Comprehensive Assessment of Dietary Micronutrient Profiles and Their Impact on Hemoglobin Status and Anemia: Provincial Nutrition and Health Surveillance

Yan Wang¹Yun Lin²Ye Lv³Yiyuan Jin⁴Hua Gao⁵Sihai Gao⁶Pingping Shentu⁷Chao Xing⁸Yan Chen⁹Shiguang Zhao¹⁰Ying Cong¹¹Guangtao Liu¹²Peiwei Xu^1*Ronghua Zhang^1*

• ¹Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
• ²Jiaxing Center for Disease Control and Prevention, Jiaxing, China
• ³Hangzhou Center for Disease Control and Prevention, Hangzhou, China
• ⁴Taizhou Center for Disease Control and Prevention, Taizhou, China
• ⁵Ningbo Center for Disease Control and Prevention, Ningbo, China
• ⁶Wenzhou Center for Disease Control and Prevention, Wenzhou, China
• ⁷Jinhua center for disease control and prevention, Jinhua, China
• ⁸Shaoxing Center for Disease Control and Prevention, Shaoxing, China
• ⁹Zhoushan Center for Disease Control and Prevention, Zhoushan, China
• ¹⁰Quzhou Center for Disease Control and Prevention, Quzhou, China
• ¹¹Lishui Center for Disease Control and Prevention, Lishui, China
• ¹²Huzhou Center for Disease Control and Prevention, Huzhou, China

Background: Micronutrients play a major role in regulating public health. Inadequate intake of micronutrients is a frequent and potentially hazardous occurrence that may lead to the development of common pathologies, such as anemia, a widespread health concern. This study aimed to estimate dietary micronutrient intake inadequacies and the association between micronutrients and hemoglobin (Hb) level or anemia. Methods: This study employed a cross-sectional design and included 15,810 participants. The questionnaire used in this study comprised sections on demographic characteristics, lifestyles, dietary assessment, and disease history. Dietary intake information was collected using the 3-day 24-hour dietary recall method. Hemoglobin levels were measured using the colorimetric method. The individual effect of micronutrients on Hb and anemia were evaluated using restricted cubic splines (RCS) and multiple logistic regression. The combined effect was assessed by weighted quantile sum regression (WQSR). Results: The study included 7,570 male and 8,240 female participants from a representative survey of Zhejiang Province, China. The prevalence of anemia was 12.2%. The mean Hb level in the overall population was 139 (15.7) g/L. Specifically, the mean Hb level was 142 (12.8) g/L in normal participants and 114 (11.2) g/L in anemic participants. Inadequate dietary intake rate for riboflavin (88.1%), vitamin E (87.6%), and calcium (81.6%) was high while the rate of inadequate dietary intake for iron (13.3%), iodine (7.06%) and selenium (3.15%) was low. The influencing factors of anemia included age, sex, living area, income, smoking status, physical activity, BMI, and diabetes. A linear dose-response positive relationship of thiamin, vitamin C, and selenium with Hb were found among females. According to the results of multiple logistic regression, thiamin (OR: 0.81; 95% CI: 0.67, 0.97) and selenium (OR: 0.93; 95% CI: 0.88, 0.99) were significantly associated with a decreased risk of anemia among females. Conclusion: The prevalence of inadequate micronutrient intake was generally high, and micronutrient intakes had a significant protective effect against anemia, suggesting that interventions should be conducted to overcome the micronutrient intake inadequacies.