Gender disparities in the functional significance of anemia among apparently healthy adults

Roni Shouval, Sharon Katz, Arnon Nagler, Drorit Merkel, Ilan Ben-Zvi, Shlomo Segev, Yechezkel Sidi, Ilan Goldenberg, Shaye Kivity, Elad Maor

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


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.

Original languageEnglish
Pages (from-to)435-442
Number of pages8
JournalEuropean Journal of Haematology
Issue number5
StatePublished - May 2017
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd


  • anemia
  • exercise stress testing
  • fitness
  • gender
  • survival


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