Hepcidin and the Global Burden of Iron Deficiency

Iron deficiency anemia is the most common type of anemia worldwide. It primarily affects women and children and is particularly prevalent in regions where their diet contains little meat, malaria and intestinal parasites are common, women have many closely spaced pregnancies, and children suffer from diarrheal illnesses (1). Iron deficiency alone or in combination with other forms of malnutrition may impair cognitive development and decrease initiative and physical stamina. On the other hand, iron deficiency may be protective against malaria. Indiscriminate iron supplementation may increase the risk of mortality from malaria and other infections, by mechanisms that are not well understood.Although the optimal strategy for iron supplementation in such settings is not yet established, it makes sense that iron supplementation should be directed only to those children who are known to be iron deficient, will absorb the supplemental iron, and will utilize it to increase their hemoglobin concentrations. Finding a simple, field-friendly diagnostic test that would sensitively and specifically identify children who are most likely to benefit from iron supplementation (and ideally also are least likely to be harmed) has become the Holy Grail of iron-related diagnostics in the global setting.Pasricha et al. (2) have made an important advance in this quest by testing the ability of serum hepcidin measurements to identify iron deficiency in well-characterized blood sample collections from children in areas of the Gambia and Tanzania where malaria is endemic. In addition to conventional diagnostics (serum ferritin, soluble transferrin receptor, and soluble transferrin receptor/log serum ferritin) used to define iron deficiency in all children, …