Anaemia Burden — Iron Alone Is No Solution, Pg6

Key Highlights:

• The National Family Health Survey (NFHS-5) indicates that over half of Indian women and about two-thirds of young children suffer from anaemia.
• Double Fortified Salt (DFS), containing iodine and iron, is proposed as a solution but faces scrutiny due to potential health risks and efficacy concerns.
• Indians consume roughly twice the World Health Organization (WHO) recommended daily salt intake, conflicting with India's Non-Communicable Disease (NCD) action plan to reduce salt consumption by 30%.
• Iron, especially non-haem iron in DFS, has poor absorption in typical Indian diets and can accumulate, posing risks like oxidative stress and exacerbating conditions like haemoglobinopathies.
• Anaemia is a multi-causal condition, with iron deficiency accounting for only about half of the cases, making a single-nutrient solution like DFS potentially ineffective.
• There are concerns about "stacking" of iron intake from multiple government programs like Public Distribution System (PDS), Pradhan Mantri Poshan Shakti Nirman (PM POSHAN) scheme, and Integrated Child Development Services (ICDS) scheme.
• India's revised strategy, the 7x7x7 approach, aims for a broader solution but still relies heavily on iron-folic acid tablets.

Detailed Insights:

• The logic of Double Fortified Salt (DFS) relies on consistent, high salt consumption, which directly contradicts public health goals for sodium reduction.
• Iron intake from DFS is not uniform, with young children and women, who are most in need, potentially receiving the smallest doses.
• Iron accumulation in the body can lead to metabolic diseases, and trials in malaria-endemic regions have shown increased hospitalizations and deaths with iron supplementation.
• Individuals with haemoglobinopathies like beta-thalassaemia and sickle cell disease are prone to iron overload, making universal iron fortification risky and mass screening impractical.
• The non-haem iron in DFS is poorly absorbed due to phytates in cereals, polyphenols in tea, and calcium in milk, common in Indian diets.
• Absorption of iron is further blunted by infections and inflammation, meaning fortification is least effective where infection burdens are highest.
• Beyond iron deficiency, anaemia in India is also caused by deficiencies in folate and vitamin B12, chronic infections, hookworm, malaria, poor sanitation, and overall undernutrition.
• Successful anaemia reduction strategies in countries like Peru and Vietnam involved political prioritization, comprehensive tracking, cash transfers, deworming, and better-absorbed iron forms like NaFeEDTA, alongside dietary diversity.
• Experts recommend that India conduct monitored district-level pilots for DFS, assessing cumulative iron exposure and potential harm in vulnerable populations, before a national rollout.

Key Concepts Involved:

• Anaemia: A condition characterized by a deficiency of red blood cells or haemoglobin, leading to reduced oxygen flow to the body's organs.
• Double Fortified Salt (DFS): Common salt fortified with both iodine and iron to address deficiencies of these micronutrients.
• Haemoglobinopathies: A group of inherited blood disorders characterized by abnormal haemoglobin production, such as thalassemia and sickle cell disease.
• Non-Communicable Diseases (NCDs): Chronic diseases that are not passed from person to person, such as heart disease, stroke, cancer, diabetes, and chronic respiratory diseases.