This toolkit advocates for a diverse diet that would provide adequate sources of all essential nutrients as well as chemicals, often called phyto-chemicals, in foods that have benefits for health. Because of the central role of iron in red blood cell production, the Toolkit will focus on food-based approaches to improve dietary intake of iron, although it recognizes the importance of food and a diverse diet to ensure adequate health and nutrition in general.
There are several micronutrients in addition to iron that are involved in red cell production and function. These include vitamins (A, B-12, folic acid, and possibly B-6, C, and riboflavin) and copper. A non-diverse diet increases the risk of micronutrient deficiencies including iron deficiency (Arimond, et. al., 2010). A recent paper (Lee, et al., 2012) on dietary takes in low- and middle-income country found the diets of pregnant were predominantly cereal-based and iron and folic acid intakes were lower than Estimated Average Requirements, followed by calcium and zinc. A 2010 publication on the Global Burden of Disease demonstrated that inadequate intake of nutritious foods (i.e., fruits, nuts and seeds, whole grains, vegetables, omega-3 fatty acids, and fiber) and excessive intake of high processed meat accounted for 20% (or 7 out of 33 risk factors) contributing to the global burden of disease.
Iron types, Requirements, and Bioavailability
The other form of iron is called “heme” iron which is present only in animal flesh and organs and fish. Heme iron is more bioavailable with 15% to 35% of heme iron absorbed. In many countries, meat is expensive and consumed in only on special occasions, if at all. Women and children, who have the highest requirements, may not have access to these foods when they are available to the family. Even small amounts of the heme iron in meat increases the absorption of non-heme iron. Click here to view the enhancers and inhibitors of iron absorption. Click here for more information about the bioavailability of iron in foods.
The main determinant of iron absorption, however, is the iron status of the individual. Iron absorption increases when the body needs iron. The highest absorption occurs when an individual’s iron requirements increase (e.g., pregnancy or growth in young children) or the individual is severely iron deficient. When an individual has enough iron (is iron replete), little is absorbed because the body regulates the absorption of iron tightly because, unlike other minerals, the body has no mechanism for iron excretion (Hurrell and Egli, 2010).
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