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The remedying of iron deficiency: what priority should it have?

Published online by Cambridge University Press:  09 March 2007

Alexander R. P. Walker
Alexander R. P. Walker*
Affiliation:
Human Biochemistry Research Unit, Department of Tropical Diseases, School of Pathology of the University of the Witwatersrand, and the South African Institute for Medical Research, Johannesburg, South Africa
*
Corresponding author:Dr A. R. P. Walker, fax +27 (0)11 489 9001
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Abstract

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Fe deficiency is considered to be the commonest of nutritional deficiencies worldwide. Adverse effects are stated to include lower growth rate and impaired cognitive scores in children and poor pregnancy outcome and lower working capacity in adults. In the present review, Fe intake, stores of the element, the magnitude of deficiencies and the benefits from interventions, as reflected in the results of clinical trials, are discussed. Because of inadequacies of knowledge in numerous respects, more information is needed regarding the extent to which clinical trials relate to public health realities, before introducing regional or national supplementation programmes. While Fe supplements are needed in certain groups, and in particular regions, increased dietary intakes could be supplied by food fortification, as well as by individual improvements in intake.

Keywords

IronDeficiency stigmataSupplementation
Type
Review Article
Information
British Journal of Nutrition , Volume 79 , Issue 3 , March 1998 , pp. 227 - 235
Copyright
Copyright © The Nutrition Society 1998

References

Akenami, FOT, Vaheri, A, Koskiniemi, M, Kivivuori, SM, Ekanem, EE, Bolarin, DM & Siimes, MA (1997) Severe malnutrition is associated with decreased levels of plasma transferrin receptor. British Journal of Nutrition 77, 391–397.CrossRefGoogle Scholar
Alexander, D, Ball, MJ & Mann, J (1994) Nutrient intake and haematological status of vegetarians and age-sex matched omnivores. European Journal of Clinical Nutrition 48, 538–546.Google ScholarPubMed
Allen, LH (1993) Iron-deficiency anemia increases risk of preterm delivery. Nutrition Reviews 51, 49–52.Google ScholarPubMed
Allen, LH (1997) Pregnancy and iron-deficiency: unresolved issues. Nutrition Reviews 55, 91–101.CrossRefGoogle ScholarPubMed
Amanor-Wilks, D (1996) Zimbabwe attempts to prevent health crisis. Lancet 347, 609.CrossRefGoogle Scholar
Armstrong, PL (1989) Iron deficiency in adolescents. British Medical Journal 298, 499.CrossRefGoogle ScholarPubMed
Ashby, D (1996) Can iron supplementation improve cognitive functioning? Lancet 348, 973.CrossRefGoogle ScholarPubMed
Auckett, MA, Parks, YA, Scott, PH & Wharton, B (1986) Treatment with iron increases weight gain and psychomotor development. Archives of Disease in Childhood 61, 849–857.CrossRefGoogle Scholar
Austoker, J (editor) (1995) Diet and cancer. In Cancer Prevention in Primary Care, pp. 45, 171. London: BMJ Publishing Group.Google Scholar
Awuonda, M (1996) Sweden prepares for health care cuts. Lancet 347, 1618.CrossRefGoogle Scholar
Ballot, DE, MacPhail, AP, Bothwell, TH, Gillooly, M & Mayet, FG (1989) Fortification of curry powder with NaFe-EDTA in an iron deficient population: report of a controlled iron fortification trial. American Journal of Clinical Nutrition 49, 162–169.CrossRefGoogle Scholar
Basta, SS, Soekirman, M, Karayadi, D & Scrimshaw, NS (1979) Iron deficiency anemia and the productivity in adult males in Indonesia. American Journal of Clinical Nutrition 32, 916–925.CrossRefGoogle ScholarPubMed
Beard, J (1995) One person's view of iron deficiency, development, and cognitive function. American Journal of Clinical Nutrition 62, 709–710.CrossRefGoogle ScholarPubMed
Beard, J (1996) Iron fortification in Venezuela. American Journal of Clinical Nutrition 64, 972–973.CrossRefGoogle ScholarPubMed
Beard, JL, Dawson, H & Pinero, DJ (1996) Iron metabolism: a comprehensive review. Nutrition Reviews 54, 295–317.CrossRefGoogle ScholarPubMed
Berger, J, Aguayo, VM, Téllez, W, Lujan, C, Traissac, P & San Miguel, JL (1997) Weekly iron supplementation is as effective as 5 day per week iron supplementation in Bolivian school children living at high altitude. European Journal of Clinical Nutrition 51, 381–386.CrossRefGoogle ScholarPubMed
Black, N (1996) Why we need observation studies to evaluate the effectiveness of health care. British Medical Journal 312, 1215–1218.CrossRefGoogle Scholar
Blankson, ML (1990) Maternal hematological status and pregnancy outcome. In New Perspectives of Prenatal Care, pp. 414–415 [MerkatzIR, IR,, Thompson, JE, Mullen, PD and Goldberg, RL, editors]. New York: Elsevier Science Publishing Co. Inc.Google Scholar
Block, G (1995) Are clinical trials really the answer? American Journal of Clinical Nutrition 62, Suppl., 1517S–1520S.CrossRefGoogle ScholarPubMed
Block, G & Subar, AF (1992) Estimates of nutrient intake from a food frequency questionnaire: The 1987 National Health Interview Survey. Journal of the American Dietetic Association 92, 969–977.CrossRefGoogle ScholarPubMed
Booyens, J, Frank M de, V & de Waal, VM (1969) A preliminary investigation of the dietary habits of Indian university students. South African Medical Journal 43, 786–792.Google ScholarPubMed
Bourne, LT, Langenhoven, ML, Steyn, K, Jooste, PL, Laubscher, JA & Van der Vyver, E (1993) Nutrient intake in the African population of the Cape Peninsula, South Africa: the BRISK study. Central African Journal of Medicine 39, 238–247.Google ScholarPubMed
Bradley, DJ, Rahmathullah, L & Narayan, R (1988) The tea plantation as a research ecosystem. In Capacity for Work in the Tropics, pp. 277–288 [Collin, KJ and Roberts, DF, editors]. New York: University Press.CrossRefGoogle Scholar
Bruner, AB, Joffe, A, Duggan, AK, Casella, JF & Brandt, J (1996) Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls. Lancet 348, 992–996.CrossRefGoogle ScholarPubMed
Cook, JD, Baynes, RD & Skikne, BS (1992) Iron deficiency and the measurement of iron status. Nutrition Research Reviews 5, 189–202.CrossRefGoogle ScholarPubMed
Cook, JD & Lynch, SR (1986) The liabilities of iron deficiency. Blood 68, 803–809.CrossRefGoogle ScholarPubMed
Cooper, MJ & Zlotkin, SH (1996) Day-to-day variation of transferrin receptor and ferritin in healthy men and women. American Journal of Clinical Nutrition 64, 738–742.CrossRefGoogle ScholarPubMed
Dean, M (1995) Health bucks the squeeze on cash. Lancet 346, 1547.CrossRefGoogle ScholarPubMed
DeMaeyer, EM, Dallman, P, Gurney, JM, Hallberg, L, Sood, SK & Srikantia, SG (1989) Preventing and Controlling Iron Deficiency Anaemia through Primary Health Care. Geneva: WHO.Google Scholar
Ekjidokun, OO, Tomkins, AM, Akinsete, I, Giwa-Osagie, OF & Afolabi, BM (1996) Does iron consumption protect against anaemia in pregnancy? Proceedings of the Nutrition Society 55, 142A.Google Scholar
Fleming, AF (1989) Tropical obstetrics and gynaecology. 1. Anaemia in pregnancy in tropical Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene 83, 441–448.CrossRefGoogle ScholarPubMed
Fleming, AF (1996) Haematological diseases in the Tropics. In Manson's Tropical Diseases, 20th ed., pp. 101–173 [Cook, GC, editor]. London: WB Saunders Company Ltd.Google Scholar
Fordy, J & Benton, D (1994) Does low iron status influence psychological functioning? Journal of Human Nutrition and Dietetics 7 127–133.CrossRefGoogle Scholar
Galloway, R & McGuire, J (1996) Daily versus weekly: how many iron pills do pregnant women need? Nutrition Reviews 54, 318–323.CrossRefGoogle ScholarPubMed
Garby, L & Areekul, S (1974) Iron supplementation in Thai fish sauce. Annals of Tropical Medicine and Parasitology 68, 467–476.CrossRefGoogle ScholarPubMed
Gilks, CF & Haran, D (1995) Impact of HIV in sub-Saharan Africa. Lancet 346, 187.CrossRefGoogle ScholarPubMed
Guidozzi, F, Patel, R & MacPhail, AP (1995) A prospective study of iron status in white and black pregnant women in an urban hospital. South African Medical Journal 85, 170–173.Google Scholar
Haas, JD & Fairchild, MW (1989) Summary and conclusions of the International Conference on Iron Deficiency and Behavioral Development, October 10–12, 1988. American Journal of Clinical Nutrition 50, 703–705.CrossRefGoogle Scholar
Hallberg, L & Rossander-Hulthén, L (1991) Iron requirements in menstruating women. American Journal of Clinical Nutrition 545, 1047–1058.CrossRefGoogle Scholar
Heitmann, BL, Milman, N & Hansen, GL (1996) Relationship between dietary iron intake, corrected for diet reporting error, and serum ferritin in Danish women aged 35–65 years. British Journal of Nutrition 75, 905–913.CrossRefGoogle ScholarPubMed
Hemminki, E & Meriläinen, J (1995) Long-term follow-up of mothers and their infants in a randomized trial on iron prophylaxis during pregnancy. American Journal of Obstetrics and Gynecology 173, 205–209.CrossRefGoogle Scholar
Hemminki, E & Starfield, B (1978) Routine administration of iron and vitamins during pregnancy: review of controlled clinical trials. British Journal of Obstetrics and Gynaecology 85, 404–410.CrossRefGoogle ScholarPubMed
Hollan, S (1996) Iron supplementation and cognitive function. Lancet 348, 1669.CrossRefGoogle ScholarPubMed
Idjaradinata, P & Pollitt, E (1993) Reversal of developmental delays in iron-deficient anaemic infants treated with iron. Lancet 341, 1–4.CrossRefGoogle Scholar
Idjaradinata, P, Watkins, WE & Pollitt, E (1994) Adverse effect of iron supplementation on weight gain of iron-replete young children. Lancet 343, 1252–1254.CrossRefGoogle Scholar
Johnson, S & van der Westhuyzen, J (1990) Nutritional evaluation of the black elderly in a rural village. South African Journal of Food Science and Nutrition 1, 23–28.Google Scholar
Joint FAO/WHO Consultation Committee (1996) Preparation and Use of Food Based Dietary Guidelines. Reports of a Joint FAO/WHO consultation, Nicosia, Cyprus. Nutrition Programme. Geneva: WHO.Google Scholar
Kivivuori, SM, Anttila, R, Viinikka, L, Pesonen, K & Siimes, MA (1993) Serum transferrin receptor for assessment of iron status in healthy prepubertal and early pubertal boys. Pediatrics Research 34, 297–299.CrossRefGoogle ScholarPubMed
Klebanoff, MA, Shiono, PH, Selby, JV, Trachtenberg, AI & Graubard, BI (1991) Anemia and spontaneous preterm birth. American Journal of Obstetrics and Gynecology 164, 59–63.CrossRefGoogle ScholarPubMed
Knox-Macaulay, HHM (1995) Blood diseases in the tropics. In Tropical Pathology, vol. 8, 2nd ed., pp. 1083–1147 [Doerr, W and Seifert, G., editors]. Hamburg: Springer-Verlag.CrossRefGoogle Scholar
Kretchmer, N, Beard, JL & Carlson, S (1996) The role of nutrition in the development of normal cognition. American Journal of Clinical Nutrition 63, 997S–1001S.CrossRefGoogle ScholarPubMed
Kuvibidila, S, Yu, L, Warrier, RP, Ode, D & Mbele, V (1994) Usefulness of serum ferritin levels in the assessment of iron status in non-pregnant Zairean women of childbearing age. Journal of Tropical Medicine and Hygiene 97, 171–179.Google ScholarPubMed
Lamparelli, RDV, Van der Westhuyzen, J, Steyn, NP, Baynes, RD, MacFarlane, BJ, Green, A & Bothwell, TH (1988) Nutritional anaemia in 11-year-old schoolchildren in the western Cape. South African Medical Journal 73, 473–476.Google ScholarPubMed
Layrisse, M, Chaves, JF, Mendez-Castellano, H, Bosch, V, Tropper, E, Bastardo, B & Gonzalez, E (1996) Early response to the effect of iron fortification in the Venezuelan population. American Journal of Clinical Nutrition 64, 903–907.CrossRefGoogle Scholar
Li, R, Chen, X, Yan, H, Deurenberg, P, Garby, L & Hautvast, JGAJ (1994) Functional consequences of iron supplementation in iron-deficient female cotton mill workers in Beijing, China. American Journal of Clinical Nutrition 59, 908–913.CrossRefGoogle ScholarPubMed
Looker, AC, Dallman, PR, Carroll, MD, Gunter, EW & Johnson, CL (1997) Prevalence of iron deficiency in the United States. Journal of the American Medical Association 277, 973–976.CrossRefGoogle ScholarPubMed
Lozoff, B, Jimenez, E & Wolf, AW (1991) Long-term developmental outcome of infants with iron deficiency. New England Journal of Medicine 325, 687–694.CrossRefGoogle ScholarPubMed
Lozoff, B, Wolf, AW & Jimenez, E (1996) Iron deficiency anaemia and infant development: effect of extended oral iron therapy. Journal of Pediatrics 129, 382–389.CrossRefGoogle ScholarPubMed
Mira, M, Alperstein, G, Karr, M, Ranmuthugala, G, Causer, J, Niec, A & Lilburne, A-M (1996) Haem iron intake in 12–36 month old children depleted in iron: case-control study. British Medical Journal 312, 881–883.CrossRefGoogle ScholarPubMed
Nakazawa, M, Ohtsuka, R, Kawabe, T, Hongo, T, Inaoka, T, Akimichi, T & Suzuki, T (1996) Iron nutrition and anaemia in a malaria endemic environment: haematological investigation of the Gidra-speaking population in lowland Papua New Guinea. British Journal of Nutrition 76, 333–346.CrossRefGoogle Scholar
National Academy of Sciences (1990) Recommended dietary allowances, 10th ed. Nutrition Reviews 48, 28–30.Google Scholar
Nelson, M (1996) Anaemia in adolescent girls: effects on cognitive function and activity. Proceedings of the Nutrition Society 55, 359–367.CrossRefGoogle Scholar
Nelson, M, Bakalopu, F & Trivedi, A (1994) Iron deficiency anaemia and physical performance in adolescent girls from different ethnic backgrounds. British Journal of Nutrition 72, 427–433.CrossRefGoogle ScholarPubMed
Nelson, M, White, J & Rhodes, C (1993) Haemoglobin, ferritin and iron intakes of British children aged 12-14 years: a preliminary investigation. British Journal of Nutrition 70, 147–155.CrossRefGoogle Scholar
Pollitt, E (1993) Iron deficiency and cognitive function. Annual Review of Nutrition 13, 521–537.CrossRefGoogle ScholarPubMed
Pollitt, E (1997) Iron deficiency and educational deficiency. Nutrition Reviews 55, 133–141.CrossRefGoogle ScholarPubMed
Powers, HJ, Bates, CJ, Downes, R, Brubacher, D, Sutcliffe, V & Thurnhill, A (1988) Running performance in Gambian children: effects of water-soluble vitamins or iron. European Journal of Clinical Nutrition 42, 895–902.Google ScholarPubMed
Powers, HJ, Bates, CJ, Eccles, M, Brown, H & George, EE (1987) Bicycling performance in Gambian children: effects of supplementation of riboflavin or ascorbic acid. Human Nutrition: Clinical Nutrition 41C, 59–69.Google Scholar
Quinn, M (1996) Canadian programme reverses high anaemia incidence. Lancet 38, 394.CrossRefGoogle Scholar
Ridwan, E, Schultink, W, Dillon, D & Gross, R (1996) Effects of weekly iron supplementation on pregnant Indonesian women are similar to those of daily supplementation. American Journal of Clinical Nutrition 63, 884–890.CrossRefGoogle ScholarPubMed
Rosado, JL, Bourges, H & Saint-Matrin, B (1995) Vitamin and mineral deficiency in Mexico. A critical review of current information. Salud Publica de Mexico 37, 130–139.Google Scholar
Ruxton, CHS & Kirk, TR (1996) Relationships between social class, nutrient intake and dietary patterns in Edinburgh schoolchildren. International Journal of Food Sciences and Nutrition 47, 341–349.CrossRefGoogle ScholarPubMed
Scholl, TO & Hediger, ML (1994) Anemia and iron-deficiency anemia: compilation of data on pregnancy outcome. American Journal of Clinical Nutrition 59, Suppl. 2, 492S–501S.CrossRefGoogle ScholarPubMed
Scholl, TO, Hediger, ML, Fischer, RL & Shearer, JW (1992) Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study. American Journal of Clinical Nutrition 55, 985–988.CrossRefGoogle ScholarPubMed
Scholz, BD, Gross, R, Schultink, W & Sastroamidjojo, S (1997) Anaemia is associated with reduced productivity of women workers even in less-physically-strenuous tasks. British Journal of Nutrition 77, 47–57.CrossRefGoogle ScholarPubMed
Scrimshaw, NS (1991) Iron deficiency. Scientific American 265, 24–30.CrossRefGoogle ScholarPubMed
Seshadri, S & Gopaldas, T (1989) Impact of iron supplementation on cognitive functions in preschool and school-aged children: the Indian experience. American Journal of Clinical Nutrition 50, 675–686.CrossRefGoogle ScholarPubMed
Seymour, J (1996) Hungry for a new revolution. New Scientist 149, 32–37.Google Scholar
Shephard, RJ (1991) Somatic growth and physical performance in Canada. In Human Growth, Physical Fitness and Nutrition. Medicine and Sport Science, vol. 31, pp. 133–155 [Shephard, RJ and Parisková, J, editors]. Basel: Karger.Google Scholar
Skikne, BS, Flowers, CH & Cook, JD (1990) Serum transferrin receptor: a quantitative measure of tissue iron deficiency. Blood 75, 1870–1876.CrossRefGoogle ScholarPubMed
Steer, P, Alam, MA, Wadsworth, J & Welch, A (1995) Relation between maternal haemoglobin concentration and birth weight in different ethnic groups. British Medical Journal 310, 489–491.CrossRefGoogle ScholarPubMed
US, Preventive, Services, Task Force (1993) Routine iron supplementation during pregnancy. Journal of the American Medical Association 270, 2846–2848.Google Scholar
Van Poppel, G, Schneijder, P, Lowik, MRH, Schrivjer, J & Kok, FJ (1991) Nutritional status and food consumption in 10–11 year old Dutch boys (Dutch Nutrition Surveillance System). British Journal of Nutrition 66, 161–169.CrossRefGoogle ScholarPubMed
Vasanthi, G, Pawashe, AB, Sushie, H, Sujatha, T & Raman, L (1994) Iron nutritional status of adolescent girls from rural area and urban slum. Indian Pediatrics 31, 127–132.Google ScholarPubMed
Viteri, FE & Torun, B (1974) Anemia and physical work capacity. In Clinics in Hematology, vol. 3, pp. 609–626 [Garby, L, editor]. London: WB Saunders.Google Scholar
Viteri, FE, Alvares, E & Torun, B (1983) Prevention of iron deficiency anemia by means of iron fortification of sugar. In Nutrition Intervention Strategies in National Development, pp. 287–314 [Underwood, BA, editor]. New York: Academy Press.CrossRefGoogle Scholar
Vorster, HH, Venter, CS, Menssink, E, Van Staden, DA, Labadarios, D, Strydom, AJC, Silvis, N, Gericke, GJ & Walker, ARP (1994) Adequate nutritional status despite restricted dietary variety in adult rural Vendas. South African Journal of Clinical Nutrition 7, 3–16.Google Scholar
Walker, ARP & Arvidsson, UB (1953) Iron ‘overload’ in the South African Bantu. Transactions of the Royal Society of Tropical Medicine and Hygiene 47, 536–548.CrossRefGoogle ScholarPubMed
Walker, ARP, Walker, BF, Richardson, BD & Smit, PJ (1972) Running performances in South African Bantu children with schistosomiasis. Tropical and Geographical Medicine 24, 347–352.Google ScholarPubMed
Walker, ARP, Walker, BF & Labadarios, D (1994) The benefits of iron supplementation and prophylaxis in Africa. Nutrition Research 14, 513–521.CrossRefGoogle Scholar
Walker, ARP, Walker, BF & Walker, AJ (1992) Comparison of nutrient intakes of South African elderly rural Black women in 1969 and 1989. Journal of Human Nutrition and Dietetics 5, 169–177.CrossRefGoogle Scholar
Walker, ARP, Walker, BF & Walker, AJ (1993) Some biological characteristics of African black pupils who walk long distances attending school: a preliminary study. South African Journal of Food Science and Nutrition 5, 14–17.Google Scholar
Weight, LM, Jacobs, P & Noakes, TD (1992) Dietary iron deficiency and sports anaemia. British Journal of Nutrition 68, 253–260.CrossRefGoogle ScholarPubMed
Williams, MD & Wheby, MS (1992) Anemia in pregnancy. Medical Clinics of North America 76, 631–647.CrossRefGoogle ScholarPubMed
Woodcock, RW (1982) Woodcock Spanish Psycho-educational Battery. Allen, TX: DLM Teaching Resources.Google Scholar
Yip, R (1994) Iron deficiency: contemporary scientific issues and international programmatic approaches. Journal of Nutrition 124, 1479S–1490S.CrossRefGoogle ScholarPubMed
Yip, R (1996) Iron supplementation during pregnancy: is it effective? American Journal of Clinical Nutrition 63, 853–855.CrossRefGoogle ScholarPubMed
Zhang, Y, Kiel, DP, Kreger, BE, Cupples, LA, Ellison, C, Dorgan, JF, Schatzkin, A, Levy, D & Felson, DT (1997) Bone mass and the risk of breast cancer among postmenopausal women. New England Journal of Medicine 336, 611–617.CrossRefGoogle ScholarPubMed