Iron Deficiency in Women: A Silent Threat and Urgent Need for Action

Let’s delve into the concerning underdiagnosis of iron deficiency, particularly nonanemic iron deficiency (NAID), in women. The Barton et al. study examined a large cohort of women in the US and Canada, revealing a significant prevalence of NAID:

  • Prevalence Spectrum: Depending on the definition used, NAID prevalence ranged from 3.12% to 15.33%. This highlights a spectrum of iron deficiency, where many women (potentially exceeding 15%) may have inadequate iron stores despite not meeting full-blown iron deficiency anemia (IDA) criteria.

Racial and Ethnic Disparities in Numbers:

The study identified a troubling disparity. Black and Hispanic women exhibited a significantly higher prevalence of NAID compared to Asian or White women. Here’s a breakdown by reported race/ethnicity:

  • Black or Hispanic: Prevalence likely above 15.33% (highest in the study)
  • Asian or White: Prevalence below 7.43% (WHO definition)

Potential Underdiagnosis Due to Low Ferritin Thresholds?

The article raises concerns about the current ferritin levels used to diagnose iron deficiency. These thresholds might be too low, particularly for women at high risk. This suggests a potential underestimation of NAID prevalence. Here’s the breakdown of current thresholds and a proposed alternative:

  • Current Thresholds:
    • World Health Organization (WHO): Ferritin < 15 ng/mL
    • National Health and Nutritional Examination Survey (NHANES): Ferritin < 25 ng/mL
  • Proposed Threshold: Ferritin < 30 ng/mL (generally accepted for adults, but potentially even lower for women at high risk)

Iron Deficiency’s Impact on Women’s Health:

Iron deficiency, even in its nonanemic form, can have significant consequences for women:

  • Fatigue and weakness
  • Impaired cognitive function
  • Restless legs syndrome
  • Increased risk of complications during pregnancy (for both mother and baby)

A Call for Change with Specific Actions:

The article emphasizes the need for specific actions to address these issues:

  • More Precise Diagnosis: Implement ferritin thresholds specifically tailored for women, potentially starting at < 30 ng/mL, to improve NAID detection.
  • Targeted Public Health Initiatives: Develop and implement programs focusing on screening and treatment for NAID, with a particular focus on Black, Indigenous, and women of color (considering their higher prevalence).
  • Addressing Systemic Barriers: Dismantle structural racism and sexism within the healthcare system, ensuring equitable access to diagnosis and treatment for all women experiencing NAID.


NAID is a preventable yet widespread condition with serious health consequences for women. By adopting more accurate diagnostic practices, implementing targeted public health initiatives, and dismantling healthcare disparities, we can ensure timely diagnosis, effective treatment, and improved health outcomes for all women. This not only benefits individual well-being but also fosters a more equitable healthcare system.

Posted June 2024.

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