IRON DEFICIENCY ANAEMIA: PROBLEM, CAUSE AND SOLUTION

By Dambar B. Khadka EM Food science, Technology and Nutrition, KaHo sint- Lieven Gent, Belgium

INTRODUCTION
Anaemia affects one-quarter of the world population (Mclean, 2008) Anaemia is defined as decrease in concentration of circulating red blood cell (RBC) or in haemoglobin concentration and related to impaired capacity to transport oxygen (WHO 2004)

IRON DEFICIENCY ANAEMIA (IDA)

One of the major factor associated with the global burden disease (WHO 2004) Is a most prevalence Micronutrient deficiency Major contributor for anaemia Mostly deals with Iron deficient Other contribution factor for anaemia: Vitamin A, Vitamin B12 and Folic Acid deficiency

WHO CUT OFF VALUE FOR IRON DEFICIENCY

Iron store directly related to the haemoglobin and Haematocrit concentration

Population category Children 0.504.99 years Pregnant Women Children 5-11.99 years Children 12-15 years Non Pregnant Women >15 years Men >15 years
Source : WHO (2001)

Threshold Haemoglobin concentration 110 g/l 110 g/l 115 g/l 120 g/l 120 g/l 130 g/l

Haematocrit concentration

6.83 mmol/l
6.83 mmol/l 7.13 mmol/l 7.45 mmol/l 7.45 mmol/l 8.07 mmol/l

RECOMMENDED IRON INTAKE

PREVALENCE IRON DEFICIENCY ANEMIA

World wide 1.2 billion people is affected by IDA (WHO Estimate 2004)

Source: WHO 2004 update databaase

PREVALENCE OF ANAEMIA ( POPULATION SUB GROUP)

Anaemia is commonly take as a indicator for iron deficiency anaemia (WHO 2002)

Source: WHO 2008

PREVALENCE OF ANAEMIA NEPAL

DISTRIBUTION AND STORAGE OF IRON

Major iron storage compound mainly located in liver, reticuloendothelial cells and erthroid precursor
Iron containing enzyme & Transport iron 3% Cytochrome C ETC and ATP production Cytochrome P450- oxidative degradation of foreign compound and endogenous substrate Other iron containing Enzymes and iron dependent enzymes

Ferritin and Haemosiderin 17% Myoglobin 10% Hemoglobin 70%

Transport and stores oxygen for use in muscle contraction

Source: Dallman 1986

essential for transfer oxygen via blood stream from the lungs to tissue

IRON ABSORPTION AND REGULATION IN BODY

Source: steele et al 2005

PROBLEMS ASSOCIATED WITH IDA

Reducing Working productivity Reducing Cognitive, Intellectual capacity and Behaviour Reduce Immune system and resistant to infection Premature birth and low birth weight Mortality in children and women Others

PROBLEM ASSOCIATED WITH IDA

Work productivity and performance

decrease the fitness and aerobic working capacity (Beard 2001) reduced oxygen transport and respiratory efficiency (ATP Formation) normally accepted problems of IDA (Dallman 1986).

PROBLEMS ASSOCIATED WITH IDA In infants

Cognitive and Behaviour loss

a lower PDI and MDI on short term and long term observation But no Improvement in most cases of intervention trials in both short term and Long Term

Preschool and Adolescent

Improvement in most of intervention Trials

Good association but still need to verify Iron deficiency decrease energy , O2 supply, can impaired myelination in CNS

PROBLEM ASSOCIATED WITH IDA

Immune response and Resistance to pathogen

Impaired cell mediated immune responses -decreasing the capacity of netrophills - impairment in T cell proliferation No improvement on iron supplementation -influence may be due to excess iron or Multiple factors Plausible evidence is not sufficient

PROBLEMS ASSOCIATED WITH IDA

Pregnancy Outcome

Risk factor for preterm delivery and low birth weight and possibility to affects the neonatal health
gestation had a 1.18-1.75 times higher risk or preterm birth and low birth weight (Murphy et al., 1986)

- e g.Women having Hb< 104g/l at 13-24 week of

PROBLEM ASSOCIATED WITH IDA

Child and Maternal Mortality

CFR in children higher (<50g/l) than children (>50g/L) for a specific cases CFR ranges 2-29% No dose specific Hb and CFR Might be influence of other factor.
et al 2001a)

(Brabin

Maternal mortality, with 5% severe anaemia (Haemoglobin <70g/l), Estimated death

9 per 100,000 live birth due to severe-malarial-anaemia 41 due to non-malarial (mostly nutritional) anaemia related death per 100,000 live birth.
et al 2001b)

(Brabin

Brabin et al. 2001a & b ,

PROBLEM ASSOCIATED WITH IDA

Child and Maternal Mortality

Most of the studies related with malarial anaemia and mortality Most of data from developing country, malaria endemic area Subjects are from hospital cases, contain more than one health problems no clear relationship between IDA and mortality. Limited on Iron Interventional trials No solid conclusion up to now

WHO ESTMATED DEATH,2004

WHO Region AFR AMR EMR EUR SEAR WPR YLL WHO Region AFR AMR EMR EUR SEAR WPR YLL Male Death per 100000 0-4 yr 5-14 yr Total 8.9 0.7 3.1 1.2 0.3 1.4 6.5 0.3 1.4 1.8 0.1 0.7 0.5 0.0 0.7 1.2 0.1 0.4 836 641 207 960 2 274 179 Female Death per 100000 5-14 yr 15-29 yr 30-44 yr 45-59 yr 1.2 2.7 2.3 6.3 0.3 0.3 0.4 1.2 0.6 0.3 0.6 2.1 0.1 0.2 0.4 0.3 0.2 0.8 3.9 9.1 0.1 0.1 0.4 0.5 381 939 Overall Total 3.7 1.5 10 per 1.6 100,000 0.9 1.8 0.5 5 852 632

0-4 yr 7.9 1.0 6.6 1.3 0.6 1.3

777 073 267 182

Total 4.4 1.7 1.8 1.0 3.0 0.7 3 578 621 482 1 102 982 453

PROBLEM ASSOCIATED WITH IDA

Others problems

Heavy metal Absorption e.g. Lead poisoning Economy loss for o Intervention and treatment o Disability or mortality (YLL AND DALY or QALY)

ETIOLOGY AND CAUSES IDA

Dietary factor Low iron Low vitamin C Excess phyatate Excess Tea/Cofee Calcium rich diet Fad diets High Risk Physical factor Life stage Iron absorption Iron loss Health conditions Genetics

High Risk Very High Risk

High Risk Socio-cultural and Demographic factor Health Education, Family Region Culture Food habit and Taboos Poverty

PREVENTION AND CONTROL

Development of Food based Preventive approach and implementation Dietary intervention & management according to RDA Supplementation and fortification Integration with local community based health and Nutrition program Education to community worker and community people

In severe risk and complexes situations Medical intervention Therapeutic Food Development of effective Surveillance system simple and fast tool for assessing and monitoring of programme and intervention

CONCLUDING REMARKS

one of the major micro nutrient deficiency Multifactor cause Major risk group Children and women (menstutrating and pregnant) affect working productivity and perforformance, growth can also affect brain and behaviour development, pregnancy outcomes and neonatal health Possibility of major cause of the anaemic mortality in children and maternal woman Food based approach along with integration of community programme essential Effective surveillance and monitoring needed Further research for true assessment of IDA and its impacts; with citing the all the possible factor helpful for strategy and intervention development

Question?