Iron deficiency not the key cause of anaemia in India: Study

A new study has shown that anaemia, a blood disorder, is rampant in India.

While anaemia has long been attributed to iron deficiency, researchers from the Indian Council of Medical Research (ICMR), St John’s Medical College, the Council of Scientific and Industrial Research, Banaras Hindu University (BHU), King Edward Memorial Hospital, and Sitaram Bhartia Institute of Science and Research have found that iron deficiency contributes only marginally to its prevalence, with other factors playing a much larger role in the widespread occurrence of anaemia.

Anaemia is a condition in which either the body doesn't have enough red blood cells (RBCs or haemoglobin) or the RBCs aren't working properly. The role of RBCs is to help the blood carry oxygen throughout the body.

According to the survey-based study, published in the peer-reviewed European Journal of Clinical Nutrition, blood samples were taken from adolescents, adults and the elderly, with a higher prevalence of anaemia witnessed in women than in men. The scientists and doctors measured venous blood haemoglobin (Hb) concentrations from about 4,500 people in eight states. Out of the participants, 34.9% of them were anaemic.

The prevalence of anaemia was 44% in adolescent girls, 41% in adults and 45% in elderly women, compared to 24%, 21% and 37% in adolescent boys, adults, and elderly men.

The overall prevalence varied widely, ranging from 12% in Meghalaya to 70% in Assam.

Iron



deficiency-associated anaemia prevalence was less than a third of the overall anaemia cases, and varied among age and sex groups, approaching 45% only in adolescent girls.

In fact, iron deficiency was even lower in the mild anaemia group.

The study contested the common knowledge that anaemia is largely caused by iron deficiency, affecting public policies of bio-fortification (iron supplementation in staple foods). The researchers found that iron deficiency affected a very lower population compared to other causes like vitamin B12 deficiency or air pollution.

"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 hemoglobinopathies, undetected blood loss, an unhygienic environment or other causes like air pollution,” the authors said in their report.

According to the National Family Health Survey (NFHS) 5, conducted in 2019–2021, anaemia is present in 25% of men (15-49 years) and 57% of women (15-49 years).

The government launched the Anaemia Mukt Bharat (AMB) strategy in 2008 by implementing six interventions: prophylactic iron and folic acid supplementation, intensified year-round behaviour change communication (BCC) campaign, testing and treatment of anaemia, addressing non-nutritional causes of anaemia, management of severe anaemia in pregnant women, and increase in intake of iron-rich foods, among others.