Sneak-peek into iron deficiency anemia in India: The need for food-based interventions and enhancing iron bioavailability

Malnutrition is among the top 6 risk factors for death in India, and iron deficiency anemia (IDA) is regarded as one of the major contributors, with nationwide prevalence > 60 % among women. Nutritional anemia accounts for ∼70 % anemia prevalence among Indian children and adolescents, specifically in females. Evidence suggests that current supplementation and fortification practices alone may make little difference in reducing the risk of IDA. Sustainable food-based strategies need to be determined. This review provides an overview of IDA in India and elaborates the food-based solutions. Factors that affect iron bioavailability have been discussed while exploring different plant-based food synergies to improve iron absorption. Nutritional and non-nutritional challenges have been highlighted. A case study has been incorporated that analyses Health Management Information System data for certain pregnancy outcomes among severely anemic pregnant women. It highlights the need for implementing alternative food-based strategies apart from the government programs. Iron-rich plant sources, with appropriate ratios of bioavailability enhancers and inhibitors can be utilized to develop effective products. However, this cannot be easily achieved. Obtaining higher concentrations of iron from food sources alone is challenging. Processing techniques may lower antinutrient content but risk mineral loss and vitamin degradation from the food matrix. Most studies focus on increasing iron content via fortification rather than enhancing its bioavailability. Safety, accessibility, and affordability issues of previous approaches need to be addressed. It is essential to understand the chemistry behind iron bio-accessibility and absorption to develop ready-to-eat plant-based food formulations, with highly bioavailable iron, which could be a plausible solution.