(P17-052-25) Increasing Trends in Iron Deficiency and Inadequate Iron Intake Among Females Are Exacerbated by Socioeconomic Factors: NHANES 1999-March 2020

Objectives: Assess prevalence and trends in usual iron intake and iron deficiency (ID) among females 15-49y.

Methods: This analysis of the NHANES 1999–March 2020 included 12,831 non-pregnant, non-lactating females 15–49y. Dietary and supplemental iron intake were collected from dietary recalls and a 30d questionnaire, respectively.  Serum ferritin (SF) and c-reactive protein (CRP) were collected in-person. Usual intake and inadequate intake (%< EAR) was assessed using the NCI method. SF was adjusted for CRP using the BRINDA adjustment method. Comparisons and trends were assessed using independent samples t-tests and linear regression, respectively.

Results: Mean [SE] usual iron intake was 17.3 [0.2]mg/d. Prevalence [SE] of inadequate iron intake was 13.9% [0.5]; yet 21.8% [0.6] were ID (SF < 15µg/L). Inadequate iron intake and ID increased from 1999–2000 to 2017–March 2020 by 6.3 [1.4] percentage points (pp) and 9.3 [1.7] pp, respectively.

Compared to non-Hispanic whites, both other Hispanics (18.2% [1.3]) and non-Hispanic blacks (17.6% [0.7]) had greater inadequate iron intake (p < 0.001 for both tests). ID was more prevalent in Mexican Americans (29.9% [1.4]), other Hispanics (24.6% [1.9]), and non-Hispanic blacks (30.2% [1.3])  than in non-Hispanic whites (18.3%[0.8]; p< 0.01 for all tests).  Overtime, Inadequate iron intake increased across all race/ethnicities (p trend < 0.05), while ID increased in all groups (p-trend < 0.05) but Mexican Americans (p-trend = 0.173). 

Inadequate iron intake increased with increasing food insecurity and overtime among all food security groups (p-trend < 0.05). ID increased in low/very low and full food security groups (p-trend < 0.05), but not in marginal food security (p trend=0.097).

Females without health insurance had greater prevalence for inadequate iron intake (13.1[0.5] vs 17.6[0.9]%; p< 0.001) and ID (20.9[0.6] vs 26 [1.1]%; p< 0.001), compared to those with insurance.  Similarly, females from low-income households had greater risk for inadequate iron intake (18.3[0.7] vs 12.8[0.5]%; p< 0.001) and ID (25.5[1] vs 20.6 [0.7]%; p< 0.001), compared to those from higher incomes.

Conclusions: Inadequate iron intake and ID are increasing among all women 15-49y. Risk disparities exist among those from racial/ethnic minorities, who experience food insecurity, who have low-income, and lack health insurance.

Funding Sources: None