The six global nutrition targets (GNTs) related to low birthweight, exclusive breastfeeding, child growth (ie, wasting, stunting, and overweight), and anaemia among females of reproductive age were chosen by the World Health Assembly in 2012 as key indicators of maternal and child health, but there has yet to be a comprehensive report on progress for the period 2012 to 2021. We aimed to evaluate levels, trends, and observed-to-expected progress in prevalence and attributable burden from 2012 to 2021, with prevalence projections to 2050, in 204 countries and territories.

The prevalence and attributable burden of each target indicator were estimated by age group, sex, and year in 204 countries and territories from 2012 to 2021 in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, the most comprehensive assessment of causes of death, disability, and risk factors to date. Country-specific relative performance to date was evaluated with a Bayesian meta-regression model that compares prevalence to expected values based on Socio-demographic Index (SDI), a composite indicator of societal development status. Target progress was forecasted from 2021 up to 2050 by modelling past trends with meta-regression using a combination of key quantities and then extrapolating future projections of those quantities.

In 2021, a few countries had already met some of the GNTs: five for exclusive breastfeeding, four for stunting, 96 for child wasting, and three for child overweight, and none met the target for low birthweight or anaemia in females of reproductive age. Since 2012, the annualised rates of change (ARC) in the prevalence of child overweight increased in 201 countries and territories and ARC in the prevalence of anaemia in females of reproductive age decreased considerably in 26 countries. Between 2012 and 2021, SDI was strongly associated with indicator prevalence, apart from exclusive breastfeeding (|r-|=0·46-0·86). Many countries in sub-Saharan Africa had a decrease in the prevalence of multiple indicators that was more rapid than expected on the basis of SDI (the differences between observed and expected ARCs for child stunting and wasting were -0·5% and -1·3%, respectively). The ARC in the attributable burden of low birthweight, child stunting, and child wasting decreased faster than the ARC of the prevalence for each in most low-income and middle-income countries. In 2030, we project that 94 countries will meet one of the six targets, 21 countries will meet two targets, and 89 countries will not meet any targets. We project that seven countries will meet the target for exclusive breastfeeding, 28 for child stunting, and 101 for child wasting, and no countries will meet the targets for low birthweight, child overweight, and anaemia. In 2050, we project that seven additional countries will meet the target for exclusive breastfeeding, five for low birthweight, 96 for child stunting, nine for child wasting, and one for child overweight, and no countries are projected to meet the anaemia target.

Based on current levels and past trends, few GNTs will be met by 2030. Major reductions in attributable burden for exclusive breastfeeding and anthropometric indicators should be recognised as huge scientific and policy successes, but the comparative lack of progress in reducing the prevalence of each, along with stagnant anaemia in women of reproductive age and widespread increases in child overweight, suggests a tenuous status quo. Continued investment in preventive and treatment efforts for acute childhood illness is crucial to prevent backsliding. Parallel development of effective treatments, along with commitment to multisectoral, long-term policies to address the determinants and causes of suboptimal nutrition, are sorely needed to gain ground.

Bill & Melinda Gates Foundation.

Observational studies have shown a potential link between immune factors and the risk of iron deficiency anemia (IDA), yet the causal relationship between immune cells and IDA remains enigmatic. Herein, we used Mendelian randomization (MR) to assess whether this association is causal.

We selected IDA genetic variants, including 8376 samples and 9810691 single nucleotide polymorphisms, and immune cells from a large open genome-wide association study (GWAS) for a bidirectional MR study. The primary method was inverse variance weighting (IVW), and auxiliary analyses were MR-Egger, weighted median, simple mode and weighted mode. The reliability of the results was subsequently verified by heterogeneity and sensitivity analysis.

IVW method showed that 19 types of immune cells may be the risk factors of IDA, whereas 15 types of immune cells are the protective factors of IDA. Reverse MR analysis suggested that immune cells from upstream etiology of IDA are not involved in follow-up immune activities. Next, we selected 731 immune cell types as the results. The research revealed that IDA may result in a rise in 23 kinds of immune cells and a reduction in 12 kinds of immune cells. In addition, sensitivity analysis demonstrated no evidence of heterogeneity or horizontal pleiotropy.

From a genetic standpoint, our study suggests that specific immune cells may be involved in the occurrence of IDA. Inversely, IDA may also contribute to immune dysfunction, thus guiding future clinical investigations.

Major gynaecological surgery is a significant risk factor for intra and postoperative blood loss. Effective iron deficiency (ID) and anaemia management is critical for ensuring patient safety. The aim of this update was to take an in-depth look at two recently published studies focusing on the assessment and management of ID and anaemia in subgroups of patients undergoing gynaecological surgery from the CARENFER PBM (2023) and PERIOPES (2023 and 2024) studies. Among the 6999 patients included in the three studies, 354 involved gynaecological procedures. Within this cohort, the prevalence of preoperative ID ranged from 70 % to 78 %, with 88 % considered absolute ID, while preoperative anaemia affected 28 %-59 % of women. Indeed, several gynaecological conditions that require surgery (e.g., uterine fibroids and gynaecological malignancies) are frequently associated with significant blood loss. Nonetheless, preoperative iron workup was only performed in 5 %-33 % of the patients. Furthermore, anaemia and/or ID were only treated in 12.5 %-24 % preoperatively and 25 % postoperatively. In conclusion, there seems to be a need to optimise perioperative ID and anaemia management in gynaecologic surgery by ensuring systematic preoperative screening and treatment for anaemia and/or ID and, wherever feasible, postponing surgery if restoration of the blood mass and iron stores is considered necessary prior to surgery.

Iron metabolism in the body is strictly regulated and organ specific. Intestinal iron absorption is mediated through complex mechanisms and is mainly regulated by a peptide called hepcidin that controls iron fluxes into plasma. Iron is transported by circulating transferrin and is stored in the protein called ferritin. Iron homeostasis in the brain is regionally regulated through complex interactions involving many genes and biochemical pathways under circadian influences. This article reviews iron metabolism and how brain iron deficiency plays a role in the pathogenesis of restless leg syndrome (RLS). The role of iron therapy in management of RLS and PLMD in pediatric population will be discussed.

Iron deficiency (ID) is frequent in adult patients with cystic fibrosis (pwCF). The effect of elexacaftor-tezacaftor-ivacaftor (ETI) on iron metabolism has rarely been reported. We aimed to study the trends and variables associated with iron store modulation under ETI. We conducted a prospective adult cohort in two referral centres for pwCF. Iron supplementation during the follow-up was an exclusion criterion. Clinical, biological data and pulmonary function tests were collected prospectively at ETI initiation (V0) and after 1 year of ETI (V12). The presence of Pseudomonas aeruginosa in forced sputum was assessed at V0 and V12. 220 (87 women) pwCF among the 278 screened were included. At V0, ID prevalence was 58% and was significantly associated with female sex and lower forced expiratory volume (FEV1). At V12, ID prevalence decreased significantly from 58 to 31% (p = 0.001). A significant decrease of C reactive protein and total globulins was found at V12. 60% of patients with ID at V0 achieved normalization of iron status at V12 with a significant association with the increase of FEV1 (moderate size effect: 0.68). A lower decrease of C reactive protein was significantly associated with the onset of ID in a small sample of patients (p < 0.001). The disappearance of Pseudomonas aeruginosa in sputum at V12 was not correlated to the evolution of iron status under ETI. ETI was associated with a decrease of ID prevalence, and improvement of pulmonary function and a correction of systemic inflammation.

A series of 2-ethoxycarbonyl imidazopyridines have been synthesised and characterised by various spectroscopic techniques (1H NMR, 13C NMR, FTIR and HRMS). Among these compounds, 3e was selected for metal sensing applications due to its favourable photophysical properties. 3e demonstrated high selectivity and sensitivity for detecting Fe3+ ions, even in the presence of other competing ions in a mixture of acetonitrile/water (1:9, v/v). It showed a turn-off fluorescence response with a fluorescence detection limit of 3.9 µM. The decrease in the fluorescence intensity of 3e is due to paramagnetic quenching resulting from its interaction with Fe3+ ions. Job's plot analysis indicated a 1:1 binding ratio between 3e and Fe3+. Density Functional Theory (DFT) calculations revealed a reduced HOMO-LUMO energy gap for the 3e-Fe3+ complex, suggesting successful complexation. The binding constant, calculated using the Benesi-Hildebrand equation, was determined to be 2.845 × 103 M-1, further confirming the strong interaction between 3e and Fe3+. Time-based studies revealed excellent photostability of 3e and its rapid response time for detecting Fe3+. Real-time detection of Fe3+ was successfully achieved using sensor-coated filter paper, demonstrating the practical utility of 3e for rapid assays in real samples.

A stable layer of 4-phenyl isothiocyanate (4-PITC) was successfully electrografted on glassy carbon electrode (GCE). The electrode modification process was performed in three sequential steps in a single solution: (1) reduction by chronoamperometry of the nitro groups of 4-NITC to amino moieties (2) in situ reaction of amino with nitrous acid to obtain unstable diazonium functional groups and (3) electrografting by chronopotentiometry of diazonium. A thin optimal layer with minimum surface fouling was obtained. The formation of the organic film was characterized by cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS). The electrode was used for detection of Pb(II) and Fe(II) by differential pulse voltammetry (DPV). Under optimal conditions, the limit of detection 1.2 μg L-1 for Pb(II) and of 2.0 μg L-1 for Fe(II) were achieved. The developed electrode was successfully applied to detect Pb(II) and Fe(II) in injectable iron pharmaceuticals used to treat iron deficiency anemia simultaneous with investigation of contamination by Pb(II).

Formulas based on red blood cell indices have been used to differentiate between iron deficiency anemia (IDA) and thalassemia (Thal). However, they exhibit varying efficiencies. In this study, we aimed to develop a tool for discriminating between IDA and Thal by using the random forest (RF) and gradient boosting (GB) algorithms. Complete blood count data from 1143 patients with anemia and low mean corpuscular volume were collected (382 patients with IDA, 635 with Thal, and 126 with IDA and Thal). The data were randomly divided into the training and testing datasets in a ratio of 80:20. The RF and GB models had good diagnostic performances for predicting IDA and Thal in the training and testing datasets. In the testing dataset for predicting binary outcomes, GB and RF both had an accuracy of 90.7%, and an area under the receiver operating characteristic curve (AUC-ROC) of 0.953. A lower diagnostic performance was observed when patients with IDA and Thal were included. GB and RF showed accuracies of 80.4% and 82.2%, respectively, and AUC-ROC values of 0.910 and 0.899, respectively. In conclusion, we developed a machine learning approach using GB algorithm. This tool is potentially useful in Thal- and IDA-endemic regions.

Anemia has been implicated in prognosis across ischemic heart diseases. This study aimed to investigate the association between time-weighted average hemoglobin (TWA-Hb) and all-cause mortality in patients with acute myocardial infarction-related cardiogenic shock (AMI-CS).

We conducted a retrospective analysis of 765 patients diagnosed with AMI-CS using data from the MIMIC-IV database (2008-2019). Kaplan-Meier survival analysis demonstrated that lower TWA-Hb levels were associated with higher cumulative mortality rates at 28 days, 90 days, 6 months, and 1 year (log-rank P = 0.002, 0.006, 0.048, and 0.005, respectively). Landmark analyses further revealed a sustained increase in mortality risk associated with lower TWA-Hb during the 28-day to 1-year follow-up period. Multivariable Cox regression analysis identified low TWA-Hb as an independent predictor of mortality risk at 90 days (P = 0.026), 6 months (P = 0.023), and 1 year (P = 0.021). Each one-unit increase in TWA-Hb was associated with a 0.93-, 0.76- and 0.71-fold decrease in the risk of 90-day, 6-month, and 1-year mortality, correspondingly. Subgroup analyses stratified by age, BMI, and comorbidities consistently supported these findings (all P < 0.05).

Low TWA-Hb is associated with long-term mortality in patients with AMI-CS. These findings imply that the application of this indicator in clinical practice could improve long-term risk stratification.

Background: Seasonal influenza viruses are primarily known for causing respiratory illness, but rare hematologic complications can occur, especially in young children. While influenza A is more commonly linked to severe manifestations, influenza B can similarly precipitate life-threatening cytopenias, particularly in toddlers. Case Presentation: We report the case of a previously healthy 1-year-and-8-months-old girl who presented with a high fever, cough, and marked pallor during peak influenza season. Laboratory tests revealed significant microcytic, hypochromic anemia and severe thrombocytopenia. Rapid antigen testing was positive for influenza B. An extensive workup for other causes of bicytopenia, including leukemia, hemolysis, aplastic anemia, and other viral infections, yielded negative results. The child was managed with urgent red blood cell and platelet transfusions, oseltamivir antiviral therapy, broad-spectrum antibiotics, corticosteroids, and supportive care. Bone marrow aspiration was deferred in light of the rapid hematologic recovery. Her hemoglobin greatly improved, and her platelet count reached normal values at discharge. Conclusions: Our case underscores the need to consider influenza in the differential diagnosis of unexplained cytopenias during flu season. This case illustrates that influenza B can mimic hematologic malignancies. Rapid diagnosis and supportive treatment are essential to avoid fatal outcomes. Influenza vaccination plays a significant role in preventing severe complications, such as those we encountered.

The course of maternal antiviral prophylaxis to prevent mother-to-child transmission of hepatitis B virus (HBV-MTCT) varies greatly, and it has not been demonstrated in a randomized controlled study.

In this multicenter, open-label, randomized controlled trial, eligible pregnant women with HBV DNA of 5.3-9.0 log 10 IU/mL who received tenofovir alafenamide fumarate (TAF) from the first day of 33 gestational weeks to delivery (expected 8 week) or to 4 weeks postpartum (expected 12 week) were randomly enrolled at a 1:1 ratio and followed until 6 months postpartum. All infants received standard immunoprophylaxis (hepatitis B immunoglobulin and vaccine). The primary end point was the safety of mothers and infants. The secondary end point was the HBV-MTCT rate of infants at the age of 7 months.

Among 119 and 120 intention-to-treat pregnant women, 115 and 116 women were followed until delivery, and 110 and 112 per-protocol mother-infant dyads in 2 groups completed the study. Overall, TAF was well tolerated, no one discontinued the therapy due to adverse events (0/239, 0%, 95% confidence interval [CI] 0%-1.6%), and no infant had congenital defects or malformations at delivery (0/231, 0%, 95% CI 0%-1.6%). The infants' physical development at birth (n = 231) and at 7 months (n = 222) was normal. Furthermore, 97.0% (224/231, 95% CI 93.9%-98.5%) of women achieved HBV DNA <5.3 log 10 IU/mL at delivery. The intention-to-treat and per-protocol infants' HBV-MTCT rates were 7.1% (17/239, 95% CI 4.5%-11.1%) and 0% (0/222, 95% CI 0%-1.7%) at the age of 7 months. Comparatively, 15.1% (18/119, 95% CI 9.8%-22.7%) vs 18.3% (22/120, 95% CI 12.4%-26.2%) of women in the 2 groups had mildly elevated alanine aminotransferase levels at 3 months and 6 months postpartum, respectively ( P = 0.507); notably, no one experienced alanine aminotransferase flare (0% [0/119, 95% CI 0%-3.1%] vs 0% [0/120, 0%-3.1%]).

Maternal TAF prophylaxis to prevent HBV-MTCT is generally safe and effective, and expected 8-week prenatal duration is feasible. ClinicalTrials.gov , NCT04850950.

Erythrocytes are a major cell type in the circulation, numbering between 20 and 30 trillion. The function of erythrocytes is to bring oxygen to the tissues and release carbon dioxide to the lungs. Anaemic patients, who have low levels of erythrocytes, show significant symptoms affecting the hair and skin; however, the detailed relationship between erythrocytes and the integumentary system is not fully understood. Here, we show that erythrocyte extracellular vesicle (EV) can transfer haemoglobin, ABO antigens and keratin into the hair and promote hair regeneration through miR-20a-5p- and miR-22-3p-mediated upregulation of Wnt/β-catenin signalling in dermal papilla cells. Moreover, we show that local injection of autologous erythrocyte EVs ameliorates hair growth in androgenic alopecia (AGA) patients. Interestingly, we found that erythrocyte EVs exit the body from the hair/skin and their membranes contribute to the formation of the outer barrier of the skin. In summary, we identify a previously unknown role of erythrocytes in amalgamating into hair structures and reveal a new therapeutic approach using erythrocyte EVs to promote hair regeneration in AGA patients.

Extreme weather events, or natural disasters, present a large and increasing threat to human health, infrastructure and food security, including in sub-Saharan Africa (SSA), where the burden of undernutrition is high. However, research about associations between natural disasters and undernutrition in early childhood is limited.

We combined anthropometric data of children aged 0-59 months from 51 Demographic and Health Surveys datasets collected from 2010 to 2019 in 30 countries in SSA with information on natural disaster events (flood, drought, other) from the Emergency Events Database database to determine disaster exposure. The analytic sample included 320 479 children. We used generalised estimating equations to predict stunting, wasting and anaemia by disaster exposure and selected covariates.

Almost 20% (19.7%) of children under five were exposed to a natural disaster in the preceding year. In adjusted analysis, children exposed to at least one disaster in the preceding year had a relative risk (RR) of wasting 1.17 times higher than unexposed children (95% CI 1.12, 1.22). Adjusted models examining exposure to drought or flood consistently estimated higher risks of wasting post-disaster (drought RR 1.36, 95% CI 1.26, 1.47; flood RR 1.07, 95% CI 1.02, 1.12). RRs increased when using a 3-month exposure period. However, exposure to natural disaster was not consistently associated with significant differences in RR of stunting or anaemia.

Natural disasters are prevalent in SSA. Given the high risk of wasting associated with disaster exposure, policymakers should prioritise interventions to address wasting in post-disaster settings.

Intravenous (IV) iron is a guideline-recommended treatment for iron deficiency when oral iron is contraindicated, ineffective, or not tolerated, or when rapid iron delivery is necessary. However, evidence suggests that some patients receive less IV iron than needed. This retrospective audit assessed the effectiveness and safety of ferric derisomaltose (FDI), a high-dose IV iron, in 2,468 patients. Efficacy outcomes assessed at 4-12 weeks post-infusion included changes in hemoglobin (Hb) and ferritin, proportion of courses (a course was defined as the treatment episode required to administer one total dose) after which patients were non-anemic (Hb ≥ 130 g/L [men] or ≥ 120 g/L [women]), and response rate (proportion of courses after which patients were non-anemic or Hb increased by ≥ 20 g/L). Safety was assessed through adverse events. Across 2,775 FDI courses, the mean dose was 1,244 mg, but mean estimated iron need was 1,580 mg. At follow-up, mean Hb had increased by 20.9 g/L and mean ferritin by 188.8 µg/L. Patients were non-anemic after 33.4% (n = 494/1,478) of courses and responded after 65.1% (n = 962/1,478) of courses. One patient (n = 1/2,468; 0.04%) had a serious allergic reaction. Patients remained anemic after > 65% of courses, demonstrating the need to optimize dosing based on iron need.

Although iron-deficiency anemia is common, interpreting iron laboratory test results can be challenging in patients with comorbidities. We aimed to study the accuracy of common iron biomarkers compared with bone marrow iron staining in a large retrospective data set of patients with hematologic disorders. We collected from 6610 patients (median age, 66 years) results of iron staining, with their concurrent ferritin, transferrin saturation, soluble transferrin receptor, transferrin, hemoglobin, and mean red blood cell volume results from Helsinki University Hospital electronic health records. In receiver operating characteristics analysis, ferritin had the highest area under the curve (AUC) with 88% (95% confidence interval [CI], 86-90) for females and 89% (95% CI, 87-91) for males in predicting reduced bone marrow iron. Using a ferritin cutoff of 30 μg/L resulted in high specificity rates of 97% in females and 99% in males. However, sensitivity rates were only 54% and 35%, respectively. Other studied biomarkers had inferior AUCs. Multivariate logistic regression models did not significantly perform better in prediction than ferritin alone. With 50% preprobability for reduced iron stores, a ferritin of 30 μg/L (females) and 51 μg/L (males) had a 95% positive predictive value for reduced iron stores. A 95% negative predictive value was achieved at 1750 μg/L (females) and 4967 μg/L (males). In our large population study, ferritin was the best single biomarker for iron deficiency in secondary care. Adding other blood tests in a multivariate model did not improve performance. However, in these patients with hematologic disorders, even a high ferritin did not rule out iron deficiency with 95% certainty.

Segmental testicular infarction (STI) is an idiopathic testicular disease with a low incidence. Accurately diagnosing and treating this disease presents a challenge for clinicians. Iron deficiency anemia (IDA) is a relatively common blood disorder and is generally accompanied by thrombocytosis, which increases the risk of thrombosis. In the present study, we report a 38-year-old man who suffered from a rare bilateral STI, which may be related to IDA. After conservative treatment and timely administration of iron supplementation, we observed an improvement in the patient's IDA and bilateral STI. Ultrasound, magnetic resonance imaging, and laboratory tests helped us to accurately diagnose the disease and avoid unnecessary surgery. Following a month of follow-up, continuous ultrasound monitoring showed that the patient's lesions had completely disappeared, with no indications of recurrence. Therefore, ultrasound is a useful tool for the diagnosis and continuous monitoring of this type of disease.

Our previous study found that 60 of 588 oral lichen planus (OLP) patients have vitamin B12 deficiency. This study assessed whether the vitamin B12-deficient OLP (B12D/OLP) patients had significantly higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity than healthy control subjects and evaluated whether all B12D/OLP patients had pernicious anemia (PA).

The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 60 B12D/OLP patients and 588 healthy control subjects were measured and compared.

We found that 60 B12D/OLP patients had significantly lower mean blood Hb and serum iron, vitamin B12, and folic acid levels as well as significantly higher mean corpuscular volume (MCV) and mean serum homocysteine level than 588 healthy control subjects (all P-values <0.01). Moreover, 60 B12D/OLP patients had significantly higher frequencies of macrocytosis (55.0 %), blood Hb (68.3 %) and serum iron (31.7 %) and vitamin B12 (100.0 %) deficiencies, hyperhomocysteinemia (91.7 %), and serum GPCA positivity (66.7 %) than 588 healthy control subjects (all P-values <0.001). The four most common types of anemia in 41 anemic B12D/OLP patients were PA (17 patients, 41.5 %), normocytic anemia (12 patients, 29.3 %), iron deficiency anemia (6 patients, 14.6 %), and macrocytic anemia other than PA (5 patients, 12.2 %).

The B12D/OLP patients have significantly higher frequencies of macrocytosis, blood Hb and serum iron and vitamin B12 deficiencies, hyperhomocysteinemia, and serum GPCA positivity than healthy control subjects. Only 17 (28.3 %) of 60 B12D/OLP patients have PA.

Our previous study found that 99 of 588 oral lichen planus (OLP) patients have iron deficiency (ID). This study assessed whether all OLP patients with ID (so-called ID/OLP patients) had iron deficiency anemia (IDA) and evaluated whether the ID/OLP patients had significantly higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity than healthy control subjects.

The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 99 ID/OLP patients and 588 healthy control subjects were measured and compared.

We found that 99 ID/OLP patients had significantly lower mean blood Hb and serum iron, vitamin B12, folic acid levels as well as significantly higher mean serum homocysteine level than 588 healthy control subjects (all P-values <0.001). Moreover, 99 ID/OLP patients had significantly higher frequencies of blood Hb (64.7 %) and serum vitamin B12 (19.2 %), and folic acid (2.0 %) deficiencies, hyperhomocysteinemia (34.3 %), and serum GPCA positivity (33.3 %) than 588 healthy control subjects (all P-values <0.05). Furthermore, of 64 anemic ID/OLP patients, 2 (3.1 %) had pernicious anemia, 30 (46.9 %) had normocytic anemia, and 32 (50.0 %) had IDA.

ID/OLP patients have significantly higher frequencies of blood Hb and serum vitamin B12 and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than healthy control subjects. Although the IDA (50.0 %) is the most common type of anemia in our 64 anemic ID/OLP patients, there are still 46.9 % of the 64 anemic ID/OLP patients who had the normocytic anemia.

Iron deficiency anemia (IDA) is a common health problem. The hepcidin hormone is the main regulator of systemic iron balance. The body responds to IDA by decreasing hepcidin. This study investigated how different iron supplementation regimens affect hepcidin levels in women with IDA. 87 female participants aged 18-45 years with hemoglobin < 10 g/dL and serum ferritin < 20 ng/ml were assigned to receive iron therapy every other day, once daily, or twice daily. Hemogram, serum iron, serum iron binding capacity, ferritin, hepcidin, and C-reactive protein values were measured at baseline and on the 15th and 90th days of treatment in all groups. On the seventh day, no significant difference was found between the once-daily and twice-daily groups (p = 0.42) in reticulocyte counts. By the 15th day, hemoglobin and MCV levels showed significant improvement in the twice-daily group compared to the other groups (p < 0.01). At the third month, ferritin levels were significantly higher in the twice-daily group compared to the every-other-day and once-daily groups (p = 0.03). No significant differences were observed in hepcidin levels at three months across all groups. The study concludes that twice-daily iron supplementation results in the most significant hematological improvements but with increased gastrointestinal side effects. These findings underscore the importance of tailoring iron dosing schedules to individual patient needs. In cases where rapid haemoglobin response is required, twice-daily dosing may provide superior results. Conversely, once-daily dosing may be preferred if tolerable anemia can be maintained. Every other day dosing, although associated with fewer side effects and better tolerability, may not provide adequate support for erythropoiesis.

The online version contains supplementary material available at 10.1007/s12288-024-01844-5.

To provide evidence-based guidance on practical aspects and potential safety concerns (infusion reactions and hypophosphataemia) related to the use of intravenous iron from a nursing perspective.

A modified Delphi consensus method.

Literature searches were conducted and used to support the development of 16 consensus statements. Six nurses with expertise in the field of gastroenterology and experience with the administration of intravenous iron participated in a modified Delphi process to develop a final set of statements.

Overall, 16 statements achieved consensus and covered the practicalities of administration, infusion reactions and hypophosphataemia. Patient preparation is a key step in the administration of intravenous iron, but information should be communicated carefully to prevent undue anxiety. Highlighting the nurse's confidence in the management of any reactions may help to reduce anxiety. The patient should be observed during the first 5-10 min of an infusion to allow prompt management of immediate infusion reactions, although severe hypersensitivity reactions are rare. Nurses should be vigilant for symptoms of hypophosphataemia (such as fatigue, weakness and muscle/bone pain), which can develop following treatment with ferric carboxymaltose, saccharated ferric oxide and iron polymaltose. Serum phosphate levels should be measured in patients receiving ferric carboxymaltose who are at risk of low phosphate.

Infusion reactions and hypophosphataemia with intravenous iron are documented in the literature, but existing publications do not approach these topics from a nursing perspective. This consensus paper highlights the importance of patient preparation, monitoring and prompt management when administering intravenous iron to ensure patient safety. Considering that nurses have a central role in the administration of intravenous iron, the availability of evidence-based guidance is essential for both nurse confidence and patient safety.

No patient or public contribution was involved in the consensus process.

Iron deficiency is prevalent among geriatric hospitalized patients, often coinciding with inflammation. This study aimed to determine a critical C-reactive protein (CRP) threshold for sufficient intestinal iron absorption using standardized tests.

This retrospective, cross-sectional study was conducted in a geriatric acute care unit. Serum iron and CRP levels were measured before breakfast and two- and four-hours after ingestion of two iron capsules. Intestinal iron absorption was calculated by subtracting baseline values from those obtained after the test, with an increase of 100 ug/dl indicating sufficient absorption. Patients were categorized into six CRP groups: ≤0.50, 0.51-2.50, 2.51-5.0, 5.1-7.50, 7.51-10.0, and ≥10.1 mg/dl.

The study included 59 participants (73% females, age range 71-99). Iron absorption was highest in groups with lower CRP levels ≤0.50 to 2.5 mg/dl) and declined significantly as CRP increased, particularly beyond 5 mg/dl. The most significant decline was noted in patients with CRP ≥ 10.1 mg/dl. A negative correlation between inflammation, as measured by CRP, and iron absorption was found. As CRP levels escalate, there is a significant reduction in the increase of serum iron levels after 2 h. A regression analysis showed that only elevated CRP levels significantly reduced serum iron increments post-iron supplementation (P = 0.004), while other factors such as age, sex, body mass index, frailty, weight loss, hemoglobin and nutritional status had no significant impact.

A CRP level above 5 mg/dl is indicative of significantly impaired intestinal iron absorption in older patients, underscoring the critical influence of inflammation on iron metabolism.

Iron deficiency (ID) is a prevalent complication of chronic kidney disease (CKD), often managed reactively when associated with anaemia. This scoping review evaluates the evidence supporting intravenous (IV) iron therapy in non-anaemic individuals with CKD and ID, focusing on safety, efficacy, and emerging therapeutic implications. Current diagnostic markers, including serum ferritin, transferrin saturation, and reticulocyte haemoglobin content, are reviewed alongside their limitations in the context of inflammation and variability. The pathophysiology of ID in CKD is explored, highlighting the roles of hepcidin, hypoxia-inducible factor pathways, and uraemic toxins. Comparative studies reveal that IV iron offers a more rapid correction of iron stores, improved compliance, and fewer gastrointestinal side effects compared to oral iron. Evidence from trials such as "iron and heart" and "iron and muscle" suggests potential benefits of IV iron on functional capacity and fatigue, though findings were statistically non-significant. Insights from heart failure trials support the safety and efficacy of IV iron in improving quality of life and reducing hospitalizations, with newer formulations like ferric derisomaltose demonstrating favourable safety profiles. This review underscores the need for standardized screening protocols for ID in CKD, even in the absence of anaemia, to facilitate earlier intervention. Future research should prioritise robust outcome measures, larger sample sizes, and person-specific treatment strategies to optimise dosing and administration frequency. Tailored approaches to IV iron therapy have the potential to significantly improve functional outcomes, quality of life, and long-term health in people with CKD.

Serum ferritin (SF) levels are associated with metabolic syndrome and dyslipidemia. However, the association between SF and atherogenic lipid profiles in high-altitude living populations remains unclear.

In 2021, a cross-sectional study was conducted on adult Tajik individuals residing in Tashkurgan Tajik Autonomous County (average altitude 3,100 meters). Demographic information and anthropometric measurements were collected in local clinics. Fasting blood samples were analyzed using a Beckman AU-680 Automatic Biochemical analyzer at the biochemical laboratory of Fuwai Hospital. Univariate linear regression analyses were used to explore the association between SF and atherogenic lipid levels. Subgroup analysis was used based on gender and different high-sensitivity C-reactive protein (hs-CRP) and serum amyloid A (SAA) levels. The association between higher SF quartiles and different kinds of dyslipidemia were analyzed by logistic regression.

There were 1,703 participants in total, among which 866 (50.9%) being men. The mean ages of male and female participants were similar (41.50 vs. 42.38 years; P = 0.224). SF levels were significantly correlated with total cholesterol (TC) (Beta = 0.225, P < 0.001), low-density lipoprotein cholesterol (LDL-C) (Beta = 0.197, P < 0.001), high-density lipoprotein cholesterol (HDL-C) (Beta = -0.218, P < 0.001), triglycerides (TG) (Beta = 0.332, P < 0.001), and small dense LDL-C (sdLDL-C) (Beta = 0.316, P < 0.001), with the exception of lipoprotein (a) (Lp(a)) (Beta = 0.018, P = 0.475). SF was significantly correlated with LDL-C and HDL-C in women, and correlated with TC, TG, and sdLDL-C levels in both men and women in different inflammatory conditions. Elevated SF levels was significantly correlated with high TC (OR: 1.413, 95% CI [1.010-1.978]), high TG (OR: 1.602, 95% CI [1.299-1.976]), and high sdLDL-C (OR: 1.631, 95% CI [1.370-1.942]) in men and high TC (OR: 1.461, 95% CI [1.061-2.014]), high LDL-C (OR: 2.104, 95% CI [1.481-2.990]), low HDL-C (OR: 1.447, 95% CI [1.195-1.752]), high TG (OR: 2.106, 95% CI [1.454-3.050]), and high sdLDL-C (OR: 2.000, 95% CI [1.589-2.516]) in women. After adjusting for potential confounders, elevated SF levels continue to be correlated with high TG in male (OR: 1.382, 95% CI [1.100-1.737]) and female (OR: 1.677, 95% CI [1.070-2.628]) participants. In both young and middle-aged subgroups, the associations between SF and TG, TC, HDL-C, LDL-C, and sdLDL-C were still significant.

SF was closely related to atherogenic lipid profiles, especially with regard to TG in high-altitude populations. This association cannot be attributed to its role as an inflammation marker.

Renal aging is a physiological process characterized by structural and functional changes in the kidneys. The presence of disorders or pathologies can exacerbate these age-related changes, potentially leading to organ dysfunction. Chronic kidney disease (CKD), a significant global public health issue, is particularly prevalent in the elderly and is often associated with the age-related decline in kidney function. Anemia is one of the most frequent complications of CKD and is also highly prevalent in the elderly. Mild anemia, often multifactorial, is the most common presentation. Understanding the mechanisms driving anemia in this population is crucial to ensure appropriate treatment. The primary etiologies include nutritional deficiency, anemia of unknown cause, and anemia of chronic diseases, including CKD. This review provides an in-depth exploration of the complex pathophysiological mechanisms underlying anemia in elderly patients with CKD.

Background: Iron deficiency anemia (IDA) is a common type of anemia in children and pregnant women. The effects of iron deficiency on gut microbiota and metabolic profiles are not fully understood. Methods: Mendelian randomization (MR) analysis was conducted to explore associations among IDA, gut microbiota, and metabolites. MR analysis was conducted using computational methods, utilizing human genetic data. Data were obtained from genome-wide association studies (GWAS), with inverse-variance-weighted (IVW) as the primary method. Animal models evaluated the effects of IDA on gut microbiota and metabolic profiles. Results: IVW analysis revealed significant associations between gut microbial taxa and IDA. The genus Desulfovibrio was protective (OR = 0.85, 95% CI: 0.77-0.93, p = 0.001), while Actinomyces (OR = 1.12, 95% CI: 1.01-1.23, p = 0.025) and family XIII (OR = 1.16, 95% CI: 1.01-1.32, p = 0.035) increased IDA risk. Glycine was protective (OR = 0.95, 95% CI: 0.91-0.99, p = 0.011), whereas medium low density lipoprotein (LDL) phospholipids increased risk (OR = 1.07, 95% CI: 1.00-1.15, p = 0.040). Animal models confirmed reduced Desulfovibrio, increased Actinomyces, and altered metabolites, including amino acids and phospholipids. Conclusions: IDA significantly impacts gut microbiota and metabolic profiles, offering insights for therapeutic strategies targeting microbiota and metabolism.

This observational study examined the relationship between self-reported dietary patterns-omnivore, pescatarian, vegetarian, and vegan-and iron status among Swedish teenage girls. Additionally, we compared the consumption of various food groups in relation to iron status.

Data were collected from 475 female high school students in Malmö and Lund, Sweden, using questionnaires on dietary habits, iron supplementation, and demographic factors. Participants were classified into dietary groups: 347 omnivores, 38 pescatarians, 27 non-consumers of red meat, 60 vegetarians and 3 vegans. Blood samples were analysed for ferritin and haemoglobin levels to determine iron status. Iron deficiency was defined as ferritin < 15 µg/L, and anaemia as haemoglobin < 110 g/L if < 19 years and < 117 g/L if ≥ 19 years. ANOVA and logistic regression were used to compare biomarker levels and the prevalence of iron deficiency and anaemia across dietary groups.

Omnivores had the highest estimated ferritin levels (19.6 µg/L), which was significantly higher than pescatarians (14.7 µg/L, p = 0.03), and vegans/vegetarians (10.9 µg/L, p < 0.001). Overall 38.1% of participants were iron deficient. Vegetarians/vegans and pescatarians were significantly more likely to be iron deficient (69.4%, p < 0.001 and 49.4%, p-value 0.016, respectively) compared to omnivores (30.5%). Lower red meat consumption and higher intake of vegetarian patties and legumes were linked to an increased risk of iron deficiency. Anaemia prevalence (haemoglobin < 110 g/L if < 19 years and < 117 g/L if ≥ 19 years) was 3% across all dietary groups.

This study highlights a higher prevalence of iron deficiency among Swedish teenage girls adhering to plant-based diets. Public health strategies should promote balanced diets that ensure adequate iron intake and absorption while considering environmental sustainability. Regular screening and targeted dietary recommendations are essential for supporting the health of this population.

Iron deficiency anaemia (IDA) related to occult gastrointestinal tract (GIT) blood loss is associated with high rates of GIT malignancies. Major society guidelines recommend bidirectional endoscopic evaluation for all men and post-menopausal women with newly diagnosed, unexplained IDA. However, in patients prescribed direct oral anticoagulants (DOACs), the endoscopic yield, specifically the rate of high-risk findings, including colorectal cancers (CRCs) and advanced adenomas (AAs), is unknown.

Our aim is to determine the endoscopic yield, specifically the prevalence of these high-risk findings in patients presenting with new-onset unexplained IDA while on a DOAC.

This is a single-centre, retrospective analysis performed at a tertiary hospital in Australia. Between January 2015 and July 2019, 178 consecutive patients underwent endoscopic evaluation for IDA while prescribed a DOAC. Patient demographics, laboratory data, medications and endoscopic findings were summarised and compared by diagnostic yield. Associations were explored using logistic regression analysis.

CRCs were present in 2/178 (1.1% (95% confidence interval (CI): 0.1-4.0)) patients. AAs were found in 35/178 (19.6% (95% CI: 14.1-26.3)) patients. The most common AAs were tubular adenomas (45.7%), tubulovillous (31.4%) and sessile serrated adenomas (14.2%). Older age (P = 0.013) and lower ferritin levels (P = 0.009) were associated with the presence of high-risk findings.

In patients presenting with new-onset, unexplained IDA while on a DOAC, the prevalence of CRCs is lower than previously reported in studies involving populations not prescribed DOACs. Conversely, there is a higher incidence of AAs, including high-risk histological features, such as tubulovillous adenomas and sessile serrated polyps.

Background: Globally, one-third of pregnant women are at risk of iron deficiency, particularly in the African region. While recent findings show that iron and folate supplementation can lower the risk of adverse birth outcomes and childhood mortality, our understanding of its impact in Africa remains incomplete due to insufficient evidence. This protocol outlines the systematic review steps to investigate the impact of oral iron and folate supplementation during pregnancy on adverse birth outcomes, neonatal mortality and infant mortality in Africa. Methods and analysis: MEDLINE, PsycINFO, Embase, Scopus, CINAHL, Web of Science, and Cochrane databases were searched for published articles. Google Scholar and Advanced Google Search were used for gray literature and nonindexed articles. Oral iron and/or folate supplementation during pregnancy is the primary exposure. The review will focus on adverse birth outcomes, neonatal mortality and infant mortality. Both Cochrane Effective Practice and Organization of Care and Newcastle-Ottawa Scale risk of bias assessment tools will be used. Meta-analysis will be conducted if design and data analysis methodologies permit. This systematic review and meta-analysis will provide up-to-date evidence about iron and folate supplementation's role in adverse birth outcomes, neonatal mortality and infant mortality in the African region. Ethics and dissemination: This review will provide insights that help policymakers, program planners, researchers, and public health practitioners interested in working in the region. PROSPERO registration number: CRD42023452588.

Iron is an essential micronutrient for abounding physiological processes in the body, and its deficiency can be caused by various factors, such as low iron intake due to economic difficulties or loss of appetite, decreased iron absorption due to gastrointestinal issues, or increased iron loss due to hemorrhages or proteinuria. Iron deficiency is a prevalent issue among heart failure (HF) patients and is a significant contributor to anemia, affecting 30-50% of patients regardless of their gender, ethnicity, or left ventricular ejection fraction. Individuals with HF have high levels of pro-inflammatory cytokines, which can inhibit erythropoiesis by degrading the membrane iron exporter ferroportin, mediated by an increased release of hepcidin. In addition, elevated sympathetic and renin-angiotensin-aldosterone system activity retains salt and water, resulting in high cardiac output HF in people with normal left ventricular function. This review provides an overview of iron deficiency and HF.

Background/Objectives: Modern societal stressors have been linked to declining testosterone levels among young men, contributing to somatic, psychological, and sexual health problems. Despite growing evidence suggesting a link between trace elements and testosterone-related symptoms, there are only a few comprehensive analyses on younger populations. This study's aim was to examine how serum trace elements modulate the relationship between testosterone levels and symptom severity. Methods: This cross-sectional study included 225 young men seeking infertility consultation in Japan. Serum total and free testosterone levels were measured, along with self-reported symptoms using the Aging Males' Symptoms scale (somatic, psychological, sexual) and the Erection Hardness Score. The serum concentrations of 20 trace elements were measured. We used unsupervised clustering to classify participants based on testosterone levels and symptom severity and then compared the distribution of trace elements among the resulting clusters. Results: Three distinct clusters emerged: (1) lowest testosterone with highest symptom severity, (2) intermediate, and (3) highest testosterone with minimal symptoms. Interestingly, the intermediate cluster displayed low testosterone levels but minimal symptoms. Eleven trace elements (phosphorus, sulfur, potassium, calcium, iron, zinc, arsenic, rubidium, strontium, molybdenum, and cesium) were identified as potential contributors to testosterone dynamics. Weighted quantile sum regression indicated that phosphorus, strontium, and molybdenum negatively influenced testosterone outcomes, whereas iron, sulfur, and zinc were beneficial. Conclusions: Serum trace element profiles are significantly associated with testosterone levels and symptom severity in young men. Targeted interventions may address testosterone decline and its implications. These findings may help develop tailored strategies for optimizing male health.

The first period of military service consists of a physically and mentally challenging basic combat training (BCT) program. Factors like demanding physical exercise, limited recovery time, and restricted diet choice and food intake may challenge iron intake and homeostasis in recruits undergoing BCT. Iron-deficient individuals may experience reduced work capacity, fatigue, weakness, frequent infections, and increased injury risk. Limited knowledge is available on the extent of this potential health risk among military recruits. The aim of the present study was to systematically review published studies on the prevalence and change in prevalence of anemia, iron deficiency (ID), and ID anemia (IDA) among recruits undergoing BCT.

Electronic searches were conducted in the databases Medline (Ovid), Embase (Embase.com), and Web of Science (Clarivate Analytics) from database inception up until April 16, 2024. Inclusion criteria were observational studies with both cross-sectional and observational longitudinal designs that examined the effects of BCT (intervention) on iron status (outcome) in military recruits (population). Extracted data were the number of participants (n), age, sex, country/population, BCT duration, and relevant measures of prevalence and changes in prevalence of anemia, ID, and IDA (primary outcome) and physical performance, mood state, stress fractures, attrition rate, and nutritional supplements (secondary outcomes). The study quality and risk of bias were assessed using the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data and The National Institutes of Health Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group. Meta-analyses were performed using restricted maximum-likelihood models, and the effect size was calculated as Cohen's h with 95% CI.

Twenty-two articles were systematically reviewed (n = 111,764 men and 12,650 women), and six of these papers (n = 388 men and 773 women) were included in the meta-analysis. There was a varying prevalence of anemia, ID, and IDA among military recruits at the start of BCT. Results from meta-analyses showed negligible and nonsignificant effects of BCT on the prevalence of anemia, ID, and IDA. The quality of the included cross-sectional studies ranging from fair to good, whereas a large proportion of the included longitudinal studies were classified as poor. No sign of publication bias was found.

The prevalence of anemia, ID, and IDA in military recruits seems not to be affected by the completion of BCT shorter than 16 weeks, whereas the effects of longer BCT durations remain unclear. Even though body iron homeostasis seems unaffected, adequate energy and nutritional intake should remain a priority. Future research could focus on dietary interventions to determine the optimal diet among female recruits in specifically exposed populations.

The incidence of vascular cognitive impairment (VCI) is high in patients suffering from ischaemic stroke or transient ischaemic attack (TIA) or with vascular risk factors. Effective prevention strategies for VCI remain limited. Anaemia or low haemoglobin was found as an independent risk factor for adverse outcomes after acute stroke. Anaemia or low haemoglobin was possibly associated with an increased risk of poststroke cognitive impairment. Whether supplement of ferrous iron to correct anaemia reduces the risk of VCI and improves adverse outcomes in patients with ischaemic cerebrovascular disease remains uncertain.

We aim to introduce the design and rationale of the safety and efficacy of Ferrous iron on the prevention of Vascular cOgnitive impaiRment in patients with cerebral Infarction or TIA (FAVORITE) trial.

FAVORITE is a randomised, placebo-controlled, double-blind, multicentre trial that compares supplement of ferrous iron with placebo for recent minor stroke/TIA patients complicated with mild anaemia or iron deficiency: Ferrous succinate sustained-release tablet 0.2 g (corresponding to 70 mg of elemental iron) once daily after or during breakfast for 12 weeks or placebo with much the same colour, smell and size as ferrous iron once daily during or after breakfast for 12 weeks. All paticipants will be followed within the next year.

The primary effective outcome is the incidence of VCI at 3 months after randomisation and the primary safety outcome includes any gastrointestinal adverse event during 3 months.

The FAVORITE trial will clarify whether supplement of ferrous iron to correct low haemoglobin reduces the risk of VCI in patients with recent ischaemic stroke or TIA complicated with mild anaemia or iron deficiency compared with placebo.

NCT03891277.

Iron deficiency has been suggested as a potential mechanism for attention-deficit hyperactivity disorder (ADHD) development due to involvement in neurotransmitter synthesis and transporter expression. As iron deficiency is particularly common in women of reproductive age, often due to heavy menstrual bleeding (HMB), we aimed to explore the relationship between iron deficiency, HMB and ADHD in women.

We screened women (18-49 years) at university and local sporting events in Western Australia. To screen for ADHD, section A of the Adult ADHD Self-Report Scale-V1.1 (ASRS-V1.1) and the Adult Concentration Inventory were used to assess cognitive disengagement syndrome (CDS) symptoms. Risk factors for iron deficiency, such as HMB, commonly reported symptoms and a fingerpick haemoglobin concentration (Hb) (Hemocue Hb801) were recorded.

Of the 405 completed questionnaires, the mean age was 24.8 ± 10.1 years, the mean Hb was 136.8 ± 12.4 g/L and 6.4% of women were anaemic. Symptoms suggestive of ADHD were reported by 174/405 (43%) women, and 128/405 (32%) women reported HMB. There was a greater prevalence of HMB reported in those experiencing symptoms suggestive of ADHD (39% vs. 26%, p = 0.01). Symptoms of fatigue, dizziness, brain fog, anxiety, heart palpitations, headaches, restless legs and depression were more common in patients with symptoms suggestive of ADHD (p ? 0.01) and HMB (p < 0.05). Anaemia status did not influence ADHD status (p = 0.87) nor CDS scores (15.7 ± 7.0 vs. 13.8 ± 6.1, p = 0.17).

There is an apparent relationship between those with symptoms reported in ADHD, HMB and iron deficiency. Further exploration is required to determine whether there is a causative relationship.

Iron deficiency anaemia (IDA) accounts for nearly two-thirds of all anaemia cases globally. Despite the widespread use of iron supplementation, the optimal dose and duration for treating IDA remain unclear. In this study, we aimed to determine the most effective dose and duration of iron supplementation for improving haemoglobin (Hb) levels in children and adolescents (≤19 years) with IDA.

A systematic review and meta-analysis were conducted. We searched MEDLINE, Embase, CINAHL, and the Cochrane Library for peer-reviewed studies published between 2013 and 2024. The interventions included iron supplementation with a defined dose and duration of at least 30 days. Comparators were placebo, no treatment, or alternative regimens. The outcome was the change in Hb levels. Eligible studies included IDA cases diagnosed through ferritin level measurements in healthy individuals. Studies involving pregnant women or children with underlying conditions were excluded. A meta-analysis was performed using standardized mean differences to pool effect sizes for Hb improvement with 95% confidence intervals (CIs). Subgroup analyses were performed for different treatment durations (<3 months, 3-6 months, >6 months) and dosage categories (<5 mg/kg/day, 5-10 mg/kg/day, >10 mg/kg/day). A random-effects meta-regression model was used to determine the optimal dose and duration, accounting for known covariates affecting Hb improvement.

A total of 28 studies with 8,829 participants from 16 countries were included. The pooled effect size for Hb improvement was 2.01 gm/dL (95% CI: 1.48-2.54, p < 0.001). Iron supplementation for less than 3 months showed the highest significant effect size (2.39 gm/dL, 95% CI: 0.72-4.07), followed by treatments exceeding 6 months (1.93 gm/dL, 95% CI: 0.09-3.77). The lowest effect size was observed in treatments lasting 3-6 months (1.58 gm/dL, 95% CI: 0.93-2.23). Low-dose iron supplementation (<5 mg/kg/day) demonstrated favourable trends in Hb improvement, particularly in individuals with lower baseline Hb levels. Oral ferrous sulphate had a significant effect (2.03 gm/dL, 95% CI: 1.24-2.82), while parenteral ferric Carboxymaltose showed consistent efficacy.

Low-dose iron supplementation (<5 mg/kg/day) combined with treatment durations of either less than 3 months or more than 6 months, is optimal for improving Hb levels in children and adolescents with IDA. Tailoring treatment based on baseline Hb levels and anaemia severity is essential. These findings provide evidence to support updated guidelines on iron supplementation in paediatric and adolescent populations and inform national anaemia management programmes.

Prospero registration number: This study was registered with PROSPERO (CRD42024541773).