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Introduction
Iron is an essential mineral in the body since it is the major input factor in multiple cell metabolism processes. Iron deficiency can occur in several ways. First, some physiological factors interact, leading to increase in its requirements in the body. In addition, several diseases can cause lead to iron deficiency. The deficiency will also occur when the intake of iron decreases. Irrespective of its causes, over 1.62 billion people worldwide suffer from anemia. The most susceptible are infants, pregnant women, and elderly people. Geographically, Africa and South Asia are the most affected regions while the Western Pacific and Europe are the least affected. Out of these cases of anemia, iron deficiency accounts in 50 percent of the cases. In light of these statistics, it is necessary to focus on iron deficiency and the resulting anemic condition.
The purpose of this research is to provide a comprehensive review of iron deficiency and the likely consequent anemic condition as well as guidelines and suggestions for its prevention and control. The particular objectives of the research include examining the groups that are highly exposed to the risk of suffering from iron deficiency and the entrenched anemic condition, identifying a correlation between iron deficiency and iron deficiency anemia, discovering the indicators of iron deficiency and iron deficiency anemia, and recommending strategies that can be adopted for prevention and regulation of the two conditions.
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The Internet database, online libraries, and a number of primary research articles focusing on the topic of iron deficiency and iron deficiency anemia were reviewed to give a scientific overview of the two concepts. The citation lists of several medical journals on anemia were also reviewed, and the articles that were identified as those of primary importance were retrieved. After all the relevant articles had been evaluated for their quality and applicability to the research topic, 15 articles were selected and reviewed further to provide findings to the research problems. All the articles selected were issued not earlier than 2008.
Iron is one of the essential mineral elements in the human body. One of its major roles is the constitution of hemoglobin, a protein that is necessary for transportation of oxygen in the body. Furthermore, iron takes part in other metabolic processes that are critical to life, such as forming part of enzymes associated with the formation of DNA and respiration process in a cell. The ability of iron element to gain and lose electrons, exchanging between Fe2+ and Fe3+ is the factor behind its importance in physiological processes. The same factor also makes iron very toxic to the body tissues as it influences various metabolic processes to form free radicals. In this regard, metabolism of iron is highly regulated, and in practice, all iron in the human body is stored in proteins. Iron taken in the diet is absorbed by the small intestines, and the absorption is extremely controlled.
Blood loss is a factor that should be investigated in all cases of iron deficiency. Hemorrhage is currently the most common cause of loss of iron and anemia as it lowers the host’s red cell mass and also decreases the availability of iron for erythropoiesis and thus increases demand for iron. 5Bleeding can take place in several sites along the intestinal tract, with the colon having the highest incidence of bleeding. Other ways in which blood can be lost, thus causing the loss of iron, include nose bleeding and blood donation.
The requirement for iron is high in pregnant and non-pregnant women. However, the demand for iron is highly increased in the period near to birth. During the gestation period, about 1200 mg of iron is needed from the time of conception to delivery. The iron intake and iron reserves of the mother must be enough to meet the fetal iron needs. Fetal demand for iron, which is needed for development, is prioritized over the demand for the mother’s red blood cells. During the post-delivery period, iron is lost from the mother in breast milk.
In most tropical regions in the world, malaria is a common cause of iron deficiency. Malaria causes a decrease in the level of iron by causing a condition known as intravascular hemolysis, which precedes the loss of hemoglobin through the urine, a condition described as blackwater fever. In addition, the immune response associated with malaria suppresses erythropoietin and directly affects erythropoiesis. In addition, the body may generate more hepcidin expression in order to protect itself from liver-stage malaria. A high level of hepcidin restricts iron and usually delays recovery of erythroid.
Economic conditions of a country determine the dietetic level of the people. The diet can sometimes cause iron deficiency anemia. It usually happens when iron reserves are exhausted, or the individual already suffers from anemia, and the body needs to absorb additional iron from the gut for recovery.
The etiologies of iron deficiency and iron deficiency anemia can be categorized into two classes: those arising from the reduced intake of iron and those resulting from the increased loss of iron in body’s metabolic processes. In addition, some physiological factors can trigger an increase in body’s iron needs, thus stimulating its deficiency. For example, there is an increased need for iron during the periods of rapid growth (childhood and adolescence), pregnancy and menstrual losses in women. Other factors, such as intestinal parasites, are also common causes of iron deficiency.
Iron deficiency has far-reaching consequences for the body since it affects all metabolic processes in which iron is involved. This ultimately leads to some negative medical consequences. The clinical manifestation of iron deficiency is different from one case to another. It depends on the rapidity of onset of anemia, its severity and other characteristics of the patient, the specific causes of ID and IDA, and also the presence of other nutritional deficiencies. In this regard, IDA or ID can be either asymptomatic or result in developing systemic symptoms including tiredness, irritability, weakness, poor concentration, intolerance to exercise, and in more serious cases, heart failure.
Some individuals with iron deficiency irrespective of whether they have anemia can experience alopecia and mouth dryness as a result of decrease in salivation. The primary effects of iron deficiency are high maternal and perinatal mortality rates. Research shows that 40 percent of perinatal and maternal deaths are related to anemia. Low levels of iron in the body have also been associated with impairment of physical abilities and cognitive performance at work and at school.
The immune system is also weakened by several mechanisms that affect the proper functioning of white blood cells, therefore increasing indisposition to resist infectious diseases. In addition, thyroid function can also be adversely affected by various mechanisms, which eventually causes reduction in triiodothyronine and surge in thyroid peroxidase function. Symptoms can be present not only with an individual suffering from IDA, but also with those who have ID.
Further, some of the effects of ID and IDA are not quantifiable. Subsequently, iron deficiency harmfully affects the quality of life of the people suffering from it. In particular, it produces negative effects on performance at work and school. It is plausible that people who grow under the conditions of iron deficiency suffer lower educational and intellectual capacity, and subsequently, their professional future and derived income are jeopardized. ID and IDA are also cited as some of the factors causing slow development in poor nations, inhibiting the sufficient development of human capital.
Iron deficiency (ID) refers to the diminution in the total iron levels, irrespective of its clinical manifestation. When ID impairs erythropoiesis, as indicated earlier, it might cause a reduction in hemoglobin and subsequent generation of iron deficiency anemia (IDA). Anemia can be defined as the reduction in blood hemoglobin to less than 13g/dl in males and 12g/dl in females. However, sometimes it is complicated to affirm that iron deficiency is the cause of anemia since some instances of iron deficiency anemia are normocytic. The further step in assessing anemia is the determination of iron metabolism. A typical pattern of iron deficiency is a decline in sideremia (serum iron blood), ferritin in plasma, and saturation of transferrin. If there is no inflammation, serum ferritin designates the cumulative iron reserves in the body. In this regard, a low level of serum ferritin (less than 30ng/L) explicitly means iron deficiency in the body. 9Transferrin’s saturation is relevant when the measurement of ferritin is ambiguous. A percentage of transferrin below 20 percent suggests iron deficiency. Once it is determined that iron deficiency is the cause of anemia, the cause of iron deficiency is defined.
Treatment of the primary cause. Patients suffering from conditions that cause deficiency of iron and iron deficiency anemia should be referred to a specialist such as gastroenterologist for a comprehensive treatment.
Iron therapy. Administration of iron supplements is necessary in order to normalize the level of hemoglobin and iron reserves. The administration is often oral. Although it is widely recommended that iron supplements should be taken before breakfast in order to improve its intestinal absorption, there is no evidence to support this recommendation, and it is more appropriate to administer the supplements with food. A single tablet of commercially available ferrous salts contains higher amount of iron than the intestines daily absorption capacity.
ID and IDA can also be prevented by improvement of the patient’s diet. However, this is a challenge in developing countries due to some economic factors. 3The principle goal of modifying the diet of the population should be a behavioral change, resulting to the rise in the selection of iron rich foods and food patterns that focus on bioavailability. There is a need to develop strategies to enable access to iron rich foods, including fruits and vegetables, fish, meat, poultry, and other foods that promote absorption of iron (such as tubers). Discrepancies in local and regional diets should also be taken to perspective. In particular groups of people whose diet is mainly vegetable based, which is a common phenomenon in the developing countries and among vegetarians, iron is consumed in the non-heme form(less absorbable), and, therefore, ID is more likely. In such cases, absorption of iron can be promoted by encouraging the consumption of foods that favor absorption, for instance foods rich in vitamin C, and avoiding foods that inhibit absorption, such as fatty foods and calcium.
Iron fortification is an economical long-term solution for extensive regulation of iron deficiency. An effective iron fortification plan requires collaboration with the stakeholders in the food industry. These include the government, producers, and consumers. Due to the reactive nature of iron, its fortification in foods is more complex than the fortification of other minerals, such as iodine in salts, as more soluble and absorbable iron compounds react with food ingredients to produce unpleasant taste and colors. Consequently, less absorbable iron compounds such as electrolytic iron should be used. In iron fortification, it is essential to identify the foodstuff that is most likely to reach the entire target population, such as flours and main cereals.
Special attention is needed for particular groups of population that are more prone to ID and IDA. These groups include infants, pregnant mothers, and elderly people. Some researchers assert a correlation between cognitive capacities and iron levels. Consequently, iron deficiency and iron deficiency anemia in children have been associated with the tendencies for poor performance at school, poor mathematical calculation, worse understanding and development of reading and writing skills, and low scores in psychomotor tests. These deficiencies can be remedied by administration of iron supplements. For primary prevention, iron supplementation through fortified foods can be important in provision of daily iron doses to infants between the age of 6 and 12 months who are at risk of iron deficiency.
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In addition, infants who are likely to suffer from ID need to be examined for detection of iron deficiency. Examination should be conducted at the age of 9 or in some cases 12 months. Special attention must be directed to preterm infants, and examination should be done at 6 months and 3 months in case the infant is not receiving iron supplements. The infant should be carefully monitored for symptoms after the age of 12 months.
For pregnant women, iron and folic acid are needed for various metabolic processes of the mother and the fetus. Subsequently, deficiency in these two interrelated substances increases the risk of preterm birth, below normal birth weight, and neural tube effects. The mother should have sufficient iron intake in order to protect the fetus from ID. 7Research shows that this can be achieved through joint supplementation of folic acid and iron during the period of pregnancy. This could substantially reduce the risk of preterm birth and early neonatal mortality, the major cause of infant mortality, particularly in developing countries. Women identified as suffering from IDA should take iron supplements. It is common for the body to have intolerance to oral iron intake during the gestation period. In these situations, iron should be administered intravenously.
In regard to iron deficiency anemia in the elderly people, several studies have associated the condition with the increase in overall indisposition, high risk of Alzheimer’s disease, low quality life scores, high number of hospital admissions, and an increased overall mortality rate. Among old people, anemia is more widespread in patients above 65 years and even higher in individuals above 80 years. In both cases, men are at higher risk than women. Conditions such as tumors often contribute to the development of iron deficiency anemia. Nevertheless, the likelihood of dietary deficiency as a causative or promoting factor should be investigated in the individual.
Conclusion
To conclude, this study provides an assessment of iron as the major element in human physiological processes, factors that can result in the deficiency of the element, and its correlation with anemia. The most predisposed groups are infants, pregnant mothers, and elderly people. The results demonstrate that iron deficiency and iron deficiency anemia are more widespread in developing nations due to inherent economic limitations whereas in developed countries, the two conditions are mainly caused by poor diet habits. Iron deficiency is associated with cognitive challenges and increased predisposition to illnesses in the general population. The social and economic costs associated with iron deficiency warrants institution of preventive and control measures with a focus on the most susceptible groups. These measures include implementation of plans for prevention of iron deficiency based on enhancement of diet habits, fortification of foods, supplementation of iron, public health schemes integrated into maternal and child health, and primary health care plans.
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