Demographic, clinical, and biochemical predictors of pica in a large cohort of blood donors

Abstract

Background: Pica is characterized as repeatedly eating or chewing a nonnutritious substance including, but not limited to ice, clay and dirt, starch, raw pasta, chalk, coal, paint, or paper. Pica symptoms can be intense and addiction-like and disrupt quality of life. It is strongly linked to iron deficiency. Since substantial iron loss occurs during blood donation, blood donors may be susceptible to development of pica behaviors.Methods: We investigated demographic, clinical, hematological, and biochemical factors associated with pica using univariable and multivariable logistic regression analysis in a cohort of 11,418 racially diverse blood donors. Pica was defined by questionnaire responses as consuming at least 8 oz of ice daily and/or consumption of non-ice substances regardless of the amount and frequency. Results: Pica was present in 2.2% of the donors. The sensitivity and specificity of pica in iron-deficient donors were 36% and 82%, respectively. Lower ferritin (p = .001), non-Asian race (p < .001), higher red cell distribution width (p < .001), younger age, and restless legs syndrome (p = .008) were independently associated with pica. Female sex is associated with iron deficiency but was not an independent predictor of pica suggesting that iron deficient males and females were equally susceptible to the development of pica behaviors. Donors with normal ferritin levels also reported pica, reinforcing the role of non-iron related factors in its presentation. Conclusions:We have identified demographic, clinical, and biochemical predictors of pica that help identify those most at risk for developing pica behaviors, and thereby assist in its clinical diagnosis and treatment.

Prevalence of pica and rumination behaviours in adults and associations with eating disorder and general psychopathology: findings form a population-based study

“…A study by Liu et al . (2021), e.g. highlighted that pica might be related to a complex comorbidity structure, insofar as it is strongly associated with restless legs syndrome, which, in turn, is associated with depressive symptoms (e.g.…”

Demographic, clinical, and biochemical predictors of pica in high‐intensity blood donors

“…This cohort contained 1748 high‐intensity donors who gave nine or more units of whole blood in the preceding 2 years without experiencing a low haemoglobin deferral 8 . High intensity donors have many demographic and behavioural differences compared to the general donor population and are less likely to experience haemoglobin deferral 6,8 . To better understand pica symptoms in this important group of donors, we characterised the demographic, clinical, and biochemical predictors of pica in these high‐intensity donors and compared these to predictors of pica in the remainder of the RBC‐Omics study population 6 …”

“…Pica is defined as excessive craving and chewing of non‐nutritious substances such as ice, clay, earth, paper, or chalk 2 . Depending on the classification, it has been estimated that from 2% to 15% of blood donors in the United States report pica symptoms 3–6 . In the United Kingdom, the reported prevalence of pica in blood donors is significantly lower because of the lower prevalence of chewing ice, and estimated to be between 0.65% and 1.83% 7 .…”

Iron status of blood donors

“…Pica, the compulsive craving, and ingestion of nonnutritive substances is associated with iron depletion in general [47] and blood donor [6,7] populations. Pica was present in 2.2% of a mostly representative United States donor population and associated with low ferritin as well as RLS [9]. In several donor studies, an association between iron and RLS was not found [6,7,48] but one recent study reported improvements in RLS, sleep, and fatigue following use of exogenous iron [49].…”

“…Consequently, donors of both sexes become iron-deficient [3]. The symptoms of iron deficiency are substantial, including fatigue [4,5], pica [6][7][8][9], and restless leg syndrome (RLS) [6,7,[9][10][11]. Here, we review recent advances in the understanding of iron deficiency in blood donors, and how it is successfully mitigated.…”