Molecular Nutrition Unit, Central Institute for Nutrition and Food Science, Research Center for Nutrition and Food Science, Technische Universität München, Freising, Germany; and
Center for Studies of Sensory Impairment, Aging, and Metabolism (CeSSIAM), Guatemala City, Guatemala.
Adv Nutr. 2017 May 15;8(3):401-408. doi: 10.3945/an.116.013847. Print 2017 May.
Anemia can be related to decreased production or increased loss of erythrocytes, or both, leading to many underlying and often overlapping causes. A largely cereal-based diet with plenty of phytates, polyphenols, and other ligands that inhibit intestinal iron absorption predominated in preindustrial Europe and predominates in present-day developing countries alike. In both situations, we find poor hygienic conditions, which frequently lead to anemia of inflammation. The large number of possible causes and their interaction shows why it is so difficult to mitigate anemia prevalence. Diagnostic biomarkers are required to differentiate the different types of anemia and to treat them appropriately. Some of them are well established in adults [e.g., concentrations of serum ferritin, soluble transferrin receptor (sTfR), and serum iron or the ratio of sTfR to log ferritin]. Others, such as serum hepcidin, hold considerable promise, although they are not yet widely used. A particular issue is to establish reference values for biomarkers in infants and children at different ages. The fact that resource-rich postindustrial societies have a very low prevalence of iron-deficiency anemia offers hope that common types of anemia can be eliminated. In contrast, inborn forms of anemia, such as thalassemia, and anemias related to underlying diseases (e.g., bleeding tumors or peptic ulcers, gynecologic blood losses, or renal diseases) require an operational health system to be addressed appropriately.
贫血可与红细胞生成减少或红细胞丢失增加有关，或两者兼有，导致许多潜在的、通常相互重叠的原因。在工业化前的欧洲，以谷物为主的饮食中含有大量植酸、多酚和其他抑制肠道铁吸收的配体，这在当今的发展中国家也同样存在。在这两种情况下，我们都发现卫生条件很差，这常常导致炎症性贫血。大量可能的原因及其相互作用表明，为什么缓解贫血的流行如此困难。需要诊断生物标志物来区分不同类型的贫血，并进行适当的治疗。其中一些在成人中已经得到很好的确立[例如，血清铁蛋白、可溶性转铁蛋白受体（sTfR）和血清铁或 sTfR 与铁蛋白对数的比值]。其他一些生物标志物，如血清铁调素，具有很大的潜力，尽管它们尚未广泛应用。一个特别的问题是为不同年龄的婴儿和儿童确定生物标志物的参考值。资源丰富的后工业化社会缺铁性贫血的患病率非常低这一事实，为消除常见类型的贫血带来了希望。相比之下，镰状细胞贫血等先天性贫血以及与潜在疾病相关的贫血（如出血性肿瘤或消化性溃疡、妇科失血或肾脏疾病）需要一个运作良好的卫生系统来适当处理。
