The Efficacy and Safety of Vitamin C for Iron Supplementation in Adult Patients With Iron Deficiency Anemia

Li, Nianyi; Zhao, Guangjie; Wu, Wanling; Zhang, Meng-Xue; Liu, Weiyang; Chen, Qin-Fen; Wang, Xiaoqin

doi:10.1001/jamanetworkopen.2020.23644

Cited by 70 publications

(74 citation statements)

References 9 publications

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“…125 Despite previous suggestions of benefit, 121 coadministration of vitamin C with oral IRT is not recommended-a recent large randomised controlled trial has confirmed that it neither enhances the haematological response or rate of iron loading, nor diminishes side effects. 126 Iron absorption from oral preparations is determined by a complex interplay involving total body iron stores, erythropoietic activity of the bone marrow, recent exposure of the small intestine to iron and systemic inflammation. 35 127-131 Hepcidin is the most important inhibitor of iron absorption.…”

Section: Oral Irtmentioning

confidence: 99%

British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults

Snook

Bhala

Beales

et al. 2021

Gut

132

111

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Iron deficiency anaemia (IDA) is a major cause of morbidity and burden of disease worldwide. It can generally be diagnosed by blood testing and remedied by iron replacement therapy (IRT) using the oral or intravenous route. The many causes of iron deficiency include poor dietary intake and malabsorption of dietary iron, as well as a number of significant gastrointestinal (GI) pathologies. Because blood is iron-rich it can result from chronic blood loss, and this is a common mechanism underlying the development of IDA—for example, as a consequence of menstrual or GI blood loss.Approximately a third of men and postmenopausal women presenting with IDA have an underlying pathological abnormality, most commonly in the GI tract. Therefore optimal management of IDA requires IRT in combination with appropriate investigation to establish the underlying cause. Unexplained IDA in all at-risk individuals is an accepted indication for fast-track secondary care referral in the UK because GI malignancies can present in this way, often in the absence of specific symptoms. Bidirectional GI endoscopy is the standard diagnostic approach to examination of the upper and lower GI tract, though radiological scanning is an alternative in some situations for assessing the large bowel. In recurrent or refractory IDA, wireless capsule endoscopy plays an important role in assessment of the small bowel.IDA may present in primary care or across a range of specialties in secondary care, and because of this and the insidious nature of the condition it has not always been optimally managed despite the considerable burden of disease— with investigation sometimes being inappropriate, incorrectly timed or incomplete, and the role of IRT for symptom relief neglected. It is therefore important that contemporary guidelines for the management of IDA are available to all clinicians. This document is a revision of previous British Society of Gastroenterology guidelines, updated in the light of subsequent evidence and developments.

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Section: Oral Irtmentioning

confidence: 99%

British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults

Snook

Bhala

Beales

et al. 2021

Gut

132

111

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“…Vitamin C interacts with iron to enhance adequate absorption of iron from diets. The interaction gives rise to the formation of an iron chelate complex at acid pH, which enhances iron solubility in the small intestine, thereby increasing its utilization in the duodenum ( Lynch & Cook, 1980 ; Beck, 2014 ; Li et al, 2020 ). On the other hand, the synergistic action of vitamins and minerals in the protection of organism at the cellular level has been recorded for vitamin E, C, carotenoid and selenium, as well as other important trace elements as an antioxidant component in diets.…”

Section: Discussion Of Literature Synthesismentioning

confidence: 99%

Revisiting food-sourced vitamins for consumer diet and health needs: a perspective review, from vitamin classification, metabolic functions, absorption, utilization, to balancing nutritional requirements

Ofoedu

Iwouno

Ofoedu

et al. 2021

PeerJ

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The significant attention gained by food-sourced vitamins has provided insights into numerous current researches; for instance, the potential reversal of epigenetic age using a diet and lifestyle intervention, the balance between food and dietary supplements in the general population, the role of diet and food intake in age-related macular degeneration, and the association of dietary supplement use, nutrient intake and mortality among adults. As relevant literature about food-sourced vitamin increases, continuous synthesis is warranted. To supplement existing information, this perspective review discussed food-sourced vitamins for consumer diet and health needs, scoping from vitamin absorption, metabolic functions, utilization, to balancing nutritional requirements. Relevant literatures were identified through a search of databases like Google Scholar, Web of Science, the Interscience Online Library, ScienceDirect, and PubMed. We demonstrated that vitamins whether from plant- and animal-based sources are prerequisites for the metabolic functions of the human body. The fat- and water-soluble classification of vitamins remains consistent with their respective absorption and dissolution potentials, underpinned by numerous physiological functions. Vitamins, largely absorbed in the small intestine, have their bioavailability dependent on the food composition, its associated interactions, as well as alignment with their metabolic functions, which involves antioxidants, coenzymes, electron acceptor/donor, and hormones. Moreover, vitamin deficiencies, in every form, pose a serious threat to human health. Vitamin toxicities remain rare, but can still occur mainly from supplementation, although it appears much less in water-soluble vitamins of which some excesses get readily removed by the human body, different from the fat-soluble ones that are stored in tissues and organs. Besides discussions of absorption, transport, and cellular uptake of vitamins, this perspective review also included approaches to meeting vitamin requirements and therapeutic strategies against micronutrient deficiency and COVID-19. We have also attempted on how to strike the balance between food-sourced vitamins and dietary supplements.

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“…Among others, ascorbic acid or vitamin C is the most effective enhancer of non-heme iron absorption, thus should be provided along within the meals rich in iron content. 11 If necessary, additional portion of iron and vitamin C fortified food can help increase the hemoglobin level, 12 before last decision for provision of iron 13 and/or micronutrient supplement is given to those workers with low hemoglobin status.…”

Section: Discussionmentioning

confidence: 99%

Anemia Status and Its Related Factors among Indonesian Workers: Hemoglobin Survey in Three Different Workplaces

2021

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This study aims to explore risk factors of low hemoglobin status (anemia) among workers in three different workplaces in Indonesia. Cross-sectional study design was applied to screen hemoglobin value by using a multiwave pulse total-hemoglobinometer Masimo® and obtain socio-demographic characteristics using a questionnaire. Three workplaces were purposively selected to have total population eligible for this study. Health safety protocol was applied both for the subjects and researchers as COVID19 prevention. Statistical analyses were used accordingly to find potential risk factor(s) of anemia among workers. A total of 2386 eligible subjects with mean age of 36.8 ± 9.2 years participated in this study consisted of mainly male workers (85.3%), mostly married (79.0%), never smoke (55.8%) and working in shift (68.7%). Mean of hemoglobin value was 14.2 ± 1.2 mg/dL with anemia prevalence of 9.9%. Risk factor of anemia among workers were female-gender, non-marriage status, never smoking and no-work shift. However, the potential determinant for anemia among workers was female-gender, in which the prevalence of anemia was 24.6% as compared to 7.4% in male-gender. Keep providing free meal in the workplace canteen is a must, but there is a need to provide iron and vitamin C-fortified food and/or iron and vitamin C supplement especially for female workers.

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The Efficacy and Safety of Vitamin C for Iron Supplementation in Adult Patients With Iron Deficiency Anemia

Cited by 70 publications

References 9 publications

British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults

British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults

Revisiting food-sourced vitamins for consumer diet and health needs: a perspective review, from vitamin classification, metabolic functions, absorption, utilization, to balancing nutritional requirements

Anemia Status and Its Related Factors among Indonesian Workers: Hemoglobin Survey in Three Different Workplaces

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