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Iron Deficiency Protective Against Malaria

A study of children in Tanzania links iron deficiency with fewer malaria infections.

By | April 13, 2012

A boy waits with his mother for his malaria lab results at a dispensary in Tanga, Tanzania. WIKIMEDIA COMMONS, U.S NAVY MASS COMMUNICATION SPECIALIST 2ND CLASS JOHANSEN LAUREL

Iron deficiency may protect against malaria infection and mortality, reports a new study published Sunday (April 15) in Clinical Infectious Diseases. The data, gathered from nearly 800 Tanzanian children followed from birth to age three, support growing doubt regarding iron supplementation in children and pregnant women living in malaria-endemic areas.

“This study provides new data indicating that naturally occurring iron deficiency is actually protective against malaria,” Philip Fischer, a Mayo Clinic pediatrician who was not involved in the research, wrote in an email. The project expands upon previous studies that had suggested that iron supplementation increased risk of malaria infection, Fischer explained.

Understanding the interaction between malaria infection and iron is of paramount importance in areas where malaria kills many children, said Patrick Duffy, study author and chief of the Laboratory of Malaria Immunology and Vaccinology at the National Institute of Allergy and Infectious Diseases. Iron deficiency can cause its own problems in children, including delayed development and poor growth, but a supplementation program that may increase malaria risk cannot be undertaken lightly, Duffy said.

His group’s study was designed to address the controversial issue of whether iron supplementation increased malaria risk, as previous studies of the phenomenon were contradictory. “We wanted to follow these children over time and see whether iron deficiency could predict malaria risk,” rather than take a snapshot and try to correlate iron deficiency with malaria infection, explained Duffy.

In order to determine whether iron deficiency might have a protective effect, Duffy’s group followed 785 children from birth to age three. Doctors assessed the children’s overall health at routine well child visits (conducted every two weeks for the first year and monthly thereafter) and analyzed blood smears for evidence of parasite infection and iron levels. The study focused on children at the greatest risk of contracting malaria, Duffy explained.

Duffy’s group found that iron deficiency appears to protect against both malaria infection and mortality, as well as all causes of mortality in the young children they followed.

Children with iron deficiencies were approximately 7 times less likely to contract malaria, and their blood parasite count when they did contract the disease was about 4-fold lower. Children with normal iron levels were 4 times more likely to acquire severe malaria infection and 24 times more likely to have elevated parasite levels in their blood.

The results are “very likely to be true,” and the number of children involved, close monitoring, and “outstanding” rate of follow-up in the study strengthened the results, said Chandy John, a pediatric infectious disease specialist at the University of Minnesota Medical School who did not participate in the study. Although causation is not yet proved, John said, the data is very unlikely to be mere correlation.

How, exactly, iron deficiency may be working to protect against malaria remains to be seen, said Duffy. Organisms in general need iron, he explained, so it may be that malaria parasites cannot grow as well without access to abundant iron. Severe malaria is associated with parasite infection creating sticky red blood cells, and it may be that without iron, infected red blood cells become less sticky.  Another hypothesis, he said, is that iron may alter the protective immune response against the parasite.

Duffy also highlighted the reduction in mortality from all causes in iron-deficient children as an important finding. Again, he noted, more work needs to examine the mechanism—does iron deficiency directly protect against many infectious diseases, or do malaria infections predispose children to other health problems?

Better tools for accurately measuring iron deficiency are needed, said Duffy, whose lab is looking at how red blood cells incorporate zinc, to which developing cells turn when iron is scarce.

It’s also vital to understand more about how the severity of iron deficiency may affect protection against infection, Duffy said, so health officials can help children avoid the detrimental effects of malaria and iron deficiency. Fischer pointed out that the results argue for a more holistic approach to children’s healthcare, rather than concentrating on only one facet, writing, “Sometimes, helping part of a child can be worse than doing nothing.”

M. Gwamaka, et al., “Iron Deficiency Protects Against Severe Plasmodium falciparum Malaria and Death in Young Children,” CID, 54:1137-44, 2012.

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Comments

Avatar of: HFletcher_679

HFletcher_679

Posts: 44

April 16, 2012

The growth of Coliform bacteria is also limited by low iron levels in human babies' guts,and iron levels are lower in human milk than cows' milk or most formula milk. Reduced iron should therefore reduce diarrhea, another common cause of infant mortality.
Farmers routinely give piglets iron supplements, and piglets routinely get scours.

April 16, 2012

Given what is already quite well known about iron metabolism in blood-stage Plasmodium, this is hardly a surprising result.  The parasite consumes hemoglobin for one reason only -- to get the iron from the molecule.  It is the blood-stage parasite's sole source of iron. The parasite does not derive amino acids from the Hb, only iron.   If an infected patient has iron-deficiency anemia, this would be expected to reduce the amount of iron available for the parasite and thus diminish the parasite's ability to reproduce in the blood cells.
 
I sure wish these "parasitologists" would learn something about what is already well known about the cell biology, biochemistry and physiology of the parasites themselves before trying to interpret results like this.
 
 

Avatar of: Jeff Buguliskis

Jeff Buguliskis

Posts: 1457

April 16, 2012

This is absolutely not true...in fact you have it backward. The parasite detoxifies the iron within the heme molecule through crystallization into hemozoin within the parasite food vacuole. The parasite ABSOLUTELY gets amino acids from Hb. Please do not comment on things that you have no idea about.   

Avatar of:

Posts: 0

April 16, 2012

The growth of Coliform bacteria is also limited by low iron levels in human babies' guts,and iron levels are lower in human milk than cows' milk or most formula milk. Reduced iron should therefore reduce diarrhea, another common cause of infant mortality.
Farmers routinely give piglets iron supplements, and piglets routinely get scours.

Avatar of:

Posts: 0

April 16, 2012

Given what is already quite well known about iron metabolism in blood-stage Plasmodium, this is hardly a surprising result.  The parasite consumes hemoglobin for one reason only -- to get the iron from the molecule.  It is the blood-stage parasite's sole source of iron. The parasite does not derive amino acids from the Hb, only iron.   If an infected patient has iron-deficiency anemia, this would be expected to reduce the amount of iron available for the parasite and thus diminish the parasite's ability to reproduce in the blood cells.
 
I sure wish these "parasitologists" would learn something about what is already well known about the cell biology, biochemistry and physiology of the parasites themselves before trying to interpret results like this.
 
 

Avatar of:

Posts: 0

April 16, 2012

This is absolutely not true...in fact you have it backward. The parasite detoxifies the iron within the heme molecule through crystallization into hemozoin within the parasite food vacuole. The parasite ABSOLUTELY gets amino acids from Hb. Please do not comment on things that you have no idea about.   

Avatar of: A

A

Posts: 1457

April 16, 2012

That used to be taught to the biology class in Greece, the last twenty years... Thalassaemia evolved in areas where malaria is common and patients with the former are immune to the latter. Isn't this something similar with this article...?

Avatar of:

Posts: 0

April 16, 2012

That used to be taught to the biology class in Greece, the last twenty years... Thalassaemia evolved in areas where malaria is common and patients with the former are immune to the latter. Isn't this something similar with this article...?

Avatar of:

Posts: 0

April 17, 2012

This is a perfect example of how the immune system is SUPPOSED to work. The body tries to keep us in this state of 'iron deficiency' because by keeping the body low in iron , when it IS attacked by an invader , bacteria , fungus , virus or parasite the body can sequester this little iron AWAY from the invader. We are going to find this 'iron deficiency' protects them from far more than malaria.
The government , prodded by the medical profession , adds iron to our food because they believe this iron deficiency is bad. The fact these people with iron deficiency are protected from malaria , bolsters the theory that the government and the medical profession have iron deficiency all wrong and are diagnosing people with iron deficiency when they are actually NORMAL and by giving iron to treat this 'iron deficiency' actually leads to higher death in those with malaria AND also in people with AIDS.
"A WHO recommendation to supply all iron-deficient children with micronutrient supplements has been called into question by a study that has found this may increase the risk of malaria"
"The inadvertent simultaneous administration of low doses of oral iron with dapsonefor the prophylaxis of Pneumocystis carinii pneumonia in HIV-positive patients may have been associated with excess mortality"

Avatar of: jhnycmltly

jhnycmltly

Posts: 65

April 17, 2012

This is a perfect example of how the immune system is SUPPOSED to work. The body tries to keep us in this state of 'iron deficiency' because by keeping the body low in iron , when it IS attacked by an invader , bacteria , fungus , virus or parasite the body can sequester this little iron AWAY from the invader. We are going to find this 'iron deficiency' protects them from far more than malaria.
The government , prodded by the medical profession , adds iron to our food because they believe this iron deficiency is bad. The fact these people with iron deficiency are protected from malaria , bolsters the theory that the government and the medical profession have iron deficiency all wrong and are diagnosing people with iron deficiency when they are actually NORMAL and by giving iron to treat this 'iron deficiency' actually leads to higher death in those with malaria AND also in people with AIDS.
"A WHO recommendation to supply all iron-deficient children with micronutrient supplements has been called into question by a study that has found this may increase the risk of malaria"
"The inadvertent simultaneous administration of low doses of oral iron with dapsonefor the prophylaxis of Pneumocystis carinii pneumonia in HIV-positive patients may have been associated with excess mortality"

Avatar of: jhnycmltly

jhnycmltly

Posts: 65

April 19, 2012

Quote: We are going to find this 'iron deficiency' protects them from far more than malaria
Answer: Iron deficiency against tuberculosis by dietary iron reduction.

"The importance of iron in the virulence of mycobacteria is discussed in relationship to the development of tuberculosis. The management of dietary iron can therefore be influential in aiding the outcome of this disease."

This 'iron deficiency' has already been shown to be protective against diabetes in pregnancy.
"The prevalence of GDM is reduced in iron deficiency anemia"
"The role of iron excess in the pathogenesis of gestational diabetes mellitus needs to be examined."

They have already shown what scientists have accepted as 'iron deficiency' is in fact NORMAL which is evidenced by healthy children with hemoglobins BELOW what is accepted normal. So in effect by using a low marker , they are giving iron supplementation to children who are normal.

Avatar of:

Posts: 0

April 19, 2012

Quote: We are going to find this 'iron deficiency' protects them from far more than malaria
Answer: Iron deficiency against tuberculosis by dietary iron reduction.

"The importance of iron in the virulence of mycobacteria is discussed in relationship to the development of tuberculosis. The management of dietary iron can therefore be influential in aiding the outcome of this disease."

This 'iron deficiency' has already been shown to be protective against diabetes in pregnancy.
"The prevalence of GDM is reduced in iron deficiency anemia"
"The role of iron excess in the pathogenesis of gestational diabetes mellitus needs to be examined."

They have already shown what scientists have accepted as 'iron deficiency' is in fact NORMAL which is evidenced by healthy children with hemoglobins BELOW what is accepted normal. So in effect by using a low marker , they are giving iron supplementation to children who are normal.

Avatar of:

Posts: 0

April 19, 2012

Allow me to add my 2 cents worth as a diagnostics chemist with extensive industrial experience in iron testing as an indicator of iron status in health: the malaria data are fully consistent with iron as an element that is essential for the growth and replication of most pathogens. And our bodies have several substances that sequester iron, one of which, plasma ferritin, is the best indicator of highly prevalent iron overload as we age to levels in excess of 1000 ng/ml, with a skewed upper value of 200 ng/ml as being normal when the healthy range is 25-100.    

Avatar of: h rutner

h rutner

Posts: 1

April 19, 2012

Allow me to add my 2 cents worth as a diagnostics chemist with extensive industrial experience in iron testing as an indicator of iron status in health: the malaria data are fully consistent with iron as an element that is essential for the growth and replication of most pathogens. And our bodies have several substances that sequester iron, one of which, plasma ferritin, is the best indicator of highly prevalent iron overload as we age to levels in excess of 1000 ng/ml, with a skewed upper value of 200 ng/ml as being normal when the healthy range is 25-100.    

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