The Traditional belief that iron deficiency is the main cause of anaemia in India is being reconsidered. A recent study, involving researchers from prominent institutions such as St. John's Medical College, Bangalore, and the National Institute of Nutrition (ICMR), suggests that other factors — from vitamin B12 deficiency to air pollution — may be equally, if not more, important contributors to this persistent public health problem. The research, published in the European Journal of Clinical Nutrition, underscores the need for changes in the causes of anaemia and policy approaches.
Understanding anaemia beyond iron deficiency.
Anaemia, characterized by symptoms such as fatigue, weakness, and pallor, is caused by a lack of red blood cells (RBC) or haemoglobin, which are important for transporting oxygen throughout the body. Traditionally, iron deficiency has been seen as the root cause, leading to policy measures such as iron supplementation and bio-fortification of staple foods.
However, studies have shown that only 9% of cases of anaemia examined can be attributed to iron deficiency. In contrast, 22% of cases were classified as resulting from unknown causes. These may include deficiencies in vitamin B12 or other nutrients such as folate, genetic conditions such as hemoglobinopathies, undetectable blood loss, an unhealthy environment, or environmental factors such as air pollution.
A new perspective on the prevalence of anaemia.
The study measured haemoglobin (Hb) levels in the blood of nearly 4,500 people across eight states in India, revealing that 34.9 percent of the participants were anaemic. This figure contrasts with the high prevalence rates reported in the National Family Health Survey (NFHS) 2019-2021, which found anaemia in 57.2% of women of reproductive age and 67.1% of children.`Among adolescent girls, for example, the study noted a prevalence of 44.3% compared to the NFHS figure of 62.6%.
Discrepancies in prevalence rates are partly attributed to differences in blood collection methods. The NFHS used capillary blood obtained from finger pricks, which can be contaminated with tissue fluids and lower haemoglobin estimates. In contrast, this study used venous blood drawing, a method now recommended by the World Health Organization (WHO) for its accuracy.
"The major proportion of anaemia in all groups studied, was due to... unknown (and unmeasured) causes of anaemia. This could be due to deficiencies in other erythropoietic (blood-producing) nutrients like B12 or folate, or due to haemoglobinopathies, undetected blood loss, an unhygienic environment or other causes like air pollution,"the authors said in their report.
Regional variations and policy implications.
Assam exemplifies the complexities of underlying causes of anaemia. While the state reported anaemia rates between 50% and 60%, only 18% of cases were due to iron deficiency, highlighting the need to look beyond traditional explanations. For women aged between 15 and 49, anaemia prevalence in the eight States was 41.1% in comparison with 60.8% in the NFHS-5. The prevalence of anaemia in adolescent girls (15-19 years) – as a group that is the most anaemic – in the eight States was 44.3% compared to 62.6% in NFHS-5. The same trend persisted in adult men (20.7% vs 26.0%) and adolescent boys (24.3% vs 31.8%) between the comparable age groups in NFHS-5. The findings call for a re-evaluation of public health interventions related to anaemia in India. A one-size-fits-all approach focused on iron supplementation may be insufficient. Addressing other nutrient deficiencies, improving environmental conditions, and adopting better assessment methods may lead to more effective solutions.
Towards a more comprehensive approach.
The key is to diversify diets. We have to intervene with ensuring more fruits, milk and vegetables are made available to a wider population which will improve absorption of essential nutrients. We have to change the economics to make high quality diets and not just single nutrients, more accessible.Dr. Anura Kurpad, Professor, St. John’s Medical College
This study underscores the importance of reexamining the conventional wisdom regarding anaemia. By broadening the scope of research and public health policies to include a wider range of contributing factors, India can better address the multifaceted nature of this situation. As the findings suggest, treating anaemia requires not only treating iron deficiency but also addressing its under-understood and overlooked causes.
Reference:
1) Original Article: Givens DI, Anitha S, Giromini C. Anaemia in India and Its Prevalence and Multifactorial Aetiology: A Narrative Review. Nutrients. 2024 May 29;16(11):1673. doi: 10.3390/nu16111673. PMID: 38892606; PMCID: PMC11174870. Accessed on 21-Jan-2025
(Input from various sources)
(Rehash/Muhammad Faisal Arshad/MSM)