ORIGINAL COMMUNICATION Prevalence of iron deficiency among schoolchildren of different socio-economic status in urban Turkey Y Keskin 2 , G Moschonis 1 , M Dimitriou 1 , H Sur 2 , B Kocaoglu 3 , O Hayran 2 and Y Manios 1 * 1 Department of Nutrition and Dietetics, Harokopio University of Athens, Greece; 2 Department of Health Education, University of Marmara School of Health Education, Istanbul, Turkey; and 3 Department of Tourism Administration, School of Applied Disciplines, Bogazici University, Istanbul, Turkey Objective: To investigate the prevalence of iron deficiency among schoolchildren of different socio-economic status (SES), living in the three largest cities of Turkey. Design: Cross-sectional study. Settings: Primary schools of Istanbul, Ankara and Izmir. Subjects: Schoolchildren aged 12 and 13 y (males: 504; females: 510) from nine primary schools. Inclusion of subjects in the study was on a voluntary basis. Methods: Data were obtained on children SES, anthropometry, haematological and biochemical indices of iron status and consumption of food items related to dietary iron bioavailability. One-way analysis of variance was mainly applied, for the evaluation of the tested hypotheses, using Bonferroni correction in order to take into account the inflation of Type I error. Results: Iron deficiency (serum ferritin o15 mg/l) prevalence was 17.5% among boys and 20.8% among girls. Furthermore, iron deficiency was significantly more prevalent among boys of lower SES, who were also found to have significantly lower levels of serum iron, serum ferritin, transferrin saturation, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration compared to those of higher SES. In terms of dietary factors affecting iron bioavailability, low SES boys exhibited significantly higher frequency of tea consumption and lower frequency of citrus fruit, red meat and fish consumption, compared to their higher SES counterparts. Conclusion: The prevalence of iron deficiency was relatively high, particularly among lower SES schoolboys. Higher tea and lower citrus fruits, red meat and fish consumption by boys of lower SES may provide an indication about the possible role of certain dietary patterns in the different manifestation of this medical condition among the socio-economic groups. However, further research is needed. Sponsorship: This study was supported by a research grant from Kellogg Europe and Bogazici University. European Journal of Clinical Nutrition (2005) 59, 64–71. doi:10.1038/sj.ejcn.1602035 Published online 28 July 2004 Keywords: iron deficiency; schoolchildren; socio-economic status; serum ferritin; Turkey Introduction Iron deficiency is probably the most prevalent and common micronutrient deficiency in the developing world today (Tatala et al, 1998; Asobayire et al, 2001; Abalkhail & Shawky, 2002; Hashizume et al, 2003). The detrimental public health effects of iron deficiency include anaemia, decreased in- tellectual and work performance as well as functional alterations of the small bowel (Oski, 1993). Besides other vulnerable age groups, such as infancy and early childhood, adolescence is placed at a high risk level for developing iron deficiency, due to a combination of menstrual iron losses in girls and a rapid physical growth, especially in boys (Fomon et al, 2003). Poor diet quality and low dietary iron bioavailability are the principal factors that contribute to the increased Received 30 March 2004; revised 21 May 2004; accepted 21 June 2004; published online 28 July 2004 *Correspondence: Y Manios, Harokopio University of Athens, Department of Nutrition and Dietetics, 70, E Venizelou Ave, 17671 Kallithea, Athens, Greece. E-mail: manios@hua.gr Guarantor: Y Manios. Contributors: YK supervised the field study, carried out the laboratory research and wrote some parts of the manuscript. GM took part in the writing of the manuscript and carried out some of the statistical analysis and interpretation. MD took part in the writing of the manuscript. HS supervised the field study and carried out the data collection and the preparation of the database. BK took part in the study design, designed and evaluated the food frequency questionnaires. OH contributed to the design of the study, managed the data and was involved in the coordination of the study. YM contributed to the design of the study, to the writing of the protocol and was responsible for the statistical analysis, the interpretation and the writing of the manuscript. European Journal of Clinical Nutrition (2005) 59, 64–71 & 2005 Nature Publishing Group All rights reserved 0954-3007/05 $30.00 www.nature.com/ejcn