Role of Micronutrient Interaction (Iron, Zinc, Vitamin B12, Folate) in Unexplained Anemia Among Adolescents
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Background: Adolescent anemia may involve multiple nutritional deficiencies, particularly when its cause remains unexplained after initial assessment. Objective: To characterize iron, zinc, vitamin B12, and folate deficiency patterns and examine their associations with hemoglobin concentration among adolescents with unexplained anemia. Methods: This observational cross-sectional study included 84 consecutively recruited adolescents aged 10–19 years attending tertiary outpatient clinics in Faisalabad, Pakistan, between September 2025 and January 2026. Complete blood counts, serum ferritin, zinc, vitamin B12, folate, and C-reactive protein were measured. Analyses included descriptive statistics, independent-samples t-tests, and Pearson correlations. Results: Mean age was 14.6 ± 2.4 years, and 57.1% of participants were female. Mean hemoglobin was 10.4 ± 1.1 g/dL. Isolated iron deficiency was reported at 28.6%, while multiple micronutrient deficiencies were reported in 61.9%. Participants with moderate anemia had lower ferritin, zinc, vitamin B12, and folate concentrations than those with mild anemia (all p < 0.001). Hemoglobin correlated positively with zinc (r = 0.52), ferritin (r = 0.48), vitamin B12 (r = 0.41), and folate (r = 0.36; all p < 0.001). Conclusion: Micronutrient co-deficiency was frequent, and lower biomarker concentrations were associated with greater anemia severity. These associations do not establish causal interactions or treatment effectiveness
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