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Blood, 15 August 2005, Vol. 106, No. 4, pp. 1142.
Iron and high livingSHAARE ZEDEK MEDICAL CENTER, JERUSALEM
Quantitative measurement of body iron reveals a striking correlation of iron status between mothers and their children (r = 0.61, P < .001), providing strong evidence of the importance of dietary iron as a determinant of iron deficiency in populations at risk.
The present study shows no consistent effect of altitude on body iron in children. By contrast, body iron in women was significantly lower in subjects living at altitudes above 3000 meters. There was a linear increase in body iron with increasing age in children aged 0 to 4 years, with body iron reaching the same levels as in women by the age of 4. However, the most interesting finding in the present study was the close correlation between mother and child throughout the entire range of body iron values. The authors interpret this correlation as an indication of the importance of dietary iron, a factor common to members of the same household, in determining the iron status of a population. The unique strength of this study is the meticulous care taken with developing the methodology, its standardization, and the ability to carry out accurate and reproducible measurements in 20-µL volume serum samples. The same amount of care was taken with statistical analysis, resulting in the spectacularly regular correlations found in the children regarding the effect of age and correlation with maternal iron status (see figure). The conclusions of this study point to interesting future challenges aimed at the elimination of iron deficiency in a population, by focusing on entire household units at risk instead of women or children alone. A limitation of the present study was validation of negative values in subjects with depleted iron stores. This was quite easy in the original study of phlebotomized subjects1 because their initial (normal) hemoglobin was known. Definition of anemia in the present survey was more complicated as it is based on assumptions: that the normal value for each subject of comparable age (women, children) is known and is identical for all subjects, and that the corrections in hemoglobin made for altitude are valid. Nevertheless, these doubts would be relevant only for the negative values, whereas the important findings of the study, namely, the correlation between mothers and their children and the correlation with age in children, are all in the range of positive values based on serum ferritin and transferrin receptors, without resorting to hemoglobin measurements.
The authors have demonstrated the utility of a new and powerful tool for quantitating body iron, suitable for cross-sectional population surveys as well as for longitudinal interventional studies. Such a method would be ideally suited for future studies to evaluate the role of Helicobacter pylori gastritis and autoimmune gastritis in iron deficiency anemia refractory to oral iron treatment,3 and designing optimal strategies to improve iron status. References
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