{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T14:28:45Z","timestamp":1793802525226,"version":"4.6.1"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,11,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fixed hemoglobin cutoffs are commonly used to define anemia, yet hemoglobin concentration varies physiologically with age. Rigid thresholds may therefore misclassify individuals, particularly in early childhood. This study proposes a dynamic, continuous model based on empirical hemoglobin\u2013age relationships to address limitations of fixed anemia cutoffs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This secondary data analysis used nationally representative data from the Lebanon Integrated Micronutrient, Anthropometry and Child Development Survey 2023 (LIMA-2023) survey conducted in Lebanon. Venous blood samples were collected, and complete blood counts were analyzed on the same day in a centralized laboratory. The analysis included 1448 children, 6 to 59 months of age and 4353 girls and non-pregnant women, 10 to 50 years of age. Polynomial regression was applied to hemoglobin distributions within a healthy reference population to derive continuous, age-specific thresholds for anemia severity (mild, moderate, or severe). Anemia prevalence under the dynamic model was compared with WHO 2024 fixed cutoffs. Misclassification patterns and age-related trends in hematological parameters (red blood cell count [RBC], mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], mean corpuscular hemoglobin concentration [MCHC], soluble transferrin receptor [sTfR]) were explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The dynamic model identified a higher prevalence of anemia among children, 6 to 59 months of age, than WHO 2024 criteria, particularly for mild and severe anemia. Estimates in older children and women were largely comparable. The continuous model captured age-dependent physiological trends and reduced misclassification linked to fixed thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Fixed hemoglobin cutoffs may not adequately reflect age-related physiology. A dynamic, continuous model offers a refined alternative that improves anemia classification, especially in early childhood, and may inform more accurate epidemiological and public health responses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jalm\/jfag096","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:33:04Z","timestamp":1780399984000},"page":"1419-1431","source":"Crossref","is-referenced-by-count":0,"title":["A Dynamic, Continuous Model for Age-Specific Anemia Classification in Children and Non-Pregnant Women"],"prefix":"10.1093","volume":"11","author":[{"given":"Charles P","family":"Wakim","sequence":"first","affiliation":[{"name":"Department of Nutrition and Food Sciences, Faculty of Agricultural Sciences, American University of Beirut , Beirut ,","place":["Lebanon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla A","family":"El-Mallah","sequence":"additional","affiliation":[{"name":"Groundwork , Fl\u00e4sch ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James P","family":"Wirth","sequence":"additional","affiliation":[{"name":"Groundwork , Fl\u00e4sch ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolai","family":"Petry","sequence":"additional","affiliation":[{"name":"Groundwork , Fl\u00e4sch ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Galetti","sequence":"additional","affiliation":[{"name":"Groundwork , Fl\u00e4sch ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amirhossein","family":"Yarparvar","sequence":"additional","affiliation":[{"name":"UNICEF , Beirut ,","place":["Lebanon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Firass","family":"Abiad","sequence":"additional","affiliation":[{"name":"Lebanese Ministry of Public Health , Beirut 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