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Anemia Of Chronic Disease: What To Know

Found in Some People With Long-Term Conditions That Involve Inflammation

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Medically reviewed by Gagandeep Brar, MD

Anemia of chronic disease is a type of anemia caused by inflammation from long-term disorders. Anemia is when you have reduced numbers or function of red blood cells (RBCs), which carry oxygen throughout the body.

Inflammation causes changes in how the body uses iron, which is needed for the oxygen-carrying hemoglobin in red blood cells. The condition results from other long-term health conditions that affect your ability to create red blood cells. It is also known as chronic anemia or anemia of inflammation. About 1 million Americans over age 65 have anemia of inflammation.

This article will define anemia of chronic disease, including what it is, what type of anemia it is, and common causes, symptoms, features, levels, and characteristics.

It will discuss the testing and lab values required for a diagnosis of chronic anemia and what happens as the disease progresses, as well as the difference between iron-deficiency anemia and anemia of chronic disease.

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What Is Anemia of Chronic Disease?

Anemia is a lack of healthy red blood cells with enough protein called hemoglobin. Hemoglobin requires iron to bring oxygen from the lungs to organs and tissues throughout the body.

If the body has too few red blood cells, if these cells are not fully formed and healthy, or if they don't have enough hemoglobin or iron, they won't be able to transport enough oxygen. Without enough oxygen, the body parts can't function correctly. This is called anemia.

There are many different types of anemia. Anemia of chronic disease is one of the more common types. The most common type of anemia is iron-deficiency anemia, but this has different characteristics, causes, and treatments from anemia of chronic disease.

Anemia of chronic disease is anemia caused by inflammation from a long-term or chronic illness. It is also called anemia of inflammation.

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People with anemia of chronic disease may have normal or even high levels of iron in the body's tissues. But they have low iron in the blood and not enough healthy red blood cells.

Underlying Conditions That Cause Chronic Anemia

Several long-term conditions can cause anemia of chronic disease. For instance, anemia of chronic disease can develop in people with cancers, especially blood cancers like lymphoma, including Hodgkin's disease.

Anemia of chronic disease is also common in people with varying types of autoimmune conditions. These can include:

People with chronic infections can develop anemia of inflammation. These include:

Tuberculosis

Human immunodeficiency virus (HIV)

Hepatitis B or C

Infection of the heart lining (bacterial endocarditis)

Bone infections (osteomyelitis)

Lung abscess

People with chronic kidney disease, diabetes, and heart failure are also at a high risk of developing anemia of inflammation.

Risk Factors for Anemia of Chronic Disease

The biggest risk factor for developing anemia of chronic disease is having a long-term illness that causes inflammation. It is more likely to develop as a person ages since older people are more likely to have a chronic disease.

When dealing with chronically high levels of inflammation, your body changes in ways that may lead to anemia. These include:

The body changes the ways it stores and uses iron.

The kidneys may make less of the hormone erythropoietin (EPO) that tells the bone marrow to make red blood cells.

The bone marrow stops responding to EPO.

The red blood cells that the bone marrow makes are more fragile. They die faster than usual and faster than they can be replaced.

Other Causes of Chronic Anemia

Aside from inflammation, other symptoms and bodily changes caused by the chronic illness can also work to cause or worsen anemia.

For example, in chronic kidney disease, EPO levels may be low not only because of inflammation but because the kidneys struggle to produce enough of the hormone due to kidney damage. A person with a restricted diet due to chronic kidney disease may not get enough nutrients to make red blood cells. Losing blood due to hemodialysis can also lead to iron-deficiency anemia.

Blood loss is also likely a factor in anemia brought on by chronic digestive conditions like inflammatory bowel disease (IBD). IBD includes ulcerative colitis and Crohn's disease), which may cause both iron-deficiency anemia due to blood loss and anemia of chronic disease.

Anemia due to cancer is often a mix of blood loss, side effects from treatments such as chemotherapy and radiation, and due to cancers that affect or spread to the bone marrow, where red blood cells are made.

It is also possible for older adults to develop anemia of inflammation without having a chronic disease or infection.

Symptoms of Anemia of Chronic Disease

Early in its course, anemia of inflammation may not have symptoms. It develops slowly. As it progresses, anemia can have mild to severe symptoms. Symptoms of anemia of chronic disease include:

Feeling weak or tired, especially during physical activity

Headache

Looking pale

Being short of breath

Speedy heartbeat

Body aches

Being dizzy or light-headed

What Tests Diagnose Chronic Anemia?

A healthcare provider will examine you to check for anemia and ask about your symptoms and your chronic disease. They'll run many blood tests to see if your chronic condition is causing anemia. Tests and related lab values that indicate anemia of chronic disease include the following.

Laboratory normal ranges used to diagnose anemia vary by the sex assigned at birth. (Note that in this article, the terms for sex or gender from the sources cited are used.)

A complete blood count (CBC), peripheral smear, and reticulocyte count to study the blood cells include these indications of anemia:

RBC count: The number of red blood cells in your blood should be 4.7 to 6.1 million cells per microliter (mcL) for adult males and 4.2 to 5.4 million cells/mcL for adult females. Lower numbers indicate anemia.

Hemoglobin: Hemoglobin under 13.8 grams per deciliter (g/dL) for adult males or 12.1 g/dL for adult females would indicate anemia.

RBC indices and appearance: The CBC and peripheral smear also examine the red blood cells' size, shape, and color, which can provide clues to the type or cause of anemia.

Reticulocyte count: The reticulocyte count is the number of developing red blood cells. A normal result for healthy adults not anemic is 0.5% to 2.5%.

Blood tests to check iron levels include:

Serum iron: The normal range for this is 40 to 165 micrograms per liter (μg/L). Levels below this indicate anemia.

Serum transferrin: Transferrin is a protein in your blood that carries iron into the cells. Normal serum transferrin level is between 200 and 400 milligrams per deciliter (mg/dL).

Transferrin saturation: Transferrin levels are used to calculate transferrin saturation, which tells the healthcare provider how much iron is available to your body. A transferrin saturation below 20% indicates anemia.

Serum ferritin: Ferritin is a protein that stores iron in your body's cells. If ferritin falls below 100 μg/L in a person with a chronic condition, that would indicate that your body doesn't have enough iron.

Other tests include:

C-reactive protein level between 1.0 to 10.0 mg/dL or higher indicates that the body is experiencing systemic inflammation, often caused by chronic diseases.

The erythrocyte sedimentation rate (ESR), or sed rate, is a measurement that indicates how much inflammation is in the body. For adults over 50, ESR should be less than 20 millimeters per hour (mm/hr) in men and less than 30 mm/hr in women.

Rarely a bone marrow biopsy is performed to rule out cancer.

Treatment for Anemia of Chronic Disease

Anemia is often mild enough that it does not need treatment. The first line of treatment for anemia of chronic disease is treating the condition causing the inflammation or working to reduce the inflammation caused by the disease. Treatment may improve or cure anemia.

Procedures that might be needed include:

Blood transfusions can quickly increase the hemoglobin in your blood and boost oxygen. This is a short-term fix.

Intravenous medicines and iron supplements given during hemodialysis can reduce and prevent anemia in people with chronic kidney disease.

Medicines:

EPO itself can be given as a shot.

Shots of erythropoiesis-stimulating agents (ESAs), epoetin alpha or darbepoetin alpha, can trigger the bone marrow to make more red blood cells.

Depending on the characteristics of your illness (but not in all cases), your healthcare provider may suggest Iron supplements as pills or shots.

Anemia of Chronic Disease vs. Iron-Deficiency Anemia

Anemia of chronic disease is different from iron-deficiency anemia.

In iron-deficiency anemia, the body doesn't have enough stored iron to make enough healthy red blood cells. Iron levels are low in both body tissues and the blood.

In anemia of chronic disease, the body has iron stores in the body tissues, but the body can't use it to make enough healthy red blood cells. Typically, iron levels are high in the body but low in the blood.

The symptoms of the two are similar, but the causes are different. In some cases, such as diseases that result in blood loss, people can have both types of anemia.

Possible Complications of Anemia of Chronic Disease

Most of the time, the symptoms of anemia are the most significant complication. Anemia of chronic disease can increase the risk of death in people with heart failure. In people with chronic kidney disease, severe anemia can lead to heart problems. And untreated, severe anemia can be life-threatening.

Does Anemia of Chronic Disease Get Better?

Generally, the outlook for people with anemia of chronic disease is promising. Most people improve when the anemia cause is discovered and treated.

Dietary and Lifestyle Changes for Chronic Anemia

A healthy diet is recommended. Your healthcare provider can share information on what you should be eating and refer you to a dietitian for nutritional counseling.

Depending on the underlying condition and how it affects nutrient absorption and use, a healthcare provider may recommend changes to address specific nutrient deficiencies, like iron, folic acid, or vitamin B12.

When to Contact a Healthcare Provider

If you have a long-term disorder or chronic disease and start showing anemia symptoms, let your healthcare provider know. They'll do an exam and blood tests to diagnose anemia and work with you to treat the cause. Treatment helps most people with anemia of chronic disease feel better.

Summary

Anemia of chronic disease is a common type of anemia. Inflammation from long-term or chronic diseases causes it. It is also known as anemia of inflammation.

Cancer, autoimmune conditions, chronic infections, and other conditions can all cause anemia of chronic disease. Symptoms may include weakness, fatigue, headache, pale appearance, and shortness of breath.

Blood tests for anemia include a complete blood count and iron and iron-related protein levels. Treatment involves addressing the underlying chronic disease or reducing inflammation.

Blood transfusions, EPO, and medicines to stimulate red blood cells can treat anemia. Supplemental iron may or may not be recommended, as this type of anemia differs from iron-deficiency anemia, but they can occur together. With treatment, the outlook for people with anemia of chronic disease is generally favorable.

What Is Anemia?

Anemia is a condition that occurs when your blood has a reduced number of red blood cells or hemoglobin, the protein that helps your red blood cells transport oxygen from your lungs to the rest of your body. When you have anemia, your blood has less oxygen than normal. This can cause symptoms like fatigue and weakness, shortness of breath, dizziness, headaches, and an irregular heartbeat.

Anemia can develop in anyone regardless of age, race, or ethnicity. However, some people are more at risk for developing the condition, including people who have cancer, an autoimmune disorder, or heavy periods.

Treatment for mild to moderate anemia usually involves supplements or medications that help your blood develop more red blood cells. In more severe cases, a blood transfusion or surgery may be necessary.

There are many types of anemia. Some types are more common and easier to treat than others, but they can all lead to complications if left untreated. Iron Deficiency Anemia When you don't have enough iron, you are at risk of developing iron deficiency anemia. This common type of anemia usually occurs when you don't consume adequate iron in your diet. It impacts 30% of women and children. Low iron levels can also develop due to blood loss or medical conditions that make it difficult for your body to absorb iron. While this type of anemia rarely causes death, it can lead to significant complications. Symptoms and possible complications include: Fatigue Headaches Restless legs syndrome, a condition that causes your legs to move uncontrollably Heart problems Pregnancy complications like early labor (before 36 weeks) and low infant birth weight Iron deficiency anemia can cause other medical conditions to worsen or cause treatments to be ineffective. Pernicious Anemia Pernicious anemia is an autoimmune disorder, meaning your body mistakenly attacks healthy cells. This type of anemia is relatively rare. It affects less than 2% of people over age 60 worldwide. People with pernicious anemia have low levels of vitamin B12. Your body needs vitamin B12 to make healthy red blood cells and keep your nervous system working properly. Pernicious anemia causes larger-than-normal red blood cells that do not divide effectively. These blood cells have difficulty moving out of bone marrow (where they're made) and so cannot carry oxygen throughout your body. If left untreated, pernicious anemia can cause serious complications. You might experience bleeding and infections, as well as irreversible brain or nerve damage. Infants of people who have a vitamin B12 deficiency are more likely to experience developmental delays and birth defects, particularly in the brain and spinal cord. Aplastic Anemia Aplastic anemia is a rare but serious blood condition. It occurs when your bone marrow cannot make enough new blood cells for your body to function properly. This type of anemia, which impacts about two out of every one million people in the United States, usually results from damage to stem cells inside your bone marrow. This causes your bone marrow to make fewer red blood cells, white blood cells, and platelets. Aplastic anemia often occurs because your immune system attacks and destroys the stem cells. Untreated aplastic anemia can lead to serious complications like an irregular heartbeat and heart failure. It also increases your risk of developing bleeding issues, leukemia (a type of cancer that begins in the blood cells), and other serious blood conditions. Aplastic anemia is a life-threatening condition with very high death rates. About 70% of people die within one year if the disease is left untreated. The five-year survival rate is about 80% for people under age 20. Hemolytic Anemia With hemolytic anemia, your red blood cells are destroyed faster than they can be replaced. There are multiple types of hemolytic anemia. It can be acquired or inherited, and the cause is not always known. This type of anemia is rare and impacts approximately 1-3 per 100,000 people every year. It can occur at any age. People with mild hemolytic anemia may not need treatment, but those with more serious cases could be at risk for serious complications if the condition is left untreated. Possible complications include an irregular heartbeat, a larger-than-normal heart, and heart failure. Anemia symptoms can vary depending on the severity of the condition and how quickly it develops. People with mild anemia may not experience any symptoms at all. Symptoms typically worsen as the condition progresses. Initial symptoms of anemia include abnormally pale skin and feeling weak or fatigued. As anemia progresses, you may experience symptoms like: Dizziness Increased thirst Sweating Rapid pulse Fast breathing Mouth symptoms like tongue swelling, dry mouth, and ulcers (small sores) Koilonychia (brittle, spoon-shaped nails) Hair loss Symptoms of more severe anemia include: It's common to experience heart-related symptoms with anemia—primarily because your heart must work harder to deliver oxygen-rich blood to your body. These symptoms can include everything from arrhythmias (abnormal heart rhythms) and heart murmurs to an enlarged heart and heart failure. There are three main causes of anemia: Lack of red blood cell production: Nutritional deficiencies or inadequate nutrient absorption can lower your body's ability to produce red blood cells. High rates of red blood cell destruction: Chronic conditions can affect your body's ability to make enough red blood cells or even lead to red blood cell destruction. Blood loss: Blood loss through menstruation or internal bleeding (for example, in the stomach or colon) can also lead to anemia. Risk Factors A variety of different conditions and genetic factors can increase your risk of developing anemia. Risk factors include: A diet low in iron, vitamin B12, or folic acid Frequent blood donation Heavy periods Pregnancy Cancer Ulcers Colon polyps Colon cancer Autoimmune disorders Inherited conditions Blood conditions like sickle cell disease (SCD), a condition in which abnormal hemoglobin causes red blood cells to become rigid and crescent-shaped Metabolic conditions like glucose-6-phosphate dehydrogenase deficiency, a genetic condition that causes red blood cells to break down Frequent exposure to toxins like pesticides Radiation and chemotherapy treatments Viral infections like Epstein-Barr virus (EBV), a common and highly contagious herpes virus that spreads through bodily fluids like saliva Diagnosis of anemia usually begins with a physical exam to look for a pale tongue and brittle nails. Your healthcare provider will ask about your medical history, diet, and whether other family members have ever been diagnosed with anemia. They will also order blood tests and consider other testing options. Blood tests might include: Complete blood count (CBC): A blood test that provides information on a variety of markers including your red blood cells, white blood cells, and platelets. It's one of the most common ways to check for anemia. Mean corpuscular hemoglobin concentration (MCHC): A blood test that measures the amount of hemoglobin a red blood cell has relative to the cell's volume. Mean corpuscular hemoglobin (MCH): A blood test that measures the average amount of hemoglobin within your red blood cells. Hematocrit levels: A blood test that measures the percentage of red blood cells in your blood. Mean corpuscular volume (MCV): A blood test that measures the average size of your red blood cells. Other possible tests and diagnostic tools include: Bone marrow tests: Two bone marrow tests—aspiration and biopsy—can detect anemia, and they're often performed together. Aspiration is a procedure to collect a small amount of fluid from your bone marrow. Your healthcare provider will then perform a biopsy, which involves removing a small amount of bone marrow tissue. The goal of a bone marrow test is to determine if your bone marrow is healthy and if it makes normal amounts of blood cells. Urine tests: Urine tests help determine if your kidneys are working properly. They may also detect bleeding in your urinary tract. Genetic tests: Genetic tests detect the presence of genes that affect how your body makes red blood cells. Other diagnostic tests: A colonoscopy can detect bleeding in your colon. Your healthcare provider may also consider an endoscopy to look for bleeding in the esophagus, stomach, and small intestine. For an endoscopy, a doctor or surgeon inserts a flexible tube with a camera, called an endoscope, into your body. Treatments for anemia depend on the cause and severity of your condition. Some forms of anemia can be treated with dietary changes and supplements. More severe anemia might require blood transfusions, blood or bone marrow transplants, or surgery. The primary goal of treatment is to increase your red blood cell count or hemoglobin and improve oxygen levels in your blood, as well as relieve your symptoms and improve your quality of life. Other treatment goals include treating the underlying condition causing your anemia as well as preventing complications such as heart or nerve damage. Diet Including more iron-rich foods in the diet is one of the main treatment strategies for early or mild iron deficiency anemia. Iron is naturally present in a variety of animal and plant-based foods. Heme iron is the type of iron found in animal foods like meat, poultry, seafood, and eggs. Non-heme iron is found in plant foods. Your body absorbs about 25% of dietary heme iron and about 17% of dietary non-heme iron. Heme iron also enhances the absorption of non-heme iron. Therefore, people who don't eat animal sources of iron often need to eat more sources of plant-based iron or take an iron supplement to meet their daily needs. Daily iron recommendations are about 1.8 times higher for vegetarians and vegans. Foods rich in iron include: Beef Poultry Eggs White beans Dark leafy greens You can combine these with foods high in vitamin C like broccoli, oranges, and strawberries. Vitamin C helps your body absorb iron. Supplements The most common approach to treating iron deficiency anemia is through oral supplementation (a pill taken by mouth) of iron. The dose depends on factors like your age and iron deficit, as well as your ability to tolerate potential side effects. For more severe cases, iron therapy (iron given through an intravenous line, or IV, into your vein) is used. One benefit of this approach is that it only takes one or two sessions to replenish the iron in your body. For people with pernicious anemia, healthcare providers may use B12 supplements or shots to restore vitamin B12 levels. Nose gels and sprays can be valuable options for people who have difficulty swallowing pills. Dietary supplements are minimally regulated by the FDA and may or may not be suitable for you. The effects of supplements vary from person to person and depend on many variables, including type, dosage, frequency of use, and interactions with current medications. Please speak with your healthcare provider or pharmacist before starting any supplements.  Medications Medications that treat the underlying condition causing anemia can also treat the anemia itself. If your current medication is causing anemia, your healthcare provider may make adjustments or change your medication to reduce your symptoms. If you have aplastic anemia or hemolytic anemia, you may be prescribed medications to suppress your immune system, known as immunosuppressants. For aplastic anemia, they also may prescribe medications that stimulate your bone marrow to make red blood cells, such as erythropoietin therapy (injections of a hormone called erythropoietin, which helps with red blood cell production). Blood Transfusions If you have severe iron deficiency anemia, your healthcare provider may recommend a blood transfusion to quickly increase your iron and red blood cell levels. This procedure usually takes one to four hours and includes monitoring before and after the procedure. Blood transfusions also help treat aplastic anemia. Blood and Bone Marrow Transplants For people with severe aplastic anemia, a healthcare provider may recommend replacing damaged stem cells in your bone marrow with healthy cells. During this procedure, high doses of chemotherapy (medications used to treat cancer)—and possibly radiation—destroy ineffective stem cells before donor stem cells are put into your body. This type of transplant works best in people who have donors with closely matching cell types. It's typically used for children and young adults. Surgery Surgery is sometimes required for internal bleeding that causes anemia. People with hemolytic anemia might also have surgery to remove the spleen because the spleen removes abnormal cells from the blood. This approach is rarely used. Some types of anemia can be prevented, particularly those caused by vitamin or mineral deficiencies. Other types of anemia are long-lasting conditions that require ongoing management and treatment. Including iron-rich foods in your diet can also help prevent iron deficiency anemia, especially if you combine them with foods high in vitamin C. You can also try to avoid potential triggers that can increase your risk of anemia. For example, some types of anemia are triggered by things like particular foods or cold temperatures. If you have hemolytic anemia, washing your hands often and maintaining distance from people who might be sick can reduce your risk of infection. If you have heavy periods, talk to an OB-GYN about how to address this condition before anemia develops. There are a number of conditions related to anemia, many of which involve the heart. For example, anemia commonly occurs with acute coronary syndromes (ACS), a group of conditions caused by sudden or severely limited blood flow to the heart. Other common related conditions include: Heart failure: Anemia frequently occurs with heart failure. Research suggests this is due to the complex relationship between iron deficiency, kidney disease, and cytokine production. Cytokines are proteins that help fight infections. Hypertension: Anemia is common among people with hypertension (high blood pressure). People with anemia also tend to have higher blood pressure readings. Chronic pulmonary obstructive disease (COPD): Anemia is common in people with COPD, a chronic lung disease that damages the lungs and makes breathing difficult. Up to 33% of people with COPD have anemia. Hypothyroidism: People with thyroid diseases like hypothyroidism (underactive thyroid gland) often have anemia. The reasons for this connection remain unclear. Chronic kidney disease (CKD): Certain factors can increase the likelihood that you have anemia with chronic kidney disease. For instance, one 2020 meta-analysis of 28 studies found that female patients with kidney disease were 36% more likely to develop anemia. Rheumatoid arthritis: Anemia is common in people with rheumatoid arthritis (RA), an autoimmune disease that causes joint inflammation. Estimates of how many people have both conditions vary widely, but falls within 30-60%. Anemia can often be treated and managed with supplements, lifestyle interventions, and medications. Treating it early can also improve energy levels, allow you to be more active, and improve your overall quality of life—especially if you have mild or moderate anemia. However, some types of anemia can be severe, long-lasting, and even fatal. If left untreated, some types of anemia can cause multi-organ failure and eventually lead to death. Talk to your healthcare provider if you think you may have anemia. People who receive prompt and appropriate treatment can often live long and healthy lives.

Common Signs And Symptoms Of Protein Deficiency

Protein deficiency is not consuming enough protein to support your body's needs. Protein is an essential macronutrient—a nutrient the body needs and uses in large amounts. It helps your body make and repair cells. Protein also helps children, teenagers, and pregnant people with growth and development.

A protein deficiency can lead to conditions like kwashiorkor and marasmus. Kwashiorkor is a severe protein deficiency accompanied by edema (swelling) in the arms and legs. Marasmus is severe malnutrition (a lack of or imbalance in food or nutrient intake) caused by not consuming enough calories.

A lack of protein in the diet can greatly affect health. Signs and symptoms of protein deficiency include swelling, stunted growth, and a weakened immune system.

Low protein intake may cause edema. One of the main signs of kwashiorkor is swelling on both sides of the body. People with kwashiorkor have low levels of a substance called albumin. Albumin helps to keep fluid inside the blood vessels. A lack of albumin can make it difficult for the body to balance fluid in blood vessels. As a result, the body tries to hold onto more water and sodium, which causes swelling. Protein is essential for growth. Growth stunting, or impaired growth and development, can occur when children don't get enough protein. This is one of the symptoms of kwashiorkor. Growth stunting can affect health and well-being in multiple ways, including: Poor performance in school Impaired cognitive development Increased risk of nutrition-related chronic health conditions It is important to treat protein deficiency early, especially in children. Early treatment can reduce the risk of complications like permanent physical disabilities. A severe protein deficiency can impair your immune system. Protein helps make antibodies that protect you from infection and other illnesses. Protein deficiency leads to fewer antibodies, which can increase your risk of developing an infection. Low protein intake often means lower intake of other nutrients. For example, one meta-analysis of over 11,000 adults aged 51 and older found that adults who didn't meet the estimated average requirement (EAR) of protein were more likely to fall below the EAR for a number of vitamins and minerals. A lack of nutrients is associated with inflammation and oxidative stress, which can affect the immune system. Oxidative stress happens when there are more free radicals in the body than there are antioxidants available to remove them. Free radicals are produced during digestion. They can damage cells, trigger changes in genes, accelerate aging, and increase the risk of various conditions like heart disease and diabetes. Protein is a major component of skin and hair, which is why protein deficiency can greatly affect skin and hair health. A lack of protein can cause your skin to appear paler, as well as drier or flakier. Your hair may appear more brittle and may break more easily. You may also experience hair loss or graying. Symptoms of kwashiorkor include: Dry, thin, or peeling skin Skin folds due to weight loss Skin lesions or dermatitis on ears, armpits, groin, and genitals Hair that's dry or falls out easily Hair and skin changes do not usually occur with marasmus. Decreased Bone Development and Density Protein is an essential component of muscles and bones. A protein deficiency can decrease muscle and bone mass, leading you to feel tired and weak. Protein from calcium-rich foods is required for bone growth, especially for young children. Bone mass, or bone mineral density (BMD) is largely genetic. Consuming adequate protein helps children reach their optimum genetic potential for bone mass. Protein is also important for bone maintenance in older adults who have or are at a higher risk of osteoporosis, a condition that causes porous, weak bones that break easily. One meta-analysis of 13 studies found that adults over the age of 65 with a higher protein intake had a lower risk of bone fractures. Skeletal muscle, the muscle attached to bones, is the type of muscle that helps your body move. Consuming higher amounts of protein can help build and maintain skeletal muscle mass and strength. Your body breaks down skeletal muscle tissue for energy when there's not enough protein for use. This leads to muscle atrophy (decrease in muscle mass). Even minor muscle loss can affect your movement and strength. Anemia is a common symptom of marasmus. Anemia is a condition where your body has a reduced number of red blood cells or hemoglobin, the protein that helps your red blood cells transport oxygen from your lungs to the rest of your body. Your body needs iron to make oxygen-rich red blood cells. Anemia is often treated with iron supplements or by eating more iron-rich foods. Many factors can contribute to weight loss as a result of protein deficiency. People who have marasmus may experience reduced heart function, which can lead to weight loss. Reduced heart function can also increase a child's risk of developing an arrhythmia, or irregular heartbeat. Eating a lower protein diet can also lead to weight gain. For example, protein is often more satiating than carbohydrates, meaning you feel full for longer periods of time after eating protein. Therefore, eating more protein might lead to lower caloric intake overall. More research is needed to determine how protein affects weight, but shorter-term research studies demonstrate that a high-protein diet can contribute to weight loss and prevent weight regain. About one billion people in the world do not get enough protein in their diets. It's commonly seen in areas with a limited food supply and lower levels of education about healthy eating. For example, about 30% of children in Central Africa and South Asia have a protein deficiency. Protein deficiency is not very common in the United States. However, some people are at a higher risk, including: People with cancer Older adults, specifically those who receive home-delivered meals or are in a long-term care facility Children who are abused or severely neglected Talk to your healthcare provider if you're concerned you may not be eating enough protein. They might refer to a registered dietician (RD), a healthcare professional who specializes in nutrition.  You can also try incorporating more protein into your diet. High-protein foods include: Dairy products like milk, yogurt, and cheese Soy products like edamame, soymilk, tofu, and tempeh Beans like black beans and chickpeas Legumes like lentils and peas Meat and poultry Fish and shellfish Nuts and seeds  Eggs Quinoa Seaweed Reach out to your healthcare provider if you or someone in your care has symptoms of kwashiorkor or marasmus. Getting medical care early on can help prevent possible complications. Protein is essential to health. It helps with growth and development, and it helps repair cells and make new ones. Protein deficiency can cause symptoms such as swelling, stunted growth, a weakened immune system, skin and hair changes, and bone and muscle loss. You can get more protein in your diet by adding foods like beans and legumes, meat, seafood, eggs, and nuts. Reach out to your healthcare if you're concerned that you or someone in your care is not eating enough protein.

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