A recent review published in The Lancet Haematology, led by Dr Ashley Benson and Dr Jamie Lo from Oregon Health and Science University, has reported that iron deficiency affects up to one in three women, making it the most common nutrient deficiency in the world.
It also supports energy production, brain development and a healthy immune system.
According to the World Health Organization, anaemia affects 31 per cent of adult women of reproductive age, 36 per cent of pregnant women and 40 per cent of children under five.
Beyond diet, inflammation – whether from acute illness or chronic conditions, such as obesity – can also reduce iron absorption. With global rates of obesity and chronic disease on the rise, this presents a further challenge in reducing the global burden of iron deficiency.
Iron deficiency
Since iron is essential for the production of red blood cells, deficiency can lead to anaemia – a condition characterised by low levels of haemoglobin, the protein that gives blood its red colour and carries oxygen.
According to the World Health Organization, anaemia affects 31 per cent of adult women of reproductive age, 36 per cent of pregnant women and 40 per cent of children under five. It’s estimated that about half of all anaemia cases worldwide are caused by iron deficiency. Common signs and symptoms include pale skin and gums, tiredness, shortness of breath and a racing or irregular heartbeat (known as heart palpitations).
Iron deficiency – especially when it leads to anaemia – can have serious health consequences. It has been linked to a weakened immune system, complications during pregnancy and childbirth, higher risks of death for both mothers and babies, and delays in children’s growth and brain development.
Not only are the consequences of iron deficiency particularly severe in women and children, but they are also at greatest risk of developing it.
Menstruating women have high iron needs due to monthly blood loss. Pregnant women require additional iron for the development of the placenta, the foetus and increased blood volume. Children need iron for rapid growth and brain development. Adolescent girls, who are both growing and menstruating, are at especially high risk.
In their paper, Benson and Lo brought together a panel of 26 experts and four patient representatives. Their collective recommendations call for a more proactive and inclusive approach to managing iron deficiency, with a particular focus on those most at risk.
The panel emphasised the need for routine screening during pregnancy and early childhood – times when the body’s demand for iron is especially high. They also highlighted the importance of using ferritin, a blood protein that reflects liver iron stores, as a reliable marker for diagnosing iron deficiency and deciding when to intervene.
When treatment is needed, oral iron supplements are the first choice – they’re effective, widely available and affordable. For people who experience side effects like nausea or constipation, the panel suggested taking supplements every other day to improve tolerability. In more severe cases, or when oral iron isn’t effective or well-tolerated, intravenous iron (given through a drip directly into a vein) may be necessary.
Finally, the panel emphasised that iron deficiency shouldn’t be treated as a separate issue. Instead, it should be part of routine care in services that support mothers and children – like pregnancy check-ups, child health visits and nutrition programmes – to make sure iron levels are monitored and managed alongside other important aspects of health.
Iron advice
While some people may need medical treatment for iron deficiency, many cases can be prevented through everyday choices, especially when it comes to diet.
Start by including more iron-rich foods in your meals, such as pulses and legumes, green leafy vegetables, seeds and nuts and iron-fortified breakfast cereals (look for low-sugar options for children and adolescents).
If you eat animal products, moderate amounts of red meat – limited to 70g (2.5oz) per day on average, as recommended by the UK Eatwell Guide – can provide a well-absorbed source of iron.
If you follow a mostly plant-based diet, try pairing iron-rich foods with sources of vitamin C – such as lemon juice, tomatoes or strawberries – to help your body absorb the iron more effectively.
Be mindful of when you drink tea or coffee, as they contain polyphenols that can inhibit iron absorption if consumed with iron-rich foods. The same goes for taking iron supplements – timing matters. Taking them with a source of vitamin C (a glass of orange juice, for example) can significantly boost absorption.
If you’re in a higher-risk group – such as if you’re pregnant, menstruating or caring for young children – or if you’re feeling unusually tired, it’s worth speaking to your doctor. A simple blood test can check whether your iron levels are where they should be. In children, iron deficiency may also show up as a poor appetite or unusual cravings for non-food items, like chewing ice.
Iron deficiency is common, but it’s also manageable and often preventable. With awareness and smart choices, keeping your iron levels healthy can be as simple as choosing what’s on your plate.
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