Iron Deficiency in Celiac Disease: Prevalence, Health Impact, and Clinical Management

Abstract

Iron is an essential nutrient to life and is required for erythropoiesis, oxidative, metabolism, and enzymatic activities. It is a cofactor for mitochondrial respiratory chain enzymes, the citric acid cycle, and DNA synthesis, and it promotes the growth of immune system cells. Thus, iron deficiency (ID) leads to deleterious effects on the overall health of individuals, causing significant morbidity. Iron deficiency anemia (IDA) is the most recognized type of anemia in patients with celiac disease (CD) and may be present in over half of patients at the time of diagnosis. Folate and vitamin B12 malabsorption, nutritional deficiencies, inflammation, blood loss, development of refractory CD, and concomitant Heliobacter pylori infection are other causes of anemia in such patients. The decision to replenish iron stores and the route of administration (oral or intravenous) are controversial due, in part, to questions surrounding the optimal formulation and route of administration. This paper provides an algorithm based on the severity of symptoms; its impact on the health-related quality of life (HRQL); the tolerance and efficiency of oral iron; and other factors that predict a poor response to oral iron, such as the severity of histological damage, poor adherence to GFD, and blood loss due to mucosal lesions.

Anemia in Celiac Disease: Prevalence, Associated Clinical and Laboratory Features, and Persistence after Gluten-Free Diet

“…Several studies have investigated the prevalence of CD in IDA patients, finding variability across time and geographical areas [ 21 ]; however, many of them were biased by the methodologic diagnostic approach used: some studies considered only antibody positivity to CD, reporting a pooled CD prevalence of 1.4%, whereas studies based on biopsy-confirmed CD reported a prevalence of 0.7% [ 22 ]. More relevant data were reported in a metanalysis by Mahadev et al; the authors analyzed 18 studies from several countries (including Italy), reporting a biopsy-confirmed CD prevalence in 3.2% of IDA patients.…”

“…Anemia is probably the most frequent extra-intestinal manifestation of CD [ 23 ]. A recent metanalysis showed that its prevalence varies widely between studies, ranging from 12% to up to 85%, and it is more common in the female sex [ 22 ]. In our study, 54.7% of CD patients were anemic and almost all of them were women (92%, p = 0.0001), confirming the above-reported literature data.…”

Gestão Em Saúde No Brasil Frente À Pandemia Da Covid-19

“…Trata-se de um dos tipos mais comuns de anemia, a qual está intimamente relacionada com o baixo consumo de alimentos ricos em ferro, como carne vermelha, ovo ou espinafres. No entanto, este tipo de anemia também pode surgir após uma hemorragia ou menstruação severa, devido à perda de ferro pelo sangue, ou devido a alguns distúrbios metabólicos, como intolerância ao glúten (Montoro-Huguet et al, 2021).…”

Clinical-anthropometric and laboratory-instrumental characteristics of iron deficiency states in children with celiac disease

“…Распространенность железодефицитных состояний (ЖДС) среди впервые диагностированных пациентов с целиакией в среднем составляет 12-85%. В свою очередь, частота выявляемости целиакии среди пациентов с анемией -5,5%, причем наиболее часто -среди больных с анемией, рефрактерной к стандартной терапии препаратами железа [6,8,9]. Следует отметить, что ЖДА в 40% случаев -единственное внекишечное клиническое проявление заболевания, следовательно, дети с целиакией относятся к группе риска по развитию ЖДС [1][2][3][4].…”