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U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion

Reduce iron deficiency in children aged 1 to 2 years — NWS‑16 Data Methodology and Measurement

On this page:  About this objective  |  Methodology  |  History  |  References

About this objective

Data

Data Source:  National Health and Nutrition Examination Survey (NHANES), CDC/NCHS

National baseline: 24.5 percent of children aged 1 to 2 years had iron deficiency in 2015-16

National target: 17.1 percent

Numerator
Number of children aged 1 to 2 years with inflammation-adjusted serum ferritin less than 15µg/L body iron less than 0.
Denominator
Number of children aged 1 to 2 years.
National target-setting method
Minimal statistical significance
National target-setting method details
Minimal statistical significance, assuming the same standard error for the target as for the baseline.
National target-setting method justification
Trend data were not available for this objective. The standard error was used to calculate a target based on minimal statistical significance, assuming the same standard error for the target as for the baseline. This method was used because it was a statistically significant improvement from the baseline.
National data collection frequency
Other

Methodology

Methodology notes

Children are defined as having iron deficiency if they have a measurement of inflammation-adjusted serum ferritin less than 15µg/L. Serum ferritin measures were adjusted for C-reactive protein (CRP), a measure of acute inflammation, using the regression approach developed by the Biomarkers Reflecting Inflammation and Nutrition Determinants of Anemia (BRINDA) project. The World Health Organization recommendation is to adjust for both alpha-1-acid glycoprotein (AGP) and CRP, which was considered, but there were not enough residual specimens to analyze AGP in children 1-2 years in NHANES 2019-2020.

Design changes were made to the August 2021-2023 NHANES cycle to minimize in-person contact during the COVID-19 pandemic. Refer to the Data Source page for more information. Unlike previous cycles, there was no oversampling of persons with family incomes <185% of the poverty threshold. This may result in lower confidence in the estimate and insufficient power to detect differences between groups. In addition, seventeen percent of interview participants had missing family income data.

History

Comparable HP2020 objective
Modified, which includes core objectives that are continuing from Healthy People 2020 but underwent a change in measurement.
Changes between HP2020 and HP2030
This objective differs from Healthy People 2020 objective NWS-21.1 in that for the Healthy People 2020 trend, back calculations were applied for the 2009-2010 and 2015-2016 serum ferritin data to make them comparable to the 2005-2008 baseline values due to immunoassay and lab instrument changes, respectively, while no back calculations were performed for the 2015-2016 baseline data starting a new trend for Healthy People 2030. In addition, the indicator used for defining iron deficiency was changed from total body iron (TBI) to inflammation-adjusted serum ferritin. TBI was selected as the previous Healthy People estimate for iron deficiency as it is less influenced by inflammation (CDC/WHO 2004). However, as a measure of iron deficiency, TBI has only been validated in adults, not children (Cook et al. 2003) and is not used in clinical settings. When it was selected, markers of inflammation were not consistently available in NHANES for children aged 1-2 years and there were no recommendations of how to adjust iron biomarkers, so serum ferritin could not be adjusted for inflammation. Since NHANES 2015-2016, high-sensitivity C-reactive protein (CRP), a measure of acute inflammation, has been measured in all participants 1 years of age and older, allowing serum ferritin to be adjusted appropriately.
Revision History
Revised. 

In 2025, the baseline was revised from 6.3% to 24.5% in 2015-2016 as the indicator used for defining iron deficiency was changed from total body iron (TBI) to inflammation-adjusted serum ferritin. The target was revised from 2.1% to 17.1% using the original target setting method.

References

Additional resources about the objective