Original Articles
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Serum Iron Concentration of Maternal and Umbilical Cord Blood during Pregnancy
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Hey Mi Jang, Hong Seok Ahn
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Korean J Community Nutr 2005;10(6):860-868. Published online December 31, 2005
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Abstract
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- Anemia diagnosed early in pregnancy is associated with increased risks of low birth weight and preterm delivery. The purposes of this study were to assess the maternal iron status during pregnancy and to evaluate the relationships between the iron indices of maternal-umbilical cord serum iron and ferritin levels and pregnancy outcomes. Dietary intakes of the pregnant women were estimated by 24 hour-recall (3 times). Serum iron and ferritin levels in maternal blood and umbilical cord were measured at 1st-, 2nd-, 3rd- trimester and delivery, respectively. The mean of maternal serum iron levels of the trimester and delivery were 124.27microgram/dl, 97.03microgram/dl, 94.32microgram/dl, and 145.53microgram/dl. Those maternal levels were significantly lower than that of umbilical cord blood (222.59microgram/dl). Serum ferritin levels of maternal trimester and delivery were 22.68microgram/l, 11.09microgram/l, 14.18microgram/l and 24.54microgram/l, which were significantly lower than those of umbilical cord blood (184.35microgram/l)(p<0.0001). This prevalence of anemia of total subjects was 30.3% by WHO criteria (Hb<11.0 g/dl, Hct<33%). Iron levels of 2nd-trimester was significantly higher in the normal group than in the anemia group. And ferritin levels of 3rd-trimester and delivery was significantly higher in the normal group than in the anemia group. Therefore, we suggest for successful pregnancy outcome and delivery differential iron supplementation programs will be carried out with individual pregnant women on the basis of pre-pregnancy nutrition.
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A Screening Tool for Identifying High-Risk Pregnant Women of Fe Deficiency Anemia : Process II
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Jung A Park, Jin Sook Yoon
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Korean J Community Nutr 2003;8(2):160-170. Published online April 30, 2003
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- Pregnant women in South Korea are a highly risk group for iron deficiency anemia. Previous studies indicated that the 24-hour recall method was insensitive in distinguishing iron deficiency anemic women from normal women. This method is also impractical to when used at community health centers where no public health dietitians are employed. The objective of this study was to develop a convenient tool to evaluate the usual iron (Fe) intake of pregnant women.
The study participants were 115 pregnant women (age 23 to 37 years) at gestational stage of 13 to 24 weeks. Anemic subjects were classified on the basis of their serum ferritin < 12.0 microgram/L and hemoglobin < 12.0microgram/dL levels. Food frequency questionnaires with 46, 29, and 15 commonly consumed food items were used to measure the usual intake of iron of the subjects. Hemoglobin and serum ferritin were measured from fasting blood samples. Nutrients intake was assessed on three consecutive days using the 24-hour recall method and the food record method. The iron index score calculated using the food frequency method showed a significantly positive correlation with iron intake for the three days dietary intake. The iron index showed a significantly difference (p < 0.05) between the normal and anemic groups. However, there was no significant difference in the iron intake between the anemic and the normal women as measured by the 24-hour recall and food record method. Our study indicated that the 29-food items questionnaire could be used as a screening tool to identify poor dietary intake of iron.
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Iron Status and Anemia of Middle School Girls in Ulsan Metropolitan City
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Soon Myung Hong, Young Eun Seo, Hye Jin Hwang
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Korean J Community Nutr 2003;8(1):26-32. Published online February 28, 2003
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- This study was designed to assess the nutritional iron status and anemia of middle school girls. Three-hundred-fiftythree female subjects in Ulsan metropolitan city were evaluated using a questionnaire, and hematological indices. The average height and weight of the respondents were 157.19 +/- 5.57 cm and 51.06 +/-9.42 kg, respectively. The average Body Mass Index (BMI, Kg/m2) was 20.63 +/-3.23, which was within the normal range. With regard to clinical symptoms, the greatest number of respondents reported that they experienced 'decreased ability to concentrate'. The total caloric intake of each subject was 1743.28 +/- 343.47 kcal (83.01% of the Korean RDA) and the calcium intake was 634.98 +/- 201.43 mg (79.37% of the Korean RDA). The mean daily intake of iron was 14.76 +/- 4.36 mg (92.25% of the Korean RDA) and the heme iron intake was 6.12 +/- 2.30 mg, which was 41.5% of the total iron intake. The average hemoglobin (Hb) concentration of the subjects was 13.24 +/- 1.01 g/dl, and the average hematocrit (Hct) level was 37.79 +/- 4.10%. The transferrin saturation {TS (%)} was 19.41 +/- 9.21%, and the ferritin level was 26.26 +/- 18.60 ng/ml. The iron deficiency anemia among the subjects was estimated at 6.1% by using Hb (< 12 g/dl), 20.5% by using Hct (< 36%), 30.8% by using TS (< 14%), and 23.1% by using ferritin (< 12 ng/ml). The total iron binding capacity (TIBC) showed a negative correlation with the Hb, iron, ferritin and TS. With regard to the correlation between blood biochemistry and clinical symptoms related to anemia, the Hb concentration was negatively correlated with 'pale face' (p < 0.05). In addition, the level of iron was significantly and negatively correlated with 'poor memory' (p < 0.01) and the ferritin concentration was negatively correlated with 'no appetite' (p < 0.05), 'pale face (p < 0.05). These results suggest that the prevalence of iron deficiency among middle school girls is very high; therefore, guidelines on dietary support and nutritional education to improve their dietary iron status should be provided.
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A Screening Tool for Identifying High-Risk Pregnant Women of Fe Deficiency Anemia : Process I
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Jung A Park, Jin Sook Yoon
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Korean J Community Nutr 2001;6(5):734-743. Published online December 31, 2001
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- Iron deficiency anemia is a worldwide public health problem relevant to unsound nutritional practice. While the prevalence of iron deficiency anemia is very common among pregnant women, appropriate nutritional service programs to improve the iron status are lacking in Korea. In an attempt to develop a nutritional screening tool to separate the high-risk subjects of iron deficiency, we carried out a nutritional survey for 115 Korean pregnant women whose gestational age ranged from 13 to 24 weeks. Each subject was interviewed with questionnaires for general characteristics and dietary habits. Food intake was measured by 24-hour recap method and 2 day record. Fasting blood was drawn for measuring hemoglobin and serum ferritin. It appeared that half of the pregnant women belonged to the anemia group and had insufficient dietary habits to provide adequate amounts of dietary iron. The first gravida and the working women had better hematological iron indicators than the second or more gravida and the housewives. It also appeared that women who had bigger family size and lower BMI in pre-pregnancy had poorer iron status. Among the food consumption habits, fruit dependent dietary habit was related to poor iron status. Sufficiently consumed green leafy vegetable and appropriate amount of food before morning sickness were positive factors of iron stares. Our results indicated that parity, BMI, current job, family size, food habits including consumption of fruits, green & yellow vegetables, and food habits before the onset of morning sickness are significant factors to contribute the Fe deficiency anemia during pregnancy.
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Effects of Iron Supplementation on Iron Status of Anomic High School Girls
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Soon Myung Hong, Hye Jin Hwang
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Korean J Community Nutr 2001;6(5):726-733. Published online December 31, 2001
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- This study was designed to investigate the effect of iron supplementation on the iron nutritional status and anemia of high school girls in Korea. One hundred thirty-five female students residing in Ulian metropolitan city in Korea diagnosed as having anemia or iron deficiency participated in this study. One or two tablets of iron medicine(80-160 mg Fe as ferrous sulfate/day) were administered to all participants for 3 months. Subjects were evaluated with a questionaire, measurement of hematological indices before and after iron supplementation. The average height and weight of respondents were 161.62 +/- 4.68 cm and 53.87 +/- 6.10 kg, respectively. Daily intakes of energy were 1597.8 +/- 302.35 kcal(76.0% RDA). Iron intakes were 13.72 +/- 4.17 mg (76.3% of RDA) and calcium intakes were 580.74 +/- 177.21(72.5% of RDA) before iron supp]ementation. At baseline, 63% of all participants had depleted store(serum ferritin 12 ug/ml and/or transferrin saturation(TS)<14%). After iron supplementation, this proportion declined to 19.3%. 55.6% of subjects had 12 ug/m1 of basal ferritin concentration before iron supplementation, and this proportion declined to 16.3% after iron supplementation. The basal hemoglobin(Hb) concentrations were 12.13 +/- 1.01 g/dl and they increased to 12.79 +/- 0.81 g/dl, which showed significant difference artier iron supplementation(p<0.001). The basal ferritin and TS(%) were 13.24 +/- 11.66 ng/ml, 18.42 +/- 10.12% and they significantly increased to 32.95 +/- 21.14 ng/ml, 33.53 +/- 16.64%, respectively(p<0.001). The basal total iron binding protein(TIBC) were 467.81 +/- 97.24 ug/dl and they significantly decreased to 325.05 +/- 48.89 ug/dl(p<0.001) after iron supplementation. The number of tablets administered was positively correlated with serum iron(t = 0.553, p<0.01), serum ferritin(t = 0.557, p<0.01), TS(%)(t = 0.588, p<0.01) and negatively correlated with TIBC(t= -0.409, p<0.01). The anemia symptoms such as 'Shortening of breath when going upstairs(p<0.01)', 'Tired out easily(p<0.01)', 'Feeling blue(p<0.001)', 'Decreased ability to concentrate(p<0.01)', and 'Poor memory(p<0.001)'improved significantly after iron supplementation. In this study, daily iron supplementations were efficacious in improving the iron status and anemic symptoms of female high school students. Regular check-ups and nutrition education for adolescents are necessary because of their vulnerability to iron deficiency. Further studies are needed to determine the minimum effective dose of iron and to examine the adverse effect of long-term iron supplementation.
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A Study on Iron Nutritional Status of Girls at Puberty in Kangnung Area
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Eun Kyung Kim, Ok Nam Ryu, Ky Wol Park
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Korean J Community Nutr 1999;4(2):139-148. Published online June 30, 1999
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- This study was designed to assess the iron nutritional status of girls at puberty in Kangnung area. The subjects consisted of 161 adolescents in sixth-grade in primary school and first-grade in middle school girls. Anthropometric measurements were taken for body weight, height, percentage of body fat, and circumferences of waist and hip. Nutrient intakes were assessed by modified 24-hour recall method. Food models and other measuring tools were also used. Fasting blood samples were obtained and analyzed for hemoglobin(Hb) concentration, hematocrit(Hct), serum iron(FE) and total iron binding capacity(TIBC). Mean values for Hb, Hct, Fe, TIBC, TS and serum ferritin were 13.6+/-0.9g/dl, 39.6+/-3.9%, 91.3+/-36.3 microgram/dl, 327.9+/-45.2 microgram/dl, 28.3+/-11.8% and 37.4+/-24.2ng/ml, respectively. Prevalence of iron deficiency greatly varied by indices from 4.8% when judged by Hb to 18.4% by serum Fe concentration. The Hb concentration was positively correlated with Hct(r=0.641), serum iron(r=0.266) and transferrin saturation(r=0.237)(p<0.05). On the other hand, serum ferritin concentration showed significantly negative correlation with TIBC(r=-0.572). Mean daily intake of iron was 14.94mg and heme iron intake was 1.13mg and which was 7.6% of total iron intake. Total absorbable iron calculated by the method of Mosen was 1.38mg and bioavailability of diectary iron was 9.3%. These results suggest that the prevalence of iron deficiency of pubertal girls is very high, therefore the guidelines for diet and social supports, such as, school food service system should be provided to improve their iron status in middle school students.
Randomized Controlled Trial
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Effect of Vitamin C Supplementation on Iron Status of Adolescent Girls with Low Hemoglobin Levels
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Joung Won Lee, Chun Keun Park
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Korean J Community Nutr 1997;2(5):687-694. Published online December 31, 1997
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- This study investigated the effects of vitamin C supplementation on the nutritional iron status of 31 adolescent girls, aged 12-15 years, with low hemoglobin levels. They were randomly divided into four groups, and for two groups daily150 mg or 900 mg of L-ascorbic acid(AsA) was given in three equal doses at three meals during 9 weeks. To another group daily 60 mg iron as ferrous sulfate was given in the same way as AsA. The control group was given sugar placebo. Body iron status was monitored through the determination of Hb, Hct, MCHC, and serum ferritin concentrations. Dietary AsA and iron intakes were measured from food consumption surveys performed by 3-day 24-hour recalls. The amount of absorbed iron was estimated from the model of Monsen et al. The average amounts of food iron for four groups were 12.3- 15.0 mg and 11.1 - 18.9 mg at initial and at final period of the supplementation trial, respectively. The tentatively estimated amount of absorbed iron was significantly increased in the 900 mg AsA and iron supplementing groups, but not in the 150 mg AsA and placebo groups. Both Hb and MCHC were improved to above normal levels in all groups except the placebo group. Hct was elevated only in the AsA 900 mg group whose Hct was relatively lower than the other groups. Serum ferritin concentrations of the four groups, which were as low as 8.50 - 14.39ng/mL on average at the intial periods, augmented significantly to 20.18ng/mL and 26.63ng/mL in the 900 mg AsA and iron groups, respectively. Serum ferritin was not elevated in either the AsA 300 mg group or the placebo group. The above data indicated that the daily supplementaion of 150 mg AsA to the meals containing 12-15 mg iron per day promoted Hb levels of adolescent girls with low Hb, and the 900 mg AsA supplementing improved not only Hb level but also body iron store. A supplementation of 60 mg iron per day appeared to be slightly more effective in improving the iron status in comparison to the 900 mg AsA supplement.
Original Article
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Iron Nutritional Status of Female Students in Kangnung National University
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Kyukee Lee, Eunkyung Kim, Mikyung Kim
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Korean J Community Nutr 1997;2(1):23-32. Published online February 28, 1997
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- To evaluate iron nutritional status of female college students, fasting blood samples were taken from 76 female students of Kangnung National University. Hemoglobin(Hb), hematocrit(Hct), serum iron(Fe), total iron binding capacity(TIBC) and serum ferritin concentrations were measured and transferrin saturation was calculated. Mean values for Hb, Hct, Fe, TIBC, TS and serum freeitin were 13.64+/-1.42g/dl, 40.99+/-4.31%, 103.0+/-33.3 microgram/dl, 395.3+/-9.07 microgram/dl, 26.58+/-9.07%and 26.76+/-17.5ng/ml, respectively. Prevalence of iron deficiency greatly varied by indices from 6.8% when judged by Hct to 26.0% by serum ferritin concentration. The Hb concentration was positively correlated with hematocrit (r=0.5402), serum iron(r=0.2819) and transferrin saturation(r=0.2777)(p<0.05). on the other hand, serum ferritin concentration showed significantly negative correlation with TIBC(r=-0.3196). Two-day dietary intake records were collected from subjects to estimate mean daily iron intake and bioavailability of dietary iron. Mean daily intake of iron was 13.15 mg and heme iron intake was 0.83 mg which was 6.4% of total iron intake. Total absorbable iron calculated by the method of Monsen was 1.27 mg and bioavailability of dietary iron was 9.6%. In the light of high prevalence of iron deficiency based of serum ferritin concentration and low bioavailability of iron in the diet, guidelines about diet should be made to increase the content and bioavailability of iron in the diet if female college students.