The association between diet quality and prevalence of anemia in an urban population of socioeconomically diverse African American and white adults
Date
2015
Authors
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Publisher
University of Delaware
Abstract
Background- Anemia is a common health concern, especially for premenopausal women and the aging population. Previous research has shown that anemia can increase the risk of morbidity as well as mortality. Approximately one-third of anemia is attributed to nutritional deficiencies, one-third to anemia of inflammation (AI) or chronic disease, and one-third to unexplained etiologies. Diet can clearly play a role in nutritional anemia (NA), but less is known about the possible role of diet on AI or unexplained anemia (UA). Since the human diet is composed of a variety of foods with many nutrients, examining single nutrient intake may not be effective in evaluating the role diet may play in the occurrence of anemia. Overall diet quality may provide evidence to suggest that diet plays a role not only in NA, but also in AI and UA. Objective- The primary aim of this study it to characterize the types of anemia present in an urban population of socio-economically diverse African American and White adults. The secondary aim is to determine if diet quality is associated with each type of anemia. Subjects- The participants were 1,977 Whites and African Americans from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) baseline study conducted between 2004 and 2009. Methods- Two 24-hour dietary recalls were collected with the USDA Automated Multiple Pass Method by trained interviewers. Diet quality was assessed using the Healthy Eating Index (HEI)-2010. Anemia was defined by applying known criteria to fasting blood samples of hemoglobin, serum ferritin, transferrin saturation, and serum B 12 and folate concentrations. Stat analysis- Chi square and one-way analyses of variance were used to compare demographic characteristics of those with anemia and those without anemia. Logistic regression models were conducted to examine the association of HEI-2010 scores and anemia. Only participants with two dietary recalls and all blood biomarkers were included in the analyses. Results- Of the 1,977 HANDLS study participants, 305 (15.4%) were identified as anemic. Of these 305 participants with anemia, 47.5% were diagnosed with anemia of inflammation, 29.8% with unexplained anemia, and 22.6% with nutritional anemia,. Based on unadjusted regression analysis; sex (p<0.01), race (p<0.01), poverty status (p<0.01), food assistance (p<0.05), education level (p<0.01) smoking status (p<0.05), hand grip strength (p<0.01), and BMI (p<0.01) were statistically significant predictors of general anemia. Diet quality as evaluated by HEI-2010 scores, were not significant predictors of general anemia, NA, AI, or UA. Conclusion- Approximately 15% of HANDLS study participants had anemia, with the AI being more prevalent than either NA or UA. Literacy, BMI, and CRP (all associated with diet quality), and handgrip strength (a marker for nutritional status), were all found to be predictors of general anemia. It is possible that no associations were found between anemia and diet quality because anemia reflects long-term dietary patterns and that diet quality as assessed by HEI-2010 only captures recent compliance to dietary guidelines.