe\tlack\tof\tvitamin\tB\n12\n\tto\tremove\tthe\t5-\nmethyl\tunit\tmeans\tthat\n\tmetabolically\tinactive\tmethyl\tTHFA\tis\ttrapped.\tIt\tcannot\trelease\tits\t1-carbon | [
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12\n\tcan\tresult\tin\ta\tdeficiency\tof\tfolic\tacid\tbecause\tfolate\tis\ntrapped\tin\tthe\tform\tof\t5-methyltetrahydrofolate\t(5-methyl\tTHFA),\twhich\tcannot\tbe\tconverted\tto\tTHFA\tand\nmethyl\tgroups\tdonated\tby\tthe\tvitamin\tB\n12\n–dependent\tpathway.\t\nDNA,\n\tDeoxyribonucleic\tacid;\t\nTHFA\n,\ntetrahydrofolic\tacid.\nPathophysiology\nFolate\tdeficiency\tdevelops\tin\tfour\tstages: | [
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Pathophysiology\nFolate\tdeficiency\tdevelops\tin\tfour\tstages:\n\ttwo\tthat\tinvolve\tdepletion,\tfollowed\tby\ttwo\tmarked\tby\ndeficiency\t(\nFig.\t31.5\n):\nStage\t1:\tCharacterized\tby\tearly\tnegative\tfolate\tbalance\t(serum\tdepletion\tto\tless\tthan\t3\tng/mL)\nStage\t2:\tCharacterized\tby\tnegative\tfolate\tbalance\t(cell\tdepletion),\twith\ta\tdecrease\tin | [
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hypersegmentation,\tand\tmacroovalocytic\tred\tcells.\nStage\t4:\tCharacterized\tby\tclinical\tfolate-deficiency\tanemia,\twith\tan\televated\tMCV\tand\nanemia. | [
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FIG.\t31.5\nSequential\tstages\tof\tfolate\tstatus.\t\ndU,\n\tDeoxyuridine;\t\nMCV\n,\tmean\tcorpuscular\tvolume;\t\nRBC,\n\tred\nblood\tcell.\n\tSource:\t(From\tHerbert\tV:\tFolic\tacid.\tIn\tShils\tME\tet\tal,\teditors:\t\nModern\tnutrition\tin\thealth\tand\tdisease\n,\ted\t9,\nPhiladelphia\t1998,\tLea\t&\tFebiger.) | [
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,\ted\t9,\nPhiladelphia\t1998,\tLea\t&\tFebiger.)\nBecause\tof\ttheir\tinterrelated\troles\tin\tthe\tsynthesis\tof\tthymidylate\tin\tDNA\tformation,\ta\tdeficiency\tof\neither\tvitamin\tB\n12\n\tor\tfolate\n\tresults\tin\ta\tmegaloblastic\tanemia.\tThe\timmature\tnuclei\tdo\tnot\tmature\nproperly\tin\tthe\tdeficient\tstate;\tand\tlarge\t(macrocytic),\timmature\t(megaloblastic)\tRBCs\tare\tthe | [
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] |
result.\tThe\tcommon\tclinical\tsigns\tof\tfolate\tdeficiency\tinclude\tfatigue,\tdyspnea,\tsore\ttongue,\ndiarrhea,\tirritability,\tforgetfulness,\tanorexia,\tglossitis,\tand\tweight\tloss.\nNormal\tbody\tfolate\tstores\tare\tdepleted\twithin\t2\tto\t4\tmonths\n\ton\ta\tfolate-deficient\tdiet,\tresulting\tin | [
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