The initial term and concept was nutritional anemias. Although
this term is not commonly used today, it lives on in the name of the
International Nutritional Anemia Consultative Group (INACG).3 Nutritional
anemia was defined in a 1968 WHO technical report as “a condition in which the hemoglobin
content of the blood is lower than normal as a
result of a deficiency of one or more essential
nutrients, regardless of the cause of such deficiency.”
To determine which nutritional deficiencies were most responsible,
WHO coordinated a series of studies in pregnant women in which anemia, serum
folate, transferrin saturation and serum B-12 were assessed. They concluded
that “Iron deficiency was present in 40–99% of the pregnant women studied and
was undoubtedly responsible for the major proportion of anemia” (WHO 1968).
Certainly the authors were impressed by the prevalence
of iron deficiency, which was;10 times higher than that of folate deficiency or
vitamin B-12 deficiency based on their indicators. However, the relation
between anemia prevalence and iron deficiency prevalence is not apparent when
the data are compared among populations. Within-population correlation
coefficients with hemoglobin were published for the study in Vellore, India. There
was a strong correlation between hemoglobin and transferring saturation (r 5
0.56, P , 0.001), but the correlation with serum folate was even
stronger (r 5 0.82, P , 0.001). There was no significant
correlation between serum vitamin B-12 and hemoglobin (Baker and DeMaeyer
1979).
The singular importance of iron deficiency was
restated with more confidence by Baker and DeMaeyer (1979): “The major factor
responsible [for nutritional anemia] is a deficiency of iron, with folate
deficiency also playing a role in some population groups, especially in
pregnant women.” The next evolution of concepts is the shift from nutritional anemia
(of which iron-deficiency anemia is one important part) to iron-deficiency
anemia as the major public health problem. This is reflected in the title of
the 1989 WHO monograph, Preventing and Controlling Iron Deficiency Anaemia
Through Primary. If you want to read full text you can download this
