National Food & Nutrition Centre

Nutrition Fact Sheet 1

The condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. Thus the oxygen - carrying capacity of the blood is decreased.

Anaemia

Types
There are many forms of anaemia |aa-ne-me-aa|, some of them common, others rare.

Women who are pregnant or breastfeeding may also have low iron levels because of the developing foetus or milk production.

They include: Iron Deficiency Anaemia (IDA) Megaloblastic Anaemia Pernicious Anaemia Sickle Cell Disease Osteopetrosis Thalassemia Aplastic Anaemia Myelodysplastic Syndrome and other bone marrow diseases

IDA Prevalence in Fiji

Rate of Anaemia in 1993 - 27.2% 2004 - 32.4% Rate of Anaemia by Age Group 6 months to <5 years 5 - 11 years 12 - 14 years 15 - 44 years 45 years and over 53% 27.5% 25.4% 19.6% 30.6%

Source: NNS 2004

Males

46.1% 24.2% 32.9% 40.9% 35.4%

Females

Picture showing Healthy Red Blood Cells under a Microscope

Iron deficiency anaemia also affects people who have had surgery to remove part of the stomach, thereby impairing the ability to absorb iron.

Causes
Anaemia can be the result of: Bodys bone marrow not making sufficient levels of red blood cells Body destroying too many blood cells, loss of blood (through heavy periods or unnoticed bleeding) or parasitic infections such as hookworm Through a Vitamin deficiency in B12, B6 or mineral deficiency folic acid and iron Due to gastrointestinal bleeding caused by aspirin or nonsteroidal anti-inflammatory medications (NSAIDS) such as ibuprofen (Brufen) Anaemia can also result when the digestive system loses its ability to absorb key vitamins and minerals. Iron deficiency anaemia, occurs when the body does not store enough iron, the primary raw material of haemoglobin. Women who lose excessive amounts of blood through heavy menstrual flows may have a lower-than-average iron level.

IDA Prevalence for Women of Child Bearing Age (CBA)

All Women Fijian Indian Urban Area Rural Area Child Bearing Age: 40.3% 33.2% 51.1% 43.3% 38.6% 15 - 44years

Source: NNS 2004

IDA becomes a public health concern when the prevalence amongst the population is high. Folic acid deficiency causes Megaloblastic anaemia. People with this form of anaemia usually are not getting enough folic acid in their diet. For some people, the problem is caused not by dietary inadequacies but by an inability to absorb sufficient amounts of folic acid. Certain intestinal disorders, such as inflammatory bowel diseases and Crohn's disease, as well as some drugs can interfere with folic acid metabolism.

Heavy alcohol consumption can also lower blood levels of folic acid by interfering with proper nutrition and by hindering the digestive system's ability to absorb the vitamin. Because most people, especially those who consume meat and eggs, get plenty of vitamin B12 from their diet, anaemia linked to a vitamin B12 deficiency usually signals the body's inability to absorb the vitamin. This type of anaemia can occur in people who have had surgery along the digestive tract. Pernicious anaemia the most common form of B12 deficiency anaemia, results when the stomach fails to produce a chemical that normally combines with vitamin B12 to aid its absorption in the small intestine. Pernicious anaemia is a rare condition that most commonly affects older people.

Weakness, Fatigue and malaise (general discomfort or uneasiness) Lips look bluish, skin is yellowish, and gums, nail beds, eyelid linings, or palm creases are pale Frequently out of breath, faint, or dizzy Burning sensation on the tongue Experience movement or balance problems, tingling in the extremities, confusion, depression, or memory loss Headaches, insomnia, decreased appetite, poor concentration, and an irregular heartbeat.

What is Haemoglobin?
Haemoglobin (Hb) is a protein in red blood cells that carries oxygen. When Hb levels are low the oxygen supply to the body decreases causing poor body functions. A blood test can tell how much hemoglobin there is in the blood.

Prevention of Anaemia
1. Eating Foods High in Iron There are two sources of iron in the diet: haem iron (meat sources) non haem iron (vegetable sources) Haem iron is readily available to the body as it is easily absorbed than non haem iron. The amount of iron absorbed from animal foods is higher (18%) compared to vegetable sources (10%), therefore vegetarians will need intakes 80% higher than those who eat meat. Sources of haem iron Liver Lean red meat (beef and lamb) Chicken, egg yolk Fish, shellfish Sources of Non haem iron Dark leafy vegetables (Bele, Tubua/Chauraiya, Saijan (drumstick leaves), rourou, Ota, Watercress/Karamua) Fortified Flour Peas and Legumes Wholegrain Cereals

Illustration above showing haemoglobin in the red blood cells

Signs of Anaemia
Haemoglobin Levels
Source: WHO

** When Hb levels are less than the stated grams per decilitre (g/dl) it indicates anaemia

Children Children Children Adult Adult Adult

6 months to <5 years 6 - 11 years 12 - 13 years Male Female (non pregnant) Female (pregnant)

11 g/dl 11.5 g/dl 12 g/dl 13 g/dl 12 g/dl 11 g/dl

Certain foods which are high in Vitamin C when consumed with iron rich foods can improve its absorption in the body. These include: Orange Orange juice Lime Tomato Guava Lemon Mango

Iron tablets can cause irritation of the stomach and discoloration of bowel movements and nausea. Iron tablets should be taken with food, or with orange juice, to increase its absorption. In severe cases of Anaemia, when Hb levels are very low - iron is replenished in the body through intravenous treatment.

Vitamin C Rich Fruits

Iron Content of Selected Foods

Cooked Foods Chicken Beef Steak Reef Fish Egg, poached Dhal, split peas Dhal, toor Taro Leaves Bele Tubua/ Chauraiya Chinese Cabbage Quantity 1 cup 1 cup 1 cup 1 egg (60g) 1 cup 1 cup 1 cup 1 cup 1 cup 1 cup

Source: Pacific Food Composition Table

Iron Content (mg) 3 10 2 2 3 3 5 4 6 3

3. De - Worming As hookworm infection may also be a reason for anaemia - treatment in the form of de-worming is also prescribed. As a precautionary measure it is advised to wear closed shoes when working outdoors.

How much Iron do we need?

Iron requirements vary in different periods of life and in various age groups. The requirements listed below have been obtained from the Nutrient Reference values for Australia & New Zealand, 2006. Infants (0 - 6 months) Iron needs for infants and children between 0 - 6 months of age, depends on their feeding method and age. Breastmilk provides all the iron needed for an exclusively breastfed infant. Children aged 7-12months In children between 7-12 months, the iron requirements are the highest (11milligrams/day), and milk alone cannot meet these requirements. Therefore it is important that complementary foods rich in iron are introduced at 6 months in addition to breastmilk.

1 cup = 250g
Similarly some foods when consumed with iron rich foods can inhibit its absorption in the body such as: Milk and milk products (cheese, yoghurt) Tea Coffee Red wine Spices - Turmeric Tamarind 2. Medication Iron tablets are given to pregnant women and men with low Hb levels. Iron supplements/ tablets can be taken over several months to increase iron levels in the blood. These tablets are available at the hospital or can be bought from the pharmacy. Women of Child Bearing Age (CBA) should also increase iron in their diets through iron rich foods or with iron tablets. This is to prevent anaemia later in life.

Age All

Source: Nutrient Reference values for Aust & NZ, 2006

Amount 1-3 years 4-8 years 9-13 years 14-18 years 9-13 years 14-18 years 9 mg/day 10 mg/day 8 mg/day 11 mg/day 8 mg/day 15 mg/day

Iron Requirement for 1 - 18 year olds

Boys Girls

Children and Adolescents Iron requirements are higher for girls above 14 years of age because it is assumed that they have begun to menstruate. Adults Men older than 19 years of age need 8mg of iron/ day. In women, those between 19-50 years need 18 milligrams/day and those above 50 years need 8 milligrams/day. The requirements for women older than 50 years are low because it is assumed that they no longer menstruate. Pregnant women During pregnancy an additional 9 milligrams/day of absorbed iron is needed. To achieve this, pregnant women aged 19-50 years need to consume 27 milligrams of iron per day. Lactating women During lactation the amount of dietary iron required will depend on the age of the mother. If the mother is breastfeeding, menstruating will resume after 6 months of exclusive breastfeeding. A 14-18 year old mother needs 10 milligrams/day and those between 19-50 years need 9 milligrams/day.

Sample Meal Plan

A female 14 - 18 year old having the following meal would meet her daily iron requirement of 15mg. Breakfast Bread, 2 slices Egg, 1 boiled Pawpaw Slice Lunch Roti, 1 Fried Tubua, 1 cup Orange, 1

Dinner Rice, cassava Chicken & Chinese Cabbage Stir fry, 1 cup Dhal, 1 cup

Global Burden of Anaemia (2009)

More than 2 billion people worldwide are anaemic Iron Deficiency Anaemia (IDA) accounts for at least half of all anemia cases worldwide Causes almost 1 million deaths a year Recognized as a top-ten contributing factor to the global burden of disease Results in lost cognitive function and lost productivity costing $50 billion annually in gross domestic product (GDP) losses worldwide

Source: WHO website

References
1. 2. 3. NFNC, 2007. 2004 Fiji National Nutrition Survey (NNS) - Main Report, NFNC, Suva FAO, 2004. The Pacific Islands Food Composition Table, 2nd Edition, Rome NHMRC 2006, Nutrient Reference Values for Australia and New Zealand, Australia

Fact Sheets Available in this series: Fact Sheet 1: Anaemia Fact Sheet 2: Cancer Fact Sheet 3: Coronary Heart Disease Fact Sheet 4: Dental Caries Fact Sheet 5: Diabetes Fact Sheet 6: Diarrhoeal Disease in Children Fact Sheet 7: Gout Fact Sheet 8: Hypertension & Stroke Fact Sheet 9: Iodine Deficiency Disorder Fact Sheet 10: Overweight & Obesity Fact Sheet 11: Protein Energy Malnutrition Fact Sheet 12: Vitamin A Deficiency Fact Sheet 13: Zinc Deficiency

This Nutrition Fact sheet is intended for information only. It is not a substitute for proper medical diagnosis or dietary advice given by a dietitian. For further information contact a Doctor or Dietitian at your nearest hospital /Health Centre or contact: National Food and Nutrition Centre P.O. Box 2450 Government Buildings Suva, Fiji Office Location: 1 Clarke Street, Suva Phone: 331 3055 Fax: 330 3921 E-mail: nfnc@connect.com.fj Website: www.nutrition.gov.fj