An Epidemiologic Approach to the Causes and Control of the Nutritional Anemias

Abstract

This chapter presents a systematic scheme for examining the multiple possible causes of nutritional anemia in a population. Such an approach identifies the preventive measures most feasible, efficient, and effective for the protection of a particular population. For nutritional diseases, the epidemiological approach is especially useful in understanding their occurrence and devising measures for their prevention and control. In deficiency diseases, the “agent” is the absence rather than the presence of a factor, but the other two elements of the epidemiological triad remain equally pertinent. In some nutritional diseases, such as scurvy, beri beri, and ariboflavinosis, the agent is a single factor—vitamin C, thiamine, and riboflavin, respectively. For the nutritional anemias, specific agents are as numerous as in all the other major nutritional syndromes combined, because the unavailability of any one of at least a dozen nutrients or a variety of inherited metabolic defects can result in anemia. Almost any combination of the nutrients required can be deficient simultaneously. There are many kinds of anemia, each related to the deficiency of a specific nutrient, and several of these may exist concurrently in the same individual or populations, depending on the circumstances.