Iron Deficiency is Still With Us
ABSTRACT & COMMENTARY
Synopsis: In a recent survey, there was a 3-5% prevalence of iron deficiency anemia in toddlers, adolescent girls, and women of childbearing age.
Source: Looker AC, et al. Prevalence of iron deficiency in the United States. JAMA 1997;277:973-976.
A nutritional survey assessed iron nutrition in a large group of Americans. Iron deficiency was defined as having an abnormal value for at least two of three laboratory tests of iron status (erythrocyte protoporphyrin, transferrin saturation, or serum ferritin). Iron deficiency anemia was defined as iron deficiency plus low hemoglobin. Nine percent of 1- to 2-year-olds were iron deficient, and 3% had iron deficiency anemia. Nine percent of adolescent girls were iron deficient, and 2% had iron deficiency anemia. Eleven percent of women of childbearing age were iron deficient, and 5% were anemic. Iron deficiency occurred in no more than 1% of teen age boys and young men. Among women and adolescent girls, iron deficiency was more likely in those who are minorities, poor, and multiparous.
COMMENT BY HOWARD A. PEARSON, MD, FAAP
This report has both good news and bad news. The good news is that iron nutrition in the United States has continued to improve over the past decade. The bad news is that it is still a significant issue in toddlers and adolescent girls. The epidemiology is the same as it was in the past, but its prevalence is much less. Twenty years ago, we spoke of a high prevalence of iron deficiency anemia; now, we speak of laboratory defined iron deficiency. The HANES data are periodically collected by the CDC to monitor nutrition in American citizens. HANES III studied nearly 25,000 Americans across a broad range of age and social status. Compared to HANES I and II, there has been a gratifying decrease in overt iron deficiency in infantsprobably related to the increased use of iron-fortified infant formulas. However, there is still a significant prevalence of non-anemic iron deficiency. Although still hotly debated, many authorities believe that there are detrimental effects of iron deficiency, and especially iron deficiency anemia, on psychomotor function.1
A similar effect on learning of adolescent girls was recently described in Pediatric and Adolescent Medicine Reports.2 Race and poverty continue to have an effect on the prevalence of iron deficiency. Looker et al estimate that there are 240,000 toddlers and 3.3 million women (including adolescents) with iron deficiency anemia, and there are more than twice these numbers with iron deficiency. If there is even a small adverse effect of iron deficiency, this is a public health issue that should be addressed.
References
1. Dallman PR. Biochemical basis for the manifestations of iron deficiency. Annu Rev Nutr 1986;6:13-40.
2. Pearson HA. Iron treatment improves verbal learning and memory of non-anemic but iron deficient adolescent girls. Pediatr Adol Med Rep l997;1:93.
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