British Journal of Nutrition

Full Papers

Dietary Surveys and Nutritional Epidemiology

Iron deficiency is uncommon among lactating women in urban Nepal, despite a high risk of inadequate dietary iron intake

Sigrun Henjuma1 c1, Mari Mangera2, Eli Skeiea2, Manjeswori Ulaka3, Andrew L. Thorne-Lymana4a5, Ram Chandyoa2a3, Prakash S. Shresthaa3, Lindsey Locksa4, Rune J. Ulvika6a7, Wafaie W. Fawzia4a8a9 and Tor A. Stranda2a10

a1 Oslo and Akershus University College of Applied Sciences, PO Box 4, St Olavs Plass, N-0130 Oslo, Norway

a2 Centre for International Health, University of Bergen, PO Box 7800, 5020 Bergen, Norway

a3 Department of Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal

a4 Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA

a5 Center on Globalization and Sustainable Development, the Earth Institute, Columbia University, New York, NY, USA

a6 Department of Clinical Science, University of Bergen, 5020 Bergen, Norway

a7 Laboratory of Clinical Biochemistry, Haukeland University Hospital, 5021 Bergen, Norway

a8 Department of Epidemiology, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA

a9 Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA

a10 Division of Medical Services, Innlandet Hospital Trust, 2629 Lillehammer, Norway


The main objective of the present study was to examine the association between dietary Fe intake and dietary predictors of Fe status and Hb concentration among lactating women in Bhaktapur, Nepal. We included 500 randomly selected lactating women in a cross-sectional survey. Dietary information was obtained through three interactive 24 h recall interviews including personal recipes. Concentrations of Hb and plasma ferritin and soluble transferrin receptors were measured. The daily median Fe intake from food was 17·5 mg, and 70 % of the women were found to be at the risk of inadequate dietary Fe intake. Approximately 90 % of the women had taken Fe supplements in pregnancy. The prevalence of anaemia was 20 % (Hb levels < 123 g/l) and that of Fe deficiency was 5 % (plasma ferritin levels < 15 μg/l). In multiple regression analyses, there was a weak positive association between dietary Fe intake and body Fe (β 0·03, 95 % CI 0·014, 0·045). Among the women with children aged < 6 months, but not those with older infants, intake of Fe supplements in pregnancy for at least 6 months was positively associated with body Fe (P for interaction < 0·01). Due to a relatively high dietary intake of non-haem Fe combined with low bioavailability, a high proportion of the women in the present study were at the risk of inadequate intake of Fe. The low prevalence of anaemia and Fe deficiency may be explained by the majority of the women consuming Fe supplements in pregnancy.

(Received July 03 2013)

(Revised February 05 2014)

(Accepted February 21 2014)

(Online publication April 08 2014)

Key Words:

  • Iron deficiency;
  • Lactating women;
  • Iron intakes;
  • Plasma ferritin;
  • Soluble transferrin receptors


c1 Corresponding author: S. Henjum, email


  Abbreviations: EAR, estimated average requirement; FCT, food composition table; R:F, soluble serum transferrin receptor:plasma ferritin ratio; RNI, recommended nutrient intake; TfR, transferrin receptor