Iron deficiency, functional performance and nutritional status in healthy adolescent male athletes
DOI:
https://doi.org/10.47197/retos.v77.116553Keywords:
Adolescents, athletes, iron deficiency anemia, nutritional status, physical performanceAbstract
Introduction: Iron deficiency is a common nutritional issue with potential impacts on physical performance, particularly in young athletes.
Aim: To analyze the relationship between iron deficiency, physical performance, and nutritional status in adolescent male athletes.
Methodology: This cross-sectional study involved 126 healthy male soccer players from two local professional clubs, divided into groups: M1≤12 (n=61) and M2> 12 (n=65). The athletes participated in training sessions six days a week. Blood tests included hemoglobin (Hb), serum iron, and ferritin levels. Physical performance was evaluated using VO2max (Course Navette Test), and nutritional status was assessed through BMI and dietary intake from Hem and non-Hem iron sources.
Results: One athlete (0.79%) was diagnosed with iron deficiency anemia (IDA); 23.02% (n=29) had ferritin levels <30 ng/mL, and 11.11% (n=14) showed signs of iron deficiency (ID). VO2max values indicated adequate performance for age: M1 = 69.17 ml/kg/min and M2 = 76.90 ml/kg/min. A high intake of Hem iron foods was recorded, with 96.90% consuming meat and 96.03% consuming poultry. A positive correlation was observed between VO2max and Hb (r=0.430, p=0.01) in M2.
Discussion: Despite the low prevalence of iron deficiency anemia, a considerable proportion of athletes showed reduced ferritin levels, indicating a subclinical risk of iron deficiency.
Conclusions: This population demonstrated iron storage deficiencies despite adequate performance levels and average weight-for-age.
References
Abad, E., Cid, C., & Calero Morales, S. (2014). Análisis y medición antropométrica en la detección de posibles talentos deportivos, en niños/as y adolescentes ecuatorianos/ Anthropometric analysis and physical aptitude for possible sports talents detection in Ecuadorian children and adolescents.
Adetola, O. Y., Taylor, J. R. N., & Duodu, K. G. (2023). Can consumption of local micronutrient- and ab-sorption enhancer-rich plant foods together with starchy staples improve bioavailable iron and zinc in diets of at-risk African populations? International Journal of Food Sciences and Nutri-tion, 74(2), 188-208. https://doi.org/10.1080/09637486.2023.2182740
Agata, K., & Monyeki, M. (2018). Association Between Sport Participation, Body Composition, Physical Fitness, and Social Correlates Among Adolescents: The PAHL Study. PubMed, 15(12). https://pubmed.ncbi.nlm.nih.gov/30544884/
Barbry, A., Carton, A., Ovigneur, H., & Coquart, J. (2022). Relationships Between Sports Club Participa-tion and Health Determinants in Adolescents and Young Adults. Frontiers in Sports and Active Living, 4. https://doi.org/10.3389/fspor.2022.918716
Berthou, C., Iliou, J. P., & Barba, D. (2021). Iron, neuro‐bioavailability and depression. EJHaem, 3(1), 263. https://doi.org/10.1002/jha2.321
Bonilla, J. F., Narváez, R., & Chuaire, L. (2005). El deporte como causa de estrés oxidativo y hemólisis. Colombia Médica, 36(4), 275-280. http://www.scielo.org.co/scielo.php?script=sci_abstract&pid=S1657-95342005000400009&lng=en&nrm=iso&tlng=es
Burke, L. M. (2015). Dietary assessment methods for the athlete: Pros and Cons of different methods. Sports Science Exchange, 28(150), 1-6.
Caleyachetty, R., Thomas, G. N., Kengne, A. P., Echouffo-Tcheugui, J. B., Schilsky, S., Khodabocus, J., & Uauy, R. (2018). The double burden of malnutrition among adolescents: Analysis of data from the Global School-Based Student Health and Health Behavior in School-Aged Children surveys in 57 low- and middle-income countries. The American Journal of Clinical Nutrition, 108(2), 414-424. https://doi.org/10.1093/ajcn/nqy105
Clénin, G., Cordes, M., Huber, A., Schumacher, Y. O., Noack, P., Scales, J., & Kriemler, S. (2015). Iron defi-ciency in sports—Definition, influence on performance and therapy. Swiss Medical Weekly, 145, w14196. https://doi.org/10.4414/smw.2015.14196
Coates, A., Mountjoy, M., & Burr, J. (2017). Incidence of Iron Deficiency and Iron Deficient Anemia in Elite Runners and Triathletes. Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine, 27(5), 493-498. https://doi.org/10.1097/JSM.0000000000000390
Cohen, C. T., & Powers, J. M. (2024). Nutritional Strategies for Managing Iron Deficiency in Adolescents: Approaches to a Challenging but Common Problem. Advances in Nutrition, 15(5), 100215. https://doi.org/10.1016/j.advnut.2024.100215
Damian, M.-T., Vulturar, R., Login, C. C., Damian, L., Chis, A., & Bojan, A. (2021). Anemia in Sports: A Nar-rative Review. Life, 11(9), 987. https://doi.org/10.3390/life11090987
Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M.-I., Corella, D., Arós, F., Gómez-Gracia, E., Ruiz-Gutiérrez, V., Fiol, M., Lapetra, J., Lamuela-Raventos, R. M., Serra-Majem, L., Pintó, X., Basora, J., Muñoz, M. A., Sorlí, J. V., Martínez, J. A., & Martínez-González, M. A. (2013). Primary Prevention of Cardio-vascular Disease with a Mediterranean Diet. New England Journal of Medicine, 368(14), 1279-1290. https://doi.org/10.1056/NEJMoa1200303
Freire, W. (with Ministerio de Salud Pública). (2014). Encuesta Nacional de Salud y Nutrición: ENSA-NUT-ECU 2012. INEC.
Freire, W. B., Silva-Jaramillo, K. M., Ramírez-Luzuriaga, M. J., Belmont, P., & Waters, W. F. (2014). The double burden of undernutrition and excess body weight in Ecuador1234. The American Jour-nal of Clinical Nutrition, 100(6), 1636S-1643S. https://doi.org/10.3945/ajcn.114.083766
García, G. C., & Secchi, J. D. (2014). Test course navette de 20 metros con etapas de un minuto. Una idea original que perdura hace 30 años. Apunts Sports Medicine, 49(183), 93-103. https://doi.org/10.1016/j.apunts.2014.06.001
Garcia-Casal, M. N., Pasricha, S.-R., Martinez, R. X., Lopez-Perez, L., & Peña-Rosas, J. P. (2021). Serum or plasma ferritin concentration as an index of iron deficiency and overload. The Cochrane Data-base of Systematic Reviews, 5(5), CD011817. https://doi.org/10.1002/14651858.CD011817.pub2
GBD 2019 Diabetes in the Americas Collaborators. (2022). Burden of diabetes and hyperglycaemia in adults in the Americas, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet. Diabetes & Endocrinology, 10(9), 655-667. https://doi.org/10.1016/S2213-8587(22)00186-3
Ghouili, H., Dridi, A., Ouerghi, N., Ben Aissa, M., Bouassida, A., Guelmami, N., Sortwell, A., Branquinho, L., Forte, P., & Dergaa, I. (2023). Normative reference and cut-offs values of maximal aerobic speed-20 m shuttle run test and maximal oxygen uptake for Tunisian adolescent (elite) soccer players. Heliyon, 9(10), e20842. https://doi.org/10.1016/j.heliyon.2023.e20842
Grosso, G., Laudisio, D., Frias-Toral, E., Barrea, L., Muscogiuri, G., Savastano, S., & Colao, A. (2022). Anti-Inflammatory Nutrients and Obesity-Associated Metabolic-Inflammation: State of the Art and Future Direction. Nutrients, 14(6), 1137. https://doi.org/10.3390/nu14061137
Gulías González, R. (2014). Condición Física y Estado Ponderal de niños y adolescentes de Castilla-La Mancha. https://hdl.handle.net/10578/4117
Heffernan, S. M., Horner, K., De Vito, G., & Conway, G. E. (2019). The Role of Mineral and Trace Element Supplementation in Exercise and Athletic Performance: A Systematic Review. Nutrients, 11(3), 696. https://doi.org/10.3390/nu11030696
Hurwitz, S. (1974). Medical aspects of adolescents participating in sports. Western Journal of Medicine, 121(5), 443-447. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1129637/
Jastrzebska, M., Kaczmarczyk, M., Suárez, A. D., Sánchez, G. F. L., Jastrzebska, J., Radziminski, L., & Ja-strzebski, Z. (2017). Iron, Hematological Parameters and Blood Plasma Lipid Profile in Vitamin D Supplemented and Non-Supplemented Young Soccer Players Subjected to High-Intensity In-terval Training. Journal of Nutritional Science and Vitaminology, 63(6), 357-364. https://doi.org/10.3177/jnsv.63.357
Kardasis, W., Naquin, E. R., Garg, R., Arun, T., Gopianand, J. S., Karmakar, E., & Gnana-Prakasam, J. P. (2023). The IRONy in Athletic Performance. Nutrients, 15(23), 4945. https://doi.org/10.3390/nu15234945
Keller, K., Friedrich, O., Treiber, J., Quermann, A., & Friedmann-Bette, B. (2024). Iron deficiency in ath-letes: Prevalence and impact on VO2 peak. Nutrition (Burbank, Los Angeles County, Calif.), 126, 112516. https://doi.org/10.1016/j.nut.2024.112516
Kuwabara, A. M., Tenforde, A. S., Finnoff, J. T., & Fredericson, M. (2022). Iron deficiency in athletes: A narrative review. PM & R: The Journal of Injury, Function, and Rehabilitation, 14(5), 620-642. https://doi.org/10.1002/pmrj.12779
Lee, E. C., Fragala, M. S., Kavouras, S. A., Queen, R. M., Pryor, J. L., & Casa, D. J. (2017). Biomarkers in Sports and Exercise: Tracking Health, Performance, and Recovery in Athletes. Journal of Strength and Conditioning Research, 31(10), 2920-2937. https://doi.org/10.1519/JSC.0000000000002122
Leung, A. K. C., Lam, J. M., Wong, A. H. C., Hon, K. L., & Li, X. (2024). Iron Deficiency Anemia: An Updated Review. Current Pediatric Reviews, 20(3), 339-356. https://doi.org/10.2174/1573396320666230727102042
Monyeki, M. A., Veldsman, T., Coetzee, B., Sparks, M., Moss, S. J., Pienaar, C., Swanepoel, M., Malan, L., & Kruger, H. S. (2024). Relationships between Iron Status and Selected Physical Fitness Compo-nents of South African Adolescents: The PAHL-Study. Children, 11(6), 659. https://doi.org/10.3390/children11060659
Nabeyama, T., Suzuki, Y., Yamamoto, K., Sakane, M., Sasaki, Y., Shindo, H., Takita, M., & Kami, M. (2020). Prevalence of iron deficiency among university kendo practitioners in Japan: An observational cohort study. Journal of the International Society of Sports Nutrition, 17, 62. https://doi.org/10.1186/s12970-020-00393-2
Naimo, M. A., Varanoske, A. N., Hughes, J. M., & Pasiakos, S. M. (2021). Skeletal Muscle Quality: A Bi-omarker for Assessing Physical Performance Capabilities in Young Populations. Frontiers in Physiology, 12, 706699. https://doi.org/10.3389/fphys.2021.706699
Parks, R. B., Hetzel, S. J., & Brooks, M. A. (2017). Iron Deficiency and Anemia among Collegiate Athletes: A Retrospective Chart Review. Medicine and Science in Sports and Exercise, 49(8), 1711-1715. https://doi.org/10.1249/MSS.0000000000001259
Pedlar, C. R., Newell, J., & Lewis, N. A. (2019). Blood Biomarker Profiling and Monitoring for High-Performance Physiology and Nutrition: Current Perspectives, Limitations and Recommenda-tions. Sports Medicine (Auckland, N.Z.), 49(Suppl 2), 185-198. https://doi.org/10.1007/s40279-019-01158-x
Poveda-Loor, C., Yaguachi-Alarcón, R., Espinoza-Burgos, Á., Frias-Toral, E., & Suárez, R. (2023). Dietary intake, anthropometric profile and somatotype in university athletes: Differences between gender and sports practiced. Mediterranean Journal of Nutrition and Metabolism, 16(4), 335-352. https://doi.org/10.3233/MNM-230065
Safiri, S., Kolahi, A.-A., Noori, M., Nejadghaderi, S. A., Karamzad, N., Bragazzi, N. L., Sullman, M. J. M., Abdollahi, M., Collins, G. S., Kaufman, J. S., & Grieger, J. A. (2021). Burden of anemia and its un-derlying causes in 204 countries and territories, 1990–2019: Results from the Global Burden of Disease Study 2019. Journal of Hematology & Oncology, 14(1), 185. https://doi.org/10.1186/s13045-021-01202-2
Sales, C. H., Rogero, M. M., Sarti, F. M., & Fisberg, R. M. (2021). Prevalence and Factors Associated with Iron Deficiency and Anemia among Residents of Urban Areas of São Paulo, Brazil. Nutrients, 13(6), 1888. https://doi.org/10.3390/nu13061888
Sandström, G., Börjesson, M., & Rödjer, S. (2012). Iron deficiency in adolescent female athletes—Is iron status affected by regular sporting activity? Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine, 22(6), 495-500. https://doi.org/10.1097/JSM.0b013e3182639522
Semenova, E. A., Miyamoto-Mikami, E., Akimov, E. B., Al-Khelaifi, F., Murakami, H., Zempo, H., Kostryu-kova, E. S., Kulemin, N. A., Larin, A. K., Borisov, O. V., Miyachi, M., Popov, D. V., Boulygina, E. A., Takaragawa, M., Kumagai, H., Naito, H., Pushkarev, V. P., Dyatlov, D. A., Lekontsev, E. V., … Ah-metov, I. I. (2020). The association of HFE gene H63D polymorphism with endurance athlete status and aerobic capacity: Novel findings and a meta-analysis. European Journal of Applied Physiology, 120(3), 665-673. https://doi.org/10.1007/s00421-020-04306-8
Shoemaker, M. E., Gillen, Z. M., Mckay, B. D., Bohannon, N. A., Gibson, S. M., Koehler, K., & Cramer, J. T. (2019). Sex-specific relationships among iron status biomarkers, athletic performance, maturi-ty, and dietary intakes in pre-adolescent and adolescent athletes. Journal of the International Society of Sports Nutrition, 16, 42. https://doi.org/10.1186/s12970-019-0306-7
Sim, M., Garvican-Lewis, L. A., Cox, G. R., Govus, A., McKay, A. K. A., Stellingwerff, T., & Peeling, P. (2019). Iron considerations for the athlete: A narrative review. European Journal of Applied Physiology, 119(7), 1463-1478. https://doi.org/10.1007/s00421-019-04157-y
Slimani, M., Znazen, H., Miarka, B., & Bragazzi, N. L. (2019). Maximum Oxygen Uptake of Male Soccer Players According to their Competitive Level, Playing Position and Age Group: Implication from a Network Meta-Analysis. Journal of Human Kinetics, 66, 233-245. https://doi.org/10.2478/hukin-2018-0060
Soares, A. V., Marcelino, E., Maia, K. C., & Borges, N. G. (2017). Relation between functional mobility and dynapenia in institutionalized frail elderly. Einstein (Sao Paulo, Brazil), 15(3), 278-282. https://doi.org/10.1590/S1679-45082017AO3932
Tarancon-Diez, L., Genebat, M., Roman-Enry, M., Vázquez-Alejo, E., Espinar-Buitrago, M. de la S., Leal, M., & Muñoz-Fernandez, M. Á. (2022). Threshold Ferritin Concentrations Reflecting Early Iron Deficiency Based on Hepcidin and Soluble Transferrin Receptor Serum Levels in Patients with Absolute Iron Deficiency. Nutrients, 14(22), 4739. https://doi.org/10.3390/nu14224739
Tomkinson, G. R., Lang, J. J., Tremblay, M. S., Dale, M., LeBlanc, A. G., Belanger, K., Ortega, F. B., & Léger, L. (2017). International normative 20 m shuttle run values from 1 142 026 children and youth representing 50 countries. British Journal of Sports Medicine, 51(21), 1545-1554. https://doi.org/10.1136/bjsports-2016-095987
Urdampilleta, A., Martínez-Sanz, J. M., & Mielgo-Ayuso, J. (2013). Anemia ferropénica en el deporte e intervenciones dietético-nutricionales preventivas. Revista Española de Nutrición Humana y Dietética, 17(4), Article 4. https://doi.org/10.14306/renhyd.17.4.16
Vázquez-López, M. A., López-Ruzafa, E., Ibáñez-Alcalde, M., Martín-González, M., Bonillo-Perales, A., & Lendínez-Molinos, F. (2019). The usefulness of reticulocyte haemoglobin content, serum trans-ferrin receptor and the sTfR-ferritin index to identify iron deficiency in healthy children aged 1-16 years. European Journal of Pediatrics, 178(1), 41-49. https://doi.org/10.1007/s00431-018-3257-0
Welde, B., Morseth, B., Handegård, B. H., & Lagestad, P. (2020). Effect of Sex, Body Mass Index and Phys-ical Activity Level on Peak Oxygen Uptake Among 14–19 Years Old Adolescents. Frontiers in Sports and Active Living, 2, 78. https://doi.org/10.3389/fspor.2020.00078
Winocur, D., Ceriani Cernadas, J. M., Imach, E., Otasso, J. C., Morales, P., & Gards, A. (2004). Prevalencia de anemia ferropénica en niños pre-escolares y escolares con necesidades básicas insatisfechas. Medicina (Buenos Aires), 64(6), 481-486. https://www.scielo.org.ar/scielo.php?script=sci_abstract&pid=S0025-76802004000600001&lng=es&nrm=iso&tlng=es
World Health Organization. (2007). Growth reference 5-19 years—BMI-for-age (5-19 years). https://www.who.int/tools/growth-reference-data-for-5to19-years/indicators/bmi-for-age
Xhufi, S., & Bozo, D. (2025). Hematological and iron status in female elite athlete players in Albania. Retos, 71, 693-702. https://doi.org/10.47197/retos.v71.116034
Young, I., Parker, H. M., Rangan, A., Prvan, T., Cook, R. L., Donges, C. E., Steinbeck, K. S., O’Dwyer, N. J., Cheng, H. L., Franklin, J. L., & O’Connor, H. T. (2018). Association between Haem and Non-Haem Iron Intake and Serum Ferritin in Healthy Young Women. Nutrients, 10(1), 81. https://doi.org/10.3390/nu10010081
Zambrano-Villacres, R., Frias-Toral, E., Maldonado-Ponce, E., Poveda-Loor, C., Leal, P., Velarde-Sotres, A., Leonardi, A., Trovato, B., Roggio, F., Castorina, A., Wenxin, X., & Musumeci, G. (2024). Explor-ing body composition and somatotype profiles among youth professional soccer players. Medi-terr J Nutr Metab, 17(3), 241-254. https://doi.org/10.3233/MNM-240038
Downloads
Published
Issue
Section
License
Copyright (c) 2026 María A. Egas-Miraglia, Mariela González-Narváez, Marlon Villacis, Domenica Ripalda, Gustavo Montijano, Cecilia Arteaga Pazmiño, Evelyn Frias-Toral, Elena López Ruiz
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
- Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).
This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.
