Anaemia higher among rural poor, iron deficiency afflicts urban rich

Solutions focusing merely on increasing iron intake not enough, shows study

A study by NIN showed about 30-32% pre-school children and adolescent girls had iron deficiency.

Scientists at the National Institute of Nutrition (NIN) here have reported that anaemia — reduced haemoglobin or red blood cells — is high in rural, poor children while iron deficiency is more among the urban and rich across the country. Although anaemia prevalence was higher in rural and poorer children as well as adolescents, counter-intuitively, iron deficiency was less common among them. Similarly, anaemia was found to be lower among their urban counterparts while iron deficiency was seen more in them.

In a recently published research paper in collaboration with the ‘Journal of Nutrition’, scientists analysed data on iron deficiency in the blood samples collected in the Comprehensive National Nutrition Survey (CNNS) conducted in 2016-18 under the Union Ministry of Health and Family Welfare.

The study included a representative sample of more than 33,000 children and adolescents in different states. It showed about 30-32% pre-school children and adolescent girls had iron deficiency whereas this proportion was lower (11-15%) in case of children aged 5-9 years. This finding provided new insights into the public health problem of anaemia, which, according to surveys, affects almost 40-50% women and children in the country.

“When anaemia prevalence increases in subsequent surveys, usually, iron supplementation interventions through supplemental iron tablets or iron fortification of foods are intensified. But are solutions that focus merely on increasing intake of iron enough to reduce anaemia prevalence in India? It does not seem so as per this study,” said NIN director R. Hemalatha.

Anaemia manifests when iron deficiency is severe, so it is expected that iron deficiency may affect the majority of the population. Measurement of iron deficiency in blood samples are expensive, population level surveys, therefore, usually measure only haemoglobin in the blood often used as a proxy to estimate the iron deficiency in the population.

“Diet quality is important for efficient haemoglobin synthesis, as iron is not the only nutrient required; many other nutrients are also essential. Underutilisation of iron for haemoglobin synthesis in poorer communities could be linked with overall low diet quality like low intake of animal source foods and fruits. Highly prevalent infections due to unhygienic environment also reduce iron absorption and utilisation for haemoglobin synthesis,” said lead author Bharati Kulkarni.

So, increasing iron intake alone without addressing the poverty-related constraints like poor diet quality, hampering iron absorption and utilisation, and high load of infections may not result in intended benefits for anaemia reduction through mere supplementation, he added.