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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×

Iron Deficiency Anemia:

Recommended Guidelines for the Prevention,
Detection, and Management Among U.S.
Children and Women of Childbearing Age

Committee on the Prevention, Detection, and
Management of Iron Deficiency Anemia Among
U.S. Children and Women of Childbearing Age

Food and Nutrition Board
Institute of Medicine

Robert Earl and Catherine E. Woteki, Editors

NATIONAL ACADEMY PRESS
Washington, D.C.
1993

Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×

National Academy Press 2101 Constitution Avenue, N.W. Washington, D.C. 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

This study was supported under contract no. 200-92-0574 from the Division of Nutrition, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services.

Library of Congress Catalog Card No. 93-86771

International Standard Book Number 0-309-04987-3

Additional copies of this report are available from:

National Academy Press
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B245

Copyright 1993 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×

COMMITTEE ON THE PREVENTION, DETECTION, AND MANAGEMENT OF IRON DEFICIENCY ANEMIA AMONG U.S. CHILDREN AND WOMEN OF CHILDBEARING AGE

DORIS H. CALLOWAY (Chair),*

Department of Nutrition, University of California, Berkeley, California

JOHN L. BEARD,

Nutrition Department and Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, Pennsylvania

JAMES D. COOK,

Division of Hematology, University of Kansas Medical Center, Kansas City, Kansas

SAMUEL J. FOMON,

Department of Pediatrics, University of Iowa Hospitals, Iowa City, Iowa

JANET L. MITCHELL,

Department of Obstetrics and Gynecology, Harlem Hospital Center, New York, New York

DAVID RUSH,

Epidemiology Program, USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts

Consultants

GEORGE H. BEATON,

Department of Nutrition Science, University of Toronto, Toronto, Ontario, Canada

PETER R. DALLMAN, Contract Writer,

San Francisco, California

*  

Member, Institute of Medicine

Staff

CATHERINE E. WOTEKI, Project Director

ROBERT EARL, Program Officer

MARCIA S. LEWIS, Project Assistant

MICHAEL K. HAYES, Editorial Consultant

Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×

FOOD AND NUTRITION BOARD

M.R.C. GREENWOOD (Chair),*

Office of Graduate Studies, University of California, Davis, California

EDWIN L. BIERMAN (Vice Chair),*

Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington

PERRY L. ADKISSON,

Department of Entomology, Texas A&M University, College Station, Texas

LINDSAY ALLEN,

Department of Nutrition, University of California, Davis, California

DENNIS M. BIER,

Pediatric Clinical Research Center, Washington University School of Medicine, St. Louis, Missouri

HECTOR F. DeLUCA,

Department of Biochemistry, University of Wisconsin, Madison, Wisconsin

MICHAEL P. DOYLE,

Department of Food Science and Technology, Georgia Experiment Station, University of Georgia, Griffin, Georgia

JOHANNA T. DWYER,

Frances Stern Nutrition Center, New England Medical Center Hospital, Boston, Massachusetts

JOHN W. ERDMAN, JR.,

Department of Food Science and Division of Nutritional Sciences, College of Agriculture, University of Illinois, Urbana, Illinois

CUTBERTO GARZA,

Division of Nutritional Sciences, Cornell University, Ithaca, New York

K. MICHAEL HAMBIDGE,

Department of Pediatrics, University of Colorado Medical Center, Denver, Colorado

JANET C. KING,

Department of Nutritional Sciences, University of California, Berkeley, California

JOHN E. KINSELLA (deceased),

School of Agriculture and Environmental Sciences, University of California, Davis, California

LAURENCE N. KOLONEL,

Cancer Center of Hawaii, University of Hawaii, Honolulu, Hawaii

SANFORD A. MILLER,

Graduate Studies and Biological Sciences, University of Texas Health Science Center, San Antonio, Texas

ARTHUR H. RUBENSTEIN (IOM Council Liaison),*

Department of Medicine, The University of Chicago, Chicago, Illinois

ALFRED SOMMER,*

School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland

STEVE L. TAYLOR (ex officio),

Department of Food Science and Technology, University of Nebraska, Lincoln, Nebraska

VERNON R. YOUNG,

School of Science, Massachusetts Institute of Technology, Cambridge, Massachusetts

*  

Member, Institute of Medicine

  

Member, National Academy of Sciences

Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×

Staff

CATHERINE E. WOTEKI, Director

MARCIA S. LEWIS, Administrative Assistant

SUSAN M. WYATT, Financial Associate

Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
This page in the original is blank.
Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×

Preface

Over the last decade, several expert groups have addressed the issue of iron deficiency anemia in young children and women of childbearing age. Dietary allowances have been revised, diagnostic criteria for defining anemia have been promulgated, and preventive and therapeutic measures have been developed and, for the most part, implemented. So, why another examination of the issue?

There are several reasons why a responsible agency would undertake such a reexamination. There are seemingly straightforward questions about the continued necessity for and effectiveness of existing programs. These questions are, however, complex and difficult to answer because the information base is not entirely secure. The answers to such problematic questions depend on a reasoned judgment as to the significance of new epidemiologic evidence and other scientific findings and on an ability to forecast trends. In the present instance account needs to be taken of, inter alia, trends in the consumption and composition of foods and changes in the nutritional environment more generally.

It is to be expected that committee members will not always be in perfect accord in the absence of sufficient, solid information. Members' judgments are influenced by their different experiences and disciplinary backgrounds. The present committee resolved this problem by accepting an argument that in order to set aside the recommendations of other expert groups, the contravening evidence must be as strong as the evidence that led to the others' decisions. The guidelines developed by the present committee are substantially in accord with existing recommendations. The committee did note areas of uncertainty and urges that high priority be given to developing the information needed to improve decision making. Some points are noted in the text, and an indicative list of research topics is included in the report.

The committee's work was assisted very greatly by the background documentation prepared by Dr. Peter Dallman in a consultative capacity; we

Page viii Cite
Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×

acknowledge his major contribution and appreciate the willingness with which he undertook revision as issues arose. Dr. Dallman participated in all deliberations of the committee as a member de facto. Professor George Beaton was available for consultation only at our last meeting; his ability to pose important clarifying questions was, as always, greatly appreciated. The committee owes a special debt to two of its members—to Professor John L. Beard for providing background on iron-dependent pathologies and to Dr. David Rush for a new analysis of data from the U.S. Department of Agriculture's Special Supplemental Food Program for Women, Infants, and Children and for solicitation of additional views and references relating to iron supplementation during pregnancy.

We wish particularly to thank Dr. Anne Looker and Dr. Christopher Sempos and their colleagues at the National Center for Health Statistics who prepared preliminary analyses of data from the third National Health and Nutrition Examination Survey and shared other, as yet unpublished, work.

I wish personally to thank the committee members for their diligence and patience, and for the care and concern they showed for those whom the guidelines are intended to benefit. None of the committee's tasks could have been accomplished without the leadership of Dr. Catherine Woteki and the support of her staff, especially Mr. Robert Earl and Ms. Marcia Lewis. We are grateful for their unfailing courtesy and generosity and commend the high standards reflected in their professional contributions.

DORIS HOWES CALLOWAY, CHAIR

COMMITTEE ON THE PREVENTION, DETECTION, AND MANAGEMENT OF IRON DEFICIENCY ANEMIA AMONG U.S. CHILDREN AND WOMEN OF CHILDBEARING AGE

Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×

Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age

Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
This page in the original is blank.
Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
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Page viii Cite
Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
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Suggested Citation:"FRONT MATTER." Institute of Medicine. 1993. Iron Deficiency Anemia: Recommended Guidelines for the Prevention, Detection, and Management Among U.S. Children and Women of Childbearing Age. Washington, DC: The National Academies Press. doi: 10.17226/2251.
×
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This book summarizes information related to public health measures on the prevention, detection, and management of iron deficiency anemia. It presents draft guidelines and recommendations related to this area, as applicable in primary health care and public health clinic settings, and it formulates recommendations for research. This volume is intended both to provide a common frame of reference for health professionals in preventing and treating iron deficiency anemia and to enable the U.S. Centers for Disease Control and Prevention to prepare national guidelines and recommendations for the prevention and control of iron deficiency anemia.

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