• Clinical and Experimental Pediatrics
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• v.49 no.2
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• pp.144-149
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• 2006

Purpose : This study investigated the breast-feeding period, the milk bottle-using period, the age of cow's milk, introduced and the amount of cow's milk consumed in relation to anemia. Methods : Over the course of three years, 930 children(12 months to 36 months) who went to the Presbyterian Medical Center, Chonju, Korea were tested for anemia and their parents were surveyed for a history of their children's milk consumption. Results : Anemia appeared more likely between 30 months and 36 months, however, iron-deficiency anemia appeared more likely between 18 months and 23 months. Anemia, low serum ferritin levels and iron-deficiency anemia appeared more likely in children breast fed less than 6 months and greater than 12 months. Although there were survey reports of side effects with cow's milk, including constipation, diarrhea and skin rash, the milk bottle-using period, age of cow's milk introduced and amount of cow's milk consumed had no connection with anemia, serum ferritin levels and irondeficiency anemia. Conclusion : The data showed no correlation between the cow's milk, milk bottle-using period and iron deficiency. But the data revealed that iron deficiency anemia is more likely in children who are breast fed for less than 6 months and over 12 months, so we suggest careful attention during this period to prevent iron deficiency anemia.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.22 no.2
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• pp.152-161
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• 2019

Purpose: We examined the prevalence of anemia, annual screening for anemia, and treatment of anemia with iron among children with inflammatory bowel disease (IBD). Methods: A retrospective study of U.S. pediatric patients with IBD was performed in the MarketScan commercial claims database from 2010-2014. Children (ages 1-21) with at least two inpatient or outpatient encounters for IBD who had available lab and pharmacy data were included in the cohort. Anemia was defined using World Health Organization criteria. We used logistic regression to determine differences in screening, incident anemia, and treatment based on age at first IBD encounter and sex. Results: The cohort (n=2,446) included 1,560 Crohn's disease (CD) and 886 ulcerative colitis (UC). Approximately, 85% of CD and 81% of UC were screened for anemia. Among those screened, 51% with CD and 43% with UC had anemia. Only 24% of anemia patients with CD and 20% with UC were tested for iron deficiency; 85% were iron deficient. Intravenous (IV) iron was used to treat 4% of CD and 4% UC patients overall and 8% of those with anemia. Conclusion: At least 80% of children with IBD were screened for anemia, although most did not receive follow-up tests for iron deficiency. The 43%-50% prevalence of anemia was consistent with prior studies. Under-treatment with IV iron points to a potential target for quality improvement.

• Nutrition Research and Practice
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• v.5 no.1
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• pp.40-45
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• 2011

Hemoglobin and zinc protoporphyrin (ZPP) tests are commonly used to screen for iron deficiency, but little research has been done to systematically evaluate the sensitivity and specificity of these two tests. The goal of this study was to evaluate the effectiveness of zinc protoporphyrin/heme (ZPP/H) ratio as a point-of-service screening test for iron deficiency among preschool-aged children by comparing the sensitivity and specificity of hemoglobin, ZPP/H ratio, and serum ferritin (SF). Also completed were assessments for the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) with indicators of ferritin models. This study was carried out with 95 children ages 3 to 6 y. Anthropometric measurements were assessed and blood samples were analyzed for hemoglobin, SF, transferrin saturation (TS), and ZPP. Anemia was common and the prevalences of anemia, ID, and IDA were 14.7%, 12.6%, and 5.2%, respectively. The ZPP/H ratio was strongly and significantly correlated with hemoglobin. And ZPP/H ratio was a more sensitive test for ID than hemoglobin or SF measurement, correctly identifying more than twice as many iron-deficient children (sensitivity of 91.7%, compared to 41.7% for hemoglobin and SF). However, ZPP/H ratio had lower specificity (60.2%, compared to 89.1% for hemoglobin or 96.4% for SF) and resulted in the false identification of more subjects who actually were not iron deficient than did hemoglobin or SF. Low hemoglobin concentration is a late-stage indicator of ID, but ZPP/H ratio can detect ID at early stages and can be performed easily at a relatively low cost. Therefore, ZPP/H ratio can serve as a potential screening test for pre-anemic iron deficiency in community pediatric practices.

• Journal of Nutrition and Health
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• v.32 no.8
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• pp.887-896
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• 1999

The purpose of this research is to assess hematological and biochemical status and the prevalence of iron deficiency of pregnant women by gestational age to provide the primary data about iron nutritional status of pregnant women. Pregnant women visiting public health centers in Ulsan participated in study and were divided into 3 trimester by last menstrual period(LMP). Hemoglobin (Hgb), hematocrit(Hct)and mean corpuscular volume(MCV) among iron status indices were not statistically different from normal distribution, however total iron binding capacity(TIBC) and serum ferritin were skewed to left and serum iron and transferrin saturation(TS) were skewed to right. Hgb was positively correlated with Hct(r=0.93, p<0.001) but TIBC was negatively correlated with all indices. Serum ferritin was also correlated with all indices, especially in 3rd trimester but not reached to 1st trimester level. Mean corpuscular hemoglobin(MCH), mean corpuscular hemoglobin concentration(MCHC), Red cell distribution width(RDW), serum iron and TS were not significantly different by trimester, however when serum serum iron was adjusted with hematocrit to correct the hemodilution, it significantly decreased in 2nd trimester. MCV increased in 2nd trimester and was maintained until late pregnancy, TIBC continued to increase throughout the trimester. The prevalence of anemic by CDC(Centers for Disease Control) Hgb criteria(Hgb <11.0g/dl in 1st and 3nd trimester, Hgb<10.5g/dl in 2nd trimester) was 2.8% in 1st trimester, 22.5% in 2nd trimester, 27.1% in 3rd trimester and was similar with prevalence by CDC Hct criteria(Hct < 33% in 1st and 3rd, Hct < 32% in 2nd). The prevalence of anemic of total subjects was 32.7% by WHO criteria(Hgb < 11.0g/dl). Although almost iron status indices increased in 3rd trimester, the prevalence of anemia by different criteria of all indices increased throughout the trimester, so iron nutritional status was considered as serious during late pregnancy. However, since factors other than iron deficiency, such as infection, infection, inflammation, other nutrient deficiency may also play a significant role, to differentiate the anemia due to mainly iron deficiency from the anemia due to other factors, serum ferritin is among the more useful indices in distinguishing the two conditions because it is depressed only in iron deficiency. Hgb<11.0g/dl and serum ferritin<12.0ug/L as the criteria of iron deficiency was suggested by CDC. 17.8% of all subjects were classified as iron deficient anemia, 14.9% as anemic from other reasons, 21.2% as iron deficiency any only 46.2% were in normal iron status.

• Clinical and Experimental Pediatrics
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• v.62 no.8
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• pp.301-306
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• 2019

Purpose: Coronary artery abnormalities (CAA) are the most important complications of Kawasaki disease (KD). Iron deficiency anemia (IDA) is a prevalent micronutrient deficiency and its association with KD remains unknown. We hypothesized that presence of IDA could be a predictor of CAA. Methods: This retrospective study included 173 KD patients, divided into 2 groups according to absence (group 1) and presence (group 2) of CAA. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a logistic regression model to estimate the association between CAA and other indicators. Due to collinearity between indicators of IDA, each indicator was paired with anemia in 3 models. Results: Serum iron, iron saturation, and ferritin concentration, the 3 indicators of IDA, were significantly higher in group 1 than in group 2. Three sets of models including anemia with iron indicators produced the OR of CAA of 3.513, 3.171, and 2.256, respectively. The 3 indicators of IDA were negatively associated with CAA, by OR of 0.965, 0.914, and 0.944, respectively. The areas under the curve (AUCs) of ferritin concentration, iron saturation, serum iron, anemia, and Kobayashi score were 0.907 (95% CI, 0.851-0.963), 0.729 (95% CI, 0.648-0.810), 0.711 (95% CI, 0.629-0.793), 0.638 (95% CI, 0.545-0.731), and 0.563 (95% CI, 0.489-0.636), respectively. Conclusion: Indicators of IDA, especially ferritin, were highly associated with CAA; therefore, they were stronger predictors of CAA than Kobayashi scores. IDA indicators can be used to predict CAA development and to suggest requirements for early interventions.

• Biomedical Science Letters
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• v.1 no.1
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• pp.81-88
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• 1995

RDW and MCV are thought to be the highly sensitive blood cell parameters in the differentiation of iron deficiency anemias. Through the medical records of 227 anemic patients and the physical checking results of 143 healthy persons in a General Hospital during the recent five years, the authors evaluated various blood cell parameters including RDW and MCV. Iron deficiency anemia, aplastic anemia and other anemias associated with chronic disease were shown as the three major causes of anemias in Korea. In the patients of iron deficiency anemia MCV was very low(62.9$\pm$13.7fl), while RDW was very high(19.3$\pm$4.8) showing much lower MCV and much higher RDW in severe IDA compared with in mild IDA. To differentiate iron deficiency anemias form other anemias, a discriminant function was developed from some blood cell parameters like MCV, MCH, MCHC, RDW and platelets(D.F.=0.26-0.012MCV -0.130MCH +0.073MCHC +0.052RDW+0.003PLT).

• Journal of Nutrition and Health
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• v.31 no.1
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• pp.96-101
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• 1998

The prevalence of iron deficiency in later infancy and the toddler years(25% to 40% at 1 year of age) has not decreased remarkably , except in Western countries. The purpose of this study was to 1) determine the relationship between current feeding practices and iron status, and 2) assess compliance to infant feeding instructions. Two groupsof infants were examined. The first group of 302 infants aged 6 to 24months was seen at a well baby clinic while the second group of 135 infants of the same age group was assessed by venipuncture. Cutoff values for laboratory tests were as follows ; hemoglobin<11g/dL, mean corpuscular volume (MCV) <72fl ; red cell distribution width(RDW)>15% ; serum ferritin level<10ng/ml ; and transferrin saturation (serum iron(TIBC)<10%. The diagnosis of iron deficiency anemia (IDA) was made when a low hemoglobin level was associated with either low ferritin orlow transferrin saturation . Of the 302 children brought to the well baby clinic , 12.3%(n=37) were found to have anemia (hemoglobin<11.0/dL). In terms of children grouped according to feeding practices, it was found that children with anemial comprised 32.0% (24/75) of the prolonged breast-fed group (Group A), significantly more than the 4.0%(7/176) of the artificial milk feeding group(Group B). and 3.9%(2/51) of the switched from breast milk to iron -fortified weaning foods group(Group C).Among the 107 children with IDA , iron deficiency in 105 children(98.1%) was suggested by their dietary histories ; exclusive or prolonged breast-feeding for more than 6 months without iron fortification in 98 infants ; cow's milk consumption> 500ml/day without iron fortification during infancy(n=12), or >800ml without iron-fortified foods after infancy(n=15) ; and the use of unfortified forumula or unbalanced diets, mainly limited to rice gruel. Despite the relatively high (79.6%) motivation on the part of the infants mothers and supervison by professional personnel, the poor results in the infants receiving iron fortified foods were due to poor compliance(85.75). Among the mothers of 98 IDA patients who were contacted by telephone , it was revealed that 29% did not give the oral iron preparation for more than 2 months. Furthermore, negligence or disregard by the parents occurred in 14% of the case , discontinuance of the oral iron preparation by the parents due to side effects occurred in 6%, and the children's refusal or poor oral intake and no further trial occurred in 6%. The dietary history of a large group of infants was highly predictive of their risk for anemia . Continued consumption of breast milk until the age of 1 year is not warranted unless iron-fortified foods are given concomitantly. Because there is a problem with compliance, more successful and safe strategies for preventing iron deficiency woold included dual coverage in the from of therapeutic iron supplementation as well use of iron-fortified foods for teddlers who are at risk of iron deficiency.

• Journal of the Korean Society of Food Science and Nutrition
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• v.27 no.1
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• pp.191-199
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• 1998

This paper has studied the nutritional iron status of adults in the city of Taegu. The subjects of the experiment were twenty six men and women living in the city of Taegu. The iron intake was 26.1mg for men and 17.1mg for women, which were respectively 217.5% and 95% of RDA. For men heme iron was 5% and nonheme iron, 95% for women heme iron was 5.8% and nonheme iron, 94.2%. The absorption rate of dietary iron was 6.2% for men and 9.1% for women. The hemoglobin was 14.5g/dl for men and 11.9g/dl for women, and the rate of developing anemia was 8.3% in men and 57.1% in women. The serum ferritin was 57.8ng/ml with men, which was found to be normal, and 14.7ng/ml with women, which showed that 57.1% of women were in the condition of iron depletion or iron deficiency anemia. The rate of developing anemia resulting from the deficiency of serum ferritin was as high as that from the deficiency of hemoglobin. The correlation between iron intake based on the dietary record, and energy intake, vegetable protein intake and dietary fiber intake was found to be positive. So was the correlation between the iron intake, and hemoglobin, serum ferritin and urinary iron excretion. There was also a positive correlation between hemoglobin, and hematocrit and serum ferritin. The correlation between fecal iron excretion and serum ferritin was positive. Fecal iron excretion and urinary iron excretion can be complemented by iron intake but the fact should be considered that 95% of iron intake is nonheme iron, which is difficult to absorb. Based on the above-mentioned things, serum ferritin and hemoglobin can be used as the standards of measuring anemia. As women in their child bearing years show the high rate of 57.1% of developing anemia, the more thorough nutritional education of iron is required.

• Journal of the Korean Dietetic Association
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• v.18 no.1
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• pp.72-80
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• 2012

This study examined the effects of custom nutrition education on dietary intakes and clinical parameters in patients diagnosed with iron deficiency anemia. A total of 34 patients visited the anemia clinic of Yeouido St. Mary's Hospital. Among these, only 16 patients were available for follow-ups. A follow-up was conducted by a clinical dietitian 2 months from the first nutrition education session. Patients were all women. For custom nutrition education, we investigated anthropometric data, dietary assessment (24 hr-recall, FFQ), and self-recognized anemic symptoms. Weight did not show a significant difference but hemoglobin, hematocrit (P<0.01), serum iron, and serum ferritin (P<0.05) were significantly increased after the nutrition education. Serum total iron binding capacity was significantly decreased (P<0.01). Self-recognized symptoms such as dizziness, fatigue (P<0.001), shortness of breath, headache (P<0.01), brittle nails, and sore tongue (P<0.05) were significantly improved. Daily intakes of protein (P<0.05), total iron (P<0.01), and animal iron (P<0.001) were significantly increased. A significantly negative correlation was observed between current serum iron and the intake of carbohydrates, fat, or phosphorus (P<0.05). But current serum ferritin showed a significantly positive correlation with the frequency of intake of meat, poultry, and fish. It could be concluded that the custom nutrition education might be effective on quality of diet as well as iron status and it might also improve the clinical parameters in patients diagnosed with the iron deficiency anemia.

• Clinical and Experimental Pediatrics
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• v.51 no.8
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• pp.820-826
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• 2008

Purpose : This study was conducted to evaluate the red cell indices and frequency of iron deficiency anemia based on the feeding patterns of nine-month-old infants. Methods : Blood tests were performed on 253 nine-month-old infants, who visited Il Sin Christian Hospital for health check-ups from January to December 2007. Their parents answered telephonic questions regarding their feeding patterns and weaning foods. Results : Three infants groups were created according to feeding patterns before they started weaning foods. One group was exclusively breast-fed (48.6%), another had mixed feeding (27.3%), and the third had artificial milk feeding (24.1%). Red cell indices (hemoglobin, hematocrit, MCV, MCH) of the breast-fed group were comparatively lower than those of the other two groups (P<0.05). Twenty-five infants (9.9%) were diagnosed with iron-deficiency anemia. According to feeding patterns, the frequency of anemia was highest in the breast-fed group. Six infants who started weaning foods before six months of age (113 infants) were diagnosed with iron-deficiency anemia (5.3%), and nineteen who started after six months of age (140 infants) were diagnosed with iron-deficiency anemia (13.6%). Conclusion : When nine-month old infants visit hospitals for health check-ups, pediatricians must consider their feeding pattern and weaning foods histories, and then recommend screening blood tests for iron-deficiency anemia.