Iron Deficiency: A Critical Concern for Australian Women
Iron deficiency remains a prevalent nutritional concern globally, with Australian women identified as a key at-risk demographic. Anaemia represents a late stage of iron deficiency; many women experience earlier symptoms such as fatigue, poor concentration, and irritability before haemoglobin levels decline. Iron is vital for haemoglobin production, oxygen transport, DNA synthesis, and muscle metabolism, and since the body cannot produce it, dietary intake is crucial. MLA Healthy Meals offers evidence-based nutrition resources online for patient education.
Current Situation in Australia
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Prevalence: The World Health Organization (WHO) reports that 30% of women aged 15–49 globally have anaemia. In Australia, 11% of non-pregnant women and 14% of pregnant women are anaemic. Nearly half of pregnant Aboriginal and Torres Strait Islander women are estimated to experience iron deficiency anaemia.
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Iron Stores: The Australian Bureau of Statistics (ABS) indicates that Australian teenage girls have median ferritin levels around 25 µg/L, suggesting insufficient iron stores. Among women aged 18–39, 35–37% have ferritin levels below 30 µg/L, frequently linked to heavy menstrual bleeding.
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Dietary Intake: A national nutrition survey revealed that women consume approximately 50% less iron than the recommended daily intake (RDI). Teenage girls consume about 9 mg/day against an RDI of 15 mg/day, while women aged 19–50 consume 8.5–9 mg/day compared to an 18 mg/day RDI. Pregnant women have an RDI of 27 mg/day. The National Health and Medical Research Council (NHMRC) notes that vegetarians require 80% higher iron intake due to lower bioavailability of non-haem iron.
Why Women Are at Risk
- Blood Loss: Heavy menstrual bleeding is the primary cause of iron deficiency in Australia, with women typically losing about 25 mg of iron (40-50ml of blood) per cycle. Between 25-53% of women experience heavy menstrual bleeding, often reporting iron deficiency symptoms and a history of anaemia.
- Physiological Demands: Children, adolescents, pregnant women, and athletes have increased iron requirements due to growth demands, and low iron intake increases their risk.
- Dietary Patterns: Lower intake of highly bioavailable haem iron, mainly from non-haem sources (like fortified cereals and grains), contributes to deficiency.
Iron Deficiency Diagnosis
- Ferritin levels below 30 µg/L indicate insufficient stores.
- Haemoglobin levels below 120 g/L (or 110 g/L in pregnancy) suggest anaemia.
- For complex cases, serum transferrin receptor and CRP may be considered.
How General Practitioners Can Help
- Screen and Diagnose: GPs should inquire about fatigue, heavy menstrual bleeding, and dietary iron intake. Routine ferritin checks are encouraged for symptomatic women or those in high-risk groups.
- Educate Patients: Explain the difference between haem iron (animal sources like red meat, poultry, fish – 25% absorbed) and non-haem iron (plant sources like nuts, cereals, beans, leafy greens – 10% absorbed, absorption increases with lower iron stores). Advise on absorption strategies, such as pairing iron-rich foods with Vitamin C and limiting inhibitors like tea, coffee, and calcium around mealtimes. Promote balanced meals rich in iron, including lean red meat (up to 3-4 times per week, aligning with Australian Dietary Guidelines of up to 455g cooked lean red meat per week), alongside seafood, legumes, leafy greens, nuts, and fortified cereals.
- Prioritise High-Risk Groups: Focus on teenage girls (education on needs during menstruation, especially athletes), pregnant women (early screening, dietary counselling, supplementation), perimenopausal women (screening for heavy menstrual bleeding), vegetarians/vegans (practical meal plans), and Indigenous women (culturally relevant nutrition programs).
- Consider Supplementation: Evaluate the need for iron supplements.
Key Takeaways for GPs:
Iron deficiency is a common, often underdiagnosed issue in Australian women, largely driven by blood loss and insufficient dietary intake. Effective screening, patient education, and tailored interventions can significantly improve iron status. Collaborating with dietitians can enhance patient outcomes.