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Старый 01.09.2007, 01:23
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Nutritional iron deficiency

Zimmermann MB, Hurrell RF.
Lancet. 2007 Aug 11;370(9586):511-20.


Epidemiology

WHO estimates that 39% of children younger than 5 years, 48% of children between 5 and 14 years, 42% of all women, and 52% of pregnant women in developing countries are anaemic,6 with half having iron deficiency anaemia.7 According to WHO, the frequency of iron deficiency in developing countries is about 2·5 times that of anaemia.6 Iron deficiency is also common in women and young children in industrialised countries. In the UK, 21% of female teenagers between 11 and 18 years, and 18% of women between 16 and 64 years are iron deficient.8 In the USA, 9–11% of non-pregnant women aged between 16 and 49 years are iron deficient, and 2–5% have iron deficiency anaemia, with more than twofold higher frequency in poorer, less educated, and minority populations.9 In pregnant women of low-income areas in the USA, the frequency of iron deficiency anaemia in the first, second, and third trimesters is 2%, 8%, and 27%, respectively.9 In France, iron deficiency and iron deficiency anaemia affect 29% and 4% of children younger than 2 years;10 in the USA, 2% of children between 1 and 2 years have iron deficiency anaemia.1

Adverse effects

The high frequency of iron deficiency anaemia in the developing world has substantial health and economic costs. In an analysis of ten developing countries, the median value of physical productivity losses per year due to iron deficiency was about US$0·32 per head, or 0·57% of the gross domestic product.54 In the WHO African subregion, it is estimated that if iron fortification reached 50% of the population, it would avert 570 000 disability adjusted life years (DALYs) every year.55 During the first two trimesters of pregnancy, iron deficiency anaemia increases the risk for preterm labour, low birthweight, infant mortality, and predicts iron deficiency in infants after 4 months of age.[56] and [57] Estimates are that anaemia accounts for 3·7% and 12·8% of maternal deaths during pregnancy and childbirth in Africa and Asia, respectively.58 Data for the adverse effects of iron deficiency on cognitive and motor development in children are equivocal because environmental factors limit their interpretation.[59], [60] and [61] Several studies reported adverse effects of iron deficiency anaemia on infant development that might be only partly reversible.[59] and [60] Other studies suggest that no convincing evidence exists that iron deficiency anaemia affects mental or motor development in children younger than 2 years, but that iron deficiency adversely affects cognition in school children.61 Anaemic school-children have decreased motor activity, social inattention, and decreased school performance.60 Whether adverse effects of iron deficiency on neuromotor development are due to anaemia or absence of iron in the developing brain is unclear.62 Iron deficiency anaemia increases susceptibility to infections, mainly of the upper respiratory tract, which happen more often and have a longer duration in anaemic than in healthy children.63 A recent study showed no positive effect of iron supplementation on physical growth during childhood.64 The response to iodine prophylaxis is reduced in goitrous children with deficiencies of both iodine and iron,[65] and [66] probably because of impairment of the haem-dependent enzyme, thyroid peroxidase.67 Iron supplementation can increase low serum retinol concentrations in iron-deficient children.[68] and [69] Iron deficiency might increase the risk for chronic lead poisoning in children exposed to environmental lead.70 In adults, physical activity is reduced,71 and manual labourers in developing countries are more productive if they are given iron and treated for hookworm and other infections.72 Iron deficiency, even in the absence of anaemia, might cause fatigue and reduce work performance.[73] and [74]
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Искренне,
Вадим Валерьевич.