An analysis of data from the National Health and Nutrition Survey (NHANES) 4 II by Johnson-Spear and Yip (1994) showed that individuals of African extraction in the U.S. The general world-wide application of the common cut-off for anemia may be questioned. 1993, Williams 1981 and Yip 1996) found that hemoglobin distribution varies among races or ethnic backgrounds. 1983, Johnson-Spear and Yip 1994, Perry et al. In addition, several investigators ( Garn et al. 1969) also influence the hemoglobin concentration. Vitamin A deficiency ( Bloem 1995) and inflammation ( Farid et al. There are some environmental factors that also influence hemoglobin distribution such as changes in altitude ( Miale 1982) and smoking habits ( Nordenberg et al. 1981a) and stage of pregnancy ( WHO 1994) influence hemoglobin concentration thus, an appropriate anemia cut-offthat takes into account the normal variations is indicated. It is well known that there are a number of physiologic characteristics such as age ( Garn et al. In view of the close relationship between anemia and iron deficiency for either individual-based screening or for defining the burden of iron deficiency on a population basis, it is very important to ensure the validity of the hemoglobin cut-off point for the detection of iron deficiency. Although other iron-related tests are required for the confirmation of iron deficiency, it is reasonable to assume that a population with a high anemia prevalence is likely to also have a high prevalence of iron deficiency ( Freire 1989, Yip 1994). Because iron deficiency is often the most common cause of anemia, the presence of anemia is also used as a screening tool for iron deficiency. ![]() ![]() The cut-off value defining anemia has been determined by convention as the value at −2 sd from the mean or the 2.5th percentile of the normal distribution of a healthy iron-replete population. These measurements are relatively simple and cheap, can be carried out under field conditions, and values below a certain cut-off point indicate or define that anemia is likely to exist. The most commonly used screening methods for the presence of iron deficiency in a population are the measurements of hemoglobin or hematocrit concentration for the presence of anemia ( WHO 1994). Considering the magnitude of the problem and the multitude effects of iron deficiency, assessment of the iron status of the population is important for every country. Most affected are children and women in the developing world. Iron deficiency is the most prevalent nutritional problem worldwide an estimated 2.15 billion individuals are anemic because of iron deficiency ( FAO/WHO 1992). Hemoglobin, anemia, iron deficiency, humans, screening On the basis of the finding of hemoglobin distribution of men and the test performance of anemia (Hb < 120 g/L) for detecting iron deficiency for women, it is concluded that there is no need to develop different cut-off points for anemia as a tool for iron-deficiency screening in this population. When the WHO cutoff (Hb < 120 g/L) was applied to female subjects, the sensitivity of 34.2% and specificity of 89.4% were more comparable to the test performance for white American women, in contrast to those of the lower cut-off. The mean hemoglobin of the Indonesian females was 2 g/L lower than that of the American reference population, which may be the result of incomplete exclusion of subjects with milder form of iron deficiency. The mean hemoglobin of Indonesian males was similar to the American reference population at 152 g/L with comparable hemoglobin distribution. Twenty percent of the Indonesian females had iron deficiency, but no male subjects were iron deficient. ![]() The hemoglobin distributions, based on individuals without evidence of clear iron deficiency and infectious process, were compared with the National Health and Nutrition Survey (NHANES) II population of the United States. Hemoglobin, iron biochemistry tests and key infection indicators that can influence iron metabolism were analyzed. This was a cross-sectional study in 203 males and 170 females recruited through a convenience sampling procedure. The study was designed to determine whether population-specific hemoglobin cut-off values for detection of iron deficiency are needed for Indonesia by comparing the hemoglobin distribution of healthy young Indonesians with that of an American population.
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