Nutritional anemia is a worldwide
problem that is increasing in developing countries 1. Anemia that
is caused due to deficiency of any nutritive substance (example: iron, vitamin
B12, folic acid and other micronutrients) which is required for erythropoiesis
is termed as nutritional anemia. Over the past two decades, nearly all of the
anemia prevalence related studies have been performed in infants, children,
adolescents and pregnant women 2. Not much is known of the same in
university students particularly medical students.
It is generally assumed that since
medical students have better knowledge about healthy lifestyle and dietary
practices, they are bound to be healthier as compared to other college students
3. This is not quite the case. There is evidence that the medical
students both day scholars and those staying in hostels are at high risk of
anemia because of long college schedule, clinical postings, stress, studies,
other curriculum activities and inappropriate diet 4.
Nutritional anemia is prevalent
globally with an estimated two billion people being iron deficient which is one
of the most common nutritional disorders of the developing world 5.
The symptoms of anemia include weakness, fatigue, palpitations, shortness of
breath, light headedness and all of these can affect the physical and mental
wellness of an individual 6. Consequently, it can decrease the
working capacity, learning and cognitive behavior, attention, regular
activities and performance of the said individual 7-8.
Anemia is defined as a hemoglobin
concentration of the blood values ? 13 g/dl in adult males and ? 11 g/dl in
adult females 9. In this study we have focused on college going students,
with the purpose of estimating the prevalence among them and to classify anemia
severity according to hemoglobin concentration cutoff values and anemia types
according to Red Blood Cell indices.
The main objective of this study is
to estimate the prevalence of anemia among medical students and to assess its
correlation with variables such as age, gender, dietary habits and Body Mass Index.
Also, an attempt is made to classify anemia severity and determine the various
risk factors in this population.
study the prevalence and classify the severity of anemia according to Red Blood
Cell indices; Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH),
Mean Corpuscular Hemoglobin Concentration (MCHC) in medical students.
identify the dietary habits of the study population.
estimate the Body Mass Index of the study population.
find out the correlation between the dietary habits, Body Mass Index and risk
factors of nutritional anemia among medical students.
The research proposal will be
reviewed by the Institutional Ethics Committee and a written informed consent from
the participants will be obtained before conducting the study.
A cross-sectional study will be carried
out to determine the prevalence of nutritional anemia and to classify anemia
severity along with the associated risk factors in medical students.
Study population: Undergraduate medical students.
Sample size :100
students of age group, 18-25 years are included.
students who give consent for using the collected blood specimens and data for
the purpose of this research study are included.
with known chronic illnesses such as cardiac and pulmonary diseases, renal
disorders, hemoglobinopathies, menstrual disorders, thyroid disorders, bleeding
disorders, history of worm infestation, dehydration due to any cause and on
fluid therapy are excluded from the study.
who do not give consent and who do not fall in the given age group are
A written informed consent including
the objectives and details of the study shall be taken from each medical
student before sample collection. All the students are informed that the
information thus obtained shall be kept confidential and only be used for
Prior to examination and blood
testing a structured questionnaire will be administered to each student which
includes general information and dietary habits (food frequency) of the student.
The general information part will include biodata, if the student is a day
scholar or lives in the hostel and socio-economic status of the student. The
dietary habits part includes the diet consumed (veg/mixed), habits, schedule,
fluid intake and snacks eaten between main meals, if applicable.
A detailed physical examination will
be done to check for signs of anemia and dehydration which will be recorded in
Anthropometric measurements such as
height and weight shall be measured using a stadiometer. Body Mass Index (BMI)
will be calculated from these parameters using Quetelet’s index; Body Mass
Index=Weight in kg/Height in m2 10.
1 ml venous blood specimens of the
students will be collected by venipuncture and stored in ethylene diamine
tetra-acetic acid (EDTA) vacutainers. All samples will be examined for Complete
Blood Count (CBC), Hemoglobin (HB), Hematocrit (PCV), Mean Corpuscular Volume
(MCV), Mean Corpuscular Hemoglobin (MCH) and Mean Corpuscular Hemoglobin
Concentration using ANALYSER
which is calibrated by using standard quality assurance at the hematological
laboratory. Blood indices are calculated to differentiate between different
types of anemia and to find out the associated risk factors in correlation to
each one of them.
Classification of anemia severity
will be done according to World Health Organization criteria. Hemoglobin levels
? 13 g/dl in males and ? 11 g/dl in females is considered as anemic. Hemoglobin
levels of 9.0 -10.9 g/dl is graded as mild anemia, hemoglobin levels of 7-9.9 g/dl
and, < 7g/dl are graded as moderate and severe anemia respectively 9. The participants are divided into two groups, day scholars and those who live in hostels to evaluate which group have a higher risk for anemia. The students are also divided based on Body Mass Index cut off values for Asians as recommended by World Health Organization. This is done to determine the correlation between Body Mass Index and the severity of anemia. Students are classified as underweight when BMI <18.5 kg/m2, Normal when BMI =18.5-24.9 kg/m2, Overweight when BMI =25-29.9 kg/m2 and Obese when BMI ?30 kg/m2 10. Quality control Statistical analysis 1. Qualitative data will be documented by using frequency/count. 2. Quantitative data will be presented by mean, standard deviation and confidence interval. 3. Student t test/Mann-Whitney 'U' test to compare between the means of two groups of study. 4. Association between categorical variables will be tested by using chi square test. 5. p<0.05 will be considered to be statistically significant. 6. Study Package for Social Sciences (SPSS) will be used to analyze the collected data. Implications Nutritional anemia is a serious global health problem. Anemia can affect the life of a medical student and can reduce their efficiency. This study is undertaken to assess the prevalence and risk factors of nutritional anemia in medical students so that further measures can be taken to prevent nutritional anemia in the 18-25year age group. Medical students are the future doctors of the society, hence care needs to be taken to ensure that these individuals are healthy. References 1. Mehta K. Prevalence of nutritional anemia among college students and its correlation with their body mass index. Int J Sci Res. 2015;4:1882-6. 2. Sultan AH. Anemia among female college students attending the University of Sharjah, UAE: prevalence and classification. J Egypt Public Health Assoc. 2007;82(3-4):261-71. 3. Likus W, Milka D, Bajor G, Jachacz-Lopata M, Dorzak B. Dietary habits and physical activity in students from the Medical University of Silesia in Poland. Roczniki Pa?stwowego Zak?adu Higieny. 2013;64(4). 4. Pandey S, Singh A. A cross sectional study of nutritional Anemia among medical students in a medical college, at Bilaspur, Chhattisgarh. National Journal of Medical Research. 2013 Apr;3(2):143-6. 5. Ramzi M, Haghpanah S, Malekmakan L, Cohan N, Baseri A, Alamdari A, Zare N. Anemia and iron deficiency in adolescent school girls in kavar urban area, southern iran. Iranian Red Crescent Medical Journal. 2011 Feb;13(2):128. 6. UNICEF/United Nations University/World Health Organization. Iron de?ciency anemia. Assessment, Prevention, and Control: A guide for programme managers. Document WHO/NHD/01.3. Geneva: World Health Organization; 2001. 7. Haas JD, Brownlie T. Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. The Journal of nutrition. 2001 Feb 1;131(2):676S-90S. 8. Halterman JS, Kaczorowski JM, Aligne CA, Auinger P, Szilagyi PG. Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States. Pediatrics. 2001 Jun 1;107(6):1381-6. 9. WHO, Assessing iron status of population. Report of a joint World Health Organization/ Centers for disease Control and Preventation, 6-8 April 2004, Geneve, Switzerland. 10. Kaur M. Correlation between body mass index and blood pressure in adolescents. Pak J Physiol. 2016;12(1):47-50.