8 Adverse Implications of Iron Deficiency Anemia and Nutrition Interventions to Combat It.

 8 Adverse Implications of Iron Deficiency Anemia and Nutrition Interventions to Combat It.

Iron is an essential nutrient involved in the circulation of oxygen to every part of body tissues, synthesis of DNA, electron transportation, cognitive health, growth, and development. The regulation of iron in the body follows a strict balance between iron absorption from the digestion tracts and unregulated excretion through sweating, menstruation in females, shedding of hair and skin cells, rapid red blood cell turnover, and excretion through feces.

Although iron is abundantly found in the environment and has a relatively low requirement in the body of about 10mg, it remains a growth-limiting nutrient in the human diet leading to iron deficiency and iron deficiency anemia.

Anemia is defined as low circulating red blood cells in the body leading to low oxygen-carrying capacities of red blood cells to meet the body’s physiological needs. Hemoglobin (HB) is the red part that gives blood its color. The iron in the red blood cells bides with oxygen and is transported to every tissue in the body. Hemoglobin levels are deficient when the Hemoglobin level is less than 11.g/dl in children, 12g/dl in women, and 13g/dl in men.

Globally, anemia affects over 2 billion people translating to over 30% of the world population making it a major public health burden. Though there are different causes of anemia, iron deficiency remains the most prevalent accounting for 50% of all anemia, and is ranked among the “top ten” risk factors that contribute to the global burden of diseases.

Risk Factors for Iron Deficiency anemia

Iron deficiency anemia develops when iron stores in the body deplete below normal levels to support red blood cell production. Without iron, the body makes few red blood cells or produces smaller cells reducing the oxygen-carrying capacity of the blood cells. Some of the major causes of insufficient iron in the body include;

Inadequate dietary iron sources

Iron deficiency may result from inadequate dietary intake. There are many reasons why people may not get enough iron from their diet. Being a strict vegetarian who does not replace animal protein with adequate plant protein to provide the heme iron that is easily absorbed. People with eating disorders, older populations who lack food diversity, children fed on cow’s milk because cow’s milk is low on iron, people who consume excessive caffeine with iron-rich meals, and people who regularly take antacids that interfere with iron absorption.   

 Iron malabsorption

Malabsorption is another cause of iron deficiency anemia. This happens when the body is unable to absorb essential nutrients from the gastrointestinal tract leading to insufficient supply of iron to support hemoglobin production. Diseases of the gastrointestinal tract like gastric ulcer, inflammatory bowel disease, parasitic infestation, coeliac diseases, and gastric surgery are some causes of iron malabsorption.  

Internal blood loss

Heavy, prolonged, or frequent menstruation, cancer in the stomach, esophagus, or colon,  peptic ulcer, or use of aspirin, or  ibuprofen are likely causes of internal bleeding leading to blood loss and subsequent iron deficiency anemia.

Increased iron demand

Pregnant and nursing mothers require additional iron. During pregnancy iron deficiency can harm the mother and the health of her unborn baby. Mother’s low iron level may lead to iron-deficient infants and early childhood.

Infants and young children require a lot of iron to support rapid growth. Children are born with iron stores that last them for up to six months. Poor complementary feeding, children fed on animal milk, or children with lead poisoning are at a greater risk of iron deficiency anemia.

Populations at higher risk of iron deficiency anemia

Although iron deficiency anemia can through the lifecycle, it is more common in children, women, and adolescents. Some factors that increase the risk of iron deficiency anemia in these populations include;

Children

Iron deficiency in children is common. At birth, children have stored iron in their bodies. This store is quickly depleted to support sprout growth. Children who are born premature, low-birth weight, infants fed on animal milk, poor complementary feeding, children exposed to lead, obese and overweight babies, and children who do not get iron rich diet are at a greater risk of iron deficiency anemia.

Women

Pregnancy, heavy menstrual cycle, endometriosis, and fibroids are conditions that increase the risk of iron deficiency in women. Women with heavy menstruation lasting for 7 days are likely to lose more blood. Fibroids, a normally ignored condition by many women is a major source of heavy bleeding increasing the loss of iron from the body beyond its natural replacement.

Adolescents between 10 and 19 years

Adolescence is a stage of rapid growth. Iron demand is increased due to the onset of menstruation in girls and muscle build-up in boys.

Signs and Symptoms of iron deficiency anemia

Features of iron deficiency are due to a poor supply of oxygen to the body tissues. Most cases of iron deficiency anemia are mild and may not be easily noticed. However, when the body continues to experience persistent iron deficit and becomes more anemic, it may present with the following symptoms;

1. Extreme fatigue due to poor oxygen circulation to body tissues.
2. General body weakness
3. Paleness of the skin especially of the mucus membrane in the mouth, conjunctivitis, and the tongue.
4. Increased heart rate to compensate for the inadequate hemoglobin supply
5. Shortness of breath
6. Cold hands and feet
7. An unusual craving for non-nutritive substances like soil, dust, and plastics
8. Reduced appetite

Implications of Iron Deficiency Anemia to general health and wellbeing 

The main role of iron in the body is to support hemoglobin, the oxygen-carrying capacity. Prolonged inadequate oxygen supply due to iron deficiency anemia can lead to;

1. Impaired cognitive development

Iron is an essential nutrient for brain metabolism. Iron deficiency impairs neuron transmission with susceptibility to poor cognitive development with short attention spans, lowered intelligence, and poor sensory functions. Iron deficiency occurs mostly in three critical periods; infancy, childhood, and early adolescence. Fetal iron deficiency results from maternal iron deficiency.

2. Increase susceptibility to infections

Iron is required for healthy immune functioning and destruction of microorganisms. Iron deficiency anemia increases susceptibility to infections by suppressing the immune response to pathogens.

3. Low work capacity and productivity

The critical role of iron is oxygen transport to every tissue of the body. Iron deficiency anemia results in reduced work output. Ample studies have purported that correction of iron deficiency anemia increases work output, reduces morbidity, and improves quality of life.

4. Poor pregnancy outcome

Iron deficiency anemia adversely affects maternal and fetal outcomes with increased morbidity and fetal death. Severe anemia during pregnancy increases the risk of maternal death, premature birth, fetal death, and low birth weight babies. Prenatal supplementation with ferrous sulphate prevents iron deficiency and iron deficiency anemia.

5. Impaired growth

Iron deficiency anemia hurts linear growth from infancy, childhood, and adolescence. An infant with iron deficiency anemia suffers delayed cognitive development, reduced motor skills, and increased mood disorders that can last over a lifetime.

6. Impaired endocrine and neurotransmitters

Iron is required in the thyroid’s physiological processes. It is involved in the conversion of thyroid hormone T4 to T3. Low iron levels have a direct effect on thyroid functions predisposing to hypothyroidism.

Iron is equally required for neurological functioning and development. Low iron levels are associated with deficient cognitive and behavioral development probably due to poor brain energy metabolism.

7. Heavy metal metabolism

A diet deficient in iron increases the risk of other metals absorption from the gastrointestinal tract such as lead, manganese, and cadmium. Elevated levels of toxic metals in the body inhibit neural, cognitive, and motor development. Consequently, cognitive impairment may result from reduced iron levels, or as a result of increased levels of toxic metals in the blood. Lead, manganese, and cadmium are naturally occurring in the environment and easily gain access into the body.

8. Heightened social-economic burden

Iron deficiency anemia in children is linked to poor mental and cognitive development, and inadequate school achievements reducing job opportunities and gainful productivity. Observation studies to assess the association between iron deficiency and mental test performance revealed a low achievement among iron-deficient children compared to non-deficient children’s mental scores.

Nutrition Interventions to Combat Iron Deficiency Anemia 

Include heme and non-heme iron-rich foods in the diet.

Iron dietary sources fall under two categories; heme and non-heme iron. Animal protein has both heme and non-heme iron. The plant is a good source of non-heme iron. Heme iron is easily absorbed in the body without the need for enhancing factors. Non-heme iron is not easily absorbed. To elaborate on how this works, after a meal, 25% of heme and 17% of non-heme iron is absorbed into the body. Studies have estimated that the bioavailability of iron is 14-18% in mixed consumers and only 5 to 12% for vegetarians putting them at greater risk of iron deficiency.

Add foods that increase iron absorption 

Ascorbic acid (Vit C) has an enhancing effect on dietary non-heme iron absorption. Vitamin C rich foods include bell pepper, citrus fruits (oranges, kiwi, and grapefruit), cruciferous vegetables (cabbage, broccoli, kale, and cauliflower), tomatoes, and straw berries.

Recognize dietary iron inhibitors and know how to safely counteract their effects

Inhibitors of iron absorption include phytates (antioxidants found in legumes), polyphenols (antioxidants found in plants foods), and calcium in milk and dairy products. Phytates (phytic acid) in grains, seeds, legumes, and nuts are known to reduce nutrient absorption including iron. Polyphenols are antioxidants found in tea as tannic acid, red wine, and berries and are known to inhibit non-heme absorption by binding in the intestine. Eating calcium-rich food together with iron-rich food inhibits iron absorption. It is advisable to withhold calcium-rich foods like milk and tea when eating iron-rich foods.

Maintain a healthy gut to reduce iron malabsorption and blood loss

Iron malabsorption is when the body is unable to absorb iron from the digestion tract and is a cause of the iron deficiency. Diseases of the digestive tract compromise gut integrity with subsequent malabsorption of iron and blood loss. For example, studies have shown that hookworm infestation induces blood loss from the digestive tract. Hookworm act by releasing an anticoagulant factor that creates a continuous blood loss of about 0.2 ml from the body every day.    

Eat iron fortified foods

Food fortification with iron is a long-term strategy that can help reduce iron deficiency and iron deficiency anemia.

Embrace iron supplements during critical times

Ferrous sulphate is an iron supplement used in the treatment of iron deficiency anemia. For people who do not get enough iron in their diet, have health conditions that reduce iron absorption, or those with increased demand like pregnancy, supplementation with ferrous sulfate is beneficial.   

Common Iron-rich dietary sources

Different varieties of foods are good sources of iron. For example;

1. Animal protein ( red meat, organ meat, poultry, pork, lamb,
2. Seafood ( shellfish, salmon, sardines, tuna)
3. Fortified whole-meal breakfast cereals, whole meal flour,
4. Seeds (pumpkin seeds, sesame seeds, hemp, and flaxseeds)
5. Nuts (pistachios, almond, brazil, and cashew nuts)
6. Vegetables( tomatoes, bell pepper, white potatoes)
7. Citrus Fruits (grapefruits such as orange, kiwi, and grape)
8. Beans and lentils ( black beans, kidney beans)

With these in tips, I hope you can now optimize iron in your diet and help curb iron deficiency anemia.

Picture courtesy of news-medical.net