A history of repetitive cesarean section is a risk factor of anemia in healthy perimenopausal women: The Korea National Health and Nutrition Examination Survey 2010-2012

Prevalence of anaemia among married women with recent birth history and high-risk fertility behaviour: secondary data analysis of the National Family Health Survey-India (2019-21)

OBJECTIVES

To describe the prevalence of anaemia among currently married women with high-risk fertility behaviour (HRFB) based on age, parity and birth spacing indicators.

DESIGN

Cross-sectional study.

SETTINGS AND PARTICIPANTS

Fifth round of the National Family Health Survey (NFHS) was conducted in India (2019-2021) and included a nationally representative sample of 724, 115 women in the reproductive age group (15-49). Our analysis focused exclusively on married women who had given birth in the preceding 5 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

The prevalence of anaemia with HRFB was the primary outcome, and the likelihood of having anaemia due to HRFB was the secondary outcome.

DATA AND METHODS

Secondary data analysis of the NFHS-5 (2019-2021) datasets was done using a weighted analysis to determine anaemia prevalence in different HRFB categories. Bivariate analysis was done using the χ2 test, and multiple binary logistic regression analyses were done to estimate the odds of having anaemia due to HRFB after adjusting for known confounders. A p value <0.05 was reported as statistically significant.

RESULTS

The final analysis comprised 145,468 women, of whom 59.1% had anaemia. About 53.1% of women depicted 'No risk' fertility behaviour, and 34.6% and 12.3% had single and multiple HRFB. Women with 'no-risk,' single and multiple HRFB had anaemia prevalence rates of 58.1%, 59.4% and 63.1%, respectively. Women with 'Single risk' had an 18% higher likelihood (1.18; 1.13-1.22) of having anaemia after controlling for confounding variables, compared with the HRFB category with 'No risk.' Women with 'Multiple risks' showed a 6% higher likelihood (adjusted OR 1.06; 95% CI 1.03 to 1.08).

CONCLUSIONS

Anaemia remains a prevalent issue in India, and HRFB is observed as a significant contributing factor. This vulnerable group can be targeted through multiple interventions and further our efforts to realise our anaemia-related goals.

Development and validation of a prediction model for iron status in a large U.S. cohort of women

Serum iron levels can be important contributors to health outcomes, but it is not often feasible to rely on blood-based measures for a large epidemiologic study. Predictive models that use questionnaire-based factors such as diet, supplement use, recency of blood donation, and medical conditions could potentially provide a noninvasive alternative for studying health effects associated with iron status. We hypothesized that a model based on questionnaire data could predict blood-based measures of iron status biomarkers. Using iron (mcg/dL), ferritin (mcg/dL), and transferrin saturation (%) based on blood collected at study entry, in a subsample from the U.S.-wide Sister Study (n = 3171), we developed and validated a prediction model for iron with multivariable linear regression models. Model performance based on these cross-sectional data was weak, with R2 less than 0.10 for serum iron and transferrin saturation, but better for ferritin, with an R2 of 0.13 in premenopausal women and 0.19 in postmenopausal women. When menopause was included in the predictive model for the sample, the R2 was 0.31 for ferritin. Internal validation of the estimates indicated some optimism present in the observed prediction model, implying there would be worse performance when applied to new samples from the same population. Serum iron status is hard to assess based only on questionnaire data. Reducing measurement error in both the exposure and outcome may improve the prediction model performance, but environmental heterogeneity, temporal variation, and genetic heterogeneity in absorption and storage may contribute substantially to iron status.

Preoperative anemia and associated factors in women undergoing cesarean section at a comprehensive specialized referral hospital in Ethiopia

Background

Anemia is a common public health burden during pregnancy. Severe maternal and fetal complications have been associated with anemia. Despite many studies on anemia during pregnancy have been conducted in Ethiopia at any time of antenatal care visits, the prevalence of preoperative anemia among women awaiting cesarean delivery and its contributing factors have not been determined. The aim of this study was to determine the prevalence and associated factors of preoperative anemia in women awaiting cesarean section at a comprehensive specialized hospital in Ethiopia.

Methods

An institution-based cross-sectional study was done from April to June 2022 to determine preoperative anemia in women undergoing cesarean delivery. Data were obtained using a standardized questionnaire that included the women's background characteristics. Bi-variable and multi-variable logistic regression analyses were performed to identify variables related to preoperative anemia. With a 95% confidence level, the estimated crude odds ratio and adjusted odds ratio were calculated. In a multivariate analysis, variables were considered statistically significant if their p-value was less than 0.05.

Results

A total of 424 pregnant women with a 100% response rate were included in this study. The prevalence of preoperative anemia among women awaiting cesarean delivery was 28.3% (95% CI: 23.8-32.5%). Previous history of abortion, lack of iron supplementation, human immunodeficiency virus infection, previous cesarean section, and American Society of Anesthesiology class III were significantly associated with preoperative anemia among women awaiting cesarean section.

Conclusion and recommendation

Preoperative anemia was diagnosed in a significant proportion of women awaiting cesarean-delivery. Anemia was linked to a lack of iron supplementation, American Society of Anesthesiology class III, previous history of abortion, human immunodeficiency virus infection, and previous cesarean section. Therefore, early detection of high-risk pregnancies, iron supplementation, prevention of HIV infection and due attention to people living with HIV/AIDs are paramount.

Low handgrip strength is closely associated with anemia among adults: A cross-sectional study using Korea National Health and Nutrition Examination Survey (KNHANES)

Background

Anemia, which is a major public health problem worldwide, represents a decline in the oxygenation function, and can therefore be related to low strength. However, hemoglobin cannot repair muscles directly, but is beneficial only in a supportive role. Previous studies on the relationship between handgrip strength and anemia have been controversial. Thus, we aimed to analyze the association between handgrip strength and anemia in Korean adults.

Methods

This cross-sectional study used the 2013–2017 data from the 6th and 7^th Korean National Health and Nutrition Examination Survey (KNHANES) that included 16,638 Korean adults, aged ≥19 years, who met the inclusion or exclusion criteria. Differences in sociodemographic factors (sex, age, education, income, and employment), lifestyle factors (alcohol consumption, smoking, and physical activity), and illness and health factors [body mass index (BMI), vitamin intake, iron intake, comorbid illnesses, and handgrip strength] by existence of anemia, were analyzed using the Chi square test. Binary logistic regression analysis was used to measure the association between handgrip strength and anemia, while adjusting for other possible confounders. Subgroup analysis, stratified by sex and age, was performed.

Results

Among Korean adults aged ≥19 years, 745,296 (7.7%) had anemia. A higher odds ratio, adjusted for other covariates/factors (OR) of anemia occurred in the weak handgrip strength group than in the strong handgrip strength group (OR = 1.92, 95% CI: 1.58–2.33). The subgroup analysis showed a higher OR adjusted for other covariates/factors of anemia in the weak handgrip strength group than in the strong handgrip strength group, regardless of sex or age. However, the association was greater for males (OR = 2.13, 95% CI: 1.35–3.34) and for those aged ≥65 years (OR = 1.92, 95% CI: 1.42–2.58).

Conclusion

This study showed a strong association between handgrip strength and anemia that was particularly strong for males and those aged ≥65 years.

Glomerular hyperfiltration may be a novel risk factor of restrictive spirometry pattern: Analysis of the Korea National Health and Nutrition Examination Survey (KNHANES) 2009-2015

BACKGROUND AND OBJECTIVES

There have been limited studies regarding the association between glomerular hyperfiltration (GHF) and restrictive spirometry pattern (RSP) in Korean adults.

METHODS

We used data of 23,189 adults from the Korea National Health and Nutritional Examination Survey 2009-2015 with a complete data set including spirometry, serum creatinine, and anthropometric measurements. Spirometry data included the forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). We defined GHF as the >90th percentile of age & sex adjusted estimated glomerular filtration rate (eGFR), and RSP was defined as an FVC <80%-predicted value and an FEV1/FVC ratio ≥0.7.

RESULTS

Participants with RSP showed higher blood pressure, fasting glucose, and triglyceride, reduced high density lipoprotein cholesterol, and central obesity, which resulted in a higher prevalence of metabolic syndrome (MetS) compared to those without RSP. Multivariate logistic regression revealed that the odds for RSP were significantly increased with an increased number of MetS components. In addition, increased eGFR was associated with decreased FVC, showing an inverted J-shaped relationship in a multivariate generalized additive model analysis. In the multivariate logistic regression analysis, the adjusted odds ratio and 95% confidence interval of GHF for RSP was 1.184 (1.026-1.368, P = 0.021), which was evident in groups without metabolic disorders.

CONCLUSIONS

We concluded that GHF was associated with increased odds for RSP, particularly in groups without metabolic disorders. Further prospective studies are needed to confirm our study results.