By Savanna Henderson, Humanitas Global
Iron deficiency is the most common micronutrient deficiency in the world, found in both the developing and developed world. The World Health Organization reports that over 30% of the world’s population is anemic, largely due to iron deficiency. Iron deficiency and anemia induce poor pregnancy outcomes, impaired physical and cognitive development, increased risk of morbidity in children and reduced work capacity through the causation of fatigue and lethargy. A reduced work capacity diminishes income, which can increase food insecurity and exacerbate micronutrient deficiencies. Beyond the scope of public health, entire communities and regions afflicted with anemia, unable to participate in the economy, can become serious obstacles to national development.
In spite of the awareness surrounding iron deficiencies, the globe remains plagued by its toll on human health and development. A number of interventions including supplementation, dietary diversification, agronomic and food-based approaches exist to combat iron deficiency, but the numbers afflicted still remain high. Some of the challenges associated with iron interventions can be attributed to the size and frequency of supplement dosage, bioavailability of the nutrient, inhibitors and enhancers of absorption, access, cultural preference, compliance and overall safety of interventions.
Iron supplements are typically used to treat existing iron deficiency anemia (IDA) but are also considered as a preventative public health measure to control at-risk populations. Supplementation of iron must be taken daily to be effective though there are promising studies of once- or twice-weekly doses. This can be a challenging endeavor anywhere but is especially so in developing countries where there are issues of program support and funding, lack of supplies, health care professionals, adequate training, economic resources, motivation of health care workers and participants, difficulties with or lack of storage and misunderstanding or confusion when it comes to instructions.
Another reason iron interventions have had varying success rates can be attributed to the fact that food preparation and dietary practices, which can be culturally and religiously significant and inelastic due to socio-economic circumstances, must be changed to sustainably and substantially combat iron deficiency. Additions of small quantities of iron rich foods are not enough to meet recommended levels, especially if staple foods contain inhibiting substances like phyates and polyphenols. The most prevalent populations suffering from iron deficiency and IDA are found in Southeast Asia and Africa, often consuming diets low in meat, poultry and fish and high in cereals, oats, rice, seeds and nuts, which strongly reduce iron absorption. Food-based strategies for iron intervention need to be highly complex, providing education and resources to raise and produce food with high levels of available iron and substances that enhance iron absorption while reducing consumption of inhibitors. Changes in food preparation like minimally cooking vegetables rich in Vitamin C and folate and using cast iron pots and cookware are examples of necessary actions to improve iron absorption in high-risk regions.
Attempts to target staple foods have resulted in fortification approaches. Iron fortification strategies are widely practiced in some areas. For example, more than 20 countries in Latin America have adopted some sort of iron fortification intervention. In spite of this, for iron fortification to be globally successful the quantity or food consumed and level of fortification must be factored in. The bioavailability of iron is hinged on the fortificant used and again, whether or not the diet is made up of inhibiting substances. While additional substances, like ascorbic acid, can be added to a food to increase iron absorption, they can be lost during storage and preparation stages making it a costly expenditure. Similar to the obstacles in supplementation, distribution and fortification of food can be challenging without stable policies, continued investment and appropriate infrastructures.
Recently, the impact of biofortified food through conventional breeding on human nutritional status has shown the opportunities biofortification offers to combat iron deficiencies. Similar to fortification strategies, biofortification is practiced in some areas with great success. Use of biotechnology to fortify staple crops can produce crops with enhanced abilities to obtain nutrients and increase bioavailable concentrations, crops that have increased concentrations of promoter substances (like ascorbate and polypeptides) and crops that have reduced concentrations of inhibiting substances. Challenges in global adoption and eradication of iron deficiency and IDA remain though, over issues of nutrient retention, grain milling, which can reduce the iron content, cultural preference, access, support, national policy and appropriate social and physical infrastructures.
A final iron intervention exists in the agronomic field. Mineral fertilizers can increase iron concentrations and even yields in areas where iron deficiencies are widespread. Foliar applications are often used in iron deficient soils to improve concentrations in the plant. Improving the soil through changes in the pH, other nutrient deficiencies and soil acidity are also methods of improving the availability and utilization of iron by crops. Unfortunately, mineral fertilizers are often not financially within reach of smallholders and have minimal impacts on iron concentrations if the soil is too degraded. Foliar applications must be repeated multiple times within a single growing season, which can make them financially unviable.
The solution to iron deficiency is not a single intervention. Instead, it is a multifaceted and contextual one comprised of elements of the above interventions and more. Increasing the consumption of iron-rich foods is crucial but it must be done in tandem with measures to enhance absorption. Collaboration, education, and support from all sectors including, public health, nutrition and agriculture, are needed to eliminate iron deficiency.