Iron Deficiency in Collegiate Athletes: Effects of a Pragmatic Program for Assessment and Treatment

Download Article
Dr. Hina Umbreen, Dr. Iqra Sadaf, Dr. Sidra Tahir

Abstract-BACKGROUND: Iron deficiency has been shown to negatively affect sports performance. Iron deficiency is more common in female athletes than male athletes and among female athletes, those who are endurance trained are at a higher risk for iron deficiency. Many studies show iron supplementation has been shown to increase iron status in athletes. However, majority of these studies are research studies rather than pragmatic studies looking at the effectiveness of the program.

OBJECTIVE: We hypothesized that oral iron supplementation is effective in improving iron status, as determined from serum ferritin levels, in female student-athletes in the real-world setting.

METHODS: The study is a retrospective analysis of existing data that were collected as part of an iron monitoring and supplementation program that was implemented by the Department of Sports Sciences & Physical Education at Punjab University (division I). Sixty-four female athletes (age 18.3 ± 0.1 years, BMI 22.5 ± 0.4 kg/m2) were screened for the 2017-2018 academic school year. Fifty- one of them were incoming freshmen athletes from any sport (age 17.8 ± 0.1 years, 23.1 ± 0.5 kg/m2) and thirteen of them were upperclassmen on the cross-country team. Two females were cross-country runners and freshmen female athletes, meaning the cross-country team included 15 female runners (age 19.7 ± 0.3 years, 20.3 ± 0.5 kg/m2, dietary iron intake 8 ± 1 mg per day). Incoming freshmen were screened at baseline from May – August 2017 while the upperclassmen cross-country runners were screened at baseline from July – October 2017. Those who were iron deficient (serum ferritin < 20 ng/mL) were advised to begin oral iron supplementation and instructed to follow up, per physician recommendation. The monitoring and intervention program began May 2017 and ran through the 2018 spring semester. Data from the university athletics dietitian were compiled from the electronic medical record, were deidentified, and provided for analysis.

RESULTS: 18 (28%) of the sample had nonanemic iron deficiency, NAID. 16 (31%) of freshmen athletes had NAID which was a higher prevalence compared to the 2 (13%) from the cross-country team. Of those with NAID, 15 received prescribed iron supplementation and 2 received over-the-counter supplementation. 8 of the 18 (44%) underwent follow-up and 6 of the 8 (75%) had resolved NAID by the end of the program. This was a significant increase (p=0.03). CONCLUSION: Iron deficiency is improved with iron supplementation, despite the variability in pill compliance and bioavailability of iron. In a pragmatic setting, more aggressive intervention is needed for increased compliance and better follow-up.

sports nutrition, iron, deficiency, iron supplementation, fatigue, performance, ferrous sulfate, athletes, cross country, freshmen, female athletes, dietary iron, collegiate athletes