Iron-Deficiency Anemia on the Rise in the U.S., Study Shows

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Key Takeaways

  • Iron-deficiency anemia is on the rise in the United States.
  • Americans are eating less red meat, and our food supply contains less iron than it used to, which both account for an increase in iron deficiency.
  • Iron deficiency is more common in females than males, mostly because of blood loss during menstruation.

While many health professionals suggest cutting back on red meat for overall health, a new study published in The Journal of Nutrition shows that iron deficiency anemia may be an unintended consequence.

Iron deficiency can lead to anemia, which is when the blood does not have enough healthy red blood cells. Symptoms of this condition include being pale, feeling tired and weak, having a rapid heartbeat, or feeling shortness of breath when active. Iron deficiency can be diagnosed with a blood test, and treatment includes medicinal doses of iron, which are more potent than supplements.

Iron deficiency is the most common cause of anemia and accounts for up to 50% of anemia cases worldwide. While it can easily be treated when it’s discovered, iron deficiency anemia is also a risk factor for an increased risk of cardiovascular disease, cognitive impairment, depression, and death. It needs to be diagnosed and treated to prevent complications.

Study Results

In the current study, researchers set out to examine the severity of iron deficiency anemia in the U.S., figure out what causes this condition, and what can be done to prevent it. The researchers looked at the daily dietary iron intake and blood iron concentration for more than 30,000 males and more than 30,000 females ages 1 to 85 years.

This data was from the Center for Disease Control and Prevention's (CDC) National Health and Nutrition Examination Survey (NHANES) from 1999-2018. Researchers also looked at mortality data to see how often anemia was used as a disease code as an underlying cause of death.

When it comes to consuming iron-rich foods, women tend to fall short more often than men. Between 1999 and 2018, 18.4% of adult females did not meet daily dietary iron requirements, compared to 4.6% of adult males.

Hongbing Sun, PhD

In adults, females have a higher anemia treatment reported, and higher iron deficiency.

— Hongbing Sun, PhD

Interestingly, not only are we eating fewer iron-rich foods, but the actual food supply is also lower in iron than it used to be. The researchers compared the iron concentration values between 1999 and 2015 for certain foods. They found 1,366 food products with iron concentrations that had changed over time, and 62.1% of these had lower iron concentrations in 2015 than in 1999. The list of foods with less iron covered most food categories, including beef, pork, turkey, corn, and most fruits and vegetables.

The researchers also found that there was a rising trend between 1999 and 2018, where iron deficiency anemia was an underlying cause of death. The mortality rate of females with iron deficiency anemia as the underlying cause of death was 10% higher than that of males. And between 1999 and 2018, 4.5% of U.S. females received anemia treatment, but only 1.4% of U.S. males received treatment for this condition.

“In adults, females have a higher anemia treatment reported, and higher iron deficiency,” says Hongbing Sun, PhD, a professor at Rider University in Lawrenceville, New Jersey, and one of the authors of this study. “There are probably multiple reasons, including a difference in dietary preferences in sexes (such as less meat consumption in women) and iron loss from menstrual bleeding in women.”

Reasons for Increase in Anemia

There are two reasons for the increase in iron deficiency in the U.S., according to Dr. Sun. First, there is a significant shift in meat consumption away from primarily beef—which has relatively higher heme iron concentrations—toward more poultry, which has lower heme iron concentrations.

And, second, there is a reduction of iron concentration in U.S. food products. Although the crop yield per acre increases every year, the iron concentration in the soil does not increase. In fact, the concentration might even decrease because of the intensive agriculture crop takeout.

Crop removal, runoff loss caused by agricultural irrigation, and oxidation retainment of iron from farm activities can contribute to the low iron levels in the soil. In terms of food intake, the shift toward more plant-based eating, and the promotion of chicken and fish over beef, have played a role in Americans' reduced iron intake.

While iron is found in many plant foods, it is in a form called non-heme iron, which is not as well-absorbed by the body as heme iron from beef. Poultry and fish contain heme iron as well but have less iron overall per serving.

Jamie Johnson, RDN, a registered dietitian nutritionist with Ingraining Nutrition, says that there’s iron in many foods, including red meat, chicken, shellfish, beans, tofu, dark leafy greens, whole grains, iron-fortified grains, nuts, and seeds.

But when you’re eating plant-based options that contain non-heme iron, it is important to pair those foods with a source of vitamin C, which can help boost iron absorption. Winning combinations include a spinach and red pepper salad, fortified cereal with strawberries, and chickpeas and broccoli.

What’s Next?

While Dr. Sun says there is no easy solution to decrease the incidence of iron deficiency anemia in the U.S., he says increasing iron-fortified foods and adding iron in fertilizer and cattle feed may help, but this would require policy changes at the government level.

Jamie Johnson, RDN

Men need 8mg of iron daily. Women need between 8 and 18mg, depending on age, but pregnant women need 27mg and lactating women need 9mg.

— Jamie Johnson, RDN

On a personal level, you can try to eat more iron-rich foods and have your blood taken to check for iron deficiency. Use supplements as indicated, especially if you have past iron deficiency or follow a vegan diet.

“Men need 8mg of iron daily,” says Johnson. “Women need between 8 and 18mg, depending on age, but pregnant women need 27mg and lactating women need 9mg.” 

Johnson says nutrition from food is almost always recommended over supplements unless they are medically indicated.

“It’s best to only take supplements if recommended by your healthcare provider because it is possible to get too much,” she says. “If you do need a supplement, you’ll still want to include iron-rich foods in your diet.”

What This Means For You:

To prevent iron deficiency anemia, try to add more iron-rich foods to your diet. You also can pair plant-based iron-rich foods like beans, whole grains, and leafy greens with a source of vitamin C to boost their absorption. And, make sure you talk to a healthcare provider for advice regarding iron supplements and to have your iron levels checked if you are concerned.

5 Sources
Verywell Fit uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Sun H, Weaver CM. Decreased iron intake parallels rising iron deficiency anemia and related mortality rates in the U.S. population. J Nutr. 2021;151(7):1947-1955. doi:10.1093/jn/nxab064

  2. American Society of Hematology. Iron-deficiency anemia.

  3. Cross AJ, Harnly JM, Ferrucci LM, Risch A, Mayne ST, Sinha R. Developing a heme iron database for meats according to meat type, cooking method and doneness level. Food Nutr Sci. 2012;3(7):905-913. doi:10.4236/fns.2012.37120

  4. Zuo Y, Zhang F. Soil and crop management strategies to prevent iron deficiency in crops. Plant Soil. 2011;339:83-95. doi:10.1007/s11104-010-0566-0

  5. National Institutes of Health; Office of Dietary Supplements. Iron Fact Sheet for Health Professionals.

By Cara Rosenbloom, RD
 Cara Rosenbloom RD is a dietitian, journalist, book author, and the founder of Words to Eat By, a nutrition communications company in Toronto, ON.