Addo O Yaw, Mei Zuguo, Jefferds Maria Elena D, Jenkins Mica, Flores-Ayala Rafael, Williams Anne M, Young Melissa Fox, Luo Hanqi, Ko Yi-An, Papassotiriou Ioannis, Palmieri Mireya, Mesarina Karla, Bhutta Zulfiqar, Suchdev Parminder S, Brittenham Gary M
Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program (IMMPaCt) Team, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), US Centers for Disease Control and Prevention, Atlanta, GA, USA.
Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program (IMMPaCt) Team, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), US Centers for Disease Control and Prevention, Atlanta, GA, USA.
Lancet Glob Health. 2025 May;13(5):e831-e842. doi: 10.1016/S2214-109X(25)00009-9.
Diagnosis of iron deficiency commonly relies on measurement of serum ferritin concentrations. WHO guidelines identify serum ferritin thresholds for iron deficiency among healthy individuals of less than 15 μg/L for women and less than 12 μg/L for children under 5 years, based on expert opinion. We report thresholds for iron deficiency for apparently healthy non-pregnant women and young children based on physiological indicators.
We performed secondary analyses of cross-sectional data from women (aged 15-49 years) and children (aged 6-59 months) from 12 countries in Africa, Asia, Europe, and central America from available surveys (2007-19). Using haemoglobin and soluble transferrin receptor concentrations as individual-level indicators of iron deficiency, we identified country-specific serum ferritin thresholds. We conducted multivariate meta-analysis using individual participant data to assess multinational heterogeneity and intercountry consistency.
Data were collected from July, 2007 to March, 2019. 18 251 individuals (13 864 women and 4387 children) were included in the final analysis. The thresholds of pooled serum ferritin levels corresponding to the starting point of decline in circulating haemoglobin concentrations were 24·8 μg/L (95% CI 24·4-25·2) for women and 22·1 μg/L (20·8-23·4) for children based on the national survey data from 12 countries. The thresholds were consistent among countries (p: women=0·73, children=0·43) but median serum ferritin concentrations and lower 5% reference ranges differed. In all countries, the prevalence of iron deficiency was higher using physiologically based thresholds than that using WHO current guidelines for women (36·0% [95% CI 25·3-46·8] vs 20·1% [11·5-28·7], p<0·0001) and for children (34·2% [24·3-44·1] vs 16·6% [11·2-22·0], p<0·0001).
These results provide evidence that the prevalence of iron deficiency as indicated by physiological measures is substantially higher than those based on current WHO guidelines. The consistency of physiologically based serum ferritin thresholds in apparently healthy women and young children offers a potential means to achieve evidence-informed coordination in thresholds for iron deficiency across populations. The use of physiologically based serum ferritin thresholds could help in detecting the clinical and functional outcomes of iron deficiency.
None.
缺铁性贫血的诊断通常依赖于血清铁蛋白浓度的测定。世界卫生组织（WHO）的指南基于专家意见，确定了健康个体缺铁的血清铁蛋白阈值，即女性低于15μg/L，5岁以下儿童低于12μg/L。我们根据生理指标报告了明显健康的非孕妇和幼儿缺铁的阈值。
我们对来自非洲、亚洲、欧洲和中美洲12个国家的女性（15 - 49岁）和儿童（6 - 59个月）的横断面数据进行了二次分析，这些数据来自现有的调查（2007 - 2019年）。使用血红蛋白和可溶性转铁蛋白受体浓度作为缺铁的个体水平指标，我们确定了特定国家的血清铁蛋白阈值。我们使用个体参与者数据进行多变量荟萃分析，以评估跨国异质性和国家间的一致性。
数据收集时间为2007年7月至2019年3月。最终分析纳入了18251名个体（其中13864名女性和4387名儿童）。根据12个国家的全国调查数据，与循环血红蛋白浓度下降起点相对应的合并血清铁蛋白水平阈值，女性为24.8μg/L（95%CI 24.4 - 25.2），儿童为22.1μg/L（20.8 - 23.4）。这些阈值在各国之间是一致的（p值：女性 = 0.73，儿童 = 0.43），但血清铁蛋白浓度中位数和较低5%参考范围有所不同。在所有国家，使用基于生理指标的阈值时缺铁的患病率高于使用WHO现行指南时的患病率，女性分别为36.0%（95%CI 25.3 - 46.8）和20.1%（11.5 - 28.7），p < 0.0001；儿童分别为34.2%（24.3 - 44.1）和16.6%（11.2 - 22.0），p < 0.0001。
这些结果表明，生理测量显示的缺铁患病率显著高于基于WHO现行指南的患病率。明显健康的女性和幼儿中基于生理指标的血清铁蛋白阈值的一致性，为实现不同人群缺铁阈值的循证协调提供了一种潜在方法。使用基于生理指标的血清铁蛋白阈值有助于检测缺铁的临床和功能后果。
无。
