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Global, regional and national burden of dietary iron deficiency from 1990 to 2021: a Global Burden of Disease study

Abstract

Although iron deficiency is well documented, less is known about dietary involvement in symptomatic iron deficiency manifesting in medical conditions. In this study, we quantified the global burden of dietary iron deficiency, focusing on where inadequate dietary iron intake leads to clinical manifestations such as anemia. We analyzed data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to estimate dietary iron deficiency prevalence and disability-adjusted life years (DALYs), stratified by age, sex, geography and socio-demographic index (SDI) across 204 countries. In 2021, global age-standardized prevalence and DALY rates were 16,434.4 (95% uncertainty interval (UI), 16,186.2–16,689.0) and 423.7 (285.3–610.8) per 100,000 population, with rates decreasing by 9.8% (8.1–11.3) and 18.2% (15.4–21.1) from 1990 to 2021. A higher burden was observed in female individual (age-standardized prevalence, 21,334.8 (95% UI, 20,984.8–21,697.4); DALYs, 598.0 (402.6–854.4)) than in male individual ((age-standardized prevalence, 11,684.7 (11,374.6–12,008.8); DALYs, 253.0 (167.3–371.0)). High-SDI countries presented greater improvement, with a 25.7% reduction compared to 11.5% in low-SDI countries. Despite global improvements, dietary iron deficiency remains a major health concern with a global prevalence of 16.7%, particularly affecting female individuals, children and residents in low-SDI countries. Urgent interventions through supplementation, food security measures and fortification initiatives are essential.

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Fig. 1: Global map of age-standardized prevalence and DALY rates of dietary iron deficiency and their percentage changes over time, both sexes combined, 2021.
Fig. 2: Numbers and rates of dietary iron deficiency, 1990–2021.
Fig. 3: Numbers and age-specific rates (per 100,000 population) of prevalence and DALYs from dietary iron deficiency at the global level by age group and sex, 2021.
Fig. 4: The M/F ratio of prevalence and DALY rates (per 100,000 population) of dietary iron deficiency by SDI and age group, 2021.

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Data availability

The findings from this study were produced using data available in public online repositories or in the published literature; data that are publicly available upon reasonable request from the data provider; and data that are not publicly available due to restrictions by the data provider and that were used under license for the current study. Details on data sources can be found on the Global Health Data Exchange website, including information about the data provider and links to where the data can be accessed or requested (where available). Citations and metadata for all input sources used in this analysis are available for download at https://ghdx.healthdata.org/gbd-2021/sources (to access all sources, select non-fatal health outcomes as the component and dietary iron deficiency as the cause).

Code availability

Our study follows the Guidelines for Accurate and Transparent Health Estimate Reporting (GATHER; Supplementary Table 1). All code used for this analysis is publicly available online at https://github.com/ihmeuw/anemia_gbd2021.

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Acknowledgements

This study was funded by the Bill and Melinda Gates Foundation, the Australian National Health and Medical Research Council and the Queensland Department of Health, Australia. This work was supported by the Yonsei Fellowship, funded by Lee Youn Jae (J.I.S.). This research was supported by the Ministry of Science and ICT (MIST), Korea, under the Information Technology Research Center (ITRC) support program (IITP-2024-RS-2024-00438239 to D.K.Y.), supervised by the Institute for Information & Communications Technology Planning & Evaluation (IITP). The funders of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. All authors had full access to the study data and had final responsibility for the decision to submit for publication.

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Contributions

Conceptualization and design: S.L., Y.S., J.H., M.S.K., J.I.S., D.K.Y. and N.J.K; methodology: S.L., Y.S., J.H., M.S.K., J.I.S., D.K.Y. and N.J.K; data acquisition: S.L., Y.S., J.H., M.S.K., J.I.S., D.K.Y. and N.J.K; statistical analysis and data curation: S.L., Y.S., J.H., M.S.K., J.I.S., D.K.Y. and N.J.K; validation: S.L., Y.S., J.H., M.S.K., J.I.S., D.K.Y. and N.J.K; data interpretation: S.L., Y.S., J.H., M.S.K., J.I.S., D.K.Y. and N.J.K; visualization: S.L., Y.S., J.H. and M.S.K.; managing the estimation or publications process: N.J.K., M.S.K. and J.I.S.; writing—original draft preparation: S.L., Y.S., J.H. and M.S.K.; writing—review and editing: all authors provided critical revision to the paper; supervision: J.I.S., D.K.Y. and N.J.K.; project administration: J.I.S., D.K.Y. and N.J.K; funding acquisition: J.I.S., D.K.Y. and N.J.K. N.J.K. is the senior author. Contributions by the GBD 2021 Dietary Iron Deficiency Collaborators are described in Supplementary Note 1.

Corresponding authors

Correspondence to Jae Il Shin or Dong Keon Yon.

Ethics declarations

Competing interests

N.J.K. reports grants or contracts from the Bill & Melinda Gates Foundations as well as grant funding for anemia-related research. N.J.K. also reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Bristol Myers Squibb (presentation on GBD 2021 findings for anemia and dietary iron deficiency), outside the submitted work. Competing interests for the GBD 2021 Dietary Iron Deficiency Collaborators are listed in Supplementary Note 2.

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Nature Medicine thanks Jiahong Sun, Jessica Grieger and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Primary Handling Editor: Ming Yang, in collaboration with the Nature Medicine team.

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Extended data

Extended Data Fig. 1 Global rank of dietary iron deficiency in DALYs rate by sex, age group, and SDI.

Global ranks of dietary iron deficiency in DALYs per 100,000 population are displayed by sex, age group, and SDI quintile. The three panels represent data for both sexes (left), males (middle), and females (right). Rows correspond to age groups (70 years), while columns represent SDI quintiles from low to high. Each cell contains the global rank of dietary iron deficiency for the corresponding subgroup, with color gradients reflecting the rank, ranging from red (higher rank) to green (lower rank).

Extended Data Fig. 2 Global distributions for dietary iron deficiency in individuals under 5 years.

Global maps display the prevalence rate and DALY rate (per 100,000 population) for dietary iron deficiency among individuals under 5 years of age, both sexes, in 2021 (a). Global maps show the percent change in prevalence rate and DALY rate (per 100,000 population) for the same population group from 1990 to 2021 (b). The maps use color gradients to illustrate geographical variations, with darker shades representing higher values in (a) or larger percent changes in (b).

Extended Data Fig. 3 Global distributions for dietary iron deficiency in individuals aged 5– 14 years.

Global maps display the prevalence rate and DALY rate (per 100,000 population) for dietary iron deficiency among individuals aged 5–14 years, both sexes, in 2021 (a). Global maps show the percent change in prevalence rate and DALY rate (per 100,000 population) for the same population group from 1990 to 2021 (b). The maps use color gradients to illustrate geographical variations, with darker shades representing higher values in (a) or larger percent changes in (b).

Extended Data Fig. 4 Global distributions for dietary iron deficiency in individuals aged 15– 49 years.

Global maps display the prevalence rate and DALY rate (per 100,000 population) for dietary iron deficiency among individuals aged 15–49 years, both sexes, in 2021 (a). Global maps show the percent change in prevalence rate and DALY rate (per 100,000 population) for the same population group from 1990 to 2021 (b). The maps use color gradients to illustrate geographical variations, with darker shades representing higher values in (a) or larger percent changes in (b).

Extended Data Fig. 5 Global distributions for dietary iron deficiency in individuals aged 50– 69 years.

Global maps display the prevalence rate and DALY rate (per 100,000 population) for dietary iron deficiency among individuals aged 50–69 years, both sexes, in 2021 (a). Global maps show the percent change in prevalence rate and DALY rate (per 100,000 population) for the same population group from 1990 to 2021 (b). The maps use color gradients to illustrate geographical variations, with darker shades representing higher values in (a) or larger percent changes in (b).

Extended Data Fig. 6 Global distributions for dietary iron deficiency in individuals aged >70 years.

Global maps display the prevalence rate and DALY rate (per 100,000 population) for dietary iron deficiency among individuals aged > 70 years, both sexes, in 2021 (a). Global maps show the percent change in prevalence rate and DALY rate (per 100,000 population) for the same population group from 1990 to 2021 (b). The maps use color gradients to illustrate geographical variations, with darker shades representing higher values in (a) or larger percent changes in (b).

Extended Data Fig. 7 Global distributions for dietary iron deficiency across all age groups.

Global maps display the all-age prevalence rate and DALY rate (per 100,000 population) for dietary iron deficiency in both sexes in 2021 (a). Global maps show the all-age percent change in prevalence rate and DALY rate (per 100,000 population) for dietary iron deficiency in both sexes from 1990 to 2021 (b). The maps use color gradients to illustrate geographical variations, with darker shades representing higher values in (a) or larger percent changes in (b).

Extended Data Fig. 8 Age-standardized prevalence and YLDs due to anemia causes by sex, 2021.

Age-standardized rates of prevalence and YLDs due to anemia causes are displayed by sex for 2021. Dietary iron deficiency (pink) constitutes the largest segment of both prevalence and YLDs for males and females, followed by contributions from hemoglobinopathies and hemolytic anemias (orange), other infectious diseases (green), and neglected tropical diseases (purple). The bars, color-coded for specific causes, illustrate the relative proportions attributed to each anemia cause across sexes.

Extended Data Fig. 9 Flow chart of dietary iron deficiency.

The methodological framework outlines the estimation process for the burden of dietary iron deficiency, anemia (nonfatal), and their causal attributions. It integrates data inputs such as individual hemoglobin levels, and survey data, utilizing ST-GPR to model hemoglobin mean and standard deviation. Cause-specific prevalence and hemoglobin shifts are derived for mild, moderate, and severe anemia, incorporating counterfactual distributions to attribute cases specifically to dietary iron deficiency. Disability weights are applied to calculate YLDs and DALYs, while comorbidity corrections refine the estimates. Relative risks, population-attributable fractions, and covariates are combined to provide a structured pathway from raw data to final burden estimation within the GBD framework.

Supplementary information

Supplementary information

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Reporting Summary

Supplementary Note 1

Author contributions by the GBD 2021 Dietary Iron Deficiency Collaborators.

Supplementary Note 2

Competing interests for the GBD 2021 Dietary Iron Deficiency Collaborators

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Lee, S., Son, Y., Hwang, J. et al. Global, regional and national burden of dietary iron deficiency from 1990 to 2021: a Global Burden of Disease study. Nat Med 31, 1809–1829 (2025). https://doi.org/10.1038/s41591-025-03624-8

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