Nutrient Intake and Anemia Risk in the Women's Health Initiative Observational Study

Cynthia Thomson, Jeffrey D. Stanaway, Marian L. Neuhouser, Linda G. Snetselaar, Marcia L. Stefanick, Leslie Arendell, Zhao Chen

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background: Nutrient-related anemia among postmenopausal women is preventable; recent data on prevalence are limited. Objective: To investigate the association between nutrient intakes and anemia prevalence, in relation to both incidence and persistence, in a longitudinal sample of postmenopausal women. We hypothesized that anemia prevalence, incidence, and persistence would be greater among women reporting lower intake of vitamin B-12, folate, and iron. Design: Prospective cohort analysis. Participants/setting: The observational cohort of the Women's Health Initiative, including 93,676 postmenopausal women, aged 50 to 79 years, who were recruited across the United States at 40 clinical study sites. Women were enrolled between 1993 and 1998; data collection for these analyses continued through 2000. Main outcome measures: Anemia was defined as a blood hemoglobin concentration of <12.0 g/dL (120.0 g/L). Persistent anemia was defined as anemia present at each measurement time point. Diet was assessed by food frequency questionnaire for iron, folate, B-12, red meat, and cold breakfast cereal; inadequacies were based on dietary reference intakes for women older than age 50 years. Statistical analysis: Descriptive statistics (mean±standard deviation) were used to characterize the population demographics, anemia rates, and diet. Unconditional logistic regression was used to investigate associations between diet and incident and persistent anemia. Associations are presented as odds ratio and 95% confidence intervals. Results: Anemia was identified in 3,979 (5.5%) of the cohort. Inadequate intakes of multiple anemia-associated nutrients were less frequent in non-Hispanic whites (7.4%) than other race/ethnic groups (inadequacies demonstrated in 14.6% to 16.3% of the sample). Age, body mass index, and smoking were associated with anemia. Women with anemia reported lower intakes of energy, protein, folate, vitamin B-12, iron, vitamin C, and red meat. Multiple (more than a single nutrient) dietary deficiencies were associated with a 21% greater risk of persistent anemia (odds ratio 1.21, 95% confidence interval 1.05 to 1.41) and three deficiencies resulted in a 44% increase in risk for persistent anemia (odds ratio 1.44, 95% confidence interval 1.20 to 1.73). Conclusions: Inadequate nutrient intake, a modifiable condition, is associated with greater risk for anemia in postmenopausal women participating in the Observational Study of the Women's Health Initiative. Efforts to identify and update incidence estimates for anemia-associated nutrient deficiencies in aging women should be undertaken.

Original languageEnglish (US)
Pages (from-to)532-541
Number of pages10
JournalJournal of the American Dietetic Association
Volume111
Issue number4
DOIs
StatePublished - Apr 2011

Fingerprint

women's health
Women's Health
observational studies
nutrient intake
anemia
Observational Studies
Anemia
Food
folic acid
odds ratio
Folic Acid
confidence interval
red meat
vitamin B12
iron
Iron
Odds Ratio
Confidence Intervals
Vitamin B 12
Diet

ASJC Scopus subject areas

  • Food Science
  • Nutrition and Dietetics

Cite this

Nutrient Intake and Anemia Risk in the Women's Health Initiative Observational Study. / Thomson, Cynthia; Stanaway, Jeffrey D.; Neuhouser, Marian L.; Snetselaar, Linda G.; Stefanick, Marcia L.; Arendell, Leslie; Chen, Zhao.

In: Journal of the American Dietetic Association, Vol. 111, No. 4, 04.2011, p. 532-541.

Research output: Contribution to journalArticle

Thomson, Cynthia ; Stanaway, Jeffrey D. ; Neuhouser, Marian L. ; Snetselaar, Linda G. ; Stefanick, Marcia L. ; Arendell, Leslie ; Chen, Zhao. / Nutrient Intake and Anemia Risk in the Women's Health Initiative Observational Study. In: Journal of the American Dietetic Association. 2011 ; Vol. 111, No. 4. pp. 532-541.
@article{6c060e6caf9f4cf6a35cf4f828f092fe,
title = "Nutrient Intake and Anemia Risk in the Women's Health Initiative Observational Study",
abstract = "Background: Nutrient-related anemia among postmenopausal women is preventable; recent data on prevalence are limited. Objective: To investigate the association between nutrient intakes and anemia prevalence, in relation to both incidence and persistence, in a longitudinal sample of postmenopausal women. We hypothesized that anemia prevalence, incidence, and persistence would be greater among women reporting lower intake of vitamin B-12, folate, and iron. Design: Prospective cohort analysis. Participants/setting: The observational cohort of the Women's Health Initiative, including 93,676 postmenopausal women, aged 50 to 79 years, who were recruited across the United States at 40 clinical study sites. Women were enrolled between 1993 and 1998; data collection for these analyses continued through 2000. Main outcome measures: Anemia was defined as a blood hemoglobin concentration of <12.0 g/dL (120.0 g/L). Persistent anemia was defined as anemia present at each measurement time point. Diet was assessed by food frequency questionnaire for iron, folate, B-12, red meat, and cold breakfast cereal; inadequacies were based on dietary reference intakes for women older than age 50 years. Statistical analysis: Descriptive statistics (mean±standard deviation) were used to characterize the population demographics, anemia rates, and diet. Unconditional logistic regression was used to investigate associations between diet and incident and persistent anemia. Associations are presented as odds ratio and 95{\%} confidence intervals. Results: Anemia was identified in 3,979 (5.5{\%}) of the cohort. Inadequate intakes of multiple anemia-associated nutrients were less frequent in non-Hispanic whites (7.4{\%}) than other race/ethnic groups (inadequacies demonstrated in 14.6{\%} to 16.3{\%} of the sample). Age, body mass index, and smoking were associated with anemia. Women with anemia reported lower intakes of energy, protein, folate, vitamin B-12, iron, vitamin C, and red meat. Multiple (more than a single nutrient) dietary deficiencies were associated with a 21{\%} greater risk of persistent anemia (odds ratio 1.21, 95{\%} confidence interval 1.05 to 1.41) and three deficiencies resulted in a 44{\%} increase in risk for persistent anemia (odds ratio 1.44, 95{\%} confidence interval 1.20 to 1.73). Conclusions: Inadequate nutrient intake, a modifiable condition, is associated with greater risk for anemia in postmenopausal women participating in the Observational Study of the Women's Health Initiative. Efforts to identify and update incidence estimates for anemia-associated nutrient deficiencies in aging women should be undertaken.",
author = "Cynthia Thomson and Stanaway, {Jeffrey D.} and Neuhouser, {Marian L.} and Snetselaar, {Linda G.} and Stefanick, {Marcia L.} and Leslie Arendell and Zhao Chen",
year = "2011",
month = "4",
doi = "10.1016/j.jada.2011.01.017",
language = "English (US)",
volume = "111",
pages = "532--541",
journal = "Journal of the Academy of Nutrition and Dietetics",
issn = "2212-2672",
publisher = "Elsevier USA",
number = "4",

}

TY - JOUR

T1 - Nutrient Intake and Anemia Risk in the Women's Health Initiative Observational Study

AU - Thomson, Cynthia

AU - Stanaway, Jeffrey D.

AU - Neuhouser, Marian L.

AU - Snetselaar, Linda G.

AU - Stefanick, Marcia L.

AU - Arendell, Leslie

AU - Chen, Zhao

PY - 2011/4

Y1 - 2011/4

N2 - Background: Nutrient-related anemia among postmenopausal women is preventable; recent data on prevalence are limited. Objective: To investigate the association between nutrient intakes and anemia prevalence, in relation to both incidence and persistence, in a longitudinal sample of postmenopausal women. We hypothesized that anemia prevalence, incidence, and persistence would be greater among women reporting lower intake of vitamin B-12, folate, and iron. Design: Prospective cohort analysis. Participants/setting: The observational cohort of the Women's Health Initiative, including 93,676 postmenopausal women, aged 50 to 79 years, who were recruited across the United States at 40 clinical study sites. Women were enrolled between 1993 and 1998; data collection for these analyses continued through 2000. Main outcome measures: Anemia was defined as a blood hemoglobin concentration of <12.0 g/dL (120.0 g/L). Persistent anemia was defined as anemia present at each measurement time point. Diet was assessed by food frequency questionnaire for iron, folate, B-12, red meat, and cold breakfast cereal; inadequacies were based on dietary reference intakes for women older than age 50 years. Statistical analysis: Descriptive statistics (mean±standard deviation) were used to characterize the population demographics, anemia rates, and diet. Unconditional logistic regression was used to investigate associations between diet and incident and persistent anemia. Associations are presented as odds ratio and 95% confidence intervals. Results: Anemia was identified in 3,979 (5.5%) of the cohort. Inadequate intakes of multiple anemia-associated nutrients were less frequent in non-Hispanic whites (7.4%) than other race/ethnic groups (inadequacies demonstrated in 14.6% to 16.3% of the sample). Age, body mass index, and smoking were associated with anemia. Women with anemia reported lower intakes of energy, protein, folate, vitamin B-12, iron, vitamin C, and red meat. Multiple (more than a single nutrient) dietary deficiencies were associated with a 21% greater risk of persistent anemia (odds ratio 1.21, 95% confidence interval 1.05 to 1.41) and three deficiencies resulted in a 44% increase in risk for persistent anemia (odds ratio 1.44, 95% confidence interval 1.20 to 1.73). Conclusions: Inadequate nutrient intake, a modifiable condition, is associated with greater risk for anemia in postmenopausal women participating in the Observational Study of the Women's Health Initiative. Efforts to identify and update incidence estimates for anemia-associated nutrient deficiencies in aging women should be undertaken.

AB - Background: Nutrient-related anemia among postmenopausal women is preventable; recent data on prevalence are limited. Objective: To investigate the association between nutrient intakes and anemia prevalence, in relation to both incidence and persistence, in a longitudinal sample of postmenopausal women. We hypothesized that anemia prevalence, incidence, and persistence would be greater among women reporting lower intake of vitamin B-12, folate, and iron. Design: Prospective cohort analysis. Participants/setting: The observational cohort of the Women's Health Initiative, including 93,676 postmenopausal women, aged 50 to 79 years, who were recruited across the United States at 40 clinical study sites. Women were enrolled between 1993 and 1998; data collection for these analyses continued through 2000. Main outcome measures: Anemia was defined as a blood hemoglobin concentration of <12.0 g/dL (120.0 g/L). Persistent anemia was defined as anemia present at each measurement time point. Diet was assessed by food frequency questionnaire for iron, folate, B-12, red meat, and cold breakfast cereal; inadequacies were based on dietary reference intakes for women older than age 50 years. Statistical analysis: Descriptive statistics (mean±standard deviation) were used to characterize the population demographics, anemia rates, and diet. Unconditional logistic regression was used to investigate associations between diet and incident and persistent anemia. Associations are presented as odds ratio and 95% confidence intervals. Results: Anemia was identified in 3,979 (5.5%) of the cohort. Inadequate intakes of multiple anemia-associated nutrients were less frequent in non-Hispanic whites (7.4%) than other race/ethnic groups (inadequacies demonstrated in 14.6% to 16.3% of the sample). Age, body mass index, and smoking were associated with anemia. Women with anemia reported lower intakes of energy, protein, folate, vitamin B-12, iron, vitamin C, and red meat. Multiple (more than a single nutrient) dietary deficiencies were associated with a 21% greater risk of persistent anemia (odds ratio 1.21, 95% confidence interval 1.05 to 1.41) and three deficiencies resulted in a 44% increase in risk for persistent anemia (odds ratio 1.44, 95% confidence interval 1.20 to 1.73). Conclusions: Inadequate nutrient intake, a modifiable condition, is associated with greater risk for anemia in postmenopausal women participating in the Observational Study of the Women's Health Initiative. Efforts to identify and update incidence estimates for anemia-associated nutrient deficiencies in aging women should be undertaken.

UR - http://www.scopus.com/inward/record.url?scp=79953047489&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79953047489&partnerID=8YFLogxK

U2 - 10.1016/j.jada.2011.01.017

DO - 10.1016/j.jada.2011.01.017

M3 - Article

C2 - 21443985

AN - SCOPUS:79953047489

VL - 111

SP - 532

EP - 541

JO - Journal of the Academy of Nutrition and Dietetics

JF - Journal of the Academy of Nutrition and Dietetics

SN - 2212-2672

IS - 4

ER -