{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:32:21Z","timestamp":1777984341930,"version":"3.51.4"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.24846.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000}}],"reference-count":44,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"This study was funded by the DBT\/Wellcome Trust India Alliance Clinical and Public Health Research Centres grant for the Centre for Training, Research, and Innovation in Tribal Health","award":["[IA\/CRC\/20\/1\/600007]awardedtoPrashanthNS"],"award-info":[{"award-number":["[IA\/CRC\/20\/1\/600007]awardedtoPrashanthNS"]}]},{"name":"This study was funded by the DBT\/Wellcome Trust India Alliance Clinical and Public Health Research Centres grant for the Centre for Training, Research, and Innovation in Tribal Health","award":["SureshShapeti"],"award-info":[{"award-number":["SureshShapeti"]}]},{"name":"This study was funded by the DBT\/Wellcome Trust India Alliance Clinical and Public Health Research Centres grant for the Centre for Training, Research, and Innovation in Tribal Health","award":["DeepaBhat"],"award-info":[{"award-number":["DeepaBhat"]}]},{"name":"This study was funded by the DBT\/Wellcome Trust India Alliance Clinical and Public Health Research Centres grant for the Centre for Training, Research, and Innovation in Tribal Health","award":["andUpendraBhojani"],"award-info":[{"award-number":["andUpendraBhojani"]}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns3:p>Introduction Anaemia remains a significant public health concern, particularly among marginalized populations such as tribal communities. This study examines the complex relationships between dietary diversity, iron status biomarkers, and anaemia prevalence among Adivasi women in southern Karnataka, India. Method A cross-sectional analysis using data from the Chiguru Adivasi cohort in Chamarajanagar District, Karnataka, India. The study included 479 women. PNC women aged 18 and above, and other women in the family aged 18\u201365 years, primarily from the Soliga tribe. The authors assessed Household Dietary Diversity Score (HDDS)\u2014a measure of food variety\u2014and measured hemoglobin (Hb), soluble transferrin receptor (sTfR) levels, and ferritin, along with sociodemographic data. Results The HDDS did not directly predict Hb levels but was negatively associated with sTfR (\u03b2 = \u20132.975, p = 0.045). After adjusting for confounders, sTfR was a significant predictor of anaemia (OR = 1.68, 95% CI: 1.40\u20132.01, p &lt; 0.01). Geographic variations in dietary diversity among the Soliga community, assessed through stratified analysis of Household Dietary Diversity Scores (HDDS) across taluks and proximity to forested areas, were found to be influenced by forest access, seasonal availability of wild foods, and local agricultural practices. Conclusions This study highlights the role of dietary diversity and iron biomarkers in understanding anaemia among Adivasi women. While household dietary diversity was not directly associated with hemoglobin, it showed a significant inverse relationship with soluble transferrin receptor (sTfR) levels, indicating improved tissue-level iron status with more diverse diets. Elevated sTfR levels were strong predictors of anaemia, reinforcing their utility as sensitive biomarkers for early iron deficiency. These findings emphasize the need for culturally relevant, cost-effective interventions that promote locally available iron-rich foods and strengthen community-led nutrition programs to enhance both dietary quality and iron status. Integrating these biomarker-informed insights into public health strategies can contribute to more targeted and sustainable anaemia reduction in tribal populations.<\/ns3:p>","DOI":"10.12688\/wellcomeopenres.24846.2","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T09:44:09Z","timestamp":1770025449000},"page":"608","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Dietary Diversity, Iron Status, and Anaemia Among Adivasi Women: Insights from the Chiguru Cohort in Chamarajanagar District, Southern Karnataka"],"prefix":"10.12688","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7947-1836","authenticated-orcid":false,"given":"Maithili","family":"Karthik","sequence":"first","affiliation":[{"name":"Public Health Bengaluru Karnataka 560038 Indian Institute of Public Health"},{"name":"Anthropology Dharwad Karnataka 580003 Karnatak University Dharwad"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7172-7958","authenticated-orcid":false,"given":"Jai Prabhakar","family":"Sosale Chandrashekaraswamy","sequence":"additional","affiliation":[{"name":"Anthropology Dharwad Karnataka 580004 Centre for Multi-disciplinary Development Research (CMDR)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7473-5024","authenticated-orcid":false,"given":"Prafulla","family":"Shriyan","sequence":"additional","affiliation":[{"name":"Public Health Bengaluru Karnataka 560038 Indian Institute of Public Health"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suresh","family":"Shapeti","sequence":"additional","affiliation":[{"name":"Public Health Bengaluru Karnataka 560038 Indian Institute of Public Health"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prashanth","family":"Thankachan","sequence":"additional","affiliation":[{"name":"Division of Nutrition Bengaluru Karnataka 560034 St. John\u2019s Research Institute"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanya","family":"Seshadri","sequence":"additional","affiliation":[{"name":"Centre of Adivasi Health Bengaluru Karnataka 560070 Institute of Public Health Bengaluru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4370-8933","authenticated-orcid":false,"given":"Giridhara","family":"R Babu","sequence":"additional","affiliation":[{"name":"Population Medicine, College of Medicine, QU Health Doha Doha Qatar University College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"e627-39","DOI":"10.1016\/S2214-109X(22)00084-5","article-title":"National, regional, and global estimates of anaemia by severity in women and children for 2000-19: a pooled analysis of population-representative data.","volume":"10","author":"G Stevens","year":"2022","journal-title":"Lancet Glob Health."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"2186-2201","DOI":"10.1177\/0300060518757355","article-title":"Effect of oral nutritional supplementation on growth and recurrent upper respiratory tract infections in picky eating children at nutritional risk: a randomized, controlled trial.","volume":"46","author":"A Ghosh","year":"2018","journal-title":"J Int Med Res."},{"key":"ref-3","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-024-17789-3","article-title":"Prevalence 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Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/10-608\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/10-608\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/10-608\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T06:49:08Z","timestamp":1777272548000},"score":1,"resource":{"primary":{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/10-608\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":44,"URL":"https:\/\/doi.org\/10.12688\/wellcomeopenres.24846.2","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/wellcomeopenres.24846.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.21956\/wellcomeopenres.28371.r146377","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/wellcomeopenres.28371.r152278","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/wellcomeopenres.28371.r146377","asserted-by":"object"},{"id-type":"doi","id":"10.21956\/wellcomeopenres.28371.r152278","asserted-by":"object"}]},"ISSN":["2398-502X"],"issn-type":[{"value":"2398-502X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]},"assertion":[{"value":"Indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/10-608\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/wellcomeopenres.27369.r140169, Meghan C McCormick, University of Miami, Miami, 31 Dec 2025, version 1, 1 approved with reservations, 2 not approved","URL":"https:\/\/wellcomeopenresearch.org\/articles\/10-608\/v1#referee-response-140169","order":0,"name":"referee-response-140169","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>maithili Karthik<\/b>; \n<i>Posted: 19 Jan 2026<\/i>; In general: -There were multiple instances throughout the manuscript of acronyms being used without being defined (In abstract-HDDD; In manuscript - sTfR, FAO, FFQ among others). Even with table of acronyms at the end these should be defined clearly the first time that they are used in the text. \n<b>Response:&nbsp;<\/b>Thank you for this important observation. We have now defined all acronyms at their first occurrence in the abstract and main text, including HDDD, sTfR, FAO, and FFQ, while retaining the table of acronyms for reference.  Introduction: -In paragraph 2 the same sentence is repeated twice &quot;Low consumption of dairy products, fruits and vegetables....&quot; One sentence should be removed. \n<b>Response:&nbsp;<\/b>Thank you for your observation. We have removed the duplicated sentence in the second paragraph of the Introduction.  -Additional information regarding what a typical diet consists of would be helpful when stating there is limited dietary diversity. \n<b>Response:&nbsp;<\/b>Thank you for your observation. We have added a brief description of the typical diet immediately before discussing low dietary diversity in the Introduction to provide a clearer context.  Methodology: -Please define what is meant by &quot;adivasi women&quot;. My understanding is that this is in reference to Indigenous women of India but is not explained in manuscript for readers not familiar with the communities of India. Likewise a brief description of what a &quot;taluk&quot; is would be helpful. \n<b>Response:&nbsp;<\/b>Thank you for this helpful suggestion. We have clarified the terms \n<i>\u201cAdivasi women\u201d<\/i> and \n<i>\u201ctaluk\u201d<\/i> at their first mention in the Methods section to ensure clarity for readers who may be unfamiliar with the Indian context.  -After reading it is a bit unclear to me how women were selected for inclusion in this study. A note was made that women were postnatal, were women recruited at postpartum follow-up visits in clinic or hospital setting? What time frame postnatal? When a female was recruited were all female family members over 18 then approached? Some additional detail regarding recruitment is requested. \n<b>Response:&nbsp;<\/b>Thank you for this suggestion\n<b>.<\/b> We have clarified the recruitment process in the Methods section under Inclusion and Exclusion Criteria, including recruitment of postnatal women, follow-up time points (3 months, 6 months, and 1 year), and inclusion of adult female household members aged 18 years and above.  -Note made that the &quot;authors now incorporate ferritin for a more appropriate evaluation.&quot; Was this lab test incorporated into study later or did all participants have ferritin testing available? \n<b>Response:&nbsp;<\/b>Thank you for pointing this out. We have clarified in the Laboratory Assessment section that serum ferritin and sTfR was measured only among postnatal women at baseline during the initial data collection and was not assessed among other adult female household members.  -More information on DAG requested for those unfamiliar with this approach and the ways in which authors selected factors for inclusion in multivariable analysis Thank you for this. We have added a brief explanation of the DAG approach and how it informed variable selection. -Biplot was not mentioned in methods but included in results. \n<b>Response:&nbsp;<\/b>Thank you for this. We have now included the biplot description in the methods section.  -Additional information on HHDD score would be appreciated to understand results. For example, what is the range of scores that can be seen and what is considered low, medium or high diversity? Perhaps a supplemental table providing information on how HHDD score is created and interpreted. \n<b>Response:&nbsp;<\/b>Thank you for the suggestion. We have included the food-group aggregation table as a supplementary table and referenced it in the Dietary Assessment section of the Methods (Statistical analysis).  Results: -Some of the commentary on interpretation of the data would be better as part of the discussion section. The results should focus on presenting objective data only. \n<b>Response:&nbsp;<\/b>Thank you for this comment. We have revised the Results section to retain only objective descriptive findings and have moved interpretative and explanatory statements to the Discussion section.  -The following line &quot;This should be explicitly mentioned in the Statistical analysis section to clarify how sTfR was handled in the model&quot; is likely a comment by the authors which should be removed from the manuscript and addressed in the methods as noted. \n<b>Response:&nbsp;<\/b>Thank you for pointing this out. We have removed the note from the Results section and clarified in the \n<i>Statistical Analysis<\/i> subsection that sTfR was treated as a continuous variable in both linear and logistic regression models.  Tables: -In table 3 the proportion of individuals residing in each Taluk with high diversity vs low diversity are swapped compared to how the data is presented in the written portion of results. Please make sure data in Table 3 is accurate in each column. \n<b>Response:&nbsp;<\/b>Thank you for this valuable observation. Upon re-examining the dataset, we found that the interpretation of Taluk-level distribution was inadvertently reversed in the text. The table itself was correct, but the description in the Results section was inconsistent with it. We have now corrected the narrative to align with the actual data, which show that a higher proportion of participants from \n<b>Hanur (63.4%)<\/b> belonged to the \n<b>high-diversity<\/b> group, whereas those from \n<b>Chamarajanagar (32.3%)<\/b> and \n<b>Yelandur (32.3%)<\/b> were more commonly in the \n<b>low-diversity<\/b> group. This revision ensures consistency between Table 3 and the Results text.  -I would not consider a p value of &gt;0.05 to be statistically significant and usually would not highlight these results. \n<b>Response:&nbsp;<\/b>Thank you for this valuable observation. We agree that results with p &gt; 0.05 should not be interpreted as statistically significant. In response, We have revised the Results section and clarified the interpretation of such findings. Specifically, we now describe these as \u201cnon-significant trends\u201d rather than \u201csignificant associations.\u201d We have also amended the note under \n<b>Table 4<\/b> to explicitly state that \n<i>p &lt; 0.05<\/i> is considered statistically significant, while \n<i>p &lt; 0.1<\/i> denotes a non-significant trend. Additionally, we added a clarification in the \n<b>Discussion<\/b> section emphasizing that only associations with \n<i>p &lt; 0.05<\/i> were treated as significant in this study. Discussion:  -The odds ratio of 1.68 cannot be directly converted into percentage odds. To calculate the percentage from the odds ratio, divide the odds ratio by the sum of 1 and the odds ratio, then multiply the result by 100, which works out to ~62% \n<b>Response:&nbsp;<\/b>We thank you for pointing out this important clarification regarding the conversion of the odds ratio into percentage odds. We have corrected the statement in the Discussion section to accurately reflect the computation. \n<i>\u201cThe odds of anaemia increased by an odds ratio of 1.68, which corresponds to approximately 62.7% higher odds of anaemia (calculated as 1.68 \/ [1 + 1.68] &times; 100 = 62.7%) for each unit increase in sTfR.\u201d<\/i> &nbsp;  -It would be helpful to discuss how seasonal availability in food supply may have affected results. Was data collection spread throughout the calendar year to reflect all seasonal variability in food sources? \n<b>Response:&nbsp;<\/b>Thank you for this valuable observation. We agree that seasonal variation in food availability likely affects dietary diversity and iron status among Adivasi women. In the revised manuscript, I have clarified the temporal coverage of our data collection first para and discussed the potential impact of seasonal food supply on dietary patterns and study findings in the Discussion 3\n<sup>rd<\/sup> para. We have also noted this as an important consideration for future longitudinal analyses. -In some cultures women who are post-partum are restricted in their food intake\/variety for a period of time post delivery, is that a potential factor in this population? \n<b>Response:&nbsp;<\/b>We thank the reviewer for highlighting the role of post-partum dietary practices. We have now added a paragraph in the Discussion section acknowledging that cultural food restrictions during the post-partum period are common in the study population and may contribute to reduced dietary diversity and iron intake. This has been discussed as a potential explanatory factor for anaemia risk.","URL":"https:\/\/wellcomeopenresearch.org\/articles\/10-608\/v2#referee-comment-6383","order":1,"name":"referee-comment-6383","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.28371.r146377, Suman Chakrabarti, International Food Policy Research Institute, Washington, District of Columbia, 12 Feb 2026, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/10-608\/v2#referee-response-146377","order":2,"name":"referee-response-146377","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.27369.r141104, Mai-Lei Woo Kinshella, Children's & Women's Health Centre of British Columbia, Vancouver, British Columbia, 07 Jan 2026, version 1, 1 approved with reservations, 2 not approved","URL":"https:\/\/wellcomeopenresearch.org\/articles\/10-608\/v1#referee-response-141104","order":3,"name":"referee-response-141104","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>maithili Karthik<\/b>; \n<i>Posted: 19 Jan 2026<\/i>; Major comments: Abstract \n<b>&quot;Geographic variations in dietary diversity among the Soliga community are influenced by forest access, seasonal availability of wild foods, and local agricultural practices&quot; is currently reported in the results but unclear how it was assessed from the methods description. Please elaborate.<\/b> Thank you for the comment. We have clarified in the \n<i>Abstract<\/i> and \n<i>Methods<\/i> that geographic variations were assessed through stratified analysis of Household Dietary Diversity Scores (HDDS) across taluks and forest proximity.  \n<b>Please rework the conclusions to more reflect the objective of the study, particularly regarding iron status biomarkers which is currently not mentioned in the conclusions.<\/b> Thank you for the helpful suggestion. We have revised the Abstract conclusion to better align with the study objective by including findings related to iron status biomarkers. The updated text now highlights the inverse association between dietary diversity and sTfR, and the predictive role of sTfR in anaemia. &nbsp; Introduction  \n<b>Please define of &quot;tribal communities&quot; as there can be multiple understandings. If this is in reference specifically to India, please explain.<\/b> We thank the reviewer for this valuable suggestion. We have clarified the meaning of \u201ctribal communities\u201d in the introduction to specify that it refers to India\u2019s constitutionally recognized Scheduled Tribes (Adivasi groups), providing cultural and geographical context to the term.  \n<b>The &quot;disproportionate impact on tribal communities&quot; is currently not well explained. Which &quot;specific tribal populations&quot; are the authors referring to? Please include the reported rate of anaemia globally, in India and in Indian &quot;tribal communities&quot;.<\/b> We thank the reviewer for this helpful suggestion. We have now revised the opening paragraph of the Introduction to clarify which tribal populations are referred to (Soliga, Jenu Kuruba, and Kadu Kuruba) and to include anaemia prevalence rates globally, in India, and among Indian tribal communities &nbsp; Methodology  \n<b>&quot;Only women aged 18 years and above&quot; - Please explain if there was a maximum age.<\/b> Thank you for this comment. We have clarified in the \n<i>Informed Consent<\/i> section that there was no maximum age limit; all adult women aged 18 years and above were eligible to participate.  \n<b>More is needed to explain the HHDD Score methodology. What is the range of scores and how is it derived from the HDDS classifications? How does it extrapolate responses from women to household dietary diversity? How does it relate to the validated Minimum Dietary Diversity for Women measure?<\/b> Thank you for the comment. We have clarified the HHDD methodology in the \n<i>Methods \u2013 Data Collection<\/i> section. The revised text explains that HHDD (range 0\u201312) was derived from FAO HDDS guidelines, based on the number of food groups consumed in the past 24 hours. Women\u2019s responses were used as reliable household-level proxies, as they manage food preparation. Only the HHDD was used in this study; MDD-W is mentioned for conceptual context  \n<b>When were blood samples collected? Were blood samples and the dietary diversity questionnaire collected at the same time?<\/b> Thank you for your valuable comment. We have clarified in the \n<i>Methodology \u2013 Data collection<\/i> section that both the dietary diversity questionnaire and blood samples were collected at baseline during the same visit.  \n<b>Any information regarding menstrual cycle during time of blood sample collection?<\/b> We thank the reviewer for the insightful comment. Information on the menstrual cycle phase during blood collection was not recorded for non-postnatal women.  \n<b>Please report using a research checklist such as STROBE.<\/b> We thank you for this suggestion regarding the STROBE checklist. Our manuscript has been structured in alignment with the core items of the STROBE guidelines (e.g., clear description of design, setting, participants, variables, and analyses). Therefore, we believe the current version already reflects those principles. However, we will be happy to provide the checklist if the editor deems it necessary. &nbsp; Results  \n<b>The full age range needs to be reported.<\/b> Thank you for your comment. We have now added the full age range of study participants in the Results section. For women aged 18 and above, including those aged 18\u201365 years and other eligible women in the household. The sentence has been revised to report both the mean age and the full range.  &quot;\n<b>Oil and fats (70.0%), sweets (70.9%), and spices, condiments, and beverages (70.9%) were also widely consumed, indicating a broad inclusion of diverse food items in the diet&quot; - these are usually unhealthy food groups. What types of beverages?<\/b> Thank you for your insightful comment. We have now specified the types of beverages consumed in the Results section. The revised sentence clarifies that beverages primarily included tea, coffee, and locally prepared herbal or jaggery-based drinks.  \n<b>Beyond organ meats, other types of meat are currently not reported in text.<\/b> Thank you for this observation. We have now clarified in the Results section that the \u201cmeat\u201d group includes both organ and flesh meats (e.g., chicken, mutton, and beef), as indicated in the HDDS food group classification (Table 2).  \n<b>&quot; it is important to note that ferritin is an acute-phase reactant that can be elevated in the presence of inflammation or infection. Given that CRP or other inflammatory markers were not included in the model, the observed association may be confounded by unmeasured inflammatory status. For instance, with a ferritin level of 56 ng\/mL, it is unclear whether this reflects adequate iron stores or an inflammatory response. Adjusting for markers such as CRP would strengthen the validity of the findings and help clarify the true nature of the ferritin\u2013haemoglobin relationship&quot; - This is not a study result and is more appropriate for the discussion.<\/b> Thank you for the helpful suggestion. We agree that the statement about ferritin and inflammation belongs in the Discussion section rather than the Results. We have moved it accordingly and revised the wording for clarity. &nbsp; Discussion  \n<b>&quot;Monotonous staple-based diets, high in phytates and low in bioavailable iron, contribute to high anaemia prevalence&quot; - This study would benefit from more information regarding dietary patterns among Adivasi women, particularly the Soliga tribe,<\/b> Thank you for your comment. We have revised the Discussion to include a detailed description of Soliga women\u2019s dietary patterns, supported by relevant literature (references 20, 21, and 41) to provide better cultural and contextual understanding.  \n<b>References in the discussion include studies with school aged children and pregnant women. Please include some references more closely related to your study population - non-pregnant women (of reproductive age? That is currently unclear).<\/b> We thank you for this valuable suggestion. We have clarified that our study population comprises \n<i>non-pregnant women of reproductive age<\/i> and added relevant references to similar studies among this group.  \n<b>While the study findings support sTfR as an emerging biomarker of iron status, it does not adequately tease out why dietary diversity was not associated with hemoglobin.<\/b> Thank you for this constructive feedback. We have now expanded the Discussion to explain the possible reasons for the lack of association between dietary diversity and hemoglobin. We clarify that hemoglobin is influenced by non-nutritional factors such as infection, inflammation, and hemoglobinopathies (15), while sTfR provides a more sensitive reflection of iron absorption and storage (10, 27, 29). We have also noted that short-term dietary diversity measures may not capture seasonal and cumulative dietary patterns (30, 31).  \n<b>&quot;The authors observed a strong link between elevated sTfR, indicating iron deficiency, and anaemia. The odds of anaemia increased by approximately 68.4% for each unit increase in sTfR, highlighting the critical role of iron deficiency as reflected by high sTfR in the population.&quot; Considering that anaemia is defined using hemoglobin cut-offs, dietary diversity is found to be associated with a marker of iron status, but not necessarily anaemia. This needs to be clarified and explained better in the discussion.<\/b> Thank you for this valuable suggestion. We have clarified in the Discussion that dietary diversity was associated with improved iron status (lower sTfR), but not necessarily with anaemia, since haemoglobin levels can be influenced by several non-nutritional factors.  \n<b>More consideration of study limitations is needed.<\/b> We thank the reviewer for this suggestion. A new subsection titled \n<i>\u201cStudy Limitations\u201d<\/i> has been added at the end of the \n<i>Discussion<\/i> section, before \n<i>Strengths of the Study<\/i>, acknowledging the key methodological and contextual limitations of the study.&nbsp;&nbsp;  \n<b>The manuscript would benefit from overall streamlining for conciseness and checking over spelling.<\/b> Thank you for this helpful suggestion. We have carefully revised the manuscript throughout to enhance conciseness and clarity. Redundant phrases were removed, and long sentences were shortened, particularly in the Abstract, Introduction (first and fourth paragraphs), and Discussion (paragraphs 2 and 3). We also corrected minor spelling and grammatical errors across the text. These edits have improved the manuscript\u2019s readability without altering the scientific content. &nbsp;  Minor comments: Abstract\u200b\u200b\u200b\u200b\u200b\u200b\u200b  \n<b>&quot;the chiguru Adivasi cohort&quot; - should Chiguru be capitalized?<\/b> Thank you for the observation. The term \n<i>chiguru<\/i> is intentionally written in lowercase, as it represents the official name of the cohort. We have retained it in lowercase throughout the manuscript for consistency and accuracy.\u200b\u200b\u200b\u200b\u200b\u200b\u200b  \n<b>Please provide age range for the 479 women<\/b> Thank you for this suggestion. We have now added the age range (18\u201365 years) in the Abstract to clarify the participants\u2019 demographic coverage.\u200b\u200b\u200b\u200b\u200b\u200b\u200b  \n<b>HHDD scores...sTfR levels... - please define acronyms on first usage<\/b> Thank you for this suggestion. We have expanded all acronyms (HDDS, Hb, sTfR) upon first mention in the abstract.\u200b\u200b\u200b\u200b\u200b\u200b\u200b  \n<b>Please report 95% confidence intervals for the odds ratio.<\/b> Thank you for this suggestion. We have now included the 95% confidence interval (1.40\u20132.01) for the odds ratio as suggested. &nbsp; Introduction\u200b\u200b\u200b\u200b\u200b\u200b\u200b  \n<b>&quot;Studies have shown that tribal communities often have diets dominated by cereals and starchy staples&quot;&nbsp; - references needed for these studies<\/b> Thank you for the suggestion. We have now cited relevant literature (Refs 5, 20, 21) to support the statement on cereal- and starch-based diets among tribal communities.\u200b\u200b\u200b\u200b\u200b\u200b\u200b  \n<b>&quot;Protein also plays a role in iron metabolism&quot; Please rework this line for clarity. It currently can be misinterpreted.<\/b> Thank you for pointing this out. The line has been revised for clarity to accurately describe the role of protein quality and source in iron absorption. &nbsp; 7.WHO, CRP, AGP...sTfR... - please define acronyms on first usage Thank you for pointing this out. All acronyms (WHO, CRP, AGP, sTfR) have now been expanded at first use in the Introduction for clarity. &nbsp;\u200b\u200b\u200b\u200b\u200b\u200b\u200b  \n<b>NFHS-5&nbsp; - please define acronyms on first usage<\/b> \n<b>Response:&nbsp;<\/b>Thank you for the suggestion. The acronym NFHS-5 has now been defined in full as \u201cNational Family Health Survey (NFHS-5)\u201d at its first occurrence in the  \n<i>Methodology<\/i> section. 9 . \n<b>Please add the HHDD questionnaire as a supplementary file &nbsp;<\/b>  \n<b>Response:&nbsp;<\/b>Thank you for the observation. The complete Household Dietary Diversity (HHDD) questionnaire has been included as Supplementary File 1 and referenced in the \n<i>Data Collection<\/i> section. &nbsp;  \n<b>&quot;Indigenous communities&quot; This is the first mention of Indigenous communities.<\/b>  \n<b>Response:&nbsp;<\/b>Thank you for pointing this out. We have clarified the terminology in the Discussion section. The phrase \u201cIndigenous communities\u201d has been revised to \u201cAdivasi (Indigenous tribal) women living in remote communities\u201d to ensure consistency with the rest of the manuscript and accurate representation of the study population.","URL":"https:\/\/wellcomeopenresearch.org\/articles\/10-608\/v2#referee-comment-6385","order":4,"name":"referee-comment-6385","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.28371.r152278, Anmol Patted, Thomas Jefferson University, Philadelphia, Pennsylvania, 27 Apr 2026, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/10-608\/v2#referee-response-152278","order":5,"name":"referee-response-152278","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This study was funded by the DBT\/Wellcome Trust India Alliance Clinical and Public Health Research Centres grant for the Centre for Training, Research, and Innovation in Tribal Health (CTRITH) [IA\/CRC\/20\/1\/600007] awarded to Prashanth NS, Suresh Shapeti, Deepa Bhat, and Upendra Bhojani (Supports to MK, PS, SS, and TS). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":6,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}