There is a significant variation in the prevalence of iron deficiency (ID) in women based on 3 definitions regardless of race, ethnicity, pregnancy, and age, according to a study published in JAMA Network Open.1
Takeaways
- The prevalence of iron deficiency (ID) in women varies significantly depending on the diagnostic criteria used, with rates ranging from 3.12% to 15.33%.
- Over 2 billion people worldwide are affected by ID, with particularly high rates among young women and children, highlighting it as a major global health issue.
- Symptoms of ID include increased fatigue, cold intolerance, poor muscle performance, pica, menstruation disturbances, and adverse pregnancy outcomes.
- There are notable differences in ID prevalence among racial and ethnic groups, with Hispanic and Native American women showing the highest rates and Asian women the lowest, based on different criteria.
- Higher serum ferritin thresholds could potentially diagnose and treat more women with ID, as shown by the substantial increase in prevalence when using WHO and IDE definitions.
Over 2 billion people worldwide are impacted by ID, with high rates reported in young women and children. Symptoms of ID include increased fatigue, cold intolerance, poor muscle performance, pica, mucosal and epithelial abnormalities, menstruation disturbances, and adverse pregnancy outcomes.
In a 2009 study, anemia was reported in approximately one-quarter of the world’s population.2 Concentration was identified in preschool-aged children and women, indicating a global public health concern. Of pregnant women, 41.8% were affected.
ID is often diagnosed based on low serum iron, low transferrin saturation (TS), and low serum ferritin (SF).1 The Hemochromatosis and Iron Overload Screening Study (HEIRS) defined ID as combined TS under 10% and SF under 15 ng/mL.
The World health Organization (WHO) defined ID as SF under 15 ng/ NL. Finally, a study based on National Health and Nutrition Examination Survey data defined iron-deficient erythropoiesis (IDE) as SF under 25 ng/mL in nonpregnant individuals.
Investigators conducted a cross-sectional study to compare ID prevalence in the HEIRS cohort using these 3 definitions. Groups included the entire HEIRS cohort, participants aged 25 to 54 years, those aged 25 to 54 years with self-reported pregnancy, and those from different self-reported racial and ethnic groups.
There were 101,168 individuals aged 25 years and older from the United States and Canada included in the HEIRS study, with enrollment between 2001 and 2003. Participants in the recent analysis included those who had not learned about the HEIRS study from a participating family member or reported prior hemochromatosis or iron overload.
Data on age, sex, race and ethnicity, TS and SF, HFE genotype, genetic screening attitudes, and pregnancy was collected. TS and SF were measured from blood samples obtained at the initial screening.
Investigators measured spectrophotometric serum iron and unsaturated iron-binding capacity, turbidometric immunoassay of SF, and calculated total iron-binding capacity and TS. ID was classified based on HEIRS, WHO, or IDE criteria.
There were 62,685 women aged a mean 49.58 years included in the final analysis. Of participants, 7615 were Asian, 17,272 Black, 8566 Hispanic, 441 Native American, 449 Pacific Islander, 27,049 White, and 1263 other race. A mean TS and SF of 26% and 107 ng/mL, respectively, was reported.
ID was identified in 3.12% of women using the HEIRS definition, 7.43% using the WHO definition, and 15.33% using the IDE definition. This indicated significant variations in prevalence based on the definition criteria used.
A mean TS of 26% and mean SF of 83 ng/mL was reported among women aged 25 to 54 years. ID was reported in 4.46%, 10.57%, and 21.23% based on HEIRS, WHO, and IDE criteria, respectively.
Differences were also observed between racial and ethnic groups, with significantly greater prevalences from WHO and IDE criteria vs HEIR criteria. Hispanic and Native American women had the highest prevalence while Asian women had the lowest prevalence.
Overall, the rate of ID increased 2.4-fold based on WHO criteria and 4.8-fold based on IDE criteria. White participants had the highest relative increases while Black and Native American participants had the lowest. Among pregnant women, ID was reported in 5.44% based on the HEIRS definition, 18.05% based on the WHO definition, and 36.10% based on the IDE definition.
These results indicated significantly different prevalences of ID in women based on definition criteria. Investigators concluded higher SF thresholds could be used to diagnose and treat more women with ID.
References
- Barton JC, Wiener HW, Barton JC, Acton RT. Prevalence of Iron Deficiency Using 3 Definitions Among Women in the US and Canada. JAMA Netw Open. 2024;7(6):e2413967. doi:10.1001/jamanetworkopen.2024.13967
- McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutrition. 2009;12(4):444-454. doi:10.1017/S1368980008002401
