Intravenous iron supplementation in distance runners with low or suboptimal ferritin

Laura GARVICAN, Philo Saunders, Tanusha Cardoso, Iain Macdougall, Ruth Fazakerley, Kieran Fallon, Bev Anderson, Judith Anson, Kevin THOMPSON, Christopher Gore

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

PURPOSE: Iron deficiency is prevalent in distance runners and may impair endurance performance. The current practice of oral supplementation is slow and often not well tolerated. The aim of this study was to assess the efficacy of intravenous (IV) iron supplementation (ferric carboxymaltose) compared with oral supplementation (ferrous sulfate) on iron status, hemoglobin mass (Hbmass), and physiological indices of running performance in distance runners.

METHODS: Twenty-seven highly trained distance runners with low (LOW) (ferritin <35 μg·L(-1) and transferrin saturation <20%, or ferritin <15 μg·L(-1)) or suboptimal (SUB) iron status (ferritin <65 μg·L(-1)) were supplemented with either IV iron (Ferinject®) or oral (ORAL) supplements (Ferrogradumet) for 6 wk. Iron status and Hbmass were assessed before supplementation and at 1, 2, 4, 6, and 8 wk in the four groups (IV LOW, IV SUB, ORAL LOW, and ORAL SUB). In addition, athletes completed a treadmill running test for running economy, lactate threshold, and V˙O2max before and after supplementation.

RESULTS: Both forms of supplementation substantially increased ferritin levels in all four groups. IV supplementation resulted in higher ferritin in both IV groups compared with both ORAL groups from week 1 onward. Hemoglobin concentration did not change substantially in any group. Hbmass increased in IV LOW (mean = +4.9%, 90% confidence interval [CI] = 1.1%-8.9%) and was accompanied by an increase in V˙O2max (mean = +3.3%, 90% CI = 0.4%-6.3%) and run time to exhaustion (mean = +9.3%, 90% CI = 0.9%-18.3%.

CONCLUSIONS: IV supplementation can effectively increase iron stores in iron-deficient runners within 6 wk and, if Hbmass is compromised, may enhance endurance capacity by facilitating erythropoiesis. Hbmass appears a more sensitive tool for measuring changes in whole body hemoglobin than hemoglobin concentration and may be useful in the diagnosis and follow-up for iron deficiency.

Original languageEnglish
Pages (from-to)376-385
Number of pages10
JournalMedicine and Science in Sports and Exercise
Volume46
Issue number2
DOIs
Publication statusPublished - Feb 2014

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Ferritins
Iron
Hemoglobins
ferrous sulfate
Confidence Intervals
Erythropoiesis
Transferrin
Exercise Test
Athletes
Lactic Acid

Cite this

GARVICAN, L., Saunders, P., Cardoso, T., Macdougall, I., Fazakerley, R., Fallon, K., ... Gore, C. (2014). Intravenous iron supplementation in distance runners with low or suboptimal ferritin. Medicine and Science in Sports and Exercise, 46(2), 376-385. https://doi.org/10.1249/MSS.0b013e3182a53594
GARVICAN, Laura ; Saunders, Philo ; Cardoso, Tanusha ; Macdougall, Iain ; Fazakerley, Ruth ; Fallon, Kieran ; Anderson, Bev ; Anson, Judith ; THOMPSON, Kevin ; Gore, Christopher. / Intravenous iron supplementation in distance runners with low or suboptimal ferritin. In: Medicine and Science in Sports and Exercise. 2014 ; Vol. 46, No. 2. pp. 376-385.
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abstract = "PURPOSE: Iron deficiency is prevalent in distance runners and may impair endurance performance. The current practice of oral supplementation is slow and often not well tolerated. The aim of this study was to assess the efficacy of intravenous (IV) iron supplementation (ferric carboxymaltose) compared with oral supplementation (ferrous sulfate) on iron status, hemoglobin mass (Hbmass), and physiological indices of running performance in distance runners.METHODS: Twenty-seven highly trained distance runners with low (LOW) (ferritin <35 μg·L(-1) and transferrin saturation <20{\%}, or ferritin <15 μg·L(-1)) or suboptimal (SUB) iron status (ferritin <65 μg·L(-1)) were supplemented with either IV iron (Ferinject{\circledR}) or oral (ORAL) supplements (Ferrogradumet) for 6 wk. Iron status and Hbmass were assessed before supplementation and at 1, 2, 4, 6, and 8 wk in the four groups (IV LOW, IV SUB, ORAL LOW, and ORAL SUB). In addition, athletes completed a treadmill running test for running economy, lactate threshold, and V˙O2max before and after supplementation.RESULTS: Both forms of supplementation substantially increased ferritin levels in all four groups. IV supplementation resulted in higher ferritin in both IV groups compared with both ORAL groups from week 1 onward. Hemoglobin concentration did not change substantially in any group. Hbmass increased in IV LOW (mean = +4.9{\%}, 90{\%} confidence interval [CI] = 1.1{\%}-8.9{\%}) and was accompanied by an increase in V˙O2max (mean = +3.3{\%}, 90{\%} CI = 0.4{\%}-6.3{\%}) and run time to exhaustion (mean = +9.3{\%}, 90{\%} CI = 0.9{\%}-18.3{\%}.CONCLUSIONS: IV supplementation can effectively increase iron stores in iron-deficient runners within 6 wk and, if Hbmass is compromised, may enhance endurance capacity by facilitating erythropoiesis. Hbmass appears a more sensitive tool for measuring changes in whole body hemoglobin than hemoglobin concentration and may be useful in the diagnosis and follow-up for iron deficiency.",
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GARVICAN, L, Saunders, P, Cardoso, T, Macdougall, I, Fazakerley, R, Fallon, K, Anderson, B, Anson, J, THOMPSON, K & Gore, C 2014, 'Intravenous iron supplementation in distance runners with low or suboptimal ferritin', Medicine and Science in Sports and Exercise, vol. 46, no. 2, pp. 376-385. https://doi.org/10.1249/MSS.0b013e3182a53594

Intravenous iron supplementation in distance runners with low or suboptimal ferritin. / GARVICAN, Laura; Saunders, Philo; Cardoso, Tanusha; Macdougall, Iain; Fazakerley, Ruth; Fallon, Kieran; Anderson, Bev; Anson, Judith; THOMPSON, Kevin; Gore, Christopher.

In: Medicine and Science in Sports and Exercise, Vol. 46, No. 2, 02.2014, p. 376-385.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Intravenous iron supplementation in distance runners with low or suboptimal ferritin

AU - GARVICAN, Laura

AU - Saunders, Philo

AU - Cardoso, Tanusha

AU - Macdougall, Iain

AU - Fazakerley, Ruth

AU - Fallon, Kieran

AU - Anderson, Bev

AU - Anson, Judith

AU - THOMPSON, Kevin

AU - Gore, Christopher

PY - 2014/2

Y1 - 2014/2

N2 - PURPOSE: Iron deficiency is prevalent in distance runners and may impair endurance performance. The current practice of oral supplementation is slow and often not well tolerated. The aim of this study was to assess the efficacy of intravenous (IV) iron supplementation (ferric carboxymaltose) compared with oral supplementation (ferrous sulfate) on iron status, hemoglobin mass (Hbmass), and physiological indices of running performance in distance runners.METHODS: Twenty-seven highly trained distance runners with low (LOW) (ferritin <35 μg·L(-1) and transferrin saturation <20%, or ferritin <15 μg·L(-1)) or suboptimal (SUB) iron status (ferritin <65 μg·L(-1)) were supplemented with either IV iron (Ferinject®) or oral (ORAL) supplements (Ferrogradumet) for 6 wk. Iron status and Hbmass were assessed before supplementation and at 1, 2, 4, 6, and 8 wk in the four groups (IV LOW, IV SUB, ORAL LOW, and ORAL SUB). In addition, athletes completed a treadmill running test for running economy, lactate threshold, and V˙O2max before and after supplementation.RESULTS: Both forms of supplementation substantially increased ferritin levels in all four groups. IV supplementation resulted in higher ferritin in both IV groups compared with both ORAL groups from week 1 onward. Hemoglobin concentration did not change substantially in any group. Hbmass increased in IV LOW (mean = +4.9%, 90% confidence interval [CI] = 1.1%-8.9%) and was accompanied by an increase in V˙O2max (mean = +3.3%, 90% CI = 0.4%-6.3%) and run time to exhaustion (mean = +9.3%, 90% CI = 0.9%-18.3%.CONCLUSIONS: IV supplementation can effectively increase iron stores in iron-deficient runners within 6 wk and, if Hbmass is compromised, may enhance endurance capacity by facilitating erythropoiesis. Hbmass appears a more sensitive tool for measuring changes in whole body hemoglobin than hemoglobin concentration and may be useful in the diagnosis and follow-up for iron deficiency.

AB - PURPOSE: Iron deficiency is prevalent in distance runners and may impair endurance performance. The current practice of oral supplementation is slow and often not well tolerated. The aim of this study was to assess the efficacy of intravenous (IV) iron supplementation (ferric carboxymaltose) compared with oral supplementation (ferrous sulfate) on iron status, hemoglobin mass (Hbmass), and physiological indices of running performance in distance runners.METHODS: Twenty-seven highly trained distance runners with low (LOW) (ferritin <35 μg·L(-1) and transferrin saturation <20%, or ferritin <15 μg·L(-1)) or suboptimal (SUB) iron status (ferritin <65 μg·L(-1)) were supplemented with either IV iron (Ferinject®) or oral (ORAL) supplements (Ferrogradumet) for 6 wk. Iron status and Hbmass were assessed before supplementation and at 1, 2, 4, 6, and 8 wk in the four groups (IV LOW, IV SUB, ORAL LOW, and ORAL SUB). In addition, athletes completed a treadmill running test for running economy, lactate threshold, and V˙O2max before and after supplementation.RESULTS: Both forms of supplementation substantially increased ferritin levels in all four groups. IV supplementation resulted in higher ferritin in both IV groups compared with both ORAL groups from week 1 onward. Hemoglobin concentration did not change substantially in any group. Hbmass increased in IV LOW (mean = +4.9%, 90% confidence interval [CI] = 1.1%-8.9%) and was accompanied by an increase in V˙O2max (mean = +3.3%, 90% CI = 0.4%-6.3%) and run time to exhaustion (mean = +9.3%, 90% CI = 0.9%-18.3%.CONCLUSIONS: IV supplementation can effectively increase iron stores in iron-deficient runners within 6 wk and, if Hbmass is compromised, may enhance endurance capacity by facilitating erythropoiesis. Hbmass appears a more sensitive tool for measuring changes in whole body hemoglobin than hemoglobin concentration and may be useful in the diagnosis and follow-up for iron deficiency.

KW - Administration, Intravenous

KW - Administration, Oral

KW - Adolescent

KW - Adult

KW - Anaerobic Threshold

KW - Dietary Supplements

KW - Female

KW - Ferric Compounds

KW - Ferritins

KW - Hematinics

KW - Hemoglobins

KW - Humans

KW - Male

KW - Maltose

KW - Oxygen Consumption

KW - Physical Endurance

KW - Running

KW - Time Factors

KW - Young Adult

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1249/MSS.0b013e3182a53594

DO - 10.1249/MSS.0b013e3182a53594

M3 - Article

VL - 46

SP - 376

EP - 385

JO - Medicine Science in Sports Exercise

JF - Medicine Science in Sports Exercise

SN - 0195-9131

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ER -