European Journal of Cardiovascular Medicine

Anemia, defined by the World Health Organization (WHO) as a hemoglobin concentration below 13 g/dL in men and below 12 g/dL in non-pregnant women, remains a significant global public health issue, particularly affecting young adults in low- and middle-income countries (1). The condition is often multifactorial, with nutritional deficiencies, chronic infections, and menstrual blood loss being common causes among adolescents and young adults (2). In the context of medical students, academic stress, irregular eating patterns, and sedentary lifestyles may further contribute to the risk of developing anemia (3).

Iron deficiency anemia is the most common form, accounting for nearly 50% of anemia cases worldwide (4). Although anemia is often associated with underprivileged populations, studies have demonstrated that even individuals with access to education and healthcare—such as medical students—are not immune to its burden (5,6). The rigorous demands of medical training, including prolonged study hours and poor sleep hygiene, may compromise students' nutritional intake and overall health (7).

Previous research has reported varying anemia prevalence rates among medical students, ranging from 20% to 60%, with a notably higher incidence in female students due to menstruation-related iron loss (8,9). Despite their knowledge of disease pathology and prevention, medical students may neglect their own health, making them a vulnerable yet overlooked group (10). Identifying the prevalence and contributing risk factors in this population is essential to design targeted interventions and promote health-conscious behavior among future healthcare providers.

This study aims to estimate the prevalence of anemia among undergraduate medical students and to analyze its associated risk factors, including dietary patterns, lifestyle variables, and menstrual history in females.

Study Design and Setting
A cross-sectional observational study was conducted over a period of three months  at a medical college located in India. The study aimed to estimate the prevalence of anemia and assess associated risk factors among undergraduate medical students.

Study Population and Sampling
Undergraduate medical students aged 18 to 25 years enrolled in MBBS programs (first to final year) were considered eligible for inclusion. Students with known hematological disorders, chronic illnesses, recent blood transfusions, or those on iron supplementation were excluded. A sample size of 300 participants was selected using stratified random sampling, ensuring proportional representation from each academic year. Informed written consent was obtained from all participants.

Data Collection Tools and Procedure
Participants were asked to complete a structured and pre-validated questionnaire that captured information on sociodemographic details, dietary habits, menstrual history (for females), physical activity, academic stress, and sleep patterns. Anthropometric measurements (height and weight) were recorded to calculate BMI.

Venous blood samples (2–3 mL) were collected under aseptic conditions and analyzed for hemoglobin concentration using an automated hematology analyzer. Anemia was defined and classified based on WHO guidelines: mild (11.0–11.9 g/dL for females and 11.0–12.9 g/dL for males), moderate (8.0–10.9 g/dL), and severe (<8.0 g/dL).

Statistical Analysis
Data were entered in Microsoft Excel and analyzed using SPSS version 25.0 (IBM Corp, Armonk, NY). Descriptive statistics were used to summarize categorical variables (frequency, percentage) and continuous variables (mean, standard deviation). The Chi-square test was applied to assess associations between anemia and categorical risk factors. Logistic regression analysis was performed to determine independent predictors of anemia. A p-value of <0.05 was considered statistically significant.

A total of 300 undergraduate medical students participated in the study, comprising 180 females (60%) and 120 males (40%), with a mean age of 21.2 ± 1.4 years. The overall prevalence of anemia was found to be 40% (n=120). Among the anemic participants, the majority were females (n=90, 75%) compared to males (n=30, 25%).

Based on WHO classification, 85 students (70.8%) had mild anemia, 30 students (25%) had moderate anemia, and 5 students (4.2%) had severe anemia. The distribution of anemia severity is shown in Table 1.

Table 1: Distribution of Anemia Severity among Anemic Students (n=120)

Among the total study population, several risk factors were found to be significantly associated with anemia. Inadequate dietary iron intake was reported by 68 students with anemia (56.7%), and irregular meal patterns were observed in 74 anemic students (61.7%). Among the 180 female students, 58 (64.4%) with anemia reported heavy menstrual bleeding. Stress levels were rated high among 80 anemic students (66.7%). The distribution of anemia across selected risk factors is provided in Table 2.

Table 2: Association between Selected Risk Factors and Anemia Status (n=300)

* Statistically significant; †Analyzed among female participants only.

As shown in Table 1, the majority of anemia cases were of mild severity. Furthermore, Table 2 highlights a statistically significant association between anemia and factors such as poor dietary habits, menstrual blood loss, and elevated stress levels.

This study highlights a notable prevalence of anemia (40%) among undergraduate medical students, with a higher burden observed among female students (50%) compared to males (25%). These findings align with prior studies conducted in similar academic settings, where the prevalence of anemia among medical students ranged between 30% to 60% (1,2). Despite having better health literacy, medical students appear equally susceptible to anemia, potentially due to poor dietary practices, stress, and lifestyle factors inherent in academic training.

The higher prevalence in females can be attributed to menstrual blood loss, inadequate dietary intake of iron, and increased physiological requirements during reproductive years (3,4). In our study, 64.4% of anemic females reported heavy menstrual bleeding, which is a well-documented contributor to iron deficiency anemia (5). Similar findings have been reported by Ahmed et al. and Patil et al., where female students had significantly higher rates of anemia than their male counterparts (6,7).

Mild anemia was the most common type identified, which is consistent with earlier research among young adults and university students (8,9). Though mild in nature, this form of anemia can still impact cognitive performance, academic productivity, and general well-being (10). Anemia-related fatigue and decreased concentration have also been associated with reduced academic performance and increased absenteeism (11).

Dietary habits emerged as a major modifiable risk factor. In this study, inadequate iron intake and irregular meal patterns were significantly associated with anemia. Previous studies in Indian and international cohorts also suggest that irregular eating patterns, preference for junk food, and low intake of iron-rich foods such as green leafy vegetables, meat, and legumes contribute substantially to anemia among youth (12,13). Interventions focused on nutritional counseling and awareness of iron-rich diets have shown promising results in lowering anemia prevalence in student populations (14).

Academic stress was another prominent risk factor. A significant proportion of anemic students in our study reported high stress levels, which could alter appetite, sleep patterns, and indirectly affect nutritional intake and absorption (15). Chronic stress has also been shown to alter inflammatory pathways, contributing to anemia of inflammation in some cases (6).

The strengths of this study include adequate sample size and comprehensive assessment of dietary, lifestyle, and gynecological factors. However, certain limitations must be acknowledged. First, the cross-sectional design restricts the ability to establish causality. Second, iron status was not confirmed via serum ferritin or peripheral smears, which could help differentiate between iron deficiency and other forms of anemia. Third, self-reported data may have introduced recall bias.

Although anemia is preventable and treatable, it often remains unrecognized in populations perceived to be healthy. This underscores the importance of routine screening, especially in high-risk groups such as female students, those with irregular eating habits, or under high academic pressure. Educational institutions should incorporate regular health check-ups and awareness programs to promote timely diagnosis and intervention

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