home Audience 5 Measures to prevent iron deficiency conditions. Pharmaceutical care: treatment of iron deficiency anemia. Possible side effects when taking iron supplements

Measures to prevent iron deficiency conditions. Pharmaceutical care: treatment of iron deficiency anemia. Possible side effects when taking iron supplements

In cases where the prevalence of iron deficiency conditions in a particular region exceeds 40%, for the purpose of mass prevention of anemia in adults and children, it is recommended to carry out a number of measures aimed at the timely detection, elimination and prevention of the development of this pathology.

MASS PREVENTION

Fortification. This procedure involves fortifying foods widely consumed by the population with iron. Typically this role is played by bread or pasta. To successfully prevent anemia, it is necessary that the percentage of the population consuming this product is at least 65%. However, the active implementation of fortification is complicated by a number of circumstances. The main one is the lack of a food product that optimally transports iron compounds and promotes its good absorption. Therefore, at present, the effectiveness of mass prevention does not exceed 50% among the population covered.

Supplementation. Targeted prevention of anemia in people at risk using prophylactic doses of ferrodrugs is considered more effective. Supplementation is carried out particularly in women in the 2nd and 3rd trimesters of pregnancy and during the first three months of lactation. Currently, statistics show that with coverage ranging from 50 to 95% of expectant mothers, only 67% of them receive an effective dose.

PRIMARY PREVENTION

SECONDARY PREVENTION OF IRON DEFICIENCY

Secondary prevention means early diagnosis of latent iron deficiency. Diagnostics are recommended to be carried out every time patients visit doctors, as well as during medical examinations, clinical examinations, etc., especially for people at risk. For secondary prevention, if necessary, the doctor prescribes iron-containing medications. In addition to them, hematogen can be used.

WHO IS IN RISK GROUPS

These include persons:

with low socio-economic status (dysfunctional families, refugees, migrants);
who have previously been diagnosed with iron deficiency anemia;
who have a history of lead poisoning;
on a vegetarian diet;
whose lifestyle includes active physical activity and professional athletes;
with gastrointestinal diseases;
females of childbearing age, especially after multiple pregnancies or frequent births.

Children also at risk include:

whose mothers refused breastfeeding or interrupted it after four months of age;
born prematurely or with low birth weight;
those who receive large amounts of cow's milk or whose diet contains mainly plant-based products;
developmentally delayed or with special needs due to their health status.

", September 2012, p. 35-38

Yu.S. Abrosimova, Nutricia LLC

Russian studies in recent years indicate nutritional status disorders in children 1–3 years old, including an increase in iron deficiency states. The article discusses the probable causes of deficiency in iron intake, and proposes enriching the diet of children over one year old with the help of a new product - the “Malyutka ®” powdered milk drink with the “Smart Iron ®” complex.

Doctors have known about the importance of a balanced diet and adherence to nutrition in the first year of life for more than 100 years. Unfortunately, less attention is paid to the nutrition of children over one year old, although a nutritious diet remains important at this stage of rapid child growth. It is known that during the second year of life, a child grows by 12–14 cm and gains 3–4 kg in weight, which is about 50% of the growth rate of an infant. The level of energy expenditure of the body on physical activity also increases, and the anatomical and functional development of the gastrointestinal tract is noted. Anatomical and physiological characteristics are not the only factor that determines the “criticality” of the age period of 1–3 years. Equally important is the formation of eating behavior. A baby's desire or unwillingness to eat anything can become a serious obstacle to ensuring adequate nutrition. .

Nutritional needs of young children

The above-described anatomical and physiological characteristics of children over 1 year of age determine their special nutritional needs (Table 1).

Table 1
Norms of daily energy and nutritional requirements for children 1–2 years old and adults

*Depending on physical activity

In terms of per kilogram of body weight, the average daily needs of children of the second and third years of life for most nutrients significantly exceed the needs of an adult, which requires an increased content of these components in the daily diet.

For example, the iron requirements of young children are equal to those of an adult male (10 mg/day). Thus, per kilogram of body weight, a child needs 5 times more iron daily than an adult.

Therefore, unbalanced nutrition at this age is critical and can lead to the development of deficiency conditions. The nature of nutrition changes rapidly in the period of 9–36 months: the intervals between meals increase significantly, the foods consumed become more varied. The vast majority of the diet is energy-intensive food: cereals, vegetables, fruits, meat, etc. Achieving a balance between the consumption of milk and other products becomes an important step in the child’s transition to an adult diet.

The influence of modern lifestyle on the nutritional status of young children

The culture of feeding children directly depends on the eating behavior of parents.

The modern rhythm of life and socio-economic factors have a significant impact on the lifestyle and nutrition of an adult: the lack of “family dinners” leads to non-compliance with the diet; Great importance is attached to speed of preparation, which leads to an increase in the consumption of fast food and semi-finished products, etc.

Studies conducted in the Russian Federation have shown that the diet of children in the younger age group is far from ideal, which ultimately leads to the development of pathology in the future: 87% have an excess of pasta, including instant noodles; every tenth child does not eat fruit; some children drink more than 1 l/day of cow's milk; 17% of children do not eat meat at all; Only 52% of children eat fish.

Iron deficiency

One of the most common nutritional deficiencies is iron deficiency. According to Russian data, more than 43% of young children have iron deficiency anemia. Taking into account that iron deficiency conditions without anemia are 1.5–2 times more common, it can be assumed that more than 60% of young children in Russia suffer from iron deficiency.

The consequences of iron deficiency are determined by the degree of involvement of this element in metabolism. Iron is a constituent element of hemoglobin, myoglobin and some enzymes, performing various functions in metabolism (Table 2).

table 2
Iron-containing proteins of the body and their functions

Protein	Localization	Function
Hemoglobin	Red blood cells	Transport of oxygen to tissues
Myoglobin	Muscles	Oxygen accumulation
Iron-containing proteins of mitochondria (cytochromes, etc.)	Most cells	Energy production in cells (ATP)
Transferrin	Blood	Iron transportation
Ferritin/hemosiderin	Liver, spleen, bone marrow	Iron depot
Iron-containing oxidase enzymes	Brain	Functioning of neurotransmitter systems

In the absence of correction of nutritional status, iron deficiency inevitably leads to the development of iron deficiency anemia, which negatively affects the intellectual development, psychomotor and cognitive development, behavioral and physical skills of the child. There is evidence that the effect of iron deficiency anemia on psychomotor development may be irreversible, despite treatment.

Practical nutrition

Specific preventive measures can prevent the development of iron deficiency conditions. It is necessary to provide the child with the main sources of iron - red meat, offal, fish, eggs. It is important to consider the bioavailability of iron in the diet and control the amount of foods that inhibit iron absorption.

Educational work with parents is important - for example, there are often misconceptions that chicken breast and apple juice are the main suppliers of iron. In fact, these products in the quantities consumed cannot provide even half of the daily iron requirement.

The dangers of early introduction of whole cow's milk and consumption of large quantities in combination with a low iron diet should be noted. Studies conducted in several countries have shown a direct link between the development of iron deficiency conditions and consumption of large quantities of whole cow's milk.

The facts described above, trends in modern lifestyle and evidence of the negative consequences of deficiency conditions were the basis for the development of specialized products for the healthy nutrition of children over one year old.

These are milk drinks produced specifically for baby food. Their key benefits are a balanced content of minerals and vitamins such as Fe, Zn, I and vitamin D, an increased concentration of essential fatty acids and reduced levels of protein and saturated fatty acids compared to whole cow's milk. Enrichment with functional ingredients, such as prebiotics, also has a positive effect on children's digestion. Modern production technologies make it possible to preserve the beneficial components of the drink when diluting it.

Numerous studies have proven the effectiveness of consumption of specialized milk drinks by young children.

For example, the study by Daly et al. demonstrated that the use of an iron-fortified formula as a primary beverage in children aged 6 to 18 months. leads to a significant reduction in the frequency of anemia at 12 and 18 months of life, as well as its complete absence by 2 years. Randomized study by Williams J et al. showed that at the age of 2 years, in the group of children who received a specialized milk drink, the parameters of psychomotor development were higher than in children who received cow's milk.

Powdered milk drink Malyutka ® for older children is a milk nutrition specially developed in addition to solid food that enriches the diet of children over 12 months with components “at risk”, for which children of a younger age group may develop deficiency, and the need for which is not covered by consumption cow's milk.

Comparative nutritional data for the milk drink and whole cow's milk are presented in Table 3.

Table 3
Composition of the milk drink Malyutka ® 3 for large ones compared to whole cow's milk

per 100 ml	Malyutka ® 3 for big ones	Whole cow's milk
Energy value, kcal	70	65
Protein, g	2	3,3
Casein/Whey Protein	80/20	80/20
Carbohydrates, g	8,5	4,8
Fat, g	3,9	3,6
Polyunsaturated fatty acids, g	0,485	0,1
Dietary fiber, g	0,8	No
Sodium, mg	25	47
Calcium, mg	97	118
Phosphorus, mg	55	84
Iron, mg	1,1	0,05
Zinc, mg	0,65	0,38
Copper, µg	42	8
Iodine, mcg	16	2,7
Selenium, mcg	1,9	1
Vitamin A, mcg RE	69	40
Vitamin D, mcg	1,5	0,07
Vitamin E, mg alpha-TE	1,2	0,09
Vitamin K, mcg	5,3	0,3
Thiamine (B1), mcg	63	39
Folic acid, mcg	13	5
Vitamin C, mg	9,7	2

Please note that, compared to cow's milk, the dry milk drink Malyutka ® 3 for adults:

Increases intake of iron, iodine, zinc and vitamin D to prevent deficiency of these components
Contains prebiotic fiber to increase the concentration of bifidobacteria and increase the frequency of bowel movements.

An important advantage of the Malyutka ® milk drink for adults is the Smart Iron ® complex - iron in optimal combination with zinc and vitamin C for better absorption of iron. When the balance is maintained, the absorption of these elements is optimal, which gives the Smart Iron ® complex an important role in the prevention of iron deficiency in young children.

In situations where children refuse milk, it is important to attract the child to a healthy product with a pleasant taste. Taking into account the food preferences of babies, baby milk Malyutka ® 3 milky and juicy was created - these are 3 milk drinks with different fruit additives (banana, peach, wild berries), which combines the benefits of baby milk and the taste of preferred fruits. The recommended amount of consumption of baby milk Malyutka ® 3 from 1 to 1.5 years and Malyutka 4 - from 1.5 to 3 years - both as a separate drink and for adding to cereals to prepare a delicious dish for breakfast or dinner - 300 –400 ml per day.

Conclusion

Iron deficiency is a common problem among children over one year of age.

Timely dietary prevention of nutrient deficiency opens up new opportunities for shaping the future health of the child. Dry milk drink Malyutka ® for adults, developed taking into account special age needs, allows you to optimize the nutrition of children of the younger age group in the modern rhythm of life.

The list of references is in the editorial office.

A.G. BLUSHIN 1.4, Doctor of Medical Sciences, Prof., I.N. ZAKHAROV 2, doctor of medical sciences, prof., V.M. CHERNOV 1.4, doctor of medical sciences, prof., I.S. TARASOVA 1.4, doctor of medical sciences, A.L. PATCHERS 2, doctor of medical sciences, prof.. ON THE. COROVIN 2, doctor of medical sciences, prof., T.E. BOROVIK 3.5, doctor of medical sciences, prof., N.G. ZVONKOVA 3.5, Ph.D., E.B. MACHNEVA 2 , S.I. LAZAREV 6 , T.M. VASILIEV 6

1 Federal State Budgetary Institution "Federal Scientific and Clinical Center for Pediatric Hematology, Oncology and Immunology named after. Dmitry Rogachev" of the Russian Ministry of Health
2 GBOU DPO "Russian Medical Academy of Postgraduate Education" of the Ministry of Health of Russia
3 Federal State Budgetary Institution "Scientific Center for Children's Health"
4 State Budgetary Educational Institution of Higher Professional Education "Russian National Research Medical University named after. N.I. Pirogov" of the Ministry of Health of Russia
5 State Budgetary Educational Institution of Higher Professional Education “First Moscow State Medical University named after. THEM. Sechenov" of the Ministry of Health of Russia
6 GBUZ "Children's City Clinic No. 133" of the Moscow Healthcare Department

Iron deficiency conditions (IDC) are widespread in all countries of the world, therefore doctors of almost all specialties need to know about this disease. Knowledge about iron deficiency anemia (IDA) and latent iron deficiency (LDI) is especially important for a practicing pediatrician. The article presents data from domestic and foreign studies on the prevalence of IDA and LVAD. The most significant factors influencing the prevalence of WDN among various population groups are discussed: gender, age, environmental, physiological, socio-economic factors.

Iron deficiency anemia (IDA) is a polyetiological disease, the occurrence of which is associated with iron deficiency (ID) in the body due to impaired intake, absorption or increased losses, characterized by microcytosis and hypochromic anemia. In turn, latent iron deficiency (LID) is an acquired condition in which there is a hidden iron deficiency, a decrease in iron reserves in the body and insufficient iron content in tissues (sideropenia, hyposiderosis), but there is no anemia yet.

Iron deficiency is a widespread pathology among the population throughout the globe. According to the World Health Organization (WHO), iron deficiency (ID) ranks first among the 38 most common human diseases. The risk of developing ID is highest in children (especially the first two years of life) and women of reproductive age. According to S.Osendarp et al. In the world, about 50% of preschool children and pregnant women have anemia. With an anemia frequency of 20%, ID exists in 50% of the population in the population, and with an anemia frequency of 40% and above, the entire population has various types of ID. According to research by D. Subramanian et al., 9% of children in the first two years of life have IDA.

According to WHO experts, iron deficiency still remains one of the most significant malnutrition-related diseases in the world. Iron deficiency negatively affects the cognitive development of children, both young and adolescent, and damages immune mechanisms, which leads to an increase in the incidence of infectious diseases. If ID is present during pregnancy, various adverse outcomes are possible, both for the mother (increased risk of bleeding, sepsis, maternal mortality) and for the fetus (increased risk of perinatal mortality and low birth weight). Even in industrialized countries, most pregnant women have insufficient iron stores in their bodies. The presence of ID affects physical performance and labor productivity of both men and women. WHO experts concluded that the economic consequences of iron deficiency make it clear that it is necessary to prevent this pathology with the use of iron-fortified food supplements.

WHO experts have done a lot of work, as a result of which it was shown that anemia is more common in developing countries; two groups of the population are most susceptible to anemia - young children and pregnant women ( table 1).

Due to its high prevalence, anemia occurs in the practice of doctors in almost any specialty. It is known that IDA accounts for 90% of all anemia in childhood and 80% of all anemia in adults. Previously, it was believed that all anemia in pregnant women was iron deficiency, however, it was later shown that IDA accounts for 60−70% of all anemia in this category of the population, and the remaining anemia has a different origin.

As already noted, iron deficiency anemia is more common in developing countries than in developed countries. In India, for example, up to 88% of pregnant and 74% of non-pregnant women suffer from anemia, in Africa - about 50% of pregnant and 40% of non-pregnant women. In Latin America and the Caribbean, the prevalence of anemia in pregnant and non-pregnant women is about 40% and 30%, respectively.

Data on the prevalence of anemia in different age groups are not available in all countries, however, the prevalence rate among preschool children is usually the same as or even higher than among pregnant women. According to WHO experts, the prevalence of IDA in the population can be moderate – from 5 to 19.9%, moderate – from 20 to 39.9% and significant – 40% or more ( table 2). When the prevalence of anemia is more than 40%, the problem ceases to be only a medical one and requires measures to be taken at the state level.

The prevalence of ID varies significantly depending on factors such as age, gender, physiological characteristics, existing diseases, environmental and socio-economic conditions.

Full-term babies, as a rule, are born with sufficient iron reserves in the liver and hematopoietic tissue. Subsequently, breast milk provides a certain amount of iron into the baby’s body. Despite the fact that breast milk has a relatively low iron content (0.2-0.4 mg/l), it is much better absorbed from breast milk (50% bioavailability) than from cow's milk. ID often develops after 6 months. in case untimely and incorrect introduction of complementary feeding products does not provide sufficient iron intake. Iron requirements based on body weight are proportional to the child's growth rate. This is why iron deficiency is most common during the preschool years and puberty. Another increase in the prevalence of ID may occur in old age, when nutrition often deteriorates in quality and quantity.

The prevalence of ID varies by gender. Gender differences are most noticeable after puberty. After the onset of menarche in adolescent girls, iron losses due to uterine bleeding are often not sufficiently compensated for by an adequate diet. VSD that arises during puberty persists in the future in 10-12% of women of reproductive age.

The physiological characteristics of the body also affect the incidence of anemia. The most noticeable differences are typical for pregnant women. Significant amounts of iron from a woman’s body enter the placenta and fetus during pregnancy. This leads to an increase in iron requirements of about 700 – 850 mg throughout pregnancy. Lactation leads to loss of iron through breast milk (1 mg/day), therefore, for some women, ID that occurs during pregnancy may worsen during lactation. However, from an iron balance perspective, lactational amenorrhea in healthy women compensates for iron losses through breast milk.

Scientists from various countries have conducted studies on the prevalence of WDN among various population groups. The studies varied in scope. In Japan, mandatory screening of school-age children has been carried out for 30 years for the purpose of early detection of IDA. Published in 2012 by Igarashi T. et al. The data showed the prevalence of anemia among schoolchildren in Japan: 0.26% in elementary school among boys, 0.27% in elementary school among girls, 1.21% in middle school among boys. The prevalence of anemia in girls' second and third years of secondary school was lower than in the first year of secondary school. IN table 3 data on the prevalence of IDA in some developed and developing countries is presented.

Table 3. Prevalence of IDA in developed and developing countries
A country	Year of publication, author	Frequency, %	Children's age
China	Zhu Y, Liao Q, 2004	20,8	6 months –1 year
China	Zhu Y, Liao Q, 2004	7,8	1–3 years
WHO	Corapci F. et al., 2010	20–25	First 2 years of life
USA	Baker R., Greer F., 2010	2,1	From 1 year to 3 years
		2,0
		1,6
		0,9
USA	Amy Zhu et al., 2010	7	1–2 years
		5	3–5 years
		4	6–11 years
African Americans USA	Angulo-Barroso R.M. et al.,2011	39,8	9 months
Ghana		55	9 months
Brazil	Cotta R. et al., 2011	55	Children under 5 years old
China	Angulo-Barroso R.M. et al., 2011	31,8	9 months
Japan	Igarashi T. et al., 2012	1,05–7,1	7–15 years

IN table 4 presents data on the prevalence of latent iron deficiency (LDI) in some developed and developing countries.

Table 4. Prevalence of latent iron deficiency in developed and developing countries
A country	Year of publication, author	Frequency, %	Children's age
China	Zhu Y, Liao Q., 2004	65,5	6 months –1 year
China	Zhu Y, Liao Q., 2004	43,7	1–3 years
Norway	Hay G. et al., 2004	4,0	6 months
Norway	Hay G. et al., 2004	12	1 year
USA	Baker R., Greer F., 2010	9,2	1–3 years
		7,3	White non-Hispanic Americans
		6,6	Black non-Hispanic Americans
		13,9	Mexican Americans

Zhu Y.P. et al. In 2004, a large epidemiological study of the prevalence of WDN among children in China was conducted. 9,118 children aged 7 months to 7 years were examined. According to the study results, the prevalence of LID and IDA was 32.5% and 7.8%, respectively. Moreover, the prevalence of LID and IDA was the highest in newborns - 44.7% and 20.8%, respectively. In preschool children aged 4 to 7 years, the prevalence was lower: 26.5% had LID, 3.5% had IDA. A comparison was made of the prevalence of WDN among children living in the city and in rural areas. Urban children had a higher prevalence of LID than rural children, however, rural children had a higher prevalence of anemia.

A. Zhu et al. in their 2010 publication, they provide data on the prevalence of IDA in the United States, taken from the Centers for Disease Control and Prevention for 1999–2000. In the United States, a developed country, the prevalence of IDA was also higher in young children (1-2 years old) - 7% and lower in older children (6-11 years old) - 4%.

Research on the prevalence of VDN is being conducted in various regions of our country. So back in 1988 Yu.E. Malakhovsky et al. The results of a study of the frequency of IDA and LVAD in children were published. It is shown that by the end of the 80s. XX century LDV frequency ( rice. 1) and mild forms of IDA ( rice. 2) among children of the first 6 months. life reached 40%. With age, there was a significant decrease in the incidence of ID (by the end of the 2nd year of life, IDA was registered in more than 10% of children, and LDJ in more than 20%).

Currently, according to various authors, it has been shown that the prevalence of VDV in children depends on the region, for example, VDV in some regions of the Russian Federation (North, Northern Caucasus, Eastern Siberia) reaches 50–60%. According to Yunusova I.M. (2002), the prevalence of IDA among the child population of various districts of Makhachkala was 43%.

Also, the frequency of VDN in our country was studied depending on the age group and gender. According to Tarasova I.S. (2013), the prevalence of anemia and the structure of IDA in adolescents have pronounced gender differences: anemia was detected in 2.7% of boys and 9% of girls, IDA – in 2.1 and 17.2%, respectively, IDA – in 2.7 and 7.3% respectively.

The prevalence of WDN is also influenced by socio-economic conditions. So, according to Malova N.E. (2003), VSD are detected in 80.2% of young children in orphanages. In the structure of sideropenic conditions, the leading place is occupied by IDA - 59.3%, LID occurred in 40.7% of the examined children.

Thus, accumulated global and domestic data on the prevalence of iron deficiency states show that it is high and depends on many factors: gender, age, environmental factors, socio-economic living conditions, and the presence of pathological factors. This should be remembered by a practicing physician of any specialty in order to promptly suspect and diagnose VHD for the purpose of adequate and early therapy. In addition, there is an obvious need for systematic updating of data on the prevalence of WDN based on epidemiological studies among various population groups, since the structure of factors influencing it changes over time.

Literature

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Subramanian D.N., Kitson S., Bhaniani A. Microcytosis and possible early iron deficiency in pediatric inpatients: a retrospective audit. BMC Pediatr. 2009; 9:36.
UNICEF, United Nations University, WHO. Iron deficiency anemia: assessment, prevention and control. A guide for program managers. Geneva: World Health Organization; 2001 (WHO/NHD/01.3). – 114 p.Available at:http://www.who.int/nutrition/publications/micronutrients /anaemia_iron_deficiency/WHO_NHD_01.3/en
Anemia in children: diagnosis, differential diagnosis, treatment. Ed. A.G. Rumyantsev and Yu.N. Tokarev. 2nd ed. add. and processed M.: MAX Press; 2004. – 216 p.
Hertl M. Differential diagnosis in pediatrics. Per. with him. Volume 2. M.: Medicine; 1990. – 510 p.
Guide to Hematology. Ed. A.I. Vorobyov, 3rd edition, volume 3. M.: Newdiamed; 2005. – 409 p.
Huh R., Breiman K. Anemia during pregnancy and the postpartum period. Per. from English Tver: Triad; 2007. – 73 p.
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Tuermen T. Maternal mortality and morbidity due to anemia and postpartum haemorrhage. In: Prevention and management of anemia in pregnancy and postpartum hemorrhage. Huch A., Huch R., Breymann C., eds. Zurich: Schellenberg Verlag; 1998: 10–15.
Igarashi T., Itoh Y., Maeda M., Igarashi T., Fukunaga Y. Mean haemoglobin levels in venous blood samples and prevalence of anemia in Japanese elementary and junior high school students. J. Nippon. Med. Sch. 2012; 79: 232–235.
Baker R.D., Greer F.R. and The Committee on Nutrition. Clinical report - diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics. 2010; 126(5):1040–1052.
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Corapci F., Calatroni A., Kaciroti N., Jimenez E., Lozoff B. Longitudinal evaluation of externalizing and internalizing behavior problems following iron deficiency in infancy. J. Pediatr. Psychol. 2010; 35(3):296–305.
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Angulo-Barroso R.M., Schapiro L., Liang W., Rodrigues O., Shafir T., Kaciroti N., Jacobson S.W., Lozoff B. Motor development in 9-month-old infants in relation to cultural differences and iron status. Dev. Psychobiol. 2011; 53: 196–210.
Cotta R.M., Oliveira F., Magalhães A., Ribeiro A.Q., Sant "Ana L.F., Priore S.E., Franceschini Sdo.C. Social and biological determinants of iron deficiency anemia. Cad. Saúde Pública, Rio de Janeiro. 2011; 27 (2 ): 309–320.
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Source: Medical Council, No. 6, 2015

The well-being of a nation is determined by its level of health, one of the components of which is nutrition. It is a necessary condition for normal life activity and performance, resistance to diseases, and an active life position both in adulthood and in childhood.

However, the negative trends of recent decades have affected the health of citizens of the entire state, which is reflected in a significant reduction in life expectancy: according to this indicator, Russia lags behind developed countries by 20–25 years. Often people, especially men, die immediately after they retire.

Of course, an unbalanced diet plays a significant role in such sad statistics, when the diet is overloaded with fats and carbohydrates, but there is a constant lack of proteins, vitamins, and microelements, including fluorine, iron, potassium, iodine, and calcium. The reason for such imbalances in nutrition may be hidden both in a significant decrease and loss of purchasing power of Russian citizens, and in a lack of knowledge in matters of proper healthy nutrition. When filling the food basket, citizens of our country are often guided solely by their own taste preferences, without thinking about the importance of providing the body with micronutrients that are not synthesized by the body itself, but come there exclusively from the outside. In this case, the main task is to ensure regular and sufficient intake of micronutrients for the body in accordance with the physiological norm.

The importance of this point was highlighted at the international conference of the World Health Organization, which was held in the early 90s in the capital of Italy. It was noted that the lack of micronutrients in the daily diet of the population is relevant even for developed countries, and in countries with a low standard of living it has become a threat on a global scale. If measures to effectively correct micronutrient deficiency are not taken in a timely manner, they can cause the formation of a number of common chronic diseases and low levels of health for entire generations, which will directly affect the quality of life of the population of our country.

Iron– an essential microelement, deficiency of which can be expressed in various forms:

prelatent,
latent,
Iron-deficiency anemia.

The prevalence of this disease among some categories of the population of the Russian Federation ranges from 20 to 80%, and so far the situation remains quite serious. This is evidenced by the resolution of the Chief State Sanitary Doctor of the Russian Federation G.G. Onishchenko. dated 05.05.2003 No. 91 “On measures to prevent diseases caused by iron deficiency in the nutritional structure of the population.” The document provides data according to which the incidence of anemia has doubled over the past decade and the reason for this is a diet poor in vitamins and microelements. Infants in the first year of life, children under 3 years of age, as well as women with different stages of pregnancy and nursing mothers are at particular risk.

Iron deficiency in a child’s body has particularly devastating consequences: almost all organs and systems of the child function in a slow mode, the immune system suffers, and there is an increasing lag in the mental and physical development of children.

This problem is being studied at the international level, comparative analyzes of the nutrition of the population of different countries are carried out, including taking into account eating habits and the objective current conditions of food production. Studies have shown that severe forms of iron deficiency anemia (IDA) are directly related to the lack of iron in the daily diet of various population groups, and they are also a consequence of the lack of prevention, which involves taking iron-containing drugs.

As it turned out, a deficiency of this microelement in any form causes a negative impact on health in general, including disruptions in the functioning of the central nervous system, cardiovascular and digestive systems, slows down the processes of hematopoiesis and tissue regeneration, causing immunity disorders, infectious diseases, slowdown intellectual and physical development of children, loss of ability to work in adults.

In this regard, the World Health Organization has developed a program for fortifying foods with iron, which is recommended for implementation in most countries of the world. Based on this document, our own national programs for the prevention of iron deficiency were adopted. There is such a program in the Russian Federation, according to which state policy concerning healthy nutrition of the population involves the production of iron-fortified products, as well as the production of biologically active additives (BAA) for food with anti-anemic effects.

Thus, the relevance of carrying out work on clinical nutritional research is dictated by the need to take urgent measures to prevent and eliminate iron deficiency in the population of our country, especially children and adolescents.

PREVENTION AND TREATMENT OF HUMAN IRON DEFICIENCY CONDITIONS

According to WHO, iron deficiency- a truly widespread disease. Of the 7 billion people who make up the world's population, about 2 billion suffer from iron deficiency to one degree or another. Currently, in medical circles this disease is called sideropenia. Sideropenia is particularly widespread in third world countries, where the low standard of living of the population does not allow sufficient diversification of the diet. However, in developed countries the picture is not so good; the reasons for this phenomenon are:

insufficient iron content in the diet,
disruption of absorption processes in the intestines,
depletion of microelement reserves due to blood loss,
increased need for iron in children and adolescents during intensive growth,
pregnancy,
lactation period.

Of no small importance is the low iron content in the soils of certain territories, such as the Vladimir, Yaroslavl, Kostroma, Ivanovo and Vologda regions of the Central Federal District, as well as in the Northern Urals, in the highlands of Central Asia.

Per kilogram of a healthy person’s weight there is approximately 60 mg of the microelement, thus the total amount of iron approaches 5 g. Most of it is contained in blood hemoglobin, but it also accumulates in the spleen, liver, muscle tissue myoglobin, brain and bone marrow, oxidative enzymes groups. More than 7 dozen enzymes, including the proteins lactoferrin and transferrin, are the main iron stores in the body.

In the muscles of an adult man, myoglobin contains 100 mg of iron, in women - 30-50 mg less, in newborns after full-term pregnancy - 400 mg, and in premature babies - only 100 mg.

If a microelement accumulates in the body in insufficient quantities, then they speak of iron deficiency - an iron deficiency state of the body. Its variety is the clinical-hematological syndrome with the abbreviation IDA, when a lack of iron provokes a failure of hemoglobin synthesis in the body.

According to WHO information, three quarters of anemia of various origins were caused by anemic IDA syndrome, which in absolute numbers amounted to more than 200 million people. Women of the fertile period of life, expectant mothers at various stages of pregnancy, as well as preschool children are at particular risk. In the United States, 25% of children under the age of two are susceptible to iron deficiency anemia, and in Russia this figure is already 50%. Children of senior preschool and primary school age also develop anemia quite often, their share is 20%.

Due to intense blood loss, 90% of women in these groups have some degree of iron deficiency, 30% of the remaining Russian women also have hidden iron deficiency. These indicators are higher in such regions of our country as the North Caucasus, eastern Siberia, and the Arctic.

Thus, they can develop iron deficiency anemia at any time.

As a rule, the initial symptoms of sideropenia do not alarm potential patients. Systolic murmur, tachycardia, dizziness, general weakness, shortness of breath, pale skin are attributed to fatigue or stress. In fact, all these symptoms are caused by a lack of oxygen in the tissues and organs, which causes IDA. Without receiving proper treatment, the body continues to degrade and disturbances appear in the functioning of the immune, respiratory systems, central nervous system, gastrointestinal tract, and cardiovascular system. Sideropenia becomes the precursor of many serious diseases, the causes of which could be eliminated by increasing iron intake. Such unpleasant signs of sideropenia as brittle nails, hair loss, changes in taste and olfactory sensations are also familiar to most people.

Thus, practically no disease in children and adults can be completely cured without eliminating IDA, which can have two pathogenetic expressions:

1) insufficient activity of tissue respiration enzymes;

2) incomplete supply of oxygen to the body.

Diagnosis of VDN is based on establishing laboratory signs of anemia itself and iron deficiency in the body (Table 1).

Table 1.

Indicators of iron, erythrocyte and hemoglobin metabolism in healthy people, patients with IDA and patients with IDD.

The World Health Organization and the American Committee on Nutrition and Nutritional Supplements consider iron microelements to be of critical importance in the treatment of anemia. It is impossible to correct the balance of iron in the body by changing the diet or using herbal medicine. They can act as maintenance therapy after the treatment itself, but they cannot fully replace it. Russian scientist A. Alperin created the most comprehensive classification of IDA, where this pathology is divided by severity, stages and form. According to his classification, severe anemia implies a hemoglobin level in the body of less than 70 g/l, moderate anemia corresponds to 70-90 g/l, and mild is estimated at Hb from 90 to 110 g/l.

IRON DEFICIENCY CONDITIONS IN CHILDREN AND ADOLESCENTS.

As medical statistics from the Department for Maternity and Child Protection of the Ministry of Health of the Russian Federation show, in our country various degrees of VHD are diagnosed in 30% of children of preschool and primary school age, as well as in almost all women with different stages of pregnancy. The consequence of this is frequent acute respiratory viral infections, infections of the digestive system, and deaths. For example, when contracting salmonellosis, children with high hemoglobin levels tolerate this disease more easily than small patients with IDA.

The lack of a microelement also causes damage to the brain activity of the developing child’s body. Apathy, inhibited reactions, dull mood, moodiness - all these deviations in behavior indicate iron deficiency anemia in a growing body. If a child is not interested in studying, he complains of deteriorating memory and concentration, then this also applies to the symptoms of IDA.

A control group of schoolchildren who were diagnosed with a mild form of anemia showed reduced mental development: their IQ was 25 points lower, and solving problems took 4.08 seconds, compared to 1.81 seconds for children without anemia.

Table 2.

Symptoms of clinical polymorphism depending on age.

Prevention of iron deficiency anemia in children in the first months of life includes a balanced diet for women during pregnancy and lactation, including a sufficient amount of meat products, fruits and vegetables rich in vitamin C, as well as specialized products containing minerals and vitamins. If the hemoglobin content is below 100 g/l, it is advisable to prescribe the woman oral ferrodrugs or multivitamins fortified with iron.

Natural prevention of IDA in children in the first months of life is exclusively breastfeeding up to 4-6 months of life. It is known that the concentration of iron in human milk is only 0.2-0.4 mg/l, but this is enough to meet the iron needs of a growing child’s body due to its high bioavailability (50%).

When artificially feeding children in the first six months of life, formulas with an iron content of 0.4 to 0.8 mg/100 ml are used, which is quite sufficient, since the “maternal” iron reserves have not yet been depleted. The iron content in “subsequent” adapted milk formulas (for children in the second half of life) increases to 0.9-1.3 mg/100 ml.

By 4–6 months of age, the child’s body is depleted of antenatal iron reserves and its metabolism becomes absolutely dependent on the amount of micronutrients supplied with food in the form of complementary foods. When choosing products to replenish iron deficiency, it is necessary to take into account not only the total amount of iron in products, but also the qualitative form of its compounds.

It is advisable to include industrially produced foods fortified with iron in the diet (fruit juices, fruit and vegetable purees, instant cereals), which increases the amount of iron entering the child’s body with food.

Despite the high iron content in some products of plant origin, they are not able to meet the high iron requirements of a growing child's body. Substances present in products of plant origin (tannins, phytins, phosphates) form insoluble compounds with Fe (III) and are excreted in feces. There is also information about the adverse effect of dietary fiber, which is rich in cereals, fresh vegetables, and fruits, on the absorption of iron. In the intestines, dietary fiber is practically not digested; iron is fixed on their surface and removed from the body. On the contrary, ascorbic and other organic acids, as well as animal protein containing heme iron, increase the bioavailability of iron.

It is important that meat and fish products increase the absorption of iron from vegetables and fruits when used simultaneously. Taking into account the above, as well as the high content of easily accessible iron in meat, it is recommended to introduce meat complementary foods no later than 6 months.

Whole cow's milk is not used in the diet of children under 1 year of age. The concentration of iron in cow's milk is only 0.3 mg/l, and its bioavailability is about 10%. Numerous studies have shown that the use of unadapted products (cow's milk and kefir) in the diet of young children leads to microdiapedetic gastrointestinal bleeding, which is a risk factor for the development of VDN.

Materials for this chapter were also provided by: Ph.D. Rybakova E.P. (Moscow), Ph.D. Bushueva T.V. (Moscow), Ph.D. Stepanova T.N. (Moscow), Ph.D. Kazyukova T.V. (Moscow)