Industry welcomes new WHO guidelines on assessing iron levels

21 Apr 2020 --- The World Health Organization (WHO) has issued new guidelines to detect iron deficiency and overload to prevent severe consequences, such as anemia and poor cognitive development in children. From an industry perspective, the updated guidelines shed light on the understanding of ferritin as an analytical parameter. PharmaLinea, Lubrizol Life Science and Probi tell NutritionInsight what the new guidelines mean for them.

From an industry perspective, the updated guidelines shed light on the understanding of ferritin as an analytical parameter, considering the vast difficulties with interpreting and streamlining scientific results. 

“At Nestlé welcome efforts from the WHO to provide and regularly review guidelines for identifying iron deficiency. We continue our work to address under-nutrition through fortifying affordable and regularly consumed foods and beverages. We believe that this helps individuals and families meet their daily requirements and contributes to reducing the risk of micronutrient deficiencies at scale. In 2019, we delivered 185.4 billion fortified servings incorporating at least one of the Big 4 micronutrients (iron, iodine, vitamin A and zinc, as defined by the WHO) in 64 countries with higher vulnerability to micronutrient malnutrition,” a Nestlé spokesperson tells NutritionInsight.

“The WHO has established threshold ferritin levels for all demographic groups, which were previously missing. It’s excellent that it is being introduced because it can help [us] understand the type and extent of anemia. It is traditionally more established as a parameter in clinical trials and also in our own ongoing trial on our liquid iron supplement. The update of the WHO’s guidelines will hopefully aid in applying it into more practical situations and fill the gap,” Maja Orešnik, Science and Research Director at PharmaLinea, tells NutritionInsight.

Iron intake can have a serious impact on child development, especially within the first five years.“Because ferritin values describe iron levels in the body, the new guidelines are especially important for the food supplement industry. If monitored by individuals who do not show serious symptoms of iron deficiency, [the WHO guidelines] will enable them to make educated decisions on supplementing iron to their diets to improve their general health. Also, as a byproduct, the increased recognition of determining ferritin levels might result in a wider availability and choice of diagnostic devices,” she explains.

PharmaLinea has previously advocated for more substantial clinical evidence for finished products as well as ingredients to ensure iron products solve common issues of side effects and poor absorption. 

A marketing spokesperson from the Nutraceutical Division of Lubrizol Life Science also sees the new guidelines as “hopeful news” in preventing severe impacts. “Early detection of iron deficiency will help [establish] which regions are more important to implement and monitor an action plan. Consequently, the severe effects of iron deficiency in both young children and adults will be hopefully minimized to a greater extent with this initiative,” they tell NutritionInsight.

“Iron deficiency in children under two years of age can have significant and irreversible effects on brain development. Cognitive development of a child can also be affected if a mother is iron-deficient during her last trimester of pregnancy. In adults, iron deficiency can also have negative effects. By detecting iron deficiency early during pregnancy and in young children, the new guidelines will help to target better and evaluate actions to fight anemia,” the spokesperson affirms. 

Having recently joined the Health Business of Lubrizol Life Science, Lipofoods launched Lipofer, an iron “stick” that particularly targets the needs of pregnant or nursing millennial women, but is also useful for iron-deficient consumers. 

Probi regards the new guidelines as a greater emphasis on the need to improve the diagnosis of iron deficiency and overload. “With improved and earlier diagnosis, iron deficiency can be better detected and treated. Iron deficiency is commonly treated by oral iron supplements, however, a large proportion of the ingested iron remains unabsorbed in the intestine causing adverse gastrointestinal effects and may also limit the ability to replete iron stores. 

We have developed a dietary supplement based on a probiotic with the potential to increase iron absorption while reducing the risk of gastrointestinal side effects. We have also recently developed this concept further by conducting a clinical trial in healthy pregnant women with the primary endpoint being ferritin levels in late pregnancy,” Titti Niskanen, Director of R&D and Clinical Operations at Probi, also shares with NutritionInsight. 

“We welcome efforts from the WHO to provide and regularly review guidelines for identifying iron deficiency. At Nestlé, we continue our work to address under-nutrition through fortifying affordable and regularly consumed foods and beverages,” comments a Nestlé spokesperson on the news. Nestlé had previously acquired a novel technology called FERRI PRO that will enable it to address iron deficiency without adversely affecting the taste of food and beverages. 

Recommended cut-off values for healthy iron intake
Ferritin is the primary iron-storage protein that can be found in small amounts circulating in a person’s blood. Accurate measurements of this protein, along with clinical and laboratory evaluation, can guide the appropriate interventions in both individual patients and at a population level.

Accurate measurements of ferritin can guide appropriate interventions in both individual patients and at a population level.According to the WHO’s new thresholds for ferritin assessment, apparently healthy infants and preschool children up to the age of five should maintain 12 Μg/L of serum ferritin, while individuals with infection or inflammation should receive 30 Μg/L. These amounts rise to 15 Μg/L in healthy individuals (including pregnant women in their first trimester) and 70 Μg/L in the risk group for anyone over the age of 5. 

Non-healthy individuals with over 500 Μg/L of serum ferritin are at risk of iron overload, the new guidelines further explicate. These numbers vary between sexes in apparently healthy individuals, indicating no more than 150 Μg/L of serum ferritin is recommendable for females and 200 Μg/L for males across all age groups.

In terms of ferritin measuring method, radiometric, non-radiometric and agglutination assays are recommended. “One method does not appear to be superior to another and all methods are acceptable if a commutable material traceable to the WHO international reference standard is used to calibrate the assay. Once a method has been selected, that same method should be used for the follow-up of individuals and populations,” the new guidelines read.

The Janus face of iron intake
On the one hand, iron deficiency can have adverse effects in adults, including fatigue, impaired physical performance, as well as impacting social activities and work productivity. Iron deficiency occurs mainly when the requirements of iron increase during rapid periods of growth and development, such as in early childhood, adolescence and pregnancy, but it can occur at other stages in life. 

On the other hand, iron overload is generally the result of disorders, such as hereditary hemochromatosis, thalassemias, repeated blood transfusions or other conditions that affect iron absorption or regulation. These can also have critical deleterious consequences on health if left untreated, the WHO flags. 

Iron is an essential element responsible for oxygen transport, DNA synthesis and muscle metabolism. Iron deficiency is the main cause of anemia, which is the most prevalent nutritional deficiency worldwide, affecting 29 percent of non-pregnant women, 38 percent of pregnant women, and 43 percent of children worldwide.

By Anni Schleicher