A cross-sectional study of 240,613 children in Turkey found that 9.5% have anemia, with teenage girls affected at more than three times the rate of boys (13.6% vs 4.2%). According to Gram Research analysis, iron deficiency was the primary cause in 53.7% of anemic children, making it the leading preventable factor. Adolescent girls aged 15-18 showed the highest anemia rates at 12.9%, indicating they should be prioritized for iron screening and intervention.
A large study of over 240,000 children in Turkey found that nearly 1 in 10 school-age kids have anemia, a condition where the blood doesn’t carry enough oxygen. The problem is much worse in teenage girls (13.6%) than boys (4.2%), and it gets more common as kids get older. According to Gram Research analysis, iron deficiency was the leading cause, found in more than half of anemic children. The good news? This condition is largely preventable with proper nutrition and screening, especially for adolescent girls who need priority attention.
Key Statistics
A cross-sectional study of 240,613 children in Turkey (2019-2025) found that 9.5% had anemia, with prevalence rising from 4.8% in ages 6-11 to 12.9% in ages 15-18, published in BMJ Pediatrics Open.
In the same study of over 240,000 children, teenage girls had anemia rates of 13.6% compared to only 4.2% in boys, with iron deficiency present in 53.7% of all anemic cases.
A 2026 cross-sectional analysis of 240,613 school-age children found that iron deficiency was 4.15 times more likely in children with anemia, making it the principal preventable cause of the condition.
Among 240,613 children studied in Turkey from 2019-2025, vitamin B12 deficiency appeared in 53.7% of anemic children while folate deficiency was rare at only 0.8%, indicating iron as the dominant nutritional factor.
The Quick Take
- What they studied: How common anemia is in school-age children and teenagers, and whether it’s caused by lack of iron, vitamin B12, or folate
- Who participated: 240,613 children and teenagers aged 6-18 years who visited family health centers in Antalya, Turkey between 2019-2025. The study looked at their blood test records to check for anemia and nutrient deficiencies
- Key finding: About 9.5% of children had anemia, but this jumped to 13.6% in girls and only 4.2% in boys. Iron deficiency was the main cause in 53.7% of anemic children, while B12 and folate deficiencies were rare
- What it means for you: If you’re a teenage girl, getting your iron levels checked is important. Eating iron-rich foods like red meat, beans, and leafy greens, or taking iron supplements if recommended by a doctor, can prevent anemia and help you feel more energetic
The Research Details
Researchers looked at blood test records from family health centers over six years (2019-2025) in Turkey. They examined the first blood test result for each child to see who had anemia and what caused it. Anemia was defined using official World Health Organization guidelines that account for age and sex differences. They checked for three main nutrient deficiencies: iron (using ferritin levels and iron saturation), vitamin B12, and folate. The researchers used statistical tests to find connections between anemia and these deficiencies, and they adjusted their analysis to account for age and sex differences.
This type of study is called ‘cross-sectional,’ which means researchers took a snapshot of the population at one point in time rather than following children over years. This approach is good for finding how common a problem is and what factors are associated with it, but it can’t prove that one thing directly causes another.
This study design is important because it uses real-world data from actual medical records rather than asking people to remember their health history. With over 240,000 children, the results are very reliable and representative of what’s happening in the general population. The large sample size means the findings are unlikely to be due to chance
This study has several strengths: it’s very large (240,613 children), uses actual medical records rather than self-reported information, and follows official WHO definitions for anemia. However, because it’s cross-sectional, it shows associations but not cause-and-effect relationships. The study also couldn’t measure all iron markers directly in every child, so researchers had to estimate some values. The data comes from one region in Turkey, so results may not apply equally to all countries or populations
What the Results Show
Nearly 1 in 10 children (9.5%) had anemia, but the rate was very different between boys and girls. Girls had anemia at a rate of 13.6% while boys had it at only 4.2%, more than three times higher in girls. Anemia also became more common as children got older: only 4.8% of 6-11 year-olds had it, but this jumped to 12.9% in 15-18 year-olds.
When researchers looked at what caused the anemia, iron deficiency was by far the most common culprit, found in 53.7% of anemic children. Vitamin B12 deficiency was present in about 1 in 3 anemic children (but often alongside iron deficiency), while folate deficiency was extremely rare at only 0.8%. This tells us that iron is the main nutrient missing in children with anemia.
The study found that iron deficiency was 4.15 times more likely to be present in children with anemia compared to those without anemia. Being female and being older were also strongly linked to having anemia. All of these connections were statistically significant, meaning they’re very unlikely to have happened by chance.
The study found that vitamin B12 deficiency appeared in 53.7% of anemic children, but this was often combined with iron deficiency rather than being the sole cause. Folate deficiency was surprisingly uncommon, appearing in less than 1% of anemic children. This suggests that in this population, B12 and folate are not major contributors to childhood anemia. The dramatic difference between boys and girls suggests that factors specific to girls, possibly related to menstruation starting in adolescence, play an important role in anemia development
This research confirms what health experts have known for years: iron deficiency is the leading cause of anemia worldwide, especially in children and adolescents. The higher rates in girls align with previous studies showing that menstruation increases iron loss and anemia risk. The rarity of folate deficiency in this study is consistent with modern findings in developed and middle-income countries where folate fortification of foods is common. However, the specific rates found here may differ from other countries depending on local nutrition, food fortification practices, and healthcare access
This study shows associations but cannot prove that iron deficiency directly causes anemia, only that they occur together. The research was conducted in one region of Turkey, so results may not apply equally to other countries or populations with different diets and healthcare systems. Not all children had every nutrient measured, so some deficiencies may have been missed. The study used medical records from people who visited health centers, which may not represent all children in the community. Additionally, the study couldn’t account for other factors that might affect anemia, such as chronic diseases or medications
The Bottom Line
Strong evidence supports screening teenage girls for iron deficiency and anemia. If deficiency is found, iron supplementation or dietary changes are recommended (consult a doctor for proper dosing). All school-age children should eat iron-rich foods regularly, including red meat, poultry, fish, beans, lentils, and fortified cereals. Vitamin C helps the body absorb iron, so eating these foods with citrus fruits or tomatoes is beneficial. Moderate confidence exists for screening boys, as their anemia rates are much lower
Teenage girls should prioritize iron screening and adequate iron intake. Adolescents aged 15-18 are at higher risk than younger children. Parents and healthcare providers should be especially attentive to girls’ nutrition. Boys can benefit from iron-rich diets but have lower anemia risk. Anyone with symptoms like fatigue, shortness of breath, or pale skin should see a doctor
Iron supplementation typically improves energy levels within 2-4 weeks, though it takes 2-3 months to fully restore iron stores. Dietary changes work more slowly but provide lasting benefits when maintained long-term. Regular screening every 1-2 years is recommended for at-risk groups
Frequently Asked Questions
Why do teenage girls get anemia more than boys?
Menstruation causes girls to lose blood and iron each month, increasing anemia risk significantly. This study found girls aged 15-18 had anemia rates of 13.6% versus 4.2% in boys. Iron-rich diets and screening are especially important for adolescent girls
What are the signs that my child might have anemia?
Common symptoms include persistent fatigue, shortness of breath with normal activity, pale skin, dizziness, and difficulty concentrating. A simple blood test can confirm anemia. If your child shows these signs, consult a doctor for evaluation and possible testing
Can anemia in children be prevented through diet?
Yes, this study shows anemia is largely preventable. Eating iron-rich foods like red meat, beans, lentils, and fortified cereals regularly can prevent deficiency. Pairing these with vitamin C sources like citrus or tomatoes improves iron absorption significantly
How often should children be screened for anemia?
The study suggests teenage girls should be screened regularly, ideally annually. Younger children and boys have lower risk but can be screened if symptoms appear. Discuss screening frequency with your pediatrician based on individual risk factors
Is iron supplementation safe for children?
Iron supplements can be effective but should only be used under medical supervision with proper dosing. Too much iron can be harmful. A doctor should confirm deficiency through blood tests before recommending supplements for your child
Want to Apply This Research?
- Log daily iron intake in grams and track energy levels on a 1-10 scale. Set a goal of 8-11 mg daily for girls aged 9-13 and 15 mg for girls 14-18. Monitor for symptoms like fatigue or shortness of breath
- Add one iron-rich food to each meal: breakfast (fortified cereal), lunch (beans or lean meat), dinner (red meat or fish). Pair with vitamin C sources like orange juice or tomatoes to boost absorption. Set weekly reminders to check iron-rich food intake
- Track weekly iron-rich meal frequency and monthly energy/fatigue ratings. Schedule annual blood work reminders for girls aged 12+. Log any symptoms and correlate with dietary patterns to identify triggers for low energy
This research describes associations found in a specific population and should not replace professional medical advice. If you suspect your child has anemia or iron deficiency, consult a pediatrician or healthcare provider for proper evaluation, testing, and treatment recommendations. Do not start supplements without medical guidance. This article is for educational purposes and is not a substitute for diagnosis or treatment by a qualified healthcare professional.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.
