Reduce iron deficiency among children and females of childbearing age - Children aged 3 to 4 years

	Baseline											Target
Objective	Year	Baseline	1998	1999	2000	2001	2002	2003	2004	2005	2006	2010

19-12c Iron deficiency in nonpregnant females (aged 12
to 49 years)	1988-94	11%	---	---	12%	---	---	---	---	---	---	7%
Race and ethnicity
American Indian or Alaska Native only	1988-94	DSU	---	---	DSU	---	---	---	---	---	---	7%
Asian or Pacific Islander only	1988-94	DNA	---	---	DNC	---	---	---	---	---	---	7%
Asian only	1988-94	DNC	---	---	DSU	---	---	---	---	---	---	7%
Native Hawaiian or Other Pacific Islander only	1988-94	DNC	---	---	DSU	---	---	---	---	---	---	7%
Black or African American only	1988-94	15%	---	---	DNA	---	---	---	---	---	---	7%
White only	1988-94	10%	---	---	DNA	---	---	---	---	---	---	7%
2 or more races	1988-94	DNC	---	---	DSU	---	---	---	---	---	---	7%
American Indian or Alaska Native; White	1988-94	DNC	---	---	DSU	---	---	---	---	---	---	7%
Black or African American; White	1988-94	DNC	---	---	DSU	---	---	---	---	---	---	7%
Hispanic or Latino	1988-94	DSU	---	---	DSU	---	---	---	---	---	---	7%
Mexican American	1988-94	19%	---	---	22%	---	---	---	---	---	---	7%
Not Hispanic or Latino	1988-94	DNA	---	---	DNA	---	---	---	---	---	---	7%
Black or African American only, not Hispanic or Latino	1988-94	15%	---	---	19%	---	---	---	---	---	---	7%
White only, not Hispanic or Latino	1988-94	8%	---	---	10%	---	---	---	---	---	---	7%
Family income level
Lower income level (<=130% of poverty threshold)	1988-94	16%	---	---	DNA	---	---	---	---	---	---	7%
Higher income level (>130% of poverty threshold)	1988-94	9%	---	---	DNA	---	---	---	---	---	---	7%
Disability status
Persons with disabilities (persons aged 20 to 49
years)	1991-94	4%	---	---	DSU	---	---	---	---	---	---	7%
Persons without disabilities (persons aged 20 to
49 years)	1991-94	12%	---	---	13%	---	---	---	---	---	---	7%


DATA ISSUES
--- = Data are not available.
BSL = Baseline data available for this year. See Baseline column.
DNA = Data have not been analyzed.
DNC = Data for specific population are not collected.
DSU = Data do not meet the criteria for statistical reliability, data quality, or confidentiality.
NA = Not applicable.


DATA SOURCE
19-12b National Health and Nutrition Examination Survey (NHANES), CDC, NCHS.

Additional Information

Numerator: Number of children aged 3 to 4 years with abnormal results for two or more of the following tests: serum ferritin, free erythrocyte protoporphyrin, or transferring saturation.

Denominator: Number of children aged 3 to 4 years.

Population Targeted: U.S. civilian, noninstitutionalized population.

Blood was collected by phlebotomy. Transferrin saturation was calculated by dividing serum iron by total iron binding capacity. Serum iron and total iron binding capacity were measured colorimetrically (by Alpkem RFA analyzer, Clackamas, Oregon), and 1 percent thiourea was added to complex copper to prevent copper interference. Free erythrocyte protoporphyrin was measured via fluorescence extraction, and serum ferritin was measured with the BioRad Quantimmune IRMA kit (BioRad Laboratories, Hercules, California).

Iron deficiency is defined as abnormal results for two or more of the following tests: serum ferritin, free erythrocyte protoporphyrin, or transferrin saturation. The basis of the use for two of three abnormal tests was the finding that populations with only one abnormal test of these three had scarcely more anemia than those with all normal test results. The prevalence of anemia was substantially elevated in those who had two or three abnormal tests. The selection of threshold values for abnormal results were based on those derived for the previous NHANES (1976-80) by an expert panel, except where (1) evidence existed for changes in assay methods or in changes in other confounding factors like blood lead; and (2) an evaluation of the iron status indicator distribution in a reference group of healthy persons from the 1988-94 NHANES supported a change in the 1976-80 NHANES thresholds.

Threshold values for abnormal results on iron tests vary by age. Abnormal values for serum ferritin concentration are defined as less than 10 �g/L for children aged 1 to 4 years and less than 12 �g/L for females aged 12 to 49 years. Abnormal values for females aged 12 to 49 years. Abnormal values for free erythrocyte protoporphyrin are greater than 1.42 �mol/L for children aged 1 to 2 years (80 �g/dL of red blood cells), and greater than 1.24 �mol/L (70 �g/dL of red blood cells) for other persons. Abnormal values for transferrin saturation are less than 10 percent for children aged 1 to 2 years, less than 12 percent for children aged 3 to 4 years, less than 14 percent for females aged 12 to 15 years, and less than 15 percent for females aged 16 years and older.

The terms anemia, iron deficiency, and iron deficiency anemia are often used interchangeably, but are not equivalent. Anemia can be caused by many factors other than iron deficiency, including other nutrient deficiencies, infection, inflammation, and hereditary anemias. When the prevalence of iron deficiency is high, such as during the third trimester of pregnancy, anemia is a good predictor of iron deficiency. When the prevalence of iron deficiency is low, such as among white, non-Hispanic children aged 3 to 4 years in the United States, the majority of anemia is due to other causes.