Iron Defieciency Anaemia-DAMBAR

8/3/2019 Iron Defieciency Anaemia-DAMBAR

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IRON DEFICIENCY ANAEMIA:

PROBLEM, CAUSE AND SOLUTION

By Dambar B. Khadka

EM Food science, Technology and Nutrition, KaHo sint- Lieven

Gent, Belgium



INTRODUCTION

Anaemia affects one-quarter of the world

population (Mclean, 2008)

Anaemia is defined as decrease in

concentration of circulating red blood cell (RBC)

or in haemoglobin concentration and related to

impaired capacity to transport oxygen (WHO

2004)



IRON DEFICIENCY ANAEMIA (IDA)

One of the major factor associated with the

global burden disease (WHO 2004)

Is a most prevalence Micronutrient deficiency

Major contributor for anaemia

Mostly deals with Iron deficient

Other contribution factor for anaemia: VitaminA, Vitamin B12 and Folic Acid deficiency



WHO CUT OFF VALUE FOR IRON DEFICIENCY

Iron store directly related to the haemoglobin and

Haematocrit concentration

Population

category Threshold

Haemoglobin

concentration Haematocrit

concentration Children 0.50 – 4.99

years 110 g/l 6.83 mmol/l

Pregnant Women 110 g/l 6.83 mmol/l Children 5-11.99 years 115 g/l 7.13 mmol/l Children 12-15 years 120 g/l 7.45 mmol/l Non Pregnant Women

>15 years 120 g/l 7.45 mmol/l

Men >15 years 130 g/l 8.07 mmol/l Source : WHO (2001)



RECOMMENDED IRON INTAKE



PREVALENCE IRON DEFICIENCY ANEMIA

Source: WHO 2004 update databaase

World wide 1.2 billion people is affected by IDA (WHO

Estimate 2004)



PREVALENCE OF ANAEMIA ( POPULATION SUB

GROUP)

Source: WHO 2008

Anaemia is commonly take as a indicator for

iron deficiency anaemia (WHO 2002)



PREVALENCE OF ANAEMIA

NEPAL

v



DISTRIBUTION AND STORAGE OF IRON

Hemoglobin

70%

Myoglobin

10%

Ferritin andHaemosiderin

17%

essential for transfer

oxygen via blood stream

from the lungs to tissue

Transport and stores

oxygen for use in muscle

contraction

Major iron storage compound mainly

located in liver, reticuloendothelial cells

and erthroid precursor

Iron containing enzyme & Transport iron 3% Cytochrome C – ETC and ATP production

Cytochrome P450- oxidative degradation

of foreign compound and endogenous

substrate

Other iron containing Enzymes

and iron dependent enzymes

Source: Dallman1986



IRON ABSORPTION AND REGULATION IN

BODY

Source: steele et al 2005



PROBLEMS ASSOCIATED WITH IDA

Reducing Working productivity

Reducing Cognitive, Intellectual capacity and

Behaviour

Reduce Immune system and resistant to

infection

Premature birth and low birth weight

Mortality in children and women

Others



PROBLEM ASSOCIATED WITH IDA

decrease the fitness and aerobic working

capacity (Beard 2001) reduced oxygen transport and respiratory

efficiency (ATP Formation)

normally accepted problems of IDA (Dallman1986).

Work productivity and performance



PROBLEMS ASSOCIATED

WITH IDA

In infants a lower PDI and MDI on short term

and long term observation

But no Improvement in most cases of

intervention trials in both short term andLong Term

Preschool and Adolescent

Improvement in most of

intervention Trials

Cognitive

and

Behaviour

loss

•Good association but still need to verify

• Iron deficiency decrease energy , O2

supply, can impaired myelination in CNS




Impaired cell mediated immune responses

-decreasing the capacity of netrophills

- impairment in T cell proliferation

No improvement on iron supplementation

-influence may be due to excess iron or

Multiple factors

Plausible evidence is not sufficient

Immune response and Resistance to pathogen



PROBLEMS ASSOCIATED WITH IDA

Risk factor for preterm delivery and low birth

weight and possibility to affects the neonatal

health

- e g.Women having Hb< 104g/l at 13-24 week of

gestation had a 1.18-1.75 times higher risk or preterm

birth and low birth weight ( Murphy et al., 1986)

Pregnancy Outcome




CFR in children higher (<50g/l) than children (>50g/L) for aspecific cases

CFR ranges 2-29%

No dose specific Hb and CFR Might be influence of other factor.(Brabin et al 2001a)

Child and Maternal Mortality

Brabin et al. 2001a & b ,

Maternal mortality, with 5% severe anaemia (Haemoglobin<70g/l), Estimated death

9 per 100,000 live birth due to severe-malarial-anaemia

41 due to non-malarial (mostly nutritional) anaemia relateddeath per 100,000 live birth.

(Brabin et al 2001b)




Most of the studies related with malarialanaemia and mortality

Most of data from developing country, malariaendemic area

Subjects are from hospital cases, containmore than one health problems

no clear relationship between IDA andmortality.

Limited on Iron Interventional trials

No solid conclusion up to now

Child and Maternal Mortality



WHO ESTMATED DEATH,2004

WHO Region Male Death per 100000

0-4 yr 5-14 yr Total

AFR 8.9 0.7 3.1

AMR 1.2 0.3 1.4EMR 6.5 0.3 1.4

EUR 1.8 0.1 0.7

SEAR 0.5 0.0 0.7

WPR 1.2 0.1 0.4YLL 836 641 207 960 2 274 179

WHO Region Female Death per 100000

0-4 yr 5-14 yr 15-29 yr 30-44 yr 45-59 yr Total

AFR 7.9 1.2 2.7 2.3 6.3 4.4

AMR 1.0 0.3 0.3 0.4 1.2 1.7

EMR 6.6 0.6 0.3 0.6 2.1 1.8

EUR 1.3 0.1 0.2 0.4 0.3 1.0

SEAR 0.6 0.2 0.8 3.9 9.1 3.0

WPR 1.3 0.1 0.1 0.4 0.5 0.7

YLL 777 073 267 182 381 939 621 482 1 102 982

3 578

453

Overall

Total

3.7

1.5

1.6

0.9

1.8

0.5

5 852 632

10 per

100,000




Heavy metal Absorption e.g. Lead poisoning

Economy loss for

o Intervention and treatment

o Disability or mortality (YLL AND DALY orQALY)

Others problems



ETIOLOGY AND CAUSES IDA

Physical factor

Life stage

Iron absorption

Iron loss

Health conditions

Genetics

Socio-cultural and

Demographic factor•Health Education, Family

•Region

•Culture

•Food habit and Taboos

•Poverty

Dietary factor

Low iron

Low vitamin C

Excess phyatate

Excess Tea/Cofee

Calcium rich diet

Fad diets

High

Risk

High

Risk High

Risk

VeryHigh

Risk



PREVENTION AND CONTROL

Development of Food based Preventive approach and implementation Dietary intervention & management according to RDA

Supplementation and fortification

Integration with local community based health and Nutritionprogram

Education to community worker and community people

In severe risk and complexes situations

Medical intervention

Therapeutic Food

Development of effective Surveillance system

simple and fast tool for assessing and monitoring of

programme and intervention



CONCLUDING REMARKS

one of the major micro nutrient deficiency Multifactor cause

Major risk group Children and women (menstutrating and pregnant)

affect working productivity and perforformance, growth

can also affect brain and behaviour development, pregnancy outcomes and

neonatal health Possibility of major cause of the anaemic mortality in children and maternal

woman

Food based approach along with integration of community programmeessential

Effective surveillance and monitoring needed Further research for true assessment of IDA and its impacts; with citing the

all the possible factor – helpful for strategy and intervention development



Question?



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Iron Defieciency Anaemia-DAMBAR