Journal List > J Nutr Health > v.52(6) > 1142010

Jang, Park, and Park: Association between vitamin D deficiency and anemia among Korean adolescent girls and young women



Although vitamin D deficiency is common among Korean adolescent girls and young women, few studies have explored the potential health effects of vitamin D deficiency in this vulnerable population. This study examined the association between vitamin D deficiency and anemia in Korean adolescent girls and young women.


The data from the Korea National Health and Nutrition Examination Survey 2008 ~ 2014 were used. A total of 3,643 girls and adult women aged 12 to 29 who provided all the information (including serum 25-hydroxy vitamin D, hemoglobin, and/or serum ferritin) needed for the analysis were included in the analysis. Demographic, lifestyle, and health data were obtained through survey questionnaires. Anemia and iron deficiency anemia were defined according to the World Health Organization cut-offs. Multivariable logistic regression, and restricted cubic spline regression were used in the analysis.


In fully adjusted logistic regression models, the vitamin D deficiency was significantly associated with higher prevalences of anemia (odds ratio (OR): 1.61, 95% confidence interval (CI): 1.04 ~ 2.49) and iron deficiency anemia (OR: 1.43, 95% CI: 1.01 ~ 2.03). In a cubic spline regression model, we observed a dose-response relationship between serum 25(OH)D concentration and anemia, and this linear relationship was also clearly observed between serum 25(OH)D concentration and iron deficiency anemia.


Vitamin D deficiency may be associated with a higher prevalence of iron deficiency anemia and anemia in adolescent girls and young women. Alternatively, vitamin D deficiency may be a concurrent event for patients with anemia, which we cannot distinguish in this cross-sectional study. Further studies are needed to verify the causality in this population of low vitamin D levels.

Figures and Tables

Fig. 1

Odds ratios (95% confidence intervals) for the non-linear relationship between serum 25-hydroxy vitamin D (25(OH)D) concentration and prevalence of (A) anemia and (B) iron deficiency anemia in adolescent girls and young women, evaluated with restricted cubic splines. The model was adjusted for age (continuous), obesity status (obese and non-obese), smoking status (smokers and non-smokers), alcohol consumption (drinkers and non-drinkers), household income (low, mid ~ low, mid ~ high, and high), and physical activity (low, mid, and high). Solid lines, OR; dashed lines, 95% CI.

Table 1

Demographic and lifestyle characteristics of participants according to the serum 25-hydroxy vitamin D (25(OH)D) concentration


Values are n (%)

1) The range of age were 12 ~ 18 years for adolescents and 19 ~ 29 years for young women.

2) Household income was calculated based on equivalised income, and divided into quartiles.

3) Obesity was defined as body mass index percentiles of ≥ 95th in adolescent girls and body mass index of ≥ 25 kg/m2 in young women.

4) Physical activity was calculated as metabolic equivalents (METs-h/week) and categorized as follows: low < 20, mid ≥ 20 to < 40, and high ≥ 40.

5) Adequate levels of sleep duration were defined according to the National Sleep Foundation criteria as follows: 9 ~ 11 hours in 12 ~ 13 years of adolescents, 8 ~ 10 hours in 14 ~ 17 years of adolescents, and 7 ~ 9 hours in 18 ~ 29 years of young women.

Statistical significance is defined as *p < 0.05, **p < 0.01, ***p < 0.001, and NS stands for not significant.

Table 2

Odds ratio and 95% confidence intervals of anemia and iron deficiency anemia according to the serum 25-hydroxy vitamin D (25(OH)D) concentration


1) Anemia was defined according to the World Health Organization criteria as follows: Hemoglobin < 12 g/dL.

2) Iron deficiency anemia was defined as ferritin < 15 ng/mL. Ferritin variable was only available from Korea National Health and Nutrition Examination Survey 2008 ~ 2012, and missing data was n = 576.

Model 1: Unadjusted

Model 2: Adjustment for age (continuous) and obesity status (obese and non-obese)

Model 3: Model 2 plus additional adjustments for smoking status (smokers and non-smokers), alcohol consumption (drinkers and non-drinkers), household income (low, mid ~ low, mid ~ high, and high), and physical activity (low, mid, and high)

Statistical significance is defined as *p < 0.05, **p < 0.01, ***p < 0.001, and NS stands for not significant.


This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (grant number: NRF-2017R1A1A3A04069759). The founding sponsor had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.


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Haeun Jang

Seonghee Park

Kyong Park

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