The Impact of Iron Deficiency on Quality of Life

It is important to note that Iron Deficiency Anemia (IDA) affects an individual’s quality of life in several aspects including economic and physical. In fact, IDA is the leading cause of DALYs (Disability Adjusted Life Years), a measure of overall disease burden and cumulative years lost due to illness/disability/death, and YLDs (Years of life lived with Disability).

According to the American Society of Hematology: A systematic analysis of global anemia burden from 1990 to 2010, anemia was responsible for 68.3 million YLD (8.8% of global total), more than major depression, chronic respiratory diseases and the totality of injuries. Total anemia YLD increased in all ages between 1990 and 2010.

Iron deficiency plays a critical role in the overall experience of life.

PRODUCTIVITY & PHYSICAL PERFORMANCE

IDA can affect the type of work and task that individuals can perform and impact the time spent on work and their income. For instance, because of reduced iron stores in the body, those afflicted with IDA tend to be less productive at work. They experience fatigue and tend to get easily tired.

Iron deficiency and anemia are associated with increased fatigue, poorer exercise performance and lower work productivity.8 9 10 11 Due to IDA, oxygen transport in the body is limited and lowers the energy of an individual. When one feels sluggish and weak, it may not be a simple case of “burnout.” It is important to have the iron levels checked to address this state of lethargy.

Thankfully, there are studies and evidences suggesting that iron replacement can improve fatigue scores and physical performance.12

COGNITION

As presented by Dr. Michael Low, a haematologist at the Monash Medical Centre in Victoria, Australia, anemia is associated with poorer cognitive development. The more severe the anemia, the worse the outcome.

IDA impairs an individual’s cognition—an ability that’s related and intertwined with IQ (intelligence quotient). Cognition and cognitive development are important in remembering, problem solving, and decision-making which are all essential in being effective at one’s tasks.

The 2007 Strenze T. Intelligence and 2007 Zagorsky JL Intelligence statistics showed that cognitive scores correlate with income. Though the study does not suggest a link between cognition/IQ scores and wealth, it showed that income and IQ are still related. IQ is associated with improved income, education and occupation.

Dr. Low states that replacement of iron in individuals with iron deficiency can improve cognitive outcomes in 5-12 years old, particularly in those who are anemic, and should be instituted in a timely manner. Early intervention is key.

IRON AND MATERNAL NUTRITION

One of the established facts in the medical field is that women of reproductive age require twice the amount of iron. This increases to more than three times in pregnancy. During pregnancy, iron needs are so high that iron supplementation is recommended especially during the 2nd and 3rd trimester when the baby’s iron stores are being built.

However, the world is dealing with a massive challenge when it comes to maternal nutrition.

Maternal and child anemia is primarily caused by iron deficiency. The underlying causes include inadequate access to nutrient-rich diets and intake of mothers and children, inadequate maternal and childcare practices, and inadequate use of curative and preventive health services.

Chronic iron deficiency and anemia in children also lead to neurodevelopmental consequences such as risks in developing brain structures, neurotransmitter systems and myelination. Apart from that, they are also in danger of cognitive function impairment which affects memory, attention span, intelligence and school performance.

Moreover, anemia in children leads to decrease in bone density and distortion of bones, hepatosplenomegaly, possible pubertal delay and altered cardiac function. Iron deficiency has a negative impact on a child’s cognition, behavior and motor skills that can have long-term negative implications.5 All of these show that anemia and IDA are serious health threats that require immediate attention from prenatal care all the way to child care.

Taking account of these health concerns, Dr. Bhutta shared some interventions across the lifecycle which can help address the situation. He recommended the following interventions that would help address anemia in pregnant women: preconception care, folic acid supplementation, multiple micronutrient supplementation, calcium supplementation and balanced energy supplementation among pregnant women.13

Overall, the alarming global statistics on IDA, especially during pregnancy and in children, is an eye-opener. It calls for stronger awareness and education, for both the health care providers and the patients, on the importance of iron supplementation and the dangers of anemia.