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Iron deficiency in Europe

Published online by Cambridge University Press:  27 September 2007

Serge Hercberg*
Affiliation:
Unité de Surveillance et d'Epidémiologie Nutritionnelle (USEN), InVS/Institut Scientifique et Technique de la Nutrition et de l'Alimentation, CNAM, 5 rue Vertbois, F-75003 Paris, France
Paul Preziosi
Affiliation:
Unité de Surveillance et d'Epidémiologie Nutritionnelle (USEN), InVS/Institut Scientifique et Technique de la Nutrition et de l'Alimentation, CNAM, 5 rue Vertbois, F-75003 Paris, France
Pilar Galan
Affiliation:
Unité de Surveillance et d'Epidémiologie Nutritionnelle (USEN), InVS/Institut Scientifique et Technique de la Nutrition et de l'Alimentation, CNAM, 5 rue Vertbois, F-75003 Paris, France
*
*Corresponding author: Email hercnerg@vcnam.cnam.fr
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Abstract

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In Europe, iron deficiency is considered to be one of the main nutritional deficiency disorders affecting large fractions of the population, particularly such physiological groups as children, menstruating women and pregnant women. Some factors such as type of contraception in women, blood donation or minor pathological blood loss (haemorrhoids, gynaecological bleeding,..) considerably increase the difficulty of covering iron needs. Moreover, women, especially adolescents consuming lowenergy diets, vegetarians and vegans are at high risk of iron deficiency.

Although there is no evidence that an anbsence of iron stores has any adverse consequences, it does indicate that iron nutrition is borderline, since any further reduction in body iron is associated with a decrease in the level of functional compounds such as haemoglobin.

The prevalence of iron-deficient anaemia has slightly decreased in infants and menstruating women. Some positive factors may have contributed to reducing the prevalence of iron-deficiency anaemia in some groups of population: the use of iron-frotified formulas and iron-fortified cereals; the use of oral contraceptives and increased enrichment of iron in several countries; and the use of iron supplements during pregnancy in some European countries.

It is possible to prevent and control iron deficiency by counseling individuals and families about sound iron nutrition during infancy and beyond, and about iron supplementation during pregnancy, by screening persons on the basis of their risk for iron deficiency, and by treating and following up persons with presumptive iron deficiency. This may help to reduce manifestations of iron deficiency and thus improve public health. Evidence linking iron status with risk of cardiovascular disease or cancer is unconvincing and does not justify changes in food fortification or medical practice, particularly because the benefits of assuring adequate iron intake during growth and development are well established. But stronger evidence is needed before rejecting the hypothesis that greater iron stores increase the incidence of CVD or cancer. At present, currently available data do not support radical changes in dietary recommendations. They include all means for increasing the content of dietary factors enhancing iron absorption or reducing the content of factors inhibiting iron absorption. Increased knowledge and increased information about factors may be important tools in the prevention of iron deficiency in Europe.

Type
Research Article
Copyright
Copyright © CABI Publishing 2001

References

1Hallberg, L.Results of surveys to assess iron status in Europe. Nutr. Rev. 1995; 11: 314322.Google Scholar
2Hercberg, S, Galan, P, Dupin, H. Recent knowledge on iron and folate deficiency in the world. Paris: INSERM, 1990; 197: 700.Google Scholar
3Hallberg, L, Hultén, L, Bengtsson, C, Lapidus, L, Lindstedt, G.Iron balance in menstruating women. Eur. J. Clin. Nutr. 1995; 49: 200207.Google ScholarPubMed
4Fogelholm, M, Alopaeus, K, Silvennoinen, T, Teirilä, J.Factors affecting iron status in non-preganant wome from urban South Finland. Eur. J. Clin. Nutr. 1993; 47: 567574.Google Scholar
5Van de Vijver, LPL, Kardinaal, AFM, Charzewska, J, Rotily, M, Charles, P, Maggiolini, M, Ando, S, Väänänen, K, Wajszczyk, B, Heikkinen, J, Deloraine, A, Schaafsma, G.Calcium intake is weakly but consistently negatively associated with iron status in girls and women in six European countries. J. Nutr. 1999; 129: 963968.CrossRefGoogle ScholarPubMed
6Strain, JJ, Barker, ME, Livingstone, MBE, Mc Kenna, PG. The Northern Ireland dietary surveys and related studies. Proc. Nutr. Soc. 1990; 49: 289296.CrossRefGoogle ScholarPubMed
7Brussaard, JH, Brants, HA, Bouman, M, Löwik, MRH. Iron intake and iron status among adults in the Netherlands. Eur. J. Clin. Nutr. 1997; 51: S52S58.Google ScholarPubMed
8Galan, P, Hercberg, S, Soustre, Y.Factors affecting iron stores in French females. Human Nutr. Clin. Nutr. 1985; 39C: 279287.Google Scholar
9Soustre, Y, Dop, MC, Galan, P, Hercberg, S.Dietary determinants of the iron status in menstruating women. Int. J. Vit. Nutr. Res. 1986; 56: 281286.Google ScholarPubMed
10Preziosi, P, Hercberg, S, Galan, P, Devanlay, M, Cherouvrier, F, Dupin, H.Iron status of a healthy French population: factors determining biochemical markers. Ann. Nutr. Met. 1994; 38: 192202.CrossRefGoogle ScholarPubMed
11Galan, P, Yoon, HC, Preziosi, P, Viteri, F, Valeix, P, Fieux, B, Briancon, S, Malvy, D, Roussel, AM, Favier, A, Hercberg, S.Determining factors in the iron status of adult women in the SU.VI.MAX study. Eur. J. Clin. Nutr. 1998; 52: 383388.CrossRefGoogle ScholarPubMed
12Knottnerus, JA, Delgado, LR, knipschild, PG, Essed, GG, Smits, F, Haematologic parameters and pregnancy outcome. J. Clin. Epidemiol. 1990; 43: 461466.CrossRefGoogle ScholarPubMed
13Robinson, S, Godfrey, K, Denne, J, Cox, V.The determinants of iron status in early pregnancy. Br. J. Nutr. 1998; 79: 249255.CrossRefGoogle ScholarPubMed
14Milman, N, Agger, AO, Nielsen, OJ. Iron supplementation during pregnancy: effect on iron status markers, serum erythropoietin and human placental lactogen: a placebo controlled study in 207 Danish women. Danish Med. Bull. 1991; 38: 471476.Google ScholarPubMed
15Hercberg, S, Galan, P, Soustre, Y, Dop, MC, Devanlay, M, Dupin, H.Prevalence of iron deficiency during pregnancy in a French area. Nutr. Rep. Int. 1985; 32: 719726.Google Scholar
16Hercberg, S, Bichon, L, Galan, P, Christides, JP, Carroget, C, Potier de Courcy, G.Iron and folacin status of pregnant women: relationship with dietary intakes. Nutr. Rep. Int. 1987; 56: 915930.Google Scholar
17De Benazé, C, Galan, P, Wainer, R, Hercberg, S.Prévention de l'anemie ferriprive au cours de la grossesse par une supplémentation martiale précoce: un essai controlé. Rev. Epidemiol. Santé Publique. 1989; 27: 109119.Google Scholar
18Michaelsen, KF, Milman, N, Samuelson, G.A longitudinal study of iron status in healthy Danish infants: effects of early iron status, growth velocity and dietary factors. Acta. Pediatr. Scand. 1995; 84: 10351044.CrossRefGoogle ScholarPubMed
19Macchia, P, Frijia, F, Mariani, F, Del Bravo, M, Protti, MA, Mariani, G, Bottone, E. Incidence of iron deficiency in an Italian area. In: Larisse, M, Tura, S, Ceccarelli, G, Ciampini, M eds. Le Sideropenie e il ruolo fisioterapeutico della ferritina. Roma: Antonio Delfino Editore, 1985: 2337.Google Scholar
20Colomer Revuelta, C, Donat Colomer, J, Fernandez-Delgado, R, Guitierrez Sogler, D, Colomeret Revuelta, J, Colomer Sala, C.La carencia de hierro en ninos de seia a deciocho meses de edad. Rev. Esp. Pediatr. 1985; 41: 273277.Google Scholar
21Hercberg, S, Papoz, L, Galan, P, Guéry, MF, Farnier, MA, Rossignol, C.Iron status and dietary pattern in young children. Nutr. Rep. Int. 1986; 35: 307316.Google Scholar
22Armstrong, P.Iron deficiency in adolescents. BMJ 1989; 298: 499.CrossRefGoogle ScholarPubMed
23Doyle, W, Jenkins, S, Crawford, MA, Puvandendran, K.Nutritional status of school children in an inner city area. Arch. Dis. Child 1994; 70: 376381.CrossRefGoogle Scholar
24Southon, S, Wright, AJA, Finglas, PM, Bailey, AL, Belsten, JL. Micronutrient intake and psychological performance of schoolchildren: consideration of the value of calculated nutrient intake for the assessment of micronutrient status in children. Proc. Nutr. Soc. 1992; 51: 315324.CrossRefGoogle ScholarPubMed
25Bergström, E, Hernell, O, Lonnerdal, B, Persson, LA. Sex differences in iron stores of adolescents: what is normal. J. Ped. Gastro. Nutr. 1995; 20: 215224.CrossRefGoogle Scholar
26Samuelson, G, Bratteby, L-E, Berggren, K, Elverby, J-E, Kempe, B.Dietary iron intake and iron status in adolescents. Acta. Paediatr. 1996; 85: 10331038.CrossRefGoogle ScholarPubMed
27Milman, N.Serum ferritin in Danes: Studies of iron status from infancy to old age, during blood donation and pregnancy. Int. J. Hematol. 1996; 63: 103135.CrossRefGoogle ScholarPubMed
28Nelson, M, White, J, Rhodes, C.Haemoglobin, ferritin, and iron intakes in British children aged 12–14 years: a preliminary investigation. Br. J. Nutr. 1993; 70: 147155.CrossRefGoogle Scholar
29Donovan, UM, Gibson, RS. Iron and zinc status of young women aged 14 to 19 years consuming vegetarian and omnivorous diets. J. Am. coll. Nutr. 1995; 14: 463472.CrossRefGoogle Scholar
30Alexander, D, Ball, MJ, Mann, J.Nutrient intake and haematological status of vegetarians and age-sex matched omnivores. Eur. J. Clin. Nutr. 1994; 48: 538546.Google ScholarPubMed
31Hallberg, L, Asp, NG. Iron nutrition in health and disease. London: John Libbey, 1996: 364.Google Scholar
32Rowland, TW, Deisroth, MB, Green, GM, Kelleher, JF. The effect of iron therapy on the exercise capacity of nonanemic iron-deficient adolescent runners. Am. J. Dis. Child 1988; 142: 165169.Google Scholar
33Ballin, A, Berar, M, Rubinstein, U, Kleter, Y, Hershkovitz, A, Meytes, D.Iron state in female adolescents. Am. J. Dis. Child 1992; 146: 803805.Google Scholar
34Bruner, AB, Joffe, A, Duggan, AK, Casella, JF, Brandt, J.Randomised study of cognitive effects of iron supplementation in non-anemic iron-deficient adolsecent girls. Lancet 1996; 348: 992996.CrossRefGoogle Scholar
35Zhu, YI, Haas, JD. Iron depletion without anemia and physical performance in young women. Am. J. Clin. Nutr. 1997; 66: 334341.CrossRefGoogle ScholarPubMed
36Allen, LH. Pregnancy and iron deficiency: unresolved issues. Nutr. Rev. 1997; 55: 91101.CrossRefGoogle ScholarPubMed
37Viteri, FE. The consequences of iron deficiency and anemia in pregnancy. In: Allen, L, King, J, Lönnerdal, B, eds. Nutrient Regulation during Pregnancy, Lactation and Infant Growh. New York: Plenum Press, 1994: 127139.CrossRefGoogle Scholar
38De Maeyer, E, Adiels-Tegman, M.The prevalence of anaemia in the world. World Health Stat. Q 1985; 38: 302316.Google ScholarPubMed
39Scholl, TO, Hediger, ML, Fisher, RL, Shearer, JW. Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study. Am. J. Clin. Nutr. 1992; 55: 985988.CrossRefGoogle ScholarPubMed
40Hallberg, L, Bengtsson, C, Garby, L.An analysis of factors leading to a reduction in iron deficiency in Swedish women. Bull. WHO 1979; 57: 147954.Google ScholarPubMed
41Takkunen, H.Iron deficiency in the Finnish adult population. Scand J. Haematol (Suppl) 1976; 25: 187.Google ScholarPubMed
42Hallberg, L, Högdahl, AM, Nilsson, L, Rybo, G.Menstrual blood loss – a population study. Variation at different ages and attempts to define normality. Acta. Obstet. Gynecol Scand 1966; 45: 320351.CrossRefGoogle ScholarPubMed
43Cole, SK, Billewicz, WZ, Thomson, AM. Sources of variation in menstrual blood loss. J. Obst. Gynaecol Br. Commonw. 1971; 78: 933939.CrossRefGoogle ScholarPubMed
44Milman, N, Kirchhoff, M, Jogersen, T.Iron stores markers, serum ferritin and haemoglobin in 1359 Danish women in relation to menstruation, hormonal contraception, parity, and postmenopausal hormone treatment. Am. Hematol. 1992; 65: 96102.Google ScholarPubMed
45Milman, N, Rosdahl, N, Lyhne, N, Jogersen, T.Iron status in 883 Danish women aged 35–65 years. Relation to menstruation and method for contraception. Acta. Obst. Gynecol. Scand 1993; 72: 601605.CrossRefGoogle ScholarPubMed
46Bothwell, TH, Charlton, RW. A general approach to the problem of iron deficiency and iron overload in the population at large. Sem. Hematol. 1982; 19: 5457.Google Scholar
47Monsen, ER, Balintly, JL. Calculating dietary iron bioavailability: refinement of computarization. J. Am. Diet. Assoc. 1978; 80: 307311.CrossRefGoogle Scholar
48Murphy, SP, Beaton, GH, Calloway, DH. Estimated mineral intakes of toodlers: predicted prevalence of inadequacy in village populations in Egypt, Kenya, and Mexico. J. Clin. Nutr. 1992; 56; 565572.CrossRefGoogle Scholar
49Tseng, M, Chakraborty, H, Robinson, DT, Mendez, M, Kohlmeier, L.Adjustment of iron intake for dietary enhancers and inhibitors in population studies: bioavailable iron in rural and urban residing russian women and children. J. Nutr. 1997; 127: 14561468.CrossRefGoogle Scholar
50Hallberg, L, Hulthen, L.Prediction of dietary iron absorption. An algorithm to calculate absorption and bioavailability of dietary iron. Am. J. Clin. Nutr. 2000; 71: 11471160.CrossRefGoogle ScholarPubMed
51Lonnerdal, B.Effects of milk and milk components on calcium, magnesium, and trace element absorption during infancy. Physiol. Rev. 1997; 77: 643669.CrossRefGoogle ScholarPubMed
52Pisacane, A, De Vizia, B, Valiante, A, Vaccaro, F, Russo, M, Grillo, G, Giustardi, A.Iron status in breast-fed infants. J. Pediatr. 1995; 127: 429431.CrossRefGoogle ScholarPubMed
53Dewey, KG, Cohen, RJ, Brown, KH, Rivera, LL. Age of introduction of complementary foods and growth of term, low-birth-weight, breast-fed infants: a randomized intervention study in Honduras. Am. J. Clin. Nutr. 1999; 69: 679686.CrossRefGoogle ScholarPubMed
54WHO (1999) Infant and young child feeding in the WHO European Region – Guidelines with emphasis on the former Soviet Union. WHO, Copenhagen (in preparation).Google Scholar
55Milman, N, Agger, AO, Nielsen, OJ. Iron status markers and serum erythropoietin in 120 mothers and newborn infants: effect of iron supplementation in normal pregnancy. Acta. Obstet. Gynecol. Scand 1994; 73: 200204.CrossRefGoogle ScholarPubMed
56Hemminki, E, Rimpela, U.A randomized comparison of routine versus selective iron supplementation during pregnancy. J. Am. Coll. Nutr. 1991; 10: 310.CrossRefGoogle ScholarPubMed
57Hurell, R.Fortification. Nutrition Rev. 1997; 55: 210222.Google Scholar