Iron Deficiency

Introduction:

Inside the cores of stars, iron is forged during the star’s last moments. A supernova scatters the elements contained inside across the universe, and sometime since then, they weaved their way into becoming essential to human life.

For something so abundantly created, why is it so scarce in women?

Iron deficiency (ID) is the most common nutrient deficiency in the world, affecting 20-25% of women globally, and more than half the population of pregnant women. Left untreated, it reaches the last stage: iron deficiency anemia (IDA), which affects 1 in 3 women aged 15-49 worldwide. Despite its alarming prevalence, these conditions are routinely dismissed, misdiagnosed, and even entirely overlooked.

Millions of women lose their spark by this essential mineral because of the following effects:

• Physical burden

  • Impaired physical performance

  • Delayed cognitive development in children

    
    

• Global economic burden of IDA is substantial due to its association with:

  • Poor growth

  • Decrease productivity

  • Increased healthcare costs

  • Poor pregnancy and infant health outcomes

    
    

• Low level of satisfaction of treatments and adverse side effects

  • Unpleasant sensory changes when consuming products fortified with iron

  • Adverse gastrointestinal side effects

  • Leads to low adherence

    
    

• Significant economic health burden

  • Lower educational attainment (especially in children & adolescents)

  • Decreased work productivity

  • Lost earning potential

  • Increased healthcare costs

    
    

Misdiagnosis:

In this day and age, however, how is it consistently missed for many women, with the rapidly advancing technology in the field of healthcare?

The answer lies in the grossly vague methods of diagnosing ID and IDA. Commonly accepted levels of iron, measured in serum ferritin and hemoglobin levels, is based on data from a combined population of both men and women. However, it is widely known that menstruating and pregnant women need more iron than men. Moreover, there is growing research that there are differences between males and females on how their unique physiologies play a role in iron absorption. Iron metabolism is influenced by sex hormones such as estrogen, progesterone, and testosterone in:

• Regulation of blood cell formation

• Iron absorption

• Hb concentrations

  
  

Therefore, not only do women need more iron, the hormonal differences between men and women show that men are relatively less susceptible to developing ID and IDA.

The following are additional factors that influence ID and IDA in women, which further complicate the issue:

• Healthcare accessibility

• Prevalence of infectious diseases

• Race/ethnicity

• Medication use

• Multiple micro-nutrient deficiencies

  
  

• Social factors:

  • Gender inequity

    • Women often receive lower food quality and nutritional intake than men

      
      

• Geographic and socioeconomic factors

  • Highest prevalence reported in Southeast Asia and Central and West Africa

    
    

• Dietary factors and multiples micronutrient deficiencies

  • Women consume significantly less meat than men in many countries and are more likely to follow a vegetarian or vegan diet

  • Plant-based iron has lower bioavailability and absorption compared to iron in meat

    
    

• Significant economic health burden

  • Lower educational attainment (especially in children and adolescents)

  • Decreased work productivity

  • Lost earning potential

  • Increased healthcare costs

    
    

• Physical burden:

  • Poor growth

  • Impaired physical performance

  • Delayed cognitive development in children

    
    

Treatments:

Commonly accepted treatments for ID and IDA also have flaws in their effectiveness. The most widely given treatment is ferrous sulfate, which is cost-efficient and works well for most patients given that they adhere to their treatment plan.

Low levels of satisfaction have been consistently reported with given treatments, due to unpleasant sensory changes that come with consuming iron-fortified products and adverse gastrointestinal side effects. This leads to low adherence to treatments given, and research on poor patient adherence remains low, stalling progress in reducing ID and IDA prevalence.

Conclusion

Consequences as a result of being unable to treat ID and IDA based on the sex differences associated with it, will continue to burden women as they impact their physical, cognitive and economic well-being. Instead of looking for temporary relief, it is important to look into solutions and treatments that will make a lasting impact on women who are continued to experience the effects from this in their daily lives.