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Prevent Iron Deficiency

by Dr. Mandar V. Bichu
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Iron deficiency causes many problems, usually in a slow and silent manner. It is a very common and easily preventable health problem affecting not only children but their parents as well.

Why is iron important for the body?

  • 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 in red blood cells starts dropping and as a result oxygen carrying capacity of the blood decreases leading to problems in different body systems.

  • An iron-dependent enzyme called Monoamine oxidase (MAO) is crucial for functioning of the nervous system.
  • 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 containing hemoglobin from meat, fish and poultry; whereas ‘non-heme’ iron is available through plant sources. 85-90% of iron intake is from Non-heme sources and 10-15% from Heme sources. Heme iron is the best absorbed up to 40% but Non-heme iron absorption is less efficient.

Red meats like beef, pork and lamb; organ meats like liver; Fish especially salmon, tuna, haddock, halibut and perch; and shell-fish like mussels, clams and oysters are good Heme iron sources.

Non-Heme plant-based iron sources come from Fortified cereals; Grains like Rice, wheat, oats, raagi and baajra; green leafy vegetables like spinach, kale and fenugreek; dried fruits such as dates, apricots and raisins; and beans like lentils and soybeans. 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?

  1. Inadequate intake through food:

It is the most common cause of iron deficiency. This happens when there is:

  • Over-reliance on milk feeding  
  • Poor weaning pattern (inadequate solid foods)
  • Fussy eating habits
  • Poor dietary selection (‘Junk’ foods)
  1. Decreased absorption of iron
  • This could happen when certain food items like tea (Tannin) and cheese interfere with iron absorption.
  • It could also happen in some malabsorption disorders.
  1. Chronic blood loss  
  • Long-standing loss of blood through worm infestation (hookworms), peptic ulcer, piles or heavy menstruation (in adolescent and adult females).

At what age is it common?

  • For the first 6 months, babies usually don’t develop iron deficiency as iron stores passed on to them from mother prevent this from happening.
  • From around 8th month to 3 years of age, the risk of iron deficiency is maximum- as the body-stores are progressively depleted to satisfy growing body’s increasing iron needs.
  • 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 less iron and in addition, that iron is more difficult to absorb.  Sometimes cow’s milk can also cause chronic occult (hidden) blood loss through stools in many babies.

Exclusive or predominant milk feeding- (breast feeding, formula feeding or cow-milk feeding) – beyond the age of six months keeps the babies away from iron-rich semi-solid and solid foods.

Such ‘Milk babies’ may look chubby but they usually suffer from iron deficiency.

How iron deficiency is manifested?

Iron deficiency is manifested by anemia (decrease in the oxygen carrying capacity of blood) which is seen as decreased blood hemoglobin level. 

(* Note that iron deficiency is just one of many causes of anemia.)

Pallor or paleness of skin, conjunctiva 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 hemoglobin and microscopic blood picture are usually sufficient to diagnose the problem. Specialized blood check-ups are needed sometimes to rule out similar problems. 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.

Intravenous or intramuscular iron injections are necessary only when oral iron therapy is not possible either because of gastric irritation or when the treatment 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, proper introduction of iron-rich semisolid/solid foods, regular deworming and supplemental iron are the steps to prevent this important health problem.

Here is a Right Parenting Tips video on Iron Deficiency.

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