Skip to main content

Iron deficiency in Europe

  • Serge Hercberg (a1), Paul Preziosi (a1) and Pilar Galan (a1)

In Europe, iron deficiency is considered to be one of the main nutritional deficiency disorders affecting large fractions of the population, particularly such physiological groups as children, menstruating women and pregnant women. Some factors such as type of contraception in women, blood donation or minor pathological blood loss (haemorrhoids, gynaecological bleeding,..) considerably increase the difficulty of covering iron needs. Moreover, women, especially adolescents consuming lowenergy diets, vegetarians and vegans are at high risk of iron deficiency.

Although there is no evidence that an anbsence of iron stores has any adverse consequences, it does indicate that iron nutrition is borderline, since any further reduction in body iron is associated with a decrease in the level of functional compounds such as haemoglobin.

The prevalence of iron-deficient anaemia has slightly decreased in infants and menstruating women. Some positive factors may have contributed to reducing the prevalence of iron-deficiency anaemia in some groups of population: the use of iron-frotified formulas and iron-fortified cereals; the use of oral contraceptives and increased enrichment of iron in several countries; and the use of iron supplements during pregnancy in some European countries.

It is possible to prevent and control iron deficiency by counseling individuals and families about sound iron nutrition during infancy and beyond, and about iron supplementation during pregnancy, by screening persons on the basis of their risk for iron deficiency, and by treating and following up persons with presumptive iron deficiency. This may help to reduce manifestations of iron deficiency and thus improve public health. Evidence linking iron status with risk of cardiovascular disease or cancer is unconvincing and does not justify changes in food fortification or medical practice, particularly because the benefits of assuring adequate iron intake during growth and development are well established. But stronger evidence is needed before rejecting the hypothesis that greater iron stores increase the incidence of CVD or cancer. At present, currently available data do not support radical changes in dietary recommendations. They include all means for increasing the content of dietary factors enhancing iron absorption or reducing the content of factors inhibiting iron absorption. Increased knowledge and increased information about factors may be important tools in the prevention of iron deficiency in Europe.

    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Iron deficiency in Europe
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Iron deficiency in Europe
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Iron deficiency in Europe
      Available formats
Corresponding author
*Corresponding author: Email
Hide All
1Hallberg, L.Results of surveys to assess iron status in Europe. Nutr. Rev. 1995; 11: 314322.
2Hercberg, S, Galan, P, Dupin, H. Recent knowledge on iron and folate deficiency in the world. Paris: INSERM, 1990; 197: 700.
3Hallberg, L, Hultén, L, Bengtsson, C, Lapidus, L, Lindstedt, G.Iron balance in menstruating women. Eur. J. Clin. Nutr. 1995; 49: 200207.
4Fogelholm, M, Alopaeus, K, Silvennoinen, T, Teirilä, J.Factors affecting iron status in non-preganant wome from urban South Finland. Eur. J. Clin. Nutr. 1993; 47: 567574.
5Van de Vijver, LPL, Kardinaal, AFM, Charzewska, J, Rotily, M, Charles, P, Maggiolini, M, Ando, S, Väänänen, K, Wajszczyk, B, Heikkinen, J, Deloraine, A, Schaafsma, G.Calcium intake is weakly but consistently negatively associated with iron status in girls and women in six European countries. J. Nutr. 1999; 129: 963968.
6Strain, JJ, Barker, ME, Livingstone, MBE, Mc Kenna, PG. The Northern Ireland dietary surveys and related studies. Proc. Nutr. Soc. 1990; 49: 289296.
7Brussaard, JH, Brants, HA, Bouman, M, Löwik, MRH. Iron intake and iron status among adults in the Netherlands. Eur. J. Clin. Nutr. 1997; 51: S52S58.
8Galan, P, Hercberg, S, Soustre, Y.Factors affecting iron stores in French females. Human Nutr. Clin. Nutr. 1985; 39C: 279287.
9Soustre, Y, Dop, MC, Galan, P, Hercberg, S.Dietary determinants of the iron status in menstruating women. Int. J. Vit. Nutr. Res. 1986; 56: 281286.
10Preziosi, P, Hercberg, S, Galan, P, Devanlay, M, Cherouvrier, F, Dupin, H.Iron status of a healthy French population: factors determining biochemical markers. Ann. Nutr. Met. 1994; 38: 192202.
11Galan, P, Yoon, HC, Preziosi, P, Viteri, F, Valeix, P, Fieux, B, Briancon, S, Malvy, D, Roussel, AM, Favier, A, Hercberg, S.Determining factors in the iron status of adult women in the SU.VI.MAX study. Eur. J. Clin. Nutr. 1998; 52: 383388.
12Knottnerus, JA, Delgado, LR, knipschild, PG, Essed, GG, Smits, F, Haematologic parameters and pregnancy outcome. J. Clin. Epidemiol. 1990; 43: 461466.
13Robinson, S, Godfrey, K, Denne, J, Cox, V.The determinants of iron status in early pregnancy. Br. J. Nutr. 1998; 79: 249255.
14Milman, N, Agger, AO, Nielsen, OJ. Iron supplementation during pregnancy: effect on iron status markers, serum erythropoietin and human placental lactogen: a placebo controlled study in 207 Danish women. Danish Med. Bull. 1991; 38: 471476.
15Hercberg, S, Galan, P, Soustre, Y, Dop, MC, Devanlay, M, Dupin, H.Prevalence of iron deficiency during pregnancy in a French area. Nutr. Rep. Int. 1985; 32: 719726.
16Hercberg, S, Bichon, L, Galan, P, Christides, JP, Carroget, C, Potier de Courcy, G.Iron and folacin status of pregnant women: relationship with dietary intakes. Nutr. Rep. Int. 1987; 56: 915930.
17De Benazé, C, Galan, P, Wainer, R, Hercberg, S.Prévention de l'anemie ferriprive au cours de la grossesse par une supplémentation martiale précoce: un essai controlé. Rev. Epidemiol. Santé Publique. 1989; 27: 109119.
18Michaelsen, KF, Milman, N, Samuelson, G.A longitudinal study of iron status in healthy Danish infants: effects of early iron status, growth velocity and dietary factors. Acta. Pediatr. Scand. 1995; 84: 10351044.
19Macchia, P, Frijia, F, Mariani, F, Del Bravo, M, Protti, MA, Mariani, G, Bottone, E. Incidence of iron deficiency in an Italian area. In: Larisse, M, Tura, S, Ceccarelli, G, Ciampini, M eds. Le Sideropenie e il ruolo fisioterapeutico della ferritina. Roma: Antonio Delfino Editore, 1985: 2337.
20Colomer Revuelta, C, Donat Colomer, J, Fernandez-Delgado, R, Guitierrez Sogler, D, Colomeret Revuelta, J, Colomer Sala, C.La carencia de hierro en ninos de seia a deciocho meses de edad. Rev. Esp. Pediatr. 1985; 41: 273277.
21Hercberg, S, Papoz, L, Galan, P, Guéry, MF, Farnier, MA, Rossignol, C.Iron status and dietary pattern in young children. Nutr. Rep. Int. 1986; 35: 307316.
22Armstrong, P.Iron deficiency in adolescents. BMJ 1989; 298: 499.
23Doyle, W, Jenkins, S, Crawford, MA, Puvandendran, K.Nutritional status of school children in an inner city area. Arch. Dis. Child 1994; 70: 376381.
24Southon, S, Wright, AJA, Finglas, PM, Bailey, AL, Belsten, JL. Micronutrient intake and psychological performance of schoolchildren: consideration of the value of calculated nutrient intake for the assessment of micronutrient status in children. Proc. Nutr. Soc. 1992; 51: 315324.
25Bergström, E, Hernell, O, Lonnerdal, B, Persson, LA. Sex differences in iron stores of adolescents: what is normal. J. Ped. Gastro. Nutr. 1995; 20: 215224.
26Samuelson, G, Bratteby, L-E, Berggren, K, Elverby, J-E, Kempe, B.Dietary iron intake and iron status in adolescents. Acta. Paediatr. 1996; 85: 10331038.
27Milman, N.Serum ferritin in Danes: Studies of iron status from infancy to old age, during blood donation and pregnancy. Int. J. Hematol. 1996; 63: 103135.
28Nelson, M, White, J, Rhodes, C.Haemoglobin, ferritin, and iron intakes in British children aged 12–14 years: a preliminary investigation. Br. J. Nutr. 1993; 70: 147155.
29Donovan, UM, Gibson, RS. Iron and zinc status of young women aged 14 to 19 years consuming vegetarian and omnivorous diets. J. Am. coll. Nutr. 1995; 14: 463472.
30Alexander, D, Ball, MJ, Mann, J.Nutrient intake and haematological status of vegetarians and age-sex matched omnivores. Eur. J. Clin. Nutr. 1994; 48: 538546.
31Hallberg, L, Asp, NG. Iron nutrition in health and disease. London: John Libbey, 1996: 364.
32Rowland, TW, Deisroth, MB, Green, GM, Kelleher, JF. The effect of iron therapy on the exercise capacity of nonanemic iron-deficient adolescent runners. Am. J. Dis. Child 1988; 142: 165169.
33Ballin, A, Berar, M, Rubinstein, U, Kleter, Y, Hershkovitz, A, Meytes, D.Iron state in female adolescents. Am. J. Dis. Child 1992; 146: 803805.
34Bruner, AB, Joffe, A, Duggan, AK, Casella, JF, Brandt, J.Randomised study of cognitive effects of iron supplementation in non-anemic iron-deficient adolsecent girls. Lancet 1996; 348: 992996.
35Zhu, YI, Haas, JD. Iron depletion without anemia and physical performance in young women. Am. J. Clin. Nutr. 1997; 66: 334341.
36Allen, LH. Pregnancy and iron deficiency: unresolved issues. Nutr. Rev. 1997; 55: 91101.
37Viteri, FE. The consequences of iron deficiency and anemia in pregnancy. In: Allen, L, King, J, Lönnerdal, B, eds. Nutrient Regulation during Pregnancy, Lactation and Infant Growh. New York: Plenum Press, 1994: 127139.
38De Maeyer, E, Adiels-Tegman, M.The prevalence of anaemia in the world. World Health Stat. Q 1985; 38: 302316.
39Scholl, TO, Hediger, ML, Fisher, RL, Shearer, JW. Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study. Am. J. Clin. Nutr. 1992; 55: 985988.
40Hallberg, L, Bengtsson, C, Garby, L.An analysis of factors leading to a reduction in iron deficiency in Swedish women. Bull. WHO 1979; 57: 147954.
41Takkunen, H.Iron deficiency in the Finnish adult population. Scand J. Haematol (Suppl) 1976; 25: 187.
42Hallberg, L, Högdahl, AM, Nilsson, L, Rybo, G.Menstrual blood loss – a population study. Variation at different ages and attempts to define normality. Acta. Obstet. Gynecol Scand 1966; 45: 320351.
43Cole, SK, Billewicz, WZ, Thomson, AM. Sources of variation in menstrual blood loss. J. Obst. Gynaecol Br. Commonw. 1971; 78: 933939.
44Milman, N, Kirchhoff, M, Jogersen, T.Iron stores markers, serum ferritin and haemoglobin in 1359 Danish women in relation to menstruation, hormonal contraception, parity, and postmenopausal hormone treatment. Am. Hematol. 1992; 65: 96102.
45Milman, N, Rosdahl, N, Lyhne, N, Jogersen, T.Iron status in 883 Danish women aged 35–65 years. Relation to menstruation and method for contraception. Acta. Obst. Gynecol. Scand 1993; 72: 601605.
46Bothwell, TH, Charlton, RW. A general approach to the problem of iron deficiency and iron overload in the population at large. Sem. Hematol. 1982; 19: 5457.
47Monsen, ER, Balintly, JL. Calculating dietary iron bioavailability: refinement of computarization. J. Am. Diet. Assoc. 1978; 80: 307311.
48Murphy, SP, Beaton, GH, Calloway, DH. Estimated mineral intakes of toodlers: predicted prevalence of inadequacy in village populations in Egypt, Kenya, and Mexico. J. Clin. Nutr. 1992; 56; 565572.
49Tseng, M, Chakraborty, H, Robinson, DT, Mendez, M, Kohlmeier, L.Adjustment of iron intake for dietary enhancers and inhibitors in population studies: bioavailable iron in rural and urban residing russian women and children. J. Nutr. 1997; 127: 14561468.
50Hallberg, L, Hulthen, L.Prediction of dietary iron absorption. An algorithm to calculate absorption and bioavailability of dietary iron. Am. J. Clin. Nutr. 2000; 71: 11471160.
51Lonnerdal, B.Effects of milk and milk components on calcium, magnesium, and trace element absorption during infancy. Physiol. Rev. 1997; 77: 643669.
52Pisacane, A, De Vizia, B, Valiante, A, Vaccaro, F, Russo, M, Grillo, G, Giustardi, A.Iron status in breast-fed infants. J. Pediatr. 1995; 127: 429431.
53Dewey, KG, Cohen, RJ, Brown, KH, Rivera, LL. Age of introduction of complementary foods and growth of term, low-birth-weight, breast-fed infants: a randomized intervention study in Honduras. Am. J. Clin. Nutr. 1999; 69: 679686.
54WHO (1999) Infant and young child feeding in the WHO European Region – Guidelines with emphasis on the former Soviet Union. WHO, Copenhagen (in preparation).
55Milman, N, Agger, AO, Nielsen, OJ. Iron status markers and serum erythropoietin in 120 mothers and newborn infants: effect of iron supplementation in normal pregnancy. Acta. Obstet. Gynecol. Scand 1994; 73: 200204.
56Hemminki, E, Rimpela, U.A randomized comparison of routine versus selective iron supplementation during pregnancy. J. Am. Coll. Nutr. 1991; 10: 310.
57Hurell, R.Fortification. Nutrition Rev. 1997; 55: 210222.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed