Iron deficiency in the body causes many problems, usually in a slow and surreptitious manner. It is the most important cause of nutritional anemia in all age-groups and also affects the mental development of growing children. It is important to be aware of the dangers of this very common and very easily preventable health problem affecting not only children but their parents as well.
Why is iron important for the body?
Ø Iron is important for hemoglobin production in the body. Hemoglobin is a pigment in the red blood cells, which carries the all-essential oxygen to tissues and carries away the harmful carbon dioxide produced during the metabolism. In case of iron deficiency, hemoglobin content of red blood cells starts dropping and as a result oxygen carrying capacity of the blood decreases leading to dysfunction of various tissues. Ø Monoamine oxidase (MAO) is an iron-dependent enzyme that is crucial for functioning of the nervous system. Ø Iron also plays a role in immunity against infections. What is the daily requirement of iron?The total body iron content in a newborn baby is 0.5 gm whereas that in an adult is 5gm. To make up this discrepancy, the body needs around 10-15 mg of iron per day in the growing years. Adults require around 30 mg of iron per day – females needing slightly more than males as they are regularly losing iron during menstruation. Which are the iron-rich foods?
Iron in diet is available in two forms – heme and non-heme. The ‘heme iron’ is available through animal sources whereas ‘non-heme’ iron is available through plant sources. Meat (especially red meat), fish, green leafy vegetables (e.g. spinach, fenugreek), dried dates and pulses are rich dietary sources of iron. Ragi and baajra are the cereals with high iron content. Jaggery – a sugar substitute commonly used in Indian subcontinent is another excellent source as it is prepared in iron vessels. What are the causes of iron deficiency?
Ø Inadequate nutritional intake is the most common cause of iron deficiency. Over-reliance on milk feeding and poor weaning pattern (inadequate solid foods) are mostly responsible for this. Fussy eating habits and poor dietary selection (‘Junk’ foods) are other contributory factors. Ø Decreased absorption of iron -either due to interference of certain food items like tea (Tannin) and cheese or due to some malabsorption disorders- can also cause deficiency. Ø Chronic blood loss -through worm infestation (hookworms), peptic ulcer, piles or heavy menstruation (in adolescent and adult females) - is often the responsible factor. At what age is it common?
Till six months, babies usually don’t develop iron deficiency as iron stores passed on to them across the uterus prevent this from happening. Later in infancy and throughout the toddler years (from 8th month onwards up to 2nd or 3rd year), the risk of deficiency is maximum- as the stores are progressively depleted to satisfy growing body’s increasing requirement of iron. In adolescent girls after onset of menstruation the iron requirements go up and they are also at an increased risk for iron deficiency. Later on, pregnancy and lactation places the females in the ‘at risk’ category. What is the role of milk feeding in this deficiency?Breast milk- although not high in iron content- contains iron that is absorbed easily and thus helps to prevent iron deficiency in early months. After six months, breast milk alone is not sufficient to take care of iron requirement. Cow’s milk contains iron in less than required concentration and in addition, that iron is more difficult to absorb and assimilate. Another important problem caused by cow’s milk is of chronic occult (hidden) blood loss through stools in many babies. Exclusive or predominant milk feeding- both breast feeding as well as cow’s milk feeding- beyond six months of age keeps the babies away from semi-solid and solid foods, which are rich in iron content. Such ‘Milk babies’ may look healthy in terms of weight but they usually suffer from iron deficiency. How iron deficiency is manifested?
Iron deficiency is manifested by anemia. Anemia means decrease in the oxygen carrying capacity of blood, usually synonymous with decrease in hemoglobin level in blood and iron deficiency is just one of its many causes. Pallor or paleness of skin, conjuctiva and nail-beds is most important sign. It develops gradually, so rather than family members, it is more likely to be noticed by a person who is seeing the child after a long time. Not eating well, pica (eating unusual things like mud on the floor or paint on the wall), irritability, tiredness, lethargy, palpitations and shortness of breath are other warning signals. In severe cases, heart failure can also occur. What is the effect of iron on mental development?A number of studies have pointed out that even when not causing anemia, iron deficiency can have significant negative effects on intellectual development. Decreased alertness, less attention span, delayed speech and learning defects have been observed in iron deficient toddlers and these effects often persist into later years- sometimes even after proper treatment. What lab tests are necessary in this condition?Blood tests to check the hemoglobin and the blood film are usually sufficient to diagnose the problem. Lower than age and sex-specific hemoglobin level and a blood film depicting small, faint-coloured and irregularly shaped red cells are clues to this condition. Occasionally more tests are necessary to differentiate other conditions that can cause similar blood picture. Stool examination to rule out worm infestation or hidden blood loss is also important to detect the cause of deficiency. How is iron deficiency corrected?
Most of the cases are managed by oral iron supplements in proper dose. Vitamin C, which improves iron absorption, is often given as an adjuvant. The therapy is continued for a minimum of three months and preferably for six months to ensure adequate build-up of body stores. Parenteral (IV/ IM) iron injections are necessary only when oral iron therapy is not possible either because of gastric irritation or when the patient/parent compliance is not reliable. These injections do not correct the deficiency more rapidly than oral preparations. In very severe cases of anemia, blood transfusions are necessary in the form of packed red blood cells. How to prevent this problem?
Awareness, less reliance on milk feeds, early weaning with iron-rich foods and regular de-worming are the steps to prevent this important health problem.
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Beware of Iron deficiency
