Department of Biostatistics.
Division of Nutrition, St John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India.
J Nutr. 2019 Mar 1;149(3):366-371. doi: 10.1093/jn/nxy283.
Anemia in Indian women continues to be highly prevalent, and is thought to be due to low dietary iron content. The high risk of dietary iron deficiency is based on the Indian Council of Medical Research recommendation of 21 mg/d, but there is a need for a secure and transparent determination of the Estimated Average Requirement (EAR) of iron in this population. In nonpregnant, nonlactating women of reproductive age (WRA), the EAR of iron was determined to be 15 mg/d. Applying this value to daily iron intakes among WRA in nationally representative Indian state-based data showed that the median risk of dietary iron deficiency was lower than previously thought (65%; IQR: 48-78%), with considerable heterogeneity between states (range: 25-93%). However, in a validation, this risk matched the risk of iron deficiency as defined by blood biomarkers in a recently completed survey. When the risk of dietary iron deficiency was modelled for an increase in iron intake through food fortification of a single dietary staple, that provided 10 mg/d, the median risk reduced substantially (from 65% to 20%), and it virtually disappeared when supplementary iron intakes through the national iron supplementation program were considered. The risk of exceeding the tolerable upper level (TUL) of intake of iron remains low in the population when receiving fortification of 10 mg/d, but is much higher if they consume greater amounts of iron through supplements (range: 0-54%). This newly and transparently defined Indian EAR of iron should be used to evaluate, with precision, the benefits and risks of iron fortification and supplementation policies.
印度女性的贫血问题仍然非常普遍,据认为这是由于饮食中铁含量低所致。饮食中铁缺乏的高风险是基于印度医学研究理事会推荐的 21 毫克/天,但需要对该人群中铁的估计平均需求量(EAR)进行安全透明的确定。在非妊娠、非哺乳期的育龄妇女(WRA)中,铁的 EAR 被确定为 15 毫克/天。将这一数值应用于印度国家代表性数据中 WRA 的日常铁摄入量,结果表明,饮食中铁缺乏的风险低于先前认为的(65%;IQR:48-78%),各州之间存在很大的异质性(范围:25-93%)。然而,在一项验证中,这种风险与最近完成的一项调查中血液生物标志物定义的铁缺乏风险相匹配。当通过对单一膳食主食进行食物强化来增加铁摄入量来模拟饮食中铁缺乏的风险时,风险显著降低(从 65%降至 20%),而当考虑国家铁补充计划的补充铁摄入量时,这种风险几乎消失。当接受 10 毫克/天的强化时,人群中摄入铁的可耐受上限(TUL)的风险仍然很低,但如果通过补充剂摄入更多的铁(范围:0-54%),则风险会大大增加。这种新的、透明定义的印度铁 EAR 应该用于精确评估铁强化和补充政策的益处和风险。