New Supplement from The Journal of Nutrition

Anemia is a blood disorder that occurs when the body does not have sufficient healthy red blood cells or hemoglobin to deliver oxygen to the body’s tissues. Hemoglobin is a protein found in red blood cells that carries oxygen taken in by the lungs to the body’s other organs.

There are many forms of anemia, each with its own etiology, including blood loss, iron deficiency, and chronic inflammation. Together, these various forms of anemia affect between 20% and 33% of the global population. Anemia can cause tiredness, weakness, and shortness of breath; however, anemia can also be more severe and a warning sign of serious illness.

“Our ability to identify anemia and all its permutations demands an approach that integrates the key elements of a complex ecology,” according to ASN member Dan Raiten et al. In their introductory review to Exploring the Anemia Ecology: A New Approach to an Old Problem, a new supplement published in The Journal of Nutrition (JN), the authors underscore that “the complexity of anemia demands an ecological approach that appreciates systems biology, translates sensitive and specific assessment methodologies and interventions, and ultimately improves clinical and public health outcomes.”

Exploring the Anemia Ecology: A New Approach to an Old Problem consists of four papers sponsored by the United States Agency for International Development (USAID) Advancing Nutrition Anemia Task Force. The introductory review introduces the topics underlying the biology and primary etiologies of anemia, presenting a framework for the public health assessment of anemia as well as effective public health interventions. The three additional papers fill in the details of the framework laid out in the introduction:

Biology of Anemia: A Public Health Perspective

Gary M. Brittenham et al explore the biological mechanisms underlying anemia from a public health perspective. According to the authors, “progress in understanding the biological mechanisms underlying anemia has steadily increased awareness of the extensive overlap between the common causes of anemia in settings with a high prevalence of iron deficiency (both absolute and functional), those with endemic infections, and those with widespread genetic conditions affecting red blood cells.” As a result, the authors assert that in low- and middle-income countries, reducing the prevalence of anemia requires public health programs that not only focus on nutrient interventions, but also assess the role of genetic conditions and incorporate measures to control infection.

Improving Anemia Assessment in Clinical and Public Health Settings

In recognition of the many overlapping causes of anemia, ASN member Anne M. Williams et al. introduce a framework for anemia assessment based on the “ecology of anemia.” The authors offer examples of how this framework can be applied to interpret data culled from population-based surveys, which in turn can inform interventions to reduce the incidence and burden of anemia. According to the authors, “our goal is to encourage assessment of non-nutritional causes of anemia, as well as the role of nutrients in addition to iron, to better understand the ecology of anemia.” Finally, the authors point to research gaps that need to be filled in order to more effectively diagnose anemia and its underlying causes.

Approaches to Address the Anemia Challenge

Cornelia U. Loechl et al. argue that approaches to address anemia “must recognize that the causal factors represent an ecology consisting of internal (biology, genetics, health) and external (social/behavioral/demographic and physical) environments.” In response, the authors offer an evidence-based integrated approach to choosing a single or a package of effective interventions which take into account both the internal and external environments. Next, they present the strengths and weaknesses of the range of nutritional and non-nutritional interventions to prevent and treat anemia, addressing efficacy, effectiveness, potential to scale up, and interactions among the interventions. Options are offered for all stages of life, with an emphasis on women of reproductive age and preschool-aged children.

We invite you to explore this JN Supplement in its entirety to gain a deeper understanding of the systemic and biological underpinnings of anemia as well as what we can do as nutritionists and health care providers to prevent and better manage anemia worldwide.