A better understanding of iron deficiency with new insights

Globally no less than 1.2 billion people suffer from iron deficiency.

This has major health implications. A new review article by Dorine Swinkels, theme Renal disorders, together with German and Australian colleagues, provides groundbreaking guidance; this guidance, based on scientific evidence, will help the diagnosis and treatment of iron deficiency to guarantee positive health effects in the long term. This article has now been published in the scientific journal The Lancet.

Fatigue, palpitations, dizziness, shortness of breath, paleness, sweating, headache, restless legs: these are all symptoms that could indicate a shortage of iron in the body. Iron deficiency, or iron deprivation, is a major cause of anemia. People with anemia have a shortage of oxygen-producing red blood cells, or hemoglobin (Hb). Hemoglobin transports oxygen from the lungs to all the cells in the body. Less oxygen in the body results in the conditions mentioned above.

Globally iron deficiency is a major health problem

Iron deficiency is a very common cause of anemia in people of all ages. Globally no less than 1.2 billion people suffer from iron deficiency and these are mainly children and women of child-bearing age. Anemia due to iron deficiency is most common in the more disadvantaged groups, including migrants and refugees, and in low-income and middle-income countries. In the Netherlands there are no general figures available for adults, but it is known that one in ten toddlers is anemic and one in fifty teenagers. Moreover, it is estimated that one in six to ten pregnant women in the Netherlands has an iron deficiency. “In short, iron deficiency is a problem that shouldn’t be underestimated and is present globally, in all population groups”, says Dorine Swinkels, Professor in Experimental Clinical Chemistry at Radboudumc and last author of the publication.

Heart problems and increased risk of low birth weight

A wide range of health problems can be caused by iron deficiency, such as fatigue, headache, hair loss and restless legs. Iron deficiency can also make other conditions worse, such as heart conditions. In particular, young children with an iron deficiency run the risk of poor mental development. Iron deficiency in pregnant women increases the risk of infants with low birth weight, with all the associated risks, Dorine Swinkels explains. “Due to these long-term effects, such as developmental disorders in children, it’s very important to make an adequate diagnosis. But we also need a better understanding and better recognition of the causes. Globally this will have a major positive impact on people’s health.”

Difficult to diagnose

A lot can be said about the causes. Often there is not enough iron in the diet. It was known previously that iron deficiency can be caused by recent trends such as vegetarianism and obesity, but the extent of the effects has become clear only over the last few years. In addition, iron deficiency can also be a sign of serious illnesses, such as certain gastric illnesses, intestinal cancer or the chronic gastric condition coeliac disease. In the case of illnesses like these, it is not enough simply to take iron tablets. Patients with a chronic infection or inflammation are unable to absorb these tablets efficiently. Sufficient attention must therefore be paid to the exact cause of the deficiency. As, according to the researchers, if we don’t know the cause, a patient cannot be diagnosed or may receive the wrong treatment, and serious, underlying conditions may be overlooked. This can be life threatening.

It is not always easy to determine whether someone has an iron deficiency. This is particularly true if the patient, in addition to iron deficiency, also has an infection or inflammation. There is still no easy answer to this. Cut-off points can be used to determine whether someone has an iron deficiency or not. Internationally there is no agreement on the optimum method and there is a lack of high-quality studies, as concluded by the researchers.

New treatment options

The article by Dorine Swinkels and her co-authors, clinical and fundamental researchers from Melbourne (Sant-Rayn Pasricha and Jason Tye-Din) and Heidelberg (Martina Muckenthaler) also focuses on new treatment strategies. A lot more information has become known in the past year. Dorine Swinkels: “In the past, patients with mild forms of anemia were given too many tablets. This resulted in a lot of side effects. Nowadays there are also iron preparations that can be administered by injection (intravenously), and lots of promising therapies are being developed to treat iron deficiency in people with inflammatory conditions.”