The truth is, iron deficiency has significant impact on every aspect of a person's life.
Anemia remains a major global public health problem with nearly 2.3 billion people suffering from it—with an estimated 50% due to IDA8. It continues to be one of the most pressing health issues in Asia.
The greatest number of children and women with anemia resided in the South-east Asian region, including 96.7 million children and 202 million women of reproductive age in 2011. The prevalence of anemia was 41.5% for non-pregnant women and 48.7% for pregnant women in this region.a
It is important to note that Iron Deficiency Anemia (IDA) affects an individual’s quality of life in several aspects including economic and physical. In fact, IDA is the leading cause of DALYs (Disability Adjusted Life Years), a measure of overall disease burden and cumulative years lost due to illness/disability/death, and YLDs (Years of life lived with Disability).b
According to the American Society of Hematology: A systematic analysis of global anemia burden from 1990 to 2010, anemia was responsible for 68.3 million YLD (8.8% of global total), more than major depression, chronic respiratory diseases and the totality of injuries. Total anemia YLD increased in all ages between 1990 and 2010.c
Iron deficiency plays a critical role in the overall experience of life.
IRON AND ECONOMIC IMPACT (PRODUCTIVITY & COGNITION)
To begin with, iron has a strong relationship with productivity and cognition, which in turn impacts the economic aspect of an individual.
Anemia is a health condition where there is an insufficient amount of healthy red blood cells or hemoglobin in the body. One of its most common types is IDA—an anemia caused by the lack of iron. Iron helps make red blood cells that transport oxygen around the body. IDA and iron deficiency impact a person’s blood's oxygen carrying capacity, which affects energy production, work capacity, and cognitive development.
PRODUCTIVITY & PHYSICAL PERFORMANCE
IDA can affect the type of work and task that individuals can perform and impact the time spent on work and their income. For instance, because of reduced iron stores in the body, those afflicted with IDA tend to be less productive at work. They experience fatigue and tend to get easily tired.
Iron deficiency and anemia are associated with increased fatigue, poorer exercise performance and lower work productivity.9 10 11 12 Due to IDA, oxygen transport in the body is limited and lowers the energy of an individual. When one feels sluggish and weak, it may not be a simple case of “burnout.” It is important to have the iron levels checked to address this state of lethargy.
Thankfully, there are studies and evidences suggesting that iron replacement can improve fatigue scores and physical performance.13
As presented by Dr. Michael Low, a haematologist at the Monash Medical Centre in Victoria, Australia, anemia is associated with poorer cognitive development. The more severe the anemia, the worse the outcome.
IDA impairs an individual’s cognition—an ability that’s related and intertwined with IQ (intelligence quotient). Cognition and cognitive development are important in remembering, problem solving, and decision-making which are all essential in being effective at one’s tasks.
The 2007 Strenze T. Intelligence and 2007 Zagorsky JL Intelligence statistics showed that cognitive scores correlate with income. Though the study does not suggest a link between cognition/IQ scores and wealth, it showed that income and IQ are still related. IQ is associated with improved income, education and occupation.
Dr. Low states that replacement of iron in individuals with iron deficiency can improve cognitive outcomes in 5-12 years old, particularly in those who are anemic, and should be instituted in a timely manner. Early intervention is key.
IRON AND MATERNAL NUTRITION
One of the established facts in the medical field is that women of reproductive age require twice the amount of iron. This increases to more than three times in pregnancy. During pregnancy, iron needs are so high that iron supplementation is recommended especially during the 2nd and 3rd trimester when the baby’s iron stores are being built.
However, the world is dealing with a massive challenge when it comes to maternal nutrition.
Iron deficiency anemia is linked to increased maternal morbidity and mortality. Maternal iron deficiency is associated with reduced iron stores in fetus, intrauterine growth retardation, prematurity and low birth weight. IDA is also linked to growth stunting and impacts a child's cognitive development.*
Maternal and child anemia is primarily caused by iron deficiency. The underlying causes include inadequate access to nutrient-rich diets and intake of mothers and children, inadequate maternal and childcare practices, and inadequate use of curative and preventive health services.
Chronic iron deficiency and anemia in children also lead to neurodevelopmental consequences such as risks in developing brain structures, neurotransmitter systems and myelination. Apart from that, they are also in danger of cognitive function impairment which affects memory, attention span, intelligence and school performance.
Moreover, anemia in children leads to decrease in bone density and distortion of bones, hepatosplenomegaly, possible pubertal delay and altered cardiac function. Iron deficiency has a negative impact on a child’s cognition, behavior and motor skills that can have long-term negative implications.6 All of these show that anemia and IDA are serious health threats that require immediate attention from prenatal care all the way to child care.
Taking account of these health concerns, Dr. Bhutta shared some interventions across the lifecycle which can help address the situation. He recommended the following interventions that would help address anemia in pregnant women: preconception care, folic acid supplementation, multiple micronutrient supplementation, calcium supplementation and balanced energy supplementation among pregnant women.14
Overall, the alarming global statistics on IDA, especially during pregnancy and in children, is an eye-opener. It calls for stronger awareness and education, for both the health care providers and the patients, on the importance of iron supplementation and the dangers of anemia.
* Abu-Ouf NM, Jan MM. The impact of maternal iron deficiency and iron deficiency anemia on child's health. Saudi Med J. 2015;36(2):146-149. doi:10.15537/smj.2015.2.10289
a WHO. The global prevalence of anaemia in 2011. Geneva: World Health Organization; 2015.
b JAMA Pediatr. 2016 March ; 170(3): 267–287. doi:10.1001/jamapediatrics.2015.4276.
c Nicholas J. Kassebaum, Rashmi Jasrasaria, Mohsen Naghavi et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014 Jan 30; 123(5): 615–624.
9 Micronutrient deficiencies. Iron Deficiency Anemia. World Health Organization website. https://www.who.int/nutrition/topics/ida/en/
10 Haas, Jere D. et.al. Iron Deficiency and Reduced Work Capacity: A critical review of the research to determine a causal relationship. ©2001 American Society for Nutritional Sciences
11 Low, MSY et al. Daily iron supplementation for improving anaemia, iron status and health in menstruating women (Review) ii Copyright © 2016 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.
12 Scholz, Barbara et al. Anaemia is associated with reduced productivity of women workers even in less-physically-strenuous tasks. British Journal of Nutrition (1997), 77, 47-57
13 Vaucher P. et al. Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. CMAJ. 2012 Aug 7;184(11):1247-54.
14 Bhutta, Zulfiqar, et al. Maternal and Child Nutrition2. Lancet 2013; 382:452-77