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

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.