{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:46:05Z","timestamp":1760143565849,"version":"build-2065373602"},"reference-count":20,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,2,4]],"date-time":"2024-02-04T00:00:00Z","timestamp":1707004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Dilated cardiomyopathy (DCM) is a severe condition, characterised by left ventricular dilation and systolic dysfunction, necessitating heart transplantation when all other treatment options fail. This case report describes a 2-year-old girl initially presenting with oedema, listlessness, and severe iron deficiency anaemia. She was diagnosed with DCM. Extensive diagnostic workup ruled out other causes, leading to the suspicion of DCM due to alimentary iron deficiency. This was confirmed by the parents\u2019 report that the girl was fed almost exclusively with low-fat cow\u2019s milk. Prompt treatment, including packed red cell transfusion, iron supplementation, and heart failure medications (diuretics, ACE inhibitors, beta blockers, and aldosterone antagonists), resulted in significant improvement in cardiac function within days. This report demonstrates the potential risks of alimentary iron deficiency, the most common cause of microcytic hypochromic anaemia in young children, which might even result in the development of life-threatening cardiac dysfunction in extreme cases.<\/jats:p>","DOI":"10.3390\/children11020196","type":"journal-article","created":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T05:22:44Z","timestamp":1707110564000},"page":"196","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dilated Cardiomyopathy Due to Alimentary Iron Deficiency"],"prefix":"10.3390","volume":"11","author":[{"given":"Leonie","family":"Dewein","sequence":"first","affiliation":[{"name":"Division of Pediatric Cardiology, University Children Hospital, Eythstr. 24, 89075 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Kresz","sequence":"additional","affiliation":[{"name":"Division of Neonatology and Intensive Medicine, University Children Hospital, Eythstr. 24, 89075 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jochen","family":"Essers","sequence":"additional","affiliation":[{"name":"Division of Neonatology and Intensive Medicine, University Children Hospital, Eythstr. 24, 89075 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Bride","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, University Children Hospital, Eythstr. 24, 89075 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Kaestner","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, University Children Hospital, Eythstr. 24, 89075 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Apitz","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, University Children Hospital, Eythstr. 24, 89075 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1161\/CIR.0000000000000682","article-title":"Cardiomyopathy in Children. Classification and Diagnosis. A Scientific Statement from the American Heart Association","volume":"140","author":"Lipshultz","year":"2019","journal-title":"Circulation"},{"key":"ref_2","first-page":"340","article-title":"The Cardiomyopathy of Iron Deficiency","volume":"33","author":"Hegde","year":"2006","journal-title":"Tex. Heart Inst. J."},{"key":"ref_3","first-page":"190","article-title":"Severe Iron Deficiency Anemia","volume":"126","author":"Pegelow","year":"1977","journal-title":"West. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Speer, C.P., Gahr, M., and D\u00f6tsch, J. (2019). P\u00e4diatrie, Springer.","DOI":"10.1007\/978-3-662-57295-5"},{"key":"ref_5","unstructured":"(2023, December 02). World Health Organisation (WHO). Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/infant-and-young-child-feeding."},{"key":"ref_6","first-page":"492","article-title":"Prevalence of iron deficiency in 12-month-old infants from 11 European areas and influence of dietary factors on iron status","volume":"90","author":"Male","year":"2001","journal-title":"Acta Paediatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e12320","DOI":"10.1111\/mcn.12320","article-title":"Iron intakes and status of 2-year-old children in the Cork BASELINE Birth Cohort Study","volume":"13","author":"McCarthy","year":"2017","journal-title":"Matern. Child Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/PL00007385","article-title":"Changes in time-trends of nutrient intake from fortified and non-fortified food in German children and adolescents\u201415-year results of the DONALD study","volume":"40","author":"Kersting","year":"2001","journal-title":"Eur. J. Nutr."},{"key":"ref_9","first-page":"S43","article-title":"Long-term brain and behavioral consequences of early iron deficiency","volume":"68","author":"Georgieff","year":"2016","journal-title":"Nutr. Rev."},{"key":"ref_10","first-page":"e125618","article-title":"Iron-deficiency anemia reduces cardiac contraction by downregulating RYR2 channels and suppressing SERCA pump activity","volume":"4","author":"Chung","year":"2019","journal-title":"J. Clin. Investig. Insight"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1161\/01.RES.0000091871.54907.6B","article-title":"Sarcoplasmic reticulum Ca2+ and heart failure: Roles of diastolic leak and Ca2+ transport","volume":"93","author":"Bers","year":"2003","journal-title":"Circ. Res."},{"key":"ref_12","first-page":"1806","article-title":"Iron Deficiency Anemia-Induced Cardiomyopathy with Congestive Heart Failure","volume":"2","author":"Miura","year":"2020","journal-title":"J. Am. Coll. Cardiol. Case Rep."},{"key":"ref_13","first-page":"7513782","article-title":"Profound Iron Deficiency Anemia and Irreversible Dilated Cardiomyopathy in a Child","volume":"2019","author":"Wittekind","year":"2019","journal-title":"Case Rep. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1111\/apa.1989.78.s361.96","article-title":"Iron for the suckling. Iron nutricion in childhood","volume":"78","author":"Aggett","year":"1989","journal-title":"Acta Paediatr. Scand."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1056\/NEJMra1401038","article-title":"Iron-Deficiency Anemia","volume":"372","author":"Camaschella","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1159\/000371357","article-title":"Iron Intake and Status of Children aged 6\u201336 Months in Europe. A Systemic Review","volume":"66","author":"Eussen","year":"2015","journal-title":"Ann. Nutr. Metab."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.1016\/S2214-109X(13)70001-9","article-title":"Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995\u20132011: A systemic analysis of population-representative data","volume":"1","author":"Stevens","year":"2013","journal-title":"Lancet Glob. Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1301\/nr.2006.may.S34-S43","article-title":"Long-lasting neural and behavioral effects of early iron deficiency in infancy","volume":"64","author":"Lozoff","year":"2006","journal-title":"Nutr. Rev."},{"key":"ref_19","unstructured":"(2023, December 13). P\u00e4diatrie Schweiz. Available online: https:\/\/www.paediatrieschweiz.ch\/handlungsanweisungen-vegetarische-vegane-ernaehrung\/."},{"key":"ref_20","first-page":"92","article-title":"Vegane Ern\u00e4hrung, Position der Deutschen Gesellschaft f\u00fcr Ern\u00e4hrung","volume":"63","author":"Richter","year":"2016","journal-title":"Ern\u00e4hrungsumschau"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/2\/196\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:54:38Z","timestamp":1760104478000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/2\/196"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,4]]},"references-count":20,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["children11020196"],"URL":"https:\/\/doi.org\/10.3390\/children11020196","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2024,2,4]]}}}