April Blog Summary

I chose this article for the ISU Journal Club Blog for April because anemia is so prevalent in the U.S., especially among the older population. Anemia has been associated with the prevalence of high mortality rates and hospitalizations. However, nutrition-related anemia can be prevented in postmenopausal women, which is why I picked this article to blog about.

For Question 1, Liz, Amy, Rose, Brooke S., Jordan, Meredith and Bethany all agreed that it was not necessary for this study to have included questions about oral health, appetite, tolerance of milk-based products, and using the Schilling test to determine lack of IF and decreased B12 absorption. The fact that this study was one of the first studies of its size to research postmenopausal women, their diet, and risk for anemia provided baseline data for future research on this topic. Amy said the Schilling test would be a good idea to use in participants that presented with persistent anemia, but not in those with incident anemia. Michela stated that it is important to keep the number of variables low and to concentrate on the basics when researching rather than including an overwhelming amount of variables.

Kara thought the study should have included questions about appetite, oral health, and tolerance of milk products to examine possible causes of anemia in these women. She also said that it would have been a good idea to perform the Schilling test, but that it would have been expensive. Stephanie and Sarah G. thought the questions would be good to ask this particular population to examine their intake of B12, iron, and folate, but that the size of the study would cause an increase in workload for the researchers due to increased questions and variables. Sarah G. said, testing and exploring these variables would be reasonable in a smaller stratified random sample of the study population in another research study.

Anna made a good point that it is important to not add too many details/variables to research and to remember to look at the big picture. Kathy pointed out that the Schilling test would likely be expensive to perform on a study with a sample size this large and Kevin agreed. Jamie thought the Schilling test should have been done on each participant because it would make the study more accurate and valid knowing if the participant had nutrition-related anemia or if they had a lack of intrinsic factor. Amanda pointed out that in order to be cost effective the study size would need to be drastically reduced and she also stated that a B12 blood test is likely more expensive compared to the Schilling test.

For Question 2, all of the bloggers agreed that using a FFQ with self-reported data comes with limitations, but it is not realistic to use another way of collecting data (i.e. observation or interview style) with a study this large in size. Everyone agreed that it would be more expensive and time consuming to choose a different method other than using a FFQ. Stephanie pointed out that it is a good idea to educate participants on portion sizes through something like a website before completing the FFQ to help reduce the potential for self-reported error. Sarah G. and Liz both thought it would be interesting to examine the variability in macronutrient versus micronutrient self-reported error. They both agreed that the same error for measuring macronutrients would be present with measuring micronutrients.

In Question 3, many of the bloggers stated that the use of multivitamin/mineral supplementation by individuals is often inconsistent and often times people believe that by taking a multivitamin/mineral, they do not need to have adequate intake of those vitamins from dietary sources. Stephanie, Rose, Amy, Brooke, all stated that this population group of women may be at a higher risk due to genetic factors, socioeconomic status, lack of nutrition education, and having a diet lacking in sufficient amounts of B12, iron, Vitamin C, folate, and protein sources.

Sarah G. made a good point that there were no controls over what type of supplement was taken, which would cause multiple variations due to differences in brands of supplements, absorption rates of the vitamins/minerals, and bioavailability. Bethany agreed that due to this population being of low socioeconomic status compared to other race/ethnicities, this population may not be purchasing food high in iron and B12 because they are expensive (e.g. fresh leafy greens, meat). She also pointed out that this population group is at a higher risk for sickle cell anemia and thalassemia due to their genetics and that she was not surprised to read that they were more at risk for developing anemia compared to the other ethnicities.

Kevin agreed with some of the bloggers about how cultural foods definitely play a role in the types of food and nutrients that are abundant or accepted in one’s culture. Kara stated that African American women are at a higher risk for anemia due to a combination of these factors (i.e. socioeconomic status, genetic factors, cultural diet) compared to other ethnicities. Finally Meredith agreed with everyone in that the African American’s cultural diet practices may not be providing adequate sources of anemia-preventative foods. She also made a great statement about implications for RDs when counseling clients of diverse cultural backgrounds when making nutrition recommendations.

In conclusion, the majority of the bloggers agreed with each other regarding the need for including questions in this study about oral health, appetite, tolerance of milk-based products, and using the Schilling test to determine lack of IF and decreased B12 absorption. Everyone including myself agrees that the purpose of this study was to establish baseline data and that future research with smaller stratified randomly sampled participants should be asked these questions. Also the use of the Schilling test or testing for B12 levels in the blood should be included if the benefit of the results outweighs the cost of the tests and should be done with participants that have persistent or pernicious anemia and in a much smaller sample size.

Practically everyone had the same ideas and opinions regarding the use of a FFQ and that it was the best choice for collecting data in this study due to the extremely large sample size (i.e. 93,676 postmenopausal women). I agree that the FFQ was the best method of collecting data for this study. As with any other research being conducted, there will always be some kind of limitation to the study because not study is “perfect.” For the final question, all of the bloggers agreed that there are multiple factors that may contribute to the African American population being more at risk for anemia such as genetics, cultural diet preferences/practices, and being of low socioeconomic status. I completely agree with Meredith that the take home message of this study is that there are many factors that come into play in the risk for developing anemia. RDs in both the inpatient and outpatient settings need to be economically, culturally, and demographically aware of the differences in one’s risk for developing anemia. In addition, dietitians need to be sensitive to personal diet preferences, ask about consistency in vitamin/mineral supplementation, and obtain a comprehensive diet recall including food intolerances/allergies, likes/dislikes, and barriers to consuming specific food or food groups.