Prevalence of Iron Deficiency and Iron Deficiency Anemia in Strenuously Training Male Army Recruits

Abstract

Objectives: The objectives of our study were to determine the effect of strenuous physical training on the prevalence of iron deficiency anemia (IDA), iron deficiency (ID) with normal hemoglobin (Hb), and anemia without ID. Methods: Our study was a prospective observational study. We followed 115 healthy male recruits in the Israel Defense Forces elite units during 15 months of training. Blood samples were collected at recruitment and at 6-, 9- and 15-month follow-ups. Results: Upon recruitment, anemia (Hb < 14 g/dL), ID, and ID anemia (IDA) were diagnosed in 28, 31, and 9% of individuals, respectively. Sixty-three subjects (54%) were followed for 6 months; 9 of them (14%) developed new-onset IDA. Among them, the prevalence of anemia rose from 19 to 52%, and ID from 33 to 35%. At the 15-month follow-up, 29% had developed new-onset IDA and 65% showed evidence of ID. Conclusion: We report a high prevalence of anemia, ID, and IDA among young healthy males participating in prolonged strenuous training programs. These findings can be partly explained by the physiological changes associated with strenuous physical activity. Further investigations aiming to develop specific diagnostic guidelines for this unique population are warranted.

Understanding Iron Deficiency and Exercise: Looking Beyond Ferritin

“…Investigations into the effects of strenuous physical activity on iron status have predominantly concentrated on females, but in this issue of Acta Haematologica , Epstein et al [1] describe the development of iron deficiency (ID) and iron deficiency anemia (IDA) in male soldiers. The prevalence of ID and IDA in recruited males was unexpectedly high.…”

“…It increased significantly following the first 6 months of training, and was attributed to the continuous physical training. Whilst there is an awareness of ID in females, this report by Epstein et al [1] shows that males undertaking arduous military training are also vulnerable to ID. Attention should be paid to the hematological monitoring and nutritional status of male soldiers and athletes to ensure that the detrimental effects of ID are recognized and treated appropriately.…”

“…For example, Epstein et al [1] used the cut-off values < 14 g/dL for hemoglobin (Hb) concentration and < 30 μg/L for serum ferritin (sFer) to define ID and IDA. They acknowledge that this definition is in contrast to that used in much of the literature.…”

“…Epstein et al [1] and Kell and Pretorius [3] question the use of sFer for monitoring the iron status of individuals who undergo physical training. Traditionally, sFer is used as an indicator of whole-body iron status based on tissue ferritin correlating strongly with iron stores.…”

Coping with Iron Deficiency and Iron Deficiency Anemia in Combat Recruits

“…Previous studies indicated that iron status may decline during military training in Israel and in other countries. Recently, Epstein et al [1] found in strenuously training male army recruits after 6 months that the prevalence of anemia rose from 19 to 52% and that of ID from 33 to 35%. During the 15-month follow-up, 29% of the recruits developed new IDA and 65% showed evidence of ID.…”