Mantadakis Elpis, Chatzimichael Eleftherios, Zikidou Panagiota
Department of Pediatrics, Hematology/ Oncology Unit, University General Hospital of Alexandroupolis, Thrace, Greece.
Democritus University of Thrace Faculty of Medicine, Alexandroupolis, Thrace, Greece.
Mediterr J Hematol Infect Dis. 2020 Jul 1;12(1):e2020041. doi: 10.4084/MJHID.2020.041. eCollection 2020.
Iron deficiency and iron-deficiency anemia (IDA) affects approximately two billion people worldwide, and most of them reside in low- and middle-income countries. In these nations, additional causes of anemia include parasitic infections like malaria, other nutritional deficiencies, chronic diseases, hemoglobinopathies, and lead poisoning. Maternal anemia in resource-poor nations is associated with low birth weight, increased perinatal mortality, and decreased work productivity. Maintaining a normal iron balance in these settings is challenging, as iron-rich foods with good bioavailability are of animal origin and either expensive and/or available in short supply. Apart from infrequent consumption of meat, inadequate vitamin C intake, and diets rich in inhibitors of iron absorption are additional important risk factors for IDA in low-income countries. In-home iron fortification of complementary foods with micronutrient powders has been shown to effectively reduce the risk of iron deficiency and IDA in infants and young children in developing countries but is associated with unfavorable changes in gut flora and induction of intestinal inflammation that may lead to diarrhea and hospitalization. In developed countries, iron deficiency is the only frequent micronutrient deficiency. In the industrialized world, IDA is more common in infants beyond the sixth month of life, in adolescent females with heavy menstrual bleeding, in women of childbearing age and older people. Other special at-risk populations for IDA in developed countries are regular blood donors, endurance athletes, and vegetarians. Several medicinal ferrous or ferric oral iron products exist, and their use is not associated with harmful effects on the overall incidence of infectious illnesses in sideropenic and/or anemic subjects. However, further research is needed to clarify the risks and benefits of supplemental iron for children exposed to parasitic infections in low-income countries, and for children genetically predisposed to iron overload.
缺铁和缺铁性贫血（IDA）影响着全球约20亿人，其中大多数居住在低收入和中等收入国家。在这些国家，贫血的其他原因包括疟疾等寄生虫感染、其他营养缺乏、慢性疾病、血红蛋白病和铅中毒。资源匮乏国家的孕产妇贫血与低出生体重、围产期死亡率增加和工作生产力下降有关。在这些情况下维持正常的铁平衡具有挑战性，因为具有良好生物利用度的富含铁的食物来自动物源性，要么价格昂贵，要么供应短缺。除了很少食用肉类外，维生素C摄入不足以及富含铁吸收抑制剂的饮食是低收入国家缺铁性贫血的其他重要风险因素。用微量营养素粉对辅食进行家庭铁强化已被证明能有效降低发展中国家婴幼儿缺铁和缺铁性贫血的风险，但与肠道菌群的不良变化和肠道炎症的诱导有关，这可能导致腹泻和住院。在发达国家，缺铁是唯一常见的微量营养素缺乏症。在工业化国家，缺铁性贫血在6个月以上的婴儿、月经过多的青春期女性、育龄妇女和老年人中更为常见。发达国家缺铁性贫血的其他特殊高危人群是定期献血者、耐力运动员和素食者。有几种药用亚铁或铁口服铁产品，它们的使用与对缺铁和/或贫血受试者的总体感染发病率没有有害影响。然而，需要进一步研究来阐明补充铁对低收入国家感染寄生虫的儿童以及对铁过载有遗传易感性的儿童的风险和益处。
