Irn and Irn Deficiency Irn and why we need it Irn is a mineral needed by ur bdies. Irn is a part f all cells and des many things in ur bdies. Fr example, irn (as part f the prtein hemglbin) carries xygen frm ur lungs thrughut ur bdies. Having t little hemglbin is called anemia. Irn als helps ur muscles stre and use xygen. Irn is a part f many enzymes and is used in many cell functins. Enzymes help ur bdies digest fds and als help with many ther imprtant reactins that ccur within ur bdies. When ur bdies dn't have enugh irn, many parts f ur bdies are affected. Irn deficiency and why it is a cncern Irn deficiency is a cnditin resulting frm t little irn in the bdy. Irn deficiency is the mst cmmn nutritinal deficiency and the leading cause f anemia. 1 The terms anemia, irn deficiency, and irn deficiency anemia ften are used interchangeably but equivalent. Irn deficiency ranges frm depleted irn stres withut functinal r health impairment t irn deficiency with anemia, which affects the functining f several rgan systems. 2 Irn deficiency is a cncern because it can: Irn deficiency can delay nrmal infant mtr functin (nrmal activity and mvement) r mental functin (nrmal thinking and prcessing skills). 3-6 Irn deficiency anemia during pregnancy can increase risk fr small r early (preterm) babies. 7-8 Small r early babies are mre likely t have health prblems r die in the first year f life than infants wh are brn full term and are nt small. Irn deficiency can cause fatigue that impairs the ability t d physical wrk in adults. 9-10 Irn deficiency may als affect memry r ther mental functin in teens. 11 Causes Of Irn Deficiency Irn deficiency has many causes. These causes fall int tw main categries: 1. Increased irn needs Many cmmn cnditins can cause peple t need additinal irn:
Because f their rapid grwth, infants and tddlers need mre irn than lder children. Smetimes it can be hard fr them t get enugh irn frm their nrmal diet. Wmen wh are pregnant have higher irn needs. T get enugh, mst wmen must take an irn supplement as recmmended by their healthcare prvider. When peple lse bld, they als lse irn. They need extra irn t replace what they have lst. Increased bld lss can ccur with heavy menstrual perids, frequent bld dnatin, as well as with sme stmach and intestinal cnditins (fd sensitivity, hkwrms.) 2. Decreased irn intake r absrptin (nt enugh irn taken int the bdy) The amunt f irn absrbed frm the diet depends n many factrs: Irn frm meat, pultry, and fish (i.e., heme irn) is absrbed tw t three times mre efficiently than irn frm plants (i.e., nn-heme irn). The amunt f irn absrbed frm plant fds (nn-heme irn) depends n the ther types f fds eaten at the same meal. Fds cntaining heme irn (meat, pultry, and fish) enhance irn absrptin frm fds that cntain nn-heme irn (e.g., frtified cereals, sme beans, and spinach). Fds cntaining vitamin C (see Dietary Surces f vitamin C) als enhance nnheme irn absrptin when eaten at the same meal. Substances (such as plyphenls, phytates, r calcium) that are part f sme fds r drinks such as tea, cffee, whle grains, legumes and milk r dairy prducts can decrease the amunt f nn-heme irn absrbed at a meal. Calcium can als decrease the amunt heme-irn absrbed at a meal. Hwever, fr healthy individuals wh cnsume a varied diet that cnfrms t the Dietary Guidelines fr Americans, the amunt f irn inhibitin frm these substances is usually nt f cncern. Vegetarian diets are lw in heme irn, but careful meal planning can help increase the amunt f irn absrbed. Sme ther factrs (such as taking antacids beynd the recmmended dse r medicine used t treat peptic ulcer disease and acid reflux) can reduce the amunt f acid in the stmach and the irn absrbed and cause irn deficiency.
Increased Irn Needs Rapid grwth Pregnancy Bld lss Heavy menstrual perids Frequent bld dnatin Decreased Irn Intake and Absrptin Lack f heme irn surces in the diet (e.g., vegetarian diets) Lw absrptin Taking antacids beynd the recmmended dse r medicine used t treat peptic ulcer disease and acid reflux can reduce the amunt f irn absrbed in the stmach. Sme stmach and intestinal cnditins (fd sensitivity, hkwrms) Peple at risk Yung children and pregnant wmen are at higher risk f irn deficiency because f rapid grwth and higher irn needs. Adlescent girls and wmen f childbearing age are at risk due t menstruatin. Amng children, irn deficiency is seen mst ften between six mnths and three years f age due t rapid grwth and inadequate intake f dietary irn. Infants and children at highest risk are the fllwing grups: Babies wh were brn early r small. Babies given cw's milk befre age 12 mnths. Breastfed babies wh after age 6 mnths are nt being given plain, irnfrtified cereals r anther gd surce f irn frm ther fds. Frmula-fed babies wh d nt get irn-frtified frmulas.
Children aged 1 5 years wh get mre than 24 unces f cw, gat, r symilk per day. Excess milk intake can decrease yur child's desire fr fd items with greater irn cntent, such as meat r irn frtified cereal. Children wh have special health needs, fr example, children with chrnic infectins r restricted diets. Signs and Symptms f Irn Deficiency T little irn can impair bdy functins, but mst physical signs and symptms d nt shw up unless irn deficiency anemia ccurs. Smene with early stages f irn deficiency may have n signs r symptms. This is why it is imprtant t screen fr t little irn amng high risk grups. Signs f irn deficiency anemia include 12 Feeling tired and weak Decreased wrk and schl perfrmance Slw cgnitive and scial develpment during childhd Difficulty maintaining bdy temperature Decreased immune functin, which increases susceptibility t infectin Glssitis (an inflamed tngue) Detectin f irn deficiency detected Yur dctr r healthcare prvider will d bld tests t screen fr irn deficiency. N single test is used t diagnse irn deficiency. The mst cmmn tests fr screening are Hemglbin test (a test that measures hemglbin which is a prtein in the bld that carries xygen) Hematcrit test (the percentage f red bld cells in yur bld by vlume) These tests shw hw much irn is in yur bdy. Hemglbin and hematcrit levels usually aren't decreased until the later stages f irn deficiency, i.e., anemia. Smetimes ther bld tests are used t cnfirm that anemia is due t irn deficiency. These might include Cmplete bld cunt (t lk at the number and vlume f the red bld cells)
Serum ferritin (a measure f a stred frm f irn) Serum irn (a measure f the irn in yur bld) Transferrin saturatin (a measure f the transprted frm f irn) Transferrin receptr (a measure f increased red bld cell prductin) Treatment f irn deficiency If yu are fund t have an irn deficiency, it is imprtant t see yur healthcare prvider fr treatment. Yur treatment will depend n factrs such as yur age, health, and cause f irn deficiency. If yur dctr r health care prvider thinks that yu have irn deficiency she r he may prescribe irn supplements fr yu t take and then ask that yu return after a perid t have yur hemglbin r hematcrit tested. If yur healthcare prvider determines that the irn deficiency is due t a diet lw in irn, yu might be tld t eat mre irn-rich fds. Yur health care prvider may als prescribe an irn supplement fr yu. Again, it is imprtant t be diagnsed by yur healthcare prvider because irn deficiency can have causes that aren't related t yur diet. Yur healthcare prvider's recmmendatins will be specific t yur needs. Preventin f irn deficiency In general, yu can eat a healthful diet that includes gd surces f irn. A healthful diet includes fruits, vegetables, whle grains, fat free r nnfat milk and milk prducts, lean meats, fish, dry beans, eggs, nuts, and is lw in saturated fat, trans fats, chlesterl, salt, and added sugars. In additin t a healthful diet that includes gd surces f irn, yu can als eat fds that help yur bdy absrb irn better. Fr example, yu can eat a fruit r vegetable that is a gd surce f vitamin C with a fd r meal that cntains nn-heme irn. Vitamin C helps yur bdy absrb the nn-heme irn fds yu eat, especially when the fd cntaining nn-heme irn and the vitamin-c rich fd are eaten at the same meal.
The fllwing recmmendatins are fr specific grups wh are at greater risk fr irn deficiency. Babies If pssible, breastfeed yur baby fr at least 12 mnths and starting at 4 t 6 mnths f age, give yur baby plain, irn-frtified infant cereal and/r pureed meat. Just tw r mre servings a day can meet a baby's irn needs at this age. Meats shuld be hme prepared r cmmercially prepared plain pureed (chpped until smth in a blender) meats. When yur baby is abut 6 mnths f age, include a feeding per day f fds rich in vitamin C with fds that are rich in nn-heme irn t imprve irn absrptin. If yu can't breastfeed, use irn-frtified frmula. Dn't give lw-irn milks (e.g. cw's milk, gat's milk, and sy milk) until yur baby is at least 12 mnths ld. If yur baby was brn early r small, talk t yur dctr abut giving irn drps t yur baby. If yur baby can't get tw r mre servings per day f irn rich fds (such as irnfrtified cereal r pureed meats), talk t yur dctr abut giving irn drps t yur baby. Yung children (aged 1 5 years) After yur child is ne year ld, give n mre than three 8 unce servings f whle cw, gat, r sy milk per day. After yur child is 2 years ld, lw fat r nnfat milks shuld be used in place f whle milks. Vitamin D-frtified milk is a gd surce f calcium and vitamin D, but nt irn. Give yur child a diet with irn-rich fds such as irn-frtified breads and irnfrtified cereals and lean meats. Include fruits, vegetables r juices that are rich in vitamin C. Vitamin C helps yur child absrb nn-heme irn especially when the fd that is a surce f nn-heme irn and the vitamin C-rich fd are eaten at the same meal. Adlescent girls and wmen f childbearing age
Eat irn-rich fds.. Eat fds that are vitamin C surces. Vitamin C helps yur bdy absrb nn-heme irn especially when the fd that is a surce f nn-heme irn and the vitamin C-rich fd are eaten at the same meal. Eat lean red meats, pultry, and fish. The irn in these fds is easier fr yur bdy t absrb than the irn in plant fds. Pregnant wmen Eat irn-rich fds. Eat fds that are vitamin C surces. Vitamin C helps yur bdy absrb nn-heme irn especially when the fd that is a surce f nn-heme irn and the vitamin-c rich fd are eaten at the same meal. Eat lean red meats, pultry, and fish. The irn in these fds is easier fr yur bdy t absrb than the irn in plant fds. Talk t yur dctr abut taking an irn supplement. Recmmended Dietary Allwance (RDA) fr irn If yu have already been diagnsed with irn deficiency, talk t yur dctr r healthcare prvider abut treatment. Fr healthy individuals, the Recmmended Dietary Allwance (RDA) fr irn is listed in the fllwing table.
References 1. Centers fr Disease Cntrl and Preventin. Irn deficiency United States, 1999 2000.MMWR 2002;51:897 899. 2. Akman M, Cebeci D, Okur V, Angin H, Abali O, Akman AC. The effects f irn deficiency n infants' develpmental test perfrmance. Acta Paediatr. 2004 Oct;93(10):1391 6. 3. Friel JK, Aziz K, Andrews WL, Harding SV, Curage ML, Adams RJ. A duble-masked, randmized cntrl trial f irn supplementatin in early infancy in healthy term breast-fed infants. J Pediatr. 2003 Nv;143(5):582 6. 4. Lzff B, De Andraca I, Castill M, Smith JB, Walter T, Pin P. Behaviral and develpmental effects f preventing irn-deficiency anemia in healthy full-term infants. Pediatrics. 2003 Oct;112(4):846 54.
5. Grantham-McGregr S, Ani C. A review f studies n the effect f irn deficiency n cgnitive develpment in children. J Nutr. 2001 Feb;131(2S 2):649S 666S; discussin 666S 668S. 6. Rnnenberg AG, Wd RJ, Wang X, Xing H, Chen C, Chen D, Guang W, Huang A, Wang L, Xu X. Precnceptin hemglbin and ferritin cncentratins are assciated with pregnancy utcme in a prspective chrt f Chinese wmen. J Nutr. 2004 Oct;134(10):2586 91. 7. Schll TO, Hediger ML, Fischer RL, Shearer JW. Anemia vs irn deficiency: increased risk f preterm delivery in a prspective study. Am J Clin Nutr. 1992 May;55(5):985 8. 8. Brwnlie T 4th, Utermhlen V, Hintn PS, Haas JD. Tissue irn deficiency withut anemia impairs adaptatin in endurance capacity after aerbic training in previusly untrained wmen. Am J Clin Nutr. 2004 Mar;79(3):437 43. 9. Haas JD, Brwnlie T 4th. Irn deficiency and reduced wrk capacity: a critical review f the research t determine a causal relatinship. J Nutr. 2001 Feb;131(2S 2):676S 688S; discussin 688S 690S. 10. Bruner AB, Jffe A, Duggan AK, Casella JF, Brandt J. Randmised study f cgnitive effects f irn supplementatin in nn-anaemic irn-deficient adlescent girls. Lancet. 1996 Oct 12;348(9033):992 6. 11. US Natinal Library f Medicine, NIH. Irn deficiency anemia. http://www.nhlbi.nih.gv/health/dci/diseases/ida/ida_whatis.html 12. Office f Dietary Supplements, NIH. Dietary supplement fact sheet. Available nline:http://dietary-supplements.inf.nih.gv/factsheets/irn.asp 13. Dietary Guidelines fr Indians. A manual.natinal Institute f Nutritin, Hyderabad, A.P.