Diet-Related Nutritional Biomarker Patterns in Maternal Anemia: A Multicenter Exploratory Analysis of Vitamin D, Ferritin, Hepcidin and mTOR

Abstract

Objective: To characterize diet-related biomarker patterns and explore statistical relationships among 25-hydroxyvitamin D [25(OH)D], ferritin, hepcidin, mTOR, and hemoglobin in pregnant women.

Methods: A multicenter cross-sectional study included 93 third-trimester pregnant women recruited from eight public health centers in Palembang, Indonesia, from September 2024 to December 2025. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire and repeated 24-hour recalls. Anthropometric and biochemical measures included BMI, MUAC, hemoglobin, 25(OH)D, ferritin, hepcidin, and mTOR. Group comparisons, correlation analysis, Principal Component Analysis (PCA), and exploratory Structural Equation Modeling (SEM) were performed.

Results: Compared with non-anemic women, those with anemia had lower vitamin D and iron intakes, lower 25(OH)D and ferritin, and higher hepcidin. 25(OH)D correlated positively with ferritin and inversely with hepcidin. PCA Component 1 explained 43.05% of variance, with loadings of 0.78, 0.65, −0.61, and 0.28 for 25(OH)D, ferritin, hepcidin, and mTOR, respectively. SEM showed significant associations of 25(OH)D with hepcidin (β = −0.41, p = 0.002) and ferritin (β = 0.47, p = 0.001), hepcidin with ferritin (β = −0.33, p = 0.010), and ferritin with hemoglobin (β = 0.52, p < 0.001). The mTOR–hemoglobin association was non-significant.

Conclusion: Maternal anemia showed an exploratory statistical pattern centered on vitamin D and iron-related biomarkers, with limited mTOR contribution. These findings support an integrated nutritional perspective and warrant longitudinal investigation.