title: Gender disparities in the functional significance of anemia among apparently healthy adults.
abstract: BACKGROUND
  Data on the functional impact of anemia on cardiorespiratory fitness (CRF) and survival in healthy individuals are limited. Our aim was to evaluate the association between anemia thresholds, low CRF, and survival in otherwise healthy adults.
  
  
  METHODS
  Study population included 16 334 apparently healthy subjects attending annual periodic health screening examinations (71 200 annual visits), including exercise stress testing (EST). Anemia was defined by the World Health Organization (WHO) or Beutler and Waalens' (BW) criteria. Low CRF was defined as the lowest fitness quintile according to the Bruce protocol.
  
  
  RESULTS
  The mean age was 46±10 years, and 70% were men. Mean Hb levels were 13±1 and 15±1 among women and men, respectively, with higher proportion of anemia among women. The majority of anemic subjects had mild anemia. When analyzing repeated annual visits, anemia was associated with a significant 39% and 64% increased risk of low CRF according the WHO and BW criteria only in women (n=18 672). Baseline anemia at first visit was associated with 2.6- and 1.9-fold increased risk of all-cause mortality using the WHO and BW criteria, exclusively in men (n=11 511).
  
  
  CONCLUSIONS
  Overall, the functional and prognostic impact of anemia is gender dependent, based on the WHO and BW arbitrary criteria, suggesting differing mechanism and responses.
authors.affiliation: Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel.|The Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Roni
authors.identifier: http://orcid.org/0000-0001-9827-8032
authors.initials: R
authors.lastname: Shouval
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.|Internal Medicine "F" Department, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Sharon
authors.initials: S
authors.lastname: Katz
authors.affiliation: Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
authors.affiliation: Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Drorit
authors.initials: D
authors.lastname: Merkel
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.|Internal Medicine "F" Department, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Ben-Zvi
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.|Institute for Medical Screening, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Segev
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.|Internal Medicine "C" Department, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Yechezkel
authors.initials: Y
authors.lastname: Sidi
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.|Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.|Internal Medicine "C" Department, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Shaye
authors.initials: S
authors.lastname: Kivity
authors.affiliation: The Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.|Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Elad
authors.initials: E
authors.lastname: Maor
mesh_terms: D000328:Adult; D000367:Age Factors; D000740:Anemia / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D000072599:Cardiorespiratory Fitness; D004909:Erythrocyte Indices; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010809:Physical Fitness; D011159:Population Surveillance; D012737:Sex Factors; D016019:Survival Analysis; D055815:Young Adult
keywords: anemia; exercise stress testing; fitness; gender; survival