Showing papers by "Gary M. Brittenham published in 1987"

Iron Deficiency Anemia and Iron Therapy Effects on Infant Developmental Test Performance

Abstract: The behavioral effects of iron deficiency and its treatment were evaluated in a double-blind randomized controlled community-based study of 191 Costa Rican infants, 12 to 23 months of age, with various degrees of iron deficiency. The Bayley Scales of Infant Development were administered before and both 1 week and 3 months after IM or oral administration of iron. Appropriate placebo-treated control infants were also tested. Infants with iron deficiency anemia showed significantly lower mental and motor test scores, even after considering factors relating to birth, nutrition, family background, parental IQ, and the home environment. After 1 week, neither IM nor oral iron treatments differed from placebo treatment in effects on scores. After 3 months, lower mental and motor test scores were no longer observed among iron-deficient anemic infants whose anemia and iron deficiency were both corrected (36%). However, significantly lower mental and motor test scores persisted among the majority of initially anemic infants (64%) who had more severe or chronic iron deficiency. Although no longer anemic, they still showed biochemical evidence of iron deficiency after 3 months of treatment. These persistent lower scores suggest either that iron therapy adequate for correcting anemia is insufficient to reverse behavioral and developmental disturbances in many infants or that certain ill effects are long-lasting, depending on the timing, severity, or chronicity of iron deficiency anemia in infancy.

Behavioral alterations in iron deficiency.

Abstract: This review has examined recent evidence from human studies that iron deficiency adversely affects behavior by impairing cognitive function, producing noncognitive disturbances, and limiting activity and work capacity. The body of research taken as a whole provides increasingly persuasive arguments for intensifying efforts to prevent and treat iron deficiency anemia. Cognitive Function. There is reasonably good evidence that mental and motor developmental test scores are lowered among infants with iron deficiency anemia. Although the research on cognitive function in iron-deficient older children and adults is sparse and diverse, it suggests that there may be alterations in attentional processes associated with iron deficiency. Iron therapy has not yet been shown effective in completely correcting the observed disturbances. Although some aspects of cognitive function seem to change with iron therapy, lower developmental, IQ, and achievement test scores have still been noted after treatment. Noncognitive Disturbances. A variety of noncognitive alterations during infant developmental testing has also been observed, including failure to respond to test stimuli, short attention span, unhappiness, increased fearfulness, withdrawal from the examiner, and increased body tension. Exploratory analyses suggest that such behavioral abnormalities may account for poor developmental test performance in infants with iron deficiency anemia. These studies indicate the fruitfulness of examining noncognitive aspects of behavior, such as affect and activity, in addition to specific cognitive processes. Activity and Work Capacity. There has been a steady accumulation of evidence that iron deficiency anemia limits maximal physical performance, submaximal endurance, and spontaneous activity in the adult, resulting in diminished work productivity with attendant economic losses. The mechanisms underlying these effects, the extent to which anemia or iron deficiency separate from anemia is responsible, and the counterpart in infants and children remain to be established.

Uniformity of liver density and nonheme (storage) iron distribution.

Abstract: The extent of variation in tissue density and hepatic nonheme iron concentration has been examined at autopsy in 21 adult livers. Samples were taken from each liver at inferior and superior sites in the midaxillary, anterior axillary, and midclavicular lines. Histologic examination showed diffuse metastatic carcinoma, cirrhosis, fibrosis, necrosis, steatosis, or congestion in 19 livers; two livers were normal. Density was determined by saline displacement of 0.5- to 1.0-g specimens. Nonheme iron concentration was measured at each site in samples of the size obtained by wedge (0.5 to 1.0 g) and percutaneous needle (0.005 to 0.010 g) biopsy using specially developed chemical assays. Density was uniform within each liver. Despite the inclusion of diseased tissues, the variation in density among the 21 livers was small (coefficient of variation, 1.25%). The mean (+/- 1 SD) hepatic density was 1.051 +/- 0.013 g/mL (range, 1.017 to 1.077 g/mL). Within each liver, the nonheme iron also was uniformly distributed among the six sites. Chemical measurements of nonheme iron concentration were not significantly different in samples of the size obtained by wedge or percutaneous liver biopsy. All the hepatic nonheme iron determinations were below the upper 95% confidence limit of concentrations in adult males (480 micrograms/g). In the absence of focal lesions, the uniformity in hepatic density and nonheme iron distribution supports the assumption of several clinical methods for measuring liver storage iron (wedge and needle biopsy, determination of hepatic magnetic susceptibility, computed tomography, and magnetic resonance imaging) that one sample of liver tissue is representative of the whole organ.

Statistical and graphical evaluation of erythrocyte volume distributions

Abstract: A protocol for the statistical and graphical evaluation of erythrocyte volume distributions has been developed using expectation-maximization methods for distribution parameter estimation. In a reference sample group of 50 healthy individuals, none of the red cell volume distributions determined by an aperture impedance method differed significantly from a log normal model. Measurements in 211 patients with anemia provided evidence that similar statistical methods could be used for the characterization of abnormal red cell volume distributions. Graphical displays accurately summarize the quantitative information derived from the analysis of volume distributions and show a reference distribution fitted to the observed distribution against the range of distributions found in healthy individuals. This protocol provides a specific, statistically valid implementation of the general principles for the analysis of cell volume distributions proposed by the International Committee for Standardization in Hematology.

High-dose carbonyl iron for iron deficiency anemia:

Abstract: To determine if high doses of oral iron could shorten the duration of therapy necessary to treat Fe deficiency anemia, high-dose Fe 600 mg three times per day (given as nontoxic carbonyl Fe) was compared with standard ferrous sulfate 60 mg Fe�� three times per day in a randomized, double-blind, 3-wk trial involving 36 female blood donors with mild Fe deficiency anemia. In animal studies, both forms of Fe have similar bioavailability when ad- ministered in equal amounts. High-dose carbonyl Fe was well tolerated with gastrointestinal side effects similar those observed with standard FeSO4 therapy. The 10-fold larger amount of Fe resulted in a mean 1.5-fold increase in estimated Fe absorption. Both regimens corrected anemia but neither replenished storage Fe. These results suggest that the principal advantage to the use of carbonyl Fe would derive from its safety rather than from the large doses that can be given. Am J Clin Nuir 1987;46: 1029-34.

Anemia ferropénica en lactantes: un estudio prospectivo

Abstract: Etude faite chez les enfants de 12 a 23 mois dans une communaute urbaine de San Jose au Costa Rica. L'incidence est de 63,5%. Le traitement a base de fer est plus efficace par voie orale que par voie intramusculaire