Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Home
Hostname: page-component-ffbbcc459-5mjdh Total loading time: 0.247 Render date: 2022-03-03T20:17:18.224Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true }
  • English
Canadian Journal of Neurological Sciences Canadian Journal of Neurological Sciences

Article contents

Iron Deficiency Anemia Prevalence at First Stroke or Transient Ischemic Attack

Published online by Cambridge University Press:  02 December 2014

Melanie D. Dubyk ,
Robert T. Card ,
Susan J. Whiting ,
Carol A. J. Boyle ,
Stanley H. Zlotkin  and
Phyllis G. Paterson
Melanie D. Dubyk
Affiliation:
College of Pharmacy and Nutrition, University of Saskatchewan
Robert T. Card
Affiliation:
Division of Hematology, Department of Medicine, University of Saskatchewan
Susan J. Whiting
Affiliation:
College of Pharmacy and Nutrition, University of Saskatchewan
Carol A. J. Boyle
Affiliation:
Division of Neurology, Department of Medicine, University of Saskatchewan Stroke Prevention Clinic, Saskatoon Health Region, Saskatoon, Saskatchewan
Stanley H. Zlotkin
Affiliation:
The Hospital for Sick Children, Departments of Pediatrics, Nutritional Sciences, and Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
Phyllis G. Paterson*
Affiliation:
College of Pharmacy and Nutrition, University of Saskatchewan
*
College of Pharmacy and Nutrition, University of Saskatchewan, 110 Science Place, Saskatoon, Saskatchewan, S7N 5C9, Canada.
Rights & Permissions[Opens in a new window]

Abstract

HTML view is not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Iron deficiency anemia (IDA) has been implicated in the etiology of transient ischemic attack and ischemic stroke. This study aimed to: 1) document IDA prevalence in patients ≥ 65 years of age admitted to hospital with transient ischemic attack or first ischemic stroke, and 2) investigate dietary intake as a predictor of iron status.

Methods:

Ninety-four patients were enrolled. An algorithm containing values for hemoglobin, ferritin, total iron binding capacity, transferrin saturation, and serum transferrin receptor measured at admission was used to identify IDA. Usual dietary intake was assessed with the Clue II food frequency questionnaire.

Results:

Prevalence estimates were 6.4% for IDA, 2.1% for iron deficiency without anemia, and 6.4% for anemia from other causes. IDA prevalence was significantly higher than published National Health and Nutrition Examination Survey III (NHANES III) estimates for gender-specific age groups ≥ 70 years (One-Sample Proportion Test; males p = 0.038 [n= 37]; females p = 0.002 [n=44]). A comparison of IDA prevalence against selected controls from the NHANES III database yielded an odds ratio (OR) of 6.3, 95% confidence interval (CI) 0.8 to 53.7, which was not statistically significant (Fisher's Exact Test; n=94; p = 0.118). Multivariate linear regression analysis of dietary intake with indicators of iron status (n=58) revealed only iron supplements (p = 0.013) and heme iron intake (p = 0.038) as negative predictors of total iron binding capacity (p<0.05).

Conclusions:

These findings support the initiation of a prospective case control study to investigate IDA as a risk factor for ischemic stroke in elderly patients.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 2 , March 2012 , pp. 189 - 195
Copyright
Copyright © The Canadian Journal of Neurological 2012

References

1Ganesan, V, Prengler, M, McShane, MA, Wade, AM, Kirkham, FJ.Investigation of risk factors in children with arterial ischemic stroke. Ann Neurol. 2003;53:167–73.CrossRefGoogle ScholarPubMed
2Saxena, K, Ranalli, M, Khan, N, Blanchong, C, Kahwash, SB.Fatal stroke in a child with severe iron deficiency anemia and multiple hereditary risk factors for thrombosis. Clin Pediatr. 2005;44:175–80.CrossRefGoogle Scholar
3Baptist, EC, Castillo, SF.Cow’s milk-induced iron deficiency anemia as a cause of childhood stroke. Clin Pediatr. 2002;41:533–5.CrossRefGoogle ScholarPubMed
4Hartfield, DS, Lowry, NJ, Keene, DL, Yager, JY.Iron deficiency: a cause of stroke in infants and children. Pediatr Neurol. 1997;16:50–3.CrossRefGoogle ScholarPubMed
5Bruggers, CS, Ware, R, Altman, AJ, Rourk, MH, Vedanarayanan, V, Chaffee, S.Reversible focal neurologic deficits in severe iron deficiency anemia. J Pediatr. 1990;117:430–2.CrossRefGoogle ScholarPubMed
6Ready, WK, Lowry, NJ.Anemia causing cerebral infarction in a child. Can Med Assoc J. 1989;140:303–4.Google Scholar
7Maguire, JL, deVeber, G, Parkin, PC.Association between iron-deficiency anemia and stroke in young children. Pediatrics. 2007;120:1053–7.CrossRefGoogle ScholarPubMed
8Akins, PT, Glenn, S, Nemeth, PM, Derdeyn, CP.Carotid artery thrombus associated with severe iron-deficiency anemia and thrombocytosis. Stroke. 1996;27:1002–5.CrossRefGoogle ScholarPubMed
9Scoditti, U, Colonna, F, Ludovico, L, Trabattoni, G.Mild thrombocytosis secondary to iron-deficiency anemia and stroke. Riv Neurol. 1990; 60:146–7.Google ScholarPubMed
10Alexander, MB.Iron deficiency anemia, thrombocytosis, and cerebrovascular accident. South Med J. 1983;76:662–3.CrossRefGoogle ScholarPubMed
11Gillum, RF, Sempos, CT, Makuc, DM, Looker, AC, Chien, C-Y, Ingram, DD.Serum transferrin saturation, stroke incidence, and mortality in women and men: The NHANES I epidemiologic followup study. Am J Epidemiol. 1996;144:59–68.CrossRefGoogle ScholarPubMed
12Marniemi, J, Alanen, E, Impivaara, O, et al.Dietary and serum vitamins and minerals as predictors of myocardial infarction and stroke in elderly subjects. Nutr Metab Cardiovas Dis. 2005;15:188–97.CrossRefGoogle ScholarPubMed
13Ekblom, K, Hultdin, J, Stegmayr, B, et al.Iron stores and HFE genotypes are not related to increased risk of ischemic stroke. A prospective nested case-referent study. Cerebrovasc Dis. 2007;24:405–11.Google Scholar
14Hankey, GJ, Jamrozik, K, Broadhurst, RJ, Forbes, S, Anderson, CS.Long-term disability after first-ever stroke and related prognostic factors in the Perth Community Stroke Study, 1989-1990. Stroke. 2002;33:1034–40.CrossRefGoogle ScholarPubMed
15Guralnik, JM, Ershler, WB, Schrier, SL, Picozzi, VJ.Anemia in the elderly: A public health crisis in hematology. Hematology Am Soc Hematol Educ Program. 2005:528–53.Google ScholarPubMed
16Ferrucci, L, Semba, RD, Guralnik, JM, et al.Proinflammatory state, hepcidin, and anemia in older persons. Blood. 2010;115:3810–6.CrossRefGoogle ScholarPubMed
17Tull, KI, Hirani, V, Ali, A, Chua, E, Mindell, JS.Impact of different diagnostic thresholds and the anaemia-ferritin-transferrin receptor model on the prevalence of anaemia and impaired iron status in older people. Age Ageing. 2009;38:609–13.CrossRefGoogle ScholarPubMed
18Fleming, DJ, Jacques, PF, Tucker, KL, Massro, JM, D’Agostino, RB, Wilson, SPF.Iron status of the free-living, elderly Framingham Heart Study cohort: an iron-replete population with a high prevalence of elevated iron stores. Am J Clin Nutr. 2001;73:638–46.Google ScholarPubMed
19Looker, AC, Dallman, PR, Carroll, MD, Gunter, EW, Johnson, CL.Prevalence of iron deficiency in the United States. J Am Med Assoc. 1997;277:973–6.CrossRefGoogle ScholarPubMed
20Fleming, DJ, Jacques, PF, Dallal, GE, Tucker, KL, Wilson, PWF, Wood, RJ.Dietary determinants of iron stores in a free-living elderly population: The Framingham Heart Study. Am J Clin Nutr. 1998;67:722–33.Google Scholar
21Health and Welfare Canada. Nutrition Canada National Survey. Ottawa: Health and Welfare Canada; 1973.Google ScholarPubMed
22Cook, JD.Diagnosis and management of iron-deficiency anaemia. Best Pract Res Clin Haematol. 2005;18:319–32.CrossRefGoogle ScholarPubMed
23Borch-Iohnsen, B.Perspective. Determination of iron status: brief review of physiological effects on iron measures. Analyst. 1995;120:891–3.Google Scholar
24Skikne, BS.Serum transferrin receptor. Am J Hematol. 2008;83:872–5.CrossRefGoogle ScholarPubMed
25Hanif, E, Ayyub, M, Anwar, M, Ali, W, Bashir, M.Evaluation of serum transferrin receptor concentration in diagnosing and differentiating iron deficiency anaemia from anemia of chronic disorders. J Pak Med Assoc. 2005;55:13–6.Google ScholarPubMed
26Baillie, FJ, Morrison, AE, Fergus, I.Soluble transferrin receptor: a discriminating assay for iron deficiency. Clin Lab Haem. 2003;25:353–7.CrossRefGoogle ScholarPubMed
27Bultink, IEM, Lems, WF, van de Stadt, RJ, et al.Ferritin and transferrin receptor predict iron deficiency in anemic patients with rheumatoid arthritis. Arth Rheum. 2001;44:979–81.3.0.CO;2-H>CrossRefGoogle ScholarPubMed
28Chua, E, Clague, JE, Sharma, AK, Horan, MA, Lombard, M.Serum transferrin receptor assay in iron deficiency anaemia and anaemia of chronic disease in the elderly. QJ Med. 1999;92:587–94.CrossRefGoogle ScholarPubMed
29Punnonen, K, Irjala, K, Rajamäi, A.Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood. 1997;89:1052–7.Google Scholar
30Pettersson, T, Kivivuori, SM, Siimes, MA.Is serum transferrin receptor useful for detecting iron-deficiency in anaemic patients with chronic inflammatory diseases? Br J Rheumatol. 1994;33:740–4.CrossRefGoogle ScholarPubMed
31Suominen, P, Mötöen, T, Rajamäi, A, Irjala, K.Single values of serum transferrin receptor and transferrin receptor ferritin index can be used to detect true and functional iron deficiency in rheumatoid arthritis patients with anemia. Arthritis Rheum. 2000;43:1016–20.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
32Ferguson, BJ, Skikne, BS, Simpson, KM, Baynes, RD, Cook, JD.Serum transferrin receptor distinguishes the anemia of chronic disease from iron deficiency anemia. J Lab Clin Med. 1992;119:385–90.Google ScholarPubMed
33McCombe, PA, Read, SJ.Immune and inflammatory responses to stroke: good or bad? Int J Stroke. 2008;3:254–65.CrossRefGoogle ScholarPubMed
34Weddle, DO, Fanelli-Kuczmarski, M.Position of the American Dietetic Association: Nutrition, aging, and the continuum of care. J Am Diet Assoc. 2000;100:580–95.Google Scholar
35Johnson, MA, Fischer, JG, Bowman, BA, Gunter, EW.Iron nutriture in elderly individuals. FASEB J. 1994;8:609–21.Google ScholarPubMed
36Garry, PJ, Hunt, WC, Baumgartner, RN.Effects of iron uptake on iron stores in elderly men and women: longitudinal and cross-sectional results. J Am Coll Nutr. 2000;19:262–9.CrossRefGoogle Scholar
37Payette, H, Gray-Donald, K.Dietary intake and biochemical indices of nutritional status in an elderly population, with estimates of the precision of the 7-d food record. Am J Clin Nutr. 1991;54:478–88.Google Scholar
38U. S. Department of Health and Human Services. National Center for Health Statistics. Third National Health and Nutrition Examination Survey, 1988-1994, NHANES III Laboratory Data File (CD-ROM). Hyattsville (MD): Centers for Disease Control and Prevention; 1996.Google Scholar
39Block, G, Norkus, E, Hudes, M, Mandel, S, Helzlsouer, K.Which plasma antioxidants are most related to fruit and vegetable consumption? Am J Epidemiol. 2001;154:1113–8.CrossRefGoogle ScholarPubMed
40Block, G, Hartman, AM, Naughton, D.A reduced dietary questionnaire: Development and vaidation. Epidemiology. 1990;1:58–64.CrossRefGoogle Scholar
41Altman, DG.Practical statistics for medical research. London: Chapman and Hall; 1991.Google Scholar
42Kapral, MK, Silver, FL, Richards, JA, Lindsay, P, Fang, J, Shi, HS: Registry of the Canadian Stroke Network. Progress Report 2001-2005. Toronto: Institute for Clinical Evaluative Sciences; 2005.Google Scholar
43Pappachan, J, Kirkham, FJ.Cerebrovascular disease and stroke. Arch Dis Child. 2008;93:890–8.CrossRefGoogle ScholarPubMed
44Kim, JS, Kang, SY.Bleeding and subsequent anemia: a precipitant for cerebral infarction. Eur Neurol. 2000;43:201–8.CrossRefGoogle ScholarPubMed
45Lee, GR, Herbert, V.Nutritional factors in the function and production of erythrocytes. In: Lee, GR, Foerster, J, Lukens, J, Paraskevas, F, Greer, JP, Rodgers, GM, editors. Wintrobe’s clinical hematology. 10th ed. Baltimore: Williams and Wilkins; 1999. p. 228–66.Google Scholar
46Borch-Iohnson, B, Meltzer, HM, Stenberg, V, Reinskou, T, Trygg, K.Bioavailability of daily low dose iron supplements in menstruating women with low iron stores. Eur J Clin Nutr. 1990;44:29–34.Google Scholar
47Carmel, R.Nutritional anemias and the elderly. Semin Hematol. 2008;45:225–34.CrossRefGoogle ScholarPubMed
48Cooper, MJ, Cockell, KA, L’Abbé, MR.The iron status of Canadian adolescents and adults: Current knowledge and practical implications. Can J Diet Pract Res. 2006;67:130–8.CrossRefGoogle ScholarPubMed
49Beguin, JL, Grek, V, Weber, G, et al.Acute functional iron deficiency in obese subjects during a very-low energy all-protein-diet. Am J Clin Nutr. 1997;66:75–9.Google ScholarPubMed
50Zhu, YI, Haas, JD.Response of serum transferrin receptor to iron supplementation in iron-depleted, nonanemic women. Am J Clin Nutr. 1998;67:271–5.Google ScholarPubMed
51Hare, GMT, Tsui, AKY, McLaren, AT, Ragoonanan, TE, Yu, J, Mazer, CD.Anemia and cerebral outcomes: Many questions, fewer answers. Anesth Analg. 2008;107:1356–70.CrossRefGoogle ScholarPubMed
52Ani, C, Ovbiagele, B.Elevated red blood cell distribution width predicts mortality in persons with known stroke. J Neurol Sci. 2009;277:103–8.CrossRefGoogle ScholarPubMed
53Kiyohara, Y, Ueda, K, Hasuo, Y, et al.Hematocrit as a risk factor of cerebral infarction: long-term prospective population survey in a Japanese rural community. Stroke. 1986;17:687–92.CrossRefGoogle Scholar
54Gebreyohanns, M, Adams, RJ.Sickle cell disease: primary stroke prevention. CNS Spectr. 2004;9:445–9.Google ScholarPubMed
You have Access
27
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Iron Deficiency Anemia Prevalence at First Stroke or Transient Ischemic Attack
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Iron Deficiency Anemia Prevalence at First Stroke or Transient Ischemic Attack
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Iron Deficiency Anemia Prevalence at First Stroke or Transient Ischemic Attack
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *