Skip to main content
NUTRITION 2026 Main banner

(OR19-03-26) Evaluation of Physiologically Based Serum Ferritin Cut-Offs for Defining Iron Deficiency Among Children Aged 5–14years: A Multi-country Analysis

Monday, July 27, 2026
10:54 AM - 11:06 AM ET
Location: National Harbor 4-5

    Presenting Author(s)

  • YA

    Yaw Addo, PhD

    Epidemiologist
    Centers for Disease Control and Prevention
    Atlanta, Georgia, United States

    Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • MJ

    Maria Elena D. Jefferds, PhD

    Centers for Disease Control and Prevention
    Atlanta, United States

  • MJ

    Mica Jenkins, PhD

    Centers for Disease Control and Prevention
    Atlanta, Georgia, United States

  • ZM

    Zuguo Mei, MD

    Centers for Disease Control and Prevention
    Atlanta, Georgia, United States

Disclosure(s):
Yaw Addo, PhD: No relevant financial relationship(s) with ineligible companies to disclose.
Objectives: Iron deficiency (ID) leads to fatigue, poor physical performance, diminished work productivity, and in children, suboptimal brain development. The World Health Organization (WHO) serum ferritin (SF) threshold for ID is < 15 µg/L for all individuals aged ≥ 5 years. We aimed to identify physiologically based SF thresholds for defining ID in healthy school-aged children aged 5-14 years (SAC) and evaluate inter-country consistency.

Methods: Venous blood databases of 6525 apparently healthy (no inflammation and/or infection) SAC from 4 countries were analyzed. SF and independent indicators of iron-deficient erythropoiesis [soluble transferrin receptor (sTfR), erythrocyte zinc protoporphyrin, (ZPP)] and hemoglobin (Hb) from Great Britain (GB), Guatemala (GT), Malawi (MW) and United States (US) were analyzed. Separate nonlinear SF curve functions (SF-Hb or SF-sTfR or SF-ZPP) along with differential equations were applied to identify SF thresholds for ID at inflection minima and plateau for each analyte and by country.

Results: Overall mean age was 10.5y. Median SF levels varied, ranging from 28.0 to 54.7 ug/L in GB and MW, respectively, with no sex or age-specific differences observed within countries. Derived SF thresholds for ID identified by Hb were consistent (SF < 21.9µg/L (95%CI:19.7-26.8) GB, < 23.2 µg/L (19.6-25.6) GT, < 26.6 µg/L (25.8-27.7) MW, <24.3 µg/L (21.9-27.4) US). The 4-country meta-analyzed pooled threshold was 24.6 µg/L (95%CI: 21.8-27.3) with no heterogeneity, P-value=0.8136). Thresholds identified by sTfR or ZPP were similar.

Conclusions: Physiologically based SF thresholds were consistent across country settings, iron analyte, and higher than current WHO thresholds, suggesting a harmonized global SAC SF threshold for defining ID may be feasible.

Funding Sources: None