Iron requirements

Absorbed iron (Fe) requirements are partly recalculated based on new figures for Fe requirements in menstruating women. The new higher figures were obtained by including in the calculation of the total requirements the effect of variations in hemoglobin concentration, which influences the variation in menstrual Fe losses and the variation in basal Fe losses. Higher figures were also found for menstruating teenage girls. Dietary iron requirements were also recalculated based on a critical examination of data available allowing estimations of bioavailability of the dietary iron in Western-type diets. In borderline Fe-deficient subjects, with optimal hemoglobin levels but no iron stores, the 95th percentile range for the bioavailability was estimated to 14–16% of the fraction of the dietary Fe that is potentially available for absorption (correction for partially available fortification Fe).     

Numerical methods for estimating iron requirements from population data

The estimation of iron requirements is crucial for nutrition and food policy. The traditional methods for estimating iron requirements are balance methods based on iron intakes and excretions and factorial methods based on estimated iron absorption rates and estimated iron losses from body compartments. As an alternative, numerical methods for estimating iron requirements from population data of iron status were developed. The iron status data reported by Satoh (1991) were used in the sixth edition of Recommended Dietary Allowances for Japanese. The menstrual iron losses in Japanese premenopausal women were estimated from the literature to calculate total iron losses as the sum of basal iron losses and menstrual iron losses. The use of this alternative method is illustrated by analyzing the same population data comprising the prevalence of iron deficiency and the distribution of iron intake. The estimated average requirements were affected by the form of distribution function, the relative standard deviation of requirements, and the correlation coefficient between iron intakes and requirements. We conclude that numerical methods can be very useful for estimating iron requirements and to elucidate dietary recommendations of iron. These methods may contribute to determining requirements of other nutrients as well as iron.     

Estimation of iron requirements for women by numerical analysis of population-based data from the National Health and Nutrition Surveys of Japan 2003–2007

Iron requirements were estimated from the results of the National Health and Nutrition Surveys of Japan 2003–2007 using the numerical analysis of requirements based on an integral equation. The numerical analysis used population-based data on iron nutriture, the prevalence of inadequate iron status, and the distribution of iron intakes. The cutoff value for inadequate iron status was defined as a serum ferritin concentration <30 ng/mL. Iron intakes and menstrual blood losses followed a log-normal distribution and published values were corrected accordingly to calculate usual values. For women aged 18–29 years old, the median of the estimated median iron requirement (corresponding to the estimated average requirement by using the terminology of the dietary reference intakes) was 7.59 mg (range, 6.86–8.11). The median of the estimated usual iron intake covering the needs of women with 80 mL per cycle of menstrual blood loss was 11.27 mg (range, 10.16–12.00), and the median of the usual iron intake covering the needs of 97.7% of women was 13.93 mg (range, 12.55–14.81). For women aged 30–49 years old, the corresponding figures were 8.13 mg (range, 7.96–8.69), 11.95 mg (range, 11.72–12.77), and 14.71 mg (range, 14.44–15.72).     

Net mineral requirements for the growth and maintenance of Somali lambs

Minerals are limiting factors in animal production, and the knowledge of mineral requirements for livestock is crucial to the success of a commercial enterprise. Hair sheep may have different mineral requirements than those presents by the international committees. A study was carried to evaluate the net calcium (Ca), phosphorus (P), magnesium (Mg), sodium (Na), potassium (K), zinc (Zn), iron (Fe), manganese (Mn) and copper (Cu) requirements for the growth and maintenance of Brazilian Somali lambs. A total of 48 hair lambs (13.5±1.8 kg) aged 60±15 days were allocated to individual pens. Eight animals were slaughtered at the beginning of the experiment to serve as a reference group to estimate initial empty BW (EBW) and initial body composition. The remaining lambs (n=40) were assigned to a completely randomized design with eight replications in five levels of metabolizable energy (ME; 4.93, 8.65, 9.41, 10.12 and 11.24 MJ/kg DM). When the lambs of a given treatment reached an average BW of 28 kg, they were slaughtered. Initial body composition was used to calculate the retention of minerals. Mineral body composition was fit using a logarithmic equation in the form of a nonlinear model. The maintenance requirements were estimated from regressions of mineral retention in the empty body on mineral intake. The body mineral concentration decreased in lambs with a BW ranging from 15 to 30 kg. The net mineral requirements (100 g/day of average daily gain (ADG)) decreased from 0.52 to 0.51 g for Ca, 0.28 to 0.23 g for P, 0.02 to 0.02 g for Mg, 0.09 to 0.08 g for Na, 0.11 to 0.09 g for K, 1.30 to 1.08 mg for Zn, 3.77 to 3.22 mg for Fe, 0.08 to 0.06 mg for Mn and 0.09 to 0.08 mg for Cu when BW increased from 15 to 30 kg. The daily net requirements for maintenance per kilogram of BW were 30.13 mg of Ca, 27.58 mg of P, 1.26 mg of Mg, 4.12 mg of Na, 8.11 mg of K, 0.133 mg of Zn, 0.271 mg of Fe, 0.002 mg of Mn and 0.014 mg of Cu. The results of this study indicate that the net mineral requirements for weight gain and maintenance in Brazilian Somali lambs are different than the values that are commonly recommended by the main evaluation systems for feed and nutritional requirements for sheep. These results for the nutritional requirements of minerals may help to optimize mineral supply for hair sheep.     

Revised D-A-CH-reference values for the intake of zinc

BackgroundThe Nutrition Societies of Germany, Austria and Switzerland as the joint editors of the ‘D-A-CH reference values for nutrient intake’ have revised the reference values for zinc in July 2019.MethodsFor infants aged 0 to under 4 months, an estimated value was set based on the zinc intake via breast feeding. For all other age groups, the reference values were calculated using the factorial method considering endogenous zinc losses via intestinal losses, urine, faeces, skin and sweat, semen in men and the additional zinc requirements to build up body weight in children and adolescents as well as in pregnant women. Due to the strong influence of phytate intake on zinc absorption, the recommendations for the intake of zinc for adults are derived depending on low (0.5 mmol/day, corresponding to 330 mg/day), moderate (1.0 mmol/day, corresponding to 660 mg/day) and high (1.5 mmol/day, corresponding to 990 mg/day) phytate intake. The reference values for lactating women take into account the zinc loss via breast milk.Results and conclusionFor adults, pregnant and lactating women, the recommended intake values for zinc range from 7 mg/day to 16 mg/day, depending on sex and dietary phytate intake.     

Modelling of sulphur amino acid requirements and nitrogen endogenous losses in kittens

ABSTRACT

The objective of this study was to estimate the sulphur amino acid (methionine + cystine) requirements and nitrogen endogenous losses in kittens aged 150 to 240 d. Thirty-six cats were distributed in six treatments (six cats per treatment) consisting of different concentrations of methionine + cystine (M + C): T1, 6.5 g/kg; T2, 8.8 g/kg; T3, 11.3 g/kg; T4, 13.6 g/kg; T5, 16.0 g/kg; and control, 6.5 g/kg. Diets were formulated by serial dilution of T5 (a diet relatively deficient in M + C but containing high protein concentrations) with a minimal nitrogen diet (MND). Thus, crude protein and amino acid concentrations in diets T1–T5 decreased by the same factor. The control diet was the T1 diet supplemented with adequate concentrations of M + C (6.5 g/kg; 8.8 g/kg; 11.3 g/kg; 13.6 g/kg and 16.0 g/kg). All diets were based on ingredients commonly used in extruded cat diets. Digestibility assays were performed for the determination of nitrogen balance. Nitrogen intake (NI) and nitrogen excretion (NEX) results data were fitted with an exponential equation to estimate nitrogen maintenance requirement (NMR), theoretical maximum for daily nitrogen retention (NR_maxT), and protein quality (b). M + C requirements were calculated from the limiting amino acid intake (LAAI) equation assuming a nitrogen retention of 45 to 65% NR_maxT. The NMR of kittens aged 150, 195, and 240 d was estimated at 595, 559, and 455 mg/kg body weight (BW)^0.67 per day, respectively, and M + C requirements were estimated at 517, 664, and 301 mg/kg BW^0.67 per day, respectively.     

A preliminary study of the nutritional requirements of Myxotrichum uncinatum

Summary Certain nutritional requirements of one strain ofMyxotrichum uncinatum were established. Growth was measured on a dry weight basis. The approximate optimum medium for growth consisted of 5% KNO₃, 4% sucrose, 0.1% K₂HPO₄, 0.05% MgSO₄. 7 H₂O, 0.2 mg % biotin and 1.0 mg % uracil. The best initial pH range was 6.0–7.0. Approximately three to five days incubation on a rotary shaker permitted excellent growth.     

Age as a major factor associated with zinc and copper deficiencies in pediatric thalassemia

BackgroundPatients with thalassemia encounter increased consumption of zinc (Zn) and copper (Cu) from chronic hemolysis and increased excretion from iron chelation. Iron-enriched diet restriction may result in low Zn and Cu intakes. Recent data on Zn and Cu status among Thai pediatric patients with thalassemia are lacking. This study aimed to identify frequencies and determine risk factors of Zn and Cu deficiencies among patients with thalassemia.MethodsPatients with transfusion-dependent thalassemia (TDT) receiving iron chelation ≥12 months and nonTDT (NTDT) aged 2–20 years were recruited. Serum Zn and Cu were measured. Dietary intakes were ascertained by interviews.ResultsA total of 209 patients (TDT = 126, NTDT = 83) were enrolled. Zn deficiency seemed to be associated with disease severity as median (IQR) Zn level of TDT was lower than that of NTDT [77 (69−85) vs. 80 (72−88) mcg/dL, p = 0.05], while higher frequency of Zn deficiency was identified in the former (24 % vs. 14 %). In TDT, Zn deficiency was associated with patients >10 years (OR 4.6; 95 %CI 1.1–6.4, p = 0.03), which likely resulted from combined low dietary Zn intake, prolonged exposures to hemolysis and iron chelators. Frequencies of Cu deficiency were similarly low in TDT and NTDT (8% and 7%) with comparable median (IQR) Cu levels of 103 (90−124) and 110 (92−132) mcg/dL, respectively (p = 0.13). Cu levels were inversely associated with age (r=-0.65 and r=-0.62 in TDT and NTDT, respectively; p < 0.001).ConclusionCompared with younger patients, Zn and Cu deficiencies were more common among patients with thalassemia >10 years. Age was a major factor associated with both Zn and Cu deficiencies.     

Meta-analysis of iron metabolism markers levels of Parkinson’s disease patients determined by fluid and MRI measurements

BackgroundParkinson’ s disease (PD) is a progressive neurodegenerative disease featured neuropathologically by the loss of dopaminergic neurons of the substantia nigra (SN). Iron overload in the SN is mainly relative to the pathology and pathogenesis of PD. Postmortem samples of PD has indicated the increased levels of brain iron. However, there is no consensus on iron content through iron-sensitive magnetic resonance imaging (MRI) techniques and the alteration of iron and iron related metabolism markers levels in blood and cerebrospinal fluids (CSF) are still unclear based on the current studies. In this study, we performed a meta-analysis to explore the iron concentration and iron metabolism markers levels through iron-sensitive MRI quantification and body fluid.MethodsA comprehensive literature search was performed in PubMed, EMBASE and Cochrane Library databases for relevant published studies that analyzed iron load in the SN of PD patients using quantitative susceptibility mapping (QSM) or susceptibility weighting imaging (SWI), and iron metabolism markers, iron, ferritin, transferrin, total iron-binding capacity（TIBC）in CSF sample or serum/plasma sample (from Jan 2010 to Sep 2022 to filter these inaccurate researches attributed to unadvanced equipment, inaccurate analytical methods). Standardized mean differences (SMD) or mean differences (MD) and 95% confidence intervals (CI) with random or fixed effect model was used to estimate the results.ResultsForty-two articles fulfilled the inclusion criteria including 19 for QSM, 6 for SWI, and 17 for serum/plasma/CSF sample including 2874 PD patients and 2821 healthy controls (HCs). Our meta-analysis results founded a notable difference for QSM values increase (19.67, 95% CI=18.69–20.64) and for SWI measurements (−1.99, 95% CI= −3.52 to −0.46) in the SN in PD patients. However, the serum/plasma/CSF iron levels and serum/plasma ferritin, transferrin, total iron-binding capacity (TIBC) did not differ significantly between PD patients and HCs.ConclusionsOur meta-analysis showed the consistent increase in the SN in PD patients using QSM and SWI techniques of iron-sensitive MRI measures while no significant differences were observed in other iron metabolism markers levels.     

Oxygen requirements for growth and citric acid production of Yarrowia lipolytica

During continuous cultivation of Yarrowia lipolytica N 1, oxygen requirements for growth and citric acid synthesis were found to depend on the iron concentration in the medium. A coupled effect of oxygen and iron concentrations on the functioning of the mitochondrial electron transport chain in Y. lipolytica N 1 was established. Based on the results obtained in continuous culture, conditions for citric acid production in a batch culture of Y. lipolytica N 1 were proposed. At relatively low pO(2) value and a high iron concentration, citric acid accumulation was as high as 120 g l(-1); the specific rate of citric acid synthesis reached 120 mg citric acid (g cells h)(-1). The mass yield coefficient was 0.87 and the energy yield coefficient was 0.31.     

Associations of iron status with breast cancer risk factors in adult women: Findings from National Health and Nutrition Examination Survey 2017–2018

ObjectiveThis study examined the association between iron status and a set of breast cancer risk factors among U.S. adult women aged 20–80 years.MethodsData from National Health and Nutrition Examination Survey (2017–2018) were used to examine the relation between serum ferritin, serum iron and transferrin saturation with a set of breast cancer risk factors [body mass index (BMI), waist circumference, glycosylated hemoglobin (HbA1c), fasting plasma glucose, insulin and HOMA-IR]. The multivariable linear regressions were used controlling for age, race/ethnicity, menopause status, education level, smoking status, alcohol consumption, physical activity, high-sensitivity C-reactive protein (hsCRP) and total energy intake.ResultsHbA1c, BMI and waist circumference data were available for 1902 women with a fasting sample (n = 913) for fasting plasma glucose, insulin and HOMA-IR. Transferrin saturation had significant, inverse associations with BMI, waist circumference and HbA1c. The size of difference observed were that participants in the fourth quartile of transferrin saturation had a 4.50 kg/m² smaller BMI, a 9.36 cm smaller waist circumference and a 0.1 % lower HbA1c level than participants in the first quartile. Similarly, serum iron concentrations were inversely associated with BMI and waist circumference. In addition, serum iron had significant, inverse associations with insulin and HOMA-IR. Sensitivity analyses among men gave similar results. For serum ferritin, there was a trend towards a positive association between waist circumference, HbA1c and fasting plasma glucose with serum ferritin. However, the associations did not reach statistical significance among women.ConclusionsIron status may impact breast cancer risk via effects on adiposity or glucose metabolism. The findings should be confirmed with further prospective data.     

Ferritin readings in young adult,female university student recreational runners

BackgroundElite female athletes have shown vulnerability to various degrees of iron deficiency. Less is known about recreational fitness exercisers. A study was done to examine plasma ferritin, an assessor of iron status, in young adult, university student fitness runners.MethodsThe present study examined serum ferritin concentrations, an indicator of iron status, in 39 female university students (age 18–25) who ran for fitness, but ran less than competition runners. Selected subjects all reported themselves as not anemic.ResultsMean + SD for 3 mile run time was 26.25 + 3.0 min. The mean ferritin reading was low: 12.4 + 12.3 ng/mL (+ SD). Out of the 39 women, 29 had readings that fell below 15 ng/mL, which some consider the cutoff for iron deficiency. In addition, all but 2 subjects had values below 35, which has been proposed as Stage 1 iron deficiency for athletes. Ferritin levels did not correlate with 3 mile run times (Pearson correlation coefficient, P > 0.05). A 1 mo intervention with 3 minerals that included iron (36 mg/day) significantly raised ferritin values when the iron was bisglycinate (p < 0.05), but not when it was ferrous sulfate (p > 0.05).ConclusionIn this study, a degree of iron deficiency was seen in most of a group of female fitness runners (each of whom had self reported as not being anemic).     

Effect of the inflammatory response on serum indices of iron status in late pregnancy

Background and aimsA systemic inflammatory response complicates the evaluation of iron status during pregnancy. We investigated the magnitude of this effect on indices of iron status in late pregnancy.MethodsWe retrospectively interrogated laboratory data and hospitalisation records from April 2016 to March 2017 and obtained results from pregnant women in which serum high-sensitivity C-reactive protein (hsCRP) or albumin had been examined together with indicators of iron status (serum ferritin [SF] and serum transferrin [ST], n = 11,571). We assessed the association of the inflammatory response, as evidenced by hsCRP and albumin, with iron status indicators by general linear regression analysis.ResultCompared to women with an hsCRP of ≤ 5 mg/L, the median SF level in those with an hsCRP of 6–10, 11–20, and > 20 mg/L significantly increased by 2.24 μg/L (95 % confidence interval [CI]: 1.22, 3.26), 4.04 μg/L (95 % CI: 2.05, 6.04), and 13.49 μg/L (95 % CI: 10.44, 16.53); while the ST level decreased by 0.10 g/L (95 % CI: 0.13, 0.06), 0.16 g/L (95 % CI: 0.23, 0.09), and 0.21 g/L (95 % CI: 0.32, 0.11), respectively (all P < 0.001). With regard to the association of inflammation with SF and ST, no significant interaction between albumin (< 35 and ≥ 35 g/L) and hsCRP was observed (SF: P for interaction = 0.426; ST: P for interaction = 0.872).ConclusionsMeasurement of hsCRP in late pregnancy is necessary to correct the levels of SF and ST. The impact of the inflammatory response on indices of iron status in late pregnancy could not be adjusted by albumin.     

Combination of Soy Protein,Amylopectin, and Chromium Stimulates Muscle Protein Synthesis by Regulation of Ubiquitin–Proteasome Proteolysis Pathway after Exercise

This review discusses the development of studies that evaluated the essentiality and requirements of iron from the ancient to the present. The therapeutic effects of iron compounds were recognized by the ancient Greeks and Romans. The earliest recognition of the essentiality of iron was stated by Paracelsus, a distinguished physician alchemist, in the sixteenth century. Iron was included in the earliest nutritional standard prepared for the Royal Army by E. A. Parkes, the first professor of hygiene. The League of Nations Health Organisation determined average iron requirements based on literature review. In the first US Recommended Dietary Allowances (RDA), the RDA of iron was determined from the results of iron balance studies. In the current Dietary Reference Intakes, iron requirements were determined based on the factorial method with the aid of Monte Carlo simulation for combining basal and menstrual iron losses. Population data analysis is a recently developed alternative that does not use the pre-estimated iron absorption rate and requires the prevalence of inadequacy instead. Population data analysis uses the convolution integral for combining basal and menstrual iron losses to ensure the required accuracy. This review also provides new estimates of hair and nail iron losses.

     

A practical methodology to improve the dosimetric accuracy of MR-based radiotherapy simulation for brain tumors

PurposeTo investigate the dosimetric accuracy of synthetic computed tomography (sCT) images generated by a clinically-ready voxel-based MRI simulation package, and to develop a simple and feasible method to improve the accuracy.Methods20 patients with brain tumor were selected to undergo CT and MRI simulation. sCT images were generated by a clinical MRI simulation package. The discrepancy between planning CT and sCT in CT number and body contour were evaluated. To resolve the discrepancies, an sCT specific CT-relative electron density (RED) calibration curve was used, and a layer of pseudo-skin was created on the sCT. The dosimetric impact of these discrepancies, and the improvement brought about by the modifications, were evaluated by a planning study. Volumetric modulated arc therapy (VMAT) treatment plans for each patient were created and optimized on the planning CT, which were then transferred to the original sCT and the modified-sCT for dose re-calculation. Dosimetric comparisons and gamma analysis between the calculated doses in different images were performed.ResultsThe average gamma passing rate with 1%/1 mm criteria was only 70.8% for the comparison of dose distribution between planning CT and original sCT. The mean dose difference between the planning CT and the original sCT were −1.2% for PTV D₉₅ and −1.7% for PTV D_max, while the mean dose difference was within 0.7 Gy for all relevant OARs. After applying the modifications on the sCT, the average gamma passing rate was increased to 92.2%. Mean dose difference in PTV D₉₅ and D_max were reduced to −0.1% and −0.3% respectively. The mean dose difference was within 0.2 Gy for all OAR structures and no statistically significant difference were found.ConclusionsThe modified-sCT demonstrated improved dosimetric agreement with the planning CT. These results indicated the overall dosimetric accuracy and practicality of this improved MR-based treatment planning method.     

Evidence for high iron requirements of colonial Phaeocystis antarctica at low irradiance

We have carried out field and laboratory experiments to examine the iron requirements of colonial Phaeocystis antarctica in the Ross Sea. In December 2003, we performed an iron/light-manipulation bioassay experiment in the Ross Sea polynya, using an algal assemblage dominated by colonial Phaeocystis antarctica, collected from surface waters with an ambient dissolved Fe concentration of ∼0.4 nM. Results from this experiment suggest that P. antarctica growth rates were enhanced at high irradiance (∼50% of incident surface irradiance) but were unaffected by iron addition, and that elevated irradiance mediated a significant decrease in cellular chlorophyll a content. We also conducted a laboratory iron dose–response bioassay experiment using a unialgal, non-axenic strain of colonial P. antarctica and low-iron (<0.2 nM) filtered seawater, both collected from the Ross Sea polynya in December 2003. By using rigorous trace-metal clean techniques, we performed this dose–response iron-addition experiment at ∼0°C without using organic chelating reagents to control dissolved iron levels. At the relatively low irradiance of this experiment (∼20 μE m⁻² s⁻¹), estimated nitrate-specific growth rate as a function of dissolved iron concentration can be described by a Monod relationship, yielding a half-saturation constant with respect to growth of 0.45 nM dissolved iron. This value is relatively high compared to reported estimates for other Antarctic phytoplankton. Our results suggest that seasonal changes in the availability of both iron and light play critical roles in limiting the growth and biomass of colonial Phaeocystis antarctica in the Ross Sea polynya.     

Estimation of Dietary Iron Bioavailability from Food Iron Intake and Iron Status

Currently there are no satisfactory methods for estimating dietary iron absorption (bioavailability) at a population level, but this is essential for deriving dietary reference values using the factorial approach. The aim of this work was to develop a novel approach for estimating dietary iron absorption using a population sample from a sub-section of the UK National Diet and Nutrition Survey (NDNS). Data were analyzed in 873 subjects from the 2000–2001 adult cohort of the NDNS, for whom both dietary intake data and hematological measures (hemoglobin and serum ferritin (SF) concentrations) were available. There were 495 men aged 19–64 y (mean age 42.7±12.1 y) and 378 pre-menopausal women (mean age 35.7±8.2 y). Individual dietary iron requirements were estimated using the Institute of Medicine calculations. A full probability approach was then applied to estimate the prevalence of dietary intakes that were insufficient to meet the needs of the men and women separately, based on their estimated daily iron intake and a series of absorption values ranging from 1–40%. The prevalence of SF concentrations below selected cut-off values (indicating that absorption was not high enough to maintain iron stores) was derived from individual SF concentrations. An estimate of dietary iron absorption required to maintain specified SF values was then calculated by matching the observed prevalence of insufficiency with the prevalence predicted for the series of absorption estimates. Mean daily dietary iron intakes were 13.5 mg for men and 9.8 mg for women. Mean calculated dietary absorption was 8% in men (50^th percentile for SF 85 µg/L) and 17% in women (50^th percentile for SF 38 µg/L). At a ferritin level of 45 µg/L estimated absorption was similar in men (14%) and women (13%). This new method can be used to calculate dietary iron absorption at a population level using data describing total iron intake and SF concentration.     

Effect of phytic acid,tannic acid and pectin on fasting iron bioavailability both in the presence and absence of calcium

ObjectiveTo determine the effect of phytic acid, tannic acid and pectin on fasting non-heme iron bioavailability in both the presence and absence of calcium.Research methodsTwenty-eight apparently healthy adult females participated in two iron absorption studies using radioactive iron isotopes (⁵⁹Fe and ⁵⁵Fe). One group received 5 mg of iron (as FeSO₄) alone (control), together with 10 mg of phytic acid, 100 mg of tannic acid and 250 mg of pectin (study A), on different days. The second group received the same iron doses and compounds as the other group, plus 800 mg of calcium (CaCl₂) (study B). The compounds were administered after an overnight fast, and no food or beverages were consumed for the following 3 h. Iron status and circulating radioactivity were measured in venous blood samples.ResultsThe geometric means of iron bioavailability (range ± 1SD) for iron alone, iron with phytic acid, iron with tannic acid, and iron with citrus pectin were 25.0% (11.9–52.0); 18.9% (9.9–35.8); 16.8% (8.7–32.3); and 21.1% (10.2–43.9), respectively (repeated-measures ANOVA, p < 0.02 (Dunnett's post hoc: control vs tannic acid p < 0.05). When 800 mg of calcium was added (study B), iron bioavailability was 16.7% (10.1–27.5); 13.2% (7.1–24.6); 14.8% (8.8–25.1); and 12.6% (5.5–28.8), respectively (repeated-measures ANOVA, NS).ConclusionsTannic acid decreases the fasting bioavailability of non-heme iron, however this effect did not exist in the presence of calcium. No effect was observed by phytic acid or citrus pectin on fasting non-heme iron bioavailability in both the presence and absence of calcium.     

Ferritin and liver fibrosis among patients with chronic hepatitis C virus infection

IntroductionIn chronic hepatitis C virus (HCV) infection there is increased iron absorption leading to iron overload, a fact that may promote ferritin synthesis. Theoretically, increased ferritin should promote ongoing liver fibrosis but disparate results have been described.ObjectiveWe analyze the behavior of iron metabolism- related variables, comparing them with fibrosis and inflammatory activity in liver biopsy in HCV infected patients.Patients and MethodsWe analyzed among 90 HCV patients subjected to liver biopsy prior to antiviral treatment the relationships of serum levels of iron, ferritin, transferrin, transferrin saturation index (TSI) and total iron binding capacity (TIBC) with liver fibrosis and histological severity, assessed by Metavir-f, Metavir-a and Knodell indices, as well as with liver function, and also compared the aforementioned iron metabolism- related variables with 34 controls.ResultsPatients showed higher values of sideremia (T = 2.04; p = 0.044) and transferrin (T = 2.29; p = 0.004) compared with controls; but not ferritin, that was significantly higher among the 33 patients who also consumed alcohol (Z = 2.05; p = 0.041). Most patients showed a well preserved liver function (86 cases, Child A). Patients with Child B or C showed higher ferritin levels (Z = 2.68; p = 0.007) and TSI (Z = 2.41; p = 0.016), but lower transferrin and TIBC (Z = 3.25; p = 0.001) than Child A patients. Transferrin and TIBC were directly related to albumin (ρ = 0.24; p = 0.026), whereas bilirubin showed direct relationships with iron (ρ = 0.25; p = 0.016), TSI (ρ = 0.39; p < 0.001) and ferritin (ρ = 0.36; p < 0.001). Both ferritin (ρ = −0.22; p = 0.04) and TSI (ρ = −0.25; p = 0.016) were related to platelet count. No relationships were observed between iron variables and Knodell index, but serum iron, serum transferrin, and TSI were directly related to Metavir-f score (ρ = 0.28; p = 0.009, ρ = 0.22; p = 0.044, and ρ = 0.22; p = 0.044, in this order).ConclusionAlterations of iron related variables are relatively subtle in our series of 90 well compensated HCV patients. Serum ferritin was not related to liver fibrosis and increases only when alcoholism co-exists with HCV infection.     

Comparison of multi-institutional pre-treatment verification for VMAT of nasopharynx with delivery errors

PurposeMeasurement-based pre-treatment verification with phantoms frequently uses gamma analysis to assess acceptable delivery accuracy. This study evaluates the sensitivity of a commercial system to simulated machine errors for three different institutions’ Volumetric Modulated Arc Therapy (VMAT) planning approaches.MethodsVMAT plans were generated for ten patients at three institutions using each institution’s own protocol (manually-planned at institution 1; auto-planned at institutions 2 and 3). Errors in Multi-Leaf Collimator (MLC) field size (FS), MLC shift (S), and collimator angle (C) of −5, −2, −1, 1, 2 and 5 mm or degrees were introduced.Dose metric constraints discriminated which error magnitudes were considered unacceptable. The smallest magnitude error treatment plans deemed clinically unacceptable (typically for a 5% dose change) were delivered to the ArcCHECK for all institutions, and with a high-dose point ion chamber measurement in 2 institutions. Error detection for different gamma analysis criteria was compared.ResultsNot all deliberately introduced VMAT plan errors were detected using a typical 3D 3%/3 mm global gamma pass rate of 95%. Considering all institutions, gamma analysis was least sensitive to negative FS errors. The most sensitive was a 2%/2 mm global analysis for institution 1, whilst for institution 2 it was 3%/3 mm global analysis. The majority of errors (58/59 for institution 1, 54/60 for institution 3) were detected using ArcCHECK and ion chamber measurements combined.ConclusionsNot all clinically unacceptable errors are detected. Combining ion chamber measurements with gamma analysis improved sensitivity and is recommended. Optimum gamma settings varied across institutions.