Relative importance of micronutrient deficiencies in iron deficiency anemia

To examine influence of micronutrient status in recently diagnosed anemic patients, a cross-sectional survey on adults from rural and urban parts of Western India was undertaken. Iron deficiency anemia (IDA) patients (81 men, 102 women) and age-sex matched healthy controls (80 men, 100 women) (32.85 ± 8.9 yr) were studied for their blood status of iron and seven micronutrients and nutrient intakes. Median levels of serum iron (647 μg/L), serum ceruloplasmin (192 mg/L), ascorbic acid (2.3 mg/L) and B12 (368 ng/L) were significantly lower in anemic subjects than the control group (750 μg/L, 251 mg/L, 3.2mg/L, 416 ng/L respectively, p < 0.01). Differences in plasma folic acid and erythrocyte membrane zinc of anemic and control groups were not significant (p > 0.05). Prevalence of riboflavin deficiency (EGRAC: erythrocyte glutathione reductase activity coefficient >1.2) was more in anemic group than control (p = 0.038). A positive correlation of plasma retinol was observed with serum transferrin (r = 0.42, p < 0.05) and hemoglobin (r = 0.15, p < 0.05). Logistic regression analyses of the blood levels of seven micronutrients with hemoglobin status indicated that risk of IDA was equal with low levels of ceruloplasmin (odds ratio = 0.92, p < 0.05) and 7 times higher with riboflavin deficiency (EGRAC, odds ratio = 7.2, p < 0.01).