Iron deficiency
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Understanding Iron Deficiency: Causes, Consequences, and Treatments
Global Prevalence and Impact of Iron Deficiency
Iron deficiency is a significant global health issue, affecting over 2 billion people worldwide, particularly in low-income and middle-income countries1 5. It is a leading cause of anemia, which impacts more than 1.2 billion individuals globally2. The condition is especially prevalent among children, premenopausal women, and the elderly1 6. Iron deficiency not only leads to anemia but also causes various clinical and functional impairments even in the absence of anemia1 4.
Causes of Iron Deficiency
Physiological and Dietary Factors
Iron deficiency can result from increased physiological demands, such as during childhood, adolescence, and pregnancy, or from inadequate dietary intake2 5. Populations consuming monotonous, plant-based diets often face nutritional iron deficiency due to low dietary iron bioavailability5. Additionally, chronic blood loss, defective iron absorption, and conditions like coeliac disease can contribute to iron deficiency2 9.
Inflammatory Conditions and Iron Regulation
Inflammation plays a crucial role in iron deficiency by causing the body to withhold iron from the plasma, primarily through the action of hepcidin, the main regulator of systemic iron homeostasis1 2. This mechanism can mask the diagnosis of iron deficiency in the presence of inflammatory conditions2.
Clinical Consequences of Iron Deficiency
Beyond Anemia
While anemia is the most recognized consequence of iron deficiency, the condition also affects various biochemical and physiological functions. Iron is essential for mitochondrial function, heme and iron-sulfur cluster biosynthesis, and the activity of numerous enzymes involved in DNA replication, repair, and cell cycle regulation4. Iron deficiency can lead to fatigue, lethargy, dyspnea, and impaired exercise capacity4. It also affects immune function, particularly T-cell immunity, and can result in poorer cognitive and motor skills, especially in children4 10.
Specific Populations at Risk
Children and adolescents are particularly vulnerable to the adverse effects of iron deficiency, which can lead to neurodevelopmental and cognitive deficits that may not be fully reversible even after treatment10. Pregnant women with iron deficiency face risks of poor pregnancy outcomes, and the elderly may experience worsened clinical outcomes in various medical conditions6.
Diagnosis and Treatment of Iron Deficiency
Diagnostic Measures
The diagnosis of iron deficiency is typically made by measuring hemoglobin and serum ferritin levels. In chronic inflammatory conditions, higher serum ferritin thresholds and evaluation of transferrin saturation may be necessary7. A low serum ferritin level is a reliable indicator of iron deficiency9 10.
Treatment Options
Oral iron therapy is the first line of treatment for most cases of iron deficiency1 2 10. However, the upregulation of hepcidin by oral iron supplementation can limit absorption efficiency, particularly during inflammation1. Modern parenteral iron formulations offer a rapid and safe alternative for total-dose iron replacement, especially in cases where oral iron is ineffective or contraindicated1 2 9.
Preventive Strategies
Preventive measures include targeted iron supplementation and iron fortification of foods, which have proven effective in controlling iron deficiency in populations5 10. Selective plant breeding and genetic engineering are emerging approaches to improve dietary iron nutritional quality5. Screening for iron deficiency, especially in high-risk groups, and dietary counseling are essential components of prevention10.
Conclusion
Iron deficiency remains a pervasive global health challenge with significant clinical and functional consequences. Early detection and appropriate treatment are crucial to mitigate the adverse effects of iron deficiency and prevent progression to anemia. Comprehensive strategies, including dietary interventions, supplementation, and fortification, are vital to address this widespread issue effectively.
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Most relevant research papers on this topic
Iron deficiency
Modern parenteral iron formulations enable rapid, safe total-dose iron replacement, improving treatment efficiency and addressing underlying causes in iron deficiency patients.
Rigorous Journal
Highly CitedIron deficiency.
Iron deficiency affects over 1.2 billion individuals worldwide, with IV iron being an effective and safe alternative for some conditions.
Highly CitedIron-deficiency anemia.
Iron-deficiency anemia is the most common form of anemia in the world, with a global prevalence of 1.1 million cases per year.
Rigorous JournalHighly CitedIron deficiency beyond erythropoiesis: should we be concerned?
Iron deficiency can lead to widespread cellular and physiological effects, highlighting the need for early detection and treatment to prevent non-erythropoietic effects and avoid progression to iron deficiency anemia.
Systematic ReviewHighly CitedNutritional iron deficiency
Targeted iron supplementation and fortification of foods can effectively control iron deficiency, with potential for improvement through selective plant breeding and genetic engineering.
Rigorous JournalHighly CitedIron deficiency anemia: a common and curable disease.
Iron deficiency anemia is a common and curable disease, but its prevention and treatment are inadequate worldwide, particularly among underprivileged women and children.
Highly CitedIron deficiency anaemia revisited
Early detection and management of iron deficiency anaemia can improve clinical outcomes in various medical conditions.
Highly CitedIron deficiency: A concise review
Iron deficiency is a major worldwide health problem, with anemia being only the last manifestation and symptoms occurring before anemia is manifest.
Literature ReviewHighly CitedIron Deficiency Anemia.
Iron deficiency is a common cause of anemia, with symptoms including fatigue, hair loss, and restless legs.
Highly CitedIron deficiency anemia: An updated review.
Oral iron therapy is the first-line treatment for iron deficiency anemia in children, with optimal response achieved with a combination of ferrous preparations and iron supplementation.
Systematic Review