Nutritional anaemia is anaemia resulting from deficiencies of nutrients necessary for haemoglobin synthesis, red blood cell production, or erythrocyte maturation. Anaemia is one of the most prevalent yet under-recognized public health problems worldwide.Anaemia affects nearly one-third of the global population, making it one of the most common nutritional disorders worldwide Nutritional anaemia is caused by iron deficiency, folate and vit B12 deficiency . It can also result from deficiency of vitamin A, riboflavin, and other micronutrients. The condition affects individuals across all age groups and socioeconomic strata, with particularly high prevalence among women of reproductive age, children, adolescents, and the elderly. Despite advances in healthcare and nutritional science, nutritional anaemia continues to contribute substantially to morbidity, impaired cognitive and physical performance, adverse pregnancy outcomes, and reduced quality of life. The condition is considerably more common than many clinicians appreciate. Vitamin B 12, iron and folate defiencies may coexist. These Deficiencies are more common in low and middle income countries including India.
Iron deficiency accounts for approximately half of all anaemia cases, though the proportion varies significantly across populations.
Iron is essential for haemoglobin synthesis and oxygen transport. Deficiency results in impaired haemoglobin production, producing microcytic hypochromic anaemia. Common causes include inadequate dietary intake, chronic blood loss, increased physiological requirements, malabsorption syndromes, and hookworm infestation.
Folate plays a critical role in DNA synthesis and cellular replication. Deficiency impairs nuclear maturation of erythroid precursors, resulting in megaloblastic anaemia. Risk factors include poor dietary intake, alcoholism, pregnancy, malabsorption, and certain medications.
Vitamin B 12 is essential for DNA synthesis and neurological function. Deficiency leads to ineffective erythropoiesis and megaloblastic anaemia. Common causes include pernicious anaemia, gastric surgery, chronic gastritis, vegan diets, and ileal disease.
Iron deficiency anaemia progresses through depletion of iron stores, iron-deficient erythropoiesis, and overt anaemia. Reduced iron availability limits haemoglobin synthesis, resulting in smaller erythrocytes with reduced haemoglobin content.
Clinical Manifestations
Symptoms often develop gradually and may remain unnoticed until anaemia becomes severe. Common symptoms include fatigue, weakness, reduced exercise tolerance, dizziness, palpitations, breathlessness on exertion, and headache.
Physical signs include pallor, tachycardia, flow murmurs, koilonychia, angular cheilitis, and glossitis.
Iron deficiency may present with pica, restless legs syndrome, brittle nails, and hair loss.
Vitamin B12 deficiency may present with peripheral neuropathy, loss of vibration sense, ataxia, cognitive impairment, and mood disturbances.
Folate deficiency typically presents with glossitis and gastrointestinal symptoms without neurological involvement.
Diagnosis is based on CBC, MCV, MCH, RDW, peripheral smear, iron study and vitamin assays. Additional investigations such as stool examination for parasites, occult blood testing, endoscopy, and malabsorption studies may be required depending on clinical suspicion. Management involves correction of the specific deficiency and treatment of underlying causes.
Prevention strategies include dietary improvement with iron-rich foods, green leafy vegetables, legumes, animal-source proteins, and fortified foods.
Supplementation programs targeting pregnant women, infants, adolescents, and other high-risk groups are essential.
Food fortification of staple foods with iron and folic acid has demonstrated significant public health benefits.
For medical graduates, a high index of suspicion is necessary, as nutritional anaemia often presents subtly yet carries significant clinical and public health implications.
MBH/DB