Comment on: Homocysteine and vitamin B ₁₂ status and iron deficiency anemia in female university students from Gaza, Palestine

Iron is the most abundant heavy metal in the earth's crust and is required by almost all organisms.¹ In the human body iron is required by and present in all cells and has several vital functions.² Anemia due to iron deficiency is the commonest type of nutritional anemia worldwide, and occurs when body iron stores become inadequate for the needs of normal erythropoiesis. Iron deficiency anemia (IDA) results from an imbalance between iron intake and iron losses or utilization.³ Vitamin B₁₂ deficiency is another type of nutritional deficiency that is encountered among the elderly of rich countries, but it is more prevalent in poorer populations around the world.⁴ On the other hand, increased levels of homocysteine (hyperhomocysteinemia) are found to be associated with coronary atherosclerosis and cerebrovascular disorders.⁵ In the current issue of the Revista Brasileira de Hematologia e Hemoterapia, Sirdah et al. present original data about serum homocysteine and vitamin B₁₂ status in female university students (18-22 years old) diagnosed with IDA.⁶ The authors explored the association between the markers of IDA (serum ferritin, hemoglobin concentration, red blood cell mass) and the serum levels of homocysteine and vitamin B₁₂. The importance of the study can be viewed in respect to different aspects. The study is among the very few scientific works that tried to find an association between anemia, specially IDA, homocysteine, and vitamin B₁₂. Also it covers a very vulnerable target group for developing IDA, females of the childbearing age. Moreover, the study was carried out in the Gaza Strip of Palestine where the socioeconomical situation, the restrictive environment and the stress in day-to-day life are risk factors for developing nutritional deficiencies.

In addition to the relatively high occurrence of IDA among the female university students, the results of the study of Sirdah et al. reveal significantly higher levels of serum homocysteine among IDA females compared to the controls, with statistically significant negative correlations of serum homocysteine with serum ferritin, vitamin B₁₂, hemoglobin, and hematocrit. A remarkable finding of the study was the statistically reduced level of vitamin B₁₂ in IDA females, which may be encountered less frequently in the modern era because of improvements in nutritional status.⁷ However, in the Gaza Strip where the local political climate is seriously affecting Gazian economics and the fact that the majority (almost 75%) of the people are United Nations Relief and Works Agency (UNRWA) refugees,⁸ this combination of iron and vitamin B₁₂ deficiencies may be understandable. However, the cause(s) of hyperhomocysteinemia in these iron and vitamin B₁₂ deficient females should be addressed properly in future works.

There is a scarcity of published information that addresses the correlation of IDA markers and serum homocysteine and vitamin B₁₂. Therefore, the results of the study of Sirdah et al. should inspire further comprehensive follow-up studies on other target groups and settings aiming to incontestably define this correlation.

REFERENCES

• ¹
  Monsen ER. Iron nutrition and absorption: dietary factors which impact iron bioavailability. J Am Diet Assoc. 1988;88:786-90.
• ²
  Centers for Disease Control and Prevention. Recommendations to prevent and control iron deficiency in the United States. MMWR Recomm Rep. 1998;47:1-29.
• ³
  Johnson-Wimbley TD, Graham DY. Diagnosis and management of iron deficiency anemia in the 21st century. Therap Adv Gastroenterol. 2011;4:177-84.
• ⁴
  Allen LH. How common is vitamin B-12 deficiency? Am J Clin Nutr. 2009;89:693S-6S.
• ⁵
  Faraci FM, Lentz SR. Hyperhomocysteinemia, oxidative stress, and cerebral vascular dysfunction. Stroke. 2004;35:345-7.
• ⁶
  Sirdah MM, Yassin MM, Shekhi SE, Lubad AM. Homocysteine and vitamin B12 status and iron deficiency anemia in female university students from Gaza, Palestine. Rev Bras Hematol Hemoter. 2014;36:208-12.
• ⁷
  Song SM, Bae KW, Yoon HS, Im HJ, Seo JJ. A case of anemia caused by combined vitamin B12 and iron deficiency manifesting as short stature and delayed puberty. Korean J Pediatr. 2010;53:661-5.
• ⁸
  Palestinian Central Bureau of Statistics (PCBS): On the Eve of the International Day of Refugees, Ramallah, Palestine; 2013.

Publication Dates

• Publication in this collection
  May-Jun 2014