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Iron Deficiency Anemia among Alaska Natives May Be Due to Fecal Loss Rather than Inadequate Intake^1,2,

Kenneth M. Petersen³, Alan J. Parkinson, Elizabeth D. Nobmann^*, Lisa Bulkow, Ray Yip and Ali Mokdad

Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), Anchorage, AK 99501 ^* Alaska Area Native Health Service, Indian Health Service, Anchorage, AK 99501 Division of Nutrition, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA 30333

To define more fully the nature of a persistently high prevalence of iron deficiency anemia observed among Alaska Native children, we examined dietary iron intake, hemoglobin concentrations, and storage iron (serum ferritin) based on multiple cross-sectional surveys of Alaska Natives between 1983 and 1989. Approximately 30 to 50% of the children studied <12 y of age had depleted iron stores. Anemia and depleted iron stores also were prevalent among adult men and women, about twice as prevalent as in the U.S. population based on the Second National Health and Nutrition Examination Survey (NHANES II). The higher rate of iron deficiency, occurring even when the dietary assessment found Alaska Native iron intake to be higher than the U.S. average with an ample intake of food high in bioavailable iron, suggests blood loss as a possible cause of the unusual pattern of iron deficiency observed. In a pilot study of stool blood loss in two villages, 65% of the samples had a significantly elevated stool heme concentration. Further investigation of iron deficiency due to gastrointestinal blood loss for the Alaska Native is warranted.

KEY WORDS: • Alaska Natives • iron deficiency • anemia • fecal occult blood • humans

¹ The opinions expressed in this paper are those of the authors and do not necessarily reflect the views of the Indian Health Service.

² The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 USC section 1734 solely to indicate this fact.

³ To whom correspondence and reprint requests should be addressed.

Manuscript received 11 August 1995. Revision accepted 17 July 1996.