Sunday, September 27, 2015

Epidemiology

According to the CDC, the tables below show the prevalence of iron deficiency anemia in the U.S. from 1988 to 2000.
Table 1

Table 2
"Iron Deficiency Anemia," by Anthony Lopez et al., published in The Lancet, found on PubMed, confirms these findings from the CDC.  The article agrees that child bearing age women and young children/toddlers are the most at risk for iron deficiency anemia. 


The charts show that the populations most at risk for iron deficiency anemia are toddlers (1-2 yo) and females of child bearing age (12-49).  Iron deficiency anemia is two times higher among non-Hispanic black and Mexican-American females than white women (Iron).  





Table 1.
Prevalence of anaemia, iron deficiency, and iron deficiency anaemia
Prevalence (%)
Anaemia
General population2032·9
Men (15–60 years)2112·7
School-age children (>5 years)2125·4
Elderly (>60 years)2123·9
Preschool children (0–5 years)2243·0
Non-pregnant women and girls (15–49 years)2229·0
Pregnant women and girls (15–49 years)2238·0
Iron deficiency
Children (<2 years)239·0
Children (3–5 years)244·5
Adolescent girls (12–19 years)2415·6
Women (20–49 years)2415·7
Pregnant women and girls (12–59 years)2518·0
Iron deficiency anaemia
General population2612·2
Hospital-based population2723·0

"Between 1995 and 2011, worldwide prevalence of anemia decreased by 4–5% in children aged 0–5 years, non-pregnant women, and pregnant women aged 15–49 years" the article reported (Lopez et al).
The United States has the lowest percentage of cases of iron deficiency anemia worldwide.  It is much more common in third world countries. Specifically central and south Asia and andean South America have high percentages of this disease world wide (Lopez et al).
Search Terms: iron deficiency anemia epidemiology
Works Cited:
Iron Deficiency--United States, 1999-2000. (2002, October 11). Retrieved September 28, 2015, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5140a1.htm

Lopez, A ., et al., (2015, August 24). Iron Deficiency Anemia. Retrieved September 28, 2015, from http://www.sciencedirect.com/science/article/pii/S0140673615608650.

Sunday, September 13, 2015

Define the Disease

Iron deficiency anemia is "when body stores of iron drop too low to support normal red blood cell (RBC) production" (Harper).  It is "the most prevalent single deficiency state on a worldwide basis" (Harper).  This could occur as a result of "inadequate dietary iron, impaired iron absorption, bleeding, or loss of body iron in the urine" (Harper).

Iron is important for the body because it helps complete metabolic processes like "oxygen transport, DNA synthesis, and electron transport" (Harper).  There are three separate pathways for iron uptake in the small intestine which include a "heme pathway and 2 distinct pathways for ferric and ferrous iron" (Harper).  The absorption of heme and non-heme iron is noncompetitive.  In healthy bodies, iron absorption is regulated by absorptive cells in the small intestine that balance the amount of iron absorbed with the amount of iron lost.  However, when either the body begins to lose iron too quickly or doesn't take in enough digestible iron, this balance can be offset, causing iron deficiency anemia (Harper).

One of the most common reasons for a lack of iron in the diet of people with iron deficiency anemia is limited access to meat (Harper).  Another common reason is hemorrhage, where a person loses a significant amount of blood suddenly.  The body responds by activating the bone marrow to create new hemoglobin to replace the lost blood, thus depleting the iron supply in the body. Other causes include hemosiderinuria, hemoglobinuria, and pulmonary hemosiderosis, all different forms of blood in the urine. Additionally, eating starch or clay, extensive surgery on the small bowel, and disease (like celiac disease) can all contribute to the development of iron deficiency anemia (Harper).

Generally, anemia is more common in areas with diets low in meat.  These places all have a higher amount of intestinal parasites, like hookworms, that result in GI tract blood loss.  In countries like the U.S., where this is less of a problem, the main demographics affected are pregnant women and people that have suffered from hemorrhage.  In general, children and particularly infants (especially those on cow milk diets instead of breastmilk) are at a higher risk to develop iron deficiency anemia.  Between men and women, women are much more at risk to develop anemia.  During pregnancy, a woman loses 500 mg of iron.  During each menstruation cycle, a woman can lose 4-100 g of iron.  In comparison, men only lose 1 mg per day during natural losses like sloughing epithelia and secretions from the skin.  Because of women's extra losses, and the fact that they eat less than men, their bodies need to be nearly twice as effective at absorbing iron than men's systems.  This makes it very important to recognize when women are becoming anemic, especially during pregnancy and during early development.  Race has little affect on the appearance of iron deficiency anemia demographically (Harper).

The symptoms of iron deficiency anemia include fatigue, leg cramps, and general lack of strength.  In children, it can lead to slower growth and development.  Although not life threatening in itself, if left untreated, it can lead to the development of pulmonary and cardiovascular disorders that can be life threatening (Harper).

Iron deficiency anemia is easily treated with iron dietary supplements and diet changes.  Some options may be prescribed to treat the causes of the anemia as well, like oral contraceptives to lighten menstruation flow, antibiotics to treat ulcers, or surgery to fix bleeding (especially in GI tract) (Clinic).  Iron deficiency anemia can be prevented by eating iron rich foods, like red meat, beans, and dark leafy vegetables.  It also helps to eat foods rich in Vitamin C, which increases iron absorption, like oranges, broccoli, and kiwi.  Finally, breast feeding infants or feeding them iron fortified formula is the best way to avoid anemia (Clinic).


Works Cited:

Harper, J. (n.d.). Iron Deficiency Anemia. Retrieved September 14, 2015.
http://emedicine.medscape.com/article/202333-overview#a7

Clinic, M. (n.d.). Iron deficiency anemia. Retrieved September 14, 2015, from http://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/basics/treatment/con-20019327