title: Inadequate riboflavin intake and anemia risk in a Chinese population: five-year follow up of the Jiangsu Nutrition Study.
abstract: OBJECTIVE
  Riboflavin (vitamin B2) has been shown in animal studies to affect the absorption and metabolism of iron. Cross-sectional population studies show a relationship between riboflavin intake and anemia but prospective population studies are limited. The aim of the study was to determine the relationship between riboflavin intake and the risk of anemia in a Chinese cohort.
  
  
  METHODS
  The study used data from 1253 Chinese men and women who participated in two waves of the Jiangsu Nutrition Study (JIN), five years apart, in 2002 and 2007. Riboflavin intake and hemoglobin (Hb) were quantitatively assessed together with dietary patterns, lifestyle, socio-demographic and health-related factors.
  
  
  RESULTS
  At baseline, 97.2% of participants had inadequate riboflavin intake (below the estimate average requirement). Riboflavin intake was positively associated with anemia at baseline, but low riboflavin intake was associated with an increased risk of anemia at follow-up among those anemic at baseline. In the multivariate model, adjusting for demographic and lifestyle factors and dietary patterns, the relative risk and 95% confidence interval for anemia at follow-up, across quartiles of riboflavin intake were: 1, 0.82(0.54-1.23), 0.56(0.34-0.93), 0.52(0.28-0.98) (p for trend 0.021). There was a significant interaction between riboflavin and iron intake; when riboflavin intake was low, a high iron intake was associated with a lower probability of anemia at follow-up. This association disappeared when riboflavin intake was high.
  
  
  CONCLUSIONS
  Inadequate riboflavin intake is common and increases the risk of anemia in Chinese adults. Given the interaction with iron intake correcting inadequate riboflavin intake may be a priority in the prevention of anemia, and population based measurement and intervention trials are required.
authors.affiliation: Department of Nutrition and Foodborne Disease Prevention, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China ; Discipline of Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: Zumin
authors.initials: Z
authors.lastname: Shi
authors.affiliation: Department of Nutrition and Foodborne Disease Prevention, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China.
authors.forename: Shiqi
authors.initials: S
authors.lastname: Zhen
authors.affiliation: Discipline of Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Wittert
authors.affiliation: Department of Nutrition and Foodborne Disease Prevention, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China.
authors.forename: Baojun
authors.initials: B
authors.lastname: Yuan
authors.affiliation: Department of Nutrition and Foodborne Disease Prevention, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zuo
authors.affiliation: Discipline of Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000740:Anemia / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D004435:Eating; D005260:Female; D005500:Follow-Up Studies; D005504:Food Analysis; D006801:Humans; D007501:Iron / Q000032:analysis; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D012256:Riboflavin / Q000032:analysis*; D012306:Risk; D055815:Young Adult
chemical_list: D007501:Iron; D012256:Riboflavin