Environmental Contaminants, Iron Deficiency, and Iron-Deficiency Anemia: A Review of the Literature

Our plain-English summary of Environmental Contaminants, Iron Deficiency, and Iron-Deficiency Anemia: A Review of the Literature, by R. Lichtler, M. Cowley (Scientifica, 2025).

The study

• Authors: R. Lichtler, M. Cowley
• Journal: Scientifica
• Published: 2025;2025:5007983
• Type of article: Review
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Iron deficiency (ID) and ID anemia (IDA) are global health concerns that tend to affect vulnerable populations, including women, children, and those living in areas disproportionately affected by environmental health hazards. A review of the literature was conducted using the top ten chemicals of public health concern as identified by the World Health Organization (WHO) in 2020, in combination with the terms "iron deficiency" and "anemia." Both epidemiological and controlled experimental studies were considered. Eight contaminants or exposure classifications were ultimately considered to be within the scope of this review: lead, cadmium, arsenic, mercury, indoor and ambient air pollution, asbestos, dioxin and dioxin-like polychlorinated biphenyls (PCBs), and fluoride. Lead, cadmium, indoor and ambient air pollution, and fluoride are reliably linked to higher IDA prevalence and lower hematological parameters, including hemoglobin, hematocrit, and red blood cell count, all indicators of anemia. Direct measures of ID are less frequently reported. Further research studies, particularly controlled exposure studies, are needed to determine the importance of arsenic and mercury in contributing to the global ID and IDA burden. There is limited evidence that supplemental or dietary iron fortification can ameliorate the effects of lead, but not fluoride, and the efficacy of fortification has not been widely studied in the context of the remaining contaminants. Asbestos, dioxin, and dioxin-like PCBs are linked to anemia; however, the role of iron homeostasis is more complex and tends to include iron bioaccumulation. The narrative review has identified a need for renewed effort to address environmental factors beyond diet and nutrition when implementing ID and IDA interventions.

Copyright © 2025 Rebecca Lichtler and Michael Cowley. Scientifica published by John Wiley & Sons Ltd.

In plain English

This article was a narrative review, which the authors described as nonsystematic. It reported no new study. The authors searched PubMed and Google Scholar for human, animal and cell studies published since 2003. They looked for links between eight contaminants from a 2020 World Health Organization list and iron deficiency or iron-deficiency anemia: lead, cadmium, arsenic, mercury, indoor and ambient air pollution, asbestos, dioxin and dioxin-like PCBs, and fluoride. They reported that lead, cadmium, air pollution and fluoride were reliably linked to higher rates of iron-deficiency anemia. For asbestos, the review described two small studies of workers. One compared 14 exposed men with 10 controls and found more iron in lung washing fluid. The other studied 10 Italian shipyard workers with asbestos-related disease and found more iron in lung tissue near asbestos fibers. The review also covered four experimental studies of lung tissue or cells. In cells, iron inside the cell was depleted, and adding iron reversed this. The authors concluded that asbestos has a more complex relationship with iron deficiency because it binds iron. They noted that the evidence on adding iron came only from cell culture models.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Nonsystematic narrative review of epidemiological and experimental studies
• Who was studied: Published studies found through PubMed and Google Scholar, limited to articles published since 2003. These included observational studies of human populations or wildlife, and controlled experiments in animals or mammalian cell lines.
• Exposure: Eight contaminants or exposure groups from the 2020 WHO list of chemicals of public health concern: lead, cadmium, arsenic, mercury, indoor and ambient air pollution, asbestos, dioxin and dioxin-like PCBs, and fluoride. The asbestos section refers to asbestos in general and to occupational asbestos exposure.
• Main results:
  • Across the reviewed literature, lead, cadmium, indoor and ambient air pollution, and fluoride were reported as reliably linked to higher iron-deficiency anemia prevalence and lower blood measures of anemia.
  • For air pollution, 26 observational studies met the inclusion criteria. Of these, 24 found a significant impact on iron deficiency or iron-deficiency anemia, one found no association, and one found elevated hemoglobin.
  • Asbestos, reviewed observational study: in 14 male asbestos-exposed workers compared with 10 male and female controls, iron in bronchoalveolar lavage (lung washing) fluid was higher.
  • Asbestos, reviewed observational study: in 9 male and 1 female shipyard workers in Italy with documented asbestos-related disease, iron content in the lungs near asbestos fibers was higher.
  • Asbestos, experimental studies: four studies examined asbestos effects on iron handling in lung tissue or cells. Two studied the inside of cells and found iron depleted, which could be rescued by adding bioavailable iron.
  • The review described extracellular iron overload as linked to mesothelioma initiation in the studies it cited.
  • Dioxin and dioxin-like compounds consistently led to anemia in experimental settings, but iron levels in these models were generally increased rather than decreased.
• The authors' conclusion: The authors concluded that asbestos, dioxin and dioxin-like compounds have a more complex relationship with iron deficiency and iron-deficiency anemia because they sequester iron.
• Limitations the authors state:
  • The suggestion that iron supplementation might prevent asbestos-related iron deficiency came only from cell culture models.
  • Direct measurements of iron deficiency, such as circulating iron or ferritin, were less frequently reported in the reviewed studies.
  • Many reviewed studies were cross-sectional, which limits conclusions about cause.

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