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Iron Deficiency

woman and child eatingThe following information is adapted from:
Recommendations to Prevent and Control Iron Deficiency in the United States. MMWR 1998;47 (No. RR-3) p. 5 

On this page:

What is iron and why do we need it?

Iron is a mineral needed by our bodies. Iron is a part of all cells and does many things in our bodies. For example, iron (as part of the protein hemoglobin) carries oxygen from our lungs throughout our bodies. Having too little hemoglobin is called anemia. Iron also helps our muscles store and use oxygen.

Iron is a part of many enzymes and is used in many cell functions. Enzymes help our bodies digest foods and also help with many other important reactions that occur within our bodies. When our bodies don’t have enough iron, many parts of our bodies are affected.


What is iron deficiency and why is it a concern?

Iron deficiency is a condition resulting from too little iron in the body. Iron deficiency is the most common nutritional deficiency and the leading cause of anemia in the United States.1

The terms anemia, iron deficiency, and iron deficiency anemia often are used interchangeably but equivalent. Iron deficiency ranges from depleted iron stores without functional or health impairment to iron deficiency with anemia, which affects the functioning of several organ systems. 2

Iron deficiency is a concern because it can:

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What causes iron deficiency?

Iron deficiency has many causes. (See table below for a summary). These causes fall into two main categories:

1. Increased iron needs
Many common conditions can cause people to need additional iron:

2. Decreased iron intake or absorption (not enough iron taken into the body)
The amount of iron absorbed from the diet depends on many factors:

Increased Iron Needs Decreased Iron Intake and Absorption
  • Rapid growth
  • Pregnancy
  • Blood loss
    • Heavy menstrual periods
    • Frequent blood donation
    • Some stomach and intestinal conditions (food sensitivity, hookworms)
  • Lack of heme iron sources in the diet (e.g., vegetarian diets)

  • Low absorption

    • Taking antacids beyond the recommended dose or medicine used to treat peptic ulcer disease and acid reflux can reduce the amount of iron absorbed in the stomach.

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Who is most at risk?

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Signs and Symptoms of Iron Deficiency

Too little iron can impair body functions, but most physical signs and symptoms do not show up unless iron deficiency anemia occurs. Someone with early stages of iron deficiency may have no signs or symptoms. This is why it is important to screen for too little iron among high risk groups.

Signs of iron deficiency anemia include12

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How is iron deficiency detected?

Your doctor or healthcare provider will do blood tests to screen for iron deficiency. No single test is used to diagnose iron deficiency. The most common tests for screening are

Sometimes other blood tests are used to confirm that anemia is due to iron deficiency. These might include

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How is iron deficiency treated?

Again, it is important to be diagnosed by your healthcare provider because iron deficiency can have causes that aren’t related to your diet. Your healthcare provider’s recommendations will be specific to your needs.
 

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What can I do to prevent iron deficiency?

In general, you can eat a healthful diet that includes good sources of iron. A healthful diet includes fruits, vegetables, whole grains, fat free or nonfat milk and milk products, lean meats, fish, dry beans, eggs, nuts, and is low in saturated fat, trans fats, cholesterol, salt, and added sugars.

In addition to a healthful diet that includes good sources of iron, you can also eat foods that help your body absorb iron better. For example, you can eat a fruit or vegetable that is a good source of vitamin C (see table on Dietary Sources of vitamin C) with a food or meal that contains non-heme iron (see table below for Dietary Sources of Iron). Vitamin C helps your body absorb the non-heme iron foods you eat, especially when the food containing non-heme iron and the vitamin-C rich food are eaten at the same meal.

The following recommendations are for specific groups who are at greater risk for iron deficiency.

Babies

Young children (aged 1–5 years)

Adolescent girls and women of childbearing age

Pregnant women

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How much iron do I need?

If you have already been diagnosed with iron deficiency, talk to your doctor or healthcare provider about treatment. For healthy individuals, the Recommended Dietary Allowance (RDA) for iron is listed in the following table.

Recommended Dietary Allowance (RDA) for iron by age and sex.
Age/Group Life Stage Iron (mg/day)
Infants 0–6 months 0.27*
  7–12 months 11
Children 1–3 years 7
  4–8 years 10
Males 9–13 years 8
  14–18 years 11
  19–30 years 8
  31–50 years 8
  51–70 years 8
  >70 years 8
Females 9–13 years 8
  14–18 years 15
  19–30 years 18
  31–50 years 18
  51–70 years 8
  >70 years 8
Pregnant Women 14–18 years 27
  19–30 years 27
  31–50 years 27
Lactating Women 14–18 years 10
  19–30 years 9
  31–50 years 9

*This value is an Adequate Intake (AI) value.  AI is used when there is not enough information known to set a Recommended Dietary Allowance (RDA).

Source: Dietary Reference Intakes, Institute of Medicine, Food and Nutrition Board.*PDF file (PDF-86k)

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Dietary Sources of Iron

Food Sources of Iron ranked by milligrams of iron per standard amount; also calories in the standard amount. (All amounts listed provide 10% or more of the Recommended Dietary Allowance (RDA) for teenage and adult females, which is 18 mg/day.)

Food, Standard Amount Iron (mg) Calories
Clams, canned, drained, 3 oz 23.8 126
*Fortified dry cereals (various), about 1 oz 1.8 to 21.1  54 to 127
Cooked oysters, cooked, 3 oz 10.2 116
Organ meats (liver, giblets), cooked, 3 oza 5.2 to 9.9 134 to 235
*Fortified instant cooked cereals (various), 1 packet 4.9 to 8.1 Varies
*Soybeans, mature, cooked, ½ cup 4.4  149
*Pumpkin and squash seed kernels, roasted, 1 oz 4.2 148
*White beans, canned, ½ cup 3.9 153
*Blackstrap molasses, 1 Tbsp 3.5 47
*Lentils, cooked, ½ cup 3.3  115
*Spinach, cooked from fresh, ½ cup 3.2 21
Beef, chuck, blade roast, cooked, 3 oz 3.1  215
Beef, bottom round, cooked, 3 oz 2.8  182
*Kidney beans, cooked, ½ cup 2.6  112
Sardines, canned in oil, drained, 3 oz 2.5  177
Beef, rib, cooked, 3 oz 2.4 195
*Chickpeas, cooked, ½ cup 2.4 134
Duck, meat only, roasted, 3 oz 2.3  171
Lamb, shoulder, cooked, 3 oz 2.3  237
*Prune juice, ¾ cup 2.3 136
Shrimp, canned, 3 oz 2.3 102
*Cowpeas, cooked, ½ cup 2.2 100
Ground beef, 15% fat, cooked, 3 oz 2.2 212
*Tomato puree, ½ cup 2.2 48
*Lima beans, cooked, ½ cup 2.2 108
*Soybeans, green, cooked, ½ cup 2.2 127
*Navy beans, cooked, ½ cup 2.1 127
*Refried beans, ½ cup 2.1 118
Beef, top sirloin, cooked, 3 oz 2.0 156
*Tomato paste, ¼ cup 2.0 54

Food Sources of iron are ranked by milligrams of iron per standard amount; also calories in the standard amount. (All amounts listed provide 10% or more of the Recommended Dietary Allowance (RDA) for teenage and adult females, which is 18 mg/day.)

aHigh in cholesterol.

*These are non-heme iron sources. To improve absorption, eat these with a vitamin-C rich food.

Source: USDA/HHS Dietary Guidelines for Americans, 2005
Nutrient values from Agricultural Research Service (ARS) Nutrient Database for Standard Reference, Release 17. Foods are from ARS single nutrient reports, sorted in descending order by nutrient content in terms of common household measures. Food items and weights in the single nutrient reports are adapted from those in the 2002 revision of USDA Home and Garden Bulletin No. 72, Nutritive Value of Foods. Mixed dishes and multiple preparations of the same food item have been omitted from this table.

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Dietary Sources of Vitamin C

Food, Standard Amount Vitamin C (mg) Calories
Guava, raw, ½ cup 188 56
Red bell pepper, raw, ½ cup 142 20
Red bell pepper, cooked, ½ cup 116 19
Kiwi fruit, 1 medium 70 46
Orange, raw, 1 medium 70 62
Orange juice, ¾ cup 61 to 93 79 to 84
Green bell pepper, raw, ½ cup 60 15
Green bell pepper, cooked, ½ cup 51 19
Grapefruit juice, ¾ cup 50 to 70 71 to 86
Vegetable juice cocktail, ¾ cup 50 34
Strawberries, raw, ½ cup 49 27
Brussels sprouts, cooked, ½ cup 48 28
Cantaloupe, ¼ medium 47 51
Papaya, raw, ¼ medium 47 30
Kohlrabi, cooked, ½ cup 45 24
Broccoli, raw, ½ cup 39 15
Edible pod peas, cooked, ½ cup 38 34
Broccoli, cooked, ½ cup 37 26
Sweet potato, canned, ½ cup 34 116
Tomato juice, ¾ cup 33 31
Cauliflower, cooked, ½ cup 28 17
Pineapple, raw, ½ cup 28 37
Kale, cooked, ½ cup 27 18
Mango, ½ cup 23 54

Food sources of vitamin C are ranked by milligrams (mg) of vitamin C per standard amount; also calories in the standard amount. (All amounts listed provide 20% or more of the Recommended Dietary Allowance (RDA) of 90 mg/day for adult men.)

Source: USDA/HHS Dietary Guidelines for Americans, 2005
Nutrient values from Agricultural Research Service (ARS) Nutrient Database for Standard Reference, Release 17. Foods are from ARS single nutrient reports, sorted in descending order by nutrient content in terms of common household measures. Food items and weights in the single nutrient reports are adapted from those in the 2002 revision of USDA Home and Garden Bulletin No. 72, Nutritive Value of Foods. Mixed dishes and multiple preparations of the same food item have been omitted from this table.

For more information about iron, see this fact sheet about iron. (NIH)

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References

  1. Centers for Disease Control and Prevention. Iron deficiency – United States, 1999–2000. MMWR 2002;51:897–899.
  2. Akman M, Cebeci D, Okur V, Angin H, Abali O, Akman AC. The effects of iron deficiency on infants' developmental test performance. Acta Paediatr. 2004 Oct;93(10):1391–6.
  3. Friel JK, Aziz K, Andrews WL, Harding SV, Courage ML, Adams RJ.
    A double-masked, randomized control trial of iron supplementation in early infancy in healthy term breast-fed infants. J Pediatr. 2003 Nov;143(5):582–6.
  4. Lozoff B, De Andraca I, Castillo M, Smith JB, Walter T, Pino P. Behavioral and developmental effects of preventing iron-deficiency anemia in healthy full-term infants. Pediatrics. 2003 Oct;112(4):846–54.
  5. Grantham-McGregor S, Ani C. A review of studies on the effect of iron deficiency on cognitive development in children. J Nutr. 2001 Feb;131(2S–2):649S–666S; discussion 666S–668S.
  6. Ronnenberg AG, Wood RJ, Wang X, Xing H, Chen C, Chen D, Guang W, Huang A, Wang L, Xu X. Preconception hemoglobin and ferritin concentrations are associated with pregnancy outcome in a prospective cohort of Chinese women. J Nutr. 2004 Oct;134(10):2586–91.
  7. Scholl TO, Hediger ML, Fischer RL, Shearer JW. Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study. Am J Clin Nutr. 1992 May;55(5):985–8.
  8. Brownlie T 4th, Utermohlen V, Hinton PS, Haas JD. Tissue iron deficiency without anemia impairs adaptation in endurance capacity after aerobic training in previously untrained women. Am J Clin Nutr. 2004 Mar;79(3):437–43.
  9. Haas JD, Brownlie T 4th. Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. J Nutr. 2001 Feb;131(2S–2):676S–688S; discussion 688S–690S.
  10. Bruner AB, Joffe A, Duggan AK, Casella JF, Brandt J. Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls. Lancet. 1996 Oct 12;348(9033):992–6.
  11. US National Library of Medicine, NIH. Iron deficiency anemia.
    http://www.nhlbi.nih.gov/health/dci/Diseases/ida/ida_whatis.html
  12. Office of Dietary Supplements, NIH. Dietary supplement fact sheet. Available online: http://dietary-supplements.info.nih.gov/factsheets/iron.asp

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Page last reviewed: May 22, 2007
Page last updated: May 22, 2007
Content Source: Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion