Nutritional anaemia
Nutritional anaemia is low haemoglobin, mostly from iron deficiency. It is India's commonest nutrition problem, affecting over half of women (NFHS-5).
WHO haemoglobin cut-offs (g/dL, 2011, as in textbooks)
| Group | Anaemia if Hb is below | Severe anaemia if Hb is below |
|---|---|---|
| Children 6-59 months | 11.0 | 7.0 |
| Children 5-11 years | 11.5 | 8.0 |
| Children 12-14 years | 12.0 | 8.0 |
| Non-pregnant women (15 years and above) | 12.0 | 8.0 |
| Pregnant women | 11.0 | 7.0 |
| Men (15 years and above) | 13.0 | 8.0 |
| WHO 2024 update | Lowered to 10.5 for children 6-23 months and for pregnant women in the second trimester; other cut-offs unchanged | Unchanged |
Causes of nutritional anaemia
| Cause | How it leads to anaemia | Examples |
|---|---|---|
| Low intake | Diet poor in iron, folate or B12 | Cereal-based vegetarian diets with little green leafy vegetables, pulses or meat |
| Poor absorption | Plant (non-haem) iron is poorly absorbed, and inhibitors block it further | Phytates in cereals, tannins in tea and coffee taken with meals, calcium; too little vitamin C |
| Blood loss | Iron is lost from the body | Hookworm, heavy periods, bleeding piles, frequent pregnancies |
| Raised needs | The body needs more than the diet gives | Infancy, adolescence, pregnancy, lactation |
| Infections | Red cells destroyed or iron use blocked | Malaria, tuberculosis, repeated diarrhoea |
| Folate or B12 lack | Large, immature red cells (megaloblastic anaemia) | Pregnancy (folate); strict vegetarians (B12) |
Clinical features
- Pallor of the conjunctiva, tongue, palms and nail beds.
- Tiredness, weakness, breathlessness on exertion, palpitations, giddiness, headache.
- Koilonychia (spoon-shaped nails), angular stomatitis (cracks at the corners of the mouth), smooth sore tongue (glossitis).
- Pica: craving for non-food items such as mud, chalk or ice.
- Poor attention and school performance in children; lower work capacity in adults.
- In pregnancy: higher risk of low birth weight, preterm birth and maternal death.
- Blood picture: iron deficiency gives microcytic hypochromic (small, pale) cells; folate or B12 deficiency gives macrocytic (large) cells.
Preventive strategies
- IFA supplementation for every at-risk group under Anemia Mukt Bharat (2018): children, adolescents, women, pregnant and lactating mothers.
- Deworming with albendazole on National Deworming Day, twice a year.
- Dietary diversification: bajra, pulses, green leafy vegetables (amaranth, drumstick leaves), garden cress seeds, meat, liver and fish.
- Better absorption: add vitamin C foods (amla, guava, lemon) to meals; keep tea and coffee away from mealtimes; cook in iron vessels.
- Fortification: double fortified salt (iodine + iron) and fortified rice through PDS, ICDS and PM POSHAN.
- Infection control: malaria control, safe water, toilets and footwear (against hookworm).
- Birth spacing, delayed cord clamping at birth, and testing and treating anaemia early.
- Nutrition education at anganwadis and schools and during Poshan Maah.
Iron requirement (ICMR-NIN 2020)
The 2020 iron RDA is 19 mg/day for adult men and 29 mg/day for adult women. Older books show the 2010 values (17 mg for men, 21 mg for women). Indian diets give mostly non-haem iron, of which only a small fraction is absorbed, so the extra needs of pregnancy cannot be met by diet alone and IFA tablets are given.
In a village, the anganwadi worker and ASHA give IFA tablets, record them on the Anemia Mukt Bharat card, and teach mothers to add amla or lemon to meals and keep tea away from lunch. Schools hold deworming day twice a year.
2 marks: “Give the WHO haemoglobin cut-offs for anaemia in pregnant and non-pregnant women.” Pregnant women: below 11.0 g/dL. Non-pregnant women: below 12.0 g/dL.
5 marks: “List the causes of nutritional anaemia.” Low intake, poor absorption (phytates, tannins), blood loss (hookworm, menstruation), raised needs (growth, pregnancy), infections (malaria), folate and B12 lack, each with an example.
10 marks: “Discuss the etiology, clinical features and prevention of nutritional anaemia.” Define with WHO cut-offs; NFHS-5 prevalence; causes table; clinical features; effects; prevention: IFA under Anemia Mukt Bharat, deworming, diet with vitamin C, fortification, infection control, education.
Causes of anaemia are 'LAB-RI': Low intake, poor Absorption, Blood loss, Raised needs, Infection.