Submitted by

Nimra Maheen

Submitted to
Aqiba-tus-Saher

Class
th
5 Semester BS-HND (evening) (2019-2023)

Roll number
BS-HND-19E-44

Topic
Iron Deficiency and Calcium Deficiency

Subject
Nutrition and Psychology

Calcium Deficiency

1. Introduction

Calcium deficiency symptoms vary depending on where you are. There are many places where you can
experience a deficiency, and so the symptoms can differ. If you live in a city, chances are you will have
many different foods that are rich in calcium. These include dairy products, red meat, and poultry. It is
also possible for a person to suffer from calcium deficiency if they do not get enough from their diet.
This deficiency can be very dangerous. The levels of calcium) in your body can decrease and cause you to
gain weight. You can also develop kidney stones or osteoporosis. It is important to try to prevent this
from happening to you, as soon as you see any signs of deficiency. Many foods have shown to have a
high amount of calcium. These include enriched white bread, many types of yogurt, cereals, bagels, and
whole-grain bread. Some fish contain high amounts of calcium as well, including sardines, salmon,
herring, and tuna. Also, many nuts and legumes contain a high amount of calcium as well. These are
some good sources of calcium for a person to consume on a daily basis. Calcium deficiency can occur
naturally, or it can be introduced into the body through a supplement. There are many options to
choose from, and each one has its own set of benefits and risks. It is important to know what each
supplement is doing before you decide to use it. Calcium supplements are usually absorbed more slowly
into the body than with other types of dietary calcium.

Calcium Deficiency – Causes and Prevention

Bones grow stronger during the adolescence period of teenagers. For the case of older people, their
bones turn weaker as years pass by. For people who drink and smoke cigarette, they are prone to having
calcium deficiency. Calcium has an important role in the overall system of a healthy body. Parts like the
muscles, bones and heart is in need of calcium for it to be healthy.

What our body does with it is that it uses it to aid on making the bones and teeth healthy. It also helps
on muscle contraction and to normalize the rhythm of the heart. Having a good amount of it in the body
helps prevent diseases in the long run. It might prevent bone loss during old age and along with
osteoporosis.

Foods with Calcium

The main source of calcium is through the everyday food that we eat. Foods like spinach, white beans,
soybeans and some fishes have a relatively good amount of Calcium in them. Breakfast foods such as
oatmeal and cereal also have calcium in them. The same goes for orange juice.

Lack of Calcium in the Body

Shortage of this in the body will eventually lead to Calcium Deficiency. If your body doesn’t have enough
calcium, it will take a substantial amount directly from the bones. This is done so that the cells are able
to function properly. Calcium Deficiency may lead to soft bones, osteoporosis and even mood problems.
Less calcium in the body may make the person vulnerable to anxiety, depression and sleeping
difficulties.

Symptoms of Calcium Deficiency include numbness of fingers, lack of enthusiasm towards eating and
muscle cramps. For severe cases, a person might experience bone malformation, cognitive confusion
and many more. Rickets and osteoporosis might be possible to acquire when having Calcium Deficiency.

Calcium Deficiency Signs

Natural aging can be one of the factors because of the bone density as a person grows older. As time
passes, our bodies require more and more of it to main and support the bones in the body.

As for the cases of women, it is important to reach the daily intake level of calcium during their middle
age. During this time is when women undergo menopause – a phase where there’s a declination of
estrogen which then makes the bones to weaken or become thinner in a faster rate.

2. Groups at Risk of Calcium Inadequacy

The following groups are among those most likely to need extra calcium.

Postmenopausal women

Menopause leads to bone loss because decreases in estrogen production reduce calcium absorption and
increase urinary calcium loss and calcium resorption from bone. On average, women lose approximately
1% of their bone mineral density (BMD) per year after menopause. Over time, these changes lead to
decreased bone mass and fragile bones. About 30% of postmenopausal women in the United States and
Europe have osteoporosis, and at least 40% of those with this condition develop at least one fragility
fracture (a fracture that occurs after minor trauma, such as a fall from standing height or lower). The
 calcium RDA is 1,200 mg for women older than 50 years (vs. 1,000 mg for younger women) to lessen
bone loss after menopause.

Individuals who avoid dairy products

People with lactose intolerance, those with an allergy to milk, and those who avoid eating dairy products
(including vegans) have a higher risk of inadequate calcium intakes because dairy products are rich
sources of calcium. Options for increasing calcium intakes in individuals with lactose intolerance include
consuming lactose-free or reduced-lactose dairy products, which contain the same amounts of calcium
as regular dairy products. Those who avoid dairy products because of allergies or for other reasons can
obtain calcium from non-dairy sources, such as some vegetables (e.g., kale, broccoli, and Chinese
cabbage), canned fish with bones, or fortified foods (e.g., fruit juices, breakfast cereals, and tofu).
However, these individuals typically need to eat foods fortified with calcium or take supplements to
obtain recommended amounts.

3. Calcium Intakes and Status

A substantial proportion of people in the United States consume less than recommended amounts of
calcium. An analysis of 2007–2010 data from the National Health and Nutrition Examination Survey
(NHANES) found that 49% of children aged 4–18 years and 39% of all individuals aged 4 and older
consume less than the EAR for calcium from foods and supplements.

Average daily intakes of calcium from foods and beverages are 1,083 mg for men aged 20 and older and
842 mg for women. For children aged 2–19, mean daily intakes of calcium from foods and beverages
range from 965 to 1,015 mg. approximately 22% of men, 32% of women, and 4 to 8% of children take a
dietary supplement containing calcium. Average daily calcium intakes from both foods and supplements
are 1,156 mg for men, 1,009 mg for women and 968 to 1,020 mg for children.

According to 2009–2012 NHANES data, rates of calcium inadequacy (intakes below the EAR) are higher
among non-Hispanic Blacks and non-Hispanic Asians (47–48%) than among Hispanics (30%) and non-
Hispanic Whites (24%) in the United States. Poverty is also associated with a higher risk of inadequacy.
NHANES data from 2007 to 2014 show that the risk of inadequate calcium intakes (less than 800 to
1,100 mg) is 11.6% higher among adults aged 50 and older in households earning less than $20,000 per
year than other households.
 4. Prevention of Calcium Deficiency

To prevent such deficiency, a person will need to increase the intake of this element in a day to day
basis. Eating foods that are rich in calcium will help increase the level of such nutrient in your body.
Other people opt in for taking in supplement to reach the required intake.

Supplement that has these in it is a great way to boost up nutrients in your body. This is such because
most supplements do not just carry one nutrient in it. Various vitamins are present as well in
supplements.

Magnical-D by Nutrifii is a product where its sole purpose is to support bones and muscles. Magnical-D is
able to do this for it has a unique blend of calcium, Magnesium and Vitamin D. All of which are vital to
aid in the strengthening of bones, teeth and the overall wellness of the body. Magnical-D utilizes both
calcium citrate and calcium malate. Both are much more to be likely absorbed by the body compared to
plain calcium.

Iron Deficiency

Introduction

Every fourth child in Pakistan is suffering from Iron deficiency, according to the National Nutritional 2018
report which surveyed 7,138 children aged between six and nine months.

Iron Deficiency Anemia (IDA) was found in 33.2% children. It is common among Pakistanis and a leading
cause of morbidity.

Iron deficiency is the result of an iron imbalance in the intestines that leads to a weak immune system as
children grow. If this prevalence rate was lower today, Pakistanis would have been able to fight
pandemics like COVID-19 with a stronger immune system.
 The numbers are quite alarming and pose a threat to the future of Pakistan as an 80% of a child’s brain
develops in the initial two years. IDA should be declared a national issue as it will enable us to safeguard
the future of our children. Musician and philanthropist Shehzad Roy agrees and has urged people not to
take the situation lightly and fight it with full force.

Usually, IDA symptoms are covered up by blaming the child for not listening in class and eventually
failing. The child might not be at fault. If they are behaving in any of the following ways, there is a
probability they are suffering from IDA. The symptoms include lack of attention, fatigue/exhaustion,
repeatedly becoming sick and breathlessness. The worst part about being in such a situation is that a
child is not able to explain how exactly they are feeling and become a victim of speculation and societal
norms.

People need to be informed about the common causes of anemia in children to adopt appropriate
measures for its prevention and control. In Pakistan, nutritional anemia has been recognized to be the
most common type of malnutrition in children. A micronutrient survey of Pakistan conducted in 1977
identified 38% of the population to be anemic. According to the 1988 National Nutrition Survey of
Pakistan, 65% of the children aged 7 – 60 months were found to be anemic.

In comparison with grown-up children, a growing child needs three times more nutrition to develop and
grow as a healthy kid. As soon as children reach 6 months of age, they should be given a healthy diet full
of nutrients, vitamins and minerals; moreover, iron should be a major part of their diet. A list of iron-rich
foods includes eggs, meat, spinach and iron-fortified products.

Pakistan Society of Food and Science Technologists have been working to create awareness in our
society regarding iron deficiency. They have joined hands with Roy to highlight the issue.

1. What is Iron Deficiency? Its causes and clinical manifestation

Description

Iron deficiency anemia is one of the most common hematologic disorders

  Iron deficiency anemia develops when body stores of iron drop too low to support normal red
blood cell (RBC) production.

 Iron equilibrium in the body normally is regulated carefully to ensure that sufficient iron is
absorbed in order to compensate for body losses of iron.

 Iron deficiency is defined as decreased total iron body content.

 Iron deficiency anemia occurs when iron deficiency is severe enough to diminish erythropoiesis
and cause the development of anemia.

Pathophysiology

Iron is vital for all living organisms because it is essential for multiple metabolic processes, including
oxygen transport, DNA synthesis, and electron transport.

 Iron equilibrium in the body is regulated carefully to ensure that sufficient iron is absorbed in
order to compensate for body losses of iron.

 Whereas body loss of iron quantitatively is as important as absorption in terms of maintaining

iron equilibrium, it is a more passive process than absorption.

 In healthy people, the body concentration of iron (approximately 60 parts per million [ppm]) is
regulated carefully by absorptive cells in the proximal small intestine, which alter iron absorption to
match body losses of iron.

 Persistent errors in iron balance lead to either iron deficiency anemia or hemosiderosis. Both are
disorders with potentially adverse consequences.
  Iron uptake in the proximal small bowel occurs by 3 separate pathways; these are the heme
pathway and 2 distinct pathways for ferric and ferrous iron.

 Heme iron is not chelated and precipitated by numerous dietary constituent that renders
nonheme iron no absorbable, such as phytates, phosphates, tannates, oxalates, and carbonates.

Causes

Causes of iron deficiency anemia may include:

 Dietary factors. Meat provides a source of heme iron, which is less affected by the dietary
constituents that markedly diminish bioavailability than nonheme iron is; the prevalence of iron
deficiency anemia is low in geographic areas where meat is an important constituent of the diet; in
areas where meat is sparse, iron deficiency is commonplace.

 Hemorrhage. Bleeding for any reason produces iron depletion; if sufficient blood loss occurs,
iron deficiency anemia ensues.

 Hemosiderinuria, hemoglobinuria, and pulmonary hemosiderosis. Iron deficiency anemia can

occur from loss of body iron in the urine; if a freshly obtained urine specimen appears bloody but
contains no red blood cells, suspect hemoglobinuria.

 Malabsorption of iron. Prolonged achlorhydria may produce iron deficiency because acidic
conditions are required to release ferric iron from food; then, it can be chelated with mucins and other
substances (e.g., amino acids, sugars, amino acids, or amides) to keep it soluble and available for
absorption in the more alkaline duodenum.

 Iron-refractory iron deficiency anemia (IRIDA). Iron-refractory iron deficiency anemia (IRIDA) is a
hereditary disorder marked by with iron deficiency anemia that is typically unresponsive to oral iron
supplementation and may be only partially responsive to parenteral iron therapy.
 Clinical Manifestations

The signs of iron deficiency anemia include:

 Below average body weight. The child with iron deficiency anemia consumes more calcium than
other nutrients, making them lighter than the average weight for their age.

 Pale skin and mucous membranes. The hemoglobin in red blood cells gives blood its red color,
so low levels during iron deficiency make the blood less red; that’s why the skin and mucous membranes
can lose its healthy, rosy color in people with iron deficiency.

 Anorexia. Loss of appetite is common, with milk as their only food source.

 Growth retardation. Due to a decrease in the consumption of other food sources, the growth of
the child becomes stunted.

 Listlessness. The child who has less hemoglobin in the blood becomes listless and weak due to a
decrease in oxygen circulating towards the brain.

Assessment and Diagnostic Findings

Although the history and physical examination can lead to the recognition of the condition and help
establish the etiology, iron deficiency anemia is primarily a laboratory diagnosis.

 Complete blood count. The CBC documents the severity of the anemia. In chronic iron deficiency
anemia, the cellular indices show a microcytic and hypochromic erythropoiesis—that is, both the mean
corpuscular volume (MCV) and the mean corpuscular hemoglobin concentration (MCHC) have values
below the normal range for the laboratory performing the test.
 Peripheral smear. Examination of the erythrocytes shows microcytic and hypochromic red blood
cells in chronic iron deficiency anemia; the microcytosis is apparent in the smear long before the MCV is
decreased after an event producing iron deficiency.

 Serum iron, total binding capacity, and serum ferritin. Low serum iron and ferritin levels with an
elevated TIBC are diagnostic of iron deficiency; while a low serum ferritin is virtually diagnostic of iron
deficiency, a normal serum ferritin can be seen in patients who are deficient in iron and have coexistent
diseases (egg, hepatitis or anemia of chronic disorders); these test findings are useful in distinguishing
iron deficiency anemia from other microcytic anemias.

 Hemoglobin electrophoresis and measurement of hemoglobin A2. Hemoglobin electrophoresis

and measurement of hemoglobin A2 and fetal hemoglobin are useful in establishing either beta-
thalassemia or hemoglobin C or D as the etiology of the microcytic anemia.

 Reticulocyte hemoglobin content. Mateo’s Gonzales assessed the diagnostic efficiency of

commonly used hematologic and biochemical markers, as well as the reticulocyte hemoglobin content
(CHr) in the diagnosis of iron deficiency in children, with or without anemia.

 Stool testing. Testing stool for the presence of hemoglobin is useful in establishing
gastrointestinal (GI) bleeding as the etiology of iron deficiency anemia.

 Incubated osmotic fragility. Microspherocytosis may produce a low-normal or slightly abnormal

MCV; however, the MCHC usually is elevated rather than decreased, and the peripheral smear shows a
lack of central pallor rather than hypochromic.

 Tissue leads concentrations. Measure tissue lead concentrations; chronic lead poisoning may
produce a mild microcytosis; the anemia probably is related to the anemia of chronic disorders.

 Bone marrow aspiration. A bone marrow aspirate can be diagnostic of iron deficiency; the
absence of stainable iron in a bone marrow aspirate that contains spicules and a simultaneous control
specimen containing stainable iron permit establishment of a diagnosis of iron deficiency without other
laboratory tests.
 Management

Medical care starts with establishing the diagnosis and reason for the iron deficiency.

 Iron therapy. Oral ferrous iron salts are the most economical and effective medication for the
treatment of iron deficiency anemia; of the various iron salts available, ferrous sulfate is the one most
commonly used.

 Management of hemorrhage. Surgical treatment consists of stopping hemorrhage and

correcting the underlying defect so that it does not recur; this may involve surgery for treatment of
either neoplastic or no neoplastic disease of the gastrointestinal (GI) tract, the genitourinary (GU) tract,
the uterus, and the lungs.

 Diet. The addition of nonheme iron to national diets has been initiated in some areas of the
world.

Pharmacologic Management

Medications for iron deficiency anemia include:

 Iron products. These agents are used to provide adequate iron for hemoglobin synthesis and to
replenish body stores of iron.

 Parenteral iron. Reserve parenteral iron for patients who are either unable to absorb oral iron or
who have increasing anemia despite adequate doses of oral iron; it is expensive and has greater
morbidity than oral preparations of iron.

2. Action Plan
 Nutritional Management

Nutrition care of iron deficiency includes the following:

Nutrition Assessment

Assessment includes:

 Dietary history. A dietary history is important; vegetarians are more likely to develop iron
deficiency unless their diet is supplemented with iron; national programs of dietary iron
supplementation are initiated in many portions of the world where meat is sparse in the diet and iron
deficiency anemia is prevalent.

 History of hemorrhage. Bleeding is the most common cause of iron deficiency, either from
parasitic infection (hookworm) or other causes of blood loss; with bleeding from most orifices
(hematuria, hematemesis, hemoptysis), patients will present before they develop chronic iron deficiency
anemia; however, gastrointestinal bleeding may go unrecognized.

 Physical exam. Anemia produces nonspecific pallor of the mucous membranes; a number of
abnormalities of epithelial tissues are described in association with iron deficiency anemia; these include
esophageal webbing, koilonychias, glossitis, angular stomatitis, and gastric atrophy.

Nutritional Diagnosis

Based on the assessment data, the major nutrition diagnoses are:

 Fatigue related to decreased hemoglobin and diminished oxygen-carrying capacity of the blood.
 Deficient knowledge related to the complexity of treatment, lack of resources, or unfamiliarity
with the disease condition.

 Risk for infection

 Risk for bleeding

Nutrition Care Planning and Goals

The major nutrition care planning goals for patients with iron deficiency anemia are:

 Client/caregivers will verbalize the use of energy conservation principles.

Client/caregivers will verbalize reduction of fatigue, as evidenced by reports of increased energy and
ability to perform desired activities.

 Client/caregivers will verbalize understanding of own disease and treatment plan.

 Client will have a reduced risk of infection as evidenced by an absence of fever, normal white
blood cell count, and implementation of preventive measures such as proper hand washing.

 Client will have vital signs within the normal limit.

 Client will have a reduced risk for bleeding, as evidenced by normal or adequate platelet levels
and absence of bruises and petechiae.

Nutritional Interventions
  Advise patient to take iron supplements an hour before meals for maximum absorption; if
gastric distress occurs, suggest taking the supplement with meals — resume to between-meals schedule
if symptoms subside.

 Inform patient that iron salts change stool to dark green or black.

 Advise patient to take liquid forms of iron via a straw and rinse mouth with water.

Reduce fatigue

 Assist the client/caregivers in developing a schedule for daily activity and rest.

 Stress the importance of frequent rest periods.

 Educate energy-conservation techniques.

 Encourage patient to continue iron therapy for a total therapy time (6 months to a year), even
when fatigue is no longer present.

Educate the client and caregivers about iron deficiency anemia:

 Explain the importance of the diagnostic procedures (such as complete blood count), bone
marrow aspiration and a possible referral to a hematologist.

 Explain the importance of iron replacement/supplementation.

 Educate the client and the family regarding foods rich in iron (organ and other meats, leafy
green vegetables, molasses, beans).

Prevent infection

 Assess for local or systemic signs of infection, such as fever, chills, swelling, pain, and body
malaise.

 Monitor WBC count;

 Instruct the client to avoid contact with people with existing infections.

 Stress the importance of daily hygiene, mouth care, and perineal care.

Prevent bleeding

 Monitor platelet count; instruct the client/caregivers about bleeding precautions.

 Assess the skin for bruises and petechiae.

Evaluation

Goals are met as evidenced by:

 Client/caregivers will verbalize the use of energy conservation principles.

 Client/caregivers will verbalize reduction of fatigue, as evidenced by reports of increased energy
and ability to perform desired activities.

 Client/caregivers will verbalize understanding of own disease and treatment plan.

 Client will have a reduced risk of infection as evidenced by an absence of fever, normal white
blood cell count, and implementation of preventive measures such as proper hand washing.

 Client will have vital signs within the normal limit.

 Client will have a reduced risk for bleeding, as evidenced by normal or adequate platelet levels
and absence of bruises and petechiae.

Documentation and Guidelines

Documentation for iron deficiency anemia includes:

 Baseline and subsequent assessment findings to include signs and symptoms.

 Individual cultural or religious restrictions and personal preferences.

 Plan of care and persons involved.

 Teaching plan.

 Client’s responses to teachings, interventions, and actions performed.

  Attainment or progress toward the desired outcome.

 Long-term needs, and who is responsible for actions to be taken

Knowledge Transmission/ awareness plans

1. Seminars

2. Nutrition awareness camps

3. Nutrition education

4. Ads on Social Media

5. Social media campaign

6. Pamphlets and broachers

3. Statistics and Incidences

Iron deficiency is the most prevalent single deficiency state on a worldwide basis.
 In North America and Europe, iron deficiency is most common in women of childbearing age and
as a manifestation of hemorrhage.

 Depending upon the criteria used for the diagnosis of iron deficiency, approximately 4-8% of
premenopausal women are iron deficient.

 A study of the national primary care database for Italy, Belgium, Germany, and Spain
determined that annual incidence rates of iron deficiency anemia ranged from 7.2 to 13.96 per 1,000
person-years.

 Higher rates were found in females, younger and older persons, patients with gastrointestinal
diseases, pregnant women and women with a history of menometrorrhagia, and users of aspirin and/or
antacids.

 Infants consuming cow milk have a greater incidence of iron deficiency because bovine milk has
a higher concentration of calcium, which competes with iron for absorption.

 During childbearing years, an adult female loses an average of 2 mg of iron daily and must
absorb a similar quantity of iron in order to maintain equilibrium; because the average woman eats less
than the average man does, she must be more than twice as efficient in absorbing dietary iron in order
to maintain equilibrium and avoid developing iron deficiency anemia.