Iron deficiency without anaemia is a potential cause of fatigue: meta-analyses of randomised controlled trials and cross-sectional studies

Yokoi, Kohei; Konomi, Aki

doi:10.1017/s0007114517001349

Cited by 49 publications

(38 citation statements)

References 44 publications

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“…It could be argued that anemia could be responsible for fatigue, but it has been observed in nonanemic individuals with ID in several reports. A recent meta-analysis of studies in iron-deficient non-anemic patients found that iron therapy improved objective and self-rated assessments of fatigue, 33 reinforcing the fact that ID is a broader condition with extensive health consequences in addition to the well-known feature of anemia. These data highlight that for women of childbearing age with unexplained prolonged fatigue, ID should be considered.…”

Section: Discussionmentioning

confidence: 92%

Iron Deficiency in Menstruating Adult Women: Much More than Anemia

Fernández-Jiménez

Moreno

Wright

et al. 2020

Women's Health Reports

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Background: Iron deficiency anemia (IDA) is highly prevalent in women of child-bearing age. However, their nonhematological symptoms have been overlooked. This study aims to analyze the nonhematological features and symptoms of IDA in a group of women of reproductive age and the changes occurred during iron therapy. Materials and Methods: IDA women underwent dietary, physical activity, menstrual blood loss, and cognitive function assessment at baseline. Hematological and biochemical parameters were analyzed. Executive attention was tested by the flanker task and working memory by the 2-back task. Oral iron therapy (ferrous sulfate) was given to 35 women for 8 weeks and the changes in iron status, biochemical markers, cognitive function, and nonhematological symptoms were evaluated. Results: Patients presented nonhematological symptoms: pica, 32.4%; cheilitis, 20.6%; restless legs syndrome (RLS), 20.6%; diffuse hair loss, 55.9%; and ungual alterations, 38.2%. Two or more symptoms were present in 58.8% of women. Serum iron and working memory were correlated at baseline. Multivariate analyses show associations (odds ratio [OR], 95% confidence interval [CI]) between pica and reaction time in the working memory test (OR 2.14, 95% CI 1.19-3.87, p = 0.012); RLS with total serum protein (OR 0.08, 95% CI 0.06-0.92, p = 0.043); and cheilitis with mean corpuscular hemoglobin (OR 0.388, 95% CI 0.189-0.799, p = 0.01). Pica, cheilitis, and RLS completely resolved with iron therapy, and ungual alterations and hair loss improved in 92.3% and 84.2% of women, respectively. Better performance in executive attention and working memory was observed after iron therapy. Conclusions: More attention should be given to the nonhematological manifestations of IDA to improve the quality of life of menstruating women.

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Section: Discussionmentioning

confidence: 92%

Iron Deficiency in Menstruating Adult Women: Much More than Anemia

Fernández-Jiménez

Moreno

Wright

et al. 2020

Women's Health Reports

View full text Add to dashboard Cite

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“…These symptoms can be related to low delivery of oxygen to body tissues and decreased activity of iron-containing enzymes. Numerous studies report fatigue and weakness when anemia due to iron deficiency is present, i.e., when hemoglobin levels are below 120 g/L in women or 130 g/L in men, and also during iron deficiency without anemia, i.e., with normal or borderline hemoglobin levels [112]. Besides increasing perceived fatigue, iron deficiency is also known to decrease physical performance, work efficiency and working capacity [113].…”

Section: Consequences Of Inadequate Status In Iron and Magnesium On Pmentioning

confidence: 99%

Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence

et al. 2020

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Vitamins and minerals are essential to humans as they play essential roles in a variety of basic metabolic pathways that support fundamental cellular functions. In particular, their involvement in energy-yielding metabolism, DNA synthesis, oxygen transport, and neuronal functions makes them critical for brain and muscular function. These, in turn, translate into effects on cognitive and psychological processes, including mental and physical fatigue. This review is focused on B vitamins (B1, B2, B3, B5, B6, B8, B9 and B12), vitamin C, iron, magnesium and zinc, which have recognized roles in these outcomes. It summarizes the biochemical bases and actions of these micronutrients at both the molecular and cellular levels and connects them with cognitive and psychological symptoms, as well as manifestations of fatigue that may occur when status or supplies of these micronutrients are not adequate.

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“…Fatigue is one of the nonspecific presentations of copper deficiency in the general population, as it generates anemia, a global cause of fatigue. Low copper levels in turn reduce iron absorption, which is the most frequent cause of fatigue . Deficiency affects many organs, the most severe being hematologic and neurologic abnormalities.…”

Section: Manifestations Of Copper Deficiencymentioning

confidence: 99%

Copper Deficiency: Causes, Manifestations, and Treatment

et al. 2019

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Background: The metabolism of the essential trace element copper remains incompletely understood and, until recently, nearly ignored in acute medicine. Menkes disease was for long the only known copper deficiency condition, but several case reports and investigations conducted over the last 2 decades have shown that deficiency is more frequent than previously suspected, with devastating individual consequences and potential public health consequences. The copper needs in healthy individuals are 0.9 mg/d, which translates to 0.3 mg/d intravenously in parenteral nutrition; the present review aims at gathering actual knowledge. Method and results: A review of literature was conducted in PubMed and Cochrane systematic reviews to identify the most recent information about copper deficiency and generate a narrative review. Copper deficiency has hereditary and acquired origins, the latter being the most frequent. Clinical manifestations are nonspecific but affect all organs and systems, particularly the hematologic (anemia) and the neurologic (myeloneuropathy) systems. Deficiency also affects the cardiovascular, cutaneous, and immune systems. Severe copper deficiency due to reduced absorption after bariatric bypass surgery has become frequent. Conclusion: Deficiency is more frequent than previously recognized, probably because of changing nutrition patterns but also because of some treatments that have become very common such as bypass bariatric surgery and, in acute medicine, prolonged continuous renal replacement therapy. The patients may present with severe hematologic and neurologic complications that go untreated because copper deficiency was not considered in the differential diagnosis: These complications often need active intravenous repletion with doses 4-8 times the usual nutrition recommendations. (Nutr Clin Pract. 2019;34:504-513)

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Iron deficiency without anaemia is a potential cause of fatigue: meta-analyses of randomised controlled trials and cross-sectional studies

Cited by 49 publications

References 44 publications

Iron Deficiency in Menstruating Adult Women: Much More than Anemia

Iron Deficiency in Menstruating Adult Women: Much More than Anemia

Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence

Copper Deficiency: Causes, Manifestations, and Treatment

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