Iron Deficiency Without Anemia Is Associated with Anger and Fatigue in Young Japanese Women

Abstract

Iron deficiency without anemia (IDNA), the most prevalent nutritional deficiency worldwide, affects young women of reproductive age. This study aimed to elucidate the relationship between IDNA and mental and somatic symptoms including anger and fatigue using the Japanese version of the Cornell Medical Index Health Questionnaire (CMI-J). Data regarding demographic characteristics, anthropometry, hematological, and biochemical indices of the iron status, frequencies of selected food intakes assessed by self-administered food frequency questionnaires (FFQs), frequencies of nonspecific symptoms, and grades of neurotic tendencies assessed by CMI-J were collected from 76 young women aged 18-22 years living in the metropolitan area of Tokyo, Japan. The subjects were classified as having IDNA (hemoglobin (Hb)≥12 g/dL and serum ferritin<20 ng/mL; n=29), having iron deficiency anemia (IDA) (Hb<12 g/dL and serum ferritin<20 ng/mL; n=10), or having a normal iron status (Hb≥12 g/dL and serum ferritin≥20 ng/mL; n=36). One subject was excluded from the analyses because of Hb<12 g/dL and serum ferritin≥20 ng/mL. Fisher's protected least significant difference and the Dwass-Steel-Chritchlow-Fligner multiple comparison tests were used to compare the data of the three groups. P values<0.05 were considered significant. Sections M-R (mental complaints) were significantly higher in the IDNA subjects than in the normal subjects. No significant difference in CMI scores was found between the normal and IDA subjects. Sections I (fatigability), Q (anger), and R (tension) were significantly higher in the IDNA subjects than in the normal subjects, regardless of no significant differences between the normal and IDA subjects in those sections. Young women with IDNA demonstrated a significantly higher proportion of neurotic tendencies (grades II-IV). The intake frequency score of canned or bottled green tea fortified with vitamin C was significantly higher in the IDNA subjects than the IDA subjects. The findings suggest that IDNA may be a risk factor for anger, fatigue, and tension in women of childbearing age.

Iron deficiency without anaemia is a potential cause of fatigue: meta-analyses of randomised controlled trials and cross-sectional studies

“…Observational studies also found a significant association of IDNA with human psychology and behaviour. Sawada et al (21) reported that women with IDNA had higher anger and tension in addition to increased fatigue. Lozoff et al (49) reported that infants with Fe deficiency (with or without anaemia) had unfavourably altered social-emotional behaviour.…”

“…The outcomes of cross-sectional studies are also controversial. On the basis of the cross-sectional studies, Piednoir et al (19) , Comin-Colet et al (20) and Sawada et al (21) found a positive and significant association between IDNA and fatigue. Lasocki et al (22) found that IDNA was associated with some increased fatigue scores.…”

Impact of preconceptional micronutrient supplementation on maternal mental health during pregnancy and postpartum: results from a randomized controlled trial in Vietnam

“…These findings were the same for the per-protocol analysis, which included women who consumed the supplements for at least 6 months prior to conception. Iron deficiency and anemia have been associated with fatigue [32, 33] and increased post-partum depressive symptoms [12], and it is possible that prenatal IFA supplements, which were received by all women after conception, may have benefited all women. The lack of differences by intervention groups in weight or anemia both during pregnancy and early post-partum also suggest possible attenuation of the preconception intervention.…”

Review article: treating‐to‐target for inflammatory bowel disease‐associated anaemia

“…Fatigue is a hugely challenging symptom to treat in IBD patients and appears to be associated with additional symptoms including self‐perceived higher disease activity, poor sleep quality, anxiety and depression and increased work impairment . Unsurprisingly, ID has a huge impact on patient‐reported outcomes (PROs) in both IBD and non‐IBD patients, such as quality of life, work capacity, cognitive performances, emotional well‐being and fatigue . Despite this, ID is generally not systematically screened for in IBD patients.…”