Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-23T08:22:38.009Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of menstrual blood loss and diet on iron deficiency among women in the UK

Published online by Cambridge University Press:  08 March 2007

Linda J. Harvey ,
Charlotte N. Armah ,
Jack R. Dainty ,
Robert J. Foxall ,
D. John Lewis ,
Nicola J. Langford  and
Susan J. Fairweather-Tait
Linda J. Harvey*
Affiliation:
Institute of Food Research, Norwich Research Park, Colney, Norwich NR4 7UA, UK
Charlotte N. Armah
Affiliation:
Institute of Food Research, Norwich Research Park, Colney, Norwich NR4 7UA, UK
Jack R. Dainty
Affiliation:
Institute of Food Research, Norwich Research Park, Colney, Norwich NR4 7UA, UK
Robert J. Foxall
Affiliation:
Institute of Food Research, Norwich Research Park, Colney, Norwich NR4 7UA, UK
D. John Lewis
Affiliation:
Central Science Laboratory, Sand Hutton, York, YO4 1LZ, UK
Nicola J. Langford
Affiliation:
Central Science Laboratory, Sand Hutton, York, YO4 1LZ, UK
Susan J. Fairweather-Tait
Affiliation:
Institute of Food Research, Norwich Research Park, Colney, Norwich NR4 7UA, UK
*
*Corresponding author: Dr Linda Harvey, fax +44 (0) 1603 507723, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Women of childbearing age are at risk of Fe deficiency if insufficient dietary Fe is available to replace menstrual and other Fe losses. Haem Fe represents 10–15 % of dietary Fe intake in meat-rich diets but may contribute 40 % of the total absorbed Fe. The aim of the present study was to determine the relative effects of type of diet and menstrual Fe loss on Fe status in women. Ninety healthy premenopausal women were recruited according to their habitual diet: red meat, poultry/fish or lacto-ovo-vegetarian. Intake of Fe was determined by analysing 7 d duplicate diets, and menstrual Fe loss was measured using the alkaline haematin method. A substantial proportion of women (60 % red meat, 40 % lacto-ovo-vegetarian, 20 % poultry/fish) had low Fe stores (serum ferritin <10 μg/l), but the median serum ferritin concentration was significantly lower in the red meat group (6·8 μg/l (interquartile range 3·3, 16·25)) than in the poultry/fish group (17·5 μg/l (interquartile range 11·3, 22·4) (P<0·01). The mean and standard deviation of dietary Fe intake were significantly different between the groups (P=0·025); the red meat group had a significantly lower intake (10·9 (sd 4·3) mg/d) than the lacto-ovo-vegetarians (14·5 (sd 5·5) mg/d), whereas that of the poultry/fish group (12·8 (sd 5·1) mg/d) was not significantly different from the other groups. There was no relationship between total Fe intake and Fe status, but menstrual Fe loss (P=0·001) and dietary group (P=0·040) were significant predictors of Fe status: poultry/fish diets were associated with higher Fe stores than lacto-ovo-vegetarian diets. Identifying individuals with high menstrual losses should be a key component of strategies to prevent Fe deficiency.

Keywords

Iron deficiencyMenstrual lossFe statusWomenVegetarianMeat
Type
Research Article
Information
British Journal of Nutrition , Volume 94 , Issue 4 , October 2005 , pp. 557 - 564
Copyright
Copyright © The Nutrition Society 2005

References

Alexander, D, Ball, MJ & Mann, J (1994) Nutrient intake and haematological status of vegetarians and age-sex matched omnivores. Eur J Clin Nutr 48, 538–546.Google ScholarPubMed
Anderson, JW, Konz, EC & Jenkins, DJA (2000) Health advantages and disadvantages of weight-reducing diets: a computer analysis and critical review. J Am Coll Nutr 19, 578–590.CrossRefGoogle Scholar
Andrews, NC (1999) Disorders of iron metabolism. N Engl J Med 341, 1986–1995.CrossRefGoogle ScholarPubMed
Australian Iron Status Advisory Panel (1996) Iron Deficiency in Adults: A Comprehensive Management Guide. Sydney: Australian Iron Status Advisory Panel.Google Scholar
Bairati, I, Herbeth, B, Spyckerelle, , Didelotbarthelemy, J, Galan, P, Hercberg, S, Christides, JP & Decourcy, GP (1989) Dietary intake and other determinants of iron and folate status in female adolescents. J Clin Biochem Nutr 7, 143–151.CrossRefGoogle Scholar
Ball, MJ & Bartlett, MA (1999) Dietary intake and iron status of Australian vegetarian women. Am J Clin Nutr 70, 353–358.CrossRefGoogle ScholarPubMed
Barr, SI (1999) Vegetarianism and menstrual cycle disturbances: is there an association? Am J Clin Nutr 70, 549S–554S.Google Scholar
Bjorn-Rasmussen, E, Hallberg, L, Isaksson, B & Arridson, B (1974) Food iron absorption in man. J Clin Invest 53, 247–255.Google ScholarPubMed
Borch-Iohnsen, B, Meltzer, HM, Stenberg, V & Reinskou, T (1990) Iron status in a group of Norwegian menstruating women. Eur J Clin Nutr 44, 23–28.Google Scholar
Borel, MJ, Smith, SM, Derr, J & Beard, JL (1991) Day-to-day variation in iron-status indices in healthy men and women. Am J Clin Nutr 54, 729–735.CrossRefGoogle ScholarPubMed
Bothwell, TH, Charlton, RW, Cook, JD & Finch, CA (1979) Iron Metabolism in Man. London: Blackwell Scientific.Google Scholar
Callard, GV, Litovsky, FS & DeMerre, LJ (1966) Menstruation in women with normally or artificially controlled cycles. Fert Steril 17, 684–688.CrossRefGoogle ScholarPubMed
Carter, P (1971) Spectrophotometric determination of serum iron at the submicrogram level with a new reagent (ferrozine). Anal Biochem 40, 450–458.Google Scholar
Cooper, MJ & Zlotkin, SH (1996) Day-to-day variation of transferrin receptor and ferritin in healthy men and women. Am J Clin Nutr 64, 738–742.Google Scholar
Craig, WJ (1994) Iron status in vegetarians. Am J Clin Nutr 59, 1233S–1237S.CrossRefGoogle ScholarPubMed
Department of Health (1991) Reference values for food, energy and nutrients for the United Kingdom. In Report of the Panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy. London: HMO.Google Scholar
Faber, M, Gouws, E, Benade, AJ & Labadarios, D (1986) Anthropometric measurements, dietary intake and biochemical data of Soth African lacto-ovo vegetarians. S Afr Med J 69, 733–738.Google Scholar
Food and Agriculture Organization/World Health Organization (1988) Requirements of Vitamin A, Iron, Folate and Vitamin B12. Report of a Joint FAO/WHO Expert Consultation. FAO Food and Nutrition Series no. 23. Rome: FAO.Google Scholar
Flowers, CA, Kuizon, M, Beard, JL, Skikne, BS, Covell, AM & Cook, JD (1986) A serum ferritin assay for prevalence studies of iron deficiency. Am J Hematol 23, 141–151.Google ScholarPubMed
Food and Nutrition Board/Institute of Medicine (2000) Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. A Report of the Panel on Micronutrients, Subcommittees on Upper Reference Levels of Nutrients and of Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Washington, DC: National Academy Press.Google Scholar
Galan, S, Hercberg, S, Soustr, Y, Dop, MC & Dupin, H (1985) Factors affecting iron stores of French female students. Hum Nutr Clin Nutr 39C, 279–287.Google Scholar
Gomez-Basauri, JV & Regenstein, JM (1992) Processing and frozen storage effects on the iron content of cod and mackerel. J Food Sci 57, 1332–1336.CrossRefGoogle Scholar
Haddad, EH, Berk, LS, Kettering, JD, Hubbard, RW & Peters, WR (1999) Dietary intake and biochemical, hematologic and immune status of vegans compared with non-vegetarians. Am J Clin Nutr 70, 586S–593S.CrossRefGoogle Scholar
Hallberg, L (1995) Results of surveys to assess iron status in Europe. Nutr Rev 53, 314–322.CrossRefGoogle ScholarPubMed
Hallberg, L, Hogdahl, A-M, Nilsson, L & Rybo, G (1966) Menstrual blood loss – a population study. Variations at different ages and attempts to define normality. Acta Obstet Gynecol Scand 45, 320–351.Google Scholar
Hallberg, L & Hulthen, L (2000) Prediction of dietary iron absorption: an algorithm for calculating absorption and bioavailability of dietary iron. Am J Clin Nutr 71, 1147–1160.CrossRefGoogle ScholarPubMed
Hallberg, L & Nilsson, L (1964a) Determination of menstrual blood loss. Scand J Clin Lab Invest 16, 244–248.CrossRefGoogle ScholarPubMed
Hallberg, L & Nilsson, L (1964 b) Constancy of individual menstrual blood loss. Acta Obstet Gynecol Scand 43, 352–359.CrossRefGoogle ScholarPubMed
Han, D, McMillin, KW, Godber, JS, Bidner, TD, Younathan, MT, Marshall, DL & Hart, LT (1993) Iron distribution in heated beef and chicken muscles. J Food Sci 58, 697–700.CrossRefGoogle Scholar
Heath, A-LM, Skeaff, CM & Gibson, R (1998) Validation of a questionnaire method for estimating extent of menstrual blood loss in young adult women. J Trace Elem Med Biol 12, 231–235.CrossRefGoogle Scholar
Heath, A-LM, Skeaff, CM, Williams, S & Gibson, R (2001) The role of blood loss and diet in the aetiology of mild iron deficiency in premenopausal adult New Zealand women. Pub Health Nutr 4, 197–206.Google Scholar
Helman, AD & Darnton-Hill, I (1987) Vitamin and iron status in new vegetarians. Am J Clin Nutr 45, 785–789.Google Scholar
Henderson, L, Gregory, J & Swan, G (2002) The National Diet and Nutrition Survey: Adults Aged 19 to 64 Years, vol. 1. London: HMSO.Google Scholar
Henderson, L, Irving, K, Gregory, J, Bates, CJ, Prentice, A, Perks, J, Swan, G & Farron, M (2003) The National Diet and Nutrition Survey: Adults Aged 19 to 64 Years, vol. 1. London: HMSO.Google Scholar
Hendricks, DG, Mahoney, AW, Zhang, D & Yu, Y (1987) Validity and assumptions in estimating heme iron for determining available dietary iron. Fed Proc 46, 1160.Google Scholar
Higham, JM & Shaw, RW (1999) Clinical associations with objective menstrual blood volume. Eur J Obstet Gynecol 82, 73–76.CrossRefGoogle ScholarPubMed
Hulthen, L, Lindstedt, G, Lundberg, P-A & Hallberg, L (1998) Effect of mild infection on serum ferritin concentration – clinical and epidemiological implications. Eur J Clin Nutr 52, 76–79.CrossRefGoogle ScholarPubMed
Hunt, JR (2003) High-, but not low-bioavailability diets enable substantial control of women's iron absorption in relation to body iron stores, with minimal adaptation within several weeks. Am J Clin Nutr 78, 1168–1177.Google Scholar
Kenney, MA (1985) Factors related to iron nutrition of adolescent females. Nutr Res 5, 157–166.CrossRefGoogle Scholar
Larsson, G, Milsom, I, Lindstedt, G & Rybo, G (1992) The influence of a low-dose combined oral contraceptive on menstrual blood loss and iron status. Contraception 46, 327–334.Google Scholar
Lawrenson, RA, Leydon, GM, Williams, TJ, Newson, RB & Feher, MD (1999) Patterns of contraception in UK women with type 1 diabetes mellitus: a GP database study. Diabet Med 16, 395–399.Google Scholar
Liu, J-M, Hankinson, SE, Stampfer, MJ, Rifai, N, Willett, WC & Ma, J (2003) Body iron stores and their determinants in healthy postmenopausal US women. Am J Clin Nutr 78, 1160–1167.CrossRefGoogle ScholarPubMed
McEndree, L, Kies, C & Fox, H (1983) Iron intake and nutritional status of lacto-ovovegetarian and omnivore students eating in a lacto-ovo vegetarian food service. Nutr Rep Int 27, 199–206.Google Scholar
Milman, N, Clausen, J & Byg, K-E (1998) Iron status in 268 Danish women aged 18–30 years: influence of menstruation, contraceptive method, and iron supplementation. Ann Hematol 77, 13–19.Google Scholar
Milman, N, Rosdahl, N, Lyhne, N, Jorgensen, T & Graudal, N (1993) Iron status in Danish women aged 35–65 years: relation to menstruation and method of contraception. Act Obstet Gynecol Scand 72, 601–605.CrossRefGoogle ScholarPubMed
Milsom, I, Andersson, K, Jonasson, K, Lindstedt, G & Rybo, G (1995) The influence of the Gyne-T 380S IUD on menstrual blood loss and iron status. Contraception 52, 175–179.Google Scholar
Morabia, A, Bernstein, MS, Heritier, S & Beer-Borst, S (1999) A Swiss population based assessment of dietary habits before and after the March 1996 ‘mad cow disease’ crisis. Eur J Clin Nutr 53, 158–163.CrossRefGoogle ScholarPubMed
Nathan, I, Hackett, AF & Kirby, S (1996) The dietary intake of a group of vegetarian children aged 7–11 years compared with matched omnivores. Br J Nutr 75, 533–544.CrossRefGoogle ScholarPubMed
Nelson, M, Bakaliou, F & Trivedi, A (1994) Iron-deficiency anaemia and physical performance in adolescent girls from different ethnic backgrounds. Br J Nutr 72, 427–433.CrossRefGoogle ScholarPubMed
Newton, J, Barnard, G & Collins, W (1977) A rapid method for measuring menstrual blood loss using automatic extraction. Contraception 16, 269–282.CrossRefGoogle Scholar
Purchas, RW, Simcock, DC, Knight, TW & Wilkinson, BHP (2003) Variation in the form of iron in beef and lamb meat and losses of iron during cooking and storage. Int J Food Sci Technol 38, 82–837.CrossRefGoogle Scholar
Rangan, AM, Aitken, I, Blight, GD & Binns, CW (1997 a) Factors affecting iron status in 15–30 year old female students. Asia Pacific J Clin Nutr 6, 291–295.Google Scholar
Rangan, AM, Ho, RWL, Blight, GD & Binns, CW (1997 b) Haem iron content of Australian meats and fish. Food Austr 49, 508–511.Google Scholar
Razagui, IB, Barlow, PJ, Izmeth, MGA & Taylor, KDA (1991) Iron status in a group of long-stay mentally handicapped menstruating women: some dietary considerations. Eur J Clin Nutr 45, 331–340.Google Scholar
R Development Core Team (2003) R: A Language and Environment for Statistical Computing. http://www.R-project.org.Google Scholar
Reddy, S & Sanders, TA (1990) Hematological studies on pre-menopausal Indian and Caucasian vegetarians compared with Caucasian omnivores. Br J Nutr 64, 331–338.Google Scholar
Rybo, G & Hallberg, L (1966) Influence of heredity and environment on normal menstrual blood loss. Acta Obstet Gynecol Scand 45, 389–410.CrossRefGoogle ScholarPubMed
Soustre, Y, Dop, MC, Galan, P & Hercberg, S (1986) Dietary determinants of iron status in menstruating women. Int J Vitam Nutr Res 56, 281–286.Google Scholar
Suominen, P, Punnonen, K, Rajamaki, A & Irjala, K (1998) Serum transferrin receptor and transferrin receptor-ferritin index identify healthy subjects with subclinical deficits. Blood 92, 2834–2839.Google Scholar
Vegetarian Society (2000) 21st Century Vegetarian through the Ages. http://www.vegsoc.org/news/2000/21cv/ages.html.Google Scholar
Vegetarian Society Summary of RealEat Polls 1984–2001. (2001) www.vegsoc.org/info/realeat.html.Google Scholar
Walters, GO, Miller, FM & Worwood, M (1973) Serum ferritin concentration and iron stores in normal subjects. J Clin Pathol 26, 770–772.Google Scholar
West, CE & Van Staveren, WA (1991) Food composition, nutrient intake and the use of food composition tables. In Design Concepts in Nutritional Epidemiology, pp. 102–103 [Margetts, BM and Nelson, M, editors]. New York: Oxford University Press.Google Scholar
Whitfield, JB, Treloar, S, Zhu, G, Powell, LW & Martin, NG (2003) Relative importance of female specific and non-female specific effects on variation in iron stores between women. Br J Haematol 120, 860–866.Google Scholar
World Health Organization (1994) Indicators and Strategies for Iron Deficiency and Anemia Programmes. Report of the WHO/UNICEF/UNU Consultation. Geneva: WHO.Google Scholar
Worthington-Roberts, BS, Breskin, MW & Monsen, ER (1988) Iron status of premenopausal women in a university community and its relationship to habitual dietary sources of protein. Am J Clin Nutr 47, 275–279.Google Scholar
Wyatt, KM, Dimmock, PW, Walker, TJ & O'Brien, PMS (2001) Determination of total menstrual blood loss. Fertil Steril 76, 125–131.CrossRefGoogle ScholarPubMed
Yokoi, K, Alcock, N & Sandstead, H (1994) Iron and zinc nutriture of premenopausal women; associations of diet with serum ferritin and plasma zinc disappearance, and of serum ferritin with plasma zinc and plasma disappearance. J Lab Clin Med 124, 852–131.Google Scholar