Pediatric iron deficiency anemia: The role of nutrition and dietary strategies

Iron deficiency accounts for most of the world’s cases of anemia, a condition wherein an individual’s blood cannot supply enough oxygen to the body. Iron is a food-derived nutrient that is essential for the production of red blood cells.  Iron-deficiency anemia (IDA) occurs when the iron demand overtakes iron supply, usually due to an iron-poor diet or when the body cannot fully absorb iron.

Individuals at risk of IDA include:

1. Those who menstruate, particularly with heavy periods
2. Pregnant, breastfeeding, or postpartum individuals
3. Those who have recently undergone major surgery or experienced physical trauma
4. Persons with gastrointestinal conditions that affect nutrient absorption
5. Those on vegan and vegetarian diets without  iron supplements
6. Children who consume more than 16 to 24 oz of cow’s milk daily (due to the low iron content of cow’s milk, decrease in  iron absorption, and  chronic blood loss secondary to irritation of the intestinal lining) 

IDA is prevalent in poverty-stricken populations due to several factors. Limited access to and/or high cost of protein-rich foods, inadequate medical services for anemia prevention and management services, and poor sanitation contribute to this prevalence. Poor hygiene increases the risk of parasitic infections which can deplete the body’s iron and other essential nutrients. Additionally, a lack of education on proper nutrition and hygiene makes it harder for affected communities to prevent IDA.

Signs and symptoms of IDA may include: 

1. Paleness
2. Unexplained fatigue and/or generalized weakness
3. Shortness of breath
4. Increased heart rate
5. Headaches during activities 
6. Sore or absence of bumps along the tongue
7. Hair loss and/or brittleness of the nails
8. Pounding in the ears
9. Craving for ice or clay, also known as “picophagia”

In diagnosing IDA, the following markers are checked: 

1. Complete blood count
2. Hemoglobin and hematocrit levels
3. Mean cellular volume
4. Ferritin 
5. Serum iron
6. Transferrin or total iron-binding capacity
7. Iron saturation 

Here are several interventions for IDA that target various points along the food supply chain: 

• Supplementation refers to providing individuals with supplements that can increase iron in the blood, as well as improve iron absorption. Iron supplements are especially important for persons who are pregnant, those who are menstruating, and those who are consuming vegan and vegetarian diets. 
• Fortification involves adding iron and other nutrients to food to ‘fortify’ them and make them more beneficial to consumers. It is a cost-effective method of iron-fortification. Mass fortification is applied for large populations, while targeted fortification approach is used for specific groups, such as in school and emergency feedings. “Point-of-use” fortification uses powdered or lipid-based fortifiers added to food before consumption. Other recent methods of iron fortification include mixing iron salts into drinking water and crop biofortification through modern biotechnology.
• Diet diversification and improving the quality of food items is a strategy to deliver higher iron content as well as other micronutrients that increase the uptake of iron in the body. This starts with educating individuals, especially parents, about the importance of a balanced diet, as well as the role of protein-rich foods. 

IDA is a multilayered condition that remains a global issue, particularly in developing countries. Since it can worsen birth outcomes, overall health, and even economic growth due to reduced productivity, improving iron intake to prevent IDA should be prioritized not only by international health organizations and healthcare providers but also by local governments and families.

Sources:

1. WHO. Iron Deficiency Anaemia Assessment, Prevention and Control: A guide for programme managers. 2001. Available from: https://cdn.who.int/media/docs/default-source/2021-dha-docs/ida_assessment_prevention_control.pdf?sfvrsn=fb8c459c_1&download=true
2. da Silva Lopes K, Takemoto Y, Garcia‐Casal MN, Ota E. Nutrition‐specific interventions for preventing and controlling anaemia throughout the life cycle: an overview of systematic reviews. Cochrane Database of Systematic Reviews 2018, Issue 8. Art. No.: CD013092.
3. WHO. Nutritional anaemias: tools for effective prevention and control. 2017. Available from:  https://www.who.int/publications/i/item/9789241513067.
4. American Society of Hematology. Iron-Deficiency Anemia - Hematology.org. Available from: https://www.hematology.org/education/patients/anemia/iron-deficiency.
5. Kaur N, et al. Food fortification strategies to deliver nutrients for the management of iron deficiency anaemia. Current Research in Food Science. 2022.2094-2107.
6. Noubactep C, et al. Iron-fortified water: a new approach for reducing iron deficiency anemia in resource-constrained settings. Sci Rep. 2023;13:13565.