Identifying factors predicting iron deficiency in United States adolescent females using the ferritin and the body iron models

Iron Deficiency and Iron Deficiency Anemia in Women with and without Obesity: NHANES 2001-2006

Obesity has been linked to numerous health and nutritional problems, including impaired iron metabolism, a common cause of anemia. We aimed to determine the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) among women aged 20-49 years based on body mass index (BMI) status. We used measures of iron status and body mass index from the 2001-2006 National Health and Nutrition Examination Survey (NHANES). Mean serum ferritin, erythrocyte protoporphyrin, and soluble transferrin receptor were higher, while those of serum iron, percent transferrin saturation, and mean cell volume (MCV) were lower in women with obesity than those with normal weight (all p < 0.016). ID based on the ferritin model was 12.5 ± 1.0% vs. 22.9 ± 1.6% (p < 0.001); 9.0 ± 0.9% vs. 20.0 ± 1.3% (p < 0.001) based on the MCV model; and 8.1 ± 1.0% vs. 10.5 ± 1.2% (p > 0.05) based on the BII model for women with normal weight and women with obesity, respectively. Anemia prevalence was 5.5 ± 0.8% (normal) vs. 9.3 ± 1.0% (obese) (p = 0.005). The IDA estimates based on the ferritin and MCV models were similar but higher than that from the BII model (p < 0.001). Generally, the prevalence rates of ID and anemia (and IDA) were higher for women with obesity, but the method used to define deficiency mattered. The choice of iron indices is important for estimating ID and IDA in populations with obesity.

Epidemiology of iron deficiency among adolescents aged 10-19 years old in Qatar: a cross-sectional study

OBJECTIVE

To estimate the magnitude and the determinants of iron deficiency among adolescents aged 10-19 years in the State of Qatar.

DESIGN

A cross-sectional study design was used to conduct the study.

SETTING

Primary healthcare centres covering the three main geographical areas. One health centre was selected randomly from each region catchment areas: Northern, Central and Western.

PARTICIPANTS

Four hundred and fifty adolescents aged 10-19 years of all nationalities were enrolled in the study.

OUTCOME MEASURES

Serum ferritin cut-off level used to diagnose iron deficiency (<15 µg/L), with normal C reactive protein.

RESULTS

The mean age of the participants was 14.00±2.920, and more than half of the participating adolescents were among 10-14 years old age group (56.9%). Fifty-five per cent of the study participants were Non-Qatari, and females consisted of 70.0% of the participants. The prevalence of iron deficiency was 26.4%. Iron deficiency was significantly associated with gender, nationality, attaining menarche and consumption of iron absorption enhancers (citrus fruits and juice).

CONCLUSION

Iron deficiency among adolescents is of moderate public health concern in the country, according to the classification of the WHO. The estimated prevalence of iron deficiency was close to what was found in other low-income and middle-income countries; however, it is still behind the developed countries. Gender, attaining menarche and dietary habits are among the important factors that are associated with iron deficiency. Thus, there is a need to coordinate efforts and resources to address this issue by implementing effective strategies at the community and primary healthcare levels.

The Special Supplemental Nutrition Program for Women, Infants, and Children food package revisions and anemia in children aged 2-5 years

BACKGROUND

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional assistance to low-income women and children in the United States. The WIC food package was revised to align more closely to dietary recommendations in October 2009. The revised package included more fruits, vegetables, whole grains, and low-fat milk.

OBJECTIVES

The objective of this study was to examine the association of the revised WIC package with anemia indicators and iron intake in children.

METHODS

A quasi-experimental difference-in-difference design compared anemia and iron intake variables between WIC (n = 1497 and n = 1626 for anemia and iron intake variables, respectively) and WIC-eligible nonparticipating children (n = 1183 and n = 1322 for anemia and iron intake variables, respectively), aged 2-5 y, before and after the 2009 revisions. The NHANES 2003-2008 and 2011-2018 data represented the period pre- and post-2009 revisions, respectively.

RESULTS

The 2009 package revisions were significantly associated with reduced probability of anemia (-4.3% points; 95% CI: -7.5, -1.1% points) and nonthalassemic microcytic anemia (-1.7% points; 95% CI: -3.3, -0.1% points) in children from WIC-participating households. The revised WIC package also was significantly related to higher nutrient adequacy ratio (0.04; 95% CI: 0.02, 0.07) and greater probability of meeting the RDA (12.1% points; 95% CI: 3.2, 21.0% points) for iron among WIC participants.

CONCLUSIONS

This study found that the WIC 2009 revisions were associated with lower probability of nonthalassemic microcytic anemia and better adequacy of dietary iron intake, thereby suggesting the beneficial impact of WIC revisions on iron deficiency anemia in children. The current study findings suggest that nutritional policies could play a crucial role in supporting the health of vulnerable children in the United States.

Prevalence and Predictors of Iron Deficiency in Adolescent and Young Adult Outpatients: Implications for Screening

Current screening guidelines may not be adequate to identify iron deficiency (ID) and iron deficiency anemia (IDA) in adolescent and young adults. Adolescent and young adult outpatients from 4 hospital-based clinics (N = 493) reported on diet, health, and bleeding, and had phlebotomy for iron and hematologic tests. We examined sex-specific factors associated with ID and IDA and ability of universal and risk factor-based screening using hemoglobin and hemoglobin plus ferritin to detect ID and IDA. Among females (n = 350), 34.6% had ID and 6.3% had IDA. Nearly 1 in 3 females with ID had no risk factors. Among males, 12.6% had ID; none had IDA. More than 1 in 3 males with ID did not have risk factors. Current screening approaches would have missed ID in 47% to 82% of females and 95% to 100% of males. ID was prevalent in both male and female adolescents and young adult outpatients. New approaches to screening for ID are needed to accurately evaluate iron status in this population.

Effect of education through video and packaging modifications of iron tablets on female adolescent behavior in the iron supplementation intake in SMPN 2 and SMPN 1 Parigi

OBJECTIVE

The purpose of this study was to reveal the effect of providing education by video and modification of iron tablet packaging on young women's behaviour in the iron supplementation intake in SMPN 2 and SMPN 1 - Parigi.

METHODS

This research was a quasi-experimental design with pretest-posttest control group design along with stratified random sampling, which was SMPN 2 Parigi as an Intervention group and SMPN 1 Parigi as a control group. The total sample of 62 respondents in each group.

RESULT

In the Wilcoxon Signed Ranks Test analysis, the Intervention group (video+modification of iron tablet packaging) valued p=0.001 <0.05. It means that there were differences in female students' knowledge, attitudes, and intentions in the pretest-posttest, while in the control group (video) obtained p-value=0.001 <0.05, which showed differences in knowledge, attitudes, and intentions of female students in the pretest-posttest.

CONCLUSION

The development of educational media for iron tablet intake through the video along packaging modification of iron tablet contributed a significant effect on the knowledge, attitudes, and intentions of young women in the iron supplementation intake.

Frequency of Meals Prepared Away from Home and Nutrient Intakes among US Adolescents (NHANES 2011-2018)

Frequency of consuming foods prepared away from home has been associated with lower diet quality among adults and adolescents in several earlier studies. Nutrient and food group intake and Healthy Eating Index (HEI)-2015 scores were compared among a U.S. nationally representative sample of adolescents (12–19 years, n = 3975) by frequency of consuming food prepared away from home ≤2 times/week (n = 2311) versus >2 times/week (n = 1664) using National Health and Nutrition Examination Survey (NHANES) data from 2011–2018. Regression analyses were used to compare intakes among adolescents by frequency of eating meals prepared away from home adjusting for covariates. Older (16–19 years) vs. younger (12–15 years) adolescents and those from homes with higher vs. lower family income to poverty ratios had greater frequency of eating meals prepared away from home. Intakes of nutrients of concern for adolescents including choline, vitamin D, potassium, magnesium, fiber, phosphorus, folate, iron, and total HEI-2015 scores and component scores for total vegetables, and greens and beans were lower among adolescents who consumed meals prepared away from home more vs. less often. However, no differences were noted among food group intakes considered good sources of nutrients of concern such as total fruit, total vegetables, whole grains, and total dairy, except for beans and peas by frequency of eating foods prepared away from home. Greater frequency of eating foods prepared away from home was associated with lower diet quality among adolescents in a nationally representative sample of U.S. adolescents.

Complications of Pregnancy in Adolescents

Teenage pregnancy is a complex issue that can have negative socioeconomic and health outcomes. About 11% of births worldwide are by adolescents aged between 15 and 19 years and middle- and low-income countries account for more than 90% of these births. Despite the downward trend in international adolescent pregnancy rates, 10 million unplanned adolescent pregnancies occur annually. Adolescents are also at increase risks of poor obstetric outcomes including preterm delivery, low birth weight, eclampsia, postpartum hemorrhage, anemia, and infant, as well as maternal morbidity. Important additional considerations include increased risk of depression, poor social support, and the need for a multidisciplinary approach to their obstetric care. We look to highlight both the unique socioeconomic and medical factors to consider when caring for these patients and demonstrate that these factors are intertwined.

Postural Orthostatic Tachycardia Syndrome and Disordered Eating: Clarifying the Overlap

OBJECTIVE

Postural orthostatic tachycardia syndrome (POTS) is estimated to occur in up to 1% of adolescents, with symptoms of dizziness, fatigue, and pain impacting daily functioning. However, many risk factors and symptoms for POTS overlap with those of youth with disordered eating, and adolescents with POTS may be at increased risk for developing eating disorders. Therefore, the present study sought to better understand this overlap. We hypothesized that patients with POTS would have higher than expected rates of weight change, restrictive eating patterns, and food sensitivities.

METHODS

We conducted a retrospective chart review of 96 adolescents and young adults diagnosed with POTS who were participating in a 3-week intensive interdisciplinary pain rehabilitation program. We conducted descriptive and correlational statistical analyses on data from self-report measures, biomarkers of nutritional status, and abstracted information about eating and weight concerns from medical notes.

RESULTS

Nearly 3 quarters of participants described engaging in restrictive eating, and more than half of them described experiencing weight loss. They also endorsed experiencing food allergies, celiac disease, and eating disorder at higher rates than would be expected in the general population. One-fifth of the sample had experienced invasive interventions to correct for nutritional imbalances, such as having a feeding tube.

CONCLUSION

Weight and eating are clear areas of risk for patients with orthostatic intolerance. It is essential that treatment team members thoroughly screen for eating disturbances and make recommendations that support regular and balanced eating habits.

Iron status and anaemia in Sri Lankan secondary school children: A cross-sectional survey

BACKGROUND

Iron deficiency, the most common micronutrient disorder and cause of anaemia globally, impairs growth, cognition, behaviour and resistance to infection.

METHODS/RESULTS

As part of a national survey of inherited haemoglobin variants in 7526 students from 72 secondary schools purposefully selected from the 25 districts of Sri Lanka, we studied 5912 students with a normal haemoglobin genotype. Median age was 16.0 (IQR 15.0-17.0) years and 3189 (53.9%) students were males. Most students were Sinhalese (65.7%), with fewer Tamils (23.1%) and Muslims (11.2%). Anaemia occurred in 470 students and was more common in females (11.1%) than males (5.6%). Haemoglobin, serum ferritin, transferrin receptor and iron were determined in 1196 students with low red cell indices and a structured sample of those with normal red cell indices (n = 513). The findings were weighted to estimate the frequencies of iron deficiency and iron deficiency anaemia classified according to WHO criteria. Iron depletion (serum ferritin <15ug/ml) occurred in 19.2% and cellular iron deficiency (low serum ferritin and transferrin receptor >28.1 nmol/l) in 11.6% students. Iron deficiency anaemia (cellular iron deficiency with low haemoglobin) occurred in only 130/2794 (4.6%) females and 28/2789 (1.0%) males. Iron biomarkers were normal in 83/470 (14.6%) students with anaemia. In multiple regression analysis, the odds for iron depletion and cellular iron deficiency were about one-third in males compared with females, and the odds for iron deficiency anaemia were about one fifth in males compared to females. Tamil ethnicity and age <16 years increased the risk of all three stages of iron deficiency and living at high altitude significantly reduced the risk of iron depletion.

CONCLUSIONS

Low iron status and anaemia remain common problems in Sri Lankan secondary school students especially females, younger students and the socioeconomically disadvantaged Tamil population. More research is needed to identify factors other than low iron status that contribute to anaemia in adolescents.