Health Wise

Iron Deficiency Anaemia (IDA) is today, one of the most significant contributory factors leading to anaemia worldwide and in Sri Lanka. Anaemia, largely resulting from iron deficiency, according to UNICEF and WHO affects 40 percent of pre-schoolers, and one in every two pregnant women. Latest statistics indicate that one in three children and one in four adults in Sri Lanka suffer from IDA. These dismal figures in a country such as Sri Lanka where every other health indicators has proved excellent, has raised concerns among health officials, with the Health Ministry even declaring a National Nutrition Month in June for the past few years.

Nutrition is closely linked to IDA. Under nutrition can lead to anaemia causing the same symptoms of slow development, slow growth and low IQ. It is a vicious cycle. Babies of anaemic malnourished mothers are usually born low weight carrying with them the problems throughout their lives. IDA also affects work output and inability to concentrate Health Minister Maithrapala Sirisena has been quoted as saying, “Iron Deficiency is a public health problem. Prevention and treatment of iron deficiency can raise national productivity by 20 percent”.

Several health officials met the media last week to discuss this year’s theme of ‘Iron rich food for health, strength and intelligence’ to underscore the grave effects that iron deficiency can have on one’s health , and drive home the message that it can affects all ages cutting across gender barriers. Training young children including infants to eat foods rich in iron they pointed out, could arrest and prevent the problem. The solution is not in iron fortified milk foods and supplementary foods or vitamins, but in your own backyards where you can grow these foods naturally, they emphasised.

Director, Nutrition Coordination unit, Ministry of Health, Dr Shanthi Gunawadana said:

“Iron deficiency can occur in many ways: a) due to insufficient dietary intake of iron b) loss of blood as in the case of parasitic infestations and heavy menstrual bleeding.

A. IDA develops gradually after the normal stores of iron have been depleted. High risk groups include women of child bearing age due to blood loss through menstruation, pregnancy or lactating women due to an increased requirement for iron; infants, children and adolescents due to rapid growth phases. Low birth weight and pre-term infants are also at risk due to inadequate iron stores.

Why iron is important

Iron is a part of all cells and does many things in our bodies. For example, iron (as part of the protein haemoglobin) carries oxygen throughout our bodies. Having too little haemoglobin is called anaemia. Iron helps our muscles store and use oxygen.

Iron is part of many enzymes and is used in many cell functions. Enzymes help our bodies digest foods and also helps with many other important reactions that occur within our bodies.

When there is not enough iron in the body, not enough oxygen is carried to the brain and muscles. This reduces brain development, available energy and proper muscle function and results in iron deficiency.

A. Anaemia has profound negative effects on human health and development in infants and young children. It results in impairment of psycho-motor development, cognition and scholastic achievements and productivity. It is also associated with increased morbidity from infectious diseases.

A. A 30 percent impairment of physical work capacity and performance has been reported in iron deficient men and women. In pregnant women iron deficiency anaemia was also found to lead to an increased risk of maternal mortality and morbidity, foetal morbidity and mortality and intrauterine growth retardation.

A. The cut off haemoglobin level for anaemia in men is generally 13.0g/dl. For women, this value is 12.0 g/dl except for pregnant mothers for whom it is 11.0 g/dl.

A. The cut-off haemoglobin level for children of different age groups are as follows: Between 6 - 59 months 11.0g/dl, 5 - 11 years 11.5 g/dl , 12 - 14 years 12.0 g/dl

Solving the problem

Dr Gunawardana also drew attention to simple cost effective methods of ensuring that one’s body does not lack in iron, highlighting iron rich foods while differentiating between vegetarian and no vegetarian diets.

“Bioavailability of iron in the vegetarian sources is lower compared to non vegetarian diets, except egg and milk”, she said. Vegetables such as dark green and other leafy vegetables such as gotukola, sana, thampala, kathurumurunga, and pulses such as beans, soya beans, green gram, chickpea, ulundu and dhall were also rich in iron. So too are products made from these foods such as tofu, bean curd and iron. These contain non haem iron (not easily absorbed) in contrast to haem iron (easily absorbable) foods.

However, bioavailability of iron found in vegetable sources can be enhanced by sprouting grains and beans and consuming them with foods that are rich in vitamin C such as lemon (dehi) orange (dodam) amla (nelli), guava (pera) star fruit (kabaranka), Ceylon olive (veralu) tamarind, siyambala) and tomato.”

She warned that iron absorption could be impaired by tannin and caffeine found in tea and coffee, and some essential minerals such as calcium. “Don’t consume tea or coffee one hour before a meal or within an hour after a meal”, she advised.

On the other hand, some of the richest iron sources came from non vegetarian diets that included: red meat i.e. chicken, pork, mutton and beef, as well as fish.

A. I specially refer to balaya, kelawella, savalaya and dried sprats as well as organ meat (e.g. liver) which contain easily absorbable haem iron.

Strategies / Interventions

Dr Gunawardana said there were several interventions and strategies that had already been put into place and would be put into place in the future, to control iron deficiency anaemia.

“ We already have several nutritional interventions targeted to prevent iron deficiency in the routine healthcare delivery system of Sri Lanka”, she pointed out. “During pregnancy, worm treatment, iron suppkentation and detection and correction of anaemia ensure adequate iron stores in foetus to maintain the optimal haemoglobin levels during the first six months of life. Pre-term infants who are at higher risk or iron deficiency anaemia are provided with iron supplements to ensure haemoglobin levels. For infants, one of the key recommendations in feeding is to include iron rich foods or animal origin within one week of starting complementary feeding.

A. Worm treatment and weekly iron supplementation with vitamin C and folic acid for school children is a newly implemented intervention targeting to cover the whole school population from grades 1 - 13.

Nutrition Specialist from UNICEF, Dr Renuka Jayatissa said, the Ministry of Health had partnered with UNICEF since the 1980s to boost awareness of the importance of iron rich foods to reduce the growing numbers of children and women affected by it.

She stressed that children and adults with IDA suffered from poor memory, had poor cognitive skills resulting in poor performance in school work and in recreational activities. “Lower IQs have been linked to iron deficiency occurring during the critical periods of growth”, she noted. “Iron is an essential mineral needed for healthy growth and development”, she reiterated.

Who is affected?

IDA affects newborns, children, adolescents, adults and the elderly regardless of race, colour, economic group or religion.

One in three Sri Lankan children and one in four adults suffer from it. Infants born of mothers with Iron Deficiency ( 16 percent of pregnant women) often have low birth weight and face higher risks of dying in infancy and childhood.

Costs

For each US $1 spent on an iron supplementary program for pregnant women there is a US $24 return in increased lifelong wages and decreased disability.

Prevention and treatment or ID can raise national productivity by 20 percent.

* Shortness of breath when doing simple tasks such as climbing the staircase, walking short distances, doing housework.

* Loss of interest in work
* Loss of interest in recreation
* Loss of interest in relationships.

As the body becomes deficient in iron and anaemia worsens, the symptoms will also worsen”, she said.

Echoing her sentiments, Ms Una McCauley, UNICEF Representative said, “Iron increases the success of early education, health and social programs for children. By treating IDA early, you give children a better chance to develop to their fullest potential”.

Additional Secretary (Public Health Services) Ministry of Health, Dr Amal Harsha de Silva, and Deputy Director of Health Services Dr R.R. M. L. Siyambalagoda and director Health Education Bureau, Dr (Mrs) Neelamani Hewageegana observed that the Health Minister’s view was that the prevention of iron deficiency required a new approach.

“It should be addressed through a multi sectoral approach. Therefore all health and non health sectors should join hands at each level from provincial to village to overcome the problem of iron deficiency anaemia.”, they said.

'Clever’ DNA may help bacteria survive

Scientists have discovered that bacteria can reshape their DNA to survive dehydration. The research, shows that bacterial DNA can change from the regular double helix - known as B-DNA, to the more compact A-DNA form, when faced with hostile conditions such as dehydration.

Crucially, scientists have pinpointed a unique process in DNA, called the B-A-B transition, which allows it to change its structure in response to environmental change.

Without impacting on the ability of the bacteria to function and reproduce, this unique structural alteration sees the B-DNA change to A-DNA, and then revert to its original B-DNA form to ensure the bacteria survive.

Associate Prof Bayden Wood, from Monash University said the study gives vital new information on how bacteria can survive periods of time in arid environments.

“Our findings may be important in understanding how dormant bacteria that are transferred from dry surfaces may become active and reproduce in the human body,’ Associate Prof Wood said.

PhD student Donna Whelan said the most common form of DNA found in most organisms is B-DNA. However, the A-form has been thought to show protective qualities to allow bacterial spores to survive high UV exposure and other extreme environmental conditions.

“Our research, which utilised infrared light to investigate the structure of DNA inside live bacteria, demonstrates that the bacteria can survive by adopting the A-DNA form after the majority of water is removed - and that really is groundbreaking,” Donna Whelan said. The new findings build on research led by Associate Prof Wood and Donna Whelan in 2011 at the Australian Synchrotron, which indicated that the same B-A-B DNA transition occurs in all cell types. Significantly, the team has now discovered that this change may have a biological function in bacteria, potentially assisting them to survive dehydration.

Associate Prof Bayden Wood said the ability for DNA to transform and then change back again in human cells had puzzled scientists until now.

“In human cells the DNA is tightly bound by proteins known as histones, so the fact that it can change to a different form and then change back again is fascinating. We have no biological reason for why this DNA transition happens in human cells, but we may now understand its role in bacteria,” he said.

The interdisciplinary team at Monash investigated four species of bacteria using live cells. By carefully hydrating and dehydrating the bacteria and then analysing the cells using an infrared-based technique, which detects the vibrations of DNA, the team found that all four species underwent the same B-A-B transition.

Prof Julian Rood, who coordinated the microbiology aspects of the research, said that because the majority of bacteria remained fully functional after hydration and rehydration the results suggest that that A-DNA may have a highly evolved protective capacity to ensure survival.

“We discovered that A-DNA has an amazing ability to protect and ensure that life continues even under extreme stress, in this case dehydration. In our tests, even after the majority of water was removed, A-DNA kicked in and then changed back to B-DNA to help the bacteria survive,” Prof Rood said.

– MNT

Social integration improves lung function in elderly

It is well established that being involved in more social roles, such as being married, having close friends, close family members, and belonging to social and religious groups, leads to better mental and physical health.

However, why social integration - the total number of social roles in which a person participates - influences health and longevity has not been clear.

New research led by Carnegie Mellon University shows for the first time that social integration impacts pulmonary function in the elderly. Lung function, which decreases with age, is an important physiological quality that affects cardiovascular disease, asthma and other lung disorders.

This study also rebuffs the popular notion that marriage is the only social role required for health benefits. In fact, different social relationships can be substituted for each other and every added social role improves health.

“We knew that when older adults have friends and family and belong to groups, they have lower mortality rates and less disease and illness risk, but now we can start to understand why that happens,” said Sheldon Cohen, Professor of Psychology. “We also answer critical questions about the importance of marriage for health. It has been suggested that marriage - and things that typically come with it such as children and family - is the only social role that matters.

"The bottom line is that marriage is not required for better health - it is the total number of social roles that predicts improved health.”

For the study, the research team analysed data collected from 1,147 healthy adults between the ages of 70 and 79. The data included a measure of the participants’ social roles and assessed their pulmonary function according to peak expiratory flow rate (PEFR).

They found that the more social roles people engaged in, the better their lung function. While analysis of specific social roles indicated that marriage was the strongest positive connection to lung function, greater numbers of roles also were associated with better lung function even in those who were not married.

Iron deficiency anaemia causes severe health impacts

Solving the problem

Strategies / Interventions

'Clever’ DNA may help bacteria survive

– MNT

Social integration improves lung function in elderly

- Medicalxpress