Pakistan Journal of Science (Vol. 62 No.

4 December, 2010)

ANEMIA IN ADOLESCENT COLLEGE GIRLS: EFFECT OF AGE, NUTRITIONAL

STATUS AND NUTRIENT INTAKE.

S. Hanan, A. H. Gilani* and I. U. Haq**

Dept: Rural Home Economics, University of Agriculture, Faisalabad.

*
Eminent Scholar, Higher Education Commission, Dept: Rural Home Economics, University of Agriculture,
Faisalabad. **Head Clinical Laboratory, Allied Hospital, Faisalabad.

ABSTRACT: A study was conducted to determine the prevalence of Iron deficiency anemia (IDA)
in apparently healthy adolescent college girls. Anthropometry, hematology and nutrient intakes of fifty
girls were recorded. The overall prevalence of IDA was 26 percent .The mean Haemoglobin (Hb) in
non- anemic girls was 13.040.13 g/dl and in anemic girls it was 10.20.45 g/dl. Similarly Packed cell
volume (PCV) was 36.20.39 percent in non-anemic and 29.50.73 percent in anemic girls.Mean cell
volume (MCV) was 82.22.34 um3 in non- anemics against 74.33.18 um3 in anemics. Thirty eight
percent girls were underweight having Body mass index (BMI>18.5) out of which 42.07 percent were
anemic. Sixty percent of girls had normal BMI of which 13.3 percent were anemic. In terms of nutrient
intake only 20 percent of the girls consumed energy according to Recommended Dietry Allowances
(RDA) and another similar number could meet 90 percent of the RDA. Only eight percent of the girls
met RDA for protein and another 18 percent could meet 90 percent of the RDA. Forty six percent girls
satisfied their needs for iron according to RDA and another 14 percent could meet 90 percent of the
RDA.
Key words: Anemia; Adolescent girls; BMI; Nutrient intake.

INTRODUCTION MATERIALS AND METHODS

Adolescence is a transitional period from
childhood to adulthood during which certain problems
may influence their future health and is considered as the
best time to intervene, to assist physical development and
to prevent later maternal anemia (Pande, 2003).
Iron deficiency anemia (IDA) is the most wide
spread nutritional deficiency affecting 3.5 billion people
and especially 42.3 percent girls in developing countries
(WHO, 2005). In Pakistan more than 40 percent of total
female population is anemic. This includes 35 percent
girls of 15-19 yrs of age (PMRC, 1998). Iron has several
functions in the body. It serves as a carrier of Oxygen as
hemoglobin and as an integral part of enzyme systems
especially of respiration (Bothwell, 1979). In adolescent
girls it occurs due to heavy menstrual blood loss,
inadequate iron intake, poor bioavailabilty and increased
need of iron (Fomon et al. 2003)
IDA in adolescent girls causes reduced physical
and mental capacity, diminished concentration in work
and educational performance (Sen and Kanani, 2005) and
also poses a major threat to their future safe motherhood.
Studies conducted in the past on anemia were mainly
focused on children and pregnant women. Work on
adolescent girls is scanty and needs attention. The aim of
the study was to determine the IDA and its grades in girls
of low socio-economic status. It was also desired to
analyze blood of these girls and assess their nutrient
intakes.
The study was carried out on 50 apparently
healthy college girls aged 16-21 years who voluntarily
consented to participate. Measurement of body weight
and height were made to evaluate nutritional status based
on BMI. Dietary intake was recorded by 24 hour recall
method. Energy, Protein and Iron intakes were calculated
from the food consumed using food composition table for
Pakistan (Khan, 2001). Blood samples were collected for
hematological measurements. Blood was collected in the
morning through venipuncture and analyzed by auto
blood analyzer (C-720 device) at Pathology lab Allied
Hospital, for the determination of haemoglobin,
hematocrit, mean corpuscular volume, mean corpuscular
haemoglobin and mean corpuscular haemoglobin
concentration. Serum iron and Total iron binding capacity
were also determined. For morphological examination of
RBC, peripheral blood film was made and stained with
Geimsa.
RESULTS AND DISCUSSION
The prevalence and grades of anemia are shown
in Fig I. The overall prevalence of anemia was 26
percent. The type of anemia assessed by Peripheral blood
film indicated 68 percent noromochromic- normocytic
while 28 percent (6 percent among non-anemic and 22
percent among anemic) had grade I microcytic

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hypochromia and only 4 percent had grade II microcytic
hypochromia.
Fig I Grades of anemia in adolescent college girls.
Various hematological values of girls under
study are shown in Table 1. In adolescent girls the mean
Hb was found to be 13.04 in non anemic against 10.2 g/dl
in anemic.
Reduced PCV and MCV were observed among
anemics, confirming the prevalence of hypochromic
microcytic IDA. The reduced Hb, PCV and MCV values
of anemic individuals are in agreement with the results
reported in literature (Shah and Gupta, 2005). Sultan
(2007) also showed similar results in college girls of
Sharjah.
It may be seen that though the RBC count, MCH
and MCHC in anemic girls reduced than there normal
counter parts these were just within normal range due to
less severity of anemia (Hassan, 2005). Serum iron in
anemics was little above the lower level of normal range
showing prevalence of mild IDA and confirms that girls
were in their pre-latent phase of iron deficiency. Ahmed
et al. (2000) also reported that mean values were within
normal range due to less severity of anemia. However,
Foo et al. (2004) observed lower than normal reserved
iron indicating more severity of anemia in those regions.
TIBC was raised to 430 g/dl in anemic girls than their
normal counterparts indicating chronic iron deficiency
anemia.

Table 1 Blood values of girls

Reference
Haematological Parameters Overall Non-Anemic Anemic
Values*
Haemoglobin (Hb) g/dl 12-14 12.310.23 13.040.13 10.20.45
Packed cell volume (PCV) % 35-55 34.500.54 36.20.39 29.50.73
Mean corpuscular volume (MCV) m3 75-100 78.771.94 82.22.34 74.33.18
Red blood cell count (RBC). million/mm3 3.5-5.5 4.340.09 4.450.10 4.020.15
Mean corpuscular haemoglobin (MCH) Pg 25-35 28.980.66 29.10.62 261.64
Mean corpuscular hemoglobin conc.(MCHC) g/dl 31-38 35.760.35 36.10.32 340.98
Serum iron (S. Iron) g/dl 60-160 83.485.85 91.316.60 7212.29
Total iron binding capacity (TIBC) g/dl 250-400 333.2417.01 29715.94 43033.93
* Reference values of Hb, PCV, MCV, RBC, MCH, MCHC,Serum iron and TIBC are adopted of Pathology Lab., Allied Hospital.,
Faisalabad.

Table 2 Different types of anemia as affected by age and BMI

Non-IDA (n=37) IDA (n=13)

Sociodemographic
Total (%) Mild (Hb, 10.1- Moderate (Hb,7-10 Severe F value
Variables.
11.9 g/dl) g/dl) (Hb ,<7 g/dl)
Age
16-17 yrs 10(20%) 8(80%) 1(10%) 1(10%) ---------
18-19 yrs 31(62%) 23(74.1%) 6(19.3%) 2(6.4%) 1(11.1%)
20-21 yrs 9(18%) 6(66.6%) 2(22.2%) --------
Nutritional status(BMI)
<18.5(underweight) 19(38%) 11(57.8%) 5(26.3%) 2(10.5%) 1(5.26%)
18.5-24.9(normal) 30(60%) 26(86.6%) 4(13.3%) ---------- ----------
>24.9(overweight) 1(2%) ---------- -------- 1(100%) ----------

Mild, moderate and severe anemia as 18,6 and 2
percent respectively is shown in Table 2. The prevalence
of IDA increased with increasing age. The increasing
trend of IDA with age is indicative of variation in diet,
activity, chronic disease, parasitic infestation, stress,
heavy menstrual blood loss, etc. Kim et al. (1998)
reported that with increase in age from 10 to 18 years,
prevalence increased from 0.8 to 19 percent. It was
commented that this happened due to iron deficient diet
and heavy menstrual blood loss ( Al-Quaiz, 2001)

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It was also found that 19(38%) girls were upto 90 percent of the RDA and 24 had protein intake
underweight including 8(42.07%) anemic girls having less than 90 percent but more than 50 percent of the
BMI <18.5 indicating the acute or chronic malnutrition, RDA, however 10 girls were consuming protein less than
while 30(60%) girls had normal BMI. and only 1 anemic 50 percent .Contrarily 2 anemic girls met the protein
girl was overweight having BMI>24.9. The results requirement of the RDA, 8 girls had less than 90 percent
indicated that malnourishment was the major cause of but more than 50 percent of the RDA. However, 3 anemic
anemia leading to low BMI. Although the results are girls were consuming protein less than 50 percent of the
apparently significant but statistically non significant due RDA. This further indicated that the girls did not
to small sample size and short difference among ranges. consume protein to meet the RDA with worse condition
Table 3 shows the number of girls consuming in anemic than non-anemic.
energy, protein and iron according to RDA. The
recommended dietary allowance of energy for young Table 3. Nutrients intake of adolescent girls according
Pakistani females has been fixed at 2150 Kcal per day to RDA
(Khan, 2001). The mean energy intakes of non-anemic
and anemic girls were 1808.63 and 1844.4 Kcal, No. of girls
respectively indicating energy malnutrition. It has been Nutrients Total Non- Anemic
reported that half of the Pakistani population has less anemic girls.
caloric intake than standard requirement, further 50 Energy (RDA 2150 Kcal/day)*
percent women have been stated to have caloric intake According to RDA 10 8 2
90% of RDA 10 8 2
below RDA (GOP, 2002). The present study showed that >90% of RDA but < 50% of RDA 25 16 9
anemic girls had low caloric intake, these findings are in > 50% of RDA 5 5
agreement with those reported by Foo et al. (2004) Protein (RDA 66.8 g/day)*
reported that out of 199 apparently healthy adolescents, According to RDA 4 2 2
91 percent had overall mean intake of energy as 1579.5 90% of RDA 9 1 8
Kcal and in girls 1474.3 Kcal. Most of the nutrients > 90% of RDA but < 50% of RDA 27 24 3
below recommended levels of Malaysian RDA. >50% of RDA 10 10
Out of 37 non-anemic girls only 8 girls Iron (RDA 18 mg/day)**
According to RDA 23 17 6
consumed the energy according to RDA, another 8 girls
90% of RDA 7 4 3
had energy intake upto 90 percent of the RDA and >90% of RDA but < 50% of RDA 18 14 4
sixteen girls had energy intake less than 90 percent but >50% of RDA 2 2
more than 50 percent of the RDA. However, 5 girls were * RDA for Energy and Protein (Khan, 2001) **RDA for Iron (DRI,
consuming energy less than 50 percent of the RDA. 1998)
Contrary to it only 2 anemic girls met the RDA The recommended dietary allowance of Iron for
requirements for energy, another 2 consumed the energy Young Pakistani female has been fixed at 18 mg (Khan,
upto 90 percent of the RDA and nine had energy 2001). The mean iron intakes of non- anemic and anemic
consumption below 90 percent but above 50 percent of girls were 18.76 vs 18.16 mg/day, respectively Out of 37
the RDA. This indicated that the girls under study did not non- anemic girls, 17 girls consumed the iron according
consume adequate amount of energy. The condition being to RDA, whereas 4 had iron intake upto 90 percent of the
worse in anemic than non-anemic .Kurniwan et al. (2006) RDA, while 9 girls had iron intake less than 90 percent
reported that 50 percent anemic girls were underweight, but more than 50 percent of the RDA. However, 2 girls
indicating chronic energy deficiency. They inferred that were consuming iron less than 50 percent of the RDA. In
these were due to inadequate dietary intake. anemic girls six met the RDA requirement for iron, 3
The recommended dietary allowance of protein consumed the iron, upto 90 percent while 4 had iron
for young Pakistani female has been fixed at 66.8 g/day consumption below 90 percent but above 50 percent of
(Khan, 2001). The mean protein intakes of non-anemic RDA. This indicated that like energy 60 percent of the
and anemic girls were 43.6 and 44.5g/day, respectively girls consumed reasonably good amount of iron.
indicating protein malnutrition which was almost equal in Although the mean intake of iron was less than normal, it
non-anemic and anemic girls. Further the protein was derived mainly from cereals and vegetables which
consumed by the girls had being of plant origin. had low bioavailability Thanckachan et al. (2007) also
Kurniwan et al. (2006) reported that average reported low intake of heme iron. Kim et al. (1998) who
consumption of protein among anemic and non-anemic commented that absorption of iron might have been
subjects were 43.8 vs 45.3 g/day being below than decreased due to heavy menstrual blood loss. The results
Indonesian RDA. This may be due to more consumption of the present study agree with those of Akhter et al.
of vegetable and cereal based diet while animal food (2005) who reported that daily iron intake of Pakistani
products were inadequate. Out of 37 non-anemic girls population was two times higher than RDA, but its
only 2 had the protein intake according to RDA. One

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bioavailability is low due to food composition habbits. It
may be concluded that dietary factors superimposed on
physical growth spurt in adolescent girls.
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