Knowledge, Attitudes, and Practices Regarding Iron Deficiency Anemia Among Young Female Adults in Mumbai and Development of Culturally Relevant Iron-Rich Recipes

Abstract

Background: Iron Deficiency Anemia (IDA) remains one of the most widespread micronutrient deficiencies globally, disproportionately affecting women of reproductive age due to factors like menstruation, dietary patterns, and lack of awareness. In India, nearly 57% of non-pregnant women aged 15–49 are anemic (NFHS-5, 2021), highlighting a critical public health concern. Despite formal education, young urban women often lack practical knowledge about iron bioavailability and dietary strategies to enhance iron intake. Given the dual burden of malnutrition (undernutrition and overnutrition), culturally relevant and accessible dietary interventions are urgently needed. Methods: A cross-sectional study was conducted among 100 young female adults aged 18–25 years in Mumbai. Participants were selected using convenience sampling. Data collection involved anthropometric assessments (self-reported weight, height, BMI), a 24-hour dietary recall, a semi-quantitative food frequency questionnaire (FFQ), and a validated Knowledge, Attitude, and Practice (KAP) questionnaire on IDA. Data were analyzed using descriptive and inferential statistics via SPSS Version 21. Additionally, five iron-rich recipes were developed and standardized using traditional Indian ingredients and evaluated through sensory assessment. Results: The mean dietary iron intake among participants was 8.83 ± 4.03 mg/day, significantly lower than the recommended dietary allowance of 27 mg/day for menstruating women. A majority 91% of participants consumed less than 50% of the RDA. Despite 93% having completed graduate or postgraduate education, knowledge and practices regarding iron-rich food consumption and absorption enhancers (e.g., vitamin C) were suboptimal. Vegetarianism (59%) and common consumption of inhibitors (e.g., tea with meals) further contributed to poor iron bioavailability. Anthropometric data revealed that 19% were underweight and 23% were overweight or obese, indicating the presence of the double burden of malnutrition. Standardized iron-rich recipes using garden cress seeds, jaggery, ragi, and amaranth were well accepted, achieving moderate sensory scores. Conclusion: Despite educational attainment, young women in urban Mumbai exhibit poor iron intake and limited practical knowledge regarding Iron Deficiency Anemia prevention. This disconnect between knowledge and practice highlights the need for targeted educational interventions and culturally appropriate dietary solutions. The study demonstrates that standardized, iron-rich recipes can serve as effective tools for improving iron intake. Integrating nutritional education with practical, locally adapted dietary interventions could significantly contribute to reducing the burden of IDA among young women.

Introduction

Iron Deficiency Anemia (IDA) is a significant public health problem in India, particularly among women of reproductive age due to factors like menstruation, poor diet, infections, and limited healthcare access. Despite government programs, around 57% of non-pregnant women aged 15–49 are anemic. Young adulthood (18–25 years) is crucial for forming lifelong dietary habits, yet even educated urban women often lack practical knowledge about iron nutrition. Dietary patterns—such as vegetarianism, consumption of iron absorption inhibitors (e.g., tea/coffee), and low intake of enhancers like vitamin C—contribute to persistent iron deficiency.

Studies show a gap between awareness and actual dietary practices, with cultural food habits and lifestyle factors complicating interventions. Recipe-based, culturally appropriate nutritional programs using locally available ingredients have shown promise in improving iron intake.

The study conducted in Mumbai assessed the knowledge, attitudes, and practices (KAP) related to IDA in 100 young urban women (mostly vegetarians). Results revealed poor iron intake (mean 8.83 mg/day vs. recommended 27 mg/day), low awareness of iron absorption factors, and a mismatch between knowledge and behavior. Most participants underestimated their need for improved iron nutrition despite common symptoms of deficiency. The findings highlight the double burden of malnutrition (both underweight and overweight participants had low iron intake) and stress the importance of targeted education and food-based interventions to improve iron status.

Conclusion

This study highlights a significant disconnect between education and dietary iron adequacy among young urban women. Despite high literacy, most participants consumed less than half the recommended iron intake and lacked practical knowledge of iron absorption. Vegetarian diets, poor food combinations, and limited awareness of national programs further contributed to the deficiency. However, the positive acceptance of simple, iron-rich recipes suggests that culturally tailored dietary interventions can be effective. Bridging the gap between knowledge and practice through food-based, behavior-driven strategies is essential to reducing the burden of Iron Deficiency Anemia.

References

[1] Auerbach, M., DeLoughery, T. G., & Tirnauer, J. S. (2025). Iron deficiency in adults: A review. JAMA, 333(20), 1813–1823. https://doi.org/10.1001/jama.2025.0452 [2] Avni, T., Bieber, A., Grossman, A., Green, H., Leibovici, L., & Gafter-Gvili, A. (2021). The safety of intravenous iron preparations: Systematic review and meta-analysis. Mayo Clinic Proceedings, 96(1), 130–147. https://doi.org/10.1016/j.mayocp.2020.03.039 [3] Bach, V., Schmitz, L., Pape, D., & Wenzel, U. (2022). Comparison of novel iron supplements: Efficacy and tolerability in iron-deficiency anemia. Nutrients, 14(1), 108. https://doi.org/10.3390/nu14010108 [4] Balshod, S. S., Mahajan, H. R., & Gaikwad, A. V. (2021). Effectiveness of structured teaching program on knowledge regarding prevention of iron deficiency anemia among adolescent girls. International Journal of Health and Clinical Research, 4(7), 238–241. [5] Camaschella, C. (2023). Iron deficiency: Challenges and strategies. The Lancet Haematology, 10(2), e101–e110. https://doi.org/10.1016/S2352-3026(22)00338-9 [6] Cappellini, M. D., Comin-Colet, J., de Francisco, A., Dignass, A., Doehner, W., Lam-CS, P., & Macdougall, I. C. (2022). Iron deficiency across chronic inflammatory conditions: International expert opinion on definition, diagnosis, and management. The American Journal of Hematology, 97(6), E179–E185. https://doi.org/10.1002/ajh.26591 [7] Gole, A. N., & Dighe, J. (2023). Development and sensory evaluation of iron-rich laddoos for adolescent girls. International Journal of Food and Nutritional Sciences, 12(1), 45–50. [8] Gopalan, C., Sastri, B. V. R., & Balasubramanian, S. C. (2016). Nutritive value of Indian foods. National Institute of Nutrition, ICMR. [9] Indian Council of Medical Research (ICMR). (2020). Nutrient requirements for Indians. National Institute of Nutrition. [10] Jain, P., & Jain, N. (2022). Assessment of iron status and dietary practices among vegetarian college girls. International Journal of Nutrition and Dietetics, 10(2), 74–79. [11] Kaur, A., Mehta, A., & Shah, S. (2025). Enhancing bioavailability of iron in snack formulations using vitamin C-rich ingredients. Journal of Nutrition & Functional Foods, 14(2), 130–139. [12] Kumar, A., & Roy, P. (2018). A study on dietary intake and anemia among college-going girls in urban India. Journal of Community Nutrition and Health, 7(1), 12–17. [13] Ministry of Health and Family Welfare. (2021). National Family Health Survey–5 (NFHS-5), India fact sheet: 2019–21. Government of India. https://main.mohfw.gov.in [14] Nemeth, E., & Ganz, T. (2021). Hepcidin and iron homeostasis. Biochimica et Biophysica Acta (BBA) - Molecular Cell Research, 1868(3), 118876. https://doi.org/10.1016/j.bbamcr.2020.118876 [15] Patil, S. M., Shinde, P. P., & Gaikwad, A. B. (2020). Nutrition awareness and dietary practices related to iron among young women. Asian Journal of Home Science, 15(1), 10–14. [16] Pavord, S., Myers, B., Robinson, S., Allard, S., Strong, J., Oppenheimer, C., & UK Guidelines Group. (2020). UK guidelines on the management of iron deficiency in pregnancy. British Journal of Haematology, 188(6), 819–830. https://doi.org/10.1111/bjh.16221 [17] Safiri, S., Kolahi, A.-A., Noori, M., Nejadghaderi, S. A., Karamzad, N., Sullman, M. J. M., ... & Murray, C. J. L. (2021). Burden of anemia and its underlying 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 [18] Saleem, S. M., & Jan, S. S. (2021). Modified Kuppuswamy socioeconomic scale updated for the year 2021. Indian Journal of Forensic and Community Medicine, 8(1), 1–3. https://doi.org/10.18231/j.ijfcm.2021.001 [19] Sinha, S., Kumari, R., & Mehta, K. (2020). Knowledge, attitude and practices related to anemia among urban college girls. Indian Journal of Nutrition, 7(3), 123–128. [20] Tolkien, Z., Stecher, L., Mander, A. P., Pereira, D. I. A., & Powell, J. J. (2019). Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: A systematic review and meta-analysis. PLoS ONE, 14(2), e0207434. https://doi.org/10.1371/journal.pone.0207434 [21] World Health Organization (WHO). (2021). Global anaemia estimates, 2021 edition. https://www.who.int/publications/i/item/9789240060203 [22] Zende, P., Pawar, R., & Kulkarni, P. (2022). Iron-rich dietary practices and hemoglobin status among adolescent girls. International Journal of Community Medicine and Public Health, 9(4), 1611–1615. [23] Zimmermann, M. B., & Hurrell, R. F. (2021). Nutritional iron deficiency. The Lancet, 397(10270), 233–248. https://doi.org/10.1016/S0140-6736(20)32594-0

Copyright

Copyright © 2025 Ms. Utkarsha Bhoir, Dr. Nisha Bellare, Dr. Anuradha Ramesh. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.