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Nutritional anemia — Clinical Guidelines

Overview

Nutritional anemia encompasses various forms of anemia resulting from deficiencies in essential nutrients such as iron, vitamin B12, folate, and vitamin D, impacting hemoglobin synthesis and red blood cell production. 1 2 5 14 26

Diagnosis

Clinical Presentation: Fatigue, pallor, shortness of breath, and in severe cases, paresthesias or neurological symptoms.

Laboratory Tests:

- Complete Blood Count (CBC): Low hemoglobin, hematocrit, and mean corpuscular volume (MCV). - Iron Studies: Serum ferritin, serum iron, total iron-binding capacity (TIBC), transferrin saturation. - Vitamin B12 and Folate Levels: Serum vitamin B12 and red blood cell folate concentrations. - Vitamin D Levels: Serum 25-hydroxyvitamin D levels for assessing deficiency contributing to rickets.

Specific Deficiencies:

- Iron Deficiency: Low serum ferritin, high TIBC, low transferrin saturation. - Vitamin B12 Deficiency: Elevated methylmalonic acid (MMA) and homocysteine levels. - Folate Deficiency: Elevated homocysteine levels. - Vitamin D Deficiency: Low 25-hydroxyvitamin D levels. 5 14 26 33

Management

Iron Deficiency: Oral iron supplements (e.g., ferrous sulfate 325 mg tid) or intravenous iron if absorption issues exist.

Vitamin B12 Deficiency: Parenteral vitamin B12 (hydroxocobalamin 1 mg IM every 1-3 months) for deficient individuals with absorption issues.

Folate Deficiency: Oral folic acid supplementation (1 mg daily).

Vitamin D Deficiency: Oral vitamin D3 supplementation (typically 1000-2000 IU/day for maintenance).

Dietary Modifications: Increase intake of iron-rich foods (red meat, beans, fortified cereals), vitamin B12 sources (dairy, meat), folate-rich foods (leafy greens, legumes), and vitamin D sources (fatty fish, fortified dairy).

Monitoring: Regular follow-up with CBC and relevant nutrient levels to assess response to treatment. 5 14 26 33

Special Populations

Pregnancy: Maternal vitamin B12 supplementation (e.g., 1 mg IM monthly) is crucial to prevent maternal and fetal complications. 16

Pediatrics: Early detection and supplementation with iron, vitamin B12, and vitamin D as needed, particularly in exclusively breastfed infants without adequate supplementation. 12 24 27

Elderly: Increased risk of vitamin B12 deficiency due to malabsorption; consider regular parenteral supplementation. 5 33

Comorbidities: Individuals with gastrointestinal disorders (e.g., celiac disease, Crohn's disease) require careful monitoring and possibly parenteral supplementation for B12 deficiency. 3 7

Key Recommendations

Screen for Nutritional Deficiencies in high-risk populations (elderly, pregnant women, vegetarians) using appropriate laboratory tests (CBC, serum ferritin, vitamin B12, folate, 25-hydroxyvitamin D). (Evidence: Moderate) 5 14 26 24

Initiate Targeted Supplementation based on identified deficiencies: oral iron for iron deficiency, parenteral vitamin B12 for absorption issues, and vitamin D supplementation as needed. (Evidence: Moderate) 5 14 26 33

Monitor Response to Treatment with periodic blood tests to ensure normalization of hemoglobin levels and nutrient parameters. (Evidence: Moderate) 5 14 26

Promote Dietary Intake of nutrient-rich foods to support long-term nutritional status, especially in pediatric and elderly populations. (Evidence: Expert opinion) 12 24

References

1 Baibatyrova S, Onerbayeva A, Sagyzbaev A, Kenzhebaev T, Mukatayeva Z, Kurmanbayeva I. Mineral-Vitamin Complexes in Sheep Nutrition: Patent Analysis and Functional Evaluation for Pregnant Ewes and Lambs. Molecules (Basel, Switzerland) 2026. link 2 Zegers RHC, Ciesielska M, Grzybowski A. Ophthalmology research in the Warsaw Jewish ghetto-hunger disease and the story of Szymon Fajgenblat, MD. Acta ophthalmologica 2023. link 3 Selhub J, Miller JW, Troen AM, Mason JB, Jacques PF. Perspective: The High-Folate-Low-Vitamin B-12 Interaction Is a Novel Cause of Vitamin B-12 Depletion with a Specific Etiology-A Hypothesis. Advances in nutrition (Bethesda, Md.) 2022. link 4 Nosewicz J, Spaccarelli N, Roberts KM, Hart PA, Kaffenberger JA, Trinidad JC et al.. The epidemiology, impact, and diagnosis of micronutrient nutritional dermatoses part 1: Zinc, selenium, copper, vitamin A, and vitamin C. Journal of the American Academy of Dermatology 2022. link 5 Huang HH, Cohen AA, Gaudreau P, Auray-Blais C, Allard D, Boutin M et al.. Vitamin B-12 Intake from Dairy but Not Meat Is Associated with Decreased Risk of Low Vitamin B-12 Status and Deficiency in Older Adults from Quebec, Canada. The Journal of nutrition 2022. link 6 Ali MA, Hafez HA, Kamel MA, Ghamry HI, Shukry M, Farag MA. Dietary Vitamin B Complex: Orchestration in Human Nutrition throughout Life with Sex Differences. Nutrients 2022. link 7 Guetterman HM, Huey SL, Knight R, Fox AM, Mehta S, Finkelstein JL. Vitamin B-12 and the Gastrointestinal Microbiome: A Systematic Review. Advances in nutrition (Bethesda, Md.) 2022. link 8 de Boer A, Geboers L, van de Koppel S, van Hunsel F. Governance of nutrivigilance in the Netherlands: Reporting adverse events of non-registered products. Health policy (Amsterdam, Netherlands) 2022. link 9 Vázquez-Vázquez A, Fewtrell MS, Chan-García H, Batún-Marrufo C, Dickinson F, Wells JC. Does maternal grandmother's support improve maternal and child nutritional health outcomes? Evidence from Merida, Yucatan, Mexico. Philosophical transactions of the Royal Society of London. Series B, Biological sciences 2021. link 10 Chouraqui JP, Turck D, Briend A, Darmaun D, Bocquet A, Feillet F et al.. Religious dietary rules and their potential nutritional and health consequences. International journal of epidemiology 2021. link 11 Benoit CR, Walsh DJ, Mekerishvili L, Houerbi N, Stanton AE, McGaughey DM et al.. Loss of the Vitamin B-12 Transport Protein Tcn2 Results in Maternally Inherited Growth and Developmental Defects in Zebrafish. The Journal of nutrition 2021. link 12 Redecilla Ferreiro S, Moráis López A, Moreno Villares JM. [Position paper on vegetarian diets in infants and children. Committee on Nutrition and Breastfeeding of the Spanish Paediatric Association]. Anales de pediatria 2020. link 13 Terry AL, Wambogo E, Ansai N, Ahluwalia N. Breakfast Intake Among Children and Adolescents: United States, 2015-2018. NCHS data brief 2020. link 14 Chibuzor MT, Graham-Kalio D, Osaji JO, Meremikwu MM. Vitamin D, calcium or a combination of vitamin D and calcium for the treatment of nutritional rickets in children. The Cochrane database of systematic reviews 2020. link 15 Zittermann A, Pilz S, Berthold HK. Serum 25-hydroxyvitamin D response to vitamin D supplementation in infants: a systematic review and meta-analysis of clinical intervention trials. European journal of nutrition 2020. link 16 Srinivasan K, Thomas S, Anand S, Jayachandra M, Thomas T, Strand TA et al.. Vitamin B-12 Supplementation during Pregnancy and Early Lactation Does Not Affect Neurophysiologic Outcomes in Children Aged 6 Years. The Journal of nutrition 2020. link 17 Rejman K, Górska-Warsewicz H, Czeczotko M, Laskowski W. Nonalcoholic Beverages as Sources of Nutrients in the Average Polish Diet. Nutrients 2020. link 18 Ward WE, Chilibeck PD, Comelli EM, Duncan AM, Phillips SM, Robinson LE et al.. Research in nutritional supplements and nutraceuticals for health, physical activity, and performance: moving forward . Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme 2019. link 19 Capone K, Sentongo T. The ABCs of Nutrient Deficiencies and Toxicities. Pediatric annals 2019. link 20 Yajnik CS, Behere RV, Bhat DS, Memane N, Raut D, Ladkat R et al.. A physiological dose of oral vitamin B-12 improves hematological, biochemical-metabolic indices and peripheral nerve function in B-12 deficient Indian adolescent women. PloS one 2019. link 21 Chaudhuri BP, Ceyssens F, Celen S, Bormans G, Kraft M, Puers R. In-vivo Intradermal Delivery of Co-57 labeled Vitamin B-12, and Subsequent Comparison with Standard Subcutaneous Administration. Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference 2019. link 22 Samal JRK, Samal IR. Protein Supplements: Pros and Cons. Journal of dietary supplements 2018. link 23 Dzikamunhenga RS, Griffith RW, Hostetter S, Fisher P, Larson W. Hematology and Serum Biochemistry Reference Intervals for Six-Week-Old, Farm-Reared Chinese Ring-Necked Pheasants ( Phasianus colchicus ) from Minnesota. Avian diseases 2017. link 24 Schüpbach R, Wegmüller R, Berguerand C, Bui M, Herter-Aeberli I. Micronutrient status and intake in omnivores, vegetarians and vegans in Switzerland. European journal of nutrition 2017. link 25 Tolkachjov SN, Bruce AJ. Oral manifestations of nutritional disorders. Clinics in dermatology 2017. link 26 Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K et al.. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. The Journal of clinical endocrinology and metabolism 2016. link 27 Mondal K, Seth A, Marwaha RK, Dhanwal D, Aneja S, Singh R et al.. A Randomized controlled trial on safety and efficacy of single intramuscular versus staggered oral dose of 600 000IU Vitamin D in treatment of nutritional rickets. Journal of tropical pediatrics 2014. link 28 Pfeiffer CM, Sternberg MR, Schleicher RL, Haynes BM, Rybak ME, Pirkle JL. The CDC's Second National Report on Biochemical Indicators of Diet and Nutrition in the U.S. Population is a valuable tool for researchers and policy makers. The Journal of nutrition 2013. link 29 Dahl WJ, Foster LM, Tyler RT. Review of the health benefits of peas (Pisum sativum L.). The British journal of nutrition 2012. link 30 Anderson OS, Sant KE, Dolinoy DC. Nutrition and epigenetics: an interplay of dietary methyl donors, one-carbon metabolism and DNA methylation. The Journal of nutritional biochemistry 2012. link 31 Jen M, Yan AC. Syndromes associated with nutritional deficiency and excess. Clinics in dermatology 2010. link 32 Kirby M, Danner E. Nutritional deficiencies in children on restricted diets. Pediatric clinics of North America 2009. link 33 Hoey L, Strain JJ, McNulty H. Studies of biomarker responses to intervention with vitamin B-12: a systematic review of randomized controlled trials. The American journal of clinical nutrition 2009. link 34 Rajah J, Jubeh JA, Haq A, Shalash A, Parsons H. Nutritional rickets and z scores for height in the United Arab Emirates: to D or not to D?. Pediatrics international : official journal of the Japan Pediatric Society 2008. link 35 Jackson JM, Blaine D, Powell-Tuck J, Korbonits M, Carey A, Elia M. Macro- and micronutrient losses and nutritional status resulting from 44 days of total fasting in a non-obese man. Nutrition (Burbank, Los Angeles County, Calif.) 2006. link 36 Altun G, Akansu B, Altun BU, Azmak D, Yilmaz A. Deaths due to hunger strike: post-mortem findings. Forensic science international 2004. link 37 Johnson MA, Hawthorne NA, Brackett WR, Fischer JG, Gunter EW, Allen RH et al.. Hyperhomocysteinemia and vitamin B-12 deficiency in elderly using Title IIIc nutrition services. The American journal of clinical nutrition 2003. link 38 Bender DA. Do we really know vitamin and mineral requirements for infants and children?. The journal of the Royal Society for the Promotion of Health 2003. link 39 Davis A, Baker S. The use of modular nutrients in pediatrics. JPEN. Journal of parenteral and enteral nutrition 1996. link 40 Bunce GE. Hypercholesterolemia of copper deficiency is linked to glutathione metabolism and regulation of hepatic HMG-CoA reductase. Nutrition reviews 1993. link 41 Ryn Z. Between life and death: experiences of concentration camp mussulmen during the holocaust. Genetic, social, and general psychology monographs 1990. link 42 Bohman VR, Cotton DB. Supralethal magnesemia with patient survival. Obstetrics and gynecology 1990. link 43 Scanes CG, Griminger P. Endocrine-nutrition interactions in birds. The Journal of experimental zoology. Supplement : published under auspices of the American Society of Zoologists and the Division of Comparative Physiology and Biochemistry 1990. link 44 Kenney JJ, Clemens R, Forsythe KD. Applied kinesiology unreliable for assessing nutrient status. Journal of the American Dietetic Association 1988. link 45 Kleczkowski M. Evaluation of selected metabolic indices for cattle in copper deficient regions. Polskie archiwum weterynaryjne 1987. link 46 Oomori Y. Immunohistochemistry and morphometry of gastrin cells in the rat pyloric antrum during starvation. Anatomy and embryology 1986. link 47 Pereira GR, Zucker AH. Nutritional deficiencies in the neonate. Clinics in perinatology 1986. link 48 MacDonald ML, Rogers QR, Morris JG. Nutrition of the domestic cat, a mammalian carnivore. Annual review of nutrition 1984. link

Nutritional anemia