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In age 0–13 years, the upper tolerable limit recommended by the Institute of Medicine in the United States is 40 mg of elemental iron per day. In school-aged children, the World Health Organization recommends doses of 30 mg/day of iron and 250 mg/day of folic acid for 3 months to prevent iron deficiency anemia. The prevalence of anemia according to the 2012 National Health and Nutrition Survey in Mexico was 10.1% (95% CI: 9.3 – 10.9) in children 5–11 years old. In Mexico City, the prevalence of iron deficiency in children 5–11 years old was 4.5%, with a 95% confidence interval (95% CI) between 2.3 and 8.6, and 11% (95% CI: 7.4 – 14.5) in adolescents 12–14 years old. Īccording to the 2006 National Health and Nutrition Survey in Mexico (relevant to the time in which the study was conducted), the prevalence of low iron stores in 5–11-year-old children nationwide was 13%. Although the precise estimate of what percentage of anemia is due to iron deficiency, parasitical infections or other deficiencies in vitamins, minerals, or nutritious food is not known it is estimated that 50% of anemia is due to iron deficiency. In addition, 56% of pregnant women in developing countries are anemic. The majority of these children live in developing countries. It has been estimated that one-fifth of the population worldwide has an iron-deficient diet and that 46% of children between 5 and 14 years are anemic. The bioavailability and iron absorption from the daily diet are influenced by the type and quantity of iron present in food as well as by the presence of inhibitors and promoters of iron absorption in the diet and the individual’s iron status.
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Therefore, interventions addressing iron deficiency should be based on prevention rather than on treatment of anemia. This is why children are particularly vulnerable to iron deficiency and/or anemia, as they are in a stage of rapid growth. Iron deficiency, even before clinically identified as anemia, compromises the immune response, physical capacity for work, and intellectual functions such as attention level. Given that Hb depletion represents the last stage in iron deficiency, Hb concentration is widely used to diagnose anemia, while serum ferritin is commonly used as indicator of iron status in populations. Therefore, different hematological markers-the most common of which include ferritin, serum transferrin, serum transferrin receptors, total serum iron, number and morphology of red blood cells, and Hb concentration-may be used to assess iron status. Iron homeostasis results from a complex set of events that start by absorption of iron by the intestinal cells, its transport into the cell, and its further release into the blood stream, where it is transported by means of carrier proteins (i.e., transferrin), stored in different body stores, mainly bone marrow, liver, and spleen-known as ferritin complexes-and eventually used in red cell formation by bone marrow. In addition to iron deficiency, mineral and vitamin insufficiencies (e.g., folate, vitamin B12, and vitamin A), chronic inflammation, parasite infestation, and hemoglobin (Hb), hereditary disorders can also cause anemia.
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Anemia is the result of a negative iron balance that may be due to any or a combination of the following causes: inadequate iron intake, impaired or low iron absorption, poor iron utilization, or increased iron losses, such as chronic blood loss. The last stage in the process of iron depletion is characterized by a decrease in hemoglobin concentration, resulting in iron deficiency anemia. It is more common when iron requirements are increased due to the growth spurts of infancy and adolescence, as well as during pregnancy, when the fetus derives all its iron stores from the mother. Iron deficiency is one of the most common nutritional deficiencies worldwide.