Biological Trace Element Research

, Volume 159, Issue 1–3, pp 22–31 | Cite as

Iron Deficiency Without Anemia Is Associated with Anger and Fatigue in Young Japanese Women

  • Takako Sawada
  • Aki Konomi
  • Katsuhiko Yokoi


Iron deficiency without anemia (IDNA), the most prevalent nutritional deficiency worldwide, affects young women of reproductive age. This study aimed to elucidate the relationship between IDNA and mental and somatic symptoms including anger and fatigue using the Japanese version of the Cornell Medical Index Health Questionnaire (CMI–J). Data regarding demographic characteristics, anthropometry, hematological, and biochemical indices of the iron status, frequencies of selected food intakes assessed by self-administered food frequency questionnaires (FFQs), frequencies of nonspecific symptoms, and grades of neurotic tendencies assessed by CMI–J were collected from 76 young women aged 18–22 years living in the metropolitan area of Tokyo, Japan. The subjects were classified as having IDNA (hemoglobin (Hb) ≥ 12 g/dL and serum ferritin < 20 ng/mL; n = 29), having iron deficiency anemia (IDA) (Hb < 12 g/dL and serum ferritin < 20 ng/mL; n = 10), or having a normal iron status (Hb ≥ 12 g/dL and serum ferritin ≥ 20 ng/mL; n = 36). One subject was excluded from the analyses because of Hb < 12 g/dL and serum ferritin ≥ 20 ng/mL. Fisher’s protected least significant difference and the Dwass–Steel–Chritchlow–Fligner multiple comparison tests were used to compare the data of the three groups. P values <0.05 were considered significant. Sections M–R (mental complaints) were significantly higher in the IDNA subjects than in the normal subjects. No significant difference in CMI scores was found between the normal and IDA subjects. Sections I (fatigability), Q (anger), and R (tension) were significantly higher in the IDNA subjects than in the normal subjects, regardless of no significant differences between the normal and IDA subjects in those sections. Young women with IDNA demonstrated a significantly higher proportion of neurotic tendencies (grades II–IV). The intake frequency score of canned or bottled green tea fortified with vitamin C was significantly higher in the IDNA subjects than the IDA subjects. The findings suggest that IDNA may be a risk factor for anger, fatigue, and tension in women of childbearing age.


Nonanemic iron deficiency Young women Mental symptoms Cornell Medical Index 



Iron deficiency


Iron deficiency anemia


Iron deficiency without anemia


Cornell Medical Index


Cornell Medical Index Japanese version


Food frequency questionnaire


Unsaturated iron binding capacity


Total iron binding capacity



This study was supported in part by the Japan Society Sasakawa Science Foundation (2006) and the Ito Foundation (2003–2007). T.S. and K.Y. designed and initiated the study; T.S., A.K., and K.Y. collected the data; T.S. and K.Y. interpreted the data; T.S. drafted the manuscript; and K.Y. supervised the entire study and provided critical revision of the manuscript. None of the authors had any conflicts of interest.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Faculty of Food and Nutritional SciencesToyo UniversityGunmaJapan
  2. 2.Faculty of Health and Medical SciencesTeikyo Heisei UniversityTokyoJapan
  3. 3.Department of Human NutritionSeitoku University Graduate SchoolMatsudoJapan

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