Optimal management of iron deficiency anemia due to poor dietary intake

Figures & data

Table 1 Iron content of different foods

		Iron (mg)
Foods that contain iron bound to a heme group: 75 g of “cooked” food (meat, fish, shellfish, poultry)
Clams		21
Liver, pork		13.4
Liver, chicken		8.7
Oysters		6.4
Mussels		5
Liver, veal		4.9
Veal		2.4
Shrimp		2.3
Sardines		2
Lamb		1.5
Foods that contain iron not bound to a heme group	Usual daily amount
Pumpkin (seeds, roots, cooked)	60 mL (1/4 glass)	8.6
“Cured” or “semicured” tofu (soy cheese)	150 g (3/4 glass)	2.4–8
Children’s cereals (dry)	28 g	6–7
Soybeans, dry, cooked	175 mL (3/4 glass)	6.5
Instant fortified flour	1 packet	4.2–6
Lentils, cooked	175 mL (3/4 glass)	4.9
Cold fortified cereals	30 g	4
Red beans, cooked	175 mL (3/4 glass)	3.9
Molasses	15 mL	3.6
Refried beans	175 mL (3/4 glass)	3.1

Table 2 Daily recommended amount of iron (mg) by gender and age

Males	Adult	8 mg
Females	>50 years	8 mg
	19–50 years	18 mg
	Pregnant	27 mg
	Breastfeeding	9–10 mg
Adolescents (9–18 years)	Female	8–15 mg
	Male	8–11 mg
Children (0–8 years)	4–8 years	10 mg
	1–3 years	7 mg
	7 months–1 year	11 mg
	0–6 months	0.27 mg

Table 3 Causes of iron deficiency or iron deficiency anemia

Gastrointestinal disorder with increased iron losses	Cancer/polyp: colon, stomach, esophagus, small bowel Peptic ulcer, esophagitis NSAID use Inflammatory bowel disease: ulcerative colitis, Crohn’s disease Intestinal parasites Vascular lesions: angiodysplasia, watermelon stomach Meckel’s diverticulum
Gastrointestinal disorders that reduce iron absorption	Celiac disease Bacterial overgrowth Whipple’s disease Lymphangiectasia Gastrectomy (partial and total) and gastric atrophy Gut resection or bypass
Urological and gynecological disorders	Menorrhagia Hematuria Chronic renal failure
Intravascular hemolysis myxomas	Prosthetic valves and cardiac Paroxysmal nocturnal hemoglobinuria Marathon runners Multiple blood donations
Deficient intake	Low socioeconomic class Vegetarian diets Dissociated diets Alcoholism Elderly patients High-risk ethnic groups
Medication that reduces gastric acid or iron affinity	Dietary factors Tannin Phytates in fiber Calcium in milk Tea Coffee
Increased requirements in various stages of life	Infants up to 3 years and adolescents Pregnant women Breastfeeding women Multiparous Post-partum

Abbreviation: NSAID, nonsteroidal anti-inflammatory drug.

Table 4 Recommendations for the use of oral iron

Initially use ferrous sulfate (if there is intolerance, assess other preparations)

Use doses that are not high (one tablet daily of any commercially available ferrous sulfate or of any other type of iron)

Administration after the main meal, perhaps accompanied by a glass of vitamin C-rich juice

Constancy until the full replenishment of deposits

Table 5 Nutritional strategy to avoid dietary iron deficiency

Increase the dietary iron intake

Promote the consumption of foods rich in iron, especially heme, as present in meat, poultry, fish, and seafood

Optimize the absorption of dietary iron

a. Enhancers of iron absorption:

Ascorbic acid or vitamin C (present in fruits, juices, potatoes and some other tubers, and other vegetables such as green leaves, cauliflower, and cabbage)

Some cooked, fermented or germinated foods and condiments, such as sauerkraut and soy sauce (they reduce the amount of phytates)

b. Inhibitors of iron absorption:

Foods with high inositol content

Phytates, present in cereal bran, cereal grains, high-extraction flour, legumes, nuts, and seeds

Iron-binding phenolic compounds (tannins); foods containing the most potent inhibitors and that are resistant to the influence of enhancers include tea, coffee, herbal infusions, and certain spices (eg, oregano)

Calcium, particularly from milk and dairy products

Table 6 Causes of anemia other than iron deficiency in developing countries

Absolute or relative deficiency of folic acid and vitamin B12

Vitamin A deficiency, also of multifactorial origin

Endemic presence of infectious disease

HIV

Intestinal parasites

Malaria

Schistosomiasis

Trichiurus trichiura infection

Tuberculosis

Presence of adaptative hemoglobinopathies

Sickle-cell anemia

Beta thalassemia

Abbreviation: HIV, human immunodeficiency virus.