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Iron Deficiency: Under-recognised Cause of Disability and Death with a Higher Impact than Lung Cancer in the WHO Global Burden of Disease


    Data supporting the need for better recognition of iron deficiency will be presented this week at the United European Gastroenterology Week Congress in Berlin1. Iron deficiency is frequently under-diagnosed, resulting in increased hospitalisation, reduced quality of life and higher death rates in patients with comorbid conditions2–8. The WHO has estimated that iron deficiency causes the loss of 48,225 disability-adjusted life-years (DALYs) worldwide, more than is seen with lung cancer2.

    To improve awareness and availability of information relating to the importance of iron deficiency, the Iron Therapy.org website (www.irontherapy.org) was set up by a group of global experts in the field. Iron Therapy.org includes the latest news in iron deficiency from across a range of therapeutic areas, as well as features from renowned international experts and footage of leading scientists discussing their latest research and its significance. Also available is the ‘Essentials’ section, consolidating background information for those who are new to the area of iron deficiency10.

    Iron deficiency is the most common nutritional disorder in the world2 and the leading cause of anaemia3. It is prevalent in many chronic diseases, including in patients with inflammatory bowel disease, heart failure and kidney disease5–12. Better recognition of the disorder is essential if patient outcomes are to improve.

    Although they frequently occur together, iron deficiency and anaemia are independent disorders. The absence of anaemia does not rule out iron deficiency, and vice versa. However, if iron deficiency is left to advance to anaemia, it is harder to treat and associated with even worse outcomes5,7; recent research indicates that treating iron deficiency early on, before progression to anaemia, reduces mortality in comorbid conditions7,9.

    The detection of iron deficiency is notoriously problematic, as outward symptoms are not always present13. Iron levels often need to be markedly reduced before anaemia occurs, meaning that the frequent reliance on haemoglobin as an assessment tool commonly delays diagnosis until negative consequences have occurred14. Serum iron values alone are not helpful in diagnosis, as they vary with the time of day and with systemic causes. Serum ferritin levels may detect iron deficiency, but are also artificially elevated in inflammatory processes – such that, higher levels of serum ferritin may still be present in iron deficient patients with inflammatory bowel disease15.

    Iron deficiency occurs frequently in patients with inflammatory bowel disease – approximately 36–76% of patients are iron deficient11. Furthermore, iron deficiency anaemia is one of the most frequent comorbid conditions linked with mortality in these patients12,13. Therefore, clinicians should be extra vigilant in their recognition and treatment of iron deficiency in this population15. Given the high prevalence of iron deficiency, and its strong links with many chronic and debilitating conditions, treatment is of the utmost importance. It is crucial that development of future strategies for treatment of chronic diseases includes iron deficiency as a high priority.

    -ENDS-

    Editor’s notes:

    Irontherapy.org is an educational programme funded by Vifor Pharma . All content is independently generated by the Irontherapy.org faculty experts reflecting their knowledge and opinions.

    References

    1. Wiesenthal M, et al. Poster presented at the United European Gastroenterology Congress, 2013. P1460.

    2. Murray CJL, et al. N Engl J Med 2013;369:448–57.

    3. World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Accessed August 2013. Available from: http://www.who.int/vmnis/indicators/haemoglobin/en/.

    4. World Health Organization. Worldwide Prevalence of Anaemia 1993–2005: WHO Global Database on Anaemia. Geneva: World Health Organization; 2008. Accessed October 2013. Available from: http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdf.

    5. Jankowska EA, et al. Eur Heart J. 2010;31:1872–80.

    6. Kulnigg S, et al. Alimen Pharmacol & Ther. 2006;24:1507–23.

    7. Okonko DO, et al. Am Coll Cardiol. 2011;58:1241–51.

    8. Aung N, et al. Int J Cardiol. 2013 Jan 22 [Epub ahead of print].

    9. Klip IT, et al. Am Heart J. 2013;165:575–82.

    10. Iron Therapy Website. Accessed October 2013. Available from: http://www.irontherapy.org/.

    11. Stein J, et al. Nat Rev Gastroenterol Hepatol. 2010;7:599–610.

    12. Gasche C, et al. Inflamm Bowel Dis. 2007;13:1545–53.

    13. Killip S, et al. Am Fam Physician. 2007;75:671–8.

    14. Beard JL. J Nutritoion. 2001;131:568S–79S.

    15. Goldberg ND, et al. Clin Exp Gastroenterol. 2013;6:61–70.