The concentration of hemoglobin is associated with the dietary iron availability, food insecurity and the use of oral contraceptives among women in socially vulnerable areas of a capital city in northeastern Brazil

This study aimed to assess hemoglobin concentration and its association with oral contraceptive (OC) use, food insecurity (FI) and dietary iron availability (DIA) in adult women of reproductive age (20-44 years). This is a population-based cross-sectional study that analysed 505 women living in favelas and urban communities in a capital city in northeastern Brazil. Hemoglobin concentration was determined using capillary blood samples. FI and DIA were assessed using the Brazilian Food Insecurity Scale and the 24-h food recall, respectively. Association analysis was carried out using logistic regression. A directed acyclic graph (DAG) was designed to illustrate the causal paths between hemoglobin concentration and DIA. A significance level of 5 % was adopted. Low hemoglobin concentrations (11<middle dot>2 g/dl: (1<middle dot>79)) and a high prevalence of anaemia (64<middle dot>0 %) were observed; 28<middle dot>7 % used OC (28<middle dot>7 %) and 76<middle dot>4 % were in FI. An average energetic intake of 1495 kcal/d (482<middle dot>0) and 0<middle dot>46 mg/d (0<middle dot>27) of DIA were also observed. In the DAG-guided multivariable analysis, it was observed that hemoglobin concentrations >= 12 mg/dl were directly associated with higher DIA (OR: 1<middle dot>67; 95 % CI (1. 08, 2<middle dot>59)) and OC use (OR: 1<middle dot>67; 95 % CI (1<middle dot>10, 2<middle dot>55)) and inversely associated with mild FI (OR: 0<middle dot>60; 95 % CI (0<middle dot>37, 0<middle dot>96)) or severe FI (OR: 0<middle dot>37; 95 % CI: (0<middle dot>18, 0<middle dot>76)). Women taking OC and with a higher DIA were less likely to have low hemoglobin concentrations, while those in the context of FI were in the opposite situation.