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1. Dietary copper deficit and genetic defects of copper metabolism have significant effects on iron metabolism and red cell resistance to oxida- tive stress and thus may contribute to the burden of anemia. Copper deficit should be included in the differential diagnosis of anemia unresponsive to iron supplementation. Copper excess may also contribute to anemia by inducing hemolysis. 2. Zinc deficit may contribute to the burden of anemia by altering erythropoiesis in the bone marrow or by decreasing red cell resistance to oxidative stress.

3. High-dose zinc supplementation interferes with copper and iron absorption. It may also interfere with iron mobilization and impair immune responses thus contributing to the anemia burden. 4. Both copper and zinc deficiency are associated with impaired host defenses and thus increase the burden of anemia secondary to infection. 5. The potential public health relevance of zinc and copper interactions with iron remains unde- fined. However, results of intervention trials to prevent anemia using iron supplementation in combination with zinc, or iron by itself, indicate the need to assess the significance of this possibil- ity under different circumstances. In addition to considering the significant effects of copper and zinc intake on childhood infections, it is impor- tant to assure nutritional adequacy of these metals in order to maximize the possibility of iron being effective in preventing anemia.

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