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PLoS One. 2017 May 9;12(5):e0177183. doi: 10.1371/journal.pone.0177183. eCollection 2017.

Association between menarche and iron deficiency in non-anemic young women.

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Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, United States.
Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, United States.
Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States.
Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania, United States.



The prevalence of iron deficiency (ID) among non-pregnant, reproductive-age US women significantly exceeds rates among males. In clinical practice ID screening relies on hemoglobin, a late-stage indicator of ID. As a single, low-cost laboratory test to diagnose ID before anemia develops is lacking, the study objective was to improve ID screening by identifying risk factors among non-anemic, iron-deficient reproductive age women.


Cross-sectional data were from the National Health and Nutrition Examination Survey (NHANES) 2003-2010. Hemoglobin identified non-anemic women. ID was defined using the body iron formula, requiring ferritin and transferrin receptor values. Logistic regression assessed the association of sociodemographic, behavioral, and reproductive risk factors in an anemia-based conceptual framework with non-anemic reproductive age women (12-49 years) with ID, as well as subsets of younger (12-21 years) and older (22-49 years) women, recognizing that risks may differ by age.


Among 6216 women, 494 had ID (prevalence was 8.0%, 95% CI 7.3%, 8.6%). Among non-anemic younger women, 250 (8.7%, 95% CI 7.7%, 9.8%) had ID, compared to 244 (7.3%, 95% CI 6.4%, 8.2%) older women. Among younger women, menstruation for over 3 years was the only variable significantly associated with non-anemic ID (risk ratio 3.18, 95% CI 2.03, 4.96). No other significant risk factors were identified.


Menstrual years was the only risk factor significantly associated with ID among non-anemic younger women. The negative results suggest ID risk factors among non-anemic women may need to be considered separately from those associated with ID anemia.

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