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IRON AS MICRONUTRIENT: FOOD SOURCES, CLINICAL PROBLEMS
Food sources
Foods in the meat group are good sources of available iron, any kind of liver or organ meat being especially rich. Oysters and clams are rich in iron but other sea-foods are somewhat lower than meat. Although egg yolk contains an appreciable amount of iron, much of this iron is not absorbed from the intestine. Legumes and nuts are fairly rich in iron. Dark green leafy vegetables of all kinds are especially rich in iron. Fruits are fair contributors. Dried prunes, apricots, peaches, and raisins are rich in iron, but their infrequent use means that the daily intake is not importantly affected.
Whole-grain or enriched breads, cereals, and pastas supply appreciable amounts of iron if eaten in quantity. The milk group supplies very little iron.
It becomes evident that the Four Food Groups do not furnish enough iron for the girl or woman. In fact, typical diets in the United States can be counted on to furnish about 6 mg iron per 1000 kcal. During periods of rapid growth in teenage girls and during pregnancy iron supplementation is desirable.
Clinical problems
Iron-deficiency anemia is widespread in the United States. Mild anemia occurs in vulnerable groups who have had a diet low in iron for some time: infants fed principally on milk formulas without iron supplement; teenagers whose food selection is poor; and women who have had several pregnancies without iron supplementation. In severe iron-deficiency anemia, blood loss from the gastrointestinal tract should be suspected; for example, a bleeding ulcer, ulcerative colitis, or the losses that accompany parasite infestation such as hookworm. It is also necessary to take into account the frequency with which persons make blood donations, and any extraordinary menstrual losses.
Iron deficiency can be detected before the stores become sufficiently depleted to lower the hematocrit and hemoglobin levels. Symptoms are often absent in mild anemias. As the deficiency becomes more severe there is insufficient hemoglobin to carry oxygen to the tissues. With physical effort the individual becomes very tired, looks pale, and may have a poor resistance to infection. Iron-deficiency anemia is most effectively treated with iron salts. It is not practical to provide iron by diet alone since it is very difficult to achieve intakes of more than 15 to 20 mg. Such levels are far too low for recovery from an existing anemia.
Hemosiderosis is an excessive accumulation of iron in the liver, lungs, pancreas, heart, and other tissues. Sometimes it is a genetic defect that permits excessive absorption of iron. It could also result from overuse of iron supplements, but is not a problem with usual American diets.
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