 Factors affecting iron status

Introduction:

Iron is an essential mineral crucial for several vital functions in the human body, including oxygen
transport, energy production, and immune system regulation.1
The most typical anemia globally is iron deficiency anemia (IDA).
According to the World Health Organisation (WHO), about two billion people, or 25% of the world's pop
ulation, are anemic, and roughly half of them have IDA.2 Maintaining adequate iron status is crucial to
prevent the development of iron deficiency anemia and related health complications. 1

As a primary care physician, understanding the various factors influencing iron status is vital for
effectively diagnosing, treating, and managing patients with iron-related conditions. This comprehensive
guide aims to explore the key factors affecting iron status.

Factors
affecting iron
status

Diseases and Physiological

Dietary factors
disorders changes

Figure 1: Factors responsible for iron status

1. Dietary factors:
Dietary consumption is the body's main source of iron. Heme iron, which is present in animal-
based meals, and non-heme iron, which is present in plant-based foods, are the two forms of
dietary iron. Heme iron is more readily absorbed by people than non-heme iron sources, on
average, in their diets. Because they rely so heavily on non-heme sources of iron, vegetarians
and vegans may be more susceptible to an iron deficit.1
 Sources of heme iron: meat, poultry, and fish
 Sources of non-heme iron: cereals, pulses, vegetables, and fruits

Iron absorption is affected by its physical state, with nonheme iron being largely oxidized or
ferric. Enterocytes are more likely to absorb ferrous iron. Ferric iron precipitates at a pH greater
than 3, but the majority of it remains soluble at neutral pH. Before it can be absorbed in the
proximal small intestine, it must be solubilized and chelated in the stomach. Chelators can
increase or decrease iron absorption through solubility shown in figure 2.3 As a result, one of the
most important elements determining nonheme iron absorption is diet composition.
 ENHANCERS INHIBITORS
Vitamin C Calcium
(Ascorbic acid) Polyphenols
Animal tissues
Oxalic acid
(beef, meat,fish)
Phytic acid

Figure 2: enhancers and inhibitors of iron absorption.3

Several dietary components enhance iron absorption:

 Vitamin C: Ascorbic acid, commonly found in fruits and vegetables, promotes the
conversion of non-heme iron into a more absorbable form. Encouraging patients to
consume vitamin C-rich foods alongside iron sources can substantially boost iron
absorption.2

 Meat, Fish, and Poultry: Heme iron present in these animal-based foods not only
contributes directly to iron intake but also enhances the absorption of non-heme iron
from other dietary sources.1

 MFP Factor: Meat, fish, and poultry also contain a component known as the "Meat, Fish,
and Poultry Factor," which further improves the absorption of non-heme iron. 1

Certain dietary substances may inhibit iron absorption:

 Phytates: Present in grains, legumes, and some vegetables, phytates can bind to non-
heme iron, reducing its absorption. Soaking, fermenting, or sprouting these foods can
help mitigate the inhibitory effects of phytates.2

 Polyphenols: Found in tea, coffee, red wine, and many plant-based foods, polyphenols
can chelate with non-heme iron, hindering its absorption. Encouraging patients to
consume these beverages separately from iron-rich meals can minimize the impact on
iron absorption.2
  Calcium: High levels of calcium, often found in dairy products and supplements, can
interfere with non-heme iron absorption when consumed simultaneously. Advising
patients to take calcium supplements and iron-rich foods at different times can optimize
iron uptake.2

2. Diseases affecting iron levels:

Iron deficiency and iron-related disorders are prevalent health conditions that significantly
impact the overall well-being and quality of life of affected individuals
Health conditions affecting iron status can broadly be categorized into iron deficiency, iron
overload, and iron-regulation disorders. In this section, we will focus on some of the most
common and clinically relevant conditions related to iron homeostasis.

Inflammatory Disorders Chronic Kidney Disease

Chronic inflammatory conditions like Impaired erythropoiesis and
rheumatoid arthritis or inflammatory bowel increased hepcidin levels can result in iron-
disease can lead to iron sequestration and restricted erythropoiesis.4
functional iron deficiency.4

Diseases affecting iron

levels

Celiac Disease Gastric Bypass Surgery

Intestinal damage can lead to malabsorption of Alters the digestive process,
nutrients, including iron.4 potentially affecting iron absorption. 4

Figure 3: Overview of diseases affecting iron levels.4

Iron Requirements in Clinical Practice:

Iron is a critical element for maintaining human health, and its deficiency or excess can lead to
significant health problems. This section provides an overview of the importance of iron in various
cellular processes and the implications of iron imbalances on patient health.

Roles of iron in our body:

 As an essential component of hemoglobin and myoglobin, iron is responsible for oxygen

transport and utilization in cells.3
 Additionally, iron acts as a cofactor for enzymes involved in energy production, DNA synthesis,
and other vital biochemical reactions.3

Good dietary sources of iron:

 lean
 meats
 poultry
 fish
 legumes
 nuts
 seeds
 and fortified cereals
 Iron supplements may also be recommended by healthcare professionals in certain cases. 1,3

However, it is always advisable to consult with a healthcare provider before starting any new
supplements. It is important for women to meet their recommended daily iron intake to prevent iron
deficiency anemia, which can lead to fatigue, weakness, and impaired cognitive function.

Risk groups for iron deficiency:

Iron deficiency anemia can affect people of all ages and backgrounds, but certain groups are at a higher
risk due to specific factors. Some of the risk groups for iron deficiency anemia include:
Table 1: RISK GROUPS OF ANEMIA WITH THEIR DESCRIPTIONS.5

Risk groups Description

Women of childbearing age
Pregnant women
Infants and young children
People with gastrointestinal
disorders
Chronic blood loss
Women who menstruate have a higher risk of iron deficiency
anemia due to monthly blood loss during menstruation.
During pregnancy, a woman's body requires more iron to
support the growing fetus and increased blood volume.
Rapid growth during infancy and childhood can lead to
increased iron needs. Additionally, premature infants may be
at higher risk due to lower iron stores at birth.
Conditions that affect the gastrointestinal tract, such as celiac
disease, inflammatory bowel disease (IBD), or gastric bypass
surgery, can interfere with iron absorption.
Conditions like peptic ulcers, gastrointestinal tumors, or
regular use of nonsteroidal anti-inflammatory drugs (NSAIDs)
 can lead to chronic blood loss and subsequent iron deficiency.

Understanding the anaemia risk categories is essential for prompt diagnosis and treatment, avoiding
complications, and enhancing patients' general well-being. Regular screening, patient education, and
appropriate interventions, such as iron supplements, dietary changes, and management of underlying
illnesses, are all crucial steps that healthcare providers take to identify and treat anaemia in these
susceptible populations.

 RDA in reproductive age group women:

The Recommended Daily Allowance (RDA) is a set of guidelines established by various health
organizations and governments to provide recommendations on the intake of essential nutrients to
maintain optimal health and prevent nutritional deficiencies.

The Reproductive Age group in women encompasses the period when they are biologically capable of
conceiving and bearing children. It typically ranges from the onset of menstruation (puberty) to
menopause, usually between 12 to 51 years of age. This phase is of great importance for women's
health, family planning, and overall well-being, warranting specific attention and support to address
their unique reproductive needs and concerns.1,6

These recommendations can vary depending on age, gender, and life stage. For women in the
reproductive age group, the RDAs focus on meeting the specific nutrient needs during this critical phase.

Figure 4:Some essential nutrients that are particularly important for reproductive-age women.7

Folic Acid (Folate):

Iron: To prevent
Essential for fetal
anemia, especially
development and
during
reducing the risk of
menstruation and
birth defects during
pregnancy
pregnancy

Calcium: To support Vitamin D:

bone health and Important for
reduce the risk of calcium absorption
osteoporosis later and overall bone
in life health

It's essential for women in the reproductive age group to follow a balanced and varied diet that includes
a wide range of nutrients to support their overall health and well-being. Consulting with a healthcare
professional or registered dietitian can be helpful in determining specific nutrient needs and making
dietary choices that align with individual requirements.

The recommended daily allowance (RDA) for nutrients can vary depending on the specific age, individual
factors, and life stage within the reproductive age group for women 5. Here are some general RDAs for
certain nutrients that are particularly important during this phase:

 Iron: The RDA for iron is around 18 mg per day for women aged 19-50 years.8
 Folic Acid (Folate): The RDA for folic acid is 300 micrograms (mcg) per day for women aged 14-
50 years.7
 Calcium: The RDA for calcium is 1000 mg per day for women aged 19-50 years.7
 Vitamin D: The RDA for vitamin D is 600 International Units (IU) per day for women aged 19-70
years.

Please note that these RDAs are general guidelines, and individual nutrient needs may vary based on
factors such as activity level, health conditions, and specific dietary preferences. It is always advisable
for women in the reproductive age group to consult with healthcare professionals or registered
dietitians to determine their specific nutrient requirements and make appropriate dietary choices to
support their overall health and well-being.

 RDA for Pregnant and Lactating Women:

During pregnancy and lactation, a woman's body undergoes significant changes to support the growth
and development of her baby. These life stages require an increased intake of essential nutrients to
ensure both the mother's health and the proper nourishment of the developing fetus or the breastfeed
infant.9

 The RDA for pregnant and lactating women provides guidance on the optimal intake of essential
nutrients such as vitamins, minerals, proteins, and fats. It takes into consideration the additional
demands placed on a woman's body during pregnancy and lactation, aiming to support fetal
growth, maternal health, and the production of breast milk.9
 Pregnant and lactating women are encouraged to obtain these nutrients primarily through a
well-balanced diet that includes a variety of nutrient-rich foods.9
 However, meeting all the increased nutritional needs through diet alone can sometimes be
challenging, especially for certain nutrients. In such cases, healthcare providers may recommend
prenatal or postnatal supplements to ensure adequate nutrient intake.
Table 2:RDA of various vitamins and minerals.9

Component RDAs for pregnant women RDAs for lactating women

Iron 27 mg/day 9-10 mg/day
Folate 600-800 mcg/day 500 mcg/day
Calcium 1000 mg/day 1000 mg/day
Vitamin d 600 IU/day 600 IU/day
Iodine 220-290 mcg/day 220-290 mcg/day
In conclusion, the RDA for pregnant and lactating women provides essential guidance for meeting
increased nutritional needs during these important life stages. Following these recommendations can
help support the health and well-being of both the mother and her developing child, contributing to a
healthy pregnancy and successful lactation period.

 RDA in postmenopausal women:

 Postmenopause is the period after a woman has gone through menopause, which is
typically defined as having no menstrual periods for 12 consecutive months.10
 During the postmenopausal stage, which follows menopause, women experience significant
hormonal changes that can impact their health and nutritional needs.
 The Recommended Daily Allowance (RDA) for nutrients becomes crucial to support their
overall well-being during this life phase.
 Postmenopausal women require specific nutrients to maintain bone health, heart health,
and overall vitality.10

Understanding and meeting these RDAs play a vital role in supporting the health and quality of life for
postmenopausal women. Recommended Dietary Allowance (RDA) of iron for postmenopausal
women is 8 milligrams (mg) per day.
Factors Affecting Iron Needs in Postmenopausal Women:

Several factors can influence the iron needs of postmenopausal women:

1. Menstrual Cessation: With menopause, women no longer experience monthly

menstrual bleeding, resulting in reduced iron losses. This decrease in blood loss often
translates to lower iron requirements compared to their premenopausal years.11
2. Age: As women age, the absorption of iron from the diet may decrease. This can further
impact the body's ability to maintain adequate iron levels.11
3. Health Status: Certain health conditions, such as gastrointestinal disorders, chronic
diseases, or blood disorders, can affect iron absorption, utilization, or loss, making
individual iron requirements variable.11
4. Physical Activity: Active lifestyles and regular exercise may influence iron needs,
especially if there is an increase in red blood cell turnover due to physical exertion.11

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