Dietary Flavonoid Intake and Anemia Risk in Children and Adolescents: Insights from National Health and Nutrition Examination Survey

Anemia, a global health concern, significantly impacts children and adolescents, impairing their physical and cognitive development. While nutritional deficiencies are primary contributors, oxidative stress has emerged as a key factor in anemia pathogenesis. Flavonoids, known for their antioxidant properties, may play a protective role, but their relationship with anemia in pediatric populations remains underexplored. Using data from the National Health and Nutrition Examination Survey (NHANES) cycles (2007-2008, 2009-2010, and 2017-2018), we analyzed 6815 participants aged ≤20 years to investigate the association between dietary flavonoid intake and anemia risk. Flavonoid intake was assessed via two 24 h dietary recalls, and anemia was defined using WHO hemoglobin thresholds. Multivariable logistic regression and restricted cubic spline (RCS) models were employed, adjusting for sociodemographic, dietary, and lifestyle factors. The results showed that lower dietary flavonoid intake was significantly associated with increased anemia risk. High-intake groups of total flavonoids and flavan-3-ols were linked to a reduced anemia prevalence compared to low-intake groups, with odds ratios (ORs) of OR = 0.641 (95% CI: 0.439, 0.935) and 0.612 (95% CI: 0.406, 0.921), respectively. This study highlights the potential protective role of dietary flavonoids, particularly flavan-3-ols, in reducing the anemia risk among children and adolescents, underscoring the importance of flavonoid-rich diets in anemia prevention.