American data show that around 35% of women of reproductive age (under 50 years old) have an iron deficiency in their bodies. In Brazil, the estimate is even higher: it is estimated that between 40% and 50% of young women suffer from some iron deficiency, which is often not identified because the dosage of this nutrient is not usually part of routine examinations. Iron deficiency is the main cause of anemia, the most prevalent nutritional deficiency in the world, which affects 33% of non-pregnant women, 40% of pregnant women and 42% of children worldwide, according to data from the WHO (World Organization of health).
The main factor that leads to iron deficiency in women is an intense menstrual cycle, with a lot of blood loss — eliminating clots can be a way to identify the amount of flow.
“Often, women are unable to recover the iron lost between periods. Furthermore, there are cases of iron deficiency caused by inadequate nutrition, with very restrictive diets. [pouca carne e pouco alimento rico em ferro]both due to the imposition of beauty and due to situations in which people do not have access to food”, observed Ana Paula Beck, gynecologist and obstetrician at the Maternal and Child Department at Hospital Israelita Albert Einstein.
Other situations also lead to the problem, such as disabsorptive bariatric surgery (which alters intestinal transit and, consequently, reduces the absorption of vitamins and nutrients), inadequate nutrition and restrictive diets. In fact, in a statement issued in 2021, the WHO stated that reducing anemia was one of the components of efforts to eradicate all forms of malnutrition. In 2020, according to the international health organization, there were 614 million women and 280 million children worldwide who suffered from anemia.
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Males can also be iron deficient. The main cause of anemia in this group is blood loss in the digestive tract, which needs to be investigated. Other causes are intestinal malabsorption or chronic diseases. In the case of men, however, anemia is not as common, since there is no monthly loss of iron, as occurs in women, due to menstruation.
Currently, the considered healthy levels of iron and ferritin in the blood in women are above 50 mcg/dl and 15 mcg/l, respectively. There is a discussion around increasing these levels for females, aiming to reduce the risk of anemia and improve the functions of these substances in the body, but there is still no definitive consensus.
“It is an absolutely debatable topic, but the ideal is to maintain at least the minimum levels already determined”, commented hematologist Nelson Hamerschlak, from Hospital Israelita Albert Einstein.
What is iron for?
Iron is used to make hemoglobin, which is a protein in red blood cells that carries oxygen from the lungs to the rest of the body. It is also essential for other functions, such as DNA synthesis and energy metabolism.
“Iron also helps in the respiratory chain of cells in the so-called mitochondria and in nitrogen fixation. It directly contributes to the manufacture of red blood cells, muscle myoglobin and liver elements,” explained Hamerschlak.
When not used to produce hemoglobin, iron is stored in tissues in general, mainly in the bone marrow and liver, where it is bound to a protein called ferritin (an indicator of iron reserves). When iron reserves decrease, what is available is redirected to the maintenance of red blood cells, to the detriment of their other functions. If the body uses up its reserves, iron deficiency leads to a reduction in hemoglobin and the number of healthy red blood cells — and this is where iron deficiency anemia appears, the main cause of anemia in Brazil and around the world.
“There are other types of anemia, including sickle cell disease, thalassemia, B12 deficiency, folic acid, autoimmune, etc., but iron deficiency anemia is by far the most common,” Hamerschlak highlighted.
Symptoms and treatment of iron deficiency
The symptoms of iron deficiency tend to be very non-specific and include everything from shortness of breath, tiredness, mental confusion, hair loss, weakening of nails, dizziness, increased sensitivity to cold and heart palpitations. The main problem is anemia, which, if not identified and treated, can progress to a serious condition and lead to heart failure and changes in cellular metabolism and energy production.
In pregnant women, the concern is even greater, due to the increased need for blood circulating to the fetus and placenta. An iron deficiency during pregnancy can cause anemia, low birth weight and premature birth. Furthermore, it has been associated with neurological development problems, with significant effects on brain development, leading to delays in neuropsychomotor progress and negative consequences for later learning and school performance.
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Figo (International Federation of Gynecology and Obstetrics) recently issued a recommendation that all patients have their iron levels measured regularly, regardless of whether they are pregnant or not. Here in Brazil, Febrasgo (Brazilian Federation of Gynecology and Obstetrics Associations) published a similar recommendation last year, which advises investigating and treating all women with abnormal uterine bleeding with iron replacement.
According to the Einstein gynecologist, there is still no guidance or guideline in Brazil for routine iron dosage screening in all women of reproductive age, but she highlights that there is an effort mainly in the third trimester of pregnancy so that women do not go for childbirth with anemia or iron deficiency.
“The ideal world would be to evaluate anemia and iron in all our patients, but we are not always able to do this in a generalized way. We have greatly increased requests for iron testing and the demand for iron deficiency anemia, which is, without a doubt, the main cause of anemia in Brazil”, said Beck.
Iron deficiency anemia is a global public health problem. From the moment it was diagnosed and the cause was identified, treatment involves iron replacement with oral or intravenous supplementation, depending on the severity of the case, in addition to an adequate diet mainly based on meat, fish and chicken. Some vegetables are also rich in iron, but for better absorption by the body, they need vitamin C. “The use of iron pans, oddly enough, can also help,” added Hamerschlak.
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