Nutritional anemia

1. DIET IN NUTRITIONAL ANEMIA

2. OUTLINE
▪Introduction
▪Global anemia prevalence
▪Types of nutritional anemia
‾ Iron deficiency anemia
‾ Megaloblastic anemia
‾ Pernicious anemia
‾ Others
•Dietary modifications
•Sample diet plan

3. NUTRITIONAL ANEMIA
▪ Deficiency in size or number of red blood cells or amount of
hemoglobin they contain, due to a poor diet, which is deficient
in
‾ Iron, copper & folate
‾ vitamin B12 ,B6 & E
‾ Protein & essential fatty acids
▪ Not a disease but a symptom of conditions including extensive
blood loss, excessive blood cell destruction, or decreased blood
cell formation

4. GLOBAL ANEMIA PREVALENCE AND NUMBER OF INDIVIDUALS AFFECTED
▪Globally, anemia affects 1.62 billion people which
corresponds to 24.8% of the population
▪The highest prevalence is in preschool-age children
47.4% and the lowest prevalence is in men 12.7%
▪However, the population group with the greatest
number of individuals affected is non-pregnant women
(468.4 million)
▪Source: Worldwide prevalence of anemia 1993-
2005. World Health Organization, 2008.

5. Population group Prevalence of anemia Population affected
Percent
Number
(millions)
Preschool-age children 47.4 293
School-age children 25.4 305
Pregnant women 41.8 56
Non-pregnant women 30.2 468
Men 12.7 260
Elderly 23.9 164
Total population 24.8 1620

6. IRON DEFICIENCY ANEMIA
▪ Characterized by the production of
small (microcytic) erythrocytes and
diminished level of circulating
hemoglobin
▪ Koilonchia—A Sign of Iron
Deficiency
▪ Inadequate ingestion & absorption
▪ Defects in release from stores
▪ Increased requirement
(From Callen JP, Greer KE, Hood AF, Paller AS, Swinyer LJ.
Color Atlas of Dermatology. Philadelphia: W.B. Saunders,
1993.)

7. MEGALOBLASTIC ANEMIA
▪ A form of anemia characterized
by the presence of large,
immature, abnormal red blood
cell progenitors in the bone
marrow
▪ 95% of cases are attributable to
folic acid or vitamin B12
deficiency

8. PERNICIOUS ANEMIA
A macrocytic, Megaloblastic anemia caused by a deficiency of
vitamin B12.
▪ Usually secondary to lack of intrinsic factor (IF)
▪ May be caused by strict vegan diet
▪ Also can be caused by ↓gastric acid secretion, gastric atrophy,
H-pylori, gastrectomy, disorders of the small intestine
▪ Drugs that inhibit B12 absorption including neomycin, alcohol,
colchicine, metformin, pancreatic disease

9. OTHER NUTRITIONAL ANEMIA'S
▪ Copper deficiency anemia
▪ Anemia of protein-energy malnutrition
▪ Sideroblastic (pyridoxine-responsive) anemia
▪ Vitamin E–responsive (hemolytic) anemia

10. COPPER DEFICIENCY
▪Copper is required for mobilization of iron from storage
sites
▪In copper deficient state, result is low serum iron and
hemoglobin, even when iron stores are normal
▪Copper is widespread in foods and needed in tiny amounts
▪Sometimes occurs in infants fed deficient formula or cow’s
milk, adults and children with malabsorption or on TPN
without copper
▪Diagnosis is important, since more iron won’t help and may
interfere with copper absorption

11. SIDEROBLASTIC ANEMIA
▪ Pyridoxine-responsive anemia,
distinguished from anemia
caused by pyridoxine
deficiency
▪ Buildup of immature
sideroblasts—hence the name
▪ B6 is essential—must replace
25 to 100 times the RDA; may
need lifelong replacement
▪ Oxidative damage to cells—
lysis occurs
▪ Vitamin E is an antioxidant
that seems to be
protective.
▪ This anemia can occur in
newborns, especially
preemies.
HEMOLYTIC ANEMIA

12. DIET FOR NUTRITIONAL ANEMIA
▪Diet must be provide the sufficient amount
of all these nutrients
‾ Iron, copper & folate
‾ vitamin B12 ,B6 & E
‾ Protein & essential fatty acids
▪Specially Iron , folate and vitamin b12

13. DIETARY MODIFICATION FOR IRON-DEFICIENCY ANEMIA
▪Increase iron rich foods
▪Increase absorbable iron in the diet
▪Include vitamin C at every meal
▪Include meat, fish or poultry at every meal
▪Decrease iron inhibitors consumption

14. IRON RICH FOODS
▪ Red meat
▪ Egg yolks
▪ Dark, leafy greens (spinach, collards)
▪ Dried fruit (prunes, raisins)
▪ Iron-enriched cereals and grains
▪ Beans, lentils, chick peas and soybeans
▪ Liver

15. ABSORBABLE IRON HAEM VS NON HAEM
HAEM IRON
▪ Haem iron is provided by animal-
origin foods (i.e. red meat and
meat products, liver, kidneys, egg
yolk, fish, chicken, etc.).
▪ derived from hemoglobin and
myoglobin, which is highly
absorbed.
▪ Absorption can range 8 to 40 %
NON HAEM
▪ Non-haem iron, which is
inorganic iron, very abundant in
vegetable foods and in fortified
foods (i.e. dried fruits and
vegetables, wholegrain cereals,
legumes).
▪ The bioavailability of non-haem
iron is much lower than haem
iron absorbed by 0.5–6%

16. VITAMINS & IRON ABSORPTION
▪Vitamins like vitamin A and C enhance iron availability, thus
counteracting the action of polyphenols and phytic acid
▪Vitamin c by citrus fruits etc
▪vitamin A are provided by both animal foods (cow's milk,
eggs, cheese, yogurt, fish chicken) and plant foods (fruits
and vegetables e.g. carrot & sweat potato)

17. IRON INHIBITORS
▪iron absorption is
inhibited by the
presence of
▪Phytic acid
▪phenolic
compounds
▪Tannins
▪Calcium
• Phytic acid found in whole grains, legumes ,
nuts & oil seed. Consuming 5-10 mg of
phytic acid can reduce iron absorption by
50%
• phenolic compounds found in spices and
herbs (i.e. chilli, garlic, pepper, shallot and
turmeric) are potent inhibitors of iron
availability, reducing iron availability from
20 to 90% in a dose-dependent manner
• Calcium more than 40mg Calcium seems to
have a direct effect on haem iron absorption,
counteracting the enhancing effect of meat.
Up to 300mg calcium inhibit iron absorption
100%

18. DIET FOR VITAMIN B12 DEFICIENCY
▪ Animal source foods are rich in b12 specially sea food
then meat and dairy products
▪The dietary management of B12 deficiency includes a
high-protein diet (1.5 g/kg body weight), a higher
consumption of green leafy vegetables and food items
rich in B12, i.e. meat, eggs and dairy products.

19. DIET FOR FOLATE DEFICIENCY
▪Natural dietary sources of folate include citrus and
other fruits, dark green leafy vegetables, and legumes &
all flour and uncooked cereal grains.
▪ Folate is sensitive to high temperatures and cooking can
destroy 50–95% of folate in the foods. Therefore, patients
should be consume fresh fruit and vegetables.

20. SAMPLE DIET PLAN
▪ Breakfast : 250 milk, 7 almonds,2 bread slice 1 egg
▪ Mid morning snack : pomegranate juice 250 ml , 200g
beef slice cooked with lemon ,125g mix vegetable salad
▪ Lunch : 2 fermented breads , 125g cooked liver (meat)
with lemon, 1 raw tomato , 1 cucumber
▪ Snack : 250ml orang juice , 100g lentils bean
▪ Dinner : 200g boiled white rice , 200g chicken with
lemon ,