CD: Iron Supplementation for Iron Deficiency Anemia 2009
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
CD: Iron Supplementation for Iron Deficiency Anemia
For individuals with iron deficiency anemia and celiac disease, the registered dietitian (RD) should advise the consumption of a daily gluten-free multivitamin with iron or additional individualized therapeutic doses of iron. Studies report that iron supplementation may be necessary to achieve normal values of hematological parameters.
Risks/Harms of Implementing This Recommendation
Consumption of iron beyond the UL may result in hemochromatosis.
Conditions of Application
- This recommendation applies to individuals with iron deficiency anemia and celiac disease
- Refer to the recommendation on Provide Resources and Education on Label Reading available at ada.portalxm.com/eal/template.cfm.
Potential Costs Associated with Application
Although costs of medical nutrition therapy (MNT) sessions and reimbursement vary, MNT sessions are essential for improved outcomes.
- For most children and adults with celiac disease, studies report that compliance with a gluten-free dietary pattern results in significant improvements in hematological parameters including serum hemoglobin, iron, ferritin, mean corpuscular volume, mean corpuscular hemoglobin and red cell distribution width (Rea et al, 1996; Annibale et al, 2001; Mitchell and Robinson, 2002; Kapur et al, 2003; Patwari et al, 2003; O'Leary et al, 2004; Rashid et al, 2005; Masjedizadeh et al, 2006; Poddar et al, 2006)
- Recovery of anemia (normalization of hemoglobin concentrations) generally occurs within six months, while recovery from iron deficiency (normalization of ferritin concentrations) may take longer than one year
- Iron supplementation in the form of a multivitamin with iron or additional therapeutic doses of iron may be necessary to achieve normal values of these hematological variables within these time periods.
Recommendation Strength Rationale
Conclusion statement received Grade II.
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
Annibale B, Severi C, Chistolini A, Antonelli G, Lahner E, Marcheggiano A, Iannoni C, Monarca B, Delle Fave G. Efficacy of gluten-free diet alone on recovery from iron deficiency anemia in adult celiac patients. Am J Gastroenterol 2001; 96: 132-137.
Kapur G, Patwari AK, Narayan S, Anand VK. Iron supplementation in children with celiac disease. Indian J Pediatr 2003; 70(12): 955-958.
Masjedizadeh R, Hajiani E, Hashemi J, Shayesteh AA, Moula K, Rajabi T. Celiac disease in South-West of Iran. World J Gastroenterol 2006;12(27):4416-9.
Mitchell RMS and Robinson TJ. Monitoring dietary compliance in coeliac disease using red cell distribution width. Int J Clin Pract 2002; 56(4): 249-250.
O'Leary C, Wieneke P, Healy M, Cronin C, O'Regan P, Shanahan F. Celiac disease and the transition from childhood to adulthood: a 28-year follow up. Am J Gastroenterol 2004; 99:2437-2441.
Patwari AK, Anand VK, Kapur G, Narayan S. Clinical and nutritional profile of children with celiac disease. Indian Pediatr 2003 Apr; 40(4): 337-342.
Poddar U, Thapa BR, Singh K. Clinical features of celiac disease in Indian children: are they different from the west? J Pediatr Gastroenterol Nutr 2006;43(3):313-7.
Rashid M, Cranney A, Zarkadas M, Graham ID, Switzer C, Case S, Molloy M, Warren RE, Burrows V, Butzner JD. Celiac disease: evaluation of the diagnosis and dietary compliance in Canadian children. Pediatrics 2005;116(6):e754-9.
Rea F, Polito C, Marotta A, Di Toro A, Iovene A, Collini R, Rea L, Sessa G. Restoration of body composition in celiac children after one year of gluten-free diet. J of Pediatric Gastroenterology and Nutrition 1996; 23: 408-412.
References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
Institute of Medicine: Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. Washington, DC, National Academies Press, 2001.