Lichtler Rebecca, Cowley Michael
Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina, USA.
Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina, USA.
Scientifica (Cairo). 2025 Sep 8;2025:5007983. doi: 10.1155/sci5/5007983. eCollection 2025.
Iron deficiency (ID) and ID anemia (IDA) are global health concerns that tend to affect vulnerable populations, including women, children, and those living in areas disproportionately affected by environmental health hazards. A review of the literature was conducted using the top ten chemicals of public health concern as identified by the World Health Organization (WHO) in 2020, in combination with the terms "iron deficiency" and "anemia." Both epidemiological and controlled experimental studies were considered. Eight contaminants or exposure classifications were ultimately considered to be within the scope of this review: lead, cadmium, arsenic, mercury, indoor and ambient air pollution, asbestos, dioxin and dioxin-like polychlorinated biphenyls (PCBs), and fluoride. Lead, cadmium, indoor and ambient air pollution, and fluoride are reliably linked to higher IDA prevalence and lower hematological parameters, including hemoglobin, hematocrit, and red blood cell count, all indicators of anemia. Direct measures of ID are less frequently reported. Further research studies, particularly controlled exposure studies, are needed to determine the importance of arsenic and mercury in contributing to the global ID and IDA burden. There is limited evidence that supplemental or dietary iron fortification can ameliorate the effects of lead, but not fluoride, and the efficacy of fortification has not been widely studied in the context of the remaining contaminants. Asbestos, dioxin, and dioxin-like PCBs are linked to anemia; however, the role of iron homeostasis is more complex and tends to include iron bioaccumulation. The narrative review has identified a need for renewed effort to address environmental factors beyond diet and nutrition when implementing ID and IDA interventions.
缺铁（ID）和缺铁性贫血（IDA）是全球健康问题，往往会影响弱势群体，包括妇女、儿童以及生活在受环境卫生危害影响尤为严重地区的人群。利用世界卫生组织（WHO）在2020年确定的十大公共卫生关注化学品，并结合“缺铁”和“贫血”等术语，对文献进行了综述。同时考虑了流行病学研究和对照实验研究。最终，八项污染物或暴露类别被纳入本综述范围：铅、镉、砷、汞、室内和室外空气污染、石棉、二噁英及二噁英类多氯联苯（PCBs）以及氟化物。铅、镉、室内和室外空气污染以及氟化物与较高的IDA患病率和较低的血液学参数（包括血红蛋白、血细胞比容和红细胞计数，这些都是贫血的指标）有可靠关联。关于ID的直接测量报告较少。需要进一步开展研究，尤其是对照暴露研究，以确定砷和汞在导致全球ID和IDA负担方面的重要性。仅有有限的证据表明，补充铁剂或进行膳食铁强化可改善铅的影响，但不能改善氟化物的影响，而且在其余污染物的背景下，强化的效果尚未得到广泛研究。石棉、二噁英和二噁英类PCBs与贫血有关；然而，铁稳态的作用更为复杂，往往包括铁的生物蓄积。叙述性综述指出，在实施ID和IDA干预措施时，需要重新努力解决饮食和营养之外的环境因素。
