Screening gaps: study uncovers alarming rates of iron deficiency in adolescents

Angela Weyand, MD

Credit: University of Michigan Health

A recent research letter shared data on the underappreciated prevalence of iron deficiency and iron-deficiency anemia among female adolescents, highlighting these conditions continue to pose significant health risks despite the availability of effective treatments.¹

Many investigations have been conducted to illuminate the prevalence of iron deficiency and anemia, but in comparison, less is known about the health implications associated with the conditions.²

Valuable insights for future screening strategies were provided based on the study which analyzed data from the National Health and Nutrition Examination Survey (NHANES) and examined the prevalence of iron deficiency among females between the ages of 12 to 21.¹

High Rate of Missed Iron Deficiency

The findings revealed iron deficiency affected almost 40% of the studied population, with iron-deficiency anemia impacting 6% of individuals. Of particular concern was the fact that a significant number of cases of iron deficiency were not associated with iron-deficiency anemia, suggesting that current screening practices may miss a large proportion of individuals with iron deficiency.

Angela Weyand, MD, Department of Pediatrics, University of Michigan Medical School, and investigators emphasized the significant risk factor of menstruation. The relationship was observed for both iron deficiency and iron-deficiency anemia.

Over a quarter of premenarchal individuals, or those who have not yet started menstruating exhibited signs of iron deficiency, indicating that factors beyond menstruation contribute to the prevalence of this condition. Associations between iron deficiency and various factors were also identified.

A total of 3490 individuals who met the inclusion criteria and had complete data were included in the analysis. Among them, 188 were premenarchal, accounting for approximately 5.4% of the sample. The overall prevalence of iron deficiency was 38.6% (95% CI, 35.8% - 40.9%).

Investigators observed in relation to iron deficiency included non-white race, Hispanic ethnicity, lower body mass index, and poverty. Food insecurity exhibited an association with iron-deficiency anemia, emphasizing the complex interplay between social determinants of health and these conditions, investigators noted.

Re-evaluation of Screening Needed

The prevalence varied depending on the ferritin cutoff used, with 17% (95% CI, 15.4% - 19.2%) when a 15-μg/L ferritin cutoff was applied and a higher prevalence of 77.5% (95% CI, 75.7% - 79.3%) when using a 50-μg/L ferritin cutoff. Prevalence among premenarchal individuals was slightly lower at 27.1% (95% CI, 17.1% - 37.0%) when using a 25-μg/L ferritin cutoff.

In terms of iron-deficiency anemia, the overall prevalence was 6.3% (95% CI, 5.2% - 7.4%). Prevalence variation depended on the hemoglobin cutoff used, with 11% (95% CI, 9.5% - 12.6%) using a 12.5-mg/dL cutoff and a higher prevalence of 17.2% (95% CI, 15.3% - 19.1%) when using a 13-mg/dL cutoff.

Among individuals with iron deficiency, only 83.6% (95% CI, 80.8% - 86.4%) were also classified as having iron-deficiency anemia, indicating that a significant proportion of those with iron deficiency did not meet the criteria for anemia.

The team also suggested that current screening guidelines, which primarily target preschool-aged children and pregnant individuals, may overlook a considerable number of individuals with iron deficiency. Therefore, a reevaluation of universal screening frequency and criteria, especially for menstruating individuals was called for.

These findings underscore the need for increased awareness and proactive measures to address iron deficiency and iron-deficiency anemia in adolescent females. By improving screening strategies and ensuring timely interventions, healthcare providers can mitigate the significant morbidity and mortality associated with these conditions.

This article was published by our sister publication HCP Live.

References:

1. Weyand AC, Chaitoff A, Freed GL, Sholzberg M, Choi SW, McGann PT. Prevalence of Iron Deficiency and Iron-Deficiency Anemia in US Females Aged 12-21 Years, 2003-2020. JAMA. 2023;329(24):2191–2193. doi:10.1001/jama.2023.8020
2. Alicea J. Study Explores Outcomes of Heart Failure-Related Anemia, Iron Deficiency. HCPLive. June 3, 2021. https://www.hcplive.com/view/study-explores-outcomes-heart-failure-related-anemia-iron-deficiency