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Cited by 26Iron Metabolism and DisordersCardiovascular Effects of ExerciseErythropoietin and Anemia Treatment

The DOI matches its Crossref record; 36 of the 36 references it cites were found in a registry or an index; none of the 27 sources its claims cite is checked for support yet.

Iron Deficiency and Anemia in Male and Female Adolescent Athletes Who Engage in Ball Games

Open access
Nicotra, Daniela, Arieli, Rakefet, Redlich, Noam, Navot-Mintzer, Dalya, Constantini, Naama W.·2023·Journal of Clinical Medicine
DOI 10.3390/jcm12030970PMC PMC9918288
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Abstract

The aim of this study was to assess the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) among male adolescent athletes who participate in non-calorie-restricting sports, and to compare the results with female athletes of the same age and sports. Data of the hemoglobin concentration (Hb) and serum ferritin (sFer) levels of male (n = 350) and female (n = 126) basketball and football players, aged 11–18, from two sport medicine centers in Israel were gathered and analyzed. Mild ID was defined as sFer ≤ 30 µg/L, moderate as sFer ≤ 20 µg/L, and severe as sFer ≤ 10 µg/L. IDA was defined as sFer ≤ 20 µg/L and Hb < 13 g/dL for males and sFer ≤ 20 µg/L and Hb < 12 g/dL for females. The prevalence of mild ID was 41.1% and 53.2%, moderate was 17.4% and 27.8%, and severe was 2% and 4.8% in males and females, respectively. The prevalence of IDA was 2.6% in males and 4% in females. Mild and moderate ID was significantly higher among females. In conclusion, non-anemic ID, which is known to be common among female athletes, especially in sports requiring leanness, is also highly prevalent among adolescent males playing ball games. Therefore, screening for hemoglobin and sFer is recommended for young athletes of both genders and in all sports.

Overview

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TL;DR

This cross-sectional study of 476 Israeli adolescent basketball and football players found that non-anemic iron deficiency is highly prevalent in male athletes (41.1%), a group not typically screened, with mild and moderate ID significantly higher in females. The authors recommend annual blood count and serum ferritin screening for adolescent athletes of both genders and all sports.

Key findings

  • Mild ID (sFer ≤ 30 µg/L) prevalence was 41.1% (n = 144) in males and 53.2% (n = 67) in females; moderate ID (sFer ≤ 20 µg/L) was 17.4% (n = 61) and 27.8% (n = 35); severe ID (sFer ≤ 10 µg/L) was 2% (n = 7) and 4.8% (n = 6), respectively.
  • IDA (sFer ≤ 20 µg/L plus Hb < 13 g/dL for males, < 12 g/dL for females) prevalence was 2.6% (n = 9) in males and 4% (n = 5) in females.
  • Mild and moderate ID were significantly higher among females; severe ID and IDA were also higher in females but not statistically significant. No difference was found between basketball and football players in either gender.
  • Sub-analysis by age showed significant gender differences in mild and moderate ID only in the 15–18 age group; no significant gender differences in IDA in either age group. Anemia (Hb < 13 g/dL) prevalence among male athletes was 10.4%, higher than the 4% reported for the general worldwide population.

Methods

  • Cross-sectional design using blood count and ferritin data from medical files of two Israeli sport medicine centers (Shaare Zedek Medical Center, Jerusalem; Wingate Institute) collected between 2017 and 2020.
  • 350 male athletes (mean age 14.5 ± 1.7; 164 football, 186 basketball) and 126 female athletes (mean age 14.8 ± 1.2; 29 football, 97 basketball), aged 11–18, all training at least five times weekly for at least 90 min per session in a competitive league; athletes without sFer data were excluded.
  • ID defined as sFer ≤ 30 µg/L (mild < 30, moderate < 20, severe < 10); anemia as Hb < 13 g/dL (males) or < 12 g/dL (females); IDA as sFer ≤ 20 µg/L plus the respective Hb cutoff. Prevalence with 95% CI estimated; χ² and Fisher's exact tests for categorical comparisons, two-sample t tests for quantitative variables (SPSS v.27.0).

Limitations

  • Stated by the authors: cross-sectional design with no non-athlete control group; 60% of female and 5% of male athletes at the Wingate Institute received nutritional guidance including iron supplementation, possibly affecting results (especially in females); no dietary/eating-habit questionnaire data could be included; blood analyses were performed in several laboratories according to the athlete's HMO.
  • Evident from the text: the female sample was heavily skewed toward basketball (97 BB vs. 29 FB), limiting sport-specific comparisons in that group; the authors also note there is no consensus on the sFer cutoff for ID (values from 10–50 µg/L in the literature), which complicates comparison across studies.

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Registry

Crossref · 10.3390/jcm12030970

Cites

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Figures

Figure 1 Males’ and females’ iron deficiency and iron deficiency anemia frequencies and a comparison between gender groups. Mild ID = sFer ≤ 30 µg/L; moderate ID = sFer ≤ 20 µg/L; severe ID = sFer ≤ 10 µg/L. IDA = sFer ≤ 20 µg/L and Hb < 13 g/dL or Hb < 12 g/dL for males and females, respectively. ID and IDA were calculated with a 95% confidence interval. † Indicates the use of χ2 test. ‡ Indicates the use of Fisher’s exact test.
Figure 1 Males’ and females’ iron deficiency and iron deficiency anemia frequencies and a comparison between gender groups. Mild ID = sFer ≤ 30 µg/L; moderate ID = sFer ≤ 20 µg/L; severe ID = sFer ≤ 10 µg/L. IDA = sFer ≤ 20 µg/L and Hb < 13 g/dL or Hb < 12 g/dL for males and females, respectively. ID and IDA were calculated with a 95% confidence interval. † Indicates the use of χ2 test. ‡ Indicates the use of Fisher’s exact test.CC BY · PubMed Central

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Citations

Cites

Research works printed but not linked: 1

  1. Harrison, T., and Kasper, D. (2015). Harrison’s Principles of Internal Medicine, McGraw-Hill Medical Publ. Division.

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Metadata

Authors
Nicotra, D., Arieli, R., Redlich, N., Navot-Mintzer, D., & Constantini, N. W.
Affiliations
  • Hebrew University of Jerusalem (IL)
  • Shaare Zedek Medical Center (IL)
  • The Ribstein Center for Sports Medicine and Research, Wingate Institute, Netanya 42902, Israel
Corresponding author
Nicotra, Daniela
ORCID
Venue
Journal of Clinical Medicine
Publisher
MDPI AG
Published
2023-01-27
Volume
12
Issue
3
Pages
970
ISSN
2077-0383 (ISSN-L)
DOI
10.3390/jcm12030970
PMC
PMC9918288
OpenAlex
W4318485867
Semantic Scholar
89eabfe56a2046bd5b9f479672834c6480c2d035
Cited by
26
References
36
Citations by year
2026: 10 · 2025: 4 · 2024: 7 · 2023: 5
FWCI
4.87
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Clinical Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
  • Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
Keywords
iron deficiency, iron deficiency anemia, youth athletes, sex differences, serum ferritin, hemoglobin, basketball, football, ball games, prevalence, screening

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