Serum Zinc Is a Major Predictor of Anemia and Mediates the Effect of Selenium on Hemoglobin in School-Aged Children in a Nationally Representative Survey in New Zealand

J Nutr. 2016 Sep;146(9):1670-6. doi: 10.3945/jn.116.235127. Epub 2016 Jul 27.


Background: Zinc, selenium, and vitamin D status of New Zealand (NZ) school-aged children was examined in a national survey in 2002. To our knowledge, however, the role of these micronutrients as predictors of hemoglobin has not been explored despite plausible mechanisms for such relations.

Objective: We examined the relations of iron, zinc, selenium, and vitamin D status with hemoglobin and anemia in children of New Zealand European and other (NZEO) ethnicity enrolled in the 2002 Children's Nutrition Survey and explored whether zinc mediated the relation between selenium and hemoglobin.

Methods: Multivariate regression was performed to examine the relations of serum micronutrient biomarkers, acute inflammation, socioeconomic status, and body mass index (BMI) with hemoglobin and anemia of NZEO children aged 5-15 y (n = 503). A mediation analysis also investigated direct and indirect (through zinc) relations between selenium and hemoglobin.

Results: In total, 4.6% of the children were anemic, 3.2% had depleted iron stores, and none had iron deficiency anemia. The prevalence of low serum zinc (<8.7-10.1 μmol/L depending on age and sex), selenium (<0.82 μmol/L), and 25-hydroxyvitamin D (<50 nmol/L) was 14.1%, 22.9%, and 48.5%, respectively. Major predictors of hemoglobin were serum zinc, age, and BMI-for-age z score (P < 0.001); log ferritin and being female were also statistically significant (P < 0.05). Selenium had an indirect effect that was mediated by zinc, with a significant effect of selenium on zinc (P = 0.002) and zinc on hemoglobin (P < 0.001). Zinc was the only variable associated with anemia risk (OR: 5.49; 95% CI: 1.95, 15.46).

Conclusions: Low serum zinc was an independent risk factor for anemia in NZEO school-aged children and mediated the effect of low selenium on hemoglobin. These findings emphasize the importance of considering multiple micronutrient deficiencies in addition to iron when interpreting anemia and of appreciating the mechanistic interactions that underlie these associations.

Keywords: anemia; hemoglobin; risk factors; school-aged children; selenium; vitamin D; zinc.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anemia, Iron-Deficiency / blood
  • Anemia, Iron-Deficiency / epidemiology*
  • Body Mass Index
  • Child
  • Cross-Sectional Studies
  • Female
  • Ferritins / blood
  • Hemoglobins / metabolism*
  • Humans
  • Iron / blood*
  • Iron / deficiency
  • Linear Models
  • Logistic Models
  • Male
  • Multivariate Analysis
  • New Zealand / epidemiology
  • Nutrition Surveys
  • Nutritional Status
  • Prevalence
  • Selenium / blood*
  • Selenium / deficiency
  • Socioeconomic Factors
  • Transferrin / metabolism
  • Vitamin D / blood
  • Vitamin D Deficiency / blood
  • Vitamin D Deficiency / epidemiology*
  • Zinc / blood*
  • Zinc / deficiency


  • Hemoglobins
  • Transferrin
  • Vitamin D
  • Ferritins
  • Iron
  • Selenium
  • Zinc