Iron deficiency is the most prevalent nutrient deficiency in the world, leading to long-term developmental and health consequences in populations at risk. Also known as prebiotics, non-digestible oligosaccharides such as fructooligosaccharide (FOS), inulin, galactooligosaccharide (GOS) and lactulose resist digestion by gastric acid and pancreatic enzymes in vivo, but are preferentially fermented by beneficial intestinal bacteria once they reach the colon. Prebiotics have been shown to increase the absorption of minerals such as iron from diets, but results from studies reported in the literature at times are contradictory, and mechanisms involved are still unclear. A better understanding of the role of FOS and other prebiotics in iron absorption may lead to new dietary modification strategies to increase intake of iron absorption enhancers in plant-based diets. The objectives of this study were therefore to determine the effects of prolonged FOS, as well as Synergy 1 (a combination of long- and short-chain FOS), inulin, GOS and lactulose supplementation on iron status of anemic rats; and to assess the enhancing effects of FOS on iron absorption and elucidate the regulatory mechanism involved using the Caco-2 cell culture model. In our animal studies, male Sprague-Dawley rats were first fed a low-iron diet for 14 days prior to prebiotics supplementation to achieve an iron-deficient status. Rats receiving the low-iron diet (12 ppm Fe) showed significantly lower non-heme iron concentrations in liver, spleen and kidney, as well as lower hemoglobin level than rats receiving a normal diet (45 ppm Fe), confirming iron-deficiency anemia. At the onset of the feeding trials, anemic rats were further divided into groups with or without supplementation of prebiotics. Prebiotics were provided to the rats by dissolving in water at 5% (w/v). Rats were kept on their respective test diets for 28 or 35 days, and all had free access to food and water during the feeding trials. The results showed significantly higher hemoglobin and non-heme iron levels in anemic rats with FOS or GOS supplementation, suggesting that both FOS and GOS could have positive effects on the iron status of anemic subjects with a low-iron intake. Rat colon contents also showed significant changes in short-chain fatty acid (SCFA) concentrations, presumably due to fermentation of prebiotics by intestinal microflora. Changes in the expression of Duodenal cytochrome b (Dcytb) and Divalent metal transporter 1 (DMT-1) in Caco-2 cells were measured by Western Blot and Real Time PCR. Our results confirmed that Caco-2 cells 14 days post confluence provided a stable research model for gene expression studies related to iron absorption. At low iron level, especially with FOS or SCFA supplementation, Dcytb and DMT-1 expression levels were increased in Caco-2 cells. While at high iron level, expression of Dcytb or DMT-1 was mostly down-regulated. Effects of SCFA were much more pronounced than FOS at different iron concentrations, suggesting that any effects of dietary FOS on improving iron status would require fermentation by the intestinal microflora. Further studies on other prebiotics (e.g., GOS and lactulose) and different combinations of SCFA are warranted.

Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 69-79).

Thesis (M.Sc. (Food and Nutrition for Development))--Mahidol University, 1999.

Introdução: A anemia é uma complicação comum em pacientes com câncer, especialmente naqueles em quimioterapia (QT). Existem poucas estratégias de tratamento para combater a anemia associada ao câncer (AAC). No entanto, pouco tem sido explorado em relação ao efeito do ferro intravenoso (IV) como uma estratégia única para o controle e tratamento da anemia. Objetivos: avaliar a efetividade da suplementação de ferro IV na prevenção da anemia em pacientes submetidos à QT para câncer de mama (CM) não metastático. O objetivo secundário foi a eficácia do Fe IV na redução da necessidade de uso de agentes estimuladores de eritropoiese (AEE) e transfusão de sangue. Métodos: Estudo prospectivo, randomizado, aberto, que incluiu 45 pacientes com CM submetidas a quimioterapia neo ou adjuvante. As pacientes foram selecionadas para o grupo de tratamento com Fe IV nos primeiros 4 ciclos de QT ou para o grupo controle (GC), de maio/10 a setembro/15. Resultados: Todos os parâmetros basais, como nível de hemoglobina (Hb), funções hepática e renal e do metabolismo do ferro, estavam dentro dos valores de referência. Houve redução da Hb inicial em 70% dos pacientes no grupo do Fe e em 82,6% nos pacientes no GC (p não significativo). No entanto, embora a queda de Hb tenha ocorrido, o nível mais baixo foi de 9,4, e nenhuma transfusão de sangue ou o uso de AEE foi necessário. Além disso, houve um bom perfil de tolerância no braço investigacional. Conclusão: A suplementação de Fe IV não foi eficaz na prevenção de AAC no presente estudo. No entanto, esse resultado não invalida novos estudos em diferentes populações e/ou com diferentes esquemas que explorem essa estratégia de tratamento / Introduction: Anemia is a common complication in cancer patients, especially those on chemotherapy (CT). There are few treatment strategies to combat cancer-associated anemia (CAA). However, little has been explored regarding the effect of intravenous (IV) iron as a unique strategy for the control and treatment of anemia. Objectives: to evaluate the effectiveness of iron supplementation in the prevention of anemia in patients undergoing CT for non-metastatic breast cancer. The secondary endpoint was the effectiveness of iron in reducing the need for ESA use and blood transfusion. Methods: A prospective, randomized, open-label study including 45 BC patients undergoing neo or adjuvant chemotherapy. Patients were selected for the IV iron treatment group in the first 4 cycles of CT or for the control group, from May/10 to September/15. Results: All baseline parameters as hemoglobin (Hb) level, liver functions and renal and the iron metabolism, were within normal reference values. There was a reduction in initial Hb in 70% of patients in the iron group and in 82.6% in patients without iron. However, even though the Hb drop occurred, the lowest level was 9.4, and no blood transfusion or ESA was required in any of the cases. In addition, there was a good tolerance profile in the investigation arm. Conclusion: IV iron supplementation was not effective in the prevention of CAA in the present study. However, this result does not invalidate further studies in different populations and with different schedules that explore this treatment strategy

Orientador: Ana Maria Segall Correa / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T13:52:08Z (GMT). No. of bitstreams: 1 Nejar_FabiolaFigueiredo_D.pdf: 2860289 bytes, checksum: 520efe4425aa2a5d56c60de1053695d8 (MD5) Previous issue date: 2007 / Resumo: O presente estudo analisou os fatores associados à anemia infantil e materna, tempo de clampeamento do cordão umbilical e duração do aleitamento materno exclusivo. Utilizou-se uma coorte com 513 crianças, selecionadas no Hospital Estadual de Sumaré, avaliadas em dois momentos (parto/alta e seguimento aos 150 dias). Encontramos 16,9% das mulheres que apresentaram anemia durante a gestação, porém essa proporção é bem menor após 150 dias do parto (1,7%). Já a análise do sangue de cordão mostrou apenas 2,1% de exames com hemoglobina menor que 11g/dl e, aos 150 dias de vida da criança, encontramos 49% de anemia. Sobre o tempo de clampeamento do cordão encontramos um tempo médio de 18,5 segundos, sendo que apenas 3,7% dos clampeamentos aconteceram com mais de um minuto. Sobre o padrão de aleitamento materno os dados mostram que 72,9% mamavam no peito, porém de maneira exclusiva essa proporção é de 6,1%. A presença de leite materno de forma exclusiva teve ação protetora contra anemia ferropriva nas crianças estudadas. Consumir alimentos da família também comprometeu o nível de hemoglobina da criança. Observamos associação entre anemia nas crianças aos 150 dias de vida e prematuridade e/ou baixo peso ao nascer. Diversos estudos epidemiológicos demonstram a forte relação entre tempo de clampeamento do cordão umbilical e a concentração de hemoglobina, contudo neste estudo não encontramos esta associação provavelmente pelo pequeno número de casos de clampeamento com tempo adequado (maior ou igual a 1 minuto) / Abstract: The aim of this study was to analyze the associ ation of infant anemia and anemia of the mother, length of umbilical cord clamping and length of exclusive breastfeeding. A cohort of 513 infants pairs recruited in Sumare Hospital were followed-up to 6 months of age, with hematological evaluations at delivery and at age of 150 days after birth. Mother interviews were performance at the day before hospital discharge and at 150 days after delivery. At delivery there were 16.9% mothers with anem ia, decreasing 150 days later to 1.7%. Just 2.1% of umbilical cord blood analyses had hemoglobin lower than 11g/dl and at 150 days of life 49% of infants had anemia. The mean length of clamping was 18.5 seconds and in just 3.7% was over 1 minute. At the 150 day, there was 72.9% of breast feeding but just 6,1 was exclusive. Infant anemia at 150 days was associated to prematur ity and /or low weight at birth. Several epidemiological studies point out a strong association between length of clamping and the hemoglobin concentration, but this research failed to observe this association provably due to the small number of cases with sufficient length of clamping.The high prevalence of infant anemia demands that the clamping length must be equal or greater than 1 minute, and observed by all hospital in our region / Doutorado / Epidemiologia / Doutor em Saude Coletiva

<p>Anemija predstavlja problem svetskih razmera sa značajnim zdravstvenim, socijalnim i ekonomskim konsekvencama. Iako je pre mnogo godina prepoznata kao javnozdravstveni problem, malo je učinjeno u uspostavljanju kontrole anemije i prevalenca je ostala neprihvatljivo visoka. Deficit gvožđa predstavlja najče&scaron;ći uzrok anemije, deca uzrasta od 6-24 meseca i adolescenti predstavljaju vulnerabilne grupe. Hepcidin je peptidni hormon niske molekularne težine koji ima ključnu ulogu u metabolizmu gvožđa. Cilj istraživanja je bio da se odredi serumska koncentracija hepcidina kod dece uzrasta od 6 meseci do 2 godine i adolescenata uzrasta od 11 do 19 godina koji boluju od sideropenijske anemije i uporedi sa serumskim koncentracijama hepcidina u kontrolnim grupama, kao i da se utvrdi njegova povezanost sa parametrima metabolizma gvožđa. Ispitivanjem je obuhvaćeno ukupno 173 ispitanika, 89 ispitanika koji su bolovali od sideropenijske anemije i 84 ispitanika koji nisu bolovali od sideropenijske anemije i koji su predstavljali kontrolnu grupu. Svim ispitanicima je venepunkcijom uzorkovana krv za određivanje kompletne krvne slike i prametara metabolizma gvožđa. ELISA metodom je određen nivo hepcidina u serumu. Ispitivanjem je utvrđeno da je koncentracija hepcidina statistički značajno niža u dece i adolescenata koji boluju od sideropenijske anemije u poređenju sa decom i adolescentima koji ne boluju od sideropenijske anemije. Potvrđena je pozitivna korelacija između koncentarcije serumskog hepcidina i gvožđa u serumu, feritina, srednjeg volumena eritrocita i saturacije transferina, a negativna korelacija između koncentracije serumskog hepcidina i transferina i broja retikulocita. Koncentracija transferina i nezasićeni kapacitet vezivanja gvožđa, ukupni kapacitet za vezivanje gvožđa i broj retikulocita su međusobno u pozitivnoj korelaciji, a korelacija koncentracije transferina sa parametrima saturacija transferina, koncentracije gvožđa i hemoglobina je negativna. Na vrednost serumskog hepcidina ne utiču niti pol niti uzrast ispitanika &scaron;to ga čini senzitivnijim pokazateljem stanja gvožđa u organizmu i pouzdanijim biolo&scaron;kim markerom u dijagnostici sideropenijske anemije.</p> / <p>Anemia represents a worldwide problem which leads to substantial health, social and economic issues. Although it was identified as a common health problem many years ago, not a lot has been done in controlling anemia and its prevalence has stayed unacceptably high. The iron deficit is the most frequent cause of anemia, 6-24 month-old children and adolescents are vulnerable groups. Hepcidin is a peptide hormone of a low molecular weight which has a main role in the iron metabolism. The aim of the research was to determine the serum concentration of hepcidin in children aged from 6 months to 2 years and in adolescents from the age of 11 to 19 which suffer from iron deficiency anemia and compare it with the serum concentration of hepcidin in the control groups, as well as to determine its connection with the parameters of the iron metabolism. The research included 173 examinees, 89 of them suffered from iron deficiency anemia and 84 did not suffer from iron deficiency anemia. The latter represented the control group. All the examinees had their blood sampled intravenously in order for full blood count results and parameters of iron metabolism to be determined. Also, ELISA method was used for establishing the level of hepcidin in the serum. The research showed that the concentration of hepticin is statistically lower in children and adolescents who suffer from iron deficiency anemia in comparison with children and adolescents who do not have this condition. The positive correlation between the level of serum hepcidin and iron in the serum, ferritin, the medium volume of erythrocytes and transferrin saturation was confirmed but the negative one occurred in the level of the serum hepcidin, transferrin and reticulocyte. Transferrin and the unsaturated capacity of iron binding, the total capacity of iron binding and reticulocytes are in a positive correlation but the correlation of transferrin with the parameters of transferrin saturation, iron and hemoglobin is negative. The sex and the age of the examinees do not influence the level of serum hepcidin which makes it a more sensitive indicator of the level of iron in the body. Besides this, serum hepcidin is a reliable biological marker in the iron deficiency anemia diagnosis.</p>

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2016-10-18T00:08:48Z No. of bitstreams: 1 DISSERTA??O FINAL - SAMILLA.pdf: 1387105 bytes, checksum: f821206b516e711d5bcb67ee1107c82e (MD5) / Made available in DSpace on 2016-10-18T00:08:48Z (GMT). No. of bitstreams: 1 DISSERTA??O FINAL - SAMILLA.pdf: 1387105 bytes, checksum: f821206b516e711d5bcb67ee1107c82e (MD5) Previous issue date: 2014-04-03 / The Iron-Deficiency Anemia (FA) has high prevalence in Brazil being associated with low birth weight, growth retardation, cognitive impairment and lower resistance to infections in children, and increased perinatal mortality in pregnant women. In response to this problem the National Program of Iron Supplementation (NPIS) created tools to record, evaluate and monitoring regularly and permanently, the process of establishing and implementing the three levels of the National Health System management and their results, forming what is called Management Module, which is nothing more than its Information System (IS). This article aimed to perform a descriptive and critique analysis of this system performance using as research outline the generation and use of data at the municipal level. The retrospective design used as the primary data interviews with health professionals, managers and users of the program, and as a secondary material, SI PNSF data and reports from the General Commission of Food and Nutrition, the state and municipal management, among other documents. The quality and relevance of the information was analyzed through the categories: completeness, reliability, timeliness, access, correction of goals and consistency of the information with the goals of health politics. Despite the SI have easily accessible data, the results showed errors in setting national goals and program coverage, in addition to wrong data input by local coordinators. Accessibility was also affected, disallowing the use of data for decision making at the local, intermediate and national levels. Finally, there was serious planning problems arising, at least in part, the institutional culture that underpins health practices and maintains the information as secret or as political and bureaucratic power resource. Studies and interventions towards the clearing and settlement of these issues could contribute to the improvement of health information systems, and in particular the PNSF, so as to allow the control and reduction of iron deficiency anemia in children and pregnant Brazilian women. / Este estudo objetivou avaliar a implanta??o do PNSF em um munic?pio baiano no per?odo de 2005 a 2012, atrav?s de uma pesquisa avaliativa. Para que se possa chegar o mais pr?ximo da apreens?o da realidade da realidade do objeto foi utilizada tanto a abordagem quantitativa baseada na tr?ade estrutura-processo-resultado a qual foi sistematiza por Donabedian (1980), quanto a qualitativa, fundamentada na avalia??o por triangula??o de m?todos (MYNAYO, 2008). Os achados da pesquisa foram divididos em dois artigos: 1) O Sistema de Informa??o do Programa nacional de suplementa??o de ferro e 2) Avalia??o do Programa Nacional de Suplementa??o de Ferro em um munic?pio da Bahia. ? ineg?vel a importa??o do PNSF como uma das estrat?gias voltadas para controle e redu??o da anemia por defici?ncia de ferro no pa?s, visto que suas a??es propostas de suplementa??o e educa??o alimentar e nutricional devem resolver a principal causa dessa defici?ncia que ? a quantidade insuficiente de ferro na dieta para satisfazer as necessidades nutricionais individuais. O presente estudo traz informa??es que permitem ter um diagn?stico do PNSF, considerando-se a diversidade de fontes utilizadas para obten??o dos dados e conclus?o dos achados. Ap?s quase uma d?cada de cria??o nota-se que o mesmo n?o consegue atingir seu objetivo geral que ? o de suplementar todas as crian?as de 6 meses a 18 meses de idade, gestantes a partir da 20? semana e mulheres at? o 3? m?s p?s-parto. Devido aos problemas encontrados e discutidos na estrutura e no processo de algumas das suas a??es. Sugere-se, ainda, que novas e continuas avalia??es governamentais e n?o governamentais sejam realizadas, no sentido de compreender melhor os fatores quem comprometem a implementa??o efetiva do programa, e que sobretudo ajude na reorganiza??o e aprimoramento do programa para que finalmente atinja o seu objetivo.

Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Uppsala : Univ., 2004. / Härtill 5 uppsatser.