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Screening for iron deficiency in young women : the predictive validity of a five-item screening instrument (IRON-5)

Vinge, Fredrik LU ; Stubbendorff, Anna LU orcid ; Bolmsjö, Beata Borgström LU ; Jakobsson, Ulf LU orcid ; Milos Nymberg, Veronica LU orcid and Wolff, Moa LU (2026) In Scandinavian Journal of Primary Health Care 44(1). p.1-13
Abstract

BACKGROUND: Iron deficiency is the most common micronutrient deficiency worldwide, negatively affecting quality of life and health. Young women are at particularly high risk due to increased iron demands during growth, menstrual blood losses, and dietary habits. There are no official guidelines recommending screening for iron deficiency in healthy young women. This study aimed to develop a screening instrument (IRON-5) to predict iron deficiency in this group, with relevance for use in primary care and school health services.

METHODS: In 2023, a cross-sectional study was conducted to assess the prevalence of iron deficiency and associated factors in high school girls. A questionnaire assessing dietary habits, menstrual bleeding... (More)

BACKGROUND: Iron deficiency is the most common micronutrient deficiency worldwide, negatively affecting quality of life and health. Young women are at particularly high risk due to increased iron demands during growth, menstrual blood losses, and dietary habits. There are no official guidelines recommending screening for iron deficiency in healthy young women. This study aimed to develop a screening instrument (IRON-5) to predict iron deficiency in this group, with relevance for use in primary care and school health services.

METHODS: In 2023, a cross-sectional study was conducted to assess the prevalence of iron deficiency and associated factors in high school girls. A questionnaire assessing dietary habits, menstrual bleeding patterns, iron supplement use, and hormonal contraceptive use was administered. Iron deficiency was defined as serum ferritin <15 µg/L. A post-hoc analysis identified the strongest predictors of iron deficiency and incorporated them into a risk-scoring model.

RESULTS: The final instrument included five predictors: a non-omnivorous diet, heavy menstruation causing discomfort, avoidance of activities due to menstruation, no iron supplementation, and non-use of hormonal contraceptives. A scoring system (0-5) was developed. Using a threshold score of ≥ 3, the model achieved a sensitivity of 74% and specificity of 57% for detecting iron deficiency.

CONCLUSION: The IRON-5 is a concise and user-friendly screening instrument designed to identify young women at risk of iron deficiency. It demonstrated good sensitivity and may serve as a cost-effective method to prioritize individuals for blood testing. IRON-5 could support identification and prevention strategies in school-based and primary care settings.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Female, Cross-Sectional Studies, Adolescent, Anemia, Iron-Deficiency/diagnosis, Surveys and Questionnaires, Mass Screening/methods, Iron Deficiencies, Prevalence, Ferritins/blood, Dietary Supplements, Primary Health Care, Iron/blood, Feeding Behavior, Menstruation
in
Scandinavian Journal of Primary Health Care
volume
44
issue
1
article number
2649329
pages
1 - 13
publisher
Informa Healthcare
external identifiers
  • pmid:41916414
  • scopus:105034798907
ISSN
0281-3432
DOI
10.1080/02813432.2026.2649329
language
English
LU publication?
yes
id
f12e4a85-9ccb-4685-8052-7be9fcd71c44
date added to LUP
2026-04-10 09:42:18
date last changed
2026-04-11 04:00:28
@article{f12e4a85-9ccb-4685-8052-7be9fcd71c44,
  abstract     = {{<p>BACKGROUND: Iron deficiency is the most common micronutrient deficiency worldwide, negatively affecting quality of life and health. Young women are at particularly high risk due to increased iron demands during growth, menstrual blood losses, and dietary habits. There are no official guidelines recommending screening for iron deficiency in healthy young women. This study aimed to develop a screening instrument (IRON-5) to predict iron deficiency in this group, with relevance for use in primary care and school health services.</p><p>METHODS: In 2023, a cross-sectional study was conducted to assess the prevalence of iron deficiency and associated factors in high school girls. A questionnaire assessing dietary habits, menstrual bleeding patterns, iron supplement use, and hormonal contraceptive use was administered. Iron deficiency was defined as serum ferritin &lt;15 µg/L. A post-hoc analysis identified the strongest predictors of iron deficiency and incorporated them into a risk-scoring model.</p><p>RESULTS: The final instrument included five predictors: a non-omnivorous diet, heavy menstruation causing discomfort, avoidance of activities due to menstruation, no iron supplementation, and non-use of hormonal contraceptives. A scoring system (0-5) was developed. Using a threshold score of ≥ 3, the model achieved a sensitivity of 74% and specificity of 57% for detecting iron deficiency.</p><p>CONCLUSION: The IRON-5 is a concise and user-friendly screening instrument designed to identify young women at risk of iron deficiency. It demonstrated good sensitivity and may serve as a cost-effective method to prioritize individuals for blood testing. IRON-5 could support identification and prevention strategies in school-based and primary care settings.</p>}},
  author       = {{Vinge, Fredrik and Stubbendorff, Anna and Bolmsjö, Beata Borgström and Jakobsson, Ulf and Milos Nymberg, Veronica and Wolff, Moa}},
  issn         = {{0281-3432}},
  keywords     = {{Humans; Female; Cross-Sectional Studies; Adolescent; Anemia, Iron-Deficiency/diagnosis; Surveys and Questionnaires; Mass Screening/methods; Iron Deficiencies; Prevalence; Ferritins/blood; Dietary Supplements; Primary Health Care; Iron/blood; Feeding Behavior; Menstruation}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{1--13}},
  publisher    = {{Informa Healthcare}},
  series       = {{Scandinavian Journal of Primary Health Care}},
  title        = {{Screening for iron deficiency in young women : the predictive validity of a five-item screening instrument (IRON-5)}},
  url          = {{http://dx.doi.org/10.1080/02813432.2026.2649329}},
  doi          = {{10.1080/02813432.2026.2649329}},
  volume       = {{44}},
  year         = {{2026}},
}