By Sheela S. Sinharoy, MPH
The 3rd Micronutrient Forum Global Conference took place from June 2-6, 2014 in Addis Ababa, Ethiopia, with approximately 1,000 attendees and more than 80 sessions. Some of my personal highlights were:
• Lindsay Allen’s talk on biomarkers for vitamin B12. Dr. Allen argued that depending on the biomarker used, vitamin B12 deficiency may be more prevalent than iron deficiency.
• Michael Fenech’s presentations on the exposome, especially the impact of nutrient deficiencies on the integrity of DNA. He has found that the DNA damage from folate deficiency is equivalent to the damage from 10 times the allowable annual exposure to ionizing radiation.
• Daniel Raiten and Bas Kremer’s talks on the importance of a systems biology perspective. It’s good to be reminded of the need for research on nutrient-nutrient interactions and the role of nutrient “clusters” within biological systems.
The most interesting session, however, was the plenary session on the risks and benefits of iron interventions. Many of us know that iron deficiency is the most common nutritional disorder in the world. It is a major cause of anemia but not always the dominant cause. We also know that the main anemia control strategy worldwide is iron supplementation. However, in cases of anemia that are caused by factors other than iron deficiency, iron supplementation can actually be harmful, exacerbating malaria and increasing pathogenic bacteria in the gut. How, then, to determine whether or not iron supplementation is appropriate?
One possible solution came from Sant-Rayn Pasricha, one of the speakers in the plenary, who presented research on the use of the hormone hepcidin to assess iron status. He and his co-authors found that measurement of plasma hepcidin concentrations is useful for detecting iron deficiency and is more sensitive than ferritin. It is also more practical than the current approach, which involves measurements of ferritin, soluble transferrin receptor, and C-reactive protein to assess iron status.
This is of major importance, especially for those of us who work in developing countries where anemia levels are high. In Dr. Pasricha’s sample of children in The Gambia and Tanzania, 61% had anemia, but only 13% had iron deficiency anemia. Under current recommendations, all of the anemic children would be given iron supplementation, even though most of them were not iron deficient. This is not only a poor use of resources but, more importantly, potentially hazardous.
Iron supplementation is normally guided by hemoglobin levels, which measure anemia but not iron deficiency. Is it time to replace hemoglobin testing with hepcidin testing? There is no low-cost assay for hepcidin, so this is not a practical solution in the field just yet. In the meanwhile, it is important to consider the risks of infection and iron overload that can follow from inappropriate supplementation.
The knowledge I obtained at Micronutrient Forum will undoubtedly enrich my work moving forward. As I continue to make my way through articles referenced in various presentations, I am already looking forward to the 4th Micronutrient Forum Global Conference, scheduled for 2016 in Mexico.