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The Association between Iron and Vitamin D Status in Female Elite Athletes
Open accessAbstract
Vitamin D may influence iron metabolism and erythropoiesis, whereas iron is essential for vitamin D synthesis. We examined whether vitamin D deficiencies (VDD) are associated with reduced iron status and whether progressive iron deficiency (ID) is accompanied by inferior vitamin D status. The study included 219 healthy female (14–34 years old) athletes. VDD was defined as a 25(OH)D concentration < 75 nmol/L. ID was classified based on ferritin, soluble transferrin receptor (sTfR), total iron binding capacity (TIBC) and blood morphology indices. The percentage of ID subjects was higher (32%) in the VDD group than in the 25(OH)D sufficient group (11%) (χ2 = 10.6; p = 0.001). The percentage of VDD subjects was higher (75%) in the ID than in the normal iron status group (48%) (χ2 = 15.6; p = 0.001). The odds ratios (ORs) for VDD increased from 1.75 (95% CI 1.02–2.99; p = 0.040) to 4.6 (95% CI 1.81–11.65; p = 0.001) with progressing iron deficiency. ID was dependent on VDD in both VDD groups (25(OH)D < 75 and < 50 nmol/L). The ID group had a lower 25(OH)D concentration (p = 0.000). The VDD group had lower ferritin (p = 0.043) and iron (p = 0.004) concentrations and higher values of TIBC (p = 0.016) and sTfR (p = 0.001). The current results confirm the association between vitamin D and iron status in female athletes, although it is difficult to assess exactly which of these nutrients exerts a stronger influence over the other.
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TL;DR
In 219 healthy female elite athletes, vitamin D deficiency and iron deficiency were mutually associated, with iron deficiency more common in vitamin D-deficient athletes and vitamin D deficiency more common in iron-deficient athletes. The authors conclude that iron deficiency may exert a stronger influence on vitamin D status than vice versa, though the cross-sectional design precludes causal inference.
Key findings
- Among 219 female athletes, 54.3% had 25(OH)D <75 nmol/L (1.8% <25 nmol/L); total iron deficiency was 23.3% (low iron stores 7.3%, latent ID 15.1%, iron deficiency anemia 0.9%).
- Iron deficiency was present in 32% of vitamin D-deficient (<75 nmol/L) athletes vs 11% of vitamin D-sufficient athletes (χ² = 10.6; p = 0.001); vitamin D deficiency was present in 75% of iron-deficient vs 48% of normal-iron-status athletes (χ² = 15.6; p = 0.001).
- Odds ratios for vitamin D deficiency increased with progressive iron deficiency, from 1.75 (95% CI 1.02–2.99; p = 0.040) at ferritin <30 µg/L to 4.6 (95% CI 1.81–11.65; p = 0.001) in latent ID/IDA; ORs for iron deficiency were 3.14 (95% CI 1.56–6.31; p = 0.001) for 25(OH)D <75 nmol/L and 3.18 (95% CI 1.09–9.26; p = 0.030) for <50 nmol/L.
- Iron-deficient athletes had lower mean 25(OH)D (p = 0.000); vitamin D-deficient athletes had lower ferritin (p = 0.043) and iron (p = 0.004) and higher TIBC (p = 0.016) and sTfR (p = 0.001).
Methods
- Cross-sectional study: initially 231 female professional athletes from seven sports (volleyball, handball, rowing, canoe sprint, cycling, speed skating, taekwondo); 12 excluded for acute phase reaction markers, leaving 219 healthy females aged 14–34. Blood was drawn once at various training phases/seasons; 51% were examined April–September.
- Blood assays: 25(OH)D by ELISA; ferritin by immunoturbidimetric method; iron and UIBC spectrophotometrically; TIBC calculated; sTfR by immunoenzymatic kits; morphology on ADVIA 120. Iron deficiency stages used ferritin <16 µg/L, sTfR >8.3 mg/L, TIBC >390 µg/dL, and anemia thresholds Hb <120 g/L, HCT <37%, RBC <4.2 × 10¹²/L.
- Statistics: chi-square tests; multivariate logistic regression with stepwise procedure adjusted for iron/vitamin D deficiency, length of day, in-/outdoor discipline, and age; unadjusted logistic regression for ferritin thresholds and 25(OH)D cutoffs; Mann–Whitney U tests; p < 0.05 considered significant.
Limitations
- Stated: cross-sectional design did not allow definite causal conclusions; lack of international unequivocal thresholds for diagnosing both vitamin D and iron deficiency; no hepcidin or interleukin data; no data on time spent outdoors, nutrient intake, or vitamin D/iron supplementation.
- Evident: single blood sample collected at varied training phases and seasons, with no longitudinal follow-up; all participants were Caucasian female athletes, most from national teams, so findings may not generalize to other populations.
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Claims the paper makes
0 Valid · 1 Not valid · 19 Not checked · 47 Own results and interpretations
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The percentage of ID subjects was higher (32%) in the VDD group than in the 25(OH)D sufficient group (11%) (χ2 = 10.6; p = 0.001).”
- Also stated in: § 3. Results · plain
“In the first case, iron deficiency was present in 32% of 25(OH)D deficient subjects, compared with 11% in the vitamin sufficient group (χ2 = 10.6; p = 0.001).”
§ The Association between Iron and Vitamin D Status in Female Elite Athletes > Abstract
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § 3. Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Logistic regression analysis (Table 3), expressed as the odds ratio (OR), with a 95% confidence interval (95%CI), indicated that in female athletes, vitamin D deficiency was significantly (p = 0.01) affected by two factors: the length of day (OR = 2.29; 95% CI 1.28–4.07; p = 0.005) and iron deficiency (OR = 2.96; 95% CI 1.45–6.02; p = 0.003).”
§ The Association between Iron and Vitamin D Status in Female Elite Athletes > 3. Results
hedgedstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Additionally, in the group with reduced vitamin D concentration, lower mean values of some hematological indices in reticulocytes (CHr, p = 0.049 and MCVr, p = 0.020) were observed, although the mean value of RBC in this group was higher (p = 0.029).”
§ The Association between Iron and Vitamin D Status in Female Elite Athletes > 3. Results
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Additionally, in the group with reduced vitamin D concentration, lower mean values of some hematological indices in reticulocytes (CHr, p = 0.049 and MCVr, p = 0.020) were observed, although the mean value of RBC in this group was higher (p = 0.029).”
§ The Association between Iron and Vitamin D Status in Female Elite Athletes > 3. Results
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The gradual increase in OR, from 1.75 (95% CI 1.02–2.99) at 30 µg/L ferritin to 4.60 (95% CI 1.81–11.65), in athletes with stage II ID and IDA suggests that disorders in vitamin D synthesis can arise along with worsening iron status.”
§ The Association between Iron and Vitamin D Status in Female Elite Athletes > 4. Discussion
hedgedstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ The Association between Iron and Vitamin D Status in Female Elite Athletes > 2. Material and Methods > 2.4. Statistical Analysis
“the risk of iron deficiency in subjects with 25(OH)D concentrations below 25 and 75 nmol/L.”
§ The Association between Iron and Vitamin D Status in Female Elite Athletes > 3. Results
“The ORs for those groups were 3.14 (95% CI 1.56–6.31; p = 0.001) and 3.18 (95% CI 1.09–9.26; p = 0.030), respectively”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ The Association between Iron and Vitamin D Status in Female Elite Athletes > 3. Results
“3.56”
§ The Association between Iron and Vitamin D Status in Female Elite Athletes > 3. Results
“(95% CI 1.6–3.12; p = 0.002)”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ The Association between Iron and Vitamin D Status in Female Elite Athletes > 2. Material and Methods > 2.2. Blood Analysis
“mean cellular hemoglobin content (CHr)”
§ The Association between Iron and Vitamin D Status in Female Elite Athletes > 4. Discussion
“mean corpuscular hemoglobin concentration (CHr)”
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Reveal the Myths about Role of Vitamin D Level on Some Hematological Parameters
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Vitamin D – das Leistungshormon im Spitzensport
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Association of Inflammatory Markers with Vitamin D Deficiency in Adult Population
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Iron deficiency in athletes: Prevalence and impact on VO2 peak
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Metadata
- Authors
- Malczewska-Lenczowska, J., Sitkowski, D., Surała, O., Orysiak, J., Szczepańska, B., & Witek, K.
- Affiliations
- Department of Nutrition Physiology and Dietetics, Institute of Sport, National Research Institute, Trylogii 2/16, 01-982 Warsaw, Poland
- Instytut Sportu (PL)
- ORCID
- Venue
- Nutrients
- Publisher
- MDPI AG
- Published
- 2018-01-31
- Volume
- 10
- Issue
- 2
- Pages
- 167
- ISSN
- 2072-6643 (ISSN-L)
- PMC
- PMC5852743
- OpenAlex
- W2791208338
- Semantic Scholar
- 711c2433c381305b58f1bcf72bfd3c777e9b8af4
- Cited by
- 76
- References
- 54
- Citations by year
- 2026: 4 · 2025: 13 · 2024: 14 · 2023: 12 · 2022: 11 · 2021: 8 · 2020: 7 · 2019: 6
- FWCI
- 3.81
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Nutrients (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- Funders
- the Ministry of Sport and Tourism of the Republic of Poland ((2016))
- the Ministry of Science and Higher Education of the Republic of Poland ((2015-2017))
- Topics
- Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Vitamin D Research Studies
- Health Sciences › Medicine › Biochemistry (medical) › Antioxidant Activity and Oxidative Stress
- Keywords
- vitamin D deficiency, iron deficiency, iron status, female athletes, 25-hydroxyvitamin D, ferritin, soluble transferrin receptor, total iron binding capacity, erythropoiesis, iron metabolism, vitamin D synthesis
- MeSH terms
- Iron Deficiencies, Adolescent, Adult, Female, Ferritins, Health Status, Humans, Iron, Physical Fitness, Poland, Receptors, Transferrin, Vitamin D, Vitamin D Deficiency, Biomarkers, Multivariate Analysis, Chi-Square Distribution, Logistic Models, Odds Ratio, Anemia, Iron-Deficiency, Young Adult, Athletes
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-11-14, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-11-14 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
