Although determining iron intakes is essential in assessing adequacy of iron in the diet, estimating iron availability may be more useful for evaluating whether iron requirements are met. Our objectives were to describe the dietary information, analytical steps, and computer algorithms needed for iron bioavailability adjustments and to demonstrate the effects of various dietary factors on calculated iron absorption. Our study was based on 9890 women and children participating in the Russian Longitudinal Monitoring Survey. Between August 1992 and February 1993, two 24-h recalls were collected from each participant, and total, heme and nonheme iron intakes were calculated. Nonheme iron availability was adjusted for meat, fish and poultry and vitamin C consumed in the same meal and then further adjusted for tea and phytates. We found mean total iron intakes to be comparable to those of women of reproductive age in the United States and lower than those of United States children. When these intakes were adjusted for enhancers and inhibitors of absorption, the iron bioavailability in these vulnerable Russian groups was extremely low. Mean bioavailable iron as well as the 25th-75th percentile ranges of intake were below the bottom of the range of requirements, indicating that iron adequacy in this population may be considerably less than expected based on total iron intakes alone. Furthermore, rural and urban food availability had a significant effect on iron bioavailability. Future research on dietary iron adequacy should be based on estimates of available iron by collecting meal-level dietary data and using detailed information on mixed dishes and phytates.
Purpose:
A critical gap in the adoption of genomic medicine into medical practice is the need for the rigorous evaluation of the utility of genomic medicine interventions.
Methods:
The Implementing Genomics in Practice Pragmatic Trials Network (IGNITE PTN) was formed in 2018 to measure the clinical utility and cost-effectiveness of genomic medicine interventions; to assess approaches for real-world application of genomic medicine in diverse clinical settings; and to produce generalizable knowledge on clinical trials using genomic interventions. Five clinical sites and a coordinating center evaluated trial proposals and developed working groups to enable their implementation.
Results:
Two pragmatic clinical trials (PCTs) have been initiated, one evaluating genetic risk
APOL1
variants in African Americans in the management of their hypertension, and the other to evaluate the use of pharmacogenetic testing for medications to manage acute and chronic pain as well as depression.
Conclusions:
IGNITE PTN is the first network to carry out PCTs in genomic medicine; it is focused on diversity and inclusion of underrepresented minority trial participants; it uses electronic health records and clinical decision support to deliver the interventions. IGNITE PTN will develop the evidence to support (or oppose) the adoption of genomic medicine interventions by patients, providers, and payers.
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