{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T16:19:10Z","timestamp":1785601150152,"version":"3.56.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,6,20]],"date-time":"2023-06-20T00:00:00Z","timestamp":1687219200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Iron deficiency and underweight are common nutritional problems among young Japanese women, many of whom show unhealthy dietary patterns owing to a desire for thinness. We conducted a cross-sectional analysis of the relationship between iron status, nutritional status, and dietary intake among young Japanese women with underweight to identify dietary risk factors for iron deficiency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Of the 159 young women (18\u201329\u2009years of age) enrolled, 77 underweight and 37 normal-weight women were included in the study. They were further categorized into four groups based on quartiles of hemoglobin levels among all participants. Dietary nutrient intake was ascertained using a brief self-administered diet history questionnaire. Blood level of hemoglobin and nutritional biomarkers such as total protein, albumin, insulin-like growth factor-1 (IGF-1), and essential amino acids were measured.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In underweight, the multiple comparison test showed that dietary intakes of fat, saturated fatty acid, and monosaturated fatty acid were significantly higher and carbohydrate intake was significantly lower in the group with the lowest hemoglobin level, whereas intakes of iron were the same across groups. Multivariate regression coefficients suggested that replacing fat with protein or carbohydrates increased hemoglobin levels under isocaloric conditions. Additionally, significant positive correlations were observed between hemoglobin levels and nutritional biomarkers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Dietary iron intake did not change across different hemoglobin groups among Japanese underweight women. However, our results suggested that an imbalanced dietary macronutrient induces anabolic status and hemoglobin synthesis deterioration among them. Especially, a higher fat intake may be a risk factor for lower hemoglobin.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2023.1121717","type":"journal-article","created":{"date-parts":[[2023,6,20]],"date-time":"2023-06-20T10:16:58Z","timestamp":1687256218000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Effect of imbalance in dietary macronutrients on blood hemoglobin levels: a cross-sectional study in young underweight Japanese women"],"prefix":"10.3389","volume":"10","author":[{"given":"Yuko","family":"Tateishi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reiko","family":"Ichikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuya","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiro","family":"Kitahara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Someya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshifumi","family":"Tamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,6,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1186\/s13045-021-01202-2","article-title":"Burden of anemia and its underlying causes in 204 countries and territories, 1990\u20132019: results from the global burden of disease study 2019","volume":"14","author":"Safiri","year":"2021","journal-title":"J Hematol Oncol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"17048","DOI":"10.1038\/s41598-019-52798-y","article-title":"Prevalence of and factors related to anemia among Japanese adult women: secondary data analysis using health check-up database","volume":"9","author":"Hisa","year":"2019","journal-title":"Sci Rep"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"3755","DOI":"10.1182\/blood.V106.11.3755.3755","article-title":"The prevalence of anemia among healthy women in Japan","volume":"106","author":"Kusumi","year":"2005","journal-title":"Blood"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1401","DOI":"10.2169\/naika.70.1401","article-title":"Prevalence and causes of iron deficiency in Japanese women (Japanese style)","volume":"70","author":"Uchida","year":"1981","journal-title":"J Jpn Soc Intern Med"},{"key":"ref5","first-page":"27","article-title":"The dietary approach to prevention and improvement of anemia in female college students (Japanese style)","volume":"8","author":"Majima","year":"2018","journal-title":"JHMS"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1546","DOI":"10.1136\/bmj.2.6204.1546","article-title":"Iron-deficiency anaemia and its effect on worker productivity and activity patterns","volume":"2","author":"Edgerton","year":"1979","journal-title":"Br Med J"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"794S","DOI":"10.1093\/jn\/132.4.794S","article-title":"Reversing productivity losses from iron deficiency: the economic case","volume":"132","author":"Hunt","year":"2002","journal-title":"J Nutr"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1007\/s12011-014-9963-1","article-title":"Iron deficiency without anemia is associated with anger and fatigue in young Japanese women","volume":"159","author":"Sawada","year":"2014","journal-title":"Biol Trace Elem Res"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1093\/ajcn\/85.3.778","article-title":"Iron treatment normalizes cognitive functioning in young women","volume":"85","author":"Murray-Kolb","year":"2007","journal-title":"Am J Clin Nutr"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2087","DOI":"10.2147\/NDT.S72491","article-title":"Iron deficiency and cognitive functions","volume":"10","author":"J\u00e1uregui-Lobera","year":"2014","journal-title":"Neuropsychiatr Dis Treat"},{"key":"ref11","year":"2019"},{"key":"ref12","first-page":"219","article-title":"Underweight as a risk factor for iron depletion and iron-deficient erythropoiesis among young women in rural areas of East Java, Indonesia","volume":"22","author":"Sumarmi","year":"2016","journal-title":"Mal J Nutr"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"63","DOI":"10.47203\/IJCH.2018.v30i01.011","article-title":"Underweight as a risk factor for nutritional anaemia \u2013 a cross-sectional study among undergraduate students of a medical College of Haryana","volume":"30","author":"Khan","year":"2018","journal-title":"Indian J Community Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e0259116","DOI":"10.1371\/journal.pone.0259116","article-title":"Is BMI associated with anemia and hemoglobin level of women and children in Bangladesh: a study with multiple statistical approaches","volume":"16","author":"Kamruzzaman","year":"2021","journal-title":"PLoS One"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"97","DOI":"10.6133\/apjcn.2016.25.2.04","article-title":"Differential dietary habits among 570 young underweight Japanese women with and without a desire for thinness: a comparison with normal weight counterparts","volume":"25","author":"Mori","year":"2016","journal-title":"Asia Pac J Clin Nutr"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"2","DOI":"10.3861\/jshhe.57.2","article-title":"Improving effect on iron deficient anemic female by using a long course of iron containing food and a proposal for preventive food composition against anemic dicease","volume":"57","author":"Shirota","year":"1991","journal-title":"Jpn J Health Hum Ecol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.1017\/S1368980008004072","article-title":"Iron intake does not significantly correlate with iron deficiency among young Japanese women: a cross-sectional study","volume":"12","author":"Asakura","year":"2009","journal-title":"Public Health Nutr"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"274","DOI":"10.7143\/jhep.41.274","article-title":"Dietary patterns and anemia-related blood biochemical parameters","volume":"41","author":"Kojima","year":"2014","journal-title":"JAMHTS"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.clnesp.2015.09.003","article-title":"Role of nutrition on anemia in elderly","volume":"11","author":"Bianchi","year":"2016","journal-title":"Clin Nutr ESPEN"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1093\/ajcn\/55.5.985","article-title":"Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study","volume":"55","author":"Hediger","year":"1992","journal-title":"Am J Clin Nutr"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"4399","DOI":"10.3390\/nu5114399","article-title":"The influence of vitamin a supplementation on iron status","volume":"5","author":"Michelazzo","year":"2013","journal-title":"Nutrients"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1093\/ajcn\/48.3.595","article-title":"Hematological effect of supplementing anemic children with vitamin a alone and in combination with iron","volume":"48","author":"Mej\u00eda","year":"1988","journal-title":"Am J Clin Nutr"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1146\/annurev.nutr.24.012003.132306","article-title":"New insights into erythropoiesis: the roles of folate, vitamin B12, and iron","volume":"24","author":"Koury","year":"2004","journal-title":"Annu Rev Nutr"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.freeradbiomed.2014.07.007","article-title":"The active role of vitamin C in mammalian iron metabolism: much more than just enhanced iron absorption!","volume":"75","author":"Lane","year":"2014","journal-title":"Free Radic Biol Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1017\/S0007114507172731","article-title":"Reduction of erythroid progenitors in protein-energy malnutrition","volume":"97","author":"Borelli","year":"2007","journal-title":"Br J Nutr"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1182\/blood.V50.6.1093.1093","article-title":"Effect of protein deprivation on erythropoiesis","volume":"50","author":"Anagnostou","year":"1977","journal-title":"Blood"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"e2053","DOI":"10.1210\/clinem\/dgab052","article-title":"Prevalence and features of impaired glucose tolerance in young underweight Japanese women","volume":"106","author":"Sato","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"151","DOI":"10.2188\/jea.je20110075","article-title":"Both comprehensive and brief self-administered diet history questionnaires satisfactorily rank nutrient intakes in Japanese adults","volume":"22","author":"Kobayashi","year":"2012","journal-title":"J Epidemiol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1016\/j.je.2016.05.005","article-title":"Availability of two self-administered diet history questionnaires for pregnant Japanese women: a validation study using 24-hour urinary markers","volume":"27","author":"Shiraishi","year":"2017","journal-title":"J Epidemiol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1483","DOI":"10.1002\/rcm.4026","article-title":"Precolumn derivatization reagents for high-speed analysis of amines and amino acids in biological fluid using liquid chromatography\/electrospray ionization tandem mass spectrometry","volume":"23","author":"Shimbo","year":"2009","journal-title":"Rapid Commun Mass Spectrom"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1007\/s10654-018-0371-2","article-title":"Substitution analysis in nutritional epidemiology: proceed with caution","volume":"33","author":"Song","year":"2018","journal-title":"Eur J Epidemiol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e9127","DOI":"10.7717\/peerj.9127","article-title":"Association between dietary mineral nutrient intake, body mass index, and waist circumference in US adults using quantile regression analysis NHANES 2007\u20132014","volume":"8","author":"Jiang","year":"2020","journal-title":"PeerJ"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"151","DOI":"10.3389\/fonc.2018.00151","article-title":"Cancer incidence in Europe: an ecological analysis of nutritional and other environmental factors","volume":"8","author":"Grasgruber","year":"2018","journal-title":"Front Oncol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1002\/gepi.21750","article-title":"Ridge regression in prediction problems: automatic choice of the ridge parameter","volume":"37","author":"Cule","year":"2013","journal-title":"Genet Epidemiol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1600","DOI":"10.1016\/j.jnutbio.2011.10.013","article-title":"High-fat diet causes iron deficiency via hepcidin-independent reduction of duodenal iron absorption","volume":"23","author":"Sonnweber","year":"2012","journal-title":"J Nutr Biochem"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e66570","DOI":"10.1371\/journal.pone.0066570","article-title":"High fat diet induces liver steatosis and early dysregulation of iron metabolism in rats","volume":"8","author":"Meli","year":"2013","journal-title":"PLoS One"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"2217","DOI":"10.1093\/ajcn\/32.11.2217","article-title":"Quantitative effect of an isoenergetic exchange of fat for carbohydrate on dietary protein utilization in healthy young men","volume":"32","author":"Richardson","year":"1979","journal-title":"Am J Clin Nutr"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"fs9","DOI":"10.1126\/scisignal.aab1203","article-title":"Amino acid uptake in erythropoiesis","volume":"8","author":"Nathan","year":"2015","journal-title":"Sci Signal"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"S77","DOI":"10.1017\/S0007114512002577","article-title":"Assessment of protein adequacy in developing countries: quality matters","volume":"108","author":"Ghosh","year":"2012","journal-title":"Br J Nutr"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"4685","DOI":"10.1016\/j.clnu.2021.04.021","article-title":"Associations of circulating insulin-like growth factor-I with intake of dietary proteins and other macronutrients","volume":"40","author":"Watling","year":"2021","journal-title":"Clin Nutr"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1016\/j.cmet.2014.02.006","article-title":"Low protein intake is associated with a major reduction in IGF-1, cancer, and overall mortality in the 65 and younger but not older population","volume":"19","author":"Levine","year":"2014","journal-title":"Cell Metab"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2023.1121717\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,20]],"date-time":"2023-06-20T10:17:05Z","timestamp":1687256225000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2023.1121717\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,20]]},"references-count":41,"alternative-id":["10.3389\/fnut.2023.1121717"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2023.1121717","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,20]]},"article-number":"1121717"}}