title: Iron deficiency occurs frequently in children with cystic fibrosis.
abstract: In adult CF patients iron deficiency (ID) is common and primarily functional due to chronic inflammation. No recent data are available on the cause of ID and iron deficiency anemia (IDA) in children with CF. Over the last decades onset of inflammation and pulmonary disease in children with CF is delayed by improved nutritional status. We questioned whether ID occurs in the same extent among children with CF as in adult CF patients. We therefore conducted a study to investigate the iron status of children with CF and to determine whether ID and IDA are associated with dietary iron intake, lung disease severity and Pseudomonas aeruginosa (PA) infection. Clinical charts of 53 children with CF aged 0-16 were reviewed. Follow-up varied from 1 to 14 years with 343 annual observations in total. Thirty-two children (60.4%) were iron deficient in at least 1 year and ID was present in 84 of 343 observations (24.5%). In 2011 ID was present in 9 children (17.0%). Ten children (18.9%) were anemic in at least 1 year and anemia was present in 13 of 328 observations (4.0%). IDA was present in at least 1 year in 6 children (11.3%). Ferritin (Fer) was positively associated with age. Higher Fer values found in older children represent an increased state of inflammation, rather than an improved iron status, and might increase the relative contribution of functional ID. This study shows that ID is common in relatively healthy, well-nourished children with CF. The mechanism of ID in children with CF is currently unknown. A prospective study using both soluble transferrin receptor and Fer as indicators for ID will provide more insight in the incidence and causes of ID in children with CF.
authors.affiliation: Department of Pediatrics, Juliana Children's Hospital/HAGA Hospital, The Hague, The Netherlands.
authors.forename: Lieke
authors.initials: L
authors.lastname: Uijterschout
authors.forename: Marianne
authors.initials: M
authors.lastname: Nuijsink
authors.forename: Daniëlle
authors.initials: D
authors.lastname: Hendriks
authors.forename: Rimke
authors.initials: R
authors.lastname: Vos
authors.forename: Frank
authors.initials: F
authors.lastname: Brus
mesh_terms: D000293:Adolescent; D000367:Age Factors; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000453:epidemiology* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007249:Inflammation; D019266:Iron, Dietary; D008297:Male; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000276:immunology; D011550:Pseudomonas aeruginosa; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D006454:Hemoglobins; D019266:Iron, Dietary; D005293:Ferritins
keywords: Pseudomonas aerigunosa; anemia; children; ferritin