IRON DEFICIENCY ANEMIA IN CHILDREN RESIDING IN HIGH AND LOW-INCOME COUNTRIES: RISK FACTORS, PREVENTION, DIAGNOSIS AND THERAPY
Main Article Content
Keywords
Low income countries, Developed countries, Prevention, Therapy, Iron deficiency, Iron deficiency anemia
Abstract
Iron deficiency and iron deficiency anemia (IDA) affect approximately two billion people worldwide and most of them reside in low- and middle-income countries. In these countries, additional causes of anemia include parasitic infections like malaria, other nutritional deficiencies, chronic diseases, hemoglobinopathies and lead poisoning. Maternal anemia in resource-poor nations is associated with low birth weight, increased perinatal mortality and decreased work productivity. Maintaining a normal iron balance in these settings is challenging, as iron-rich foods with good bioavailability are of animal origin that are expensive and/or available in short supply. Apart from infrequent consumption of meat, inadequate vitamin C intake and diets rich in inhibitors of iron absorption are additional important risk factors for IDA in low-income countries. In-home iron fortification of complementary foods with micronutrient powders has been shown to effectively reduce the risk of iron deficiency and IDA in infants and young children in developing countries but is associated with unfavorable changes in gut flora and induction of intestinal inflammation that may lead to diarrhea and hospitalization. In developed countries, iron deficiency is the only frequent micronutrient deficiency. In the industrialized world, IDA is more common in infants beyond the sixth month of life, in adolescent females with heavy menstrual bleeding, in women of childbearing age and elderly people. Other special at-risk populations for IDA in developed countries are regular blood donors, endurance athletes and vegetarians. Several medicinal ferrous or ferric oral iron products exist, and their use is not apparently associated with harmful effects on the overall incidence of infectious illnesses in sideropenic and/or anemic subjects. Further research is needed to clarify the risks and benefits of supplemental iron for children exposed to parasitic infections in the third world, and for children genetically predisposed to iron overload.
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https://academic.oup.com/ajcn/article/103/2/495/4662868
5. Bailey RL, West KP Jr, Black RE. The epidemiology of global micronutrient deficiencies. Ann Nutr Metab. 2015;66 (Suppl 2):22-33.
https://doi.org/10.1159/000371618
6. Gupta PM, Perrine CG, Mei Z, Scanlon KS. Iron, anemia, and iron deficiency anemia among young children in the United States. Nutrients. 2016;8(6). pii: E330.
https://doi.org/10.3390/nu8060330
7. Eussen S, Alles M, Uijterschout L, Brus F, van der Horst-Graat J. Iron intake and status of children aged 6-36 months in Europe: a systematic review. Ann Nutr Metab. 2015;66(2-3):80-92.
https://www.karger.com/Article/Pdf/371357
8. Armitage AE, Moretti D. The importance of iron status for young children in low- and middle-income countries: a narrative review. Pharmaceuticals (Basel). 2019;12(2). pii: E59.
https://doi.org/10.3390/ph12020059
9. Swinkels H, Pottie K, Tugwell P, Rashid M, Narasiah L; Canadian Collaboration for Immigrant and Refugee Health (CCIRH). Development of guidelines for recently arrived immigrants and refugees to Canada: Delphi consensus on selecting preventable and treatable conditions. CMAJ. 2011;183(12):E928-932.
https://doi.org/10.1503/cmaj.090290
10. Marx JJ. Iron deficiency in developed countries: prevalence, influence of lifestyle factors and hazards of prevention. Eur J Clin Nutr. 1997;51(8):491-494. https://doi.org/10.1038/sj.ejcn.1600440
11. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545-1602.
https://doi.org/10.1016/S0140-6736(16)31678-6
12. Baker RD, Greer FR. Committee on Nutrition American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics. 2010;126(5):1040-1050.
https://doi.org/10.1542/peds.2010-2576
13. Lozoff B, Georgieff MK. Iron deficiency and brain development. Semin Pediatr Neurol. 2006 Sep;13(3):158-165.
https://doi.org/10.1016/j.spen.2006.08.004
14. Jang HN, Yoon HS, Lee EH. Prospective case control study of iron deficiency and the risk of febrile seizures in children in South Korea. BMC Pediatr. 2019;19(1):309. https://doi.org/10.1186/s12887-019-1675-4
15. Tomoum H, Habeeb N, Elagouza I, Mobarez H. Paediatric breath-holding spells are associated with autonomic dysfunction and iron deficiency may play a role. Acta Paediatr. 2018;107(4):653-657.
https://doi.org/10.1111/apa.14177
16. Howard H, Kamat D. Restless legs syndrome in children. Pediatr Ann. 2018;47(12):e504-506.
https://doi.org/10.3928/19382359-20181114-02
17. Houston BL, Hurrie D, Graham J, Perija B, Rimmer E, Rabbani R, Bernstein CN, Turgeon AF, Fergusson DA, Houston DS, Abou-Setta AM, Zarychanski R. Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic iron-deficient adults: a systematic review of randomised controlled trials. BMJ Open. 2018;8(4):e019240.
http://dx.doi.org/10.1136/bmjopen-2017-019240
18. Brotanek JM, Gosz J, Weitzman M, Flores G. Secular trends in the prevalence of iron deficiency among US toddlers, 1976-2002. Arch Pediatr Adolesc Med. 2008;162(4):374-381.
http://doi.org/10.1001/archpedi.162.4.374
19. De Andrade Cairo RC, Rodrigues Silva L, Carneiro Bustani N, Ferreira Marques CD. Iron deficiency anemia in adolescents; a literature review. Nutr Hosp. 2014;29(6): 1240-1249.
https:// doi: 10.3305/nh.2014.29.6.7245.
20. Powers JM, Buchanan GR. Disorders of iron metabolism: new diagnostic and treatment approaches to iron deficiency. Hematol Oncol Clin North Am. 2019;33:393-408.
https://doi.org/10.1016/j.hoc.2019.01.006
21. Zhang AS, Enns CA. Iron homeostasis: recently identified proteins provide insight into novel control mechanisms. J Biol Chem. 2009;284(2):711-715.
https://doi.org/10.1074/jbc.R800017200
22. Teucher B, Olivares M, Cori H. Enhancers of iron absorption: ascorbic acid and other organic acids. Int J Vitam Nutr Res. 2004;74(6):403-419.
https://doi.org/10.1024/0300-9831.74.6.403
23. Centers for Disease Control and Prevention. Recommendations to prevent and control iron deficiency in the United States. MMWR Recomm Rep. 1998;47(RR-3):1-29. https://www.cdc.gov/mmwr/preview/mmwrhtml/00051880.htm
24. Ginzburg YZ. Hepcidin-ferroportin axis in health and disease. Vitam Horm. 2019;110:17-45.
https://doi.org/10.1016/bs.vh.2019.01.002
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