Nearly half of Cambodian women of reproductive age suffer from at least mild anemia, however iron and other nutrient deficiencies may not be to blame, a study published on Friday suggests.

Low Prevalence of Iron and Vitamin A Deficiency among Cambodian Women of Reproductive Age, published in human nutrition journal Nutrients, surveyed blood samples from more than 2,000 women between the ages of 15 and 39 across the country.

It found that “neither a lack of vitamin A nor iron are important causes of anemia, which was a bit surprising for us, because we thought it would be a major cause, but it is not”, lead author Dr Frank Wieringa, from the Institut de Recherche pour le Developpement (IRD) in Montpellier, France, said in a phone interview yesterday.

While nutritional causes for anemia include a lack of iron, vitamin A, folate and vitamin E, this is not always the case, Wieringa continued.

“You can have haemoglobinpathies, where you have a genetically different form of haemoglobin [the protein in red blood cells that carries oxygen] that is fragile; it’s easier to be broken down, so your concentration of haemoglobin is lower.”

“We think that maybe half the people of Cambodia have this haemoglobin,” compared to rates of “8 to 10 per cent in Thailand”, he said.

Although other nutritional causes for high anemia rates have not been ruled out, according to Wieringa, a genetic explanation appears most likely. The most prevalent form of the genetic disorder in the Kingdom is Haemoglobinpathy E, however, “it’s not really bad, it’s not a disease you die of. It’s probably a trait, or selection, that helps for survival,” Wieringa said, drawing a parallel to the relative resistance to malaria gained by the genetic condition of sickle cell anemia, which has high rates in certain African populations.

“It does have implications for health policies. If anemia is not caused by iron deficiencies, then there is no reason to give iron supplements,” Wieringa said, while nonetheless cautioning that women going through pregnancy and young children are groups that should continue to receive iron supplements under government programs as their anemia is linked to iron deficiency.

“The policymakers should not be frustrated that giving iron does not have an impact on anemia,” he said.