What Is Nutritional Anemia?
In nutritional anemia, the hemoglobin content of blood is lower than normal, resulting in a deficiency of one or more essential nutrients.
From the view of public health, there are three possible causes of anemia. They are :
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Nutritional anemia.
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Anemia is associated with hereditary abnormalities of the hemoglobin molecule.
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Anemia is associated with chronic infections.
For the synthesis of hemoglobin and erythrocytes, a sufficient amount of all essential nutrients are required. When there is insufficient absorption of certain nutrients such as iron, vitamin B12, or folic acid, it causes nutritional anemia. The most common deficiency is iron, vitamin B12, followed by folic acid.
What Is the Etiology of Nutritional Anemia?
There are many nutrients involved in the production of red cells and hemoglobin, but iron deficiency anemia is the most common nutritional anemia in the world. Folate deficiency is common in pregnant women. Vitamin B12 deficiency may produce classical pernicious anemia, which is rare. In children, protein energy malnutrition may lead to anemia.
Vulnerable Groups
In developing countries, between 40 percent and 50 percent of children below five years of age are iron deficient. Iron is essential for rapid growth and development in infants and young children. Anemia in children has adverse functional effects such as:
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Work capacity and productivity are reduced physically.
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Cellular immunity is reduced.
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Morbidity is increased.
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Cognitive function is impaired.
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Child growth deficits.
In adolescents and women, after childbirth, there is blood loss during menstruation, so there is iron loss. Adults above sixty-five years of age require additional iron supplements.
Causes of Nutritional Anemia
Nutritional anemia is due to a low hemoglobin concentration imbalance between the absorption of nutrients and the body's need. The imbalance is due to poor absorption, low nutrient intake, and poor utilization.
What Are the Effects of Nutritional Anemia?
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In individuals with iron deficiency anemia, work capacity is reduced due to striated muscle dysfunction with reduced activity of the muscle enzyme glycerol-3-phosphate dehydrogenase. This can be treated with iron therapy.
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Severe anemia in pregnant women will have an increased risk of premature delivery and increased fetal and maternal morbidity. Mild anemia in pregnancy may also lead to premature delivery, lower birth weight, and placental hypertrophy.
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There are histological changes in various tissues in oral and pharyngeal mucosae and nails due to iron deficiency anemia.
How Is Anemia Diagnosed?
The measurement of blood hemoglobin concentration can diagnose anemia. It can also be diagnosed using hematocrit (packed cell volume), blood reticulocyte count, mean cell volume, blood film analysis, or hemoglobin electrophoresis. Iron deficiency anemia can be determined by serum ferritin or serum transferrin receptor measurement. They are the most commonly used indicators.
Which Diseases Can Cause Anemia?
Malaria
Malaria is one of the primary causes of anemia. Iron metabolism is disturbed due to malaria, where increased hemolysis decreases the production of red blood cells. In malarial infection, hepcidin is upregulated, leading to anemia due to the redistribution of iron to macrophages and decreasing iron uptake through diet.
Human Immune-Deficiency Virus (HIV)
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In HIV individuals, one of the most common hematological abnormalities is anemia. They are characterized by low reticulocyte count, normochromic and normocytic anemia, and impaired erythropoietin response.
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HIV also directly affects anemia by affecting hematopoietic progenitor cells and decreasing response to erythropoietin.
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"Anaemia of chronic disease/inflammation" is caused by HIV infection linked to pro-inflammatory cytokines and alters the iron metabolism. Individuals with anemia and HIV is a predictor of progression to acquired immune deficiency syndrome (AIDS).
Tuberculosis
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Anemia is most common among patients with tuberculosis and common among individuals coinfected with tuberculosis and HIV.
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In pulmonary tuberculosis, there might be increased blood loss from hemoptysis (blood in sputum), decreased production of red blood cells (RBC), and poor appetite, which leads to poor nutritional status.
Low-Grade Inflammation
A deficiency or excess of iron affects the inflammatory response and is susceptible to infections.
Control of Nutritional Anemia
Nutritional anemia can be controlled by:
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Supplementation of iron and folate.
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Breastfeeding infants.
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Fortification of food.
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Conducting educational camps for public awareness.
Iron Supplement
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Iron supplements are given in tablets or syrup for children when there is iron deficiency or anemia. The parental iron injection is not indicated due to the risk of allergic reactions. Therefore, it is not recommended for public health use.
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Increase intake of iron-rich foods more of animals –source food such as meat, poultry, and fish and rich-plant sources including legumes.
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To improve bioavailability and absorption, promote feasible food processing and preparation methods.
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Increase intake of foods rich in vitamin A, such as green leafy vegetables, fruits, dairy products, eggs, and fish oil.
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Consume more fruits rich in citric and ascorbic acid, including citrus fruits.
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Avoid combining known inhibitors of iron absorption with meals that are high in iron content.
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The total amount of iron supplement required is calculated with daily basal iron losses, additional iron loss due to menstruation, pregnancy incur, etc., and total amount needed to replenish the body store.
Breastfeeding Infants
For optimal growth, development, and health, infants should be exclusively breastfed for the first six months of life. To continue receiving adequate nutrition in infants, they must be breastfed for up to two years. Infants with low birth weight will require an additional source of iron before six months of age.
Fortification of Food
The process of increasing the content of essential micronutrients in food to improve the nutritional quality of the food supply. It also provides public health benefits with minimal health risks. Food fortification is one of the most cost–effective and sustainable approaches to improving individuals' nutritional status. It can potentially improve the nutritional status of many of the population.
Conclusion:
Nutritional anemia is caused by a diet lacking sufficient hematopoietic nutrients required for hemoglobin and red blood cell synthesis. Therefore, all essential nutrients such as iron, folate, and folic acid are needed by consuming a balanced diet.
