Conclusions

Nutritional anemia is not only an outcome of iron deficiency but also reflects the combined influence of multiple micronutrient deficiencies, inflammation, oxidative stress, impaired absorption, and altered iron utilization. Micronutrients such as vitamin B12, B9 (folate), B6, A, C, E, copper, zinc, and selenium contribute to red blood cell production, heme synthesis, iron transport, antioxidant defense, and erythrocyte survival. When these deficiencies occur together, they can produce mixed hematological features and reduce the effectiveness of conventional iron-centered treatment.

A broader diagnostic and therapeutic approach is therefore needed. Assessment of nutritional anemia should consider dietary history, inflammatory status, red blood cell indices, iron markers, and relevant micronutrient biomarkers. Management should combine dietary diversification, targeted supplementation, treatment of infections and inflammation, food fortification, public health education, and monitoring of treatment response. Future strategies should move toward integrated and individualized anemia care. Advances in biomarker discovery, omics technologies, microbiome research, and precision nutrition may help identify mixed deficiencies earlier and guide more effective interventions. Distinguishing nutritional anemia as a multi-micronutrient disorder may improve clinical care and support stronger public health strategies, particularly for vulnerable groups.