Vitamin A, Vitamin D, and Iron: New Evidence on Childhood Anemia Risk

Iron supplementation alone may not be enough. A new study published in Nutrients (2025) reveals the causal relationships between Vitamin A, Vitamin D, iron status, and childhood anemia, offering fresh insights into prevention strategies.

Background

Anemia is a common clinical condition characterized by reduced red blood cell volume. It remains a major global public health issue, with a prevalence of 24.3% worldwide (affecting nearly 1.9 billion people). In China, approximately 136 million individuals suffer from anemia, including a significant proportion of schoolaged children.

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Childhood anemia leads to growth delays, higher infection rates, impaired cognition and motor development, ultimately reducing learning efficiency and social participation, while negatively impacting economic development.

Study Design

COMPONENT
DETAILS

Crosssectional data
1,725 children (6-17 years) in Hunan Province

Indicators
Demographics, diet, outdoor activity, serum micronutrients (Vitamin A, 25hydroxy Vitamin D, ferritin, zinc)

Analysis
Multivariable logistic regression

Genetic analysis
Mendelian Randomization (MR) using GWAS datasets

Outcomes
Causal links between micronutrients and anemia risk

Lifestyle Factors

FACTOR
EFFECT ON ANEMIA RISK

greater than or equal to 30 min outdoor activity
down 47-63%

Daily/occasional milk intake
down 38-53%

Rural residence
up risk

Picky eating
up risk

Ferritin deficiency
up risk

Micronutrient Associations

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MICRONUTRIENT
OBSERVATIONAL FINDINGS
MR FINDINGS

Vitamin A
Higher levels ( greater than or equal to 0.44 g/mL) right lower anemia risk
No clear causal effect

Ferritin
Jshaped curve:Strong protective causal effect

Serum Iron
Deficiency increases risk
Strong protective causal effect

Vitamin D
No significant association
Weak protective effect after removing outliers

Zinc
No significant association
No causal effect

Implications

*
Vitamin A may reduce anemia risk by supporting red blood cell production, iron metabolism, and immune function.

*
Vitamin D may play a role in erythropoiesis and iron homeostasis, with MR analysis providing new evidence of its protective potential.

*
Ferritin and serum iron are confirmed as key biomarkers and intervention targets for childhood anemia.

*
Lifestyle factors such as outdoor activity and milk consumption indirectly lower anemia risk by improving overall health and immunity.

Conclusion

This study highlights that iron supplementation alone is insufficient. A holistic approach involving Vitamin A, Vitamin D, iron status, and healthy lifestyle factors is essential to reduce childhood anemia. Public health strategies should integrate nutritional diversity, outdoor activity, and targeted supplementation to achieve better outcomes.

Reference: Tang, J.; Tan, Y.; Chen, Y.; Wang, F.; Wang, T.; Sun, M.; Luo, M.; Chen, Y.; Wen, Y.; Li, Z.; et al. Vitamin A, Vitamin D, Iron, and Zinc in Relation to Anemia Risk: Observational Evidence and Mendelian Randomization. Nutrients 2025, 17, 3220.

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