Iron deficiency common among girls, young women
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Key takeaways:
- Iron deficiency affected almost 40% of females aged 12 to 21 years and iron-deficiency anemia affected about 6%.
- More than one-fourth of premenarchal individuals experienced iron deficiency.
Iron deficiency appeared common among a cohort of U.S. females aged 12 years to 21 years, with an overall prevalence of nearly 40%, according to study results published in a research letter in JAMA.
In addition, iron-deficiency anemia affected about 6% of the study population, researchers noted.
Rationale and methodology
“Iron deficiency and iron-deficiency anemia are common, underappreciated conditions with significant morbidity and mortality despite widespread availability of effective treatment,” Angela C. Weyand, MD, pediatric hematologist/oncologist in the department of pediatrics at University of Michigan Medical School, and colleagues wrote. “Although screening for anemia by measurement of hemoglobin level is recommended, there is benefit in identifying and treating iron deficiency in those without anemia because supplementation improves exercise performance and reduces fatigue, and iron deficiency is associated with increased all-cause mortality.”
Weyand and colleagues aimed to determine prevalence of iron deficiency among females aged 12 to 21 years in order to inform future screening practices.
The researchers used the National Health and Nutrition Examination Survey (NHANES) to obtain data on 3,490 nonpregnant females (median age, 16 years; 59.4% white; 5.4% premenarchal) between 2003 and 2010, as well as 2015 and 2020.
They determined iron deficiency anemia using hemoglobin cutoffs of 12.5 mg/dL and 13 mg/dL.
The investigators also used quasibinomial models to generate independent adjusted odds ratios to examine associations among race and ethnicity, income, food security, menstruation and BMI with having iron deficiency (n = 1,413) or iron-deficiency anemia (n = 271). They collected self-reported race and ethnicity to evaluate for associations between social determinants of health and iron deficiency.
Findings
Results showed an overall prevalence of iron deficiency of 38.6% (95% CI, 35.8-40.9). More specifically, iron deficiency prevalence was 17% (95% CI, 15.4-19.2) with a 15 g/L ferritin cutoff and 77.5% (95% CI, 75.7-79.3) with a 50 g/L cutoff.
Researchers reported an iron deficiency prevalence of 27.1% (95% CI, 17.1-37) with a 25 g/L ferritin cutoff among premenarchal females.
Iron-deficiency anemia occurred among 6.3% (95% CI, 5.2-7.4) of the study population. Weyand and colleagues reported iron-deficiency anemia prevalence of 11% (95% CI, 9.5-12.6) with a 12.5 mg/dL hemoglobin cutoff and 17.2% (95% CI, 15.3- 19.1) with a 13 mg/dL cutoff.
Of note, iron deficiency was not associated with iron-deficiency anemia for 83.6% (95% CI, 80.8-86.4) of the overall study population.
When researchers restricted models to menstruating individuals, they observed no association of number of years menstruating with iron deficiency (adjusted OR = 1.05; 95% CI, 0.98-1.13) or iron-deficiency anemia (adjusted OR = 1.05; 95% CI, 0.92-1.21).
Results of multivariate analyses showed associations of nonwhite race, Hispanic ethnicity and menstruation with both iron deficiency and iron-deficiency anemia. Moreover, lower BMI and poverty appeared associated with iron deficiency, whereas food insecurity appeared associated with iron-deficiency anemia.
Implications
“Given the high prevalence of iron deficiency found with the majority not associated with iron-deficiency anemia, current screening guidance may miss many individuals with iron deficiency,” the researchers wrote. “Although annual screening is recommended for higher-risk patients, risk factors are not clearly defined and likely result in inconsistent screening.”
Researchers recommended future research to evaluate the frequency of universal screening for iron deficiency and iron-deficiency anemia in menstruating persons and the best ferritin and hemoglobin thresholds.
“Further study is [also] needed to identify risk factors and inform screening practices among premenarchal individuals,” they wrote.
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