Assessment of Thiamin and Riboflavin Status Among Adolescent Women in Lebanon

Abstract

Background: Adolescent women are nutritionally vulnerable due to increased physiological demands associated with growth, development, and reproductive maturation. Adequate thiamin and riboflavin are essential for energy metabolism, redox balance, and overall health. In Lebanon, economic instability, food insecurity, and ongoing dietary transitions have raised concerns regarding micronutrient deficiencies, particularly in the context of limited dietary diversity and absence of food fortification programs. Objectives: This study aimed to evaluate functional thiamin and riboflavin status among adolescent women in Lebanon using erythrocyte transketolase activation coefficient (ETKAC) and erythrocyte glutathione reductase activation coefficient (EGRAC), estimate the prevalence of subclinical insufficiency, and examine associations with dietary intake and potential determinants. Methods: Data were drawn from the nationally representative Lebanon Integrated Micronutrient, Anthropometry, and Child Development (LIMA) survey (2023–2024). The analytic sample included 1,310 adolescent females aged 10–19 years with available biomarker data. Functional vitamin status was assessed using ETKAC and EGRAC. Nonparametric statistical analyses were conducted to evaluate associations with anthropometric, dietary, socioeconomic, and physiological variables. Results: The majority of participants demonstrated adequate thiamin status (92.1%), with a small proportion classified as marginal (7.3%) or deficient (0.6%). In contrast, riboflavin deficiency was highly prevalent, affecting 60.7% of participants, with an additional 25.2% classified as marginal. No significant associations were observed between functional vitamin status and BMI-for-age, dietary intake variables, or inflammation markers. A weak but statistically significant inverse association was identified between total flour intake and ETKAC (ρ = -0.072, p = 0.011), while no significant association was observed with riboflavin status. Riboflavin status was significantly associated with menarche status (p = 0.008) and wealth quintile (p < 0.001). Additionally, riboflavin status was inversely associated with hemoglobin levels (ρ = -0.093, p < 0.001). Conclusion: Riboflavin deficiency represents a significant public health concern among adolescent women in Lebanon, while thiamin status appears largely adequate. The observed associations with menarche status, socioeconomic factors, and hemoglobin levels highlight vulnerable subgroups and potential functional implications of deficiency. These findings underscore the importance of incorporating functional biomarkers into nutritional assessment and support the need for targeted interventions, including improving access to riboflavin-rich foods and evaluating the feasibility of food fortification strategies to address subclinical micronutrient insufficiency in this population.