Iron Biomarker Profiles and Prediction of Iron Deficiency Anemia among Women of Reproductive Age in the US Open Access

Abstract

Iron deficiency (ID) and iron deficiency anemia (IDA) are significant public health concerns among women of reproductive age in the United States (Looker 1997a). Serum ferritin (SF) is considered the gold standard for assessing ID (Daru et al. 2017) and, when combined with hemoglobin (Hb), is used to diagnose IDA. However, SF is not routinely measured in clinical practice. This study aimed to evaluate the prevalence of ID using nine iron biomarkers, including SF, and to assess the performance of alternative biomarkers for predicting IDA in non-pregnant women aged 12-49 years using data from the National Health and Nutrition Examination Survey (NHANES) (n = 12781). Serum iron had the highest estimated prevalence of ID (31.58%), while soluble transferrin receptor (sTfR) had the lowest (2.21%), and SF showed a prevalence of 26.42%. Stratified by age, race, parity, and family poverty income ratio, the estimates revealed a higher prevalence of ID among non-Hispanic Black populations, those with lower family parity income ratios, and younger age groups (12-19 years old). Cluster analysis identified three subgroups of non-pregnant women with different patterns of iron biomarkers and prevalence of IDA, with Cluster 3 having the highest prevalence (61.95%). We developed a model to predict IDA using RBC and MCV, achieving an area under the receiver operating characteristic (ROC) Curve (AUC) of 98.61% in the training set and a sensitivity of 97.4%, and a specificity of 93.7% in the test set. These findings highlight the heterogeneity of ID and the importance of tailored approaches to diagnose IDA. Further research is needed to validate the prediction model and develop effective interventions to prevent and diagnose IDA in non-pregnant women.

Table of Contents

1     Introduction................................... 1

2     Subjects and methods................... 2

2.1      Study population and sample selection............................................... 2

2.2      Laboratory method and variable definition............................. 3

2.3      Statistical analysis................. 7

3     RESULTS....................................... 9

4     DISCUSSION.............................. 17

About this Master's Thesis

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School	Rollins School of Public Health
Department	Biostatistics
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Nutrition Biology, Biostatistics
Keyword	Iron deficiency Iron Biomarker iron deficiency anemia
Committee Chair / Thesis Advisor	Yi-An Ko, Emory University
Committee Members	Hanqi Luo, Emory University Melissa Fox Young, Emory University

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