Malnutrition is the deficiency, excess, or imbalance in an individual’s intake of caloric energy and nutrients. Malnutrition is generally categorized into three groups: undernutrition, micronutrient-related, and overnutrition. Undernutrition is when not enough energy or nutrients are consumed, resulting in wasting, stunting, and underweight individuals, particularly in children. Micronutrient-related malnutrition occurs when there is a deficiency in vitamins and minerals, with some key nutrients being critical to health maintenance. Overnutrition happens when an individual consumes too much or inadequate quality or diversity of foods, as well as leading unhealthy lifestyles such as lack of exercise. Obesity that results from that is characterized by abnormal fat accumulation which can impair health (John Hopkins Medicine, n.d.). Virtually all kinds of malnutrition are associated with negative health outcomes, the focus of this paper will be anemia, one of the most common nutrition-associated conditions.
Anemia is an illness where the hemoglobin (Hb) concentration and/or red blood cell (RBC) count are abnormally low and struggle to meet physiological needs of the individual. Anemia affects up to a third of the global population to some extent. The function of Hb and RBC in the body is to deliver oxygen from the lungs to tissues, and carbon dioxide reverse, the standard function of the human respiratory and cardiovascular systems. RBC are continuously replenished, so when anemia occurs, it results from a disproportionate loss of RBC compared to production capabilities of the body. This generally occurs for one of two reasons, deficient erythropoiesis (process of RBC formation in living tissue) or excessive loss of erythrocytes due to blood loss or hemolysis (Chaparro & Suchdev, 2019).
Once anemia is present, the physiological effects on the body will range from mild to severe, as RBC is the essential key to functioning organs and tissue. Initial symptoms are typically dizziness and light-headedness, potential hypotension with signs such as irregular heartbeat and headaches. As anemia progresses, an individual may experience pain, weakness, shortness of breath, pale skin, and cold extremities, with long-term impacts beginning to emerge such as stunted growth in children if presented over a period of time. Finally, the most severe anemia will present itself in the form of fainting, coma, angina/heart attack, and high risk of death (Maakaron, 2021).
Anemia can be caused by a range of conditions and diseases that impact the RBC, such as pregnancy, menstruation, injury, or sickle cell disease, among others. However, the most prevalent form of the condition, accounting for over 40% of cases, particularly in low and middle-income countries is iron deficiency anemia. This is the condition when anemia forms due to a lack of nutrients or issues with absorbing them, that limit RBC production. As evident by the name, iron deficiency anemia stems from a deficit of iron, which humans receive from food intake. Iron is necessary to produce oxygen-carrying proteins hemoglobin and myoglobin (MedlinePlus, 2021). Other nutrients are also involved in RBC and hemoglobin production, the deficiency of which can cause anemia. Vitamin C is critical for iron absorption in the body, so even if enough sources of iron are present but there is a shortage of vitamin C, the iron will not absorb. Furthermore, vitamin B12 and folate are necessary to maintain healthy RBC, without them the body produces red blood cells that are too large and do not function properly, greatly reducing the capability to carry oxygen (Mayo Clinic, 2022).
For individuals diagnosed with iron-deficiency anemia, it is important to maximize foods that are rich in iron, vitamin C, and Vitamin B12 and folate. These food categories typically include red meat, poultry, and pork, seafood, beans and peas, dark green leafy vegetables, and iron-fortified wheat products. Access to meat and seafood is often highly limited in low-income populations, that is why the risk of anemia is generally higher due to iron deficiencies. Vitamin C is more diverse and present in a wide range of fruits, vegetables, berries including tomatoes, broccoli, peppers, grapefruit and oranges, strawberries, and melons. However, there are also a wide variety of food groups that anemics should avoid. Gluten-rich foods damage the intestine wall hindering iron and folate absorption. Calcium-containing foods (which is the majority of dairy) should be approached with a balanced perspective – calcium is necessary for survival as well but the mineral conflicts with iron absorption. Finally, polyphenols (found in coffee and tea) and alcohol are also not recommended (Visser at al., 2019). Iron consumption and absorption is a complex process, and for those diagnosed with iron deficiency anemia, the approach to diet should be well-planned. It should be noted, that although rare, iron overload is possible as well from a metabolic standpoint.
In the human body, iron exists in complex compound forms tied to hemoprotein to create hemoglobin, myoglobin or hem enzymes. Nearly two-thirds of the body’s iron is found in the hemoglobin present in the circulating erythrocytes. Iron is recycled and conserved by the body, but 1-2 mg are lost per day from essentially recycled or dying cells. However, the rate of absorption of iron in the human body is very low at 35%, and at an average diet of 10-20 mg of iron daily, only 1-2mg are absorbed (Abbaspour et al., 2014). Iron is absorbed by enterocytes, part of the carrier group of membrane transport proteins, occurring in the duodenum and upper jejunum. At which point, it is transferred across the duodenal mucosa into the bloodstream to be carried by transferrin to the bone marrow for erythropoiesis, or RBC production. People with iron deficiencies generally have mechanisms that adapt to increase iron absorption from foods, but only by slight amounts. Iron absorption is ultimately controlled by ferroportin which determines how much iron to allow to pass through the mucosal cell into plasma.
References
Abbaspour, N., Hurrel, R., & Kelishadi, R. (2014). Review on iron and its importance for human health.Journal of Research in Medical Sciences, 19(2), 164-174. Web.
Chaparro, C. M., & Suchdev, P. S. (2019). Anemia epidemiology, pathophysiology, and etiology in low‐ and middle‐income countries. Annals of the New York Academy of Sciences, 1450(1). Web.
John Hopkins Medicine. (n.d.). Malnutrition. Web.
Maakaron, J.E. (2021). Anemia. Web.
Mayo Clinic. (2022). Iron deficiency anemia. Web.
Medline Plus. (2021). Iron in diet. Web.
Visser, M., Van Zyl, T., Hanekom, S. M., Baumgartner, J., van der Hoeven, M., Taljaard-Krugell, C., Smuts, C. M., & Faber, M. (2019). Nutrient patterns and their relation to anemia and iron status in 5- to 12-y-old children in South Africa.Nutrition, 62, 194–200. Web.