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Association of Dietary Diversity and Odds of Anemia in Children and Adolescents: A Systematic Review and Meta-Analysis of Observational Studies Publisher



Li H1 ; Moosavian SP2 ; Ghanbari N3 ; Mirlohi SH4 ; Rahimlou M5
Authors
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Authors Affiliations
  1. 1. Department of Physical Education, Henan University of Animal Husbandry and Economy, No.6, Longzihu North Road, Zhengdong New District, Henan Province, Zhengzhou, 450000, China
  2. 2. Department of Community Nutrition, Vice-Chancellery for Health, Shiraz University of Medical Sciences, Shiraz, Iran
  3. 3. Assistant Professor of General Pediatrician, Emergency division, Bahrami hospital, school of medicine, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Pediatric Respiratory Disease and Sleep Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Metabolic Diseases Research Center, Health and Metabolic Research Institute, Zanjan University of Medical Sciences, Zanjan, Iran

Source: BMC Nutrition Published:2025


Abstract

Background: Anemia, characterized by a deficiency in red blood cells or hemoglobin, remains a significant public health concern worldwide, particularly among children and adolescents. Inadequate dietary intake, including micronutrient deficiencies, has been associated with anemia. Dietary diversity, characterized by the consumption of a variety of food groups, may contribute to adequate iron intake and a reduced likelihood of anemia. This systematic review and meta-analysis examined the association between dietary diversity and odds of anemia among children and adolescents. Methods: A comprehensive search of electronic databases (PubMed, Web of Science, Scopus) was conducted for observational studies (cross-sectional or case–control) published before April 2024 that assessed the association between dietary diversity and anemia among children and adolescents. The odds of Bias in Non-Randomized Studies of Exposures (ROBINS-E) tool was used to assess the quality of included studies, ensuring a standardized and rigorous evaluation process. Subgroup analyses explored potential variations in this association based on age group, geographic location, and type of anemia. Results: Nineteen studies (18 cross-sectional and 1 case–control) examined the association between dietary diversity and anemia in children under 5 years old. Pooled analysis revealed a significant association between lower dietary diversity and higher odds of anemia among children aged 0 to 5 years (OR = 1.96; 95% CI: 1.57, 2.45; I2 = 83.6%, τ2 = 0.38 P < 0.001). Ten studies examined the relationship in children and adolescents aged 6–18 years, showing a similar pattern (OR = 1.73; 95% CI: 1.27, 2.36; I2 = 87%, τ2 = 0.44; P < 0.001). Subgroup analyses suggested that the association varied across specific geographic regions. Conclusions: This meta-analysis indicates a significant association between lower dietary diversity and higher odds of anemia in children and adolescents. These findings underscore the importance of dietary diversity as a potential factor related to anemia prevalence. Future research should focus on standardizing dietary diversity assessment methods and incorporating detailed dietary quality measurements. © The Author(s) 2025.
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