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The role of blood loss and diet in the aetiology of mild iron deficiency in premenopausal adult New Zealand women

Published online by Cambridge University Press:  27 September 2007

Anne-Louise M Heath ,
C Murray Skeaff ,
Sheila Williams  and
Rosalind S Gibson
Anne-Louise M Heath
Affiliation:
Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand
C Murray Skeaff
Affiliation:
Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand
Sheila Williams
Affiliation:
Department of Preventive & Social Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
Rosalind S Gibson*
Affiliation:
Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand
*
*Corresponding author: Email [email protected]
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Abstract

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Objective

To investigate the role of blood loss and diet in the aetiology of mild iron deficiency (MID) in premenopausal New Zealand women. Mild iron deficiency was defined as low, but not necessarily exhausted, iron stores (i.e. serum ferritin <20 μg/L) in the absence of anaemia (i.e. haemoglobin ≥120 g/L).

Design

Cross-sectional study of a volunteer sample of premenopausal adult women. Information on habitual dietary intakes (using a specially designed and validated computerised iron food frequency questionnaire), health and demographic status, sources of blood loss (including menstrual blood loss estimated using a validated menstrual recall method), contraceptive use, height and weight, haemoglobin, serum ferritin and C-reactive protein were collected.

Setting

Dunedin, New Zealand during 1996/1997.

Participants

Three hundred and eighty-four women aged 18–40 years.

Results

The characteristics that were associated with an increased risk of MID were: low meat/fish/poultry intake, high menstrual blood loss, recent blood donation, nose bleeds, and low body mass index. The protective factors included shorter duration of menstrual bleeding, and multivitamin–mineral supplement use in the past year.

Conclusions

There are a number of potentially modifiable factors that appear to influence risk of MID. Women with low menstrual blood loss may be able to decrease their risk of MID by increasing their meat/fish/poultry intake, while those with a higher menstrual blood loss may be able to decrease their risk by decreasing their menstrual blood loss, perhaps by changing their method of contraception. Women should be encouraged to maintain a healthy body weight, and those who choose to donate blood, or who experience nose bleeds, should have their iron stores monitored.

Keywords

Iron deficiencyRisk factorsDiet surveysWomen's healthPremenopausal women
Type
Research Article
Information
Public Health Nutrition , Volume 4 , Issue 2 , April 2001 , pp. 197 - 206
Copyright
Copyright © CABI Publishing 2001

References

1Bruner, AB, Joffe, A, Duggan, AK, Casella, JF, Brandt, J.Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls. Lancet 1996; 348: 992–6.CrossRefGoogle ScholarPubMed
2Rowland, TW, Deisroth, MB, Green, GM, Kelleher, JF. The effect of iron therapy on the exercise capacity of nonanemic iron-deficient adolescent runners. Am. J. Dis. Child. 1988; 142: 165–9.Google Scholar
3Zhu, YI, Haas, JD. Iron depletion without anemia and physical performance in young women. Am. J. Clin. Nutr. 1997; 66: 334–41.CrossRefGoogle ScholarPubMed
4Gregory, J, Foster, K, Tyler, H, Wiseman, M. The Dietary and Nutritional Survey of British Adults. London: HMSO, 1990.Google Scholar
5Allen, LH, Ahluwalia, N. Improving Iron Status through Diet: The Application of Knowledge Concerning Dietary Iron Bioavailability in Human Populations. Arlington, VA: John Snow, Inc./OMNI Project, 1997.Google Scholar
6Milman, N, Kirchhoff, M, Jørgensen, T.Iron status markers, serum ferritin and hemoglobin in 1359 Danish women in relation to menstruation, hormonal contraception, parity and postmenopausal hormone treatment. Ann. Hematol. 1992; 65: 96–102.CrossRefGoogle ScholarPubMed
7Davis, P, McLeod, K, Ransom, M, Ongley, P. The New Zealand Socioeconomic Index of Occupational Status (NZSEI). Wellington, New Zealand: Statistics New Zealand, 1997.Google Scholar
8Gibson, RS. Nutritional Assessment: A Laboratory Manual. New York: Oxford University Press, 1993.Google Scholar
9Lohman, TG, Roche, AF, Martorell, R. eds. Anthropometric Standardization Manual. Champagne, IL: Human Kinetic Books, 1988.Google Scholar
10American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington, DC: American Psychiatric Association, 1994.Google Scholar
11Heath, A-LM, Skeaff, CM, Gibson, RS. Validation of a questionnaire method for estimating extent of menstrual blood loss in young adult women. J. Trace Elements Med. Biol. 1998; 12: 231–5.CrossRefGoogle Scholar
12Heath, A-LM, Skeaff, CM, Gibson, RS. The relative validity of a computerized food frequency questionnaire for estimating intake of dietary iron and its absorption modifiers. Eur. J. Clin. Nutr. 2000; 54: 592–9.CrossRefGoogle ScholarPubMed
13LINZ Activity & Health Research Unit. Twenty Four Hour Diet Recall: Nutrient Analysis Based on 1992 DSIR Database, April 1992. Dunedin, New Zealand: LINZ Activity & Health Research Unit, University of Otago, 1992.Google Scholar
14Burlingame, BA, Milligan, GC, Quigley, RJ, Spriggs, T. FOODfiles Manual. Wellington, NZ: New Zealand Institute for Crop and Food Research Ltd, 1995.Google Scholar
15Donovan, UM, Gibson, RS. Iron and zinc status of young women aged 14 to 19 years consuming vegetarian and omnivorous diets. J. Am. Coll. Nutr. 1995; 14: 463–72.CrossRefGoogle Scholar
16Hosmer, DW, Lemeshow, S. Applied Logistic Regression. New York: John Wiley & Sons, 1989.Google Scholar
17Rybo, G.Menstrual blood loss in relation to parity and menstrual pattern. Acta Obstet. Gynecol. Scand. 1966; 45: 25–45.CrossRefGoogle ScholarPubMed
18Hobbs, FDR, Kenkre, JE, Carter, YH, Thorpe, GH, Holder, RL. Reliability and feasibility of a near patient test for C-reactive protein in primary care. Br. J. Gen. Prac. 1996; 46: 395–400.Google ScholarPubMed
19Hulthén, L, Lindstedt, G, Lundberg, P-A, Hallberg, L.Effect of a mild infection on serum ferritin concentration–clinical and epidemiological implications. Eur. J. Clin. Nutr. 1998; 52: 376–9.CrossRefGoogle ScholarPubMed
20Kim, I, Yetley, EA, Calvo, MS. Variations in iron-status measures during the menstrual cycle. Am. J. Clin. Nutr. 1993; 58: 705–9.CrossRefGoogle ScholarPubMed
21Hallberg, L, Bengtsson, C, Lapidus, L, Lindstedt, G, Lundberg, PA, Hultén, L.Screening for iron deficiency: an analysis based on bone marrow examinations and serum ferritin determinations in a population sample of women. Br. J. Haematol. 1993; 85: 787–98.CrossRefGoogle Scholar
22Brussaard, JH, Brants, HAM, Bouman, M, Löwik, MRH. Iron intake and iron status among adults in the Netherlands. Eur. J Clin. Nutr. 1997; 51: S51–8.Google ScholarPubMed
23Milman, N, Rosdahl, N, Lyhne, N, Jørgensen, T, Graudal, N.Iron status in Danish women aged 35–65 years: relation to menstruation and method of contraception. Acta Obstet. Gynecol. Scand. 1993; 72: 601–5.CrossRefGoogle ScholarPubMed
24Rangan, AM, Aitken, I, Blight, GD, Binns, CW. Factors affecting iron status in 15–30 year old female students. Asia Pacific J. Clin. Nutr. 1997; 6: 291–5.Google ScholarPubMed
25Fogelholm, M, Alopaeus, K, Silvennoinen, T, Teirilä, J.Factors affecting iron status in non-pregnant women from urban South Finland. Eur. J. Clin. Nutr. 1993; 47: 567–74.Google ScholarPubMed
26Russell, D, Parnell, W, Wilson, N. NZ Food: NZ People: Key Results of the 1997 National Nutrition Survey. Wellington, NZ: Ministry of Health, 1999.Google Scholar
27Garry, PJ, Koehler, KM, Simon, TL. Iron stores and iron absorption: effects of repeated blood donations. Am. J. Clin. Nutr. 1995; 62: 611–20.CrossRefGoogle ScholarPubMed
28Finch, CA, Cook, JD, Labbe, RF, Culala, M.Effect of blood donation on iron stores as evaluated by serum ferritin. Blood 1977; 50: 441–7.CrossRefGoogle ScholarPubMed
29Leggett, BA, Brown, NN, Bryant, SJ, Duplock, L, Powell, LW, Halliday, JW. Factors affecting the concentrations of ferritin in serum in a healthy Australian population. Clin. Chem. 1990; 36: 1350–5.CrossRefGoogle Scholar
30Bairati, I, Herbeth, B, Spyckerelle, Y, et al. Dietary intake and other determinants of iron and folate status in female adolescents. J. Clin. Bioc. Nutr. 1989; 7: 143–51.CrossRefGoogle Scholar
31Kenney, MA. Factors related to iron nutrition of adolescent females. Nutr. Res. 1985; 5: 157–66.CrossRefGoogle Scholar
32Yokoi, K, Alcock, NW, Sandstead, HH. 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 zinc disappearance. J. Lab. Clin. Med. 1994; 124: 852–61.Google ScholarPubMed
33Hallberg, L, Högdahl, A-M, Nilsson, L, Rybo, G.Menstrual blood loss–a population study: variation at different ages and attempts to define normality. Acta Obstet. Gynecol. Scand. 1966; 45: 320–51.CrossRefGoogle ScholarPubMed
34Galán, S, Hercberg, S, Soustre, Y, Dop, MC, Dupin, H.Factors affecting iron stores in French female students. Hum. Nutr.: Clin. Nutr. 1985; 39C: 279–87.Google Scholar
35Razagui, IB, Barlow, PJ, Izmeth, MGA, Taylor, KDA. Iron status in a group of long-stay mentally handicapped menstruating women: some dietary considerations. Eur. J. Clin. Nutr. 1991; 45: 331–40.Google Scholar
36Soustre, Y, Dop, MC, Galan, P, Hercberg, S.Dietary determinants of the iron status in menstruating women. Int. J. Vit. Nutr. Res. 1986; 56: 281–6.Google ScholarPubMed
37Small, M, Murray, J, Maran, A.A study of patients with epistaxis requiring admission to hospital. Health Bull. 1982; 40: 24.Google ScholarPubMed
38Acosta, A, Amar, M, Cornbluth-Szarfarc, SC. Iron absorption from typical Latin American diets. Am. J. Clin. Nutr. 1984; 39: 953–62.CrossRefGoogle ScholarPubMed
39Hallberg, L, Rossander, L.Improvement of iron nutrition in developing countries: comparison of adding meat, soy protein, ascorbic acid, citric acid, and ferrous sulphate on iron absorption from a simple Latin American-type of meal. Am. J. Clin. Nutr. 1984; 39: 577–83.CrossRefGoogle ScholarPubMed
40Galan, P, Yoon, H-C, Preziosi, P, et al. Determining factors in the iron status of adult women in the SU.VI.MAX study. Eur. J. Clin. Nutr. 1998; 52: 383–8.CrossRefGoogle ScholarPubMed
41Worthington-Roberts, BS, Breskin, MW, Monsen, ER. Iron status of premenopausal women in a university community and its relationship to habitual dietary sources of protein. Am. J. Clin. Nutr. 1988; 47: 275–9.CrossRefGoogle Scholar
42Donovan, UM, Gibson, RS. Dietary intakes of adolescent females consuming vegetarian, semi-vegetarian, and omnivorous diets. J. Adol. Health 1996; 18: 292–300.CrossRefGoogle ScholarPubMed
43Preziosi, P, Hercberg, S, Galan, P, Devanlay, M, Cherouvrier, F, Dupin, H.Iron status of a healthy French population: factors determining biochemical markers. Ann. Nutr. Metab. 1994; 38: 192–202.CrossRefGoogle ScholarPubMed
44Ilich-Ernst, JZ, McKenna, AA, Badenhop, NE, et al. Iron status, menarche, and calcium supplementation in adolescent girls. Am. J. Clin. Nutr. 1998; 68: 880–7.CrossRefGoogle ScholarPubMed
45Minihane, AM, Fairweather-Tait, SJ. Effect of calcium supplementation on daily nonheme-iron absorption and long-term iron status. Am. J. Clin. Nutr. 1998; 68: 96–102.CrossRefGoogle ScholarPubMed
46Reddy, MB, Cook, JD. Effect of calcium intake on nonhemeiron absorption from a complete diet. Am. J. Clin. Nutr. 1997; 65: 1820–5.CrossRefGoogle ScholarPubMed
47Sokoll, LJ, Dawson-Hughes, B.Calcium supplementation and plasma ferritin concentrations in premenopausal women. Am. J. Clin. Nutr. 1992; 56: 1045–8.CrossRefGoogle ScholarPubMed
48Hallberg, L, Brune, M, Erlandsson, M, Sandberg, A-S, Rossander-Hultén, L.Calcium: effect of different amounts on nonheme- and heme-iron absorption in humans. Am. J. Clin. Nutr. 1991; 53: 112–19.CrossRefGoogle ScholarPubMed
49Johnson, MA. Iron: nutrition monitoring and nutrition status assessment. J. Nutr. 1990; 120: 1486–91.CrossRefGoogle ScholarPubMed
50Callard, GV, Litofsky, FS, DeMerre, LJ. Menstruation in women with normal or artificially controlled cycles. Fert. Steril. 1966; 17: 684–8.CrossRefGoogle ScholarPubMed
51Guttorm, E.Menstrual bleeding with intrauterine contraceptive devices. Acta Obstet. Gynecol. Scand. 1971; 50: 9–16.CrossRefGoogle ScholarPubMed
52Wood, CE. Menorrhagia: a clinical update. Med. J. Aust. 1996; 165: 510–14.CrossRefGoogle ScholarPubMed
53Dwyer, JT. Health aspects of vegetarian diets. Am. J. Clin. Nutr. 1988; 48: 712–38.CrossRefGoogle ScholarPubMed