Abstract
Background and objectives: Anemia affects 1.65 billion individuals worldwide, especially young children and women of reproductive age. Anemia prevalence in pregnant women (hemoglobin <110 g/L) in Malaysia is estimated to be 38%. However, there is limited evidence on the prevalence of anemia and iron deficiency anemia (IDA) in non-pregnant Malaysian women and no studies have adjusted ferritin values for inflammation. This cross-sectional study aims to determine the prevalence of anemia and IDA in a sample of healthy non-pregnant Malay and Chinese women (19-45 years) living in Kuala Lumpur, Malaysia. Methods: Fasting blood samples were collected from women living in Kuala Lumpur, Malaysia (n=210) and, for comparison purposes, from women living in Vancouver, Canada (n=206). Malaysian participants were of Malay (n=105) and Chinese (n=105) descent; Canadian participants were of European (n=110) and Chinese (n=96) descent. Samples were analyzed for hemoglobin, plasma vitamin B12, serum retinol binding protein (RBP), serum iron biomarkers (soluble transferrin receptor [sTfR] and ferritin), and acute and chronic inflammation biomarkers (C-reactive protein [CRP] and α-1 acid glycoprotein [AGP]). Results: Anemia (hemoglobin <120 g/L) prevalence was higher in Malaysian women compared to Canadian women (18% and 7%, respectively; p=0.001). In Malaysia, 11% (n=24) of women had IDA (based on hemoglobin <120 g/L and either inflammation- adjusted ferritin <15 µg/L or sTfR >8.3 mg/L), compared to 3% (n=6) of Canadian women. No significant ethnic differences were found among women in anemia or IDA prevalence. Depleted iron stores (inflammation-adjusted ferritin <15 µg/L) were found in 21% of Malaysian women and in 15% of Canadian women. The prevalence of acute (CRP >5 mg/L) and chronic (AGP >1 g/L) inflammation was 7% and <1%, respectively, in Malaysian participants, compared to 4% and <1% in Canadian participants. Adjustment for inflammation (using AGP and CRP biomarkers) did not change the prevalence of IDA in Malaysian or Canadian women. There was no biochemical evidence of vitamin A deficiency (RBP <0.7 µmol/L) and <1% of women had vitamin B12 deficiency (B12 <148 pmol/L) in both populations. Conclusions: These findings suggest that over half the anemia in Malaysian non-pregnant women is attributed to iron deficiency. Further research is required to investigate the prevalence of IDA in a nationally representative sample.