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Assefa DT, Berbada DA, Merkina MM, Hayelom DH, Belete NK, Kefene SW, Gutema BT. Association Between Nutritional Status and Physical Activity Among Reproductive Age Women in Arba Minch Health and Demographic Surveillance Site, Southern Ethiopia. Int J Public Health 2025; 70:1608161. [PMID: 40206456 PMCID: PMC11978501 DOI: 10.3389/ijph.2025.1608161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 03/17/2025] [Indexed: 04/11/2025] Open
Abstract
Objectives Reproductive age women in Ethiopia face significant double burden malnutrition. Although underweight prevalence has declined, overweight and obesity rates are raising due to rapid nutrition transitions and physical activity levels changes. This study aimed to assess the association between nutritional status and physical activity among these women. Methods Community-based cross-sectional study was conducted in Arba Minch Health and Demographic Surveillance Site involving 422 randomly selected women from April to May 2022. Data were collected through interviews, including weight and height measurements. Multinomial logistic regression assessed associations, with significance at p < 0.05. Result Approximately 20.1% women faced malnutrition with 7.8% underweight and 12.3% overweight/obesity. Notably, 84.6% engaging in ≥600 MET-minutes of physical activity weekly and inactive women were 2.8 times more likely to be overweight/obese. Significant associations were found between nutritional status and factors like educational status, contraceptive use, household food insecurity, and family size. Conclusion Increased overweight/obesity risk among inactive women underscores the need for promoting active lifestyles and targeted interventions for better health.
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Affiliation(s)
- Darik Temesgen Assefa
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Dessalegn Ajema Berbada
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Melesse Mengesha Merkina
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Desta Haftu Hayelom
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Nigus Kabtu Belete
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Simegn Wagaye Kefene
- Department of Public Health, Arba Minch College of Health Science, Arba Minch, Ethiopia
| | - Befikadu Tariku Gutema
- School of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
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Demirdjian SP, Kerr MA, Mulhern MS, Thompson PD, Ledwidge M, McCann MT. Association between Adiposity and Iron Status in Women of Reproductive Age: Data from the UK National Diet and Nutrition Survey (NDNS) 2008-2019. J Nutr 2024; 154:3048-3059. [PMID: 39236809 PMCID: PMC11522960 DOI: 10.1016/j.tjnut.2024.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 08/07/2024] [Accepted: 08/29/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Overweight/obesity and iron deficiency (ID) are highly prevalent in women of reproductive age (WRA), impacting on women's health. Obesity is a risk factor for nutritional deficiencies but its association with ID is unclear. OBJECTIVES To determine the association between adiposity and markers of iron status and ID prevalence in WRA. METHODS This cross-sectional study analyzed the National Diet and Nutrition Survey (2008-2019) data, focusing on women aged 18-49 y with body mass index (BMI) ≥18.5 kg/m2. Prevalence of anemia, iron deficiency anemia (IDA), and ID were analyzed. Ferritin was adjusted for C-reactive protein. Iron status was assessed across high and low BMI, waist circumference (WC), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR). χ2, linear and logistic regressions were performed adjusting for covariates. RESULTS Among 1098 WRA, 496 normal weight and 602 overweight/obesity, prevalence rates were: anemia 9.2% and IDA 6.8%. Anemia was more prevalent in those with higher WHtR and WHR (11.9% compared with 5.9% and 16.7% compared with 6.5%, both P < 0.001). WRA with increased WC, WHtR, and WHR had higher IDA prevalence than those with lower adiposity (8.5% compared with 4.3%, P = 0.005; 9.4% compared with 3.3%, P < 0.001; 12.1% compared with 4.9%, P < 0.001). ID prevalence was 49.7% (ferritin cutoff 30 μg/L) and 19.6% (ferritin cutoff 15 μg/L), showing similar rates across adiposity groups. ID prevalence defined by soluble transferrin receptor (sTfR) was higher in women with increased WHR (P = 0.001). Higher WHR predicted ID categorized by sTfR (adjusted odds ratio [aOR]: 2.104, P = 0.004), and WHtR and WHR predicted anemia and IDA (anemia: WHtR aOR: 2.006, P = 0.036; WHR aOR: 4.489, P < 0.001 and IDA: WHtR aOR: 2.942, P = 0.012; WHR aOR: 4.142, P < 0.001). CONCLUSIONS At least 1 in 5 WRA in the UK are iron deficient, highlighting the need to revise current policies. Greater central adiposity was strongly associated with impaired iron status and the development of anemia, IDA, and ID.
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Affiliation(s)
- Sabrina P Demirdjian
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland
| | - Maeve A Kerr
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland
| | - Maria S Mulhern
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland
| | - Paul D Thompson
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland
| | - Mark Ledwidge
- School of Medicine, University College Dublin, Ireland
| | - Mary T McCann
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland.
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Armah-Ansah EK. Determinants of anemia among women of childbearing age: analysis of the 2018 Mali demographic and health survey. Arch Public Health 2023; 81:10. [PMID: 36658651 PMCID: PMC9854152 DOI: 10.1186/s13690-023-01023-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/01/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Anemia occurs at all stages of life and it is of public health concern as it serves as an indicator of quality nutrition and health of a society. Almost one third of the global prevalence of anemia occur among reproductive aged women and almost 40% of these women reside in sub-Saharan Africa including Mali. This study, therefore, sought to assess the determinants of anemia among women of childbearing age in Mali. METHODS Secondary data analysis of the 2018 Mali Demographic and health Survey (MDHS). Anemia in women was the outcome variable for the study. Data of 5,048 women aged 15-49 was used for the study. Using binary and multivariate logistic regression models, factors associated with anemia among women were identified. The analysis was conducted using Stata version 14.2 software and adjusted Odds Ratio (aOR) with a 95% Confidence Interval (CI) and p-value < 0.05 were used to see the significant association. RESULTS The prevalence of anemia among women of childbearing age in Mali is 63.5%. Of these, 4.3% and 24.9% were severely and mildly anemic respectively, and the rest 34.3% were moderately anemic. Women who had secondary education (aOR = 0.70, 95% CI: 0.58-0.84), overweight (aOR = 0.63, 95% CI: 0.50-0.81), exposure to mass media (aOR = 0.90, 95% CI = 0.76-1.49) and women with two births (aOR = 0.86, 95% CI = 0.71-1.05) were less likely to be anemic. Likely, richest wealth quintile (aOR = 0.73, 95% CI = 0.51-1.05), living in urban setting (aOR = 0.85, 95% CI = 0.70-1.03) and women in Kidal Region (aOR = 0.42, 95% CI = 0.27-0.65) were less likely to be anemic. However, pregnant women, women covered by health insurance, women with unimproved drinking water, women in communities with low literacy and low socioeconomic status had higher odds of anemia. CONCLUSION These findings point to the need for community and household level public health sensitization interventions to highlight the pro-anemic factors and mitigating strategies. More especially, women with no education, pregnant women, women covered by health insurance, women from communities with low literacy and socioeconomic status ought to be the focus of such interventions.
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Affiliation(s)
- Ebenezer Kwesi Armah-Ansah
- grid.413081.f0000 0001 2322 8567Department of Population and Health, University of Cape Coast, Cape Coast, Ghana ,grid.410682.90000 0004 0578 2005Department of Population and Development, National Research University - Higher School of Economics, Moscow, Russia ,grid.413355.50000 0001 2221 4219Population Dynamics Sexual and Reproductive Health Unit, African Population and Health Research Center, Nairobi, Kenya
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Teshome AA, Berra WG, Huryi AF. Modern Contraceptive Methods Predict Hemoglobin Levels Among Women of Childbearing Age from DHS 2016. Open Access J Contracept 2022; 13:1-8. [PMID: 35125896 PMCID: PMC8807863 DOI: 10.2147/oajc.s329045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/20/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE This study aimed to study the association of different modern contraceptive methods and anemia on women of childbearing age. METHODS The study was conducted based on secondary data from Ethiopia demographic and health surveys (EDHS) in 2016. The study included 12,981, women of childbearing age. The dependent variable is anemia which was defined based on the level of hemoglobin concentration, and was classified as non-anemic (above 12 g/dL) or anemic (below 12 g/dL). The association between anemia with modern contraceptive method and BMI was analyzed using a logistic regression model. RESULTS A total of 12,891 non-pregnant women were recruited for this study, 26.3% (95% CI: 25.9 to 27.1) had anemia, and hemoglobin level was 12.9 ± 1.7. The current use of modern contraceptives has substantially reduced the odds of anemia by 50% compared with non-users. Compared to barrier methods, individual modern contraceptive use showed higher odds ratio of, oral contraceptive pills (OCP) 0.6 (95% CI: 0.45 to 1.12), injectables 0.59 (95% CI: 0.24 to 1.79), implant 0.72 (95% CI: 0.60 to 0.86) and significantly reduces the risk of anemia. In addition to the contraceptive method, BMI found to improve anemia and the underweight women showed significant effect on an anemia (OR 2.20 (95% CI 1.58-2. 62)) P = 0.000. CONCLUSION The use of hormonal contraceptive methods reduces anemia among women of childbearing age. Moreover, there is an association between BMI and anemia.
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Affiliation(s)
- Anissa Abebe Teshome
- Department of Food Science and Technology, Haramaya University, Dire Dawa, Ethiopia
- Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People’s Republic of China
| | | | - Aschalew Fikru Huryi
- Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People’s Republic of China
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Kamruzzaman M. Is BMI associated with anemia and hemoglobin level of women and children in Bangladesh: A study with multiple statistical approaches. PLoS One 2021; 16:e0259116. [PMID: 34710186 PMCID: PMC8553127 DOI: 10.1371/journal.pone.0259116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/12/2021] [Indexed: 01/09/2023] Open
Abstract
Background The coexistence of undernutrition and obesity is an emerging problem for developing countries like Bangladesh. Anemia is another critical public health threat, prevalent predominantly among women and children. Undernutrition is linked with a higher risk of anemia, and lower dietary iron intake might be the possible reason. However, the risk of anemia among obese/overweight individuals is controversial. The study explores the relation of BMI with anemia and blood hemoglobin level among women and children in Bangladesh. Methods Multiple statistical approaches were employed to nationally representative secondary data (BDHS 2011) on women (n = 5680) age 15–49 years and children (n = 2373) age 6–59 months to illuminate the relation between BMI and anemia. BMI was categorized according to the WHO recommended BMI category for Asian people. Descriptive statistics were used to measure mean hemoglobin level. Chi-square test, Pearson correlation, Two-way ANOVA, binary, ordinal, and restricted cubic splines (RCS) regression were used to study the association of BMI with anemia and hemoglobin level. Results Chi-square test reveals significant association, though not intense, among BMI and anemia categories of women (15–49 years) (χ2 ≥99, p<2.2e-16 and Cramér’s V = 0.0799–0.1357). From ANOVA analysis, a significant difference in blood hemoglobin level was found among women (total sample and nonpregnant) with different BMI categories (p≤0.05). Binary (Severely Underweight: OR 1.2680, 95% CI 0.755–2.161; Obese: OR 0.4038, 95% CI 0.120–1.177), Ordinal logistic regression (Severely Underweight: OR 1.337, 95% CI 0.842–2.115; Obese: OR 0.504, 95% CI 0.153–1.411) and restricted cubic spline regression (Severely Underweight: OR >1.5; Obese: OR ~0.5) reveal that the risk of anemia was higher among underweight and lower among obese/overweight women compared to normal women. Lower anemia risk among richest women indicates probable higher dietary iron intake among obese/overweight women. Conclusion In the current study, women with overweight/obesity from Bangladesh were shown to have lower likelihood of being anemic, while underweight women more likely to be anemic. However, no relation between BMI and anemia was found among children.
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Affiliation(s)
- Md Kamruzzaman
- Dept. of Applied Nutrition and Food Technology, Islamic University, Kushtia, Bangladesh
- * E-mail: ,
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Sun Y, Shen ZZ, Huang FL, Jiang Y, Wang YW, Zhang SH, Ma S, Liu JT, Zhan YL, Lin H, Chen YL, Shi YJ, Ma LK. Association of gestational anemia with pregnancy conditions and outcomes: A nested case-control study. World J Clin Cases 2021; 9:8008-8019. [PMID: 34621857 PMCID: PMC8462208 DOI: 10.12998/wjcc.v9.i27.8008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/01/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gestational anemia is a serious public health problem that affects pregnant women worldwide. Pregnancy conditions and outcomes might be associated with the presence of gestational anemia. This study investigated the association of pregnancy characteristics with anemia, exploring the potential etiology of the disease.
AIM To assess the association of pregnancy parameters with gestational anemia.
METHODS A nested case-control study was conducted based on the Chinese Pregnant Women Cohort Study-Peking Union Medical College Project (CPWCS-PUMC). A total of 3172 women were included. Patient characteristics and gestational anemia occurrence were extracted, and univariable and multivariable logistic regression models were used to analyze the association of pregnancy parameters with gestational anemia.
RESULTS Among the 3172 women, 14.0% were anemic, 46.4% were 25-30 years of age, 21.9% resided in eastern, 15.7% in middle, 12.4% in western 18.0% in southern and 32.0% in northern regions of China. Most women (65.0%) had a normal prepregnancy body mass index. Multivariable analysis found that the occurrence of gestational anemia was lower in the middle and western regions than that in the eastern region [odds ratio (OR) = 0.406, 95% confidence interval (CI): 0.309-0.533, P < 0.001)], higher in the northern than in the southern region (OR = 7.169, 95%CI: 5.139-10.003, P < 0.001), lower in full-term than in premature births (OR = 0.491, 95%CI: 0.316-0.763, P = 0.002), and higher in cases with premature membrane rupture (OR=1.404, 95%CI: 1.051-1.876, P = 0.02).
CONCLUSION Gestational anemia continues to be a health problem in China, and geographical factors may contribute to the situation. Premature birth and premature membrane rupture may be associated with gestational anemia. Therefore, we should vigorously promote local policy reformation to adapt to the demographic characteristics of at-risk pregnant women, which would potentially reduce the occurrence of gestational anemia.
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Affiliation(s)
- Yin Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Zhong-Zhou Shen
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Fei-Ling Huang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Yu Jiang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ya-Wen Wang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Su-Han Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Shuai Ma
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jun-Tao Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Yong-Le Zhan
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hang Lin
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Yun-Li Chen
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ying-Jie Shi
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Liang-Kun Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
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Adu P, Attivor W, Nartey ST, Ephraim RKD, Awuku YA. Low iron stores in preconception nulliparous women; a two-center cross-sectional study in peri-urban Ghana. Nutrition 2019; 71:110604. [PMID: 31811997 DOI: 10.1016/j.nut.2019.110604] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The nutritional status of women affects pregnancy outcomes. Preconception care adequately prepares women for the demands of pregnancy. The aim of this study was to evaluate the prepregnancy iron status of nulliparous women in Ghana to provide empirical data to inform policy formulation. METHODS We recruited 336 nulliparous women of reproductive age from Denkyembour District and Ejura Municipal assemblies, respectively, in the Eastern and Ashanti regions of Ghana. Serum ferritin was estimated to assess the women's iron stores. Hemoglobin (Hb) variants and fecal occult blood were determined for participants using cellulose acetate electrophoresis and lateral flow chromatographic immunoassay, respectively. Logistic regression analysis was used to determine factors associated with depleted iron stores (ferritin < 15 ng/dL). RESULTS Whereas 41.5% of the women were anemic (Hb <11.5 g/dL), 34.5% were iron depleted (serum ferritin <15 g/mL; C-reactive protein <5 ng/dL). Also, 17.1% suffered from iron deficiency anemia (concomitant Hb <11.5 g/dL and serum ferritin <15 ng/dL). Serum ferritin significantly differed among the participants with anemia (P < 0.001). Multivariate regression analysis showed that age (<20 y: adjusted odds ratio [AOR], 13.916, P = 0.002; 20-30 y: AOR, 4.304, P = 0.023), moderate anemia (AOR, 3.045, P = 0.004), Ashanti region (AOR, 3.984, P = 0.002), and mean cell volume <80 fL (AOR, 2.546, P = 0.003) were significantly associated with increased odds of having depleted iron stores. However, body mass index, waist-to-hip ratio >0.85, educational status, or inherited Hb type were not significantly associated with depleted iron stores. CONCLUSION The high prevalence of depleted iron stores in nulliparous women is a severe public health problem that requires attention.
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Affiliation(s)
- Patrick Adu
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Waldemer Attivor
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Sampson Takyi Nartey
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Richard K D Ephraim
- Department of Medical Laboratory Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Yaw A Awuku
- Department of Medicine and Therapeutics, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana.
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Ghose B, Yaya S, Tang S. Anemia Status in Relation to Body Mass Index Among Women of Childbearing Age in Bangladesh. Asia Pac J Public Health 2016; 28:611-619. [PMID: 27469310 DOI: 10.1177/1010539516660374] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Undernutrition and micronutrient deficiency disorders together constitute a major public health concern in Bangladesh. Among many vitamin and mineral deficiency diseases, iron-deficiency anemia remains the most persistent and has been shown to contribute to high maternal and child morbidity and mortality in the country. In parallel with micronutrient malnutrition, the country is also experiencing a rising epidemic of overweight and obesity due to changing pattern in dietary behavior and body mass index status. Previous empirical studies have demonstrated a strong correlation between body weight and anemia status. However, results remain inconclusive and for Bangladesh such evidence is nonexistent. To this end, we conducted this study using Bangladesh Demographic and Health Survey 2011 data with an aim to explore the association between body mass index and anemia status among adult women in Bangladesh. According to the findings, age between 15 and 29 years ( P < .001, OR = 1.30, 95% CI = 1.12-1.49), experiencing first birth before reaching the age of 18 years ( P < .001, OR = 1.31, 95% CI = 1.15-1.50), lack of access to potable water ( P = .013, OR = 1.467, 95%CI = 1.085- 1.982), being underweight ( P < .001, 95% CI = 1.208-1.570) and normal weight ( P < .001, 95% CI = 1.819-2.516) were significantly associated with anemia status.
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Affiliation(s)
| | - Sanni Yaya
- 2 University of Ottawa, Ottawa, Ontario, Canada
| | - Shangfeng Tang
- 3 Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Zhao L, Zhang X, Shen Y, Fang X, Wang Y, Wang F. Obesity and iron deficiency: a quantitative meta-analysis. Obes Rev 2015; 16:1081-93. [PMID: 26395622 DOI: 10.1111/obr.12323] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 12/12/2022]
Abstract
Hypoferraemia (i.e. iron deficiency) was initially reported among obese individuals several decades ago; however, whether obesity and iron deficiency are correlated remains unclear. Here, we evaluated the putative association between obesity and iron deficiency by assessing the concentration of haematological iron markers and the risks associated with iron deficiency in both obese (including overweight) subjects and non-overweight participants. We performed a systematic search in the databases PubMed and Embase for relevant research articles published through December 2014. A total of 26 cross-sectional and case-control studies were analysed, comprising 13,393 overweight/obese individuals and 26,621 non-overweight participants. Weighted or standardized mean differences of blood iron markers and odds ratio (OR) of iron deficiency were compared between the overweight/obese participants and the non-overweight participants using a random-effects model. Compared with the non-overweight participants, the overweight/obese participants had lower serum iron concentrations (weighted mean difference [WMD]: -8.37 μg dL(-1) ; 95% confidence interval [CI]: -11.38 to -5.36 μg dL(-1) ) and lower transferrin saturation percentages (WMD: 2.34%, 95% CI: -3.29% to -1.40%). Consistent with this finding, the overweight/obese participants had a significantly increased risk of iron deficiency (OR: 1.31; 95% CI: 1.01-1.68). Moreover, subgroup analyses revealed that the method used to diagnose iron deficiency can have a critical effect on the results of the association test; specifically, we found a significant correlation between iron deficiency and obesity in studies without a ferritin-based diagnosis, but not in studies that used a ferritin-based diagnosis. Based upon these findings, we concluded that obesity is significantly associated with iron deficiency, and we recommend early monitoring and treatment of iron deficiency in overweight and obese individuals. Future longitudinal studies will help to test whether causal relationship exists between obesity and iron deficiency.
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Affiliation(s)
- L Zhao
- Department of Nutrition, Nutrition Discovery Innovation Center, Institute of Nutrition and Food Safety, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, Zhejiang, China
| | - X Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - Y Shen
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - X Fang
- Department of Nutrition, Nutrition Discovery Innovation Center, Institute of Nutrition and Food Safety, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Y Wang
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - F Wang
- Department of Nutrition, Nutrition Discovery Innovation Center, Institute of Nutrition and Food Safety, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, Zhejiang, China.,Department of Nutrition, Nutrition Discovery Innovation Institute, College of Public Health, Zhengzhou University, Zhengzhou, China
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Choma SSR, Alberts M, Modjadji SEP. Conflicting effects of BMI and waist circumference on iron status. J Trace Elem Med Biol 2015; 32:73-8. [PMID: 26302915 DOI: 10.1016/j.jtemb.2015.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/24/2015] [Accepted: 06/17/2015] [Indexed: 02/07/2023]
Abstract
The association between obesity and iron status has a long history and is still receiving attention. However comparative analysis of the association between general obesity (BMI) and visceral obesity (waist circumference) with iron status has not been extensively researched. The aim of the present study is thus to determine if body mass index and waist circumference have the same correlation with iron status. One thousand one hundred and thirty people (225 men and 905 women) aged 30 years and above participated in this study. Anthropometric parameters, haemoglobin, iron and total iron binding capacity concentrations were measured using standard methods. Percentage transferrin saturation was calculated and ferritin concentrations were measured using an enzyme linked immunosorbent assay. Obese or overweight women had significantly lower iron and transferrin saturation concentration when compared to non-obese women. In contrast, women with high waist circumference had comparable plasma iron and transferrin saturation to women with normal waist circumference. Partial correlation analysis and linear regression analysis showed that BMI is negatively and significantly associated with plasma iron, transferrin saturation, Hb and ferritin concentration, whilst waist circumference is positively but insignificantly associated with plasma iron, transferrin saturation, Hb and ferritin concentration. Binary regression analysis showed that obese or overweight people are more likely to have iron deficiency, whilst those with raised waist circumference are more likely to have iron overload. Multivariate analysis showed that body mass index is negatively and significantly associated with low iron status, while waist circumference is positively and insignificantly associated with iron status. This is supported by a comparison of plasma iron, transferrin saturation and ferritin concentrations in participants with high body mass index and normal waist circumference and participants with normal body mass index and high waist circumference to those participants having normal body mass index and normal waist circumference. The present study suggests that in women body mass index is associated with low plasma iron, transferrin saturation and ferritin concentrations, while waist circumference is associated with high plasma iron, transferrin saturation and ferritin concentrations.
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Affiliation(s)
- Solomon Simon Ramphai Choma
- Department of Medical Sciences, Public Health and Health Promotion, Faculty of Health Sciences, University of Limpopo, Private Bag X1106, Sovenga, Polokwane, South Africa.
| | - Marianne Alberts
- Department of Medical Sciences, Public Health and Health Promotion, Faculty of Health Sciences, University of Limpopo, Private Bag X1106, Sovenga, Polokwane, South Africa.
| | - Sewela Elizabeth Perpetua Modjadji
- Department of Medical Sciences, Public Health and Health Promotion, Faculty of Health Sciences, University of Limpopo, Private Bag X1106, Sovenga, Polokwane, South Africa.
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Interactive effects of dietary fat/carbohydrate ratio and body mass index on iron deficiency anemia among Taiwanese women. Nutrients 2014; 6:3929-41. [PMID: 25255383 PMCID: PMC4179196 DOI: 10.3390/nu6093929] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/25/2014] [Accepted: 09/01/2014] [Indexed: 12/18/2022] Open
Abstract
Whether being overweight or obese is associated with increased risk of iron deficiency anemia (IDA) remains controversial. We evaluated the dietary intakes and risk for IDA in relation to body mass index (BMI). One thousand two hundred and seventy-four females aged ≥19 years, enrolled in the third Nutrition and Health Survey in Taiwan (NAHSIT) 2005–2008, were selected. Half of the women were either overweight (24.0%) or obese (25.3%). The overall prevalence of anemia, iron deficiency and IDA among adult women was 19.5%, 8.6% and 6.2%. BMI showed a protective effect on IDA: overweight (odds ratio, OR: 0.365 (0.181–0.736)) and obese (OR: 0.480 (0.259–0.891)) when compared with normal weight. Univariate analysis identified increased IDA risk for overweight/obese women who consumed higher dietary fat but lower carbohydrate (CHO) (OR: 10.119 (1.267–80.79)). No such relationship was found in IDA women with normal weight (OR: 0.375 (0.036–4.022)). Analysis of interaction(s) showed individuals within the highest BMI tertile (T3) had the lowest risk for IDA and the risk increased with increasing tertile groups of fat/CHO ratio; OR 0.381 (0.144–1.008; p = 0.051), 0.370 (0.133–1.026; p = 0.056) and 0.748 (0.314–1.783; p = 0.513); for T1, T2 and T3, respectively. In conclusion, a protective effect of BMI on IDA may be attenuated in women who had increased fat/CHO ratio.
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Abstract
OBJECTIVE To examine the association between overweight and obesity and serum ferritin among women of reproductive age (15-49 years) in Nicaragua, considering the effect of α1-acid glycoprotein (AGP), a marker of inflammation. DESIGN We analysed data from the 2004-05 Nicaraguan Integrated Surveillance System for Nutrition Interventions. Three logistic regression models were analysed with low serum ferritin (<15 μg/l) as the dependent variable: (i) overweight or obese status and covariates; (ii) model 1 plus AGP; and (iii) model 1 restricted to only women with normal AGP levels (≤1.0 g/l). SETTING Nicaragua. SUBJECTS Included in this analysis were 832 non-pregnant mother/caregivers (15-49 years) surveyed in 2004-2005. RESULTS In the sample, prevalence of overweight and obesity was 31.8 % and 19.2 %, respectively, and 27.6 % had low serum ferritin. In model 1, the adjusted OR of low serum ferritin was 0.74 (95 % CI 0.52, 1.05) for overweight women and 0.42 (95 % CI 0.26, 0.65) for obese women. In model 2, AGP was significantly independently associated with low serum ferritin (adjusted OR=0.56, 95 % CI 0.34, 0.92) while the adjusted OR for overweight and obesity were largely unchanged. Excluding women with elevated AGP did not appreciably affect the relationship between overweight or obesity and low serum ferritin (model 3). CONCLUSIONS Overall, in this population of reproductive-age women, obese women were less likely to have low serum ferritin levels, and this was independent of inflammation as measured by AGP.
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Kordas K, Fonseca Centeno ZY, Pachón H, Jimenez Soto AZ. Being overweight or obese is associated with lower prevalence of anemia among Colombian women of reproductive age. J Nutr 2013; 143:175-81. [PMID: 23236023 DOI: 10.3945/jn.112.167767] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Overweight and micronutrient deficiencies have manifested in the same individuals. This study investigated the association among iron deficiency (ID), anemia, and weight status among nonpregnant Colombian females aged 13-49 y (n = 3267). Data from the 2005 National Survey of the Nutrition Situation were used. The prevalence of ID (plasma ferritin <12.0 μg/L; individuals with CRP >0.012 g/L excluded) and anemia (altitude-adjusted hemoglobin <120 g/L) was estimated separately. The likelihood of having ID or anemia was tested as a function of overweight (BMI-age Z-score 1-1.9 SD for 13-17 y, BMI 25.0-29.9 kg/m² for 18-49 y) and obesity (≥2 SD for 13-17 y, ≥30 kg/m² for 18-49 y) using multivariate logistic regressions accounting for survey design. Additionally, demographic predictors of combined overweight/obesity with ID or anemia were identified. The prevalence of overweight and obesity was 29.2 and 13.1%, respectively, whereas that of ID and anemia was 16.1 and 32.5%, respectively. Contrary to previous reports, overweight and obese women had a lower likelihood of anemia [OR (95% CI) = 0.8 (0.7, 0.9) and 0.8 (0.6, 1.0), respectively] than normal-weight women. Overweight/obesity combined with ID or anemia was present among 6.3 and 12.8% of women, respectively. Although overweight and obesity were associated with a lower likelihood of anemia, a sizeable group of women was identified as experiencing both over- and undernutrition. Because of the potential for exacerbated health problems in the presence of over- and undernutrition, these conditions should continue to be monitored.
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Affiliation(s)
- Katarzyna Kordas
- Department of Nutritional Sciences, Pennsylvania State University, State College, PA, USA.
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Qin Y, Melse-Boonstra A, Pan X, Yuan B, Dai Y, Zhao J, Zimmermann MB, Kok FJ, Zhou M, Shi Z. Anemia in relation to body mass index and waist circumference among Chinese women. Nutr J 2013; 12:10. [PMID: 23311667 PMCID: PMC3548732 DOI: 10.1186/1475-2891-12-10] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 01/09/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This study aimed to investigate the relationship of anemia and body mass index among adult women in Jiangsu Province, China. Data were collected in a sub-national cross-sectional survey, and 1,537 women aged 20 years and above were included in the analyses. Subjects were classified by body mass index (BMI) categories as underweight, normal weight, overweight and obese according to the Chinese standard. Central obesity was defined as a waist circumference ≥ 80 cm. Anemia was defined as hemoglobin concentration < 12 g/dl. Prevalence ratios (PRs) of the relationship between anemia and BMI or waist circumference were calculated using Poisson regression. FINDINGS Overall, 31.1% of the Chinese women were anemic. The prevalence of overweight, obesity and central obesity was 34.2%, 5.8% and 36.2%, respectively. The obese group had the highest concentrations of hemoglobin compared with other BMI groups. After adjustment for confounders, overweight and obese women had a lower PR for anemia (PR: 0.72, 95% CI: 0.62-0.89; PR: 0.59, 95% CI: 0.43-0.79). Central obesity was inversely associated with anemia. CONCLUSION In this Chinese population, women with overweight/obesity or central obesity were less likely to be anemic as compared to normal weight women. No measures are required currently to target anemia specifically for overweight and obese people in China.
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Affiliation(s)
- Yu Qin
- Department of Chronic Disease Control, Jiangsu Province Centre for Disease Control and Prevention, Nanjing, China
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