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Incidence of Iron Deficiency and Iron Deficient Anemia in Elite Runners and Triathletes

Coates, Alexandra BSc*; Mountjoy, Margo MD, PhD†,‡,§; Burr, Jamie PhD*

Clinical Journal of Sport Medicine: September 2017 - Volume 27 - Issue 5 - p 493–498
doi: 10.1097/JSM.0000000000000390
Original Research

Objective: To assess the incidence of iron deficiency (ID), and iron deficient anemia (IDA) within a cohort of highly trained runners and triathletes, and to examine the association of oral iron supplementation history with serum ferritin (sFe) and hemoglobin (Hb) concentrations.

Methods: A retrospective analysis of routine blood test data taken from 2009 to 2015 from (n = 38) elite level runners and triathletes between the ages of 21 to 36 years. Oral iron supplement intake was assessed through a questionnaire.

Results: Triathletes (female, FT; male, MT) and runners (female, FR; male, MR) had higher incidence of at least 1 episode of ID (FT 60.0%, MT 37.5%, FR 55.6%, MR 31.3%) compared with values reported in the literature for endurance athletes (20%-50% females, 0%-17% males). Male triathletes and runners had a higher incidence of IDA than their female teammates (25% MT, 20% FT, 6.3% for MR, 0% FR), a finding which has previously not been reported. Hemoglobin concentrations were low, with incidence of Hb <140 g/L in men occurring at least once in 87.5% of triathletes, and 31.3% of runners, and Hb <120 g/L in women occurring at least once in 20% of triathletes, but 0% of runners. Although the athletes were appropriately treated with oral iron (mean 94 ± 115 mg/d), there was no observed correlation between iron intake and sFe or Hb.

Conclusions: Even with monitoring and treatment in place, ID and IDA are significant concerns for the health and performance of elite runners and triathletes, and this issue affects males and females.

*Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada;

Health and Performance Centre, University of Guelph, Guelph, ON, Canada;

Department of Family Medicine, McMaster University, Hamilton, ON, Canada; and

§The International Olympic Committee's Medical Commission.

Corresponding Author: Jamie Burr, PhD, Department of Human Health and Nutritional Sciences, University of Guelph, Animal Science/Nutrition Building, 50 Stone Rd East, Guelph, ON N1G 2W1, Canada (

J. Burr is supported by an NSERC Discovery Grant.

The authors report no conflicts of interest.

Received June 05, 2016

Accepted July 21, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.