Iron metabolism and vitamin A deficiency in children in northeast Thailand

Inadequate Vitamin C Intake and Intestinal Inflammation Are Associated with Multiple Micronutrient Deficiency in Young Children: Results from a Multi-Country Birth Cohort Study

Children living in resource-limited settings often suffer from multiple micronutrient deficiencies (MMD). However, there lacks evidence on the correlates of MMD in young children. We investigated the role of diets, water, sanitation and hygiene practice, enteric infections, and impaired gut health on MMD in children at 24 months of age using data from the multi-country MAL-ED birth cohort study. Co-existence of more than one micronutrient deficiency (e.g., anemia, iron, zinc, or retinol deficiency) was considered as MMD. We characterized intestinal inflammation by fecal concentrations of myeloperoxidase (MPO) and neopterin (NEO) measured in the non-diarrheal stool samples. Bayesian network analysis was applied to investigate the factors associated with MMD. A total of 1093 children were included in this analysis. Overall, 47.6% of the children had MMD, with the highest prevalence in Pakistan (90.1%) and lowest in Brazil (6.3%). MMD was inversely associated with the female sex [OR: 0.72, 95% CI: 0.54, 0.92]. A greater risk of MMD was associated with lower vitamin C intake [OR: 0.70, 95% CI: 0.48, 0.94] and increased fecal concentrations of MPO [OR: 1.31, 95% CI: 1.08, 1.51]. The study results imply the importance of effective strategies to ameliorate gut health and improve nutrient intake during the early years of life.

Risk factors of anaemia and iron deficiency in Somali children and women: Findings from the 2019 Somalia Micronutrient Survey

There are limited data on the prevalence of anaemia and iron deficiency (ID) in Somalia. To address this data gap, Somalia's 2019 micronutrient survey assessed the prevalence of anaemia and ID in children (6–59 months) and non‐pregnant women of reproductive age (15–49 years). The survey also collected data on vitamin A deficiency, inflammation, malaria and other potential risk factors for anaemia and ID. Multivariable Poisson regressions models were used to identify the risk factors for anaemia and ID in children and women. Among children, the prevalence of anaemia and ID were 43.4% and 47.2%, respectively. Approximately 36% and 6% of anaemia were attributable to iron and vitamin A deficiencies, respectively, whereas household possession of soap was associated with approximately 11% fewer cases of anaemia. ID in children was associated with vitamin A deficiency and stunting, whereas inflammation was associated with iron sufficiency. Among women, 40.3% were anaemic, and 49.7% were iron deficient. In women, ID and number of births were significantly associated with anaemia in multivariate models, and approximately 42% of anaemia in women was attributable to ID. Increased parity was associated with ID, and incubation and early convalescent inflammation was associated with ID, whereas late convalescent inflammation was associated with iron sufficiency. ID is the main risk factor of anaemia in both women and children and contributed to a substantial portion of the anaemia cases. To tackle both anaemia and ID in Somalia, food assistance and micronutrient‐specific programmes (e.g. micronutrient powders and iron supplements) should be enhanced.

Impact of Crude Palm Oil Fortified Cookies Supplementation on Anthropometry, Vitamin A and Hematological Status of School Children in India

Abstract. Objectives: Food-based strategies remain the most sustainable solutions for combating micronutrient deficiencies. Crude palm oil being the richest natural source of β-carotene, the study aimed to assess the impact of crude palm oil fortified cookies supplementation on anthropometry, vitamin A and hematological status of school children.

Methods: 444 children (boys-226, girls-218), aged 5-13 years from two Municipal Corporation of Delhi primary schools were enrolled. By draw of lot, children from one of the schools formed the experimental (n = 224; boys-119, girls-105) while other formed the placebo group (n = 220; boys-107; girls-113). Children from the experimental group received six crude palm oil fortified cookies providing 2152 μg of β-carotene while the placebo group received similar but non-fortified cookies each day for 50 school days. Anthropometry, vitamin A, and hematological status were assessed at baseline and post supplementation.

Results: Post supplementation, the number of stunted subjects reduced significantly (p < 0.05) in the experimental group. There was a significant increase in plasma retinol (170.9%; mean change: 1.55 ± 1.30 μmol/L - experimental group vs. 0.45 ± 0.99 μmol/L - placebo group) and β-carotene (p < 0.01; median change from 0.55 to 0.76 μmol/L - experimental group vs. 0.59 to 0.55 μmol/L -placebo group) concentrations of the experimental group. The increase in hematological parameters (mean change in Hemoglobin: 1.64 g/dL in experimental group vs. 2.10 g/dL in placebo group) of both the groups were however, comparable.

Conclusion: To address micronutrient deficiencies particularly in developing nations, the use of crude palm oil should be encouraged through supplementary feeding programs by way of ready-to-eat snacks.

Ascaris lumbricoides infection: Still a threat for iron deficiency anaemia in 2-year-old Bangladeshi slum-dwelling children

INTRODUCTION

Although parasitic infections lead to extracorporeal iron loss resulting in iron deficiency anaemia (IDA), data associating IDA with parasitic infections in the first two years of life are limited. We sought to evaluate the prevalence and severity of anaemia and IDA during this period and to investigate the association between intestinal parasitic infections and IDA.

METHODOLOGY

Data was collected under MAL-ED study protocol in Bauniabadh slum of Dhaka, Bangladesh. The presence of parasites in stool was detected using wet preparation microscopy at 7, 15, and 24 months. Anaemia was defined as serum haemoglobin < 11 g/dL and IDA was defined by serum haemoglobin < 11 g/dL, serum ferritin < 12 g/L and soluble transferrin receptor > 8.3 mg/L. Logistic regression was done to quantify the relation between stool parasite and IDA separately on samples collected at 7, 15 and 24 months.

RESULTS

265 children were enrolled after birth and samples were collected at 7, 15 and 24 months. Anaemia was detected at 7, 15 and 24 months in 117 (48.8%), 106 (44.2%) and 67 (27.9%) cases whereas IDA was found in 15 (6.3%), 47 (19.6%) and 39 (16.3%) cases, respectively. Iron deficiency anaemia at 24 months was significantly associated with Ascaris lumbricoides infection (OR 3.76; 95 % CI, 1.08-13.11).

CONCLUSIONS

The prevalence of anaemia and IDA in slum dwelling children of Dhaka is high and Ascaris lumbricoides infection was found to have a strong association with IDA at 24 months of age.

Vitamin A and Nutritional Anaemia

A cross-sectional study of the prevalence of iron and vitamin A deficiencies in 318 pregnant women revealed that 50.7% had iron deficiency and 21.3% had marginally deficient or deficient vitamin A status. Based on results, the influence of vitamin A and iron supplementation was studied in 305 anaemic pregnant women in west Java, in a randomized, doubleblind, placebo-controlled field trial. The women with a haemoglobin between 80 and 109 g/L were randomly allocated to four groups: vitamin A (2.4 mg retinol) and placebo iron tablets; iron (60 mg elemental iron as ferrous sulphate) and placebo vitamin A; vitamin A and iron; and both placebos, all daily for eight weeks. Maximum haemoglobin was achieved with both vitamin A and iron supplementation (12. 78 g/L, 95% Cl 10.86 to 14.70), with one-third of the response attributable to vitamin A (3.68 g/L, 2.03 to 5.33) and two-thirds to iron (771 g/L, 5.97 to 9.45). After supplementation, the proportion of women who became non-anaemic was 35 % in the vitamin Asupplemented group, 68% in the ironsupplemented group, 97% in the group supplemented with both, and 16% in the placebo group. We conclude that improvement in vitamin A status may contribute to the control of anaemia in pregnant women.

Effect of vitamin A supplementation on iron status in humans: A systematic review and meta-analysis

Anemia is a worldwide public health problem that can be related to many causes, including vitamin A deficiency. The aim of this study was to assess and estimate the effect of vitamin A supplementation (VAS) on iron status biomarkers and anemia in humans. Six databases, including Cochrane, EMBASE, LILACS, Pubmed, Scopus and Web of Science, were searched for clinical trials and cohort studies that investigated the effect of vitamin A supplementation alone on iron status and anemia, without time-restriction. The search yielded 23 eligible studies, 21 clinical trials and 2 cohort studies, with children, teenagers, pregnant or lactating women. The meta-analysis of the clinical trials showed that VAS reduces the risk of anemia by 26% and raises hemoglobin levels, compared to non-treated group, independent of the life stage. VAS did not alter the prevalence of iron deficiency among the clinical trials conducted with children and teenagers (RR 0.82, 95% CI 0.60 to 1.12, p = 0.204), whereas a significant increase in serum ferritin levels was observed in trials conducted with pregnant and lactating women (WMD 6.61 μg/L; 95% CI 6.00 to 7.21 μg/L; p < 0.001). Therefore, vitamin A supplementation alone may reduce the risk of anemia, by improving hemoglobin and ferritin levels in individuals with low serum retinol levels.

Vitamin A in Pregnancy: Impact on Maternal and Neonatal Health

Vitamin A is an essential nutrient, for which there is a slightly increased requirement during the third trimester of pregnancy, with even greater requirements for lactating women. Serum retinol levels decline during pregnancy, especially during the third trimester, followed by a rapid increase postpartum. Hemodilution and inadequate nutritional status contribute to this pattern. Night-blindness is more common in the third trimester of pregnancy, and night-blind pregnant women have lower mean serum retinol concentrations. Increased morbidity is associated with night-blindness in women, especially during pregnancy. Vitamin A supplementation during pregnancy in deficient populations reduces night-blindness, low serum retinol levels, and nutritional anemia during pregnancy and substantially reduces maternal postpartum infections. A substantial reduction in maternal mortality has been observed in malnourished vitamin A–deficient women following vitamin A or β-carotene supplementation. Infant cord blood retinol and birthweight appear to be resistant to maternal supplementation with vitamin A during pregnancy. No studies have reported an impact of maternal vitamin A supplementation on neonatal morbidity or mortality.

Underutilized β-carotene–rich Crops of Vietnam

Solutions to micronutrient deficiencies that capitalize upon indigenous resources and foodstuffs offer a long-term mechanism for elevating the health status of disadvantaged people. in populations where intakes of animal foods are inadequate and food sources of retinol are not economically possible, efficient use of carotene-rich plants may prevent vitamin A deficiency. in Vietnam the gac fruit (Momordica cochinchinensis Spreng) is an excellent source of β-carotene (17–35 mg per 100 g of edible portion). This fruit is familiar to indigenous people and is easy to grow. However, it has been underutilized because it is available only three months a year, there have been no efforts to educate the at-risk population about its nutritional benefit, and research efforts in production or preservation techniques have been lacking. This paper describes the fruit, compares its nutritional value with that of familiar carotenoid-rich fruits, details its traditional usage in preparing rice, and discusses the acceptance of this rice preparation (xoi gac ) by Vietnamese preschoolers in their daily diet. Financial support for research directed at improving the production and preservation of indigenous β-carotene–rich crops is needed to alleviate the problem of vitamin A deficiency of children in northern Vietnam.

Effect of a single high dose vitamin A supplementation on the hemoglobin status of children aged 6-59 months: propensity score matched retrospective cohort study based on the data of Ethiopian Demographic and Health Survey 2011

Background

Vitamin A deficiency can cause anemia as the nutrient is essential for hematopoiesis, mobilization of iron store and immunity. Nevertheless, clinical trials endeavored to evaluate the effect of Vitamin A Supplementation (VAS) on hemoglobin concluded inconsistently. Accordingly, the objective of the current study is to assess the effect of single high dose VAS on the hemoglobin status of children aged 6–59 months.

Methods

The study was conducted based on the data of Ethiopian Demographic Health Survey 2011. The data from 2397 children aged 6–59 months who received a single dose of 30 or 60 mg of VAS (depending on age) in the preceding 6 months were matched with similar number children who did not receive the supplement in the reference period. The matching was based on propensity scores generated from potential confounders. Distributions of hemoglobin concentration and risks of anemia were compared between the groups using paired t-test, matched Relative Risk (RR) and standardized mean difference.

Result

The supplemented and non-supplemented groups were homogeneous in pertinent socio-demographic variables. Compared to propensity score matched non-supplemented children, those who received vitamin A had a 1.50 (95% CI: 0.30-2.70) g/l higher hemoglobin concentration (P = 0.014). In the supplemented and non-supplemented groups, the prevalences of anemia were 46.4% and 53.9%, respectively. VAS was associated with a 9% reduction in the risk of anemia (RR = 0.91 (95% CI: 0.86-0.96)). Stratified analysis based on household wealth status indicated that the association between VAS and hemoglobin status was restricted to children from the poor households (RR = 0.74 (95% CI: 0.61-0.90)). Effect size estimates among all children (Cohen’s d = 0.07) and children from poor households (d = 2.0) were modest.

Conclusion

Single high dose VAS among Ethiopian children 6–59 months of age was associated with a modest increase in hemoglobin and decrease in risk of anemia. Household wealth status may modify the apparent association between VAS and hemoglobin status.

Effects of vitamin A supplementation on iron status indices and iron deficiency anaemia: a randomized controlled trial

Iron deficiency anaemia (IDA) is the most common nutritional deficiency in the world including developed and developing countries. Despite intensive efforts to improve the quality of life of rural and aboriginal communities in Malaysia, anaemia and IDA are still major public health problems in these communities particularly among children. A randomized, double-blind, placebo-controlled trial was conducted on 250 Orang Asli (aboriginal) schoolchildren in Malaysia to investigate the effects of a single high-dose of vitamin A supplementation (200,000 IU) on iron status indices, anaemia and IDA status. The effect of the supplement was assessed after 3 months of receiving the supplements; after a complete 3-day deworming course of 400 mg/day of albendazole tablets. The prevalence of anaemia was found to be high: 48.5% (95% CI=42.3, 54.8). Moreover, 34% (95% CI=28.3, 40.2) of the children had IDA, which accounted for 70.1% of the anaemic cases. The findings showed that the reduction in serum ferritin level and the increments in haemoglobin, serum iron and transferrin saturation were found to be significant among children allocated to the vitamin A group compared to those allocated to the placebo group (p<0.01). Moreover, a significant reduction in the prevalence of IDA by almost 22% than prevalence at baseline was reported among children in the vitamin A group compared with only 2.3% reduction among children in the placebo group. In conclusion, vitamin A supplementation showed a significant impact on iron status indices and IDA among Orang Asli children. Hence, providing vitamin A supplementation and imparting the knowledge related to nutritious food should be considered in the efforts to improve the nutritional and health status of these children as a part of efforts to improve the quality of life in rural and aboriginal communities.

An evidence-based systematic review of vitamin A by the natural standard research collaboration

An evidence-based systematic review of vitamin A by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated and reproducible grading rationale. This paper includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

Obesity among school children in a province of southern Thailand and its association with socioeconomic status

The association of nutrition status of children aged 7-12 years (n=663) with socioeconomic factors in a province of southern Thailand in 1995 was investigated. Three type of schools were surveyed: a school with a higher educational standard (elite school) in the municipality of the province, a school with many children from low-income families (low-income school) in the same municipality, and five ordinary schools in rural areas of the province (district schools). The proportions of obese children were 22.1%, 5.8% and 2.7%, respectively for the three type of schools, when obesity was defined as weight to height of over 120% of the median of children in Bangkok. The risk ratios and 95% confidence intervals for obesity in the elite and the low-income schools were 5.0 (3.5-7.2) and 1.9 (0.8-4.8), respectively, taking the district schools as a reference. Our research suggested that the high prevalence of obesity among elite-school children could be related to the comparatively high socioeconomic status of the children's families. It also shows that the children in the province studied were as a whole considerably leaner than children in the big cities of Thailand. These results imply a need for appropriate interventions which cannot only prevent obesity, but also improve the malnutrition of school children in the rural provinces of southern Thailand.

Relação entre níveis de hemoglobina, concentração de retinol sérico e estado nutricional em crianças de 6 a 59 meses do Estado da Paraíba

OBJETIVO: Analisar a relação entre os níveis de hemoglobina, concentração de retinol sérico e estado nutricional em crianças de 6 a 59 meses de idade do estado da Paraíba. MÉTODOS: Corte transversal, de base populacional, envolvendo 1.108 crianças de 6 a 59 meses de idade, de ambos os sexos, do Estado da Paraíba. As concentrações de hemoglobina foram analisadas em sangue venoso por meio decontador automático, e as de retinol sérico por cromatografia líquida de alta resolução. Para a avaliação do estado nutricional energético-proteico, foram utilizados peso e estatura pelos índices: peso/idade, estatura/idade e peso/estatura em escores-Z. As proporções foram comparadas pelo teste do Qui-quadrado de Pearson e teste exato de Fisher, e a associação entre as concentrações de hemoglobina e de retinolemia e o estado nutricional, pelo modelo de regressão de Poisson. RESULTADOS: Observou-se prevalência de 36,5% (IC95%=33,7-39,3) de anemia (Hb<11,0 g/dL), 21,4% (IC95%=17,3-22,2) de hipovitaminose A (<0,70µmol/L), 7,3% (IC95%=5,8-8,8)) de desnutrição crônica (estatura/idade<-2), 1,3% (IC95%=0,6-2,0) de desnutrição global (peso/idade<-2), e 2,3% (IC95%=1,4-3,2) de desnutrição aguda (estatura/idade<-2). Na análise multivariada, observou-se associação direta entre anemia e retinolemia inadequada, assim como entre anemia e desnutrição crônica. CONCLUSÃO: A elevada prevalência da anemia e da hipovitaminose A impõe a adoção de medidas efetivas de prevenção e controle. A associação entre as carências nutricionais demonstrou que uma melhoria na retinolemia bem como no estado nutricional tende a reduzir a anemia no contexto estudado.

Efficacy of pandesal baked from wheat flour fortified with iron and vitamin a in improving the iron and anthropometric status of anemic schoolchildren in the Philippines

OBJECTIVE

To determine the efficacy of pandesal baked from wheat flour fortified with iron, with or without vitamin A (VA), in improving anemic schoolchildren's iron and anthropometric status.

METHODS

Anemic 6- to 12-year-old Filipino children (n = 250) received two 60 g pandesal daily for 8 months. They were randomized into 1 of 4 groups: (1) iron-fortified (with hydrogen-reduced iron at 80 mg/kg, electrolytic iron at 80 mg/kg, or ferrous fumarate at 40 mg/kg), (2) iron and VA-fortified, (3) VA-fortified (at 490 RE/100 g), and (4) nonfortified flour. Hemoglobin (Hb) and zinc protoporphyrin (ZnPP) concentrations and weight and height were determined before and after intervention. Analyses of variance and chi-square and multiple regression analyses were performed.

RESULTS

Mean Hb increased by 1.3 g/dL (p < 0.001) and mean ZnPP decreased by 24.4 micromol/mol (p < 0.001) after 8 months. Anemia decreased to 26% and iron deficiency decreased from 58% to 12%. After controls were applied for baseline concentration, age, and gender, Hb concentration at post intervention was significantly higher in the Iron + VA group than in the nonfortified group (coefficient = 0.37; p = 0.034). The odds of being iron deficient at post intervention were significantly lower in the Iron group than in the nonfortified group after controls were applied for age, gender, and baseline prevalence (coefficient = 0.12; p = 0.006). None of the 3 fortified groups had significantly different weight-for-age z-score, body mass index-for-age z-score, or height-for-age z-score compared with the nonfortified group after controls were applied for baseline z-scores, age, and gender.

CONCLUSIONS

Our study shows that in a non-malaria-endemic area, iron fortification of flour significantly reduced the prevalence of iron deficiency among anemic schoolchildren, and double fortification with iron and VA significantly improved Hb status.

Supplementation of iron alone and combined with vitamins improves haematological status, erythrocyte membrane fluidity and oxidative stress in anaemic pregnant women

Pregnancy is a condition exhibiting increased susceptibility to oxidative stress, and Fe plays a central role in generating harmful oxygen species. The objective of the present study is to investigate the changes in haematological status, oxidative stress and erythrocyte membrane fluidity in anaemic pregnant women after Fe supplementation with and without combined vitamins. The study was a 2 months double-blind, randomised trial. Pregnant women (n 164) were allocated to four groups: group C was the placebo control group; group I was supplemented daily with 60 mg Fe (ferrous sulphate) daily; group IF was supplemented daily with Fe plus 400 μg folic acid; group IM was supplemented daily with Fe plus 2 mg retinol and 1 mg riboflavin, respectively. After the 2-month trial, Hb significantly increased by 15.8, 17.3 and 21.8 g/l, and ferritin by 2.8, 3.6 and 11.0 μg/l, in the I, IF and IM groups compared with placebo. Polarisation (ρ) and microviscosity (η) decreased significantly in other groups compared with placebo, indicating an increase in membrane fluidity. Significant decreases of ρ and η values compared with group C were 0.033 and 0.959 for group I, 0.037 and 1.074 for group IF and 0.064 and 1.865 for group IM, respectively. In addition, significant increases of glutathione peroxidase activities and decreases of malondialdehyde were shown in all treated groups, as well as increases of plasma retinol and urine riboflavin in group IM. The findings show that supplementation with Fe and particularly in combination with vitamins could improve the haematological status as well as oxidative stress and erythrocyte membrane fluidity.

Relationship of serum carotenoids and retinol with anaemia among pre-school children in the northern mountainous region of Vietnam

Objective

To characterize the relationship between serum carotenoids, retinol and anaemia among pre-school children.

Design

A cross-sectional study was conducted in two groups: anaemic and non-anaemic. Serum levels of retinol, α-carotene, β-carotene, β-cryptoxanthin, lycopene, lutein and zeaxanthin were measured in the study subjects.

Setting

Six rural communes of Dinh Hoa, a rural and mountainous district in Thai Nguyen Province, in the northern mountainous region of Vietnam.

Subjects

A total of 682 pre-school children, aged 12–72 months, were recruited.

Results

Geometric mean serum concentrations of carotenoids (μmol/l) were 0·056 for α-carotene, 0·161 for β-carotene, 0·145 for β-cryptoxanthin, 0·078 for lycopene, 0·388 for lutein and 0·075 for zeaxanthin. The mean levels of Hb and serum retinol were 108·8 g/l and 1·02 μmol/l, respectively. The prevalence of anaemia and vitamin A deficiency was 53·7 % and 7·8 %, respectively. After adjusting for sex and stunting, serum retinol concentrations (μmol/l; OR = 2·06, 95 % CI 1·10, 3·86, P = 0·024) and total provitamin A carotenoids (μmol/l; OR = 1·52, 95 % CI 1·01, 2·28, P = 0·046) were independently associated with anaemia, but non-provitamin A carotenoids (μmol/l; OR = 0·93, 95 % CI 0·63, 1·37, P = 0·710) were not associated with anaemia.

Conclusions

Among pre-school children in the northern mountainous region of Vietnam, the prevalences of vitamin A deficiency and anaemia are high, and serum retinol and provitamin A carotenoids are independently associated with anaemia. Further studies are needed to determine if increased consumption of provitamin A carotenoids will reduce anaemia among pre-school children.

Nutritional Status of Primary Schoolchildren in Garhwali Himalayan Villages of India

Background

Anemia and micronutrient deficiencies are common among Indian schoolchildren. However, past studies have narrowly focused on only a few micronutrients and have not carefully evaluated the association between sociodemographic factors and nutritional status of schoolchildren.

Objective

To assess the nutritional status of schioolchildren in Himalayan villages of India and to determine the relationships between their nutritional status, intestinal helminth infection, and sociodemographic characteristics.

Methods

A random sample of 499 children 6 to 10 years of age from 20 public primary schools was selected. Household sociodemographic data and morbidity data on children were collected through interviews with their caretakers. Height and weight were measured, and venous blood was drawn for assessment of hemoglobin, serum ferritin, soluble transferrin receptor, retinol, zinc, folic acid, vitamin B12, and C-reactive protein. Stool samples were analyzed for parasitic infections.

Results

Underweight, stunting, and wasting were present in 60.9%, 56.1%, and 12.2% of schoolchildren, respectively. Anemia, iron-deficiency anemia, and low serum concentrations of ferritin, zinc, retinol, folate, and vitamin B12 were found in 36.7%, 10.2%, 24.1%, 57.1%, 56.1%, 67.9%, and 17.4% of the children, respectively. One-fifth of the children had intestinal parasites. Being underweight was associated with lower household wealth ( p < .05). Helminth infection was associated with stunting, anemia, and low serum retinol ( p < .05). Living at higher altitude was associated with low serum levels of ferritin, retinol, and vitamin B12. There were no associations between any sociodemographic variables and serum zinc or folate.

Conclusions

Growth impairment and micronutrient deficiencies are prevalent among schoolchildren in Himalayan villages of India.

Community-level micronutrient fortification of school lunch meals improved vitamin A, folate, and iron status of schoolchildren in Himalayan villages of India

Anemia and micronutrient deficiencies are common among Indian schoolchildren. We assessed the effectiveness of micronutrient fortification of meals cooked and fortified at school on anemia and micronutrient status of schoolchildren in Himalayan villages of India. In this placebo-controlled, cluster-randomized study, 499 schoolchildren (6-10 y) received either multiple micronutrients (treatment group) or placebo (control group) as part of school meals (6 d/wk) for 8 mo. Both groups were dewormed at the beginning of the study. The micronutrient premix provided 10 mg iron, 375 microg vitamin A, 4.2 mg zinc, 225 microg folic acid, and 1.35 microg vitamin B-12 for each child per day (approximately 75% recommended dietary allowance). Blood samples drawn before and after the intervention were analyzed for hemoglobin, ferritin, retinol, zinc, folate, and vitamin B-12. Baseline prevalence of anemia (37%), iron deficiency anemia (10%), low serum ferritin (24%), retinol (56%), zinc (74%), folate (68%), and vitamin B-12 (17%) did not differ between groups. Postintervention, fewer in the treatment group had lower serum retinol [odds ratio (OR) (95% CI): 0.57 (0.33-0.97)] and folate [OR (95% CI): 0.47 (0.26-0.84)] than the control group. The serum vitamin B-12 concentration decreased in both groups, but the magnitude of change was less in the treatment than in the control group (P < 0.05). Total body iron (TBI) increased in both groups; however, the change was greater in the treatment than in the control group (P < 0.05). Micronutrient fortification of school meals by trained school personnel was effective in improving vitamin A, folate, and TBI status while also reducing the magnitude of a decrease in vitamin B-12 status.

Influence of carotene-rich vegetable meals on the prevalence of anaemia and iron deficiency in Filipino schoolchildren

OBJECTIVE

To determine the effects of eating carotene-rich green and yellow vegetables on the prevalence of anaemia, iron deficiency and iron-deficiency anaemia in schoolchildren.

SUBJECTS AND METHODS

Schoolchildren (n=104), aged 9-12 years, received standardized meals containing 4.2 mg of provitamin A carotenoids/day (mainly beta-carotene) from yellow and green leafy vegetables and at least 7 g dietary fat/day. The meals were provided three times/day, 5 days/week, for 9 weeks at school. Before and after the dietary intervention, total-body vitamin A pool size was assessed by using the deuterated-retinol-dilution method; serum retinol and beta-carotene concentrations were measured by high-performance liquid chromatography; and whole blood haemoglobin (Hb) and zinc protoporphyrin (ZnPP) concentrations were measured by using a photometer and a hematofluorometer, respectively.

RESULTS

After 9 weeks, the mean total-body vitamin A pool size increased twofold (95% confidence interval (CI): -0.11, -0.07 micromol retinol; P<0.001), and serum beta-carotene concentration increased fivefold (95% CI: -0.97, -0.79 micromol/l; P<0.001). Blood Hb (95% CI: -1.02, -0.52 g per 100 ml; P<0.001) and ZnPP increased (95% CI: -11.82, -4.57 microol/mol haem; P<0.001). The prevalence of anaemia (Hb<11.5 g per 100 ml) decreased from 12.5 to 1.9% (P<0.001). There were no significant changes in the prevalence of iron deficiency or iron-deficiency anaemia.

CONCLUSIONS

Ingestion of carotene-rich yellow and green leafy vegetables improves the total-body vitamin A pool size and Hb concentration, and decreases anaemia rates in Filipino schoolchildren, with no effect on iron deficiency or iron-deficiency anaemia rates.

Is there an association between the nutritional status of the mother and that of her 2-year-old to 5-year-old child?

The aim of this study was to determine whether there is an association between the nutritional status of the mother and that of her 2-year-old to 5-year-old child in a rural village in South Africa where there is a high prevalence of childhood malnutrition (in particular, deficiencies of vitamin A and iron) and of maternal obesity. A blood sample and anthropometric measurements were obtained for 118 child-mother pairs. There was a positive mother-child correlation for serum ferritin (R=0.2304, P<0.05) and haemoglobin (R=0.2664, P<0.01) concentrations, respectively. The child of an anaemic mother had a relative risk of 1.632 of also being anaemic. There was no mother-child association for either serum retinol concentration or anthropometric measurements. Serum retinol concentrations showed a positive correlation with both serum ferritin (mothers only; R=0.2161, P<0.01) and haemoglobin (R=0.2807, P<0.01 for mothers; and R=0.2710, P < 0.01 for children) concentrations. The mother-child association for iron status is probably because of an inadequate dietary intake and low bioavailability of dietary iron, which are major causes of iron deficiency. The lack of mother-child association for serum retinol concentration could probably be ascribed to the fact that children are more susceptible to vitamin A deficiency than adults because of childhood diseases.

Circulating retinol-binding protein-4 concentration might reflect insulin resistance-associated iron overload

OBJECTIVES

The mechanisms behind the association between retinol-binding protein-4 (RBP4) and insulin resistance are not well understood. An interaction between iron and vitamin A status, of which RBP4 is a surrogate, has long been recognized. We hypothesized that iron-associated insulin resistance could be behind the impaired insulin action caused by RBP4.

RESEARCH DESIGN AND METHODS

Serum ferritin and RBP4 concentration and insulin resistance were evaluated in a sample of middle-aged men (n = 132) and in a replication independent study. Serum RBP4 was also studied before and after iron depletion in patients with type 2 diabetes. Finally, the effect of iron on RBP4 release was evaluated in vitro in adipose tissue.

RESULTS

A positive correlation between circulating RBP4 and log serum ferritin (r = 0.35 and r = 0.61, respectively; P < 0.0001) was observed in both independent studies. Serum RBP4 concentration was higher in men than women in parallel to increased ferritin levels. On multiple regression analyses to predict serum RBP4, log serum ferritin contributed significantly to RBP4 variance after controlling for BMI, age, and homeostasis model assessment value. Serum RBP4 concentration decreased after iron depletion in type 2 diabetic patients (percent mean difference -13.7 [95% CI -25.4 to -2.04]; P = 0.024). The iron donor lactoferrin led to increased dose-dependent adipose tissue release of RBP4 (2.4-fold, P = 0.005) and increased RBP4 expression, while apotransferrin and deferoxamine led to decreased RBP4 release.

CONCLUSIONS

The relationship between circulating RBP4 and iron stores, both cross-sectional and after iron depletion, and in vitro findings suggest that iron could play a role in the RBP4-insulin resistance relationship.

Relação entre os níveis de vitamina A e os marcadores bioquímicos do estado nutricional de ferro em crianças e adolescentes

OBJETIVO: Verificar a relação entre vitamina A e os marcadores bioquímicos da situação nutricional do ferro. MÉTODOS: Participaram deste estudo 178 indivíduos com idade entre 7 e 17 anos, residentes na cidade de Jequié (BA). Os indivíduos foram submetidos a exame de sangue para dosagem de retinol e de marcadores bioquímicos do estado nutricional relativo ao ferro. Além disso, foram realizados exames antropométricos, parasitológico de fezes e coletadas informações de consumo dietético de ferro e das condições sócio-ambiental e domiciliar da família. Utilizou-se a análise de regressão linear múltipla como técnica estatística para avaliar a associação de interesse. RESULTADOS: Constatou-se associação positiva e estatisticamente significante entre os níveis de retinol sérico e a concentração de hemoglobina (p=0,007), ferro sérico (p=0,010) e transferrina saturada (p=0,027). Esses efeitos se mantiveram após ajuste dos modelos pelas variáveis demográficas, infecções parasitárias (Schistosoma mansoni, Trichiura trichuris, Ascaris lumbricoides e ancilostomídeos), consumo de ferro alimentar biodisponível e condições ambientais e domiciliares. CONCLUSÃO: A vitamina A parece contribuir para elevar o ferro orgânico da população, em especial, em áreas onde a deficiência de vitamina A e a anemia coexistem.

Concentrações de retinol e de beta-caroteno séricos e perfil nutricional de crianças em Teresina, Piauí, Brasil

OBJETIVO: Avaliar as concentrações séricas de retinol e beta-caroteno de pré-escolares em Teresina, Piauí, com caracterização do perfil antropométrico e do consumo alimentar. MATERIAL E MÉTODOS: Estudo transversal envolvendo 135 crianças em creche municipal, com avaliação do estado nutricional pelos métodos: bioquímico (concentração sérica de retinol e beta-caroteno), antropométrico (índices de peso para estatura - P/E e estatura para idade - E/I) e dietético (freqüência de consumo alimentar). RESULTADOS: Observou-se prevalência de deficiência de vitamina A (DVA) de 8,9% (IC95%: 4,7 - 15,0%) e existência de associação entre suplementação anterior e concentrações de retinol, com maior proporção de crianças com níveis normais de retinol entre as suplementadas (p = 0,025). As concentrações de retinol e de beta-caroteno mostraram-se correlacionadas, porém com força leve a moderada (p < 0,021). Os percentuais de crianças com baixo P/E e de baixa E/I foram de 1,9% (IC95%: 0,2 - 6,8%) e 9,7% (IC95%: 4,8 - 17,1%), respectivamente. Na avaliação dietética verificou-se baixo consumo de alimentos ricos em vitamina A. CONCLUSÕES: A elevada prevalência de DVA nas crianças, combinada com a alta percentagem de crianças com valores aceitáveis de retinol, os baixos valores medianos de beta-caroteno, a alta percentagem de déficit estatural e a inadequação do consumo de alimentos ricos em vitamina A, indicam a necessidade de se aprimorar as estratégias de educação em saúde e nutrição da população, incentivando o consumo de alimentos fontes de vitamina A, como medidas auto-sustentáveis importantes no combate ao problema. Além disso, deve ser considerado o incentivo à fortificação dos alimentos e ao fortalecimento de Programas de suplementação.

Age and gender as factors in the distribution of global micronutrient deficiencies

Although micronutrient deficiency is a global problem, the burden is not evenly shared within affected households. This review suggests that there are important non-linearities in relationships among food intake, sharing, and caring behavior within the household. Since micronutrient status relates to interactions among biological, social, behavioral, economic, and environmental processes, outcomes are not always predictable by age, gender, or location. Understanding such variability is crucial to identifying appropriate solutions. This review represents an exploratory first step toward unmasking population-specific variations that are important for better understanding the nature of micronutrient deficiencies and for improving the focus of public health action.

The contribution of plant foods to the vitamin A supply of lactating women in Vietnam: a randomized controlled trial

BACKGROUND

More information is needed on the efficacy of carotenoids from plant foods in improving vitamin A status.

OBJECTIVE

We aimed to quantify the efficacy of provitamin A-rich vegetables and fruit in improving vitamin A status.

DESIGN

Breastfeeding women in 9 rural communes in Vietnam were randomly allocated to 1 of 4 groups: the vegetable group (n = 73), which ingested 5.6 mg beta-carotene/d from green leafy vegetables; the fruit group (n = 69), which ingested 4.8 mg beta-carotene/d from orange or yellow fruit; the retinol-rich group (n = 70), which ingested 610 microg retinol/d from animal foods and 0.6 mg beta-carotene/d; and the control group (n = 68), which ingested 0.4 mg beta-carotene/d. Meals of groups 1, 2, and 4 contained <30 microg retinol/d. Lunch and dinner were provided 6 d/wk for 10 wk.

RESULTS

Mean (95% CI) changes in serum retinol concentrations of the vegetable, fruit, retinol-rich, and control groups were 0.09 (0.03, 0.16), 0.13 (0.07, 0.19), 0.25 (0.17, 0.33), and 0.00 (-0.06, 0.06) micromol/L, respectively. Mean (95% CI) changes in breast-milk retinol concentrations were 0.15 (0.04, 0.27), 0.15 (0.02, 0.28), 0.48 (0.32, 0.64), and -0.06 (-0.21, 0.09) micromol/L, respectively. According to these findings, the equivalent of 1 microg retinol would be 12 microg beta-carotene (95% CI: 8, 22 microg) for fruit and 28 microg beta-carotene (17, 84 microg) for green leafy vegetables. Thus, apparent mean vitamin A activity of carotenoids in fruit and in leafy vegetables was 50% (95% CI: 27%, 75%) and 21% (7%, 35%), respectively, of that assumed.

CONCLUSION

The bioavailability of carotenoids from vegetables and fruit is less than previously assumed.

Interação entre vitamina A e ferro em diferentes grupos populacionais

A interação entre ferro e vitamina A tem sido alvo de pesquisas científicas, visto que existem questões ainda pouco esclarecidas. Através de um levantamento bibliográfico, mediante consulta à base de dados Medline da National Library of Medicine, Estados Unidos da America, foram selecionadas publicações que tratavam sobre a interação entre ferro e vitamina A em seres humanos, a partir da década de 80 até o ano de 2003. As palavras chave utilizadas no levantamento bibliográfico foram "ferro", "vitamina A" e "anemia" e seus correspondentes em língua inglesa. Os resultados indicam que existe correlação entre os indicadores do estado nutricional de vitamina A e ferro em crianças, adolescentes e gestantes e que a fortificação e suplementação com vitamina A têm efeito favorável no metabolismo do ferro nesses grupos. Entretanto, ainda são necessários mais estudos para se conseguir estabelecer quais as doses e o período necessário de suplementação de vitamina A para beneficiar significantemente o estado nutricional de ferro. Os mecanismos que explicam a associação entre vitamina A e ferro ainda são desconhecidos, entretanto alguns autores atribuem essa interação ao fato de a vitamina A beneficiar a eritropoese, prevenir infecções ou melhorar a absorção de ferro.

Distribution of Anemia Associated with Micronutrient Deficiencies Other than Iron in a Probabilistic Sample of Mexican Children

BACKGROUND

This investigation aims to explore the association among anemia and vitamins A, C, and folate deficiencies in a probabilistic sample of Mexican children.

METHODS

Data on hemoglobin, serum vitamins A and C and folate concentrations and percent transferrin saturation (PTS) in children 0.5-11 years (n = 1,770) were extracted from the database of the probabilistic Mexican National Nutrition Survey 1999 (NNS-99).

RESULTS

Overall, 16.6% of children were anemic. Iron deficiency children with or without anemia had more frequent low serum retinol (40.6 vs. 16% and 27.7 vs. 11.9%, p < 0.05, respectively) and lower hemoglobin folate (11.5 vs. 22%, p < 0.05) than their non-iron deficiency counterparts. Mean concentrations of serum iron (p < 0.01), folate (p < 0.001) and retinol (p < 0.0001), but not ascorbic acid (p < 0.6), were significantly lower in anemic than in nonanemic children. In a linear regression model, 15% of hemoglobin variation in children was explained by retinol, folate and PTS, but not vitamin C (p <0.0001).

CONCLUSION

Anemia was mostly associated with iron deficiency and with a lesser proportion of folate and vitamin A deficiencies. Vitamin A deficiency might be overestimated since iron deficiency may lower serum retinol concentrations. Interventions aimed to reduce anemia in this population must consider interactions between those micronutrients in designing strategies.

Combined iron and zinc supplementation in infants improved iron and zinc status, but interactions reduced efficacy in a multicountry trial in southeast Asia

Deficiencies of iron and zinc are prevalent worldwide. Interactions between these micronutrients therefore have important consequences, also for supplementation. To investigate effects on hemoglobin and zinc concentrations and interactions of iron and zinc supplementation in infants, data from 4 parallel, randomized, placebo-controlled, double-blind trials in Indonesia, Thailand, and Vietnam were pooled. Infants (n=2468), aged 4-6 mo, were supplemented daily with iron (10 mg) and/or zinc (10 mg) for 6 mo. At 3 sites, infants were given vitamin A capsules (VAC) at recruitment. Combined supplementation reduced prevalences of anemia by 21% (P<0.01) and zinc deficiency by 10% (P<0.05) but was less effective (P<0.05) than supplementation with either iron (28% reduction in anemia) or zinc alone (18% reduction in zinc deficiency). Iron reduced the effect of zinc supplementation (interaction P<0.01), but had no separate effect on zinc status, whereas zinc supplementation had a negative effect on hemoglobin concentrations (-2.5 g/L, P<0.001), independent of iron supplementation (Pinteraction=0.25). The effect of iron supplementation on hemoglobin concentrations was almost twice as large in boys than in girls (effect size 12.0 vs. 6.8 g/L, respectively). In infants not receiving iron, VAC administration tended to be associated with lower (3.2%, P=0.07) hemoglobin concentrations. Combined supplementation of iron and zinc was safe and effective in reducing the high prevalences of anemia and iron and zinc deficiencies. Zinc supplementation may negatively affect iron status but iron supplementation does not seem to affect zinc status. Furthermore, VAC administration in the absence of iron supplementation may increase the incidence of anemia.

Low anemia prevalence in school-aged children in Bangalore, South India: possible effect of school health initiatives

OBJECTIVE

Anemia is a serious public health problem in Indian school children. Since 2003, simple health intervention programs such as antihelminthic treatment and vitamin A supplementation have been implemented in primary schools in the Bangalore region, Karnataka, India. This study examines the prevalence of anemia in school children who are beneficiaries of this program.

DESIGN

Cross-sectional survey.

SETTING

Bangalore district, South India.

SUBJECTS

A total of 2,030 boys and girls, aged 5-15 years, attending schools in the Bangalore district.

INTERVENTIONS

School-based, twice yearly intervention: deworming (albendazole 400 mg, single oral dose) and vitamin A supplementation (200,000 IU, single oral dose).

MAIN OUTCOME MEASURES

Anemia prevalence based on measure of blood hemoglobin (Hb).

RESULTS

Mean age and blood Hb concentration of all children were 9.5+/-2.6 years and 12.6+/-1.1 g/dl (range 5.6-16.7), respectively. The overall anemia prevalence in this group was 13.6%. Anemia prevalence was lower in boys than girls (12.0%; n=1037 vs 15.3%; n=993 respectively, P<0.05). There was no significant difference in anemia prevalence between children in urban and rural locations (14.6 and 12.3%, respectively).

CONCLUSIONS

The current low anemia prevalence in Bangalore could be due to the impact of school-based intervention programs that have been in place since 2003. The beneficial interactions of deworming and vitamin A supplementation could have widespread implications for current preventive public health initiatives. There is now need for the development of clear policy guidelines based on these simple and integrated interventions.

Vitamin A supplementation in children with poor vitamin A and iron status increases erythropoietin and hemoglobin concentrations without changing total body iron

BACKGROUND

Vitamin A deficiency impairs iron metabolism; vitamin A supplementation of vitamin A-deficient populations may reduce anemia. The mechanism of these effects is unclear. In vitro and in animal models, vitamin A treatment increases the production of erythropoietin (EPO), a stimulant of erythropoiesis.

OBJECTIVE

We measured the effect of vitamin A supplementation on hemoglobin, iron status, and circulating EPO concentrations in children with poor iron and vitamin A status.

DESIGN

In a double-blind, randomized trial, Moroccan schoolchildren (n = 81) were given either vitamin A (200,000 IU) or placebo at baseline and at 5 mo. At baseline, 5 mo, and 10 mo, hemoglobin, indicators of iron and vitamin A status, and EPO were measured.

RESULTS

At baseline, 54% of children were anemic; 77% had low vitamin A status. In the vitamin A group at 10 mo, serum retinol improved significantly compared with the control group (P < 0.02). Vitamin A treatment increased mean hemoglobin by 7 g/L (P < 0.02) and reduced the prevalence of anemia from 54% to 38% (P < 0.01). Vitamin A treatment increased mean corpuscular volume (P < 0.001) and decreased serum transferrin receptor (P < 0.001), indicating improved iron-deficient erythropoiesis. Vitamin A decreased serum ferritin (P < 0.02), suggesting mobilization of hepatic iron stores. Calculated from the ratio of transferrin receptor to serum ferritin, overall body iron stores remained unchanged. In the vitamin A group at 10 mo, we observed an increase in EPO (P < 0.05) and a decrease in the slope of the regression line of log10(EPO) on hemoglobin (P < 0.01).

CONCLUSION

In children deficient in vitamin A and iron, vitamin A supplementation mobilizes iron from existing stores to support increased erythropoiesis, an effect likely mediated by increases in circulating EPO.

Effect of maternal and neonatal vitamin A supplementation and other postnatal factors on anemia in Zimbabwean infants: a prospective, randomized study

BACKGROUND

Anemia is prevalent in infants in developing countries. Its etiology is multifactorial and includes vitamin A deficiency.

OBJECTIVE

Our primary aim was to measure the effect of maternal or neonatal vitamin A supplementation (or both) on hemoglobin and anemia in Zimbabwean infants. Our secondary aim was to identify the underlying causes of postnatal anemia.

DESIGN

A randomized, placebo-controlled trial was conducted in 14 110 mothers and their infants; 2854 infants were randomly selected for the anemia substudy, of whom 1592 were successfully observed for 8-14 mo and formed the study sample. Infants were randomly assigned within 96 h of delivery to 1 of 4 treatment groups: mothers and infants received vitamin A; mothers received vitamin A and infants received placebo; mothers received placebo and infants received vitamin A; and mothers and infants received placebo. The vitamin A doses were 400,000 and 50,000 IU in the mothers and infants, respectively.

RESULTS

Vitamin A supplementation had no effect on hemoglobin or anemia (hemoglobin <105 g/L) in unadjusted or adjusted analyses. Infant HIV infection independently increased anemia risk >6-fold. Additional predictors of anemia in HIV-negative and -positive infants were male sex and lower total body iron at birth. In addition, in HIV-positive infants, the risk of anemia increased with early infection, low maternal CD4+ lymphocyte count at recruitment, and frequent morbidity. Six-month plasma ferritin concentrations <12 microg/L were a risk factor in HIV-negative but not in HIV-positive infants. Maternal HIV infection alone did not cause anemia.

CONCLUSION

Prevention of infantile anemia should include efforts to increase the birth endowment of iron and prevent HIV infection.

Risk of zinc, iodine and other micronutrient deficiencies among school children in North East Thailand

INTRODUCTION

Micronutrient deficiencies during childhood can contribute to impairments in growth, immune competence, and mental and physical development, and the coexistence of several such deficiencies can adversely affect the efficacy of single micronutrient interventions.

OBJECTIVE

To assess the prevalence of zinc and iodine deficiency and their interrelationships with vitamin A deficiency and anemia and associations with socio-economic status, hemoglobin type, and anthropometry in a cross-sectional study.

SETTING

A total of 10 primary schools in North East Thailand.

METHODS

Non-fasting venipuncture blood samples and casual urine samples were collected from 567 children aged 6-13 years. Anthropometric measures and serum zinc, albumin, C-reactive protein and urinary iodine, are reported here and integrated with published data on vitamin A, anemia, and socio-economic status.

RESULTS

Of the children, 57% had low serum zinc and 83% had urinary iodine levels below the 100 microg/l cutoff. Suboptimal serum zinc and urinary iodine concentrations may result from low intakes of zinc and iodized salt. Significant risk factors for low serum zinc were serum retinol <1.05 micromol/l and being male. Those for urinary iodine <100 microg/l were height-for-age score>median and being female. For serum retinol <1.05 micromol/l, risk factors were low hemoglobin, low serum zinc, and <9 years, and for low hemoglobin indicative of anemia risk factors were <9 years, AE hemoglobinopathy, and serum retinol <1.05 micromol/l. Of the children, 60% were at risk of two or more coexisting micronutrient deficiencies, most commonly suboptimal urinary iodine and low serum zinc.

CONCLUSION

The findings emphasize the need for multimicronutrient interventions in North East Thailand.

A multimicronutrient-fortified seasoning powder enhances the hemoglobin, zinc, and iodine status of primary school children in North East Thailand: a randomized controlled trial of efficacy

Anemia and co-existing deficiencies of zinc, iron, iodine, and vitamin A occur among children in many developing countries including NE Thailand, probably contributing to impairments in growth, immune competence, and cognition. Sustainable strategies are urgently required to combat these deficiencies. We assessed the efficacy of a micronutrient-fortified seasoning powder served with a school lunch on reducing anemia and improving the micronutrient status of rural NE Thai children. Children (n = 569) aged 5.5-13.4y from 10 schools were randomly assigned to receive a seasoning powder either unfortified or fortified with zinc (5 mg), iron (5 mg), vitamin A (270 microg), and iodine (50 microg) (per serving) and incorporated into a school lunch prepared centrally and delivered 5 d/wk for 31 wk. Teachers monitored school lunch consumption. Baseline and final micronutrient status, hemoglobinopathies, and infection or inflammation were assessed from blood and urine samples. For the primary outcome, anemia (based on hemoglobin), no intervention effect was apparent (odds ratio: 1.02 95% CI: 0.69, 1.51) after adjustment for design strata. The odds of zinc (based on serum zinc) and urinary iodine deficiency in the fortified group were 0.63 (0.42, 0.94) and 0.52 (0.38, 0.71) times those in the unfortified group, respectively. Fortification had no effect on serum retinol (0.61: 0.25,1.51), ferritin (1.12: 0.43, 2.96), or mean red cell volume (1.16: 0.82, 1.64). Therefore, a micronutrient-fortified seasoning powder is a promising vehicle for improving zinc, iodine, and hemoglobin status, and its potential for incorporation into lunch programs in day care centers and schools in NE Thailand warrants investigation.

Anaemia, iron deficiency and vitamin A status among school-aged children in rural Kazakhstan

OBJECTIVES

To investigate the prevalence of anaemia and iron deficiency and vitamin A status among school-aged children in rural Kazakhstan and identify factors associated with anaemia in this population.

DESIGN

A cross-sectional design.

SETTING

School-aged children in rural Kazakhstan.

SUBJECTS

Socio-economic and anthropometric information was collected from 159 school-aged children living in the Kzyl-Orda region of Kazakhstan. Blood samples were collected and the concentrations of haemoglobin (Hb), serum iron, serum ferritin (SF), erythrocyte protoporphyrin (EP), serum retinol and beta-carotene, total iron binding capacity (TIBC), transferrin saturation (TS) and other haematological indices were measured.

RESULTS

Among the 159 children, the prevalence of anaemia and iron deficiency defined by the multiple criteria model (SF, TS and EP) was 27% and 13%, respectively. Nine per cent had iron-deficiency anaemia and 21% had serum retinol value < 1.05 micromol l(-1). Mean SF and serum iron concentrations and TS were significantly lower in anaemic children than in their non-anaemic peers, while TIBC and EP were significantly higher in children with anaemia. Hb was significantly correlated with serum iron and retinol concentrations. Serum retinol and SF concentrations and mean corpuscular volume were significantly correlated with Hb by multiple regression analysis.

CONCLUSIONS

Anaemia among school-aged children in rural Kazakhstan appears to be related to iron indices and vitamin A status.

Only a small proportion of anemia in northeast Thai schoolchildren is associated with iron deficiency

BACKGROUND

Iron deficiency is assumed to be the major cause of anemia in northeast Thailand, but other factors may be involved.

OBJECTIVE

We determined the prevalence of anemia among schoolchildren in northeast Thailand and the role of hemoglobinopathies, selected micronutrient deficiencies, and other factors in hemoglobin status.

DESIGN

Blood samples were collected from 567 children aged 6-12.9 y attending 10 primary schools for the determination of a complete blood count and hemoglobin type [Hb AA (normal hemoglobin), Hb AE (heterozygous for Hb type E), and Hb EE (homozygous for Hb type E)] and the measurement of serum ferritin, transferrin receptor, retinol, vitamin B-12, and plasma and erythrocyte folate concentrations. Children with a C-reactive protein concentration > or = 10 mg/L (n = 12), which indicated infection, were excluded.

RESULTS

The prevalence of anemia was 31%. Age, hemoglobin type, and serum retinol were the major predictors of hemoglobin concentration. Hb AA and Hb AE children with anemia had lower (P < 0.01) hematocrit, mean cell volume, and serum retinol values than did their nonanemic counterparts; no significant differences in serum ferritin were found by hemoglobin type. Only 16% (n = 22) of the anemic Hb AA and Hb AE children were iron deficient. Hb AA and Hb AE children with a serum retinol concentration <0.70 micromol/L (n = 14) had a significantly higher geometric mean serum ferritin concentration than did those with a retinol concentration > or = 0.70 micromol/L (P = 0.009); no significant difference in transferrin receptor concentrations was found between these 2 groups.

CONCLUSIONS

Hemoglobinopathies, suboptimal vitamin A status, and age were the major predictors of hemoglobin concentration. The contribution of iron deficiency to anemia was low, and its detection was complicated by coexisting suboptimal vitamin A status.

Iron deficiency anemia in children: a challenge for public health and for society

Iron deficiency anemia is the principal nutritional dearth in the world, and it especially affects children and pregnant women in developing countries. This paper presents a survey of the literature in this area, with the aim of providing a brief overview regarding the occurrence of iron deficiency anemia in Brazil. The article describes the etiology of the disease, the risk groups, the high prevalence of anemia in several areas of Brazil, and also the consequences of iron deficiency in children. The paper also shows some ways to control iron deficiency anemia and some intervention programs applied in Brazilian cities for curing and/or preventing this disease. The article concludes by emphasizing the need to establish strategies and treatments in our country that are based on a policy that brings together not only governmental administration but also all the community.

Níveis séricos de retinol em escolares de 7 a 17 anos no município do Rio de Janeiro

OBJETIVO: Avaliar o estado nutricional quanto à vitamina A em escolares de 7 a 17 anos. Foram analisados 574 escolares, com idade entre 7 e 17 anos, regularmente matriculados na rede municipal de ensino no Rio de Janeiro. MÉTODOS: Os níveis séricos de retinol foram determinados pelo método Bessey-Lowry modificado e o ponto de corte utilizado para caracterizar inadequação sérica de retinol foi <1,05µmol/L. RESULTADO: Encontrou-se um total de 10,30% de escolares com baixos níveis de retinol sérico. Ao considerar a faixa etária, observou-se uma tendência a maiores percentuais de níveis inadequados de retinol sérico entre escolares mais jovens (11,98% na faixa etária de 7 a 10 anos e 7,92% na faixa etária de 10 a 17 anos). CONCLUSÃO: Ainda que os níveis séricos de retinol tendam a elevar-se com a idade, eles ainda são baixos com freqüência suficiente para justificar maior atenção ao segmento populacional mais jovem e tornar pertinente a sua inclusão em programas de combate às deficiências de micronutrientes.

Co-existence of anemia, vitamin A deficiency and growth retardation among children 24-84 months old in Maracaibo, Venezuela

Iron deficiency anemia has been associated with alterations in child development and psychomotor function, being myelination and dopaminergic functioning especially vulnerable. Iron deficiency, at different ages, has different reversible and irreversible effects on CNS. Anemia has also been related to vitamin A deficiency (VAD) and growth retardation. The aim of the present paper was to determine the coexistence of micronutrient deficiency, iron and vitamin A, and macronutrient deficiency (growth retardation). The sample consisted of 202 Venezuelan children, aged 24-84 month old, (104 girls, 98 boys); Anemia, VAD and growth retardation was evaluated by means of blood hemoglobin concentration analysis, HPLC serum retinol (values <20 microg/dl reveal VAD) and height/age and weight/age Z scores (< or = - 2 SD express stunting and underweight). Prevalence of anemia was 38.11%; VAD, 21.78%; stunting, 14.36% and underweight, 9.40%. Anemia and VAD clustered in 7.92%; anemia + stunting or + underweight coexisted in 5.94% and 2.97%, respectively. Stunting and underweight clustered with VAD in 2.97% and 1.48%. The three-way combination with anemia was only seen with stunting in 0.99% of the sample. The prevalence of micronutrient deficiencies remain as significant public health problems which should be simultaneously treated as virtually independent, giving priority to infant, toddler and preschool age groups.

Experiences of a community-based dietary intervention to enhance micronutrient adequacy of diets low in animal source foods and high in phytate: a case study in rural Malawian children

A community-based dietary diversification/modification intervention, employing a quasiexperimental design with a nonequivalent control group, was conducted in two intervention and two control villages in rural Southern Malawi. The aim was to enhance the content and bioavailability of micronutrients in maize-based diets of stunted children ages 30-90 mo. Efficacy was evaluated through a comparison of the changes in knowledge and practices, anthropometry, malaria screening, hemoglobin and hair zinc after 12 mo, common infections monthly postintervention and nutrient adequacy postintervention via 24-h recalls. Intervention diets were more diverse and of higher quality than the control diets, supplying significantly more animal source foods, especially soft-boned fish, but less phytic acid (p < 0.01). Median intakes of energy, protein, calcium, available zinc, heme iron and vitamin B-12 were greater (p < 0.05) in intervention compared to the control groups; some spread of knowledge and practices to the control groups occurred. Intervention enhanced Z-scores for mid-upper-arm circumference and arm muscle area (p < 0.001), but had no impact on weight or height gain. After controlling for baseline variables, mean hemoglobin was higher (107 vs. 102 g/L; p < 0.01) postintervention, whereas incidence of anemia and common infections were lower in the intervention groups compared to the control groups, with no change in malaria or hair zinc status. Dietary strategies reduced the prevalence of inadequate intakes of protein, calcium, zinc and vitamin B-12, but not iron, because fish was the major source of animal food consumed. More efforts to raise small animals and promote their consumption are needed to enhance dietary quality and ensure optimal growth, health and cognitive development in young Malawian children.