Demystifying Intricate Factors of Nutritional Anemia Beyond Iron Deficiency-A Narrative Review.

Background & Aims: Nutritional anemia is a widespread public health issue, impacting about one-quarter of the global population (24.3% in 2021; ∼1.92 billion people). Iron-deficiency anemia (IDA) is the most prevalent form, primarily caused by inadequate dietary intake, poor iron absorption, or increased physiological needs. However, the complexity of nutritional anemia extends beyond iron deficiency, involving other micronutrients such as vitamin B12, folate, zinc, copper, and vitamin A. Additionally, anti-absorptive dietary inhibitors (e.g., phytates, polyphenols, oxalates), chronic infections, and inflammation exacerbate the condition. This review aims to provide a comprehensive understanding of the multifactorial etiology of nutritional anemia and discuss emerging insights and innovative approaches for its prevention and management.

Objective: To critically examine the contributions of various micronutrient deficiencies, the impact of anti-absorptive dietary inhibitors, and the influence of socioeconomic and environmental determinants. The review also evaluates the challenges of modern dietary trends, such as the rise of plant-based diets, and explores promising strategies for mitigating anemia prevalence.

Approach: Narrative review synthesizing evidence from recent literature, including epidemiological studies, clinical trials, and public health interventions. This integrative approach provides a holistic understanding of nutritional anemia and identifies gaps in current knowledge and intervention strategies.

Insights: The review highlights the intricate interplay of micronutrient deficiencies, dietary inhibitors, and socio-environmental factors that contribute to the high prevalence of anemia. Emerging solutions such as hepcidin modulation, biofortification, and novel iron formulations have shown promise in clinical and public health settings. However, the success of anemia reduction efforts varies across different regions, emphasizing the need for culturally tailored, multi-pronged approaches.

Conclusions: Addressing nutritional anemia requires an integrated strategy that includes improving micronutrient bioavailability, implementing effective public health policies, and addressing underlying social and environmental determinants. Continued interdisciplinary research and policy development are crucial to creating sustainable, impactful solutions, particularly for the most vulnerable populations, including young children, women of reproductive age, and the elderly.