Medline ® Abstracts for References 3,4
of 'Iron requirements and iron deficiency in adolescents'
Prevalence of iron deficiency in Swedish adolescents.
Hallberg L, Hultén L, Lindstedt G, Lundberg PA, Mark A, Purens J, Svanberg B, Swolin B
Pediatr Res. 1993;34(5):680.
The prevalence of iron deficiency was determined in Göteborg, Sweden, in a sample of 15- to 16-y-old girls (n = 220) and boys (n = 207) using serum ferritin (SF). In a recent study in women on the relationship between SF and stainable bone marrow iron, it was established that at a cutoff value for SF of<16 micrograms/L in 75% of women with no iron stores SF concentration was below this value (sensitivity 75%), whereas in 98% of iron-replete women it was above this cutoff value (specificity 98%). The present study showed that in 40% of the girls and 15% of the boys SF was below this cutoff value, indicating iron deficiency. Low SF concentration was associated with significant decreases in transferrin saturation, Hb concentration, mean corpuscular Hb, and mean corpuscular volume. The results from this cross-sectional study showed that, with decreasing SF, the decrease of values for these parameters occurred already before SF had reached the level 16 micrograms/L, suggesting that SF can be validly used as a single criterion of iron deficiency. Using the cutoff value SF<16 micrograms/L, the figures for the prevalence of iron deficiency in adolescents in different countries were compared and found to be rather similar in Australia, Canada, the United States, and Sweden. High iron requirements combined with the present low-energy life-style leading to an insufficient supply of dietary iron may be a reasonable main explanation for the paradoxical, high prevalence of iron deficiency in adolescents in affluent societies.
Department of Internal Medicine, University of Göteborg, Sahlgrenska Hospital, Sweden.
Anaemia and iron deficiency screening in adolescence: a pilot study of iron stores and haemoglobin response to iron treatment in a population of 14-15-year-olds in Norway.
Eskeland B, Hunskaar S
Acta Paediatr. 1999;88(8):815.
Screening for haemoglobin (Hb) and s-ferritin, in 176 of all 189 (93%) pupils at 8th grade (14-15-years-old) in one Norwegian community was performed in order to map the prevalence of anaemia and depleted iron stores. In order to determine the clinical significance of the findings, a questionnaire aimed at detecting symptoms or risk factors for iron deficiency was completed by all participants, and a 3 mo therapeutic trial with iron was offered to subjects with s-ferritin values below 15 microg/l. Four percent of girls and 8% of boys were anaemic according to WHO cut-off levels. S-ferritin<15 microg/l was found in 25% of girls and 30% of boys. Forty-four of 48 pupils with s-ferritin<15 microg/l completed the therapeutic trial. Only three pupils had a clinically significant increase in Hb, representing less than 2% of the population. The questionnaire gave no clues that could identify subjects with depleted iron stores. To increase Hb in one 14-15-y-old with depleted iron stores, 59 (95% CHI: 20-285) had to be screened and 16 (6-76) had to be given iron treatment. This pilot study suggests that functional iron deficiency is rare in Norwegian adolescents despite a high frequency of low iron stores. A double blind, placebo controlled study covering the entire span of pubescence is needed to confirm these results.
Department of Public Health and Primary Health Care, University of Bergen, Norway.