Iron Deficiency In Adolescents Research Articles

Attention for and awareness of anemia in adolescents in Karnataka, India: A qualitative study.

Between 1990 and 2016 the number of adolescents with anemia world-wide increased by 20% to almost one in four. Iron deficiency in adolescence results in compromised growth, decreased cognitive function, and depressed immune function, and can increase the risk of negative outcomes in pregnancy, especially in the case of young adolescents. In India, despite several decades of governmental investment in anemia prevention and treatment, more than half of women of reproductive age are anemic, with rates even higher in the adolescent population. Although awareness of adolescence as a nutrition-sensitive developmental stage is increasing, there is a lack of qualitative research on the perspectives of adolescents and families on anemia and related services. In this study, we explored the issues influencing adolescents' awareness of anemia in three rural areas of Karnataka. Sixty-four in-depth interviews and six focus group discussions were conducted with adolescents (those who had never been pregnant, pregnant adolescents, and young mothers), community members, and nutrition-related service providers in the health and education sectors. An inductive analytical approach was used. We found that adolescent girls, particularly those who have not experienced pregnancy or motherhood, had very low awareness of anemia. State programs including school-based distribution of iron and folic acid supplements and nutrition talks were not seen to be resulting in knowledge and acceptance of the importance of preventing anemia. Pregnancy represents a turning point in which adolescents are systematically tested for anemia as part of routine antenatal care, increasing their awareness of, and access to, treatment for the condition. At the same time, pregnancy represents to family and community a period to insist on a nutritious diet. For progress in anemia reduction to be made, improved age-appropriate measures specific for adolescence are required. Improving school-based nutrition outreach is an important opportunity to reach adolescents.

The relationship of energy intake, menstruation duration, and anemia symptoms in adolescent girls

An adolescent girl is categorized into a group prone to anemia. The prevalence of anemia in Indonesia is quite high because the iron nutritional anemia rate in Indonesia is 72.3%. Iron deficiency in adolescents causes paleness, weakness, fatigue, dizziness, and decreased concentration when learning. This study employed a quantitative method with a cross-sectional approach to determine the relationship of energy intake, menstruation duration, and anemia symptoms of adolescent girls at Senior High School 6 Jambi. This study was conducted in December 2020. The research population was 434 adolescent girls in grades 11 and 12 at Senior High School 6 Jambi City. Meanwhile, 70 samples were selected using a random sampling technique. The data were analyzed univariately and bivariately using the chi-square test. The results of the univariate analysis showed that 24.3% of the respondents experienced symptoms of anemia, 74.3% had a lack of energy intake, and 42.9% had long menstrual periods. The bivariate analysis discovered that there was a relationship between energy intake and anemia symptoms of adolescent girls with a p-value = 0.031. Moreover, there was a relationship between the menstruation period and anemia symptoms of adolescent girls with a p-value = 0.018. The school is suggested to improve their students’ health by revitalizing the school health unit and the youth red cross and screening students with health problems, especially anemia in young girls.

EXPENDITURE OF IRON DEFICIENCY SCREENING IN ADOLESCENTS BY DETERMINATION OF BLOOD FERRITIN

The aim: Substantiation of the expediency of screening for iron deficiency in adolescents of Ukraine, determining the relationship between blood ferritin levels and erythrocyte indices. Materials and methods: The literature data analizys and laboratory examinations of 699 patients in medical records throughout Ukraine in children aged 10-19 who applied for medical care in 2018. Results: According to the obtained data we found that there is no significant difference between the ferritin level (p = 0.728) between groups of urban and rural territory of inhabitance (p = 0.728)/ Total amount of children aged 10-15 years with ferritin below normal 7 ng / ml was 16.3%, of which men 7.7%, women 92.3%. According to European guidelines for the determination of iron deficiency, the number of children with ferritin levels less than 30 ng / ml in this group is 63%, of which men 15.9% and women 84.1%. in a group aged 16 (297 results) the number of male children with ferritin levels less than 22 ng / ml is 12%, and female children with ferritin levels less than 10 ng / ml – 31%. According to WHO recommendations with a rate of 30 ng / ml, the number of people with lower rates was 24% males 69% females. Conclusion: When using the reference values recommended by the WHO for the European region as a criterion for iron deficiency, the percentage of adolescents with iron deficiency increases mainly by 2 times in both the male and female groups.

Assessment of Iron Status in Adolescents Presenting to the Emergency Department With Heavy Menstrual Bleeding.

Iron deficiency is extremely common in adolescents with heavy menstrual bleeding (HMB) presenting to the emergency department; however, patients are rarely screened for this. The objective of this study was to evaluate screening for iron deficiency in adolescents presenting to the emergency department for HMB. This is a secondary analysis of a single-center, cross-sectional observational study using retrospective chart review. The study subjects are adolescents ages 11 to 19 years with International Classification of Diseases, Ninth Revision, Clinical Modification/International Classification of Diseases, Tenth Revision, Clinical Modification, codes for HMB who presented to the emergency department at a national tertiary care hospital from 2006 to 2018. Pregnant adolescents with HMB were excluded. Chart abstraction for demographic data, symptoms, laboratory tests, treatments, and outcomes was performed. The main outcome measure was the number of adolescents who had an iron evaluation in the emergency department and were discharged on oral iron. Of the 258 nonpregnant adolescents who sought care for HMB in the emergency department, 225 (87.2%) were evaluated with serum hemoglobin testing. Ninety-four (41.7%) of those tested were anemic. Only 23 of the 258 patients (8.9%) had iron studies (serum ferritin) performed; 18 of 23 (78.3%) had iron deficiency and 21 of 23 (92.3%) were anemic. Subjects presenting with fatigue, headache, or palpitations were more likely to have iron studies performed than those without these symptoms (all P < 0.01). Thirty-two of the 258 subjects (12.4%) were discharged on oral iron therapy, which included only 15 of the 18 subjects (83.3%) with iron deficiency determined by ferritin testing. Adolescents presenting to the emergency department with HMB are at significant risk of iron deficiency but are not being screened or treated, which may have significant consequences.

Relationship between Obesity and Iron Deficiency in Healthy Adolescents.

The relationship between overweight/obesity (excess of weight [EW]) and iron deficiency (ID) is not well defined. Objective: To analyze the relationship between EW and ID in healthy adolescents, assessing the contribution of new diagnostic measures of iron status and erythropoietic activity. Method: A cross-sectional study was made of 405 healthy adolescents, 12-16 years of age. A total of 289 were normal weight (NW) and 116 were otherwise healthy EW. Epidemiological, socioeconomic, diet, BMI Z-score, CRP (C-reactive protein), hematological, iron status, and erythropoietic activity parameters were measured. Statistical tests were Student's, analysis of variance (ANOVA), Chi-square, Pearson's correlation, and odds ratio. Results: ID prevalence in the EW group was 22.6% vs. 29.5% in the NW group (p: 0.3). Greater body weight was associated with lower reticulocyte hemoglobin content (CHr) (NW: 31.3 ± 1.7 pg vs. OW: 30.2 ± 1.7 pg, p: 0.007) and greater CRP (NW: 0.1 ± 0.2 mg/dL vs. OW: 0.2 ± 0.18 mg/dL, p < 0.001), leukocytes (NW: 6.69 ± 1.57 × 103/L vs. OW: 7.43 ± 1.63 × 103/L, p < 0.02), platelets (NW: 265.6 ± 58.9 × 103/L vs. OW: 291.8 ± 54.4 × 103/L, p < 0.002), ferritin (NW: 32.1 ± 17.9 ng/mL vs. OW: 42.8 ± 20.3 ng/mL, p: 0.01), serum transferrin receptor (sTfR) (NW: 1.39 ± 0.4 mg/L vs. OW: 1.73 ± 0.45 mg/L, p: 0.008), sTfR-F index (sTfR/log Ferritin) (NW: 1.06 ± 0.7 vs. OW: 1.33 ± 0.85, p: 0.036) and reticulocyte count (NW: 54.2 ± 18 × 103/L vs. OW: 65.4 ± 24.2 × 103/L, p: 0.003). A positive correlation was observed between the BMI Z-score and CRP, ferritin, sTfR, leukocytes, platelets, and reticulocyte count, and a negative one between the BMI Z-score and CHr and medium corpuscular volume. Conclusions: The prevalence of ID in otherwise healthy EW adolescents was no higher than in NW. The effect of obesity on iron status was low. The findings reveal the concomitant low-grade inflammation, and probably the effect of adiposity on erythropoietic activity. Specific cutoff values for ID in adolescents with OW need to be defined.

Prevalence of Folic Acid And Vitamin B12 Deficiency in Anemic Adolescents

Adolescents may enjoy nourishment trends, macrobiotic weight control plans and semi-starvation regimens in calories, nutrients and minerals. Protein need in a juvenile for every unit body weight is higher than that of grown-up; however, not exactly a quickly developing newborn child. Adolescence has higher nutrient and mineral needs contrasted and individuals all things considered other life stages. A community-based cross-sectional study of 200 school going anaemic adolescents of age group 10 – 19 years. A predesigned semi-organized survey was readied dependent on the audit of writing on Adolescent iron deficiency. The study included 200 anaemic adolescents belonging to two schools, 89 were males, and 111 were females. Male: female ratio was 1.25:1. Among a total of 200 participants, 122 anaemic adolescents belonged to early adolescence. The mean age of anaemic adolescent participants of this study was 13.19 years with a standard deviation of 1.23. among the participants, 137 anaemic adolescents took a vegetarian diet, and 63 anaemic adolescents took a mixed diet. There were three participants underweight according to BMI classification, and 190 had normal range of BMI, 132 adolescents had moderate anaemia (Hb- 8.0 to 10.9 ). Majority of 66.5%(133/200) had Vitamin B12 deficiency anaemia, 72.5%(145/200) had folic acid deficiency anaemia, and 58.5% (117/200) had combined Vitamin B12 and folic acid deficiency anaemia. Prevalence of anaemia in adolescent is a significant public health concern. Supplementation with not only iron and folic acid but also Vitamin B12 may be need of the day. Besides supplementation adequate education regarding quality food, cooking practices and health education is also necessary to be emphasized in adolescents.

FAKTOR – FAKTOR YANG BERHUBUNGAN DENGAN KEJADIAN ANEMIA PADA REMAJA PUTRI DI SMA N 2 KOTA JAMBI

Anemia is a nutritional problem in the world, especially in developing countries including Indonesia. The number of iron nutritional anemia in Indonesia is 2.3%. Iron deficiency in adolescents results in pallor, weakness, fatigue, dizziness, and decreased concentration of learning. The prevalence rate of anemia in Indonesia is 26,50% for female, 26,9% for fertile woman, 40.1% for pregnant women and 47.0% for infants. Anemia is a medical condition in which the hemoglobin level is less than normal. Hormone levels of Hb in adolescent girls are> 12 gr / dl. Young women are said to be anemic if Hb levels <12 g / dl. This research was analytic descriptive by using cross sectional study design using primary data, and using random sampling that is simple random technique, the sample in this research is female teenager with number 88 people in SMAN 2 Jambi City 2017 in june 2017. From research result There was anemia (45,5%), knowledge (28,4%), motivation (61,4%), family support (64,6%), and health officer role (55,7%). From the result of the research, there is correlation between knowledge (p = 0.005), motivation (p = 0,008), family support (p = 0,020), and health officer role (p = 0.001), with anemia incidence among adolescent girls, Less knowledge, less motivation, less family support, and less healthcare professionals, more anemia. It is expected that there will be an increase and the role of health officer to do counseling about the incidence of anemia.

Poor Performance of Risk-Based Screening for Adolescent Iron Deficiency or Anemia

Current joint guidelines from the American Academy of Pediatrics (AAP), Bright Futures (BF), and the CDC recommend screening for iron deficiency anemia

Iron deficiency in adolescence

The prevalence of iron deficiency anemia is estimated at 2-5% among reproductive age women, with perhaps 3 times that number having deficient iron stores that may contribute to fatigue, cognitive deficits, and other symptoms even in the absence of overt anemia. The combination of rapid growth, menstrual blood loss, and often inadequate dietary intake of iron places adolescent females at particular risk. Although general recommendations in favor of routine screening for iron deficiency have been made by the Centers for Disease Control and Prevention, the current US Preventive Services Task Force guidelines state that there is insufficient evidence to recommend universal laboratory screening for iron deficiency in nonpregnant women. In older women, dietary iron intake and menstrual blood loss have been shown to correlate with iron deficiency, and questions targeting those areas are included in the American Academy of Pediatrics' Bright Futures adolescent previsit questionnaire. However, these screening questions have not been validated in adolescent females, whose risk factors for iron deficiency differ from older women. In this volume of The Journal, Sekhar et al report on a cross-sectional study of 96 adolescent females in whom laboratory evaluation of iron status was compared to the results of the 4 questions from the Bright Futures questionnaire, as well as an expanded model that also incorporated body mass index along with self-reported measures of depression, attention, food insecurity, and daytime sleepiness. Disappointingly, neither model proved predictive of iron status or anemia; indeed, most cases of anemia were missed by the questionnaires, while most patients identified at risk for anemia had normal iron studies. These results lend support to the Centers for Disease Control and Prevention's recommendation for routine laboratory evaluation of iron status in adolescent women, although the optimal methodology and frequency of testing are still to be defined. Article page 194 ▶ Risk-Based Questionnaires Fail to Detect Adolescent Iron Deficiency and AnemiaThe Journal of PediatricsVol. 187PreviewTo evaluate the predictive ability of screening questionnaires to identify adolescent women at high-risk for iron deficiency or iron deficiency anemia who warrant objective laboratory testing. Full-Text PDF

Risk-Based Questionnaires Fail to Detect Adolescent Iron Deficiency and Anemia

To evaluate the predictive ability of screening questionnaires to identify adolescent women at high-risk for iron deficiency or iron deficiency anemia who warrant objective laboratory testing. Cross-sectional study of 96 female individuals 12-21 years old seen at an academic medical center. Participants completed an iron deficiency risk assessment questionnaire including the 4 Bright Futures Adolescent Previsit Questionnaire anemia questions, along with depression, attention, food insecurity, and daytime sleepiness screens. Multiple linear regression controlling for age, race, and hormonal contraception use compared the predictive ability of 2 models for adolescent iron deficiency (defined as ferritin <12 mcg/L) and anemia (hemoglobin <12 g/dL). Model 1, the Bright Futures questions, was compared with model 2, which included the 4 aforementioned screens and body mass index percentile. Among participants, 18% (17/96) had iron deficiency and 5% (5/96) had iron deficiency anemia. Model 1 (Bright Futures) poorly predicted ferritin and hemoglobin values (R2 = 0.03 and 0.08, respectively). Model 2 demonstrated similarly poor predictive ability (R2 = 0.05 and 0.06, respectively). Mean differences for depressive symptoms (0.3, 95% CI -0.2, 0.8), attention difficulty (-0.1, 95% CI -0.5, 0.4), food insecurity (0.04, 95% CI -0.5, 0.6), daytime sleepiness (0.1, 95% CI -0.1, 0.3), and body mass index percentile (-0.04, 95% CI -0.3, 0.2) were not significantly associated with ferritin in model 2. Mean differences for hemoglobin were also nonsignificant. Risk-based surveys poorly predict objective measures of iron status using ferritin and hemoglobin. Next steps are to establish the optimal timing for objective assessment of adolescent iron deficiency and anemia.

Hepcidin detects iron deficiency in Sri Lankan adolescents with a high burden of hemoglobinopathy: A diagnostic test accuracy study.

Anemia affects over 800 million women and children globally. Measurement of hepcidin as an index of iron status shows promise, but its diagnostic performance where hemoglobinopathies are prevalent is unclear. We evaluated the performance of hepcidin as a diagnostic test of iron deficiency in adolescents across Sri Lanka.We selected 2273 samples from a nationally representative cross‐sectional study of 7526 secondary schoolchildren across Sri Lanka and analyzed associations between hepcidin and participant characteristics, iron indices, inflammatory markers, and hemoglobinopathy states. We evaluated the diagnostic accuracy of hepcidin as a test for iron deficiency with estimation of the AUCROC, sensitivity/specificity at each hepcidin cutoff, and calculation of the Youden Index to find the optimal threshold.Hepcidin was associated with ferritin, sTfR, and hemoglobin. The AUCROC for hepcidin as a test of iron deficiency was 0.78; hepcidin outperformed Hb and sTfR. The Youden index‐predicted cutoff to detect iron deficiency (3.2 ng/mL) was similar to thresholds previously identified to predict iron utilization and identify deficiency in African populations. Neither age, sex, nor α‐ or β‐thalassemia trait affected diagnostic properties of hepcidin. Hepcidin pre‐screening would prevent most iron‐replete thalassemia carriers from receiving iron whilst still ensuring most iron deficient children were supplemented. Our data indicate that the physiological relationship between hepcidin and iron status transcends specific populations. Measurement of hepcidin in individuals or populations could establish the need for iron interventions.

Evaluation of Efficacy of Intravenous Iron Sucrose in Management of Adolescent Iron Deficiency Anaemia

Evaluation of Efficacy of Intravenous Iron Sucrose in Management of Adolescent Iron Deficiency Anaemia

Iron Deficiency and Schooling Attainment in Peru

Do nutritional deficiencies contribute to the intergenerational persistence of poverty by reducing the earnings potential of future generations? To address this question, we made available supplemental iron pills at a health center in rural Peru and encouraged adolescents to take them via media messages. School administrative data provide novel evidence that reducing iron deficiency results in a large and significant improvement in school performance and aspirations for anemic students. Our findings demonstrate that combining low-cost outreach efforts and local supplementation programs can be an affordable and effective method of reducing rates of adolescent iron deficiency anemia. (JEL I21, I23, I26, J24, J31, Q51, Q53)

Identifying factors predicting iron deficiency in United States adolescent females using the ferritin and the body iron models

Iron deficiency is the most prevalent nutritional deficiency in the United States affecting 9-16% of female adolescents. With the primary purpose of detecting iron deficiency, primary care screening consists of a hemoglobin or hematocrit laboratory test. This method is simple and inexpensive, but tests for anemia, and is neither sensitive nor specific for iron deficiency. Alternate methods for diagnosing iron deficiency using the ferritin and body iron models are not widely utilized. The study objective was to compare iron deficiency risk factors among adolescent females defined by the ferritin and body iron models to better characterize those who may benefit from iron deficiency testing as opposed to the current anemia-based screen. This cross-sectional study of female adolescents aged 12-21 years utilized National Health and Nutrition Examination Survey 2003-2006 data. Anemia was defined by standard hemoglobin cutoffs. The ferritin model defines iron deficiency through transferrin saturation, ferritin and erythrocyte protoporphyrin laboratory testing. Body iron calculates iron status with a formula involving transferrin receptor and ferritin. Bivariate and multivariable analyses examined associations between questionnaire responses and iron deficiency defined by each model. Among 1765 participants, 2.7% were anemic. Iron deficiency prevalence was 13.1% and 9.1% by the ferritin and body iron models, respectively. Based on the model, anemia-based screening had a sensitivity of 15.6-18.8% for iron deficiency. Multivariable associations for ferritin model iron deficiency included age, race/ethnicity, activity level and medroxyprogresterone acetate injection. Age and food insecurity were significant using the body iron model. Universal anemia-based screening misses the majority of iron-deficient adolescent females. The common risk factor identified here, adolescent age, may both inform preventive care guidelines on age-based screenings and prospective studies of adolescent iron deficiency risk factors.

Relationship Between being Overweight and Iron Deficiency in Adolescents

Being overweight has been considered to be a risk factor of iron deficiency (ID). The objective of this study was to examine the relationship between being overweight and body iron status among Taiwanese adolescents. A total of 2099 adolescents (1327 female) aged 12-19years from four middle schools and one college in southern Taiwan participated in this study. Data on sex, age, body weight, height, hemoglobin concentration, plasma ferritin (PF), and serum iron (SI) levels were collected. According to the age- and sex-specific body mass index (BMI) percentiles, the participants were divided into four weight groups: underweight (<5(th) percentile), normal weight (5-84(th) percentile), overweight (85-94(th) percentile), and obese (≥95(th) percentile). A multivariate logistic regression model was used to estimate the odds ratio (OR) and the 95% confidence interval (CI) for each factor. The correlation coefficients of linear regression were positive for BMI-hemoglobin and BMI-PF, but negative for BMI-SI. Compared with the normal-weight group, the obese group had a lower risk of PF level <15μg/L with an OR (95% CI) of 0.51 (0.30-0.87) but a higher risk of SI <60μg/dL with an OR (95% CI) of 1.78 (1.34-2.37). The percentages of low PF declined as BMI increased, but the percentages of low SI rose, from underweight to obesity groups. The relationship between being overweight and depleted iron store depends on which indicator is used to define the iron deficiency. Being overweight or obese would not be a risk factor of ID in adolescents, if ID were defined by PF rather than SI level.

An algorithm using reticulocyte hemoglobin content (CHr) measurement in screening adolescents for iron deficiency

Purpose To evaluate whether the use of an algorithm including reticulocyte hemoglobin content (CHr), a new hematologic parameter, in addition to the screening complete blood count (CBC), improves detection of iron deficiency and iron deficiency anemia in healthy adolescents. Methods After initiation of an algorithm using CHr in addition to CBC results for identifying iron-deficient patients in a primary care hospital-based adolescent clinic, we reviewed results of all hematological tests performed in the clinic during an 8-month period. Electronic medical records were screened for health status and inclusion criteria. We determined the number of patients with low hematocrit values, low mean cell volume (MCV), and low CHr. To evaluate the impact of the protocol, we calculated the percentage of cases in which the CHr results suggested a management plan different from that which would have been formulated using the CBC results only. Results A total of 381 patients (mean age 16.8 ± 3.1 years) were included in the study. Anemia was diagnosed by the Centers for Disease Control (CDC) guidelines in 63 patients (16.5%), low MCV in 170 patients (44.6%), and a low CHr in 80 (21%) patients. In 68% of anemia cases, a normal CHr suggested that iron deficiency was not the cause of the anemia. Although low MCV values were found in 38 (60.4%) of all anemic cases, mean MCV was significantly ( p < 0.001) lower in the 19 cases with a low CHr as well. In 19% of 318 patients with a normal hematocrit (HCT), a low CHr suggested the need for treatment of early iron deficiency. In 103 (27%) cases, CHr suggested a different treatment plan from that which would have been formulated using the screening CBC only. Conclusions The use of an algorithm including CHr to screen for iron deficiency anemia may increase the accuracy of diagnosis, enabling early detection and treatment of iron deficiency in adolescents without the need for additional costly iron studies.

Increased serum soluble transferrin receptor concentration detects subclinical iron deficiency in healthy adolescent girls.

The objective of this study was to investigate whether the measurement of serum soluble transferrin receptor could detect subclinical iron deficiency in adolescent girls, and to assess the possible specificity-compromising effects of growth, menarche, and intensive physical activity. The study population consisted of 191 physically active (control) girls aged 9-15 years. Dietary iron intake was estimated at baseline, and after 6 and 12 months. Iron status of the subjects was assessed by haematological laboratory tests at 6 and 12 months. A 3-month iron and multivitamin supplementation was started after the visit at 6 months. The supplementation consistently decreased soluble transferrin receptor concentrations in subjects with initial values greater than 2.4 mg/l, which was determined by regression analysis to be the cut-off value for iron-deficient erythropoiesis. The 95% reference interval in the iron-replete subjects (0.9-2.4 mg/l) was consistent with this finding. In our population, the incidence of subclinical iron deficiency was 10%. Growth or physical activity had no effect on the iron status. This study shows that, similarly to adults, soluble transferrin receptor measurement can be used to detect subclinical iron deficiency in adolescents (competitive athletes or normal controls). We suggest that soluble transferrin receptor concentrations above 2.4 mg/l indicate clinically relevant iron deficiency in adolescents.

Development of Iron Status and Response to Iron Medication in Pubertal Boys

SummaryDuring male puberty, rapid growth of body mass and the rise in hemoglobin concentration require much iron. The increasing need for iron may carry a risk of iron deficiency. Criteria for iron deficiency in adolescence are difficult to assess, as indicated by prevalences ranging from 0.5 to 30% in five recent studies from developed countries. We followed 60 prepubertal or early pubertal boys, testing them at 6‐month intervals for 24 months and relating hemoglobin levels and other iron parameters to age, pubertal development, and response to iron medication. A significant increase in mean hemoglobin was first seen at genital stage G4. In early puberty, in contrast, between stages G1 and G3, ferritin decreased. Mean transferrin increased slightly during the study. The prevalence of iron deficiency increased both with age and with advancing puberty. However, the early decline in ferritin may be a physiologic response to guarantee increasing intestinal absorption. After iron medication, we observed improvements in the levels of our parameters of iron status, which showed that hemoglobin levels had been limited by iron deficiency. In pubertal boys, evaluation of iron deficiency should not be based on laboratory parameters alone; age, pubertal development, and growth should also be taken into account.

Development of Iron Status and Response to Iron Medication in Pubertal Boys

During male puberty, rapid growth of body mass and the rise in hemoglobin concentration require much iron. The increasing need for iron may carry a risk of iron deficiency. Criteria for iron deficiency in adolescence are difficult to assess, as indicated by prevalences ranging from 0.5 to 30% in five recent studies from developed countries. We followed 60 prepubertal or early pubertal boys, testing them at 6-month intervals for 24 months and relating hemoglobin levels and other iron parameters to age, pubertal development, and response to iron medication. A significant increase in mean hemoglobin was first seen at genital stage G4. In early puberty, in contrast, between stages G1 and G3, ferritin decreased. Mean transferrin increased slightly during the study. The prevalence of iron deficiency increased both with age and with advancing puberty. However, the early decline in ferritin may be a physiologic response to guarantee increasing intestinal absorption. After iron medication, we observed improvements in the levels of our parameters of iron status, which showed that hemoglobin levels had been limited by iron deficiency. In pubertal boys, evaluation of iron deficiency should not be based on laboratory parameters alone; age, pubertal development, and growth should also be taken into account.

Sex Differences in Iron Stores of Adolescents

We evaluated iron status and its determinants in healthy adolescents. Fasting morning blood samples from a school-based cross-sectional study were analyzed for serum ferritin (SF), serum iron, total iron-binding capacity, and circulating transferrin receptors. Physical development, chronic disease, medication, dietary intake, and physical activity were assessed using clinical examination, questionnaires, and 7-day records. The risk of having low serum ferritin values was estimated using bivariate and multivariate regression. Subjects were 867 healthy Swedish adolescents, 14- and 17-year-olds (472 boys and 395 girls). SF values increased with pubertal stage in boys but not in girls. Five percent of the boys and 15% of the girls had SF values < 12 micrograms/L. Of the 17-year-old boys, 7% compared to 1% of the 17-year-old girls had SF values > 100 micrograms/L. Forty-one percent of cases with SF values > 12 micrograms/L had serum iron values < 15 microM, and 22% had transferrin saturation values < 16%. Mean total iron intakes of the boys were high [1.6 times recommended daily allowance (RDA)] and mean intakes of the girls were adequate (0.9 times RDA). Low heme iron intakes increased the risk of low iron stores (< 12 micrograms/L) in girls but not in boys. Total iron intake or other dietary factors, physical development, or level of physical activity did not influence the risk of low SF. The findings of this study suggest that the differences in iron status between boys and girls in adolescence results primarily from biological differences other than menstrual bleeding or insufficient iron intake. Furthermore, the results question the role of SF as an indicator of iron deficiency in adolescence, in particular if age and sex are not taken into consideration. We suggest that different reference values for SF, including the cut-off limit for low SF, adjusted for age and sex, should be considered. The high iron intakes and corresponding high SF values found in the older boys are noticeable in light of the possible negative health consequences of iron overload.