Assessment of iron status and iron deficiency anemia in patients with celiac, a single center experience Iron status and iron deficiency anemia in patients with celiac disease
Gastroenterology and Hepatology from Bed to Bench,
Vol. 16 No. 2 (2023),
21 April 2023
https://doi.org/10.22037/ghfbb.v16i2.2728
Abstract
Aim: This study aimed to assess the status of iron stores and the frequency of iron deficiency anemia in Celiac disease (CD) patients referred to the Golestan Research Center of Gastroenterology and Hepatology, Gorgan, Iran.
Background: Studies have shown that nutritional deficiencies affect 20-38% of patients with CD due to malabsorption and as a result of a gluten-free diet.
Methods: In this study, 59 out of 100 CD patients were assessed. The presence and severity of anemia were determined using the concentration of serum hemoglobin according to WHO criteria. The status of body iron stores was also assessed based on serum ferritin levels.
Results: Mean and SD of age, duration of disease, serum hemoglobin, ferritin, TIBC, and serum iron were 39.9±11.9 years, 69.8±45.4 months, 12.6±1.99 g/dl, 54.3±55.3 mg/dL, 365.9±49.1 μg/dL, and 84.1±37.1 μg/dL, respectively. 68.42% had no anemia, 19.3% had mild anemia, 8.77% had moderate anemia, and 3.51% had severe anemia. 25.42% of patients had depleted iron stores, 71.19% had normal iron stores, and 3.39% were exposed to iron overload. There was a statistically significant correlation between serum hemoglobin and the duration of disease diagnosis (P=0.037, r=0.302).
Conclusion: In this study, 31.58% of CD patients on a gluten-free diet had some degree of anemia. In addition, 25.42% of patients had depleted iron stores. These results suggest that CD patients should be evaluated for iron status, even with a gluten-free diet.
Keywords:
- Celiac Disease; Iron Deficiencies; Anemia, Iron-Deficiency; Ferritins; Diet, Gluten-Free; Nutrition Assessment
How to Cite
Pirzadeh, S. A., Amiriani, T., Besharat, S., Norouzi, A., Mirkarimi, H., Shokouhifar, N., Roshandel, G., & Sharifi, A. (2023). Assessment of iron status and iron deficiency anemia in patients with celiac, a single center experience: Iron status and iron deficiency anemia in patients with celiac disease. Gastroenterology and Hepatology from Bed to Bench, 16(2). https://doi.org/10.22037/ghfbb.v16i2.2728
References
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17. Kirby M, Danner E. Nutritional deficiencies in children on restricted diets. Pediatric clinics of North America. 2009;56(5):1085-103.
18. Martin-Masot R, Nestares MT, Diaz-Castro J, Lopez-Aliaga I, Alferez MJM, Moreno-Fernandez J, et al. Multifactorial Etiology of Anemia in Celiac Disease and Effect of Gluten-Free Diet: A Comprehensive Review. Nutrients. 2019;11(11).
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20. Annibale B, Severi C, Chistolini A, Antonelli G, Lahner E, Marcheggiano A, et al. Efficacy of gluten-free diet alone on recovery from iron deficiency anemia in adult celiac patients. Am J Gastroenterol. 2001;96(1):132-7.
21. Thompson T. Folate, iron, and dietary fiber contents of the gluten-free diet. Journal of the American Dietetic Association. 2000;100(11):1389-96.
22. Organization WH. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. World Health Organization; 2011.
23. Organization WH. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. World Health Organization; 2011.
24. DeLoughery TG. Microcytic anemia. New England Journal of Medicine. 2014;371(14):1324-31.
25. Vaucher P, Druais PL, Waldvogel S, Favrat B. Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. CMAJ. 2012;184(11):1247-54.
26. Verdon F, Burnand B, Stubi CL, Bonard C, Graff M, Michaud A, et al. Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial. BMJ (Clinical research ed). 2003;326(7399):1124.
27. Krayenbuehl PA, Battegay E, Breymann C, Furrer J, Schulthess G. Intravenous iron for the treatment of fatigue in nonanemic, premenopausal women with low serum ferritin concentration. Blood. 2011;118(12):3222-7.
28. Balaban DV, Popp A, Ionita Radu F, Jinga M. Hematologic Manifestations in Celiac Disease-A Practical Review. Medicina (Kaunas, Lithuania). 2019;55(7).
29. Halfdanarson TR, Litzow MR, Murray JA. Hematologic manifestations of celiac disease. Blood. 2007;109(2):412-21.
30. Freeman HJ. Iron deficiency anemia in celiac disease. World J Gastroenterol. 2015;21(31):9233-8.
31. Bottaro G, Cataldo F, Rotolo N, Spina M, Corazza GR. The clinical pattern of subclinical/silent celiac disease: an analysis on 1026 consecutive cases. Am J Gastroenterol. 1999;94(3):691-6.
32. Ertekin V, Tozun MS, Kucuk N. The prevalence of celiac disease in children with iron-deficiency anemia. Turk J Gastroenterol. 2013;24(4):334-8.
33. Cannizzaro R, Da Ponte A, Tabuso M, Mazzucato M, De Re V, Caggiari L, et al. Improving detection of celiac disease patients: a prospective study in iron-deficient blood donors without anemia in north Italy. European journal of gastroenterology & hepatology. 2014;26(7):721-4.
34. Annibale B, Capurso G, Chistolini A, D’Ambra G, DiGiulio E, Monarca B, et al. Gastrointestinal causes of refractory iron deficiency anemia in patients without gastrointestinal symptoms. The American journal of medicine. 2001;111(6):439-45.
35. Barisani D, Parafioriti A, Bardella MT, Zoller H, Conte D, Armiraglio E, et al. Adaptive changes of duodenal iron transport proteins in celiac disease. Physiol Genomics. 2004;17(3):316-25.
36. Sharma N, Begum J, Eksteen B, Elagib A, Brookes M, Cooper BT, et al. Differential ferritin expression is associated with iron deficiency in coeliac disease. European journal of gastroenterology & hepatology. 2009;21(7):794-804.
37. Fine KDJNEJoM. The prevalence of occult gastrointestinal bleeding in celiac sprue. 1996;334(18):1163-7.
2. Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, et al. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Journal of pediatric gastroenterology and nutrition. 2005;40(1):1-19.
3. Husby S, Koletzko S, Korponay-Szabo IR, Mearin ML, Phillips A, Shamir R, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. Journal of pediatric gastroenterology and nutrition. 2012;54(1):136-60.
4. Mustalahti K, Catassi C, Reunanen A, Fabiani E, Heier M, McMillan S, et al. The prevalence of celiac disease in Europe: results of a centralized, international mass screening project. Annals of medicine. 2010;42(8):587-95.
5. Choung RS, Larson SA, Khaleghi S, Rubio-Tapia A, Ovsyannikova IG, King KS, et al. Prevalence and Morbidity of Undiagnosed Celiac Disease From a Community-Based Study. Gastroenterology. 2017;152(4):830-9 e5.
6. Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE. The prevalence of celiac disease in the United States. Am J Gastroenterol. 2012;107(10):1538-44; quiz 7, 45.
7. Ludvigsson JF, Leffler DA, Bai JC, Biagi F, Fasano A, Green PH, et al. The Oslo definitions for coeliac disease and related terms. Gut. 2013;62(1):43-52.
8. Botero-López JE, Araya M, Parada A, Méndez MA, Pizarro F, Espinosa N, et al. Micronutrient deficiencies in patients with typical and atypical celiac disease. Journal of pediatric gastroenterology and nutrition. 2011;53(3):265-70.
9. Dahele A, Ghosh S. Vitamin B 12 deficiency in untreated celiac disease. The American journal of gastroenterology. 2001;96(3):745.
10. Wierdsma NJ, van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, van Bodegraven AA. Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Nutrients. 2013;5(10):3975-92.
11. Jamnik J, Jenkins DJ, El-Sohemy A. Biomarkers of cardiometabolic health and nutritional status in individuals with positive celiac disease serology. Nutrition and health. 2018;24(1):37-45.
12. Babio N, Alcazar M, Castillejo G, Recasens M, Martinez-Cerezo F, Gutierrez-Pensado V, et al. Patients With Celiac Disease Reported Higher Consumption of Added Sugar and Total Fat Than Healthy Individuals. Journal of pediatric gastroenterology and nutrition. 2017;64(1):63-9.
13. Balamtekin N, Aksoy C, Baysoy G, Uslu N, Demir H, Koksal G, et al. Is compliance with gluten-free diet sufficient? Diet composition of celiac patients. The Turkish journal of pediatrics. 2015;57(4):374-9.
14. Forchielli ML, Fernicola P, Diani L, Scrivo B, Salfi NC, Pessina AC, et al. Gluten-Free Diet and Lipid Profile in Children With Celiac Disease: Comparison With General Population Standards. Journal of pediatric gastroenterology and nutrition. 2015;61(2):224-9.
15. Alzaben AS, Turner J, Shirton L, Samuel TM, Persad R, Mager D. Assessing Nutritional Quality and Adherence to the Gluten-free Diet in Children and Adolescents with Celiac Disease. Canadian journal of dietetic practice and research : a publication of Dietitians of Canada = Revue canadienne de la pratique et de la recherche en dietetique : une publication des Dietetistes du Canada. 2015;76(2):56-63.
16. Di Nardo G, Villa MP, Conti L, Ranucci G, Pacchiarotti C, Principessa L, et al. Nutritional Deficiencies in Children with Celiac Disease Resulting from a Gluten-Free Diet: A Systematic Review. Nutrients. 2019;11(7):1588.
17. Kirby M, Danner E. Nutritional deficiencies in children on restricted diets. Pediatric clinics of North America. 2009;56(5):1085-103.
18. Martin-Masot R, Nestares MT, Diaz-Castro J, Lopez-Aliaga I, Alferez MJM, Moreno-Fernandez J, et al. Multifactorial Etiology of Anemia in Celiac Disease and Effect of Gluten-Free Diet: A Comprehensive Review. Nutrients. 2019;11(11).
19. Berry N, Basha J, Varma N, Varma S, Prasad KK, Vaiphei K, et al. Anemia in celiac disease is multifactorial in etiology: A prospective study from India. JGH open : an open access journal of gastroenterology and hepatology. 2018;2(5):196-200.
20. Annibale B, Severi C, Chistolini A, Antonelli G, Lahner E, Marcheggiano A, et al. Efficacy of gluten-free diet alone on recovery from iron deficiency anemia in adult celiac patients. Am J Gastroenterol. 2001;96(1):132-7.
21. Thompson T. Folate, iron, and dietary fiber contents of the gluten-free diet. Journal of the American Dietetic Association. 2000;100(11):1389-96.
22. Organization WH. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. World Health Organization; 2011.
23. Organization WH. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. World Health Organization; 2011.
24. DeLoughery TG. Microcytic anemia. New England Journal of Medicine. 2014;371(14):1324-31.
25. Vaucher P, Druais PL, Waldvogel S, Favrat B. Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. CMAJ. 2012;184(11):1247-54.
26. Verdon F, Burnand B, Stubi CL, Bonard C, Graff M, Michaud A, et al. Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial. BMJ (Clinical research ed). 2003;326(7399):1124.
27. Krayenbuehl PA, Battegay E, Breymann C, Furrer J, Schulthess G. Intravenous iron for the treatment of fatigue in nonanemic, premenopausal women with low serum ferritin concentration. Blood. 2011;118(12):3222-7.
28. Balaban DV, Popp A, Ionita Radu F, Jinga M. Hematologic Manifestations in Celiac Disease-A Practical Review. Medicina (Kaunas, Lithuania). 2019;55(7).
29. Halfdanarson TR, Litzow MR, Murray JA. Hematologic manifestations of celiac disease. Blood. 2007;109(2):412-21.
30. Freeman HJ. Iron deficiency anemia in celiac disease. World J Gastroenterol. 2015;21(31):9233-8.
31. Bottaro G, Cataldo F, Rotolo N, Spina M, Corazza GR. The clinical pattern of subclinical/silent celiac disease: an analysis on 1026 consecutive cases. Am J Gastroenterol. 1999;94(3):691-6.
32. Ertekin V, Tozun MS, Kucuk N. The prevalence of celiac disease in children with iron-deficiency anemia. Turk J Gastroenterol. 2013;24(4):334-8.
33. Cannizzaro R, Da Ponte A, Tabuso M, Mazzucato M, De Re V, Caggiari L, et al. Improving detection of celiac disease patients: a prospective study in iron-deficient blood donors without anemia in north Italy. European journal of gastroenterology & hepatology. 2014;26(7):721-4.
34. Annibale B, Capurso G, Chistolini A, D’Ambra G, DiGiulio E, Monarca B, et al. Gastrointestinal causes of refractory iron deficiency anemia in patients without gastrointestinal symptoms. The American journal of medicine. 2001;111(6):439-45.
35. Barisani D, Parafioriti A, Bardella MT, Zoller H, Conte D, Armiraglio E, et al. Adaptive changes of duodenal iron transport proteins in celiac disease. Physiol Genomics. 2004;17(3):316-25.
36. Sharma N, Begum J, Eksteen B, Elagib A, Brookes M, Cooper BT, et al. Differential ferritin expression is associated with iron deficiency in coeliac disease. European journal of gastroenterology & hepatology. 2009;21(7):794-804.
37. Fine KDJNEJoM. The prevalence of occult gastrointestinal bleeding in celiac sprue. 1996;334(18):1163-7.
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