{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:32:39Z","timestamp":1793395959957,"version":"4.5.0"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,6,23]],"date-time":"2019-06-23T00:00:00Z","timestamp":1561248000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["nyaspubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of the New York Academy of Sciences"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The correct interpretation of hemoglobin (Hb) to identify anemia requires adjusting for altitude and smoking. Current adjustments were derived using data collected before 1985, from low\u2010income preschool\u2010aged children (PSC) in the United States and indigenous men in Peru for altitude, and from White women of reproductive age (WRA) in the United States for smoking. Given the oldness and limited representativeness of these data, we reexamined associations between Hb and altitude and\/or smoking using 13 population\u2010based surveys and 1 cohort study each conducted after 2000. All WHO regions except South\u2010East Asia were represented. The dataset included 68,193 observations among PSC (6\u221259 months) and nonpregnant WRA (15\u221249 years) with data on Hb and altitude (\u221228 to 4000\u00a0m), and 19,826 observations among WRA with data on Hb and smoking (status or daily cigarette quantity). Generalized linear models were used to assess the robustness of associations under varying conditions, including controlling for inflammation\u2010corrected iron and vitamin A deficiency. Our study confirms that Hb should be adjusted for altitude and\/or smoking; these adjustments are additive. However, recommendations for Hb adjustment likely need updating. Notably, current recommendations may underadjust Hb for light smokers and for those residing at lower altitudes and overadjust Hb for those residing at higher altitudes.<\/jats:p>","DOI":"10.1111\/nyas.14167","type":"journal-article","created":{"date-parts":[[2019,6,24]],"date-time":"2019-06-24T05:34:52Z","timestamp":1561354492000},"page":"190-203","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":75,"title":["Reexamination of hemoglobin adjustments to define anemia: altitude and smoking"],"prefix":"10.1111","volume":"1450","author":[{"given":"Andrea J.","family":"Sharma","sequence":"first","affiliation":[{"name":"Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion International Micronutrient Malnutrition Prevention and Control Program (IMMPaCt), Centers for Disease Control and Prevention Atlanta Georgia"},{"name":"The U.S. Public Health Service Commissioned Corps Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O. Yaw","family":"Addo","sequence":"additional","affiliation":[{"name":"Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion International Micronutrient Malnutrition Prevention and Control Program (IMMPaCt), Centers for Disease Control and Prevention Atlanta Georgia"},{"name":"Hubert Department of Global Health Emory University Rollins School of Public Health Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuguo","family":"Mei","sequence":"additional","affiliation":[{"name":"Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion International Micronutrient Malnutrition Prevention and Control Program (IMMPaCt), Centers for Disease Control and Prevention Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parminder S.","family":"Suchdev","sequence":"additional","affiliation":[{"name":"Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion International Micronutrient Malnutrition Prevention and Control Program (IMMPaCt), Centers for Disease Control and Prevention Atlanta Georgia"},{"name":"Hubert Department of Global Health Emory University Rollins School of Public Health Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,6,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2015.11.002"},{"key":"e_1_2_10_3_1","unstructured":"WHO (World Health Organization).2011.Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: WHO. Accessed March 17 2019.http:\/\/www.who.int\/vmnis\/indicators\/haemoglobin.pdf."},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00174.2010"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-553X.2008.01067.x"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cca.2006.08.028"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1990.03450120068031"},{"key":"e_1_2_10_8_1","unstructured":"WHO UNICEF & UNU (World Health Organization).2001.Iron deficiency anaemia: assessment prevention and control a guide for programme managers. Geneva: WHO. Accessed March 17 2019.http:\/\/www.who.int\/nutrition\/publications\/micronutrients\/anaemia_iron_deficiency\/WHO_NHD_01.3\/en\/index.html."},{"key":"e_1_2_10_9_1","first-page":"400","article-title":"CDC criteria for anemia in children and childbearing\u2010aged women","volume":"38","author":"Centers for Disease Control and Prevention","year":"1989","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1945.00210290007002"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2008.02143.x"},{"key":"e_1_2_10_12_1","volume-title":"Hypoxia and the Brain: Proceedings of the 8th International Hypoxia Symposium","author":"Yip R.","year":"1993"},{"key":"e_1_2_10_13_1","first-page":"625","article-title":"Altitude correction for hemoglobin","volume":"48","author":"Dirren H.","year":"1994","journal-title":"Eur. J. Clin. Nutr."},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/nm.3814"},{"key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"333S","DOI":"10.3945\/ajcn.116.142273","article-title":"Methodologic approach for the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project","volume":"106","author":"Namaste S.M.","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.3945\/an.115.010215"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12404"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/132.12.3680"},{"key":"e_1_2_10_19_1","unstructured":"2014.Elevation and elevation maps of cities\/towns\/villages in UK. Accessed October 13 2017.http:\/\/www.floodmap.net\/Elevation\/CountryElevationMap\/?ct=GB."},{"key":"e_1_2_10_20_1","unstructured":"2014.Elevation and elevation maps of cities\/towns\/villages in Georgia. Accessed October 13 2017.http:\/\/www.floodmap.net\/Elevation\/CountryElevationMap\/?ct=GB."},{"key":"e_1_2_10_21_1","unstructured":"WHO (World Health Organization).2011.Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. V.a.M.N.I. System. Geneva: WHO. Accessed March 17 2019.https:\/\/www.who.int\/vmnis\/indicators\/serum_ferritin.pdf."},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/134.11.3127"},{"key":"e_1_2_10_23_1","unstructured":"WHO (World Health Organization).2011.Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations. Geneva: WHO. Accessed March 17 2019.http:\/\/www.who.int\/vmnis\/indicators\/retinol.pdf."},{"key":"e_1_2_10_24_1","doi-asserted-by":"crossref","first-page":"428s","DOI":"10.3945\/ajcn.116.142372","article-title":"Research, policy, and programmatic considerations from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project","volume":"106","author":"Stoltzfus R.J.","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"e_1_2_10_25_1","article-title":"Special supplement: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA)","volume":"106","author":"BRINDA","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"e_1_2_10_26_1","unstructured":"Instituto de Nutrici\u00f3n de Centro Am\u00e9rica y Panam\u00e1 (INCAP).2015.Informe del Sistema de Vigilancia Epidemiol\u00f3gica de Salud y Nutrici\u00f3n\u2010SIVESNU\u20142013. Documento de trabajo. Guatemala: INCAP."},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/tc.2003.003673"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0009-8981(03)00005-6"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1089\/ham.2018.0032"},{"key":"e_1_2_10_30_1","first-page":"201","article-title":"Tibetan and Andean patterns of adaptation to high\u2010altitude hypoxia","volume":"72","author":"Beall C.M.","year":"2000","journal-title":"Hum. Biol."},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.252649199"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1089\/152702901750265341"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-014-3182-z"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.00275.2009"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwx196"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.80.9.1057"}],"container-title":["Annals of the New York Academy of Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fnyas.14167","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/nyaspubs.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nyas.14167","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,20]],"date-time":"2024-07-20T04:04:35Z","timestamp":1721448275000},"score":1,"resource":{"primary":{"URL":"https:\/\/nyaspubs.onlinelibrary.wiley.com\/doi\/10.1111\/nyas.14167"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,23]]},"references-count":35,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,8]]}},"alternative-id":["10.1111\/nyas.14167"],"URL":"https:\/\/doi.org\/10.1111\/nyas.14167","archive":["Portico"],"relation":{},"ISSN":["0077-8923","1749-6632"],"issn-type":[{"value":"0077-8923","type":"print"},{"value":"1749-6632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,23]]},"assertion":[{"value":"2019-03-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-05-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-06-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}