Young Women Need Iron

The U.S. Centers for Disease Control and Prevention (CDC) recommends that nonpregnant women and adolescent girls be screened for anemia every five to 10 years. But the U.S. Preventive Services Task Force makes no recommendations about screening in these populations.

That may be a mistake. A recent study found that nearly 40 percent of young women are iron deficient. Women who are pregnant are especially at risk for iron-deficiency anemia, the most common nutritional deficiency worldwide. Symptoms of anemia include fatigue, dizziness, headache, chills, tongue inflammation and pallor.

A team led by researchers at the University of Michigan recently looked at the prevalence of iron deficiency and iron-deficiency anemia among young women between the ages of 12 and 21 years old to help develop future screening strategies. “If you compare iron deficiency to other things we universally screen for, such as cholesterol levels, those things are prevalent in a much smaller proportion of the population,” Angela Weyand, corresponding author on the study, told TheDoctor.

Almost 40 percent of the women in the study had iron deficiency.

It’s easy to treat an iron deficiency with over-the-counter or prescription supplements. Multivitamins with iron in them are also widely available. Weyand said, “It is a good idea to talk to your provider about any supplements you take, but iron supplements are a readily available, low-cost option.”

Data from almost 3,500 young women between the ages of 12 and 21 years old who were enrolled in the National Health and Nutrition Examination Survey were used in the study. Overall, almost 40 percent of participants had iron deficiency: 17 percent were iron deficient because their blood ferritin levels were below 15-µg/L (the low-point of normal range), and 77.5 percent had ferritin levels below 50-µg/L. Of the 188 participants who were premenarchal, or had not yet started their period, 27 percent were iron deficient, with blood ferritin levels below 25-µg/L.

Six percent of participants had iron-deficiency anemia overall: 11 percent had blood hemoglobin levels lower than 12.5-mg/dL (the low-point of normal range) and 17.2 percent had hemoglobin levels lower than 13-mg/dL. Among those who were iron deficient, less than 17 percent of the cases had iron-deficiency anemia. Menstruation was seen as a risk factor for iron deficiency, but more than one-quarter of premenarchal women in the study had iron deficiency as well.

Both iron deficiency and iron-deficiency anemia were more common among those of non-white race, Hispanic ethnicity and who were menstruating. Poverty and a high body mass index also made it more likely that a woman would have iron deficiency. Similarly, food insecurity was also positively associated with iron-deficiency anemia.

This is no surprise. Not only do people who live in poverty often have less access to healthcare, they are more likely to live in food deserts with less access to healthy foods, explained Weyand, an associate professor of pediatrics at the University of Michigan Medical School. They may also be more likely to have their symptoms dismissed by providers. “Unfortunately, systemic racism and other factors may lead to more adverse outcomes in these populations,” she said.

Questions remain about the best time to screen patients if a program is put into place. “No guidelines exist for the age at which we should start screening for iron deficiency and how often people should be screened,” Weyand said, and more evidence is needed about how screening programs should be run and how these programs might improve health outcomes over the long term. But more women need to be made aware that among young women, iron deficiency is common. And they need to be screened to be sure they are not deficient.

It's better to avoid a deficiency by getting iron through your diet. There are two types of iron available in food: Heme iron comes from hemoglobin and is more easily absorbed by the body. It is found meat, eggs, poultry, liver and seafood. Non-heme iron is commonly found in nuts, seeds, legumes and vegetables like spinach and potatoes. Tofu, milk, grains, bread and cereal are all fortified with iron.

The study was published in JAMA, the Journal of the American Medical Association.