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Am J Clin Nutr. 2017 Feb;105(2):503-512. doi: 10.3945/ajcn.116.136861. Epub 2016 Dec 28.

Associations of dietary, lifestyle, and sociodemographic factors with iron status in Chinese adults: a cross-sectional study in the China Health and Nutrition Survey.

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Cornell University College of Human Ecology, Ithaca, NY.
Departments of Nutrition and.
Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; and.
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Departments of Nutrition and



Although a high prevalence of anemia and related disease burden have been documented in China, limited evidence is available on the current population-level iron status and risk factors for iron imbalance.


We explored the associations of dietary, lifestyle, and sociodemographic factors with iron status in Chinese adults.


Our study population consisted of 7672 adults aged 18-65 y from the 2009 China Health and Nutrition Survey. Diet was assessed with the use of 3 consecutive 24-h dietary recalls. Serum ferritin, serum transferrin receptor, and hemoglobin concentrations were measured.


The geometric means ± SDs for ferritin concentrations were 135.9 ± 2.7 ng/mL in men and 42.7 ± 3.1 ng/mL in women. After adjustment for potential risk factors, including high-sensitivity C-reactive protein concentration, the association between age and ferritin concentration was inverse in men (P-trend < 0.001) and positive in women (P-trend < 0.001). We observed a positive association between body mass index (in kg/m2) and ferritin concentration in both men and women (both P-trends < 0.001). Dietary phytate intake was inversely associated with ferritin concentration in men (P-trend = 0.002) but not in women. Red meat consumption was positively associated with ferritin concentration both in men (P-trend = 0.002) and in older women (P-trend = 0.009). Lower intakes of grains and higher intakes of pork and poultry were associated with higher ferritin concentrations (all P-trends ≤ 0.05) in men but not in women. We observed variations in ferritin concentrations across different geographic regions (both P ≤ 0.01).


Serum ferritin concentrations varied across different sociodemographic, lifestyle, and dietary factors in this Chinese population. A higher intake of red meat was associated with higher ferritin concentrations in men and older women.


China; anemia; diet; ferritin; iron stores; lifestyle

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