Oral Supplementation with Sucrosomial Ferric Pyrophosphate Plus L-Ascorbic Acid to Ameliorate the Martial Status: A Randomized Controlled Trial

Abstract

Altered martial indices before orthopedic surgery are associated with higher rates of complications and greatly affect the patient’s functional ability. Oral supplements can optimize the preoperative martial status, with clinical efficacy and the patient’s tolerability being highly dependent on the pharmaceutical formula. Patients undergoing elective hip/knee arthroplasty were randomized to be supplemented with a 30-day oral therapy of sucrosomial ferric pyrophosphate plus L-ascorbic acid. The tolerability was 2.7% among treated patients. Adjustments for confounding factors, such as iron absorption influencers, showed a relevant response limited to older patients (≥ 65 years old), whose uncharacterized Hb loss was averted upon treatment with iron formula. Older patients with no support lost −2.8 ± 5.1%, while the intervention group gained +0.7 ± 4.6% of circulating hemoglobin from baseline (p = 0.019). Gastrointestinal diseases, medications, and possible dietary factors could affect the efficacy of iron supplements. Future opportunities may consider to couple ferric pyrophosphate with other nutrients, to pay attention in avoiding absorption disruptors, or to implement interventions to obtain an earlier martial status optimization at the population level.

Nutritional Orthopedics and Space Nutrition as Two Sides of the Same Coin: A Scoping Review

“…Nonetheless, it is sometimes preferred to adopt a population medicine approach in which all patients undergo nutritional optimization, regardless of their nutritional status. In fact, some age-related comorbidities and medications could inevitably worsen micronutrient reservoirs during the period up to surgery, even in the presence of a good nutritional status at the evaluation prior to admission [ 27 ]. Some patients may necessitate different routes of nutrition administration, depending on the ability to chew or on the gastrointestinal function.…”

“…Some deficiency syndromes, such as iron deficiency and hypovitaminosis D, are a very common burden in aged orthopedic patients and engineered formulas that facilitate intestinal absorption are therefore used (e.g., oil-in-water emulsion with propylene glycol for vitamin D [ 8 ] and sucrosomial matrix for iron [ 27 ]). Proper perioperative interventions should comprise diet and supplements tailored according to age, sex, and disease conditions, integrated with physical training, psychological support, smoking cessation, and alcohol reduction [ 32 , 33 , 34 ].…”

The Central Role of Iron in Human Nutrition: From Folk to Contemporary Medicine

“…Of note, comparable bioavailability to ferrous fumarate has been observed for ferrous sulphate [ 98 ], the latter still remaining among the most used. Concerning other fragile individuals, a multipart formula may be used, such as a sucrosomial matrix of ferric pyrophosphate for older adults undergoing orthopedic surgery [ 99 ] or a polysaccharide-iron complex of ferric polymaltose for pregnant women with iron-deficiency anemia [ 100 ]. These pharmaceuticals may be preferred because the metal is prevented to get in contact with enterocytes, thus possibly reducing local inflammation [ 101 ].…”

“…The carbohydrate shell helps to isolate the metal from blood components until the complex enters the macrophages of the spleen, the liver, and the bone marrow to be either stored or used. A single dose of intravenous iron may be sufficient to optimize the martial status in fragile individuals, such as older adults who are scheduled for elective orthopedic surgery, whereas oral supplements may require daily administrations for weeks [ 99 ]. Diverse intravenous iron formulas are available, with differences in unit size, nature of the carbohydrate shell (e.g., dextran, sucrose, gluconate, maltose, sorbitol), surface charge, iron form (Fe 2+ or Fe 3+ ) and content [ 106 ].…”

SARS-CoV-2 Aiming for the Heart: A Multicenter Italian Perspective About Cardiovascular Issues in COVID-19

“…This latter mechanism may be advocated for SARS-CoV-2 by recent computational modeling that showed the possibility of the virus to cause hemoglobin derangements ( Liu and Li, 2020 ). If this were the case, then the incorporation of the virus into Trojan horses would be plausible since white cells are known to commonly engulf hemoglobin in various tissues ( Briguglio et al, 2020c ). Aberrant coagulation is the underlying mechanism for ischemic heart disease, stroke, and venous thromboembolism, but it has been observed also in severe influenza pneumonia and SARS-CoV-1 ( Chong et al, 2004 ; Yang and Tang, 2016 ).…”