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Klaus Kraemer, Michael B. Zimmermann "Nutritional Anemia"

For half a billion women in developing regions worldwide, anemia is a life-long burden, one which affects most of their infants and young children as well. Controlling anemia in these vulnerable groups could significantly reduce maternal and infant morbidity.

It would also enhance intellectual and work capacity, thereby improving family, community and national socioeconomic development. In May 2002, the General Assembly of the United Nations reemphasized that control of nutritional anemia should be one of the global Development Goals to be achieved in the early years of this new millennium. Despite this, the global prevalence of anemia has hardly declined in the past decade, although considerable programmatic experience exists and a vast amount of scientific data has been compiled on iron metabolism. Much is still unknown, however, and many new issues continue to emerge from the ongoing research, both basic and programmatic. The reasons for this lack of improvement include the multifactorial etiology of anemia, underfunding and poor program implementation, often designed on the assumption that the sole cause of anemia is iron deficiency.

It is increasingly clear that effective control of anemia requires integrated solutions that are tailored to the particular needs and opportunities in each country. Components of such an approach include food fortification, micronutrient supplementation of vulnerable groups (particularly children and women of childbearing age), education, and dietary diversification, as well as control of diseases such as malaria, worm infections, and other chronic endemic infections. While each of these can help reduce the burden of anemia, none is capable of doing the job on its own. The chapters of this book offer an account of the information that was presented and comprehensively discussed at a workshop on Nutritional Anemia in Barcelona, Spain, on September 27, 2006, in which all the contributors to this volume themselves took part. This event was co-organized by the editors of this volume. We sought the timely publication of this book in order to provide the latest update on the complex causes and consequences of nutritional anemia, and the effectiveness of current control strategies. The field of anemia is clearly of great interest to scientists, policy makers and program mangers. We hope this volume will help point the way forward in controlling this major global health problem. The introductory chapters in this book give an overview of the global burden of anemia prevalence, the economic implications and functional consequences, and the significance of these factors for policy makers. Subsequent chapters provide basic scientific information on iron metabolism and interactions with macronutrients and micronutrients as well as the role of infections in fostering anemia. Other chapters address the information needs of program managers, detailing programmatic approaches and outlining the safety and technical aspects of interventions.

Contents

Nutritional Anemia

Cover

Title Page

Copyright

PREFACE

FOREWORD

CONTRIBUTORS

CONTENTS

CHAPTER 1 Worldwide prevalence of anemia in preschool aged children,pregnant women and non-pregnant women of reproductive age

CHAPTER 2 The case for urgent action to address nutritional anemia

CHAPTER 3 The economics of addressing nutritional anemia

CHAPTER 4 Diagnosis of nutritional anemia – laboratory assessment of iron status

CHAPTER 5 An overview of the functional significance of iron deficiency

CHAPTER 6 Iron metabolism

CHAPTER 7 Optimizing the bioavailability of iron compounds for food fortification

CHAPTER 8 Copper and zinc interactions in anemia: a public health perspective

CHAPTER 9 Nutritional anemia: B-vitamins

CHAPTER 10 Vitamin A in nutritional anemia

CHAPTER 11 Oxidative stress and vitamin E in anemia

CHAPTER 12 Selenium

CHAPTER 13 Interactions between iron and vitamin A, riboflavin, copper, and zinc in the etiology of anemia

CHAPTER 14 Anemia in severe undernutrition (malnutrition)

CHAPTER 15 Infection and the etiology of anemia

CHAPTER 16 Making programs for controlling anemia more successful

CHAPTER 17 Successful approaches: Sprinkles

CHAPTER 18 Safety of interventions to reduce nutritional anemias

CHAPTER 19 The importance and limitations of food fortification for the management of nutritional anemias

CHAPTER 20 Food-based approaches for combating iron deficiency

CHAPTER 21 Global perspectives: accelerating progress on preventing and controlling nutritional anemia

CHAPTER 22 Conclusions and research agenda

Index

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