Factors associated with anemia among female adult vegetarians in Malaysia

Abstract

BACKGROUND/OBJECTIVESA large number of studies on anemia have focused mostly on pregnant women or children. The vegetarian population, which is another potential risk group for anemia, remains largely unexplored. Therefore, this cross-sectional study examined the associations of the sociodemographic, lifestyle, nutritional, and psychological factors with the anemia status among female adult vegetarians.SUBJECTS/METHODSA total of 177 female vegetarians were recruited from a Buddhist and Hindu organization in Selangor, Malaysia. The participants completed a self-administered questionnaire, which analyzed their sociodemographic characteristics, physical activity level, sleep quality, depression, anxiety, and stress. The body weight, height, waist circumference, and body fat percentage of the participants were also measured. A 3-day dietary recall was conducted to assess their dietary intake. Blood samples (3 ml) were withdrawn by a nurse from each participant to determine the hemoglobin (Hb) level.RESULTSThe findings revealed 28.2% of the participants to be anemic. The age group (AOR = 2.46, 95% CI = 1.19–5.05), marital status (AOR = 2.69, 95% CI = 1.27–5.71), and percentage of energy from protein (AOR = 5.52, 95% CI = 1.41–21.65) were the significant predictors of anemia.CONCLUSIONSAnemia is a public health problem among female vegetarians in this study. Health promotion programs that target female adult vegetarians should be conducted to manage and prevent anemia, particularly among those who are married, aged 50 and below, and with an inadequate protein intake.

Association between vegetarian and vegan diets and depression: A systematic review

“…As presented in Table 2, the majority of the included studies ( n = 20, 86%) were published after 2012. Eighteen out of 23 (78%) were cross‐sectional studies (Baines et al, 2007; Beezhold et al, 2010; Chai et al, 2019; Forestell & Nezlek, 2018; Hessler‐Kaufmann et al, 2021; Hibbeln et al, 2018; Hosseinzadeh et al, 2016; Jin et al, 2021; Kapoor et al, 2017; Lavallee et al, 2019; Li et al, 2019; Matta et al, 2018; Meesters et al, 2016; Michalak et al, 2012; Northstone et al, 2018; Norwood et al, 2019; Paslakis et al, 2020; Zamani et al, 2020), three (13%) were cohort studies (Link et al, 2008; Sánchez‐Villegas et al, 2015; Shen et al, 2021), and the remaining two (9%) were RCTs (Agarwal et al, 2015; Beezhold & Johnston, 2012). Six studies were conducted in Europe (Hibbeln et al, 2018; Matta et al, 2018; Meesters et al, 2016; Michalak et al, 2012; Northstone et al, 2018; Sánchez‐Villegas et al, 2015), another six in the US (Agarwal et al, 2015; Beezhold & Johnston, 2012; Beezhold et al, 2010; Forestell & Nezlek, 2018; Jin et al, 2021; Link et al, 2008), two were conducted in Australia (Baines et al, 2007; Norwood et al, 2019), four in Asia (Chai et al, 2019; Hosseinzadeh et al, 2016; Kapoor et al, 2017; Li et al, 2019), and one study combined Europe, Asia and America (a grouping of populations from Germany, Russia, China and the US) (Lavallee et al, 2019).…”

“…In contrast, nine cross‐sectional studies found that adherence to vegetarian diets was associated with an increased risk of depression (Baines et al, 2007; Forestell & Nezlek, 2018; Hibbeln et al, 2018; Kapoor et al, 2017; Li et al, 2019; Matta et al, 2018; Meesters et al, 2016; Michalak et al, 2012; Norwood et al, 2019). Five cross‐sectional studies assessing the relationship between a vegetarian diet and depression found no association between the two (Chai et al, 2019; Hessler‐Kaufmann et al, 2021; Lavallee et al, 2019; Northstone et al, 2018; Paslakis et al, 2020). The Lavallee et al (2019) study, however, found no association between vegetarianism and depression in the US, German and Russian representative samples or in German student samples but found that vegetarianism was related to slight increases over time in anxiety and depression in Chinese students (Lavallee et al, 2019).…”

“…Of the 23 studies, only four (17%) studies were rated as ‘good’ (Beezhold et al, 2010; Hosseinzadeh et al, 2016; Lavallee et al, 2019 and Sánchez‐Villegas et al, 2015), with the remaining 19 (83%) studies rated ‘fair’ (Agarwal et al, 2015; Baines et al, 2007; Beezhold & Johnston, 2012; Chai et al, 2019; Forestell & Nezlek, 2018; Hessler‐Kaufmann et al, 2021; Hibbeln et al, 2018; Jin et al, 2021; Kapoor et al, 2017; Li et al, 2019; Link et al, 2008; Matta et al, 2018; Meesters et al, 2016; Michalak et al, 2012; Northstone et al, 2018; Norwood et al, 2019; Paslakis et al, 2020; Shen et al, 2021; Zamani et al, 2020). A meta‐analysis was not conducted due to the heterogeneity of the studies in terms of assessments and outcomes.…”

“…Moreover, some of the studies were conducted in specific population groups that adopt vegetarian diets due to ethical or religious reasons, for example Buddhists (Shen et al, 2021) and where people are more likely to have grown up as vegetarian or vegan. Only one study (Chai et al, 2019) with a population of 177 participants was conducted in a population (Malaysia), where mainstream religions adopt vegetarianism. This may be important since the reasons or motivations for adopting vegetarianism might reflect mental health status (Rosenfeld, 2019).…”

Maternal diet, nutritional status and infant birth weight in Malaysia: a scoping review

“…This is particularly evident in Indian ethnicity, exposing Indian women to a higher risk of developing iron-deficiency anemia during pregnancy [ 43 – 45 ]. This could be due to the common practices of vegetarian diet among Indians who do not receive adequate iron-rich foods in their meals [ 46 ]. Poverty, low education, and lack of iron-rich sources in food intake are often regarded as reasons to poor dietary intake of iron among women in developing nations [ 41 , 45 , 47 , 48 ].…”