Original articles
Helicobacter pylori–associated iron-deficiency anemia in adolescent female athletes,☆☆

https://doi.org/10.1067/mpd.2001.114700Get rights and content

Abstract

Objective: The objective was to investigate the role of Helicobacter pylori infection in iron-deficiency anemia (IDA) of pubescent athletes. Study design: Blood sampling and a questionnaire survey were performed on 440 regular high school students and 220 athletes of a physical education high school. Hemoglobin, serum iron, total iron-binding capacity, ferritin, and immunoglobulin G antibody to H pylori were measured to compare the prevalence of IDA and H pylori infection in the groups. Nutritional analysis and a questionnaire survey for socioeconomic status were undertaken to compare and control for other risk factors that might influence IDA and H pylori infection in the groups. In those with IDA coexistent with H pylori infection, we also determined whether IDA can be managed by H pylori eradication. Results: The prevalence rates of IDA, H pylori infection, and H pylori –associated IDA in female athletes were higher than in the control group. The relative risk of IDA was 2.9 (95% CI, 1.5 to 5.6) for those with H pylori infection. Athletes who exhibited H pylori –associated IDA showed significant increases in hemoglobin, iron, and ferritin levels after H pylori eradication. The subjects in the control group who were treated orally with iron alone showed no significant changes. Conclusion: Adolescent female athletes may have development of H pylori –associated IDA, which can be managed by H pylori eradication. (J Pediatr 2001;139:100-4)

Section snippets

Study Population

We selected 2 coeducational schools: a general high school and a physical education high school. Blood sampling and a questionnaire survey were performed; 660 subjects who met the study requirements were enrolled. Criteria for enrollment included no history of significant diseases such as infectious or gastrointestinal bleeding disorders, and menorrhagia in girls. Of these, 440 (228 boys and 212 girls) were regular high school students and nonathletes, and 220 (148 boys and 72 girls) were

Measurement of IDA Parameters and Serum H pylori IgG Antibody

The ages of the 660 subjects ranged from 15 to 17 years (mean age, 15.9 years). The prevalence rates of anemia, IDA, and H pylori infection in athletes were higher than those of the control group (Table I).

. Comparisons of the prevalence rates of anemia, IDA, H pylor i infection, and H pylori -associated IDA in athletes and control group

Empty CellNumber (% positive)P value
Athletes (n = 220)Control group (n = 440)
Anemia32 (14.6)42 (9.6).05
IDA18 (8.2)24 (5.5).176
H pylori infection95 (43.2)100 (22.7).001
H

DISCUSSION

Our results show that pubescent female athletes are likely to have H pylori -associated IDA. Their environments, involving extended stays at training camps, overcrowding, and poor hygiene, expose them to H pylori infection. In other words, H pylori infection exacerbates the iron deficit in adolescent female athletes whose iron supply is marginal.

H pylori is acquired primarily early in life. Although there is debate as to whether residency in an institution or a nursing home beginning at an

Acknowledgements

We are indebted to the parents for allowing their sons and daughters to participate in this study, to the schoolteachers for helping us execute our study, and to Ji Sun Lee for nutritional analysis.

References (27)

  • AW Nichols

    Nonorthopedic problems in the aquatic athlete

    Clin Sports Med

    (1999)
  • JF Escanero et al.

    Iron stores in professional athletes throughout the sports season

    Physiol Behav

    (1997)
  • MA Mendall et al.

    Childhood living conditions and Helicobacter pylori seropositivity in adult life

    Lancet

    (1992)
  • C Dufour et al.

    Helicobacter pylori gastric infection and sideropenic refractory anemia

    J Pediatr Gastroenterol Nutr

    (1993)
  • R Yip et al.

    Pervasive occult gastrointestinal bleeding in an Alaska native population with prevalent iron deficiency

    JAMA

    (1997)
  • M Marignani et al.

    Reversal of long-standing iron deficiency anaemia after eradication of Helicobacter pylori infection

    Scand J Gastroenterol

    (1997)
  • A Barabino et al.

    Unexplained refractory iron-deficiency anemia associated with Helicobacter pylori gastric infection in children: further clinical evidence

    J Pediatr Gastroenterol Nutr

    (1999)
  • B Annibale et al.

    Reversal of iron deficiency anemia after Helicobacter pylori eradication in patients with asymptomatic gastritis

    Ann Intern Med

    (1999)
  • YH Choe et al.

    Randomized placebo-controlled trial of Helicobacter pylori eradication for irondeficiency anemia in preadolescent children and adolescents

    Helicobacter

    (1999)
  • YH Choe et al.

    Effect of Helicobacter pylori eradication on sideropenic refractory anaemia in adolescent girls with Helicobacter pylori infection

    Acta Paediatr

    (2000)
  • L Hallberg et al.

    Prevalence of iron deficiency in Swedish adolescents

    Pediatr Res

    (1993)
  • H Yoshimura

    Anemia during physical training (sports anemia)

    Nutr Rev

    (1970)
  • DB Clement et al.

    Iron status and sports performance

    Sports Med

    (1984)
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    Supported by a grant from the Korea Research Foundation (KRF-99-003-F00181).

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    Reprint requests: Yon Ho Choe, MD, Department of Pediatrics, Samsung Medical Center, 50 Ilwon-dong, Kangnam-ku, Seoul, 135-710, Korea.

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