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Iron

Hertanto W Subagio

Sources
Heme iron - animal ( 30%) Non Heme iron - vegetable, legumes etc.

Internal cycle of iron

Absorption
Increase
Acid in stomach Heme iron High body demand Low body stores of iron Meat protein factors (MPF) - Vit C (converts ferri to ferro)

Decrease
- Phytic acid (dietary fibre) - Oxalic acid - Polyphenols (tea, coffee) - Full body stores of iron - Excess of other minerals (Zn, Mn,Ca) - Reduction in stomach acid - Antacid

iron status regulated through absorption

Transport
- Transferrin is a protein that transports iron in the blood

- When iron stores are adequate all iron binding sites are saturated
-Transferrin can be used as an indicator of overload or deficiency - Almost all cells in the body have transferrin receptor (TfR)

- Serum soluble Tfr (sTfR) is a good indicator of deficiency.

Sintesis Hemoglobin

Storage
Ferritin is the primary store of iron Iron not taken up by transferrin is stored as ferritin in the intestinal wall (short term store) also stored in the liver and spleen as ferritin Hemosiderin is a stable iron-protein compound in the liver that stores iron when iron exceeds the storage capacity of ferritin.

Iron Losses
average iron loss of 1 mg / day in men and post menopausal women sweat and urine = negligible exfoliation of the skin and GIT

menstruation

Deficiency and excess


Deficiency
IDA high prevalence Reduced cognitive functioning Reduce capacity for physical work Increased maternal mortality Stages : normal- depletion of storage- IDE IDA.

Excess
Haemochromatosis genetic disorders Fe deposits cause cell damage in pancreas, liver and heart Leads to diabetes, liver and heart failure

Tahap deplesi besi dan indikatornya

Public health programs


supplementation

fortification
dietary modification food processing : reduce inhibitory factors education

Elements of successful iron supplementation programs


Fig.1. Elements of successful iron supplementation programs Policy making

Tablet Supply Adequate budget Data Base Ordering number In target group + 25% surplus Timely ordering Distribution System

Delivery System Accessible to Target group Motivated, WellTrained Approachable staff

Consumer demand Good Quality Supplements Communications To educate Public and Promote Program

Coverage Do intended Recipients get Supplements?

Compliance Do recipients take the supplements

Impact Reduction of Iron Deficiency anemia

Monitoring and Evaluation

Broek dan Lestky 2000


Among anemic pregnant women only 53% showed biochemical evidence of iron deficiency. That is the maximum proportion of people among whom anemia could be expected to respond to the administration of iron

Perubahan Hb selama kehamilan