Nutrition Research and Practice

The Korean Nutrition Society (한국영양학회)
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Factors associated with anemia among female adult vegetarians in Malaysia

  • Chai, Zi Fei (Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia) ;
  • Gan, Wan Ying (Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia) ;
  • Chin, Yit Siew (Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia) ;
  • Ching, Yuan Kei (Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia) ;
  • Appukutty, Mahenderan (Sports Science Programme, Faculty of Sport Science and Recreation, University Teknologi MARA)
  • Received : 2018.11.21
  • Accepted : 2018.01.15
  • Published : 2019.02.01
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Abstract

BACKGROUND/OBJECTIVES: A 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/METHODS: A 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 Blood samples (3 ml) were withdrawn by a nurse from each participant to determine the hemoglobin (Hb) level. RESULTS: The 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. CONCLUSIONS: Anemia 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.

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References

  1. Nath J. 'God is a vegetarian': the food, health and bio-spirituality of Hare Krishna, Buddhist and Seventh-Day Adventist devotees. Health Soc Rev 2010;19:356-68. https://doi.org/10.5172/hesr.2010.19.3.356
  2. Leitzmann C. Vegetarian nutrition: past, present, future. Am J Clin Nutr 2014;100 Suppl 1:496S-502S. https://doi.org/10.3945/ajcn.113.071365
  3. Key TJ, Appleby PN, Rosell MS. Health effects of vegetarian and vegan diets. Proc Nutr Soc 2006;65:35-41. https://doi.org/10.1079/PNS2005481
  4. Henderson L, Gregory J, Swan G. The National Diet & Nutrition Survey: Adults Aged 19 to 64 Years. London: The Stationary Office; 2002.
  5. Piccoli GB, Clari R, Vigotti FN, Leone F, Attini R, Cabiddu G, Mauro G, Castelluccia N, Colombi N, Capizzi I, Pani A, Todros T, Avagnina P. Vegan-vegetarian diets in pregnancy: danger or panacea? A systematic narrative review. BJOG 2015;122:623-33. https://doi.org/10.1111/1471-0528.13280
  6. Craig WJ. Health effects of vegan diets. Am J Clin Nutr 2009;89: 1627S-33S. https://doi.org/10.3945/ajcn.2009.26736N
  7. Pizarro F, Olivares M, Hertrampf E, Mazariegos DI, Arredondo M. Heme-iron absorption is saturable by heme-iron dose in women. J Nutr 2003;133:2214-7. https://doi.org/10.1093/jn/133.7.2214
  8. de Benoist B, McLean E, Egli I, Cogswell M. Worldwide Prevalence of Anemia 1993-2005: WHO Global Database on Anemia. Geneva: World Health Organization; 2008.
  9. Mihrshahi S, Ding D, Gale J, Allman-Farinelli M, Banks E, Bauman AE. Vegetarian diet and all-cause mortality: evidence from a large population-based Australian cohort - the 45 and up study. Prev Med 2017;97:1-7. https://doi.org/10.1016/j.ypmed.2016.12.044
  10. Bedford JL, Barr SI. Diets and selected lifestyle practices of self-defined adult vegetarians from a population-based sample suggest they are more 'health conscious'. Int J Behav Nutr Phys Act 2005;2:4. https://doi.org/10.1186/1479-5868-2-4
  11. Harris CR, Jenkins M, Glaser D. Gender differences in risk assessment: why do women take fewer risks than men? Judgm Decis Mak 2006;1:48-63.
  12. Abdullah B, Moize B, Ismail BA, Zamri M, Mohd Nasir NF. Prevalence of menopausal symptoms, its effect to quality of life among Malaysian women and their treatment seeking behaviour. Med J Malaysia 2017;72:94-9.
  13. Bachman E, Travison TG, Basaria S, Davda MN, Guo W, Li M, Connor Westfall J, Bae H, Gordeuk V, Bhasin S. Testosterone induces erythrocytosis via increased erythropoietin and suppressed hepcidin: evidence for a new erythropoietin/hemoglobin set point. J Gerontol A Biol Sci Med Sci 2014;69:725-35. https://doi.org/10.1093/gerona/glt154
  14. Le CH. The prevalence of anemia and moderate-severe anemia in the US population (NHANES 2003-2012). PLoS One 2016;11:e0166635. https://doi.org/10.1371/journal.pone.0166635
  15. Institute for Public Health (IPH). National Health and Morbidity Survey 2015 (NHMS 2015). Vol. II: Non-Communicable Diseases, Risk Factors & Other Health Problems. Kuala Lumpur: Ministry of Health Malaysia; 2015.
  16. Lilare RR, Sahoo DP. Prevalence of anemia and its epidemiological correlates among women of reproductive age group in an urban slum of Mumbai. Int J Community Med Public Health 2017;4:2841-6. https://doi.org/10.18203/2394-6040.ijcmph20173333
  17. Mahajani K, Bhatnagar V. Comparative study of prevalence of anaemia in vegetarian and non vegetarian women of Udaipur City, Rajasthan. J Nutr Food Sci 2015;S3:1-6.
  18. Kassebaum NJ, Jasrasaria R, Naghavi M, Wulf SK, Johns N, Lozano R, Regan M, Weatherall D, Chou DP, Eisele TP, Flaxman SR, Pullan RL, Brooker SJ, Murray CJ, Pullan RL, Brooker SJ, Murray CJ. A systematic analysis of global anemia burden from 1990 to 2010. Blood 2014;123:615-24. https://doi.org/10.1182/blood-2013-06-508325
  19. Bharati S, Pal M, Som S, Bharati P. Temporal trend of anemia among reproductive-aged women in India. Asia Pac J Public Health 2015;27:NP1193-207. https://doi.org/10.1177/1010539512442567
  20. Aigner E, Feldman A, Datz C. Obesity as an emerging risk factor for iron deficiency. Nutrients 2014;6:3587-600. https://doi.org/10.3390/nu6093587
  21. Choudhary S, Rajnee, Binawara BK. Effect of exercise on serum iron, blood haemoglobin and cardiac efficiency. J Postgrad Med Inst 2012;26:13-6.
  22. Murat S, Ali U, Serdal K, Suleyman D, Ilknur P, Mehmet S, Bahattin A, Tunahan U. Assessment of subjective sleep quality in iron deficiency anaemia. Afr Health Sci 2015;15:621-7. https://doi.org/10.4314/ahs.v15i2.40
  23. Noorazar SG, Ranjbar F, Nemati N, Yasamineh N, Kalejahi P. Relationship between severity of depression symptoms and iron deficiency anemia in women with major depressive disorder. J Anal Res Clin Med 2015;3:219-24. https://doi.org/10.15171/jarcm.2015.034
  24. Gan WY, Boo S, Seik MY, Khoo HE. Comparing the nutritional status of vegetarians and non-vegetarians from a Buddhist organization in Kuala Lumpur, Malaysia. Malays J Nutr 2018;24:89-101.
  25. World Health Organization. Global Physical Activity Questionnaire (GPAQ) Analysis Guide. Geneva: World Health Organization; 2012.
  26. Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales. Sydney: Psychology Foundation of Australia; 1995.
  27. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213. https://doi.org/10.1016/0165-1781(89)90047-4
  28. World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Report of a World Health Organisation Consultation. WHO Technical Report Series 894. Geneva: World Health Organization; 2000.
  29. World Health Organization Regional Office for the Western Pacific. The Asia-Pacific Perspective: Redefining Obesity and its Treatment. Sydney: Health Communications Australia; 2000.
  30. Lee RD, Nieman DC. Nutritional Assessment. New York (NY): McGraw-Hill; 2013.
  31. Tee ES, Mohd Ismail N, Mohd Nasir A, Khatijah I. Nutrient Composition of Malaysian Foods. Kuala Lumpur: Malaysian Food Composition Database Programme, Institute for Medical Research; 1997.
  32. National Coordinating Committee on Food and Nutrition. Recommended Nutrient Intakes for Malaysia. Kuala Lumpur: Ministry of Health Malaysia; 2017.
  33. World Health Organization. Hemoglobin Concentrations for the Diagnosis of Anemia and Assessment of Severity. Geneva: World Health Organization; 2011.
  34. McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO vitamin and mineral nutrition information system, 1993-2005. Public Health Nutr 2009;12:444-54. https://doi.org/10.1017/S1368980008002401
  35. International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3), 2005-06. Mumbai: IIPS; 2007.
  36. Wilson SE. Marriage, gender and obesity in later life. Econ Hum Biol 2012;10:431-53. https://doi.org/10.1016/j.ehb.2012.04.012
  37. Tzotzas T, Vlahavas G, Papadopoulou SK, Kapantais E, Kaklamanou D, Hassapidou M. Marital status and educational level associated to obesity in Greek adults: data from the national epidemiological survey. BMC Public Health 2010;10:732. https://doi.org/10.1186/1471-2458-10-732
  38. Kamruzzaman M, Rabbani MG, Saw A, Sayem MA, Hossain MG. Differentials in the prevalence of anemia among non-pregnant, ever-married women in Bangladesh: multilevel logistic regression analysis of data from the 2011 Bangladesh demographic and health survey. BMC Womens Health 2015;15:54. https://doi.org/10.1186/s12905-015-0211-4
  39. Zhao L, Zhang X, Shen Y, Fang X, Wang Y, Wang F. Obesity and iron deficiency: a quantitative meta-analysis. Obes Rev 2015;16: 1081-93. https://doi.org/10.1111/obr.12323
  40. Qin Y, Melse-Boonstra A, Pan X, Yuan B, Dai Y, Zhao J, Zimmermann MB, Kok FJ, Zhou M, Shi Z. Anemia in relation to body mass index and waist circumference among Chinese women. Nutr J 2013;12:10-2. https://doi.org/10.1186/1475-2891-12-10
  41. Ausk KJ, Ioannou GN. Is obesity associated with anemia of chronic disease? A population-based study. Obesity (Silver Spring) 2008;16: 2356-61. https://doi.org/10.1038/oby.2008.353
  42. Thomson CA, Stanaway JD, Neuhouser ML, Snetselaar LG, Stefanick ML, Arendell L, Chen Z. Nutrient intake and anemia risk in the women's health initiative observational study. J Am Diet Assoc 2011;111:532-41. https://doi.org/10.1016/j.jada.2011.01.017
  43. Alzaheb RA, Al-Amer O. The prevalence of iron deficiency anemia and its associated risk factors among a sample of female university students in Tabuk, Saudi Arabia. Clin Med Insights Womens Health 2017;10:1179562X17745088.
  44. Azadbakht L, Kimiagar M, Mehrabi Y, Esmaillzadeh A, Hu FB, Willett WC. Soy consumption, markers of inflammation, and endothelial function: a cross-over study in postmenopausal women with the metabolic syndrome. Diabetes Care 2007;30:967-73. https://doi.org/10.2337/dc06-2126
  45. Hider RC. Nature of nontransferrin-bound iron. Eur J Clin Invest 2002;32 Suppl 1:50-4. https://doi.org/10.1046/j.1365-2362.2002.0320s1050.x
  46. Goulas A, Triplett EL, Taborsky G. Oligophosphopeptides of varied structural complexity derived from the egg phosphoprotein, phosvitin. J Protein Chem 1996;15:1-9. https://doi.org/10.1007/BF01886805
  47. Onder G, Penninx BW, Cesari M, Bandinelli S, Lauretani F, Bartali B, Gori AM, Pahor M, Ferrucci L. Anemia is associated with depression in older adults: results from the InCHIANTI study. J Gerontol A Biol Sci Med Sci 2005;60:1168-72. https://doi.org/10.1093/gerona/60.9.1168
  48. Pai MF, Hsu SP, Yang SY, Ho TI, Lai CF, Peng YS. Sleep disturbance in chronic hemodialysis patients: the impact of depression and anemia. Ren Fail 2007;29:673-7. https://doi.org/10.1080/08860220701459642

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