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De Neve JW, Karlsson O, Rai RK, Kumar S, Vollmer S. Relationship between adolescent anemia and school attendance observed during a nationally representative survey in India. COMMUNICATIONS MEDICINE 2024; 4:112. [PMID: 38866923 DOI: 10.1038/s43856-024-00533-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 05/28/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Anemia has been suggested to be related with schooling outcomes in India. Less is known, however, about whether the observed relationship persists after accounting for all household-level factors which may confound the association between anemia and schooling. METHODS Nationally representative data on adolescents aged 15-18 years with data on measured hemoglobin level and school attendance were extracted from India's National Family Health Surveys conducted between 2005 and 2021. We compared school attendance between adolescents living in the same household but with varying levels of hemoglobin concentration, while controlling for age and period effects. We assessed heterogeneity in the relationship between anemia and school attendance across anemia severity groups and socio-demographic characteristics. RESULTS The proportion of adolescents with any anemia is 55.2% (95% CI: 55.0-55.5) among young women and 31.0% (95% CI: 30.6-31.5) among young men. In conventional (between-household) regression models, having any anemia is associated with a 2.5 percentage point reduction (95% CI: 2.1-2.8) in school attendance; however, in household fixed-effects models, anemia has qualitatively small and non-significant effects on school attendance. Our results are consistent using alternative model specifications as well as across anemia severity groups, genders, types of relationship to the household head, household wealth quintiles, and states and union territories in India. CONCLUSIONS This within-household analysis finds little evidence that anemia is associated with school attendance among adolescents in India. Observational studies likely overstate the connection between anemia and school attendance due to household factors that have not been accounted for.
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Affiliation(s)
- Jan-Walter De Neve
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany.
| | - Omar Karlsson
- Department of Economic History, Lund University, Lund, Sweden
- Duke University Population Research Institute, Durham, NC, USA
| | - Rajesh Kumar Rai
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Society for Health and Demographic Surveillance, Suri, West Bengal, India
- Department of Economics, University of Goettingen, Göttingen, Germany
- Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
- Institute of Nutrition, Mahidol University, Nakhon Pathom, Thailand
| | - Santosh Kumar
- Keough School of Global Affairs, University of Notre Dame, Notre Dame, IN, USA
| | - Sebastian Vollmer
- Department of Economics, University of Goettingen, Göttingen, Germany
- Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
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Şarkaya K, Özçelik H, Yaşar E, Güner T, Dokuzparmak E, Hooshmand S, Akgöl S. Selective Extraction and Quantification of Hemoglobin Based on a Novel Molecularly Imprinted Nanopolymeric Structure of Poly(acrylamide-vinyl imidazole). ACS OMEGA 2024; 9:18458-18468. [PMID: 38680349 PMCID: PMC11044176 DOI: 10.1021/acsomega.4c00547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/19/2024] [Accepted: 03/28/2024] [Indexed: 05/01/2024]
Abstract
Imbalances in hemoglobin (Hb) levels can lead to conditions such as anemia or polycythemia, emphasizing the importance of precise Hb extraction from blood. To address this, a novel synthetic imprinted polymer was meticulously developed for capturing and separating Hb. Poly(acrylamide-vinylimidazole) nanopolymer (poly(AAm-VIM)) was synthesized using acrylamide and vinyl imidazole as functional monomers through surfactant-free emulsion polymerization. Characterization using FTIR, particle size, zeta potential, and SEM ensured the polymer's structure. The Hb-imprinted nanopolymer (Hb-poly(AAm-VIM)) demonstrated notable specificity, with a calculated Hb-specific adsorption value (Qmax) of 3.7377 mg/g in a medium containing 2.5 mg/mL Hb. The molecularly imprinted polymer (MIP) exhibited approximately 5 times higher Hb adsorption than the nonimprinted polymer (NIP). Under the same conditions, the imprinted nanopolymer displayed 2.39 and 2.17 times greater selectivity for Hb over competing proteins such as bovine serum albumin (BSA) and lysozyme (Lys), respectively. Also, SDS-PAGE analysis results confirmed the purification of Hb by the molecularly imprinted nanopolymer. These results underscore the heightened specificity and efficacy of the molecularly imprinted nanopolymer in selectively targeting Hb atoms among other proteins. Incorporating such polymers is justified by their notable affinity, cost-effectiveness, and facile production. This research contributes valuable insights into optimizing synthetic imprinted polymers for efficient Hb extraction, with potential in medical diagnostics and treatment applications.
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Affiliation(s)
- Koray Şarkaya
- Department
of Chemistry, Faculty of Science, Pamukkale
University, Denizli 20160, Turkey
| | - Hilal Özçelik
- Department
of Biochemistry, Faculty of Science, Ege
University, Izmir 35100, Turkey
| | - Esra Yaşar
- Department
of Biochemistry, Faculty of Science, Ege
University, Izmir 35100, Turkey
| | - Timuçin Güner
- Department
of Biochemistry, Faculty of Science, Ege
University, Izmir 35100, Turkey
| | - Emre Dokuzparmak
- Department
of Bioengineering, Ege University, Izmir 35100, Turkey
| | - Sara Hooshmand
- Sabanci
University Nanotechnology Research and Application Center (SUNUM), Tuzla, Istanbul 34956, Turkey
| | - Sinan Akgöl
- Department
of Biochemistry, Faculty of Science, Ege
University, Izmir 35100, Turkey
- Sabanci
University Nanotechnology Research and Application Center (SUNUM), Tuzla, Istanbul 34956, Turkey
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3
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Braat S, Fielding KL, Han J, Jackson VE, Zaloumis S, Xu JXH, Moir-Meyer G, Blaauwendraad SM, Jaddoe VWV, Gaillard R, Parkin PC, Borkhoff CM, Keown-Stoneman CDG, Birken CS, Maguire JL, Bahlo M, Davidson EM, Pasricha SR. Haemoglobin thresholds to define anaemia from age 6 months to 65 years: estimates from international data sources. Lancet Haematol 2024; 11:e253-e264. [PMID: 38432242 PMCID: PMC10983828 DOI: 10.1016/s2352-3026(24)00030-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Detection of anaemia is crucial for clinical medicine and public health. Current WHO anaemia definitions are based on statistical thresholds (fifth centiles) set more than 50 years ago. We sought to establish evidence for the statistical haemoglobin thresholds for anaemia that can be applied globally and inform WHO and clinical guidelines. METHODS In this analysis we identified international data sources from populations in the USA, England, Australia, China, the Netherlands, Canada, Ecuador, and Bangladesh with sufficient clinical and laboratory information collected between 1998 and 2020 to obtain a healthy reference sample. Individuals with clinical or biochemical evidence of a condition that could reduce haemoglobin concentrations were excluded. We estimated haemoglobin thresholds (ie, 5th centiles) for children aged 6-23 months, 24-59 months, 5-11 years, and 12-17 years, and adults aged 18-65 years (including during pregnancy) for individual datasets and pooled across data sources. We also collated findings from three large-scale genetic studies to summarise genetic variants affecting haemoglobin concentrations in different ancestral populations. FINDINGS We identified eight data sources comprising 18 individual datasets that were eligible for inclusion in the analysis. In pooled analyses, the haemoglobin fifth centile was 104·4 g/L (90% CI 103·5-105·3) in 924 children aged 6-23 months, 110·2 g/L (109·5-110·9) in 1874 children aged 24-59 months, and 114·4 g/L (113·6-115·2) in 1839 children aged 5-11 years. Values diverged by sex in adolescents and adults. In pooled analyses, the fifth centile was 122·2 g/L (90% CI 121·3-123·1) in 1741 female adolescents aged 12-17 years and 128·2 g/L (126·4-130·0) in 1103 male adolescents aged 12-17 years. In pooled analyses of adults aged 18-65 years, the fifth centile was 119·7 g/L (90% CI 119·1-120·3) in 3640 non-pregnant females and 134·9 g/L (134·2-135·6) in 2377 males. Fifth centiles in pregnancy were 110·3 g/L (90% CI 109·5-111·0) in the first trimester (n=772) and 105·9 g/L (104·0-107·7) in the second trimester (n=111), with insufficient data for analysis in the third trimester. There were insufficient data for adults older than 65 years. We did not identify ancestry-specific high prevalence of non-clinically relevant genetic variants that influence haemoglobin concentrations. INTERPRETATION Our results enable global harmonisation of clinical and public health haemoglobin thresholds for diagnosis of anaemia. Haemoglobin thresholds are similar between sexes until adolescence, after which males have higher thresholds than females. We did not find any evidence that thresholds should differ between people of differering ancestries. FUNDING World Health Organization and the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Sabine Braat
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia; Methods and Implementation Support for Clinical and Health research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Katherine L Fielding
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia; Medical Biology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia; Clinical Haematology, The Austin Hospital, Heidelberg, VIC, Australia
| | - Jiru Han
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia; Medical Biology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Victoria E Jackson
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia; Medical Biology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Sophie Zaloumis
- Methods and Implementation Support for Clinical and Health research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Jessica Xu Hui Xu
- Methods and Implementation Support for Clinical and Health research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Gemma Moir-Meyer
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia; Medical Biology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Sophia M Blaauwendraad
- Generation R Study Group, and Department of Pediatrics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Vincent W V Jaddoe
- Generation R Study Group, and Department of Pediatrics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Romy Gaillard
- Generation R Study Group, and Department of Pediatrics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Patricia C Parkin
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Cornelia M Borkhoff
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Charles D G Keown-Stoneman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Unity Health Toronto, Toronto, ON, Canada
| | - Catherine S Birken
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jonathon L Maguire
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Unity Health Toronto, Toronto, ON, Canada
| | - Melanie Bahlo
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia; Medical Biology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Eliza M Davidson
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia; Medical Biology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia; Diagnostic Haematology, The Royal Melbourne Hospital, Parkville, VIC, Australia; Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Parkville, VIC, Australia.
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4
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Daru J, Zamora J. Defining global thresholds for anaemia: a challenging mission. Lancet Haematol 2024; 11:e242-e243. [PMID: 38432240 DOI: 10.1016/s2352-3026(24)00061-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Jahnavi Daru
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Javier Zamora
- Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRICIS-CIBERESP), Madrid, Spain; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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Singh A, Ram S, Chandra R, Tanti A, Singh S, Kundu A. A district-level geospatial analysis of anaemia prevalence among rural men in India, 2019-21. Int J Equity Health 2024; 23:9. [PMID: 38243230 PMCID: PMC10799465 DOI: 10.1186/s12939-023-02089-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/28/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Despite its considerable impact on health and productivity, anemia among men has received limited attention. In a country as diverse as India, characterized by extensive geographic variations, there is a pressing need to investigate the nuanced spatial patterns of anemia prevalence among men. The identification of specific hotspots holds critical implications for policymaking, especially in rural areas, where a substantial portion of India's population resides. METHODS The study conducted an analysis on a sample of 61,481 rural men from 707 districts of India, utilizing data from the National Family Health Survey-5 (2019-21). Various analytical techniques, including Moran's I, univariate LISA (Local Indicators of Spatial Association), bivariate LISA, and spatial regression models such as SLM (Spatial Lag Model), and SEM (Spatial Error Model) were employed to examine the geographic patterns and spatial correlates of anaemia prevalence in the study population. RESULTS In rural India, three out of every ten men were found to be anemic. The univariate Moran's I value for anaemia was 0.66, indicating a substantial degree of spatial autocorrelation in anaemia prevalence across the districts in India. Cluster and outlier analysis identified five prominent 'hotspots' of anaemia prevalence across 97 districts, primarily concentrated in the eastern region (encompassing West Bengal, Jharkhand, and Odisha), the Dandakaranya region, the Madhya Pradesh-Maharashtra border, lower Assam, and select districts in Jammu and Kashmir. The results of SLM revealed significant positive association between anaemia prevalence at the district-level and several key factors including a higher proportion of Scheduled Tribes, men in the 49-54 years age group, men with limited or no formal education, individuals of the Muslim faith, economically disadvantaged men, and those who reported alcohol consumption. CONCLUSIONS Substantial spatial heterogeneity in anaemia prevalence among men in rural India suggests the need for region-specific targeted interventions to reduce the burden of anaemia among men in rural India and enhance the overall health of this population.
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Affiliation(s)
- Aditya Singh
- Department of Geography, Banaras Hindu University, Varanasi, India.
- Girl Innovation, Research, and Learning (GIRL) Centre, Population Council, New York, USA.
| | - Sumit Ram
- Department of Geography, Banaras Hindu University, Varanasi, India.
| | - Rakesh Chandra
- School of Health System Studies, Tata Institute of Social Sciences, Mumbai, India
| | - Arabindo Tanti
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, India
| | | | - Ananya Kundu
- Department of Geography, University of Calcutta, Kolkata, India
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6
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Williams AM, Brown KH, Allen LH, Dary O, Moorthy D, Suchdev PS. Improving Anemia Assessment in Clinical and Public Health Settings. J Nutr 2023; 153 Suppl 1:S29-S41. [PMID: 37778891 PMCID: PMC11002965 DOI: 10.1016/j.tjnut.2023.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/28/2023] [Accepted: 05/10/2023] [Indexed: 10/03/2023] Open
Abstract
We aim to provide a practical approach to assess anemia and its primary causes, both in clinical settings and in the context of public health programs. Anemia remains a global challenge; thus, to achieve goals for anemia reduction and assess progress, standardized approaches are required for the assessment of anemia and its causes. We first provide a brief review of how to assess anemia, based on hemoglobin concentrations and cutoffs that correspond to age, sex, and physiologic status. Next, we discuss how to assess the likely causes of anemia in different settings. The causes of anemia are classified as non-nutritional (for example, because of infection, inflammation, blood loss, or genetic disorders) or nutrition-specific (for example, because of deficiencies of iron, vitamin A, riboflavin, vitamin B12, or folate). There is an important overlap between these 2 categories, such as the increased likelihood of iron deficiency in the context of inflammation. Given the multifaceted nature of anemia etiology, we introduce a framework for anemia assessment based on the "ecology of anemia," which recognizes its many overlapping causes. This conceptual framework is meant to inform what data on anemia causes may need to be collected in population surveys. The framework has a supporting table with information on the diagnostic tests, biomarkers and proposed cutoffs, characteristics, and feasibility of collecting the myriad information that can help elucidate the anemia etiology. We also provide examples of how this framework can be applied to interpret the anemia risk factor data from population-based surveys that can inform decisions about context-specific interventions. Finally, we present research gaps and priorities related to anemia assessment.
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Affiliation(s)
- Anne M Williams
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand; Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States; Emory University, Atlanta, GA, United States.
| | - Kenneth H Brown
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA, United States
| | - Lindsay H Allen
- United States Department of Agriculture, Agricultural Research Service Western Human Nutrition Research Center, Davis, CA, United States
| | - Omar Dary
- Division of Nutrition and Environmental Health, Office of Maternal and Child Health and Nutrition, Bureau for Global Health, United States Agency for International Development, Washington, DC, United States
| | | | - Parminder S Suchdev
- Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States; Emory University, Atlanta, GA, United States
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7
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Silva CSS, Bensenor IM, Goulart AC, Lotufo PA, Santos IS. Anaemia and its causes at the Brazilian Longitudinal Study of Adult Health: a cross-sectional analysis of baseline data. Fam Pract 2023:cmad102. [PMID: 37951231 DOI: 10.1093/fampra/cmad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Most anaemia studies focus on children and women of childbearing age. We assessed the frequency and main aetiologies of anaemia according to sociodemographic characteristics at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort of middle-aged adults. METHODS The primary analyses included 15,051 participants aged 35-74 years with a valid blood cell count. We built logistic models to analyse the association between socioeconomic characteristics and anaemia diagnosis. We also described the main aetiologies in a subset (n = 209) of participants with anaemia. RESULTS Anaemia was present in 3.0% (95% confidence interval [95%CI]: 2.6-3.4%) of men and 7.4% (95%CI: 6.9-8.0%) of women. The frequency of anaemia diagnosis was higher in women in all subgroups except for the oldest age stratum (65-74 years). The frequency of anaemia was particularly high in Blacks (6.0% and 15.5% in men and women, respectively). The most common causes of anaemia were iron deficiency (in women), chronic kidney disease, and chronic inflammation (in men). The frequency of unexplained anaemia was respectively 33.3% and 34.2% for men and women, and this condition was more frequent among participants of Black or Mixed races. CONCLUSIONS Anaemia was associated with age, female sex, Black race, and low socioeconomic status. Unexplained anaemia was common and more frequent in individuals of Black and Mixed races. ELSA-Brasil follow-up data may provide further insight into the relevance of unexplained anaemia in this setting.
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Affiliation(s)
- Cássia S S Silva
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil
| | - Isabela M Bensenor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alessandra C Goulart
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil
- Departamento de Epidemiologia, Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Itamar S Santos
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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8
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Graham FJ, Friday JM, Pellicori P, Greenlaw N, Cleland JG. Assessment of haemoglobin and serum markers of iron deficiency in people with cardiovascular disease. Heart 2023; 109:1294-1301. [PMID: 37130747 PMCID: PMC10423540 DOI: 10.1136/heartjnl-2022-322145] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/07/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND The prevalence of anaemia and iron deficiency and their prognostic association with cardiovascular disease have rarely been explored at population level. METHODS National Health Service records of the Greater Glasgow region for patients aged ≥50 years with a broad range of cardiovascular diagnoses were obtained. During 2013/14, prevalent disease was identified and results of investigations collated. Anaemia was defined as haemoglobin <13 g/dL for men or <12 g/dL for women. Incident heart failure, cancer and death between 2015 and 2018 were identified. RESULTS The 2013/14 dataset comprised 197 152 patients, including 14 335 (7%) with heart failure. Most (78%) patients had haemoglobin measured, especially those with heart failure (90%). Of those tested, anaemia was common both in patients without (29%) and with heart failure (prevalent cases in 2013/14: 46%; incident cases during 2013/14: 57%). Ferritin was usually measured only when haemoglobin was markedly depressed; transferrin saturation (TSAT) even less often. Incidence rates for heart failure and cancer during 2015-18 were inversely related to nadir haemoglobin in 2013/14. A haemoglobin of 13-15 g/dL for women and 14-16 g/dL for men was associated with the lowest mortality. Low ferritin was associated with a better prognosis and low TSAT with a worse prognosis. CONCLUSION In patients with a broad range of cardiovascular disorders, haemoglobin is often measured but, unless anaemia is severe, markers of iron deficiency are usually not. Low haemoglobin and TSAT, but not low ferritin, are associated with a worse prognosis. The nadir of risk occurs at haemoglobin 1-3 g/dL above the WHO definition of anaemia.
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Affiliation(s)
- Fraser J Graham
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK
| | - Jocelyn M Friday
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK
| | - John Gf Cleland
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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9
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Shalini T, Pullakhandam R, Ghosh S, Kulkarni B, Rajkumar H, Sachdev HS, Kurpad AV, Reddy GB. Prevalence of Vitamin B 12 and Folate Deficiencies in Indian Children and Adolescents. Nutrients 2023; 15:3026. [PMID: 37447351 DOI: 10.3390/nu15133026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Deficiencies of vitamin B12 (B12) and folate (FA) are of particular interest due to their pleiotropic role in 1-carbon metabolism. In addition to adverse birth outcomes, deficiencies of B12 and FA, or an imbalance in FA/B12 status, are linked to metabolic disorders. Indian diets that are predominantly plant food-based could be deficient in these vitamins, but there are no national estimates of the prevalence of B12 and FA deficiency in Indian children and adolescents, nor their associations with age, sex and growth indicators. The recent Comprehensive National Nutrition Survey (CNNS-2016-18) provided estimates of the prevalence of B12 and FA deficiency at the national and state levels among preschool (1-4 years: 9976 and 11,004 children, respectively), school-age children (5-9 years: 12,156 and 14,125) and adolescents (10-19 years: 11,748 and 13,621). Serum B12 and erythrocyte FA were measured by the direct chemiluminescence method and their deficiency was defined using WHO cut-offs. The prevalence of B12 and FA deficiency was high among adolescents (31.0%, CI: 28.7-33.5 and 35.6%, CI: 33.1-8.2) compared to school-age (17.3%, CI: 15.4-19.3 and 27.6%, CI: 25.5-29.9) and preschool children (13.8%, CI: 11.7-16.2 and 22.8%, CI: 20.5-25.2, respectively). The prevalence of both B12 and FA deficiency was significantly higher by 8% and 5%, respectively, in adolescent boys compared to girls. There was no association between anthropometric undernutrition and B12 and FA deficiency. There was wide regional variation in the prevalence of B12 and FA deficiency, but no rural-urban differences were observed across all age groups. The national prevalence of B12 deficiency among preschool or school-age children was <20% (the cut-off that indicates a public health problem). However, FA deficiency in these age groups and both FA and B12 deficiencies in adolescents were >20%, warranting further investigation.
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Affiliation(s)
- Tattari Shalini
- National Institute of Nutrition, Jamai-Osmania, Tarnaka, Hyderabad 500007, India
| | - Raghu Pullakhandam
- National Institute of Nutrition, Jamai-Osmania, Tarnaka, Hyderabad 500007, India
| | - Santu Ghosh
- St. John's Medical College, Bangalore 560034, India
| | - Bharati Kulkarni
- National Institute of Nutrition, Jamai-Osmania, Tarnaka, Hyderabad 500007, India
| | - Hemalatha Rajkumar
- National Institute of Nutrition, Jamai-Osmania, Tarnaka, Hyderabad 500007, India
| | - Harshpal S Sachdev
- Sitaram Bhartia Institute of Science and Research, New Delhi 110016, India
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10
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Sahoo J, Mohanty S, Gupta S, Panigrahi SK, Mohanty S, Prasad D, Epari V. Prevalence and Risk Factors of Iron Deficiency Anemia among the Tribal Residential Adolescent School Students of Odisha: A Cross-Sectional Study. Indian J Community Med 2023; 48:562-566. [PMID: 37662116 PMCID: PMC10470574 DOI: 10.4103/ijcm.ijcm_453_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 04/26/2023] [Indexed: 09/05/2023] Open
Abstract
Background Globally, anemia is one of the biggest public health challenges. The highest prevalence of anemia is seen among adolescents. Tribal communities are especially at a disadvantage, with several studies documenting a high prevalence of anemia among tribal adolescents. We investigated the prevalence of anemia and its associated risk factors among the tribal residential adolescent school students in Odisha. Material and Methods In a cross-sectional survey, the prevalence of anemia was estimated by spectrophotometry among adolescents of residential schools in three predominantly tribal districts of Odisha. The severity of anemia was defined as per the World Health Organization classification for adolescents. Results The mean age of 953 subjects was 13.07 ± 1.48 years. The prevalence of anemia was found to be 37.3%. As per the World Health Organization classification, 19.9% had mild anemia, 16.3% had moderate, and 1% had severe anemia. Consumption of Iron Folic Acid (IFA) was associated with the level of hemoglobin at a statistically significant level. Conclusion We found that the prevalence of anemia was lower than in similar studies conducted in other parts of the country. Despite poor coverage of beneficiaries with iron and folic acid at the national level, our study showed better compliance and was associated with a significantly higher level of hemoglobin among those who consumed IFA.
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Affiliation(s)
- Jyotiranjan Sahoo
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Smaraki Mohanty
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Sandhya Gupta
- Department of Physiology, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Sandeep K. Panigrahi
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Sambedana Mohanty
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | | | - Venkatarao Epari
- Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
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Odo DB, Yang IA, Dey S, Hammer MS, van Donkelaar A, Martin RV, Dong GH, Yang BY, Hystad P, Knibbs LD. A cross-sectional analysis of ambient fine particulate matter (PM 2.5) exposure and haemoglobin levels in children aged under 5 years living in 36 countries. ENVIRONMENTAL RESEARCH 2023; 227:115734. [PMID: 36963710 DOI: 10.1016/j.envres.2023.115734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/23/2023] [Accepted: 03/20/2023] [Indexed: 05/08/2023]
Abstract
Low haemoglobin (Hb) concentrations and anaemia in children have adverse effects on development and functioning, some of which may have consequences in later life. Exposure to ambient air pollution is reported to be associated with anaemia, but there is little evidence specific to low- and middle-income countries (LMICs), where childhood anaemia prevalence is greatest. We aimed to determine if long-term ambient fine particulate matter (≤2.5 μm in aerodynamic diameter [PM2.5]) exposure was associated with Hb levels and the prevalence of anaemia in children aged <5 years living in 36 LMICs. We used Demographic and Health Survey data, collected between 2010 and 2019, which included blood Hb measurements. Satellite-derived estimates of annual average PM2.5 was the main exposure variable, which was linked to children's area of residence. Anaemia was defined according to standard World Health Organization guidelines (Hb < 11 g/dL). The association of PM2.5 with Hb levels and anaemia prevalence was examined using multivariable linear and logistic regression models, respectively. We examined whether the effects of ambient PM2.5 were modified by a child's sex and age, household wealth index, and urban/rural place of residence. Models were adjusted for relevant covariates, including other outdoor pollutants and household cooking fuel. The study included 154,443 children, of which 89,904 (58.2%) were anaemic. The country-level prevalence of anaemia ranged from 15.8% to 87.9%. Mean PM2.5 exposure was 33.0 (±21.6) μg/m3. The adjusted model showed that a 10 μg/m3 increase in annual PM2.5 concentration was associated with greater odds of anaemia (OR = 1.098 95% CI: 1.087, 1.109). The same increase in PM2.5 was associated with a decrease in average Hb levels of 0.075 g/dL (95% CI: 0.081, 0.068). There was evidence of effect modification by household wealth index and place of residence, with greater adverse effects in children from lower wealth quintiles and children in rural areas. Exposure to annual PM2.5 was cross-sectionally associated with decreased blood Hb levels, and greater risk of anaemia, in children aged <5 years living in 36 LMICs.
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Affiliation(s)
- Daniel B Odo
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia; College of Health Sciences, Arsi University, Asela, Ethiopia.
| | - Ian A Yang
- Thoracic Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia; UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sagnik Dey
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India; Arun Duggal Centre of Excellence for Research in Climate Change and Air Pollution, Indian Institute of Technology Delhi, New Delhi, India
| | - Melanie S Hammer
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Aaron van Donkelaar
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Randall V Martin
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, USA
| | - Luke D Knibbs
- School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia; Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, NSW, 2050, Australia
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Zheng Y, Liu X, He Y, Yuchi Y, Zhao H, Li L, Huo W, Mao Z, Hou J, Wang C. Prevalence and morphological subtype distributions of anaemia in a Chinese rural population: the Henan Rural Cohort study. Public Health Nutr 2023; 26:1254-1263. [PMID: 36788680 PMCID: PMC10346018 DOI: 10.1017/s1368980023000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 12/12/2022] [Accepted: 01/27/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE This study aimed to evaluate the recent prevalence and the distributions of morphological subtypes of anaemia in the rural population. DESIGN Anaemia was defined according to the WHO and the Chinese criteria, and the morphological subtypes of anaemia were classified based on the erythrocyte parameters. The age-standardised prevalence was calculated according to the data of the Population Census 2010 in China. SETTING A cross-sectional study in Henan Province. PARTICIPANTS 33 585 subjects aged 18-79 years old. RESULTS The standardised prevalence of anaemia across the WHO and the Chinese definitions was 13·63 % and 5·45 %, respectively. Regardless of which criteria was used, the standardised prevalence of anaemia was higher among women than among men and that increased with age in men, while markedly decreased after menopause in women. There were shifts in morphological patterns of anaemia using the WHO and the Chinese criteria that the standardised prevalence of microcytic anaemia was 3·74 % and 2·97 %, normocytic anaemia was 9·20 % and 2·34 %, and macrocytic anaemia was 0·75 % and 0·14 %, respectively. Besides, there were differences in the influencing factors of anaemia according to different criteria or gender. However, age, education level and renal damage were consistently significantly associated with anaemia in all participants. CONCLUSIONS Anaemia may still be a serious health problem in rural China. It is necessary to reformulate prevention and management strategies to reduce the disease burden of anaemia.
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Affiliation(s)
- Yiquan Zheng
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
| | - Yaling He
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
| | - Yinghao Yuchi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
| | - Hongfei Zhao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
| | - Linlin Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
| | - Wenqian Huo
- Department of Occupational and Environmental Health Sciences, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan450001, People’s Republic of China
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Braat S, Fielding K, Han J, Jackson VE, Zaloumis S, Xu JXH, Moir-Meyer G, Blaauwendraad SM, Jaddoe VWV, Gaillard R, Parkin PC, Borkhoff CM, Keown-Stoneman CDG, Birken CS, Maguire JL, Bahlo M, Davidson E, Pasricha SR. Statistical haemoglobin thresholds to define anaemia across the lifecycle. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.22.23290129. [PMID: 37292786 PMCID: PMC10246131 DOI: 10.1101/2023.05.22.23290129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Detection of anaemia is critical for clinical medicine and public health. Current WHO values that define anaemia are statistical thresholds (5 th centile) set over 50 years ago, and are presently <110g/L in children 6-59 months, <115g/L in children 5-11 years, <110g/L in pregnant women, <120g/L in children 12-14 years of age, <120g/L in non-pregnant women, and <130g/L in men. Haemoglobin is sensitive to iron and other nutrient deficiencies, medical illness and inflammation, and is impacted by genetic conditions; thus, careful exclusion of these conditions is crucial to obtain a healthy reference population. We identified data sources from which sufficient clinical and laboratory information was available to determine an apparently healthy reference sample. Individuals were excluded if they had any clinical or biochemical evidence of a condition that may diminish haemoglobin concentration. Discrete 5 th centiles were estimated along with two-sided 90% confidence intervals and estimates combined using a fixed-effect approach. Estimates for the 5 th centile of the healthy reference population in children were similar between sexes. Thresholds in children 6-23 months were 104.4g/L [90% CI 103.5, 105.3]; in children 24-59 months were 110.2g/L [109.5, 110.9]; and in children 5-11 years were 114.1g/L [113.2, 115.0]. Thresholds diverged by sex in adolescents and adults. In females and males 12-17 years, thresholds were 122.2g/L [121.3, 123.1] and 128.2 [126.4, 130.0], respectively. In adults 18-65 years, thresholds were 119.7g/L [119.1, 120.3] in non-pregnant females and 134.9g/L [134.2, 135.6] in males. Limited analyses indicated 5 th centiles in first-trimester pregnancy of 110.3g/L [109.5, 111.0] and 105.9g/L [104.0, 107.7] in the second trimester. All thresholds were robust to variations in definitions and analysis models. Using multiple datasets comprising Asian, African, and European ancestries, we did not identify novel high prevalence genetic variants that influence haemoglobin concentration, other than variants in genes known to cause important clinical disease, suggesting non-clinical genetic factors do not influence the 5 th centile between ancestries. Our results directly inform WHO guideline development and provide a platform for global harmonisation of laboratory, clinical and public health haemoglobin thresholds.
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Ghosal J, Bal M, Ranjit M, Das A, Behera MR, Satpathy SK, Dutta A, Pati S. To what extent classic socio-economic determinants explain trends of anaemia in tribal and non-tribal women of reproductive age in India? Findings from four National Family Heath Surveys (1998-2021). BMC Public Health 2023; 23:856. [PMID: 37170116 PMCID: PMC10172723 DOI: 10.1186/s12889-023-15838-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/06/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Despite unprecedented socio-economic growth experienced by Indians in the past few decades, and a long history of anti-anaemia public health measures, prevalence of anaemia in Indian non-pregnant women of reproductive age group (NPWRA) has not declined. This warrants a firm understanding of what explains the anaemia situation over time, preferably by sub-populations. Therefore, we aimed to examine the trends of anaemia in tribal NPWRA (least privileged) and compare with the trends in the NPWRA of general caste (most privileged) between 1998 to 2021. Additionally, the study also explored explanation of any decline and tribal/general narrowing of these trends. METHODS We studied four rounds of National Family Health Survey (1998-99, 2005-06, 2015-16, 2019-21). We examined the trend of anaemia (haemoglobin < 12 g/dl) and its possible determinants in tribal and general NPWRA and estimated the portion of "decline" and "narrowing" that could be explained by the underlying and intermediate determinants (wealth, education, residence, parity and food security) using multiple logistic regression. RESULTS The distribution of determinants improved over 23 years in both the groups but more in tribals. But anaemia either remained unchanged or increased in both except 7.1 points decline in tribals between 2006-2016, leading also to 7 points narrowing of tribal/general gap. The modest attenuation of beta coefficients representing the change of anaemia prevalence (log of odds) in tribals from -0.314(-0.377, -0.251) to -0.242(-0.308, -0.176) after adjustment with determinants could explain only 23% of the decline. Similarly, only 7% of the narrowing of the tribal/general anaemia gap could be explained. CONCLUSIONS The structural determinants wealth, education, food security, parity and urban amenities improved immensely in India but anaemia did not decline in this 23-year period. This implies that the "usual suspects" - the structural determinants are not the main drivers of anaemia in the country. The main driver may be absolute and/or functional deficiency status of micronutrients including iron attributable to inadequate uptake and absorption of these elements from Indian diets; and therefore, their effects are noticeable in every socio-economic stratum of India. Future research for aetiologies and new interventions for anaemia alleviation in India may focus on these factors.
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Affiliation(s)
- Jyoti Ghosal
- School of Public Health, KIIT Deemed to be University, Bhubaneswar, Odisha, India
- ICMR-Regional Medical Research Center, Odisha, Bhubaneswar, India
| | - Madhusmita Bal
- ICMR-Regional Medical Research Center, Odisha, Bhubaneswar, India
| | | | - Arundhuti Das
- ICMR-Regional Medical Research Center, Odisha, Bhubaneswar, India
| | - Manas Ranjan Behera
- School of Public Health, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | | | - Ambarish Dutta
- Indian Institute of Public Health, Public Health Foundation of India, Odisha, Bhubaneswar, India.
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Center, Odisha, Bhubaneswar, India.
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15
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Kurpad AV, Sachdev HS. Balance and Threats of Mandatory Micronutrient Fortification of Foods in India. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:73-75. [PMID: 38692592 DOI: 10.25259/nmji_148_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Affiliation(s)
- Anura Viswanath Kurpad
- Department of Physiology, St John's Medical College, Sarjapur Road, Bengaluru, Karnataka, India
| | - Harshpal Singh Sachdev
- Department of Paediatrics, Sitaram Bhartia Institute of Health and Research, B-16, Qutab Institutional Area, New Delhi, India
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Abstract
Despite several efforts by the Government of India, the national burden of anaemia remains high and its growing prevalence (between 2015-2016 and 2019-2021) is concerning to India's public health system. This article reviews existing food-based and clinical strategies to mitigate the anaemia burden and why they are premature and insufficient. In a context where multiple anaemia control programmes are in play, this article proposes a threefold strategy for consideration. First, except the Comprehensive National Nutrition Survey, 2016-2018, which measured Hb concentration among children and adolescents aged 1-19 years using venous blood samples, all national surveys use capillary blood samples to determine Hb levels, which could be erroneous. The Indian government should prioritise conducting a nationwide survey for estimating the burden of anaemia and its clinical determinants for all age groups using venous blood samples. Second, without deciding the appropriate dose of Fe needed for an individual, food fortification programmes that are often compounded with layering of other micronutrients could be harmful and further research on this issue is needed. Same is true for the pharmacological intervention of Fe tablet or syrup supplementation programmes, which is given to individuals without assessing its need. In addition, there is a dire need for robust research to understand both the long-term benefit and side effects of Fe supplementation programmes. Third and final, the WHO is in process of reviewing the Hb threshold for defining anaemia, therefore the introduction of new anaemia control programmes should be restrained.
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Su F, Cao L, Ren X, Hu J, Tavengana G, Wu H, Zhou Y, Fu Y, Jiang M, Wen Y. Age and sex trend differences in hemoglobin levels in China: a cross-sectional study. BMC Endocr Disord 2023; 23:8. [PMID: 36624464 PMCID: PMC9827637 DOI: 10.1186/s12902-022-01218-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/15/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Both age and gender are the influence factors of hemoglobin concentration. However, the changing trend of hemoglobin levels between males and females with age remains unclear. This study aimed to explore their changing characteristics in different genders. METHODS A cross-sectional study was conducted in Physical Examination Center of the First Affiliated Hospital of Wannan Medical College in Wuhu, China from 2014 to 2016. The generalized linear model was applied to explore the relationship between age, gender and hemoglobin levels. RESULTS Among the 303,084 participants, the mean age for females and males was 46.9 ± 13.4(15-98) and 48.1 ± 13.7(14-98) years old, respectively. Generalized smoothing splines showed that hemoglobin levels increased up to age 25 and then decreased in men; in women the levels increased up until age 20, and then decreased, with slight increase again (β = 0.244, P < 0.01). After dividing all participants into hyperglycemia and normal groups, only the normal female group showed a significant upward trend (β = 0.257, P < 0.01) between ages 50-59. CONCLUSIONS Hemoglobin concentration changes with age and the curve is different in males and females. The slightly upward trend of female hemoglobin in the age range of 50-59 years old should be considered in developing the reference range of hemoglobin making.
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Affiliation(s)
- Fan Su
- School of Public Health, Wannan Medical College, Anhui Province, No.22, Wenchang Xi Road, Wuhu, 241002, China
| | - Lei Cao
- School of Public Health, Wannan Medical College, Anhui Province, No.22, Wenchang Xi Road, Wuhu, 241002, China
| | - Xia Ren
- School of Public Health, Wannan Medical College, Anhui Province, No.22, Wenchang Xi Road, Wuhu, 241002, China
| | - Jian Hu
- School of Public Health, Wannan Medical College, Anhui Province, No.22, Wenchang Xi Road, Wuhu, 241002, China
| | - Grace Tavengana
- School of Public Health, Wannan Medical College, Anhui Province, No.22, Wenchang Xi Road, Wuhu, 241002, China
| | - Huan Wu
- School of Laboratory Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Yumei Zhou
- School of Public Health, Wannan Medical College, Anhui Province, No.22, Wenchang Xi Road, Wuhu, 241002, China
| | - Yuhan Fu
- School of Public Health, Wannan Medical College, Anhui Province, No.22, Wenchang Xi Road, Wuhu, 241002, China
| | - Mingfei Jiang
- School of Clinical Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Yufeng Wen
- School of Public Health, Wannan Medical College, Anhui Province, No.22, Wenchang Xi Road, Wuhu, 241002, China.
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18
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Sneak-peek into iron deficiency anemia in India: The need for food-based interventions and enhancing iron bioavailability. Food Res Int 2022; 162:111927. [DOI: 10.1016/j.foodres.2022.111927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 11/22/2022]
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Kassem E, Na’amnih W, Shapira M, Ornoy A, Muhsen K. Comparison between School-Age Children with and without Obesity in Nutritional and Inflammation Biomarkers. J Clin Med 2022; 11:jcm11236973. [PMID: 36498548 PMCID: PMC9739253 DOI: 10.3390/jcm11236973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/20/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Childhood obesity is a major health problem. We examined differences between children with obesity and normal weight in nutritional and inflammation biomarkers. A cross-sectional study was conducted among healthy children aged 10-12 years from Arab villages in Israel. Parents were interviewed regarding sociodemographic and children's health status. Body weight and height measurements were performed and weight categories were defined using the 2007 WHO growth curves. Blood samples were tested for complete blood count, levels of iron, ferritin, lipids, uric acid, and C-reactive protein (CRP). Overall, 146 children (59.0% males, mean age = 11.3 [SD = 0.5]) were enrolled. In total 43.8%, 14.1% and 42.3% of the participants had normal weight, overweight and obesity, respectively. A multivariable logistic regression model showed that children with overweight and obesity had lower iron, and HDL-C levels than children with normal weight. Levels of CRP, uric acid, LDL-C and lymphocytes were higher among children with overweight and obesity. In conclusion, our findings highlight the worse metabolic and nutritional status in overweight and obese children. Such markers play a role in metabolic syndrome, thus suggesting that metabolic syndrome might start in childhood.
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Affiliation(s)
- Eias Kassem
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera 3810101, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
| | - Wasef Na’amnih
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Maanit Shapira
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
- Laboratory Division, Hillel Yaffe Medical Center, Hadera 3810101, Israel
| | - Asher Ornoy
- Adelson School of Medicine, Ariel University, Ariel 4077625, Israel
- Laboratory of Teratology, Department of Medical Neurobiology, The Hebrew University Hadassah Medical School, Jerusalem 9112002, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-3-6405945
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Chao DL, Oron AP, Chabot-Couture G, Sopekan A, Nnebe-Agumadu U, Bates I, Piel FB, Nnodu O. Contribution of malaria and sickle cell disease to anaemia among children aged 6-59 months in Nigeria: a cross-sectional study using data from the 2018 Demographic and Health Survey. BMJ Open 2022; 12:e063369. [PMID: 36385021 PMCID: PMC9670918 DOI: 10.1136/bmjopen-2022-063369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To estimate the fraction of anaemia attributable to malaria and sickle cell disease (SCD) among children aged 6-59 months in Nigeria. DESIGN Cross-sectional analysis of data from Nigeria's 2018 Demographic and Health Survey (DHS). SETTING Nigeria. PARTICIPANTS 11 536 children aged 6-59 months from randomly selected households were eligible for participation, of whom 11 142 had complete and valid biomarker data required for this analysis. Maternal education data were available from 10 305 of these children. PRIMARY OUTCOME MEASURE Haemoglobin concentration. RESULTS We found that 70.6% (95% CI: 62.7% to 78.5%) of severe anaemia was attributable to malaria compared with 12.4% (95% CI: 11.1% to 13.7%) of mild-to-severe and 29.6% (95% CI: 29.6% to 31.8%) of moderate-to-severe anaemia and that SCD contributed 0.6% (95% CI: 0.4% to 0.9%), 1.3% (95% CI: 1.0% to 1.7%) and 10.6% (95% CI: 6.7% to 14.9%) mild-to-severe, moderate-to-severe and severe anaemia, respectively. Sickle trait was protective against anaemia and was associated with higher haemoglobin concentration compared with children with normal haemoglobin (HbAA) among malaria-positive but not malaria-negative children. CONCLUSIONS This approach used offers a new tool to estimate the contribution of malaria to anaemia in many settings using widely available DHS data. The fraction of anaemia among young children in Nigeria attributable to malaria and SCD is higher at more severe levels of anaemia. Prevention of malaria and SCD and timely treatment of affected individuals would reduce cases of severe anaemia.
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Affiliation(s)
- Dennis L Chao
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Assaf P Oron
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | | | - Alayo Sopekan
- Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Uche Nnebe-Agumadu
- Department of Paediatrics, University of Abuja College of Health Sciences, Abuja, Nigeria
| | - Imelda Bates
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Frédéric B Piel
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Obiageli Nnodu
- Centre of Excellence for Sickle Cell Disease Research & Training (CESRTA), University of Abuja, Abuja, Nigeria
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Kurpad AV, Sachdev HS. Childhood and Adolescent Anemia Burden in India: The Way Forward. Indian Pediatr 2022; 59:837-840. [PMID: 36036186 PMCID: PMC9748895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The burden of anemia in Indian children, based on capillary blood sampling, is believed to be profound and worsening (67.1%) according to the successive National Family Health Surveys (NFHS). This might be an overestimate. The recent Comprehensive National Nutrition Survey of Indian children, that used venous blood sampling, found only less than half (30.7%) the NFHS prevalence, of which only one third was due to iron deficiency (ID). Unfortunately, the apparently worsening NFHS anemia burden estimate has been interpreted as an inadequacy of the present iron supplementation policy. This has led to additional iron supply through mandatory rice fortification. However, the lack of efficacy of iron supplementation appears inevitable, if the true prevalence of iron deficiency anemia is only about 10%. Thus, etiology is a critical consideration when devising appropriate and effective prevention policies. Future policies must focus on precision, thoughtfulness, restraint, and community engagement.
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Affiliation(s)
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi. Correspondence to: Prof Harshpal Singh Sachdev, Senior Consultant Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi 110 016.
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22
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Arora EK, Sharma V. Iron metabolism: pathways and proteins in homeostasis. REV INORG CHEM 2022. [DOI: 10.1515/revic-2022-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Iron is essential to human survival. The biological role and trafficking of this trace essential inorganic element which is also a potential toxin is constantly being researched and unfolded. Vital for oxygen transport, DNA synthesis, electron transport, neurotransmitter biosynthesis and present in numerous other heme and non-heme enzymes the physiological roles are immense. Understanding the molecules and pathways that regulate this essential element at systemic and cellular levels are of importance in improving therapeutic strategies for iron related disorders. This review highlights the progress in understanding the metabolism and trafficking of iron along with the pathophysiology of iron related disorders.
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Affiliation(s)
- Ekta Kundra Arora
- Chemistry Department, St. Stephen’s College , University of Delhi , Delhi 110007 , India
| | - Vibha Sharma
- Chemistry Department, St. Stephen’s College , University of Delhi , Delhi 110007 , India
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Scott S, Lahiri A, Sethi V, de Wagt A, Menon P, Yadav K, Varghese M, Joe W, Vir SC, Nguyen PH. Anaemia in Indians aged 10–19 years: Prevalence, burden and associated factors at national and regional levels. MATERNAL & CHILD NUTRITION 2022; 18:e13391. [PMID: 35719126 PMCID: PMC9480897 DOI: 10.1111/mcn.13391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Samuel Scott
- International Food Policy Research Institute New Delhi India
| | - Anwesha Lahiri
- MRC Epidemiology Unit, Institute of Metabolic Science University of Cambridge School of Clinical Medicine Cambridge UK
- Population Research Centre, Institute of Economic Growth New Delhi India
| | - Vani Sethi
- Nutrition Division, UNICEF New Delhi India
| | | | - Purnima Menon
- International Food Policy Research Institute New Delhi India
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences New Delhi India
| | | | - William Joe
- Population Research Centre, Institute of Economic Growth New Delhi India
| | - Sheila C. Vir
- Public Health Nutrition and Development Centre New Delhi India
| | - Phuong Hong Nguyen
- International Food Policy Research Institute Washington District of Columbia USA
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Chandra J, Dewan P, Kumar P, Mahajan A, Singh P, Dhingra B, Radhakrishnan N, Sharma R, Manglani M, Rawat AK, Gupta P, Gomber S, Bhat S, Gaikwad P, Elizabeth KE, Bansal D, Dubey AP, Shah N, Kini P, Trehan A, Datta K, Basavraja GV, Saxena V, Kumar RR. Diagnosis, Treatment and Prevention of Nutritional Anemia in Children: Recommendations of the Joint Committee of Pediatric Hematology-Oncology Chapter and Pediatric and Adolescent Nutrition Society of the Indian Academy of Pediatrics. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2622-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ghosh S, Kurpad AV, Sachdev HS, Thomas T. A risk-based approach to measuring population micronutrient status from blood biomarker concentrations. Front Nutr 2022; 9:991707. [PMID: 36225864 PMCID: PMC9548994 DOI: 10.3389/fnut.2022.991707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Nutrient biomarkers and their definitive cut-offs are used to classify individuals as nutrient-deficient or sufficient. This determinism does not consider any uncertainty, and a probability approach, using biomarker distributions, is then preferable to define the risk of nutrition deficiency when in populations. Method Healthy 1–19-year-old children and adolescents were selected from the Comprehensive National Nutrition Survey (CNNS), to obtain probability distributions of their retinol, zinc and vitamin B12, along with erythrocyte folate. Model-based estimates of location, scale and shape parameters of these distributions were obtained across ages. Subsequently, in the entire sample of 1–19 year old children of CNNS, the population risk of deficiency (PRD) which is average risk of deficiency in individuals in the population was computed, which is “of concern” when >50%. When individual risk of deficiency is >97.5% it is called “severe risk of deficiency” (SRD). Results In the entire CNNS sample, the PRD of concern was low for serum retinol (3.6–8.2%), zinc (0–5.5%), and SRD of vitamin B12 and erythrocyte folate were 2.3–7.2% and 4.2–9.7%, respectively, across age and sex groups. Conclusion This proposed method assesses the adequacy of nutrient exposures without relying on pre-defined deterministic biomarker cut-offs to define micronutrient deficiency and avoids errors in exposure assessment.
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Affiliation(s)
- Santu Ghosh
- Department of Biostatistics, St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, India
| | - Anura V. Kurpad
- Department of Physiology, St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, India
| | - Harshpal S. Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Tinku Thomas
- Department of Biostatistics, St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, India
- *Correspondence: Tinku Thomas
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26
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Ghosh S, Thomas T, Pullakhandam R, Nair KM, Sachdev HS, Kurpad AV. A proposed method for defining the required fortification level of micronutrients in foods: An example using iron. Eur J Clin Nutr 2022; 77:436-446. [PMID: 36076065 DOI: 10.1038/s41430-022-01204-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/09/2022]
Abstract
In 2006, the WHO published a framework for calculating the desired level of fortification of any micronutrient in any staple food vehicle, to reduce micronutrient malnutrition. This framework set the target median nutrient intake, of the population consuming the fortified food, at the 97.5th percentile of their nutrient requirement distribution; the Probability of Inadequacy (PIA) of the nutrient would then be 2.5%. We argue here that the targeted median nutrient intake should be at Estimated Average Requirement (50th percentile), since the intake distribution will then overlap the requirement distribution in a population that is in homeostasis, resulting in a PIA of 50%. It is also important to recognize that setting the target PIA at 2.5% may put a sizable proportion at risk of adverse consequences associated with exceeding the tolerable upper limit (TUL) of intake. This is a critical departure from the WHO framework. For a population with different age- and sex-groups, the pragmatic way to fix the fortification level for a staple food vehicle is by achieving a target PIA of 50% in the most deprived age- or sex-group of that population, subject to the condition that only a very small proportion of intakes exceed the TUL. The methods described here will aid precision in public health nutrition, to pragmatically determine the precise fortification level of a nutrient in a food vehicle, while balancing risks of inadequacy and excess intake.
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Affiliation(s)
- Santu Ghosh
- Department of Biostatistics, St John's Medical College, Bengaluru, India
| | - Tinku Thomas
- Department of Biostatistics, St John's Medical College, Bengaluru, India
| | - Raghu Pullakhandam
- Drug Safety Division, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - Krishnapillai Madhavan Nair
- Former Senior Scientist, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - Harshpal S Sachdev
- Senior Consultant Paediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India.
| | - Anura V Kurpad
- Department of Physiology, St John's Medical College, Bengaluru, India.
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Pullakhandam R, Ghosh S, Kulkarni B, Reddy GB, Rajkumar H, Kapil U, Deb S, Kurpad AV, Sachdev HS. Reference cut-offs to define low serum zinc concentrations in healthy 1-19 year old Indian children and adolescents. Eur J Clin Nutr 2022; 76:1150-1157. [PMID: 35140314 DOI: 10.1038/s41430-022-01088-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVES Population zinc (Zn) status assessment is based on serum zinc concentration (SZC) cut-offs defined by the International Zinc Nutrition Consultative Group (IZiNCG). The objective of this study is to derive reference SZC cut-offs in apparently healthy 1-19 year Indian children and adolescents using comprehensive national nutrition survey (CNNS) data, and to measure the prevalence of Zn deficiency. SUBJECTS/METHODS Apparently healthy children (n = 12,473) were selected from the CNNS, by including the highest 2 wealth quintiles, and excluding stunted, thin and obese children, and those with CRP > 5 mg/L, anaemia, hypo-albuminemia, diabetes, recent diarrhoea and history of smoking. The 2.5th centile of age-based distributions defined the SZC cut-offs, used to measure the prevalence of Zn deficiency in India, as against the IZiNCG cut-offs. RESULTS The present study SZC cut-offs were significantly lower, by 10-18 µg/dL, than the IZiNCG cut-offs; more in adolescents. Prevalence of Zn deficiency in the entire CNNS, with these cut-offs, was 2.7 (<10 years) to 5.5 (10-19 years) times lower than with the IZiNCG cut-offs. No geographical state, nor any age group, had Zn deficiency as a serious public health problem (≥20%). In contrast, with IZiNCG cut-offs, 9-27 states (depending on age group) had a public health problem. CONCLUSIONS The present study reference SZC cut-offs for Zn deficiency are lower than the IZiNCG cut-offs, and their rigorous selection from a national sample makes them more appropriate for use in India. A re-examination of the global applicability of IZiNCG recommended cut-offs in other LMICs appears appropriate.
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Affiliation(s)
- Raghu Pullakhandam
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | | | - Bharati Kulkarni
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - G Bhanuprakash Reddy
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - Hemalatha Rajkumar
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India
| | - Umesh Kapil
- Institute of Liver and Biliary Sciences, New Delhi, India
| | - Sila Deb
- Ministry of Health and Family Welfare, New Delhi, India
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28
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Response to Comments from Brown et al. (ref: 2021EJCN0980RR). Eur J Clin Nutr 2022; 76:1206-1207. [PMID: 35817883 DOI: 10.1038/s41430-022-01162-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 11/08/2022]
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Chaudhary V, Saraswathy KN, Sarwal R. Dietary diversity as a sustainable approach towards micronutrient deficiencies in India. Indian J Med Res 2022; 156:31-45. [PMID: 36510896 PMCID: PMC9903373 DOI: 10.4103/ijmr.ijmr_3314_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The silent epidemic of micronutrient deficiencies (MNDs) continues to be a major public health challenge in the developing world, including India. The prevalence of iron, iodine, zinc, vitamin A and folate deficiencies is alarmingly high worldwide. India is additionally facing a high prevalence of vitamin D and B12 deficiencies. To combat the hidden epidemic of MNDs, various governments around the world have mostly relied on supplementation or fortification-based interventions. India launched salt iodization programme in 1962 and vitamin A and iron-folate supplementation programmes in 1970. Yet, even after decades of these programmes, MNDs are still widespread in the country. Due to slow progress in alleviating the burden of most MNDs, the Government of India aims to scale up fortification-based intervention programmes. However, there are safety and effectiveness concerns with such approaches. Hence, overdependence on supplementation and fortification alone may be counterproductive. Instead, food based dietary diversification approach can be the way forward. In this article, we list the common MNDs in India, evaluate major policy interventions, discuss concerns pertaining to fortification and suggest the need for a concurrent food-based approach, in particular dietary diversification, as a long-term and sustainable strategy to address population-based MNDs.
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Affiliation(s)
| | | | - Rakesh Sarwal
- National Minorities Development and Finance Corporation, Delhi, India,For correspondence: Dr Rakesh Sarwal, National Minorities Development and Finance Corporation, Delhi 110 092, India e-mail:
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30
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Efficacy of iron-folic acid treatment for reducing anemia prevalence and improving iron status in women of reproductive age: A one-year longitudinal study. Clin Nutr ESPEN 2022; 49:390-397. [DOI: 10.1016/j.clnesp.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 11/18/2022]
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31
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Kurpad AV, Sachdev HS. Childhood and Adolescent Anemia Burden in India: The Way Forward. Indian Pediatr 2022. [PMID: 36036186 PMCID: PMC9748895 DOI: 10.1007/s13312-022-2639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The burden of anemia in Indian children, based on capillary blood sampling, is believed to be profound and worsening (67.1%) according to the successive National Family Health Surveys (NFHS). This might be an overestimate. The recent Comprehensive National Nutrition Survey of Indian children, that used venous blood sampling, found only less than half (30.7%) the NFHS prevalence, of which only one third was due to iron deficiency (ID). Unfortunately, the apparently worsening NFHS anemia burden estimate has been interpreted as an inadequacy of the present iron supplementation policy. This has led to additional iron supply through mandatory rice fortification. However, the lack of efficacy of iron supplementation appears inevitable, if the true prevalence of iron deficiency anemia is only about 10%. Thus, etiology is a critical consideration when devising appropriate and effective prevention policies. Future policies must focus on precision, thoughtfulness, restraint, and community engagement.
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Affiliation(s)
- Anura Viswanath Kurpad
- grid.416432.60000 0004 1770 8558Department of Physiology, St John’s Medical College, Bengaluru, Karnataka India
| | - Harshpal Singh Sachdev
- grid.419277.e0000 0001 0740 0996Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, 110 016 India
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32
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Overview of Anemia; risk factors and solution offering. GACETA SANITARIA 2021; 35 Suppl 2:S235-S241. [PMID: 34929820 DOI: 10.1016/j.gaceta.2021.07.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/30/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The study aims to determine the picture risk factor-related anemia and the solution offered by searching the literature and reviewing it. METHOD using literature studies. Article searches using online data-based Science Direct, PubMed, and Google Scholar from 2019 to 2021. They have obtained as many as 20 articles based on inclusion criteria and relevance. RESULT Anaemia in young women is still a severe problem among the community. There need to be early detection measures to quickly determine the incidence of anemia and describe anemia as one of the information for all circles young women. Women have a higher risk of anemia, especially young women. This is due to strict dietary habits to prevent weight gain, resulting in malnutrition due to the unmet intake of essential nutrients for the body. Whereas in adolescence, there is an increase in iron demand due to growth and menstruation. Therefore it is very important to provide smart solutions to the incidence of anemia. One that is offered is early detection so that prevention can be done. The use of information technology can be used to conduct early detection of anemia in adolescents because it has been widely utilized among the community, especially adolescents. CONCLUSION From the entire literature review, it seems that nutritional status greatly influences the incidence of anemia suffered, and young women are a target for the best intervention. Early detection and use of technology are innovative solutions offered.
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McCollum ED, King C, Ahmed S, Hanif AAM, Roy AD, Islam AA, Colbourn T, Schuh HB, Ginsburg AS, Hooli S, Chowdhury NH, Rizvi SJR, Begum N, Baqui AH, Checkley W. Defining hypoxaemia from pulse oximeter measurements of oxygen saturation in well children at low altitude in Bangladesh: an observational study. BMJ Open Respir Res 2021; 8:8/1/e001023. [PMID: 34728475 PMCID: PMC8565559 DOI: 10.1136/bmjresp-2021-001023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/21/2021] [Indexed: 12/16/2022] Open
Abstract
Background WHO defines hypoxaemia, a low peripheral arterial oxyhaemoglobin saturation (SpO2), as <90%. Although hypoxaemia is an important risk factor for mortality of children with respiratory infections, the optimal SpO2 threshold for defining hypoxaemia is uncertain in low-income and middle-income countries (LMICs). We derived a SpO2 threshold for hypoxaemia from well children in Bangladesh residing at low altitude. Methods We prospectively enrolled well, children aged 3–35 months participating in a pneumococcal vaccine evaluation in Sylhet district, Bangladesh between June and August 2017. Trained health workers conducting community surveillance measured the SpO2 of children using a Masimo Rad-5 pulse oximeter with a wrap sensor. We used standard summary statistics to evaluate the SpO2 distribution, including whether the distribution differed by age or sex. We considered the 2.5th, 5th and 10th percentiles of SpO2 as possible lower thresholds for hypoxaemia. Results Our primary analytical sample included 1470 children (mean age 18.6±9.5 months). Median SpO2 was 98% (IQR 96%–99%), and the 2.5th, 5th and 10th percentile SpO2 was 91%, 92% and 94%. No child had a SpO2 <90%. Children 3–11 months had a lower median SpO2 (97%) than 12–23 months (98%) and 24–35 months (98%) (p=0.039). The SpO2 distribution did not differ by sex (p=0.959). Conclusion A SpO2 threshold for hypoxaemia derived from the 2.5th, 5th or 10th percentile of well children is higher than <90%. If a higher threshold than <90% is adopted into LMIC care algorithms then decision-making using SpO2 must also consider the child’s clinical status to minimise misclassification of well children as hypoxaemic. Younger children in lower altitude LMICs may require a different threshold for hypoxaemia than older children. Evaluating the mortality risk of sick children using higher SpO2 thresholds for hypoxaemia is a key next step.
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Affiliation(s)
- Eric D McCollum
- Global Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA .,Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | - Tim Colbourn
- Global Health Institute, University College London, London, UK
| | - Holly B Schuh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amy Sarah Ginsburg
- Clinical Trial Center, University of Washington, Seattle, Washington, USA
| | - Shubhada Hooli
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Nazma Begum
- Projahnmo Research Foundation, Sylhet, Bangladesh
| | - Abdullah H Baqui
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Kurpad AV, Ghosh S, Thomas T, Bandyopadhyay S, Goswami R, Gupta A, Gupta P, John AT, Kapil U, Kulkarni B, Kuriyan R, Madan J, Makkar S, Nair KM, Pullakhandam R, Reddy GB, Shah D, Sachdev HS. Perspective: When the cure might become the malady: the layering of multiple interventions with mandatory micronutrient fortification of foods in India. Am J Clin Nutr 2021; 114:1261-1266. [PMID: 34320172 DOI: 10.1093/ajcn/nqab245] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/29/2021] [Indexed: 12/24/2022] Open
Abstract
When public health programs with single nutrients are perceived to have a poor impact on the target health outcome, the policy response can be to supply more, by layering additional mandatory programs upon the extant programs. However, we argue for extreme caution, because nutrients (like medicines) are beneficial in the right dose, but potentially harmful when ingested in excess. Unnecessary motivations for the reactionary layering of multiple intervention programs emerge from incorrect measurements of the risk of nutrient inadequacy in the population, or incorrect biomarker cutoffs to evaluate the extent of nutrient deficiencies. The financial and social costs of additional layered programs are not trivial when traded off with other vital programs in a resource-poor economy, and when public health ethical dilemmas of autonomy, equity, and stigma are not addressed. An example of this conundrum in India is the perception of stagnancy in the response of the prevalence of anemia to the ongoing pharmacological iron supplementation program. The reaction has been a policy proposal to further increase iron intake through mandatory iron fortification of the rice provided in supplementary feeding programs like the Integrated Child Development Services and the School Mid-Day Meal. This is in addition to the ongoing pharmacological iron supplementation as well as other voluntary iron fortifications, such as those of salt and manufactured food products. However, before supplying more, it is vital to consider why the existing program is apparently not working, along with consideration of the potential for excess intake and related harms. This is relevant globally, particularly for countries contemplating multiple interventions to address micronutrient deficiencies. Supplying more by layering multiple nutrient interventions, instead of doing it right, without thoughtful considerations of social, biological, and ethics frameworks could be counterproductive. The cure, then, might well become the malady.
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Affiliation(s)
- Anura V Kurpad
- Department of Physiology, St. John's Medical College, St. John's National Academy of Health Sciences, Bengaluru, India.,Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, India
| | - Santu Ghosh
- Department of Biostatistics, St. John's Medical College, St. John's National Academy of Health Sciences, Bengaluru, India
| | - Tinku Thomas
- Department of Biostatistics, St. John's Medical College, St. John's National Academy of Health Sciences, Bengaluru, India
| | - Sulagna Bandyopadhyay
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, India
| | - Ravinder Goswami
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Gupta
- Breastfeeding Promotion Network of India (BPNI), New Delhi, India
| | - Piyush Gupta
- Department of Pediatrics, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Anjaly T John
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, India
| | - Umesh Kapil
- Institute of Liver and Biliary Sciences, New Delhi, India
| | - Bharati Kulkarni
- Clinical Division, National Institute of Nutrition-ICMR, Hyderabad, India
| | - Rebecca Kuriyan
- Department of Physiology, St. John's Medical College, St. John's National Academy of Health Sciences, Bengaluru, India.,Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, India
| | - Jagmeet Madan
- Department of Food, Nutrition and Dietetics, Sir Vithaldas Thackersey College of Home Science, SNDT Women's University, Mumbai, India
| | - Sanchit Makkar
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bengaluru, India
| | | | - Raghu Pullakhandam
- Clinical Division, National Institute of Nutrition-ICMR, Hyderabad, India
| | | | - Dheeraj Shah
- Department of Pediatrics, University College of Medical Sciences and GTB Hospital, New Delhi, India
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35
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Addo OY, Yu EX, Williams AM, Young MF, Sharma AJ, Mei Z, Kassebaum NJ, Jefferds MED, Suchdev PS. Evaluation of Hemoglobin Cutoff Levels to Define Anemia Among Healthy Individuals. JAMA Netw Open 2021; 4:e2119123. [PMID: 34357395 PMCID: PMC8346941 DOI: 10.1001/jamanetworkopen.2021.19123] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/27/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Anemia, defined as low hemoglobin (Hb) concentration insufficient to meet an individual's physiological needs, is the most common blood condition worldwide. Objective To evaluate the current World Health Organization (WHO) Hb cutoffs for defining anemia among persons who are apparently healthy and to assess threshold validity with a biomarker of tissue iron deficiency and physiological indicator of erythropoiesis (soluble transferrin receptor [sTfR]) using multinational data. Design, Setting, and Participants In this cross-sectional study, data were collected and evaluated from 30 household, population-based nutrition surveys of preschool children aged 6 to 59 months and nonpregnant women aged 15 to 49 years during 2005 to 2016 across 25 countries. Data analysis was performed from March 2020 to April 2021. Exposure Anemia defined according to WHO Hb cutoffs. Main Outcomes and Measures To define the healthy population, persons with iron deficiency (ferritin <12 ng/mL for children or <15 ng/mL for women), vitamin A deficiency (retinol-binding protein or retinol <20.1 μg/dL), inflammation (C-reactive protein >0.5 mg/dL or α-1-acid glycoprotein >1 g/L), or known malaria were excluded. Survey-specific, pooled Hb fifth percentile cutoffs were estimated. Among individuals with Hb and sTfR data, Hb-for-sTfR curve analysis was conducted to identify Hb inflection points that reflect tissue iron deficiency and increased erythropoiesis induced by anemia. Results A total of 79 950 individuals were included in the original surveys. The final healthy sample was 13 445 children (39.9% of the original sample of 33 699 children; 6750 boys [50.2%]; mean [SD] age 32.9 [16.0] months) and 25 880 women (56.0% of the original sample of 46 251 women; mean [SD] age, 31.0 [9.5] years). Survey-specific Hb fifth percentile among children ranged from 7.90 g/dL (95% CI, 7.54-8.26 g/dL in Pakistan) to 11.23 g/dL (95% CI, 11.14-11.33 g/dL in the US), and among women from 8.83 g/dL (95% CI, 7.77-9.88 g/dL in Gujarat, India) to 12.09 g/dL (95% CI, 12.00-12.17 g/dL in the US). Intersurvey variance around the Hb fifth percentile was low (3.5% for women and 3.6% for children). Pooled fifth percentile estimates were 9.65 g/dL (95% CI, 9.26-10.04 g/dL) for children and 10.81 g/dL (95% CI, 10.35-11.27 g/dL) for women. The Hb-for-sTfR curve demonstrated curvilinear associations with sTfR inflection points occurring at Hb of 9.61 g/dL (95% CI, 9.55-9.67 g/dL) among children and 11.01 g/dL (95% CI, 10.95-11.09 g/dL) among women. Conclusions and Relevance Current WHO cutoffs to define anemia are higher than the pooled fifth percentile of Hb among persons who are outwardly healthy and from nearly all survey-specific estimates. The lower proposed Hb cutoffs are statistically significant but also reflect compensatory increased erythropoiesis. More studies based on clinical outcomes could further confirm the validity of these Hb cutoffs for anemia.
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Affiliation(s)
- O. Yaw Addo
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Emma X. Yu
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Anne M. Williams
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
- Emory University Rollins School of Public Health, Atlanta, Georgia
- McKing Consulting Corporation, Atlanta, Georgia
| | | | - Andrea J. Sharma
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
- USPHS Commissioned Corps, Atlanta, Georgia
| | - Zuguo Mei
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Maria Elena D. Jefferds
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Parminder S. Suchdev
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
- Emory University Rollins School of Public Health, Atlanta, Georgia
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Cross-sectional Study to Identify the Range of Hemoglobin Levels in Normal Infants, Children, and Adolescents in India. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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