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Abd Almonaem ER, Mostafa MA, El-Shimi OS, Saeed YA, Abdulsamea S. Effectiveness of zinc protoporphyrin/heme ratio and ferritin for assessing iron status in preterm infants. J Neonatal Perinatal Med 2023; 16:627-638. [PMID: 38143383 DOI: 10.3233/npm-230161] [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] [Indexed: 12/26/2023]
Abstract
BACKGROUND Since iron is crucial for many tissue processes, we, therefore, aimed to assess ferritin and the zinc protoporphyrin to heme ratio (ZnPP/H) as indicators of iron status in preterm newborns, particularly during certain inflammatory episodes. METHODS From 170 preterm babies, paired ferritin and ZnPP/H measurements were collected twice (on the first postnatal day and six weeks later). To compare these measures and assess the impact of anemia, sepsis, and packed red blood cell transfusion (PRBT), three different scenarios were considered. RESULTS Compared to the non-anemic group, the anemic patients' serum ferritin level was considerably lower (p = 0.044), whereas the anemic patients' ZPP/H ratio was significantly greater (p < 0.001). In neonates with sepsis, ferritin levels were considerably greater in both anemic and non-anemic septic neonates compared to neonates without sepsis (p < 0.001 for each). Regarding ZPP/H ratio, no appreciable variations were found between the two groups. In addition, serum ferritin significantly increased following each PRBT (p < 0.001 for each). As a result of each PRBT, the ZPP/H ratio considerably decreased (p < 0.001). CONCLUSION As a measure of iron status during particular inflammatory processes like infection and PRBT, ZnPP/H may be more accurate.
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Affiliation(s)
- E R Abd Almonaem
- Pediatric department, Benha Faculty of Medicine, Benha University, Banha, Egypt
| | - M A Mostafa
- Pediatric department, Benha Faculty of Medicine, Benha University, Banha, Egypt
| | - O S El-Shimi
- Clinical and Chemical Pathology Department, Benha Faculty of Medicine, Benha University, Banha, Egypt
| | - Y A Saeed
- Faculty of Medicine, Benha University, Banha, Egypt
| | - Sameh Abdulsamea
- Pediatric department, Benha Faculty of Medicine, Benha University, Banha, Egypt
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Sanjeevi N, Freeland-Graves JH. The Special Supplemental Nutrition Program for Women, Infants, and Children food package revisions and anemia in children aged 2-5 years. Am J Clin Nutr 2022; 116:1030-1037. [PMID: 36055958 DOI: 10.1093/ajcn/nqac141] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/11/2022] [Accepted: 05/09/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional assistance to low-income women and children in the United States. The WIC food package was revised to align more closely to dietary recommendations in October 2009. The revised package included more fruits, vegetables, whole grains, and low-fat milk. OBJECTIVES The objective of this study was to examine the association of the revised WIC package with anemia indicators and iron intake in children. METHODS A quasi-experimental difference-in-difference design compared anemia and iron intake variables between WIC (n = 1497 and n = 1626 for anemia and iron intake variables, respectively) and WIC-eligible nonparticipating children (n = 1183 and n = 1322 for anemia and iron intake variables, respectively), aged 2-5 y, before and after the 2009 revisions. The NHANES 2003-2008 and 2011-2018 data represented the period pre- and post-2009 revisions, respectively. RESULTS The 2009 package revisions were significantly associated with reduced probability of anemia (-4.3% points; 95% CI: -7.5, -1.1% points) and nonthalassemic microcytic anemia (-1.7% points; 95% CI: -3.3, -0.1% points) in children from WIC-participating households. The revised WIC package also was significantly related to higher nutrient adequacy ratio (0.04; 95% CI: 0.02, 0.07) and greater probability of meeting the RDA (12.1% points; 95% CI: 3.2, 21.0% points) for iron among WIC participants. CONCLUSIONS This study found that the WIC 2009 revisions were associated with lower probability of nonthalassemic microcytic anemia and better adequacy of dietary iron intake, thereby suggesting the beneficial impact of WIC revisions on iron deficiency anemia in children. The current study findings suggest that nutritional policies could play a crucial role in supporting the health of vulnerable children in the United States.
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Affiliation(s)
- Namrata Sanjeevi
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Jeanne H Freeland-Graves
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, TX, USA
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Rajpal S, Kumar A, Rana MJ, Kim R, Subramanian SV. Small area variation in severe, moderate, and mild anemia among women and children: A multilevel analysis of 707 districts in India. Front Public Health 2022; 10:945970. [PMID: 36203697 PMCID: PMC9530333 DOI: 10.3389/fpubh.2022.945970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/23/2022] [Indexed: 01/21/2023] Open
Abstract
India is home to the highest global number of women and children suffering from anemia, with one in every two women impacted. India's current strategy for targeting areas with a high anemia burden is based on district-level averages, yet this fails to capture the substantial small area variation in micro-geographical (small area) units such as villages. We conducted statistical and econometric analyses to quantify the extent of small area variation in the three grades of anemia (severe, moderate, and mild) among women and children across 36 states/union territories and 707 districts of India. We utilized data from the fifth round of the National Family Health Survey conducted in 2019-21. The final analytic sample for analyses was 183,883 children aged 6-59 months and 690,153 women aged 15-49 years. The primary outcome variable for the analysis was the three anemia grades among women and children. We adopted a three-level and four-level logistic regression model to compute variance partitioning of anemia among women and children. We also computed precision-weighted prevalence estimates of women and childhood anemia across 707 districts and within-district, between-cluster variation using standard deviation (SD). For severe anemia among women, small area (villages or urban blocks) account for highest share (46.1%; Var: 0.494; SE: 0.150) in total variation followed by states (39.4%; Var: 0.422; SE: 0.134) and districts (12.8%; Var: 0.156; SE: 0.012). Similarly, clusters account for the highest share in the variation in severe (61.3%; Var: 0.899; SE: 0.069) and moderate (46.4%: Var: 0.398; SE: 0.011) anemia among children. For mild and moderate anemia among women, however, states were the highest source of variation. Additionally, we found a high and positive correlation between mean prevalence and inter-cluster SD of moderate and severe anemia among women and children. In contrast, the correlation was weaker for mild anemia among women (r = 0.61) and children (0.66). In this analysis, we are positing the critical importance of small area variation within districts when designing strategies for targeting high burden areas for anemia interventions.
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Affiliation(s)
- Sunil Rajpal
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea,Department of Economics, FLAME University, Pune, India
| | - Akhil Kumar
- Turner Fenton Secondary School, Brampton, ON, Canada
| | - Md Juel Rana
- Korea University Research and Business Foundation, Seoul, South Korea
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea,Division of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea,Harvard Center for Population and Development Studies, Cambridge, MA, United States,*Correspondence: Rockli Kim
| | - S. V. Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA, United States,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Takele WW, Baraki AG, Wolde HF, Desyibelew HD, Derseh BT, Dadi AF, Mekonnen EG, Akalu TY. Anemia and Contributing Factors in Severely Malnourished Infants and Children Aged between 0 and 59 Months Admitted to the Treatment Centers of the Amhara Region, Ethiopia: A Multicenter Chart Review Study. Anemia 2021; 2021:6636043. [PMID: 33854799 PMCID: PMC8019621 DOI: 10.1155/2021/6636043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/25/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Anemia among severely malnourished children is a double burden that could make the treatment outcome of severe acute malnutrition (SAM) more unfavorable. The burden and the factors are, however, uncovered among children in the Amhara region. Therefore, the study was aimed at determining the prevalence of anemia and identifying contributing factors in severely malnourished children aged between 0 and 59 months admitted to the treatment centers of the Amhara region referral hospitals. METHODS A facility-based cross-sectional study was conducted that included 1,301 infants and children, who developed SAM and were admitted to the three referral hospitals of the Amhara region. Data were extracted using a data extraction checklist. The binary logistic regression analysis was employed to show an association between the dependent and independent variables. Multicollinearity was assessed using the variance inflation factor (VIF) and no problem was detected (overall VIF = 1.67). The presence of association was declared based on the p-value (≤0.05), and the adjusted odds ratio with its respective 95% confidence interval was used to report the direction, as well as the strength of association. RESULTS About 41.43% (95% CI: 38.78%-44.13%) of severely malnourished infants and children have developed anemia, of which around half (47%) of them were under six months old. Rural residence (AOR = 1.56; 95% CI: 1.14-2.12) and HIV infection (AOR = 2.00; 95% CI: 1.04-3.86) were significantly associated with higher odds of anemia. Furthermore, being exclusively breastfed (AOR = 0.57; 95% CI 0.39-0.83) remarkably reduced the likelihood of anemia. CONCLUSIONS This data confirms that anemia among severely malnourished infants and children is a public health problem in the Amhara region. Infants younger than six months were at a higher risk of anemia. Being a rural resident and contracting HIV infection have elevated the occurrence of anemia, whereas being exclusively breastfed decreased the risk. Therefore, the study gives an insight to policymakers and planners to strengthen the existing exclusive breastfeeding practice. Strategies being practiced to prevent HIV transmission and early detection, as well as treatment, should also be strengthened. Furthermore, mothers/caretakers of infants and children residing in the rural areas deserve special attention through delivering nutrition education.
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Affiliation(s)
- Wubet Worku Takele
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adhanom Gebreegziabher Baraki
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hanna Demelash Desyibelew
- Department of Human Nutrition, College of Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Behailu Tariku Derseh
- Department of Public Health, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Abel Fekadu Dadi
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatistics, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA 5001, Australia
| | - Eskedar Getie Mekonnen
- Departent of Reproductive and Child Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Rhodamine-Based Arylpropenone Azo Dyes as Dual Chemosensor for Cu2+/Fe3+ Detection. J Photochem Photobiol A Chem 2020. [DOI: 10.1016/j.jphotochem.2020.112836] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Onyeneho NG, Ozumba BC, Subramanian SV. Determinants of Childhood Anemia in India. Sci Rep 2019; 9:16540. [PMID: 31719548 PMCID: PMC6851096 DOI: 10.1038/s41598-019-52793-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 10/21/2019] [Indexed: 11/09/2022] Open
Abstract
We analyzed a sample of 112714 children from the 2015-2016 Indian National Fertility and Health Survey with available data on hemoglobin. Multinomial logistic regression models were used to establish associations between parent anemia, household characteristics and nutritional intake of children. Linear regression analysis was also conducted to see the link between the household characteristic and childhood nutritional intake on one hand and hemoglobin levels on the other hand. A number of socio-demographic factors, namely maternal age, type of residence and maternal education, as well as wealth index, among others correlate with incidence of childhood anemia. For instance, whereas 52.9% of children in the richest households were anemic, 63.2% of children in the poorest household were anemic (p < 0.001). Mean Vitamin A intake in the last six months was 0.63 (0.626-0.634) which was 0.18% of the recommended intake. Mean iron intake, from sources other than breast milk, in the last 24 hours was 0.29 (0.286-0.294) and 2.42% of the recommended daily intake. Fifty-nine percent (58.5%) of the children surveyed were anemic (Hb level: 9.75 g/dL [9.59-9.91]). Children with anemia were more prone to being iron deficient (odds ratio [OR]: 0.981 (0.961-1.001), Vitamin A deficient (OR: 0.813 (0.794-0.833)), and have lower maternal hemoglobin level (OR: 1.992 (1.957-2.027)). Combining nutritional supplementation and food-fortification programmes with reduction in maternal anemia and family poverty may yield optimal improvement of childhood anemia in India.
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Affiliation(s)
- Nkechi G Onyeneho
- Takemi Program in International Health, Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, Massachusetts, USA. .,Department of Sociology/Anthropology, University of Nigeria, Nsukka, Enugu State, Nigeria.
| | - Benjamin C Ozumba
- Department of Obstetrics and Gynaecology, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, Massachusetts, USA
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Vanlalsanga, Singh SP, Singh YT. Rice of Northeast India harbor rich genetic diversity as measured by SSR markers and Zn/Fe content. BMC Genet 2019; 20:79. [PMID: 31646978 PMCID: PMC6806518 DOI: 10.1186/s12863-019-0780-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rice (Oryza sativa L.) is one of the most important crops of the world and a major staple food for half of the World's human population. The Northeastern (NE) region of India lies in the Indo-Burma biodiversity hotspot and about 45% of the total flora of the country is found in the region. Local rice cultivars from different states of NE India were analyzed for genetic diversity and population structure using microsatellite markers, and their zinc and iron content. RESULTS A total of 149 bands were detected using twenty-two microsatellite markers comprising both random and trait-linked markers, showing 100% polymorphism and high value of expected heterozygosity (0.6311) and the polymorphism information content (0.5895). Nali Dhan cultivar of Arunachal Pradesh possessed the highest genetic diversity (0.3545) among studied populations while Moirangphou Khonganbi of Manipur exhibited the lowest genetic diversity (0.0343). The model-based population structure revealed that all the studied 65 rice cultivars were grouped into two clusters. Cluster I was represented by 36 cultivars and cluster II by 29 cultivars. Badalsali cultivar of Assam possessed the highest Zn content (75.8 μg/g) and Kapongla from Manipur possessed the lowest (17.98 μg/g). The highest and the lowest Fe content was found in Fazu (215.62 μg/g) and Idaw (11.42 μg/g) of Mizoram. CONCLUSION The result suggested rice cultivars of NE India possessing high genetic diversity (Nali dhan), high Zn (Badalsali) and Fe (Fazu) content can be useful as a source of germplasm for future rice improvement programs.
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Affiliation(s)
- Vanlalsanga
- Department of Botany, Mizoram University, Aizawl, Mizoram, India
| | | | - Y Tunginba Singh
- Department of Botany, Mizoram University, Aizawl, Mizoram, India.
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Arnaud A, Lioret S, Vandentorren S, Le Strat Y. Anaemia and associated factors in homeless children in the Paris region: the ENFAMS survey. Eur J Public Health 2019; 28:616-624. [PMID: 29161380 DOI: 10.1093/eurpub/ckx192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Food insecurity is a major concern in homeless population, however nutritional consequences remain poorly documented, especially for children. The objective of this study was to assess the prevalence of anaemia and to investigate the relation between both food insecurity and dietary intake to moderate-to-severe anaemia (MSA) in homeless sheltered children. Methods In 2013, a cross-sectional survey was conducted on a random sample of 801 sheltered homeless families in the Paris region. Haemoglobin concentration was measured in 630 mother/child dyads and questionnaires administrated to mothers collected socio-demographic, socioeconomic, health and dietary data. Factors associated with MSA were analysed in two stratified child age groups; 0.5-5 and 6-12 years old. Results Anaemia was detected in 39.9% of the children and 50.6% of the mothers, and MSA in 22.3% and 25.6%, respectively. In both age groups, MSA was positively associated with maternal MSA. In the 0.5-5 years group, it was also positively associated with child food insecurity, no cooking facilities and household monthly income. In the 6-12 years group, it was positively associated with household food insecurity and children's age. Conclusion A higher food insecurity score was associated with greater prevalence of moderate-to-severe anaemia in children. Considering the high prevalence of anaemia among homeless mothers and their children, these findings highlight the need for reducing food insecurity in shelters so as to prevent anaemia in this vulnerable population.
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Affiliation(s)
- Amandine Arnaud
- Observatoire du Samusocial de Paris, Paris, France.,Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Sandrine Lioret
- Early ORigin of the Child's Health and Development Team (ORCHAD), UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), INSERM, Paris Descartes University, Paris, France
| | - Stéphanie Vandentorren
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France.,Department of Social Epidemiology, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, INSERM, Paris, France
| | - Yann Le Strat
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France
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Abstract
Measurement of serum ferritin (SF) is currently the laboratory test recommended for diagnosing iron deficiency. In the absence of an associated disease, a low SF value is an early and highly specific indicator of iron deficiency. The WHO criteria proposed to define depleted storage iron are 12μg/L for children under 5 years and 15μg/L for those over 5 years. A higher threshold of 30μg/L is used in the presence of infection or inflammation. Iron deficiency anemia, with typical low mean corpuscular volume and mean corpuscular hemoglobin, is only present at the end stage of iron deficiency. Other diagnostic tests for iron deficiency including iron parameters (low serum iron, increased total iron-binding capacity, low transferrin saturation) and erythrocyte traits (low mean corpuscular volume, increased zinc protoporphyrin) provide little additional diagnostic value over SF. In children, serum soluble transferrin receptor (sTfR) has been reported to be a sensitive indicator of iron deficiency and is relatively unaffected by inflammation. On the other hand, sTfR is directly related to extent of erythroid activity and not commonly used in clinical practice. In population surveys, approaches based on combinations of markers have been explored to improve the specificity and sensitivity of diagnostic. In addition to Hb value determination, a combination of parameters (among transferrin saturation, zinc protoporphyrin, mean corpuscular volume or serum ferritin) was generally used to assess iron deficiency. More recently sTfR/ ferritin index were evaluated, sTfR in conjunction with SF allowing to better distinguishing iron deficiency from inflammatory anemia. Also, hepcidin measurements appeared an interesting marker for diagnosing iron deficiency and identifying individuals in need of iron supplementation in populations where inflammatory or infectious diseases are frequently encountered. Reticulocyte Hb content (CHr) determination is an early parameter of iron deficiency erythropoiesis. CHr can be measured with several automated hematology analyzers and so, used for individual's iron status assessment. In addition to Hb concentration determination, individual's iron status is commonly assessed in the pediatric clinical practice by the SF measurement accompanied by the determination of C-reactive protein for detection of a simultaneous acute infection and/or inflammation.
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Affiliation(s)
- I Thuret
- Service d'onco-hématologie pédíatrique, CHU Timone Enfants, centre de référence des thalassémies, 264, rue Saint-Pierre, 13005 Marseille, France.
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El Amin Aissiou MY, Assami MK, El Hadi Cherifi M, Djennadi N, Aroua H, Bitam A. Prolonged exclusive lactation and low educational level of mothers as potential risk factors for the occurrence of iron deficiency anemia among young Algerian preschool children living in poor rural area (Djelfa). MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2017. [DOI: 10.3233/mnm-16104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mohammed Yehya El Amin Aissiou
- Laboratory of Human Nutrition and food Technology of Algiers, High National School of Agronomy of El Harrach, Street of Hassan Badi El Harrach, Algiers, Algeria
| | - Mustapha Kamel Assami
- Laboratory of Human Nutrition and food Technology of Algiers, High National School of Agronomy of El Harrach, Street of Hassan Badi El Harrach, Algiers, Algeria
| | | | | | - Hayet Aroua
- Clinical Laboratory of Larbaa, Larbaa, Blida, Algeria
| | - Arezki Bitam
- Laboratory of Human Nutrition and food Technology of Algiers, High National School of Agronomy of El Harrach, Street of Hassan Badi El Harrach, Algiers, Algeria
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Tooley UA, Makhoul Z, Fisher PA. Nutritional status of foster children in the U.S.: Implications for cognitive and behavioral development. CHILDREN AND YOUTH SERVICES REVIEW 2016; 70:369-374. [PMID: 28626279 PMCID: PMC5472390 DOI: 10.1016/j.childyouth.2016.10.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Children in foster care are at greater risk for poor health, physical, cognitive, behavioral, and developmental outcomes than are children in the general population. Considerable research links early nutrition to later cognitive and behavioral outcomes. The aim of this narrative review is to examine the prevalence of poor nutrition and its relation to subsequent health and development in foster children. METHOD Relevant studies for inclusion were identified from numerous sources (e.g., PubMed, Google Scholar, and reference sections). Inclusion criteria were studies published between 1990 and 2016 of (i) the nutritional status of children in foster care or (ii) the nutritional status of children exposed to early adversity (e.g., low-income and internationally adopted children) or (iii) the developmental effects of poor nutrition and micronutrient deficiencies. RESULTS Two key findings that have adverse implications for cognitive development emerged: (i) the prevalence of anemia and iron-deficiency anemia is higher among foster children than among the general population of children in the U.S., and (ii) the developmental demands of catch-up growth post-placement may lead to micronutrient deficiencies even after children have begun sufficient dietary intake of these nutrients. Moreover, there is a paucity of recent studies on the nutritional status of children in foster care, despite the multiple factors that may place them at risk for malnutrition. CONCLUSION Attention to nutritional status among care providers and medical professionals may remove one of the possible negative influences on foster children's development and in turn significantly alter their trajectories and place them on a more positive path early in life. Recommendations for further research, policy, and practice are discussed.
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Affiliation(s)
- Ursula A. Tooley
- Department of Psychology, University of Oregon, UO Prevention Science Institute, 6217 University of Oregon, Eugene, OR 97403, USA
| | - Zeina Makhoul
- SPOON Foundation, 135 SE Main St, Suite 201, Portland, OR 97214, USA
| | - Philip A. Fisher
- Department of Psychology, University of Oregon, UO Prevention Science Institute, 6217 University of Oregon, Eugene, OR 97403, USA
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Kumar T, Taneja S, Sachdev HPS, Refsum H, Yajnik CS, Bhandari N, Strand TA. Supplementation of vitamin B12 or folic acid on hemoglobin concentration in children 6-36 months of age: A randomized placebo controlled trial. Clin Nutr 2016; 36:986-991. [PMID: 27486122 DOI: 10.1016/j.clnu.2016.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/30/2016] [Accepted: 07/06/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS The main objective of this report is to measure to what extent folate or vitamin B12 given daily for 6 months to young North Indian Children improves hemoglobin (Hb) concentration. METHODS In a randomized placebo controlled trial in low-to-middle income neighborhoods in New Delhi, India, children were randomized into four groups in a 1:1:1:1 ratio and supplemented daily for 6 months with 2 RDAs of vitamin B12, folic acid, both, or placebo. All children with anemia at baseline were given iron supplementation daily for 2 months. We measured the plasma concentrations of soluble transferrin receptor (sTfR), folate, vitamin B12, total homocysteine (tHcy) and Hb in 262 children. RESULTS Mean Hb concentration decreased in all four study groups during the six months of follow up and supplementation of either or both of the vitamins did not improve the Hb concentration. Iron supplements for the initial 2 mo had limited effect on anemia at 6 mo as almost 90% were still anemic at study end. CONCLUSION Supplementation of folic acid and/or vitamin B12 for 6 months does not improve Hb concentration in young children. Our findings do not argue for widespread vitamin B12 or folic acid supplementation to combat anemia. Our results also call for alternative strategies to improve iron status and treat iron deficiency anemia. CLINICAL TRIAL REGISTRY NCT00717730 at www.clinicaltrials.gov, CTRI No.: CTRI/2010/091/001090 at www.ctri.nic.in.
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Affiliation(s)
- Tivendra Kumar
- Society for Essential Health Action and Training, New Delhi, India
| | | | - H P S Sachdev
- Department of Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Helga Refsum
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway
| | | | | | - Tor A Strand
- Innlandet Hospital Trust, Lillehammer, Norway; Centre for International Health, University of Bergen, Norway.
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Using Soluble Transferrin Receptor and Taking Inflammation into Account When Defining Serum Ferritin Cutoffs Improved the Diagnosis of Iron Deficiency in a Group of Canadian Preschool Inuit Children from Nunavik. Anemia 2016; 2016:6430214. [PMID: 27382488 PMCID: PMC4921626 DOI: 10.1155/2016/6430214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/27/2016] [Accepted: 05/15/2016] [Indexed: 11/17/2022] Open
Abstract
The prevalence of iron depletion, iron deficient erythropoiesis (IDE), and iron deficiency anemia (IDA) was assessed in preschool Inuit children using soluble transferrin receptor (sTfR) and traditional indicators of iron status while disregarding or taking inflammation into account when defining SF cutoffs. Iron depletion was defined as follows: (1) SF < 15 μg/L regardless of the C-reactive protein (CRP) level and (2) SF < 15 or <50 μg/L with CRP ≤ 5 or >5 mg/L, respectively. IDE corresponded to iron depletion combined with total iron binding capacity > 72 μmol/L and/or transferrin saturation < 16%. Iron depletion and IDE affected almost half of the children when accounting for inflammation, compared to one-third when the SF cutoff was defined regardless of CRP level (P < 0.0001). The prevalence of IDE adjusted for inflammation (45.1%) was very similar to the prevalence observed when sTfR was used as a sole marker of IDE (47.4%). The prevalence of anemia was 15%. The prevalence of IDA (IDE + hemoglobin < 110 g/L) was higher when accounting for than when disregarding inflammation (8.0% versus 6.2%, P = 0.083). Using sTfR and different SF cutoffs for children with versus without inflammation improved the diagnosis of iron depletion and IDE. Our results confirm that Inuit children are at particularly high risk for iron deficiency.
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Factors associated with anemia in children under three years of age in Perú: analysis of the Encuesta Demográfica y de Salud Familiar, ENDES, 2007-2013. BIOMEDICA 2016; 36:220-9. [PMID: 27622483 DOI: 10.7705/biomedica.v36i2.2896] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/18/2015] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Despite the reduction of poverty in Perú, the prevalence of anemia in the country remains high. OBJECTIVE To identify socio-demographic, child and maternal-child care factors associated with anemia in children between 6 and 35 months in Perú. MATERIALS AND METHODS We conducted an analytical and descriptive study that included registered data from the national survey on demography and family health, 2007-2013, on children between 6 and 35 months old, including the measurement of blood hemoglobin. Anemia was confirmed by hemoglobin-altitude corrected values below 11 mg/dl. We used multivariate logistic regression models to assess potential associated factors for anemia. RESULTS Anemia prevalence was high (47.9%). Twelve factors were independently associated with anemia in children: Socio-demographic factors such as living outside Lima and Callao, in a low socioeconomic household, and having an adolescent mother with low education level; child-related factors as being male, younger than 24 months of age, and having fever in the previous two weeks, and maternal-child care factors such as lack of prenatal control in the first trimester of pregnancy, lack or short period of iron supplementation during pregnancy, house delivery, anemia detection at the moment of the survey, and lack of intestinal anti-parasite preventive treatment in the child. CONCLUSIONS The analysis of survey data provided valuable information about factors associated with anemia in children between 6 and 35 months, which can be used to increase the coverage and effectiveness of maternal-child care practices.
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Kerling EH, Souther LM, Gajewski BJ, Sullivan DK, Georgieff MK, Carlson SE. Reducing Iron Deficiency in 18-36-months-old US Children: Is the Solution Less Calcium? Matern Child Health J 2016; 20:1798-803. [PMID: 26987860 DOI: 10.1007/s10995-016-1982-4] [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: 10/22/2022]
Abstract
Objectives National surveys consistently identify iron deficiency (ID) in US children between 1 and 3 years of age, when the brain is rapidly developing and vulnerable to the effects of ID. However, controversy remains as to how best to recognize and prevent ID in young children, in part because of the multiple potential etiologies. The objective of this project was to assess ID in children and identify potential individual dietary predictors of status. Methods We examined three biomarkers of ID [soluble transferrin receptor (sTfR) and serum ferritin (SF), and body iron (calculated from sTfR and SF)] against parent-provided dietary calcium and iron intake for eight-three 18-36 month old children from middle class families. Results Using literature-based cutoffs, fourteen children (16.9 %) had at least one indicator of ID: low SF(<10 μg/l, 7.2 %), negative body iron (<0 mg/kg, 7.2 %) or elevated sTfR (>8.4 μg/ml, 13.2 %). All children consumed more than the Dietary Reference Intake (DRI) Estimated Average Requirement of 3 mg/d iron. The mean iron intake of children identified with ID approximated the Recommended Dietary Allowance of 7 mg/d. Most children (81 %) consumed above the DRI Adequate Intake of 500 mg/d of calcium. Calcium intakes were generally high and predicted lower body iron (p = 0.0005), lower SF (p = 0.0086) and higher sTfR (p = 0.0176). Conclusions for Practice We found rates of ID similar to US national averages. Dietary calcium intake predicted lower iron status more than deficits in iron intake. Teaching parents to balance calcium and iron intake in toddlers could be a strategy to prevent ID.
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Affiliation(s)
- Elizabeth H Kerling
- Department of Dietetics and Nutrition, University of Kansas Medical Center, MS 4013, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Laura M Souther
- Department of Dietetics and Nutrition, University of Kansas Medical Center, MS 4013, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Byron J Gajewski
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, MS 4013, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | | | - Susan E Carlson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, MS 4013, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
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16
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Mhanna RG, Rahal M, Iskandarani M, Hammoudi D. Incidence and risk factors associated with iron deficiency anaemia among hospitalised Lebanese infants. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2015; 24:203-8. [PMID: 26671320 DOI: 10.1111/ijpp.12236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/24/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The primary objective of this study was to determine the prevalence of iron deficiency anaemia (IDA) in hospitalised 6- to 24-month-old infants in rural versus urban settings. The secondary objective was to determine associated risk factors in rural versus urban settings. METHODS A 6-month prospective multicentre cross-sectional study was conducted in paediatrics departments of three Lebanese hospitals. Preterm to term infants aged 6-24 months were included. Infants with blood disorders, chronic infections, congenital immunodeficiency and mental or congenital growth retardation were excluded. Incidence of IDA was assessed using haematologic laboratory values, while risk factors were assessed using questionnaires addressed to infants' caregivers. For data analysis, P values, chi-squared and logistic regression were used. KEY FINDINGS Among 520 screened infants, a total of 100 patients were selected. Thirty-seven per cent of patients were anaemic with haemoglobin levels <11 g/dl. Significant risk factors included: exclusive breastfeeding for more than 6 months (95% CI, 1.03 to 8.9; P = 0.043), low family income (95% CI, 0.19 to 0.98; P = 0.045), residing in rural areas (95% CI, 0.064 to 0.0509; P < 0.001), inadequate maternal iron supply (95% CI, 1.01 to 8.26; P = 0.05), low maternal education level (95% CI, 0.07 to 0.88; P = 0.03) and lack of infant iron supply (95% CI, 1.39 to 8.41; P = 0.007). CONCLUSION Incidence of IDA among Lebanese infants is moderate and multifactorial. High maternal education level, urban residence, giving iron supplements to exclusively breastfed infants starting from 6 months of age, adequate family income and iron supplementation in both mother and infant are significant protective factors against anaemia in this population.
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Affiliation(s)
| | - Mohamad Rahal
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | | | - Dalal Hammoudi
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
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17
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Chandyo RK, Henjum S, Ulak M, Thorne-Lyman AL, Ulvik RJ, Shrestha PS, Locks L, Fawzi W, Strand TA. The prevalence of anemia and iron deficiency is more common in breastfed infants than their mothers in Bhaktapur, Nepal. Eur J Clin Nutr 2015; 70:456-62. [PMID: 26626049 PMCID: PMC4827010 DOI: 10.1038/ejcn.2015.199] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 12/02/2022]
Abstract
Background/Objectives: Iron deficiency anemia is a widespread public health problem, particularly in low- and middle-income countries. Maternal iron status around and during pregnancy may influence infant iron status. We examined multiple biomarkers to determine the prevalence of iron deficiency and anemia among breastfed infants and explored its relationship with maternal and infant characteristics in Bhaktapur, Nepal. Subjects/Methods: In a cross-sectional survey, we randomly selected 500 mother–infant pairs from Bhaktapur municipality. Blood was analyzed for hemoglobin, ferritin, total iron-binding capacity, transferrin receptors and C-reactive protein. Results: The altitude-adjusted prevalence of anemia was 49% among infants 2–6-month-old (hemaglobin (Hb) <10.8 g/dl) and 72% among infants 7–12-month-old (Hb <11.3 g/dl). Iron deficiency anemia, defined as anemia and serum ferritin <20 or <12 μg/l, affected 9 and 26% of infants of these same age groups. Twenty percent of mothers had anemia (Hb <12.3 g/dl), but only one-fifth was explained by depletion of iron stores. Significant predictors of infant iron status and anemia were infant age, sex and duration of exclusive breastfeeding and maternal ferritin concentrations. Conclusions: Our findings suggest that iron supplementation in pregnancy is likely to have resulted in a low prevalence of postpartum anemia. The higher prevalence of anemia and iron deficiency among breastfed infants compared with their mothers suggests calls for intervention targeting newborns and infants.
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Affiliation(s)
- R K Chandyo
- Centre for International Health, University of Bergen, Bergen, Norway.,Department of Community Medicine, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
| | - S Henjum
- Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - M Ulak
- Department of Child Health, Institute of Medicine, Kathmandu, Nepal
| | - A L Thorne-Lyman
- WorldFish, Malaysia, Bayan Lepas, Malaysia.,Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - R J Ulvik
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - P S Shrestha
- Department of Child Health, Institute of Medicine, Kathmandu, Nepal
| | - L Locks
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - W Fawzi
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.,Department of Epidemiology and Global Health and Population, Harvard School of Public Health
| | - T A Strand
- Centre for International Health, University of Bergen, Bergen, Norway.,Innlandet Hospital Trust, Lillehammer, Norway
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18
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Beard J, deRegnier RA, Shaw MD, Rao R, Georgieff M. Diagnosis of Iron Deficiency in Infants. Lab Med 2015. [DOI: 10.1309/7kj11rx758uklxxm] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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19
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Salarkia N, Neyestani TR, Omidvar N, Zayeri F. Household Food Insecurity, Mother's Feeding Practices, and the Early Childhood's Iron Status. Int J Prev Med 2015; 6:86. [PMID: 26445633 PMCID: PMC4587075 DOI: 10.4103/2008-7802.164414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 05/14/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Health consequences of food insecurity among infants and toddlers have not been fully examined. The purpose of this study was to assess the relationship between household food insecurity, mother's infant feeding practices and iron status of 6-24 months children. METHODS In this cross-sectional study, 423 mother-child pairs were randomly selected by multistage sampling method. Children blood samples were analyzed for hemoglobin and serum ferritin concentrations. Household food security was evaluated using a validated Household Food Insecurity Access Scale. The mother's feeding practices were evaluated using Infant and Young Child Feeding practice variables including: The duration of breastfeeding and the time of introducing of complementary feeding. RESULTS Based on the results, of the studied households only 47.7% were food secure. Mild and moderate-severe household food insecurity was 39.5% and 12.8%, respectively. Anemia, iron deficiency (ID), and iron deficiency anemia were seen in 29.1%, 12.2%, and 4.8% of children, respectively. There was no significant association between household food insecurity; mother's feeding practices and child ID with or without anemia. CONCLUSIONS We found no association between household food insecurity and the occurrence of anemia in the 6-24 months children. However, these findings do not rule out the possibility of other micronutrient deficiencies among the food-insecure household children.
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Affiliation(s)
- Nahid Salarkia
- Department of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tirang R Neyestani
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Omidvar
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- Deptartment of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Iran
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20
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Abdullah K, Thorpe KE, Maguire JL, Birken CS, Fehlings D, Hanley AJ, Parkin PC. Risk factors, practice variation and hematological outcomes of children identified with non-anemic iron deficiency following screening in primary care setting. Paediatr Child Health 2015; 20:302-6. [PMID: 26435669 PMCID: PMC4578469 DOI: 10.1093/pch/20.6.302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine the prevalence, risk factors, physician practice patterns and longitudinal hematological outcome of children following screening for non-anemic iron deficiency (NAID). METHODS The present analysis was a longitudinal cohort study invovling healthy children one to five years of age. Descriptive statistics were used to describe the prevalence, risk factors, practice patterns and hematological outcome of children identified with NAID. The association between NAID and potential risk factors were examined using multivariate logistic regression analysis. RESULTS Of 2276 children undergoing screening, 155 had NAID, corresponding to a prevalence of 7% (95% CI 5.95% to 8.05%). Risk factors significantly associated with NAID included: younger age (OR 1.08 [95% CI 1.06 to 1.11]), higher body mass index z-score (OR 1.22 [95% CI 1.01 to 1.48]), longer duration of breastfeeding (OR 1.05 [95% CI 1.01 to 1.08]) and increased volume of cow's milk intake (OR 1.13 [95% CI 1.01 to 1.26]). An assessment of practice patterns revealed that for 37% of children, an intervention for NAID was documented; and for 8.4% a physician-ordered follow-up laboratory test was completed to re-evaluate iron status. A total of 58 (37%) children underwent a follow-up laboratory test, of whom 38 (65.5%) had resolution of NAID, 15 (25.9%) had persistence of NAID and two (3.4%) had progression of NAID to anemia. CONCLUSION NAID is common in early childhood and is associated with modifiable risk factors. Substantial practice variation exists in the management of NAID. Further research is necessary to understand the benefits of screening for NAID and evidence-informed practice guidelines may reduce practice variation in the management of NAID in early childhood.
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Affiliation(s)
- Kawsari Abdullah
- Pediatrics Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
| | - Kevin E Thorpe
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Jonathon L Maguire
- Pediatrics Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
- Department of Pediatrics, St Michael’s Hospital, University of Toronto, Toronto, Ontario
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Catherine S Birken
- Pediatrics Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario
| | - Darcy Fehlings
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
- Division of Developmental Pediatrics, Holland Bloorview Kids Rehabilitation Hospital and Bloorview Research Institute, Toronto, Ontario
| | - Anthony J Hanley
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario
| | - Patricia C Parkin
- Pediatrics Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario
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21
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Chandyo RK, Ulak M, Adhikari RK, Sommerfelt H, Strand TA. Prevalence of Iron Deficiency and Anemia among Young Children with Acute Diarrhea in Bhaktapur, Nepal. Healthcare (Basel) 2015; 3:593-606. [PMID: 27417782 PMCID: PMC4939584 DOI: 10.3390/healthcare3030593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 06/26/2015] [Accepted: 07/14/2015] [Indexed: 11/21/2022] Open
Abstract
Iron deficiency anemia is still common in children under five years of age and may impair their growth and cognitive development. Diarrhea is the second most common reason for seeking medical care for young children in Nepal. However, neither screening programs nor effective preventive measures for anemia and iron deficiencies are in place among children with diarrhea in many developing countries. The aims of this study were to determine the prevalence of anemia and iron deficiency and explore their associations with clinical, socioeconomic, and anthropometric parameters in Nepalese children. This was a cross-sectional study based on 1232 children, six to 35 months old, with acute diarrhea participating in a zinc supplementation trial. The mean (SD) hemoglobin was 11.2 g/dL (1.2). Anemia was found in 493 children (40%); this estimate increased to 641 (52%) when we adjusted for the altitude of the study area (hemoglobin <11.3 g/dL). One in every three children had depleted iron stores and 198 (16%) of the children had both depleted iron stores and anemia, indicating iron deficiency anemia. The prevalence of anemia among children presenting with acute diarrhea was high but the degree of severity was mainly mild or moderate. Iron deficiency explained less than half of the total anemia, indicating other nutritional deficiencies inducing anemia might be common in this population.
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Affiliation(s)
- Ram K Chandyo
- Centre for International Health, University of Bergen, Overlege Danielsens Hus, 5 et. Årstadveien 21, N-5009 Bergen, Norway.
- Community Medicine Department, Kathmandu Medical College, Kathmandu University, Kathmandu P.O. Box 21266, Nepal.
| | - Manjeswori Ulak
- Department of Child Health, Institute of Medicine, Kathmandu P.O. Box 1524, Nepal.
| | - Ramesh K Adhikari
- Department of Pediatrics, Kathmandu Medical College, Kathmandu University, Kathmandu P.O. Box 21266, Nepal.
| | - Halvor Sommerfelt
- Centre for International Health, University of Bergen, Overlege Danielsens Hus, 5 et. Årstadveien 21, N-5009 Bergen, Norway.
| | - Tor A Strand
- Centre for International Health, University of Bergen, Overlege Danielsens Hus, 5 et. Årstadveien 21, N-5009 Bergen, Norway.
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22
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Abdullah K, Thorpe KE, Mamak E, Maguire JL, Birken CS, Fehlings D, Hanley AJ, Macarthur C, Zlotkin SH, Parkin PC. Optimizing early child development for young children with non-anemic iron deficiency in the primary care practice setting (OptEC): study protocol for a randomized controlled trial. Trials 2015; 16:132. [PMID: 25873050 PMCID: PMC4389731 DOI: 10.1186/s13063-015-0635-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/05/2015] [Indexed: 11/15/2022] Open
Abstract
Background Three decades of research suggests that prevention of iron deficiency anemia (IDA) in the primary care setting may be an unrealized and unique opportunity to prevent poor developmental outcomes in children. A longitudinal study of infants with IDA showed that the developmental disadvantage persists long term despite iron therapy. Early stages of iron deficiency, termed non-anemic iron deficiency (NAID), provide an opportunity for early detection and treatment before progression to IDA. There is little research regarding NAID, which may be associated with delayed development in young children. The aim of this study is to compare the effectiveness of four months of oral iron treatment plus dietary advice, with placebo plus dietary advice, in improving developmental outcomes in children with NAID and to conduct an internal pilot study. Methods/Design From a screening cohort, those identified with NAID (hemoglobin ≥110 g/L and serum ferritin <14 μg/L) are invited to participate in a pragmatic, multi-site, placebo controlled, blinded, parallel group, superiority randomized trial. Participating physicians are part of a primary healthcare research network called TARGet Kids! Children between 12 and 40 months of age and identified with NAID are randomized to receive four months of oral iron treatment at 6 mg/kg/day plus dietary advice, or placebo plus dietary advice (75 per group). The primary outcome, child developmental score, is assessed using the Mullen Scales of Early Learning at baseline and at four months after randomization. Secondary outcomes include an age appropriate behavior measure (Children’s Behavior Questionnaire) and two laboratory measures (hemoglobin and serum ferritin levels). Change in developmental and laboratory measures from baseline to the end of the four-month follow-up period will be analyzed using linear regression (analysis of covariance method). Discussion This trial will provide evidence regarding the association between child development and NAID, and the effectiveness of oral iron to improve developmental outcomes in children with NAID. The sample size of the trial will be recalculated using estimates taken from an internal pilot study. Trial registration This trial was registered with Clinicaltrials.gov (identifier: NCT01481766) on 22 November 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0635-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kawsari Abdullah
- Pediatric Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3 M6, Toronto, Canada.
| | - Kevin E Thorpe
- Li Ka Shing Knowledge Institute of St Michael's Hospital, 30 Bond Street, M5B 1 W8, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, M5T 3 M7, Toronto, Canada.
| | - Eva Mamak
- Department of Psychology, The Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, Canada.
| | - Jonathon L Maguire
- Pediatric Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3 M6, Toronto, Canada. .,Li Ka Shing Knowledge Institute of St Michael's Hospital, 30 Bond Street, M5B 1 W8, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, M5T 3 M7, Toronto, Canada. .,Department of Pediatrics, St Michael's Hospital, University of Toronto, 30 Bond Street, M5B 1 W8, Toronto, Canada. .,Department of Pediatrics, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2109, M5S 1A8, Toronto, Canada.
| | - Catherine S Birken
- Pediatric Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3 M6, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, M5T 3 M7, Toronto, Canada. .,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, M5G 0A4, Toronto, Canada. .,Department of Pediatrics, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2109, M5S 1A8, Toronto, Canada.
| | - Darcy Fehlings
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3 M6, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, M5T 3 M7, Toronto, Canada. .,Division of Developmental Pediatrics, Holland Bloorview Kids Rehabilitation Hospital, and Bloorview Research Institute, 150 Kilgour Road, M4G 1R8, Toronto, Canada. .,Department of Pediatrics, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2109, M5S 1A8, Toronto, Canada.
| | - Anthony J Hanley
- Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, M5T 3 M7, Toronto, Canada. .,Department of Nutritional Sciences, University of Toronto, FitzGerald Building, 150 College Street, Room 316, M5S 3E2, Toronto, Canada. .,Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2109, M5S 1A8, Toronto, Canada.
| | - Colin Macarthur
- Pediatric Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3 M6, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, M5T 3 M7, Toronto, Canada. .,Department of Pediatrics, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2109, M5S 1A8, Toronto, Canada. .,Research Institute, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, M5G 0A4, Toronto, Canada.
| | - Stanley H Zlotkin
- Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, M5T 3 M7, Toronto, Canada. .,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, M5G 0A4, Toronto, Canada. .,Department of Pediatrics, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2109, M5S 1A8, Toronto, Canada. .,Department of Nutritional Sciences, University of Toronto, FitzGerald Building, 150 College Street, Room 316, M5S 3E2, Toronto, Canada. .,Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, 555 University Avenue, M5G 1X8, Toronto, Canada.
| | - Patricia C Parkin
- Pediatric Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street Suite 425, M5T 3 M6, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street 6th floor, M5T 3 M7, Toronto, Canada. .,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, M5G 0A4, Toronto, Canada. .,Department of Pediatrics, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2109, M5S 1A8, Toronto, Canada.
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McDonagh MS, Blazina I, Dana T, Cantor A, Bougatsos C. Screening and routine supplementation for iron deficiency anemia: a systematic review. Pediatrics 2015; 135:723-33. [PMID: 25825534 DOI: 10.1542/peds.2014-3979] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Supplementation and screening for iron-deficiency anemia (IDA) in young children may improve growth and development outcomes. The goal of this study was to review the evidence regarding the benefits and harms of screening and routine supplementation for IDA for the US Preventive Services Task Force. METHODS We searched Medline and Cochrane databases (1996-August 2014), as well as reference lists of relevant systematic reviews. We included trials and controlled observational studies regarding the effectiveness and harms of routine iron supplementation and screening in children ages 6 to 24 months conducted in developed countries. One author extracted data, which were checked for accuracy by a second author. Dual quality assessment was performed. RESULTS No studies of iron supplementation in young children reported on the diagnosis of neurodevelopmental delay. Five of 6 trials sparsely reporting various growth outcomes found no clear benefit of supplementation. After 3 to 12 months, Bayley Scales of Infant Development scores were not significantly different in 2 trials. Ten trials assessing iron supplementation in children reported inconsistent findings for hematologic measures. Evidence regarding the harms of supplementation was limited but did not indicate significant differences. No studies assessed the benefits or harms of screening or the association between improvement in impaired iron status and clinical outcomes. Studies may have been underpowered, and control factors varied and could have confounded results. CONCLUSIONS Although some evidence on supplementation for IDA in young children indicates improvements in hematologic values, evidence on clinical outcomes is lacking. No randomized controlled screening studies are available.
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Affiliation(s)
- Marian S McDonagh
- Department of Medical Informatics & Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Ian Blazina
- Department of Medical Informatics & Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Tracy Dana
- Department of Medical Informatics & Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Amy Cantor
- Department of Medical Informatics & Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Christina Bougatsos
- Department of Medical Informatics & Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
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Bock F, Borucki K, Vorwerk P, Biemann R, Isermann B. A two-and-a-half-year-old breastfed toddler presenting with anemia: a case report. BMC Res Notes 2014; 7:917. [PMID: 25514884 PMCID: PMC4300836 DOI: 10.1186/1756-0500-7-917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anemia is a common presentation in children but the differential diagnosis of iron deficiency and β-thalassemia remains a diagnostic challenge. Red blood cell indices have been shown to perform weakly in such scenarios. One potential cause is breastfeeding, but the evidence for unusually prolonged exclusive breastfeeding as a cause of iron deficiency anemia in older (>2 years) toddlers is sparse and the association of breastfeeding with iron deficiency in this age group of older toddlers is not unequivocally established. In this case we describe an unusual cause of nutritional iron deficiency anemia in the age group of 2-3 years. CASE PRESENTATION We describe a two-and-a-half-year-old Turkish boy who presented to our outpatient clinic with recurrent diarrhea and anemia. The patient was febrile (99.1°F) with pale skin and signs of mild dehydration. A reduced nutritional status with a weight of 11.5 kg between the 3rd and 10th percentile was noted. Nutritional evaluation revealed that the boy was still exclusively breastfed with more than 6 times breastfeedings per day. Iron supplementation ameliorated the anemia and reduced hypochromic red blood cells. CONCLUSION The case demonstrates that unusually prolonged (longer than two years) exclusive breastfeeding is a potential cause of iron deficiency anemia in older toddlers. We discuss a simple combination of laboratory tests with ferritin and red cell distribution width that together with a nutritional evaluation provide a quick diagnosis and show that even at such an advanced stage of nutritional iron deficiency oral iron supplementation is an effective treatment.
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Affiliation(s)
| | | | | | | | - Berend Isermann
- Department of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke-University, Leipziger Straße 44, 39120 Magdeburg, Germany.
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Desalegn A, Mossie A, Gedefaw L. Nutritional iron deficiency anemia: magnitude and its predictors among school age children, southwest Ethiopia: a community based cross-sectional study. PLoS One 2014; 9:e114059. [PMID: 25438147 PMCID: PMC4250059 DOI: 10.1371/journal.pone.0114059] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 11/03/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Iron deficiency anemia (IDA) is a global public health problem among school age children, which retards psychomotor development and impairs cognitive performance. There is limited data on prevalence and risk factors for IDA. OBJECTIVE The aim of this study was to determine the prevalence, severity, and predictors of nutritional IDA in school age children in Southwest Ethiopia. METHODOLOGY A community based cross-sectional study was conducted in Jimma Town, Southwest Ethiopia from April to July 2013. A total of 616 school children aged 6 to 12 years were included in the study using multistage sampling technique. A structured questionnaire was used to collect sociodemographic data. Five milliliter venous blood was collected from each child for hematological examinations. Anemia was defined as a hemoglobin level lower than 11.5 g/dl and 12 g/dl for age group of 5-11 years and 12-15 years, respectively. Iron deficiency anemia was defined when serum iron and ferritin levels are below 10 µmol/l and 15 µg/dl, respectively. Moreover, fresh stool specimen was collected for diagnosis of intestinal parasitic infection. Stained thick and thin blood films were examined for detection of Plasmodium infection and study of red blood cell morphology. Dietary patterns of the study subjects were assessed using food frequency questionnaire and anthropometric measurements were done. Data were analyzed using SPSS V-20.0 for windows. RESULT Overall, prevalence of anemia was 43.7%, and that of IDA was 37.4%. Not-consuming protein source foods [AOR = 2.30, 95%CI(1.04,5.14)], not-consuming dairy products [AOR = 1.83, 95%CI(1.14,5.14)], not-consuming discretionary calories [AOR = 2.77, 95%CI(1.42,5.40)], low family income [AOR = 6.14, 95%CI(2.90,12.9)] and intestinal parasitic infections [AOR = 1.45, 95%CI(1.23, 5. 27)] were predictors of IDA. CONCLUSION Iron deficiency anemia is a moderate public health problem in the study site. Dietary deficiencies and intestinal parasitic infections were predictors of IDA. Therefore, emphasis should be given to the strategies for the prevention of risk factors for IDA.
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Affiliation(s)
- Amare Desalegn
- Department of Biomedical Sciences, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Andualem Mossie
- Department of Biomedical Sciences, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Lealem Gedefaw
- Department of Medical Laboratory Science and Pathology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
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Kumar T, Taneja S, Yajnik CS, Bhandari N, Strand TA. Prevalence and predictors of anemia in a population of North Indian children. Nutrition 2014; 30:531-7. [DOI: 10.1016/j.nut.2013.09.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/23/2013] [Accepted: 09/26/2013] [Indexed: 11/29/2022]
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Gong L, Yuan F, Teng J, Li X, Zheng S, Lin L, Deng H, Ma G, Sun C, Li Y. Weight loss, inflammatory markers, and improvements of iron status in overweight and obese children. J Pediatr 2014; 164:795-800.e2. [PMID: 24518166 DOI: 10.1016/j.jpeds.2013.12.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 11/27/2013] [Accepted: 12/03/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the effect of a weight-loss program on improving iron status in overweight and obese school-aged children. STUDY DESIGN The data were analyzed in overweight and obese children (7-11 years of age; 114 girls and 212 boys) with body mass index-for-age z-scores (BAZ) >1 from a weight-loss program. Schools were randomly divided into 2 groups: intervention and control. Children in the intervention group underwent a 1-year, nutrition-based comprehensive intervention weight-loss program. Anthropometric, dietary intake, and physical activity data were collected at baseline and follow-up (1 year). Iron status and inflammatory markers were assessed within a month. RESULTS In the intervention group, BAZ decreased more than that in the control group (-0.4 ± 0.7 vs -0.1 ± 0.6, P < .0001); and iron profiles and inflammation status were improved at follow-up. In multivariable linear regression models, a greater decrease of BAZ and inflammation factors predicted a better improvement of iron status. After adjustment of ΔBAZ, ΔC-reactive protein was significantly associated with Δserum ferritin (β: 1.89; 95% CI, 0.70-3.09; P = .002) and Δsoluble transferrin receptor (β: 0.88; 95% CI, 0.16-0.59; P = .017); Δinterleukin-6 was significantly associated with Δserum ferritin (β: 1.22; 95% CI, 0.64-1.79; P < .0001). CONCLUSIONS Iron status and inflammation were improved by weight reduction. The improvement in inflammatory markers during weight reduction was independently associated with improvements of iron status.
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Affiliation(s)
- Liya Gong
- Departments of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China
| | - Feifei Yuan
- Departments of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China
| | - Jianhua Teng
- Departments of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China; Institute for Tuberculosis Control and Prevention of Harbin, Harbin, China
| | - Xue Li
- Departments of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China
| | - Sining Zheng
- Departments of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China
| | - Liqun Lin
- Departments of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China
| | - Haoyuan Deng
- Departments of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China
| | - Guansheng Ma
- National Institute for Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Changhao Sun
- Departments of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China
| | - Ying Li
- Departments of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, China.
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Grant FKE, Martorell R, Flores-Ayala R, Cole CR, Ruth LJ, Ramakrishnan U, Suchdev PS. Comparison of indicators of iron deficiency in Kenyan children. Am J Clin Nutr 2012; 95:1231-7. [PMID: 22456661 PMCID: PMC4697948 DOI: 10.3945/ajcn.111.029900] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the absence of a feasible, noninvasive gold standard, iron deficiency (ID) is best measured by the use of multiple indicators. However, the choice of an appropriate single iron biomarker to replace the multiple-criteria model for screening for ID at the population level continues to be debated. OBJECTIVE We compared ID defined as ≥ 2 of 3 abnormal ferritin (< 12 μg/L), soluble transferrin receptor (TfR; > 8.3 mg/L), or zinc protoporphyrin (ZP; > 80 μmol/mol) concentrations (ie, multiple-criteria model) with ID defined by abnormal concentrations of any of the independent candidate iron biomarkers (ferritin alone, TfR alone, or ZP alone) and TfR/ferritin index (ID, > 500). Values either were adjusted for inflammation [as measured by C-reactive protein (> 5 mg/L) and α(1)-acid glycoprotein (> 1 g/L) before applying cutoffs for ID] or were unadjusted. DESIGN In this community-based cluster survey, capillary blood was obtained from 680 children (aged 6-35 mo) for measurement of iron status by using ferritin, TfR, and ZP. RESULTS On the basis of the multiple-criteria model, the mean (±SE) prevalence of ID was 61.9 ± 2.2%, whereas the prevalences based on abnormal ferritin, TfR, or ZP concentrations or an abnormal TfR/ferritin index were 26.9 ± 1.7%, 60.9 ± 2.2%, 82.8 ± 1.6%, and 43.1 ± 2.3%, respectively, for unadjusted values. The prevalences of ID were higher for adjusted values only for low ferritin and an elevated TfR/ferritin index compared with the unadjusted values. The κ statistics for agreement between the multiple-criteria model and the other iron indicators ranged from 0.35 to 0.88; TfR had the best agreement (κ = 0.88) with the multiple-criteria model. Positive predictive values of ID based on the other iron indicators in predicting ID based on the multiple-criteria model were highest for ferritin and TfR. Receiver operating characteristic curve analysis indicated that TfR (AUC = 0.94) was superior to the other indicators in diagnosing ID based on the multiple-criteria model (P < 0.001). The inflammation effect did not appear to alter these observations appreciably. CONCLUSION TfR better estimates the prevalence of ID in preschoolers than do ferritin, ZP, and the TfR/ferritin index on the basis of multiple indexes in a high inflammation, resource-poor setting. This trial was registered at clinicaltrials.gov as NCT101088958.
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Affiliation(s)
- Frederick K E Grant
- Nutrition and Health Sciences program of Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA 30322, USA.
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Yu KH. Effectiveness of zinc protoporphyrin/heme ratio for screening iron deficiency in preschool-aged children. Nutr Res Pract 2011; 5:40-5. [PMID: 21487495 PMCID: PMC3061269 DOI: 10.4162/nrp.2011.5.1.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 02/01/2011] [Accepted: 02/01/2011] [Indexed: 11/21/2022] Open
Abstract
Hemoglobin and zinc protoporphyrin (ZPP) tests are commonly used to screen for iron deficiency, but little research has been done to systematically evaluate the sensitivity and specificity of these two tests. The goal of this study was to evaluate the effectiveness of zinc protoporphyrin/heme (ZPP/H) ratio as a point-of-service screening test for iron deficiency among preschool-aged children by comparing the sensitivity and specificity of hemoglobin, ZPP/H ratio, and serum ferritin (SF). Also completed were assessments for the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) with indicators of ferritin models. This study was carried out with 95 children ages 3 to 6 y. Anthropometric measurements were assessed, and blood samples were analyzed for hemoglobin, SF, transferrin saturation (TS), and ZPP. Anemia was common and the prevalences of anemia, ID, and IDA were 14.7%, 12.6%, and 5.2%, respectively. The ZPP/H ratio was strongly and significantly correlated with hemoglobin. And ZPP/H ratio was a more sensitive test for ID than hemoglobin or SF measurement, correctly identifying more than twice as many iron-deficient children (sensitivity of 91.7%, compared to 41.7% for hemoglobin and SF). However, ZPP/H ratio had lower specificity (60.2%, compared to 89.1% for hemoglobin or 96.4% for SF) and resulted in the false identification of more subjects who actually were not iron deficient than did hemoglobin or SF. Low hemoglobin concentration is a late-stage indicator of ID, but ZPP/H ratio can detect ID at early stages and can be performed easily at a relatively low cost. Therefore, ZPP/H ratio can serve as a potential screening test for pre-anemic iron deficiency in community pediatric practices.
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Affiliation(s)
- Kyeong Hee Yu
- Department of Hotel Culinary Arts, Ulsan College, 101 Bongsu-ro, Dong-gu, Ulsan 682-715, Korea
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Pasricha SR, Black J, Muthayya S, Shet A, Bhat V, Nagaraj S, Prashanth NS, Sudarshan H, Biggs BA, Shet AS. Determinants of anemia among young children in rural India. Pediatrics 2010; 126:e140-9. [PMID: 20547647 DOI: 10.1542/peds.2009-3108] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE More than 75% of Indian toddlers are anemic. Data on factors associated with anemia in India are limited. The objective of this study was to determine biological, nutritional, and socioeconomic risk factors for anemia in this vulnerable age group. METHODS We conducted a cross-sectional study of children aged 12 to 23 months in 2 rural districts of Karnataka, India. Children were excluded if they were unwell or had received a blood transfusion. Hemoglobin, ferritin, folate, vitamin B(12), retinol-binding protein, and C-reactive protein (CRP) levels were determined. Children were also tested for hemoglobinopathy, malaria infection, and hookworm infestation. Anthropometric measurements, nutritional intake, family wealth, and food security were recorded. In addition, maternal hemoglobin level was measured. RESULTS Anemia (hemoglobin level < 11.0 g/dL) was detected in 75.3% of the 401 children sampled. Anemia was associated with iron deficiency (low ferritin level), maternal anemia, and food insecurity. Children's ferritin levels were directly associated with their iron intake and CRP levels and with maternal hemoglobin level and inversely associated with continued breastfeeding and the child's energy intake. A multivariate model for the child's hemoglobin level revealed associations with log(ferritin level) (coefficient: 1.20; P < .001), folate level (0.05; P < .01), maternal hemoglobin level (0.16; P < .001), family wealth index (0.02; P < .05), child's age (0.05 per month; P < .005), hemoglobinopathy (-1.51; P < .001), CRP level (-0.18; P < .001), and male gender (-0.38; P < .05). Wealth index and food insecurity could be interchanged in this model. CONCLUSIONS Hemoglobin level was primarily associated with iron status in these Indian toddlers; however, maternal hemoglobin level, family wealth, and food insecurity were also important factors. Strategies for minimizing childhood anemia must include optimized iron intake but should simultaneously address maternal anemia, poverty, and food insecurity.
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Affiliation(s)
- Sant-Rayn Pasricha
- Nossal Institute for Global Health, University of Melbourne, Parkville, Victoria, Australia
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Sparks PJ. Childhood morbidities among income- and categorically-eligible WIC program participants and non-participants. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/10796120903575093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Santana MAP, Norton RDC, Fernandes RAF. Deficiência de ferro: ainda a principal etiologia entre crianças encaminhadas por motivo de anemia para serviço especializado de hematologia. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2009. [DOI: 10.1590/s1519-38292009000300010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: determinar os motivos de encaminhamento e diagnósticos de crianças com anemia para serviço especializado. MÉTODOS: coorte histórico e concorrente de crianças com anemia encaminhadas ao Serviço de Hematologia do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil, entre maio de 1999 e dezembro de 2001. RESULTADOS: foram avaliadas 153 crianças menores de 16 anos, sendo 83% procedentes de Centros de Saúde. Aproximadamente um terço das crianças não recebeu qualquer terapêutica no serviço de origem. Cento e onze (71,3%) tiveram diagnóstico de anemia ferropriva. Treze crianças (8,6%) tiveram diagnóstico de talassemia minor; outras treze crianças apresentaram outros diagnósticos de anemias e 11,5% das crianças não apresentavam anemia. Os valores médios de hemoglobina na abordagem pelo hematologista foram significativamente maiores que os dos serviços de origem (9,7±1,9 vs. 8,9±2,0); p=0,001. Somente 16,2% crianças não responderam ao primeiro tratamento com sais de ferro oral, sendo o sulfato ferroso o principal medicamento prescrito (79,3%). CONCLUSÕES: A deficiência de ferro foi a principal etiologia das crianças encaminhadas por motivo de anemia para serviço especializado. Encaminhamentos desnecessários de indivíduos com anemia ferropriva para serviços especializados representam prejuízo aos pacientes e ônus excedente para o sistema de saúde.
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Abstract
Elimination of iron deficiency and iron deficiency anemia in children is a crucial public health concern because these conditions have been linked to cognitive and behavioral deficits. In the infant age group, great strides have been made to reduce iron deficiency and iron deficiency anemia significantly. However, similar progress has not yet been made with toddlers. Cow's milk consumption has long been associated with iron deficiency and iron deficiency anemia in children. Because cow's milk is a staple in the diet of most toddlers, they are at particular risk for these conditions. Two unusual presentations of anemia in toddlers caused by excessive cow's milk consumption are described: one in a child with congestive heart failure, the other in a child with profound eosinophilia. The role of cow's milk in iron deficiency and iron deficiency anemia is also examined.
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Affiliation(s)
- Steven A. Bondi
- Department of Primary Care and Community Medicine, Irwin
Army Community Hospital, Fort Riley, Kansas,
| | - Kenneth Lieuw
- Uniformed Services University of the Health Sciences,
Bethesda, Maryland
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Thomas DG, Grant SL, Aubuchon-Endsley NL. The role of iron in neurocognitive development. Dev Neuropsychol 2009; 34:196-222. [PMID: 19267295 DOI: 10.1080/87565640802646767] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this article we present a review of the current literature relating iron and iron deficiency to psychological and neurobiological outcomes in both humans and experimental animals. In particular, we focus on the role of iron during gestation and infancy and the possible impact on neurobehavioral development in the short and long term. In the context of reviewing this literature, the following questions are addressed: (1) What are the neural mechanisms that are directly influenced by iron and iron deficiency? (2) Does iron play a true causal role in determining these outcomes? (3) Is there a sensitive period during which iron deficiency is most harmful?
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Affiliation(s)
- David G Thomas
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma 74078, USA.
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Gambling L, Czopek A, Andersen HS, Holtrop G, Srai SKS, Krejpcio Z, McArdle HJ. Fetal iron status regulates maternal iron metabolism during pregnancy in the rat. Am J Physiol Regul Integr Comp Physiol 2009; 296:R1063-70. [PMID: 19176888 DOI: 10.1152/ajpregu.90793.2008] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Iron metabolism during pregnancy is biased toward maintaining the fetal supply, even at the cost of anemia in the mother. The mechanisms regulating this are not well understood. Here, we examine iron deficiency and supplementation on the hierarchy of iron supply and the gene expression of proteins that regulate iron metabolism in the rat. Dams were fed iron-deficient diets for 4 wk, mated, and either continued on the deficient diet or an iron-supplemented diet during either the first half or the second half of their pregnancy. A control group was maintained on normal iron throughout. They were killed at 0.5, 12.5, or 21.5 days of gestation, and tissues and blood samples were collected. Deficiency and supplementation had differential effects on maternal and fetal hematocrit and liver iron levels. From early in pregnancy, a hierarchy of iron supply is established benefiting the fetus to the detriment of the mother. Transferrin receptor, transferrin receptor 2, and hepcidin mRNA expression were regulated by both iron deficiency and supplementation. Expression patterns showed both organ and supplementation protocol dependence. Further analysis indicated that iron levels in the fetal, and not maternal, liver regulate the expression of liver transferrin receptor and hepcidin expression in the mother.
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Abstract
AbstractIron deficiency (ID) is the most prevalent micronutrient deficiency in the world, particularly in developing countries. Blood samples and a qualitative FFQ on Fe- and vitamin C-rich foods were obtained in 180 adolescent girls aged 12 to 17 years living in two boarding schools from south Benin. ID, defined as serum ferritin either <20μg/l or 20–50μg/l, plus two of the following parameters: serum Fe<11μmol/l, total iron-binding capacity>73μmol/l or transferrin saturation<20%, was found in 32% of subjects. Anaemia (Hb<120g/l) was found in 51% of adolescents, while 24% suffered from iron-deficiency anaemia (IDA) (ID and Hb<20g/l). After adjusting for confounding factors (age, mother's and father's occupation, household size) in a logistic regression equation, subjects having a low meat consumption (beef, mutton, pork) (<4 times/week) were more than twice as likely to suffer from ID (OR=2·43; 95% CI 1·72, 3·35;P=0·04). Adolescents consuming less fruits (<4 times/week) also had a higher likelihood of suffering from ID (OR=1·53; 95% CI 1·31, 2·80;P=0·03). Finally, subjects whose meat consumption was low were twice as likely to suffer from IDA (OR=2·24; 95% CI 1·01, 4·96;P=0·04). The prevalence of ID represents an important health problem in these Beninese adolescent girls. A higher consumption of Fe-rich foods and of promoters of Fe absorption (meat factor and vitamin C) is recommended to prevent ID deficiency in these subjects.
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Abstract
A large body of epidemiologic data show that diet quality follows a socioeconomic gradient. Whereas higher-quality diets are associated with greater affluence, energy-dense diets that are nutrient-poor are preferentially consumed by persons of lower socioeconomic status (SES) and of more limited economic means. As this review demonstrates, whole grains, lean meats, fish, low-fat dairy products, and fresh vegetables and fruit are more likely to be consumed by groups of higher SES. In contrast, the consumption of refined grains and added fats has been associated with lower SES. Although micronutrient intake and, hence, diet quality are affected by SES, little evidence indicates that SES affects either total energy intakes or the macronutrient composition of the diet. The observed associations between SES variables and diet-quality measures can be explained by a variety of potentially causal mechanisms. The disparity in energy costs ($/MJ) between energy-dense and nutrient-dense foods is one such mechanism; easy physical access to low-cost energy-dense foods is another. If higher SES is a causal determinant of diet quality, then the reported associations between diet quality and better health, found in so many epidemiologic studies, may have been confounded by unobserved indexes of social class. Conversely, if limited economic resources are causally linked to low-quality diets, some current strategies for health promotion, based on recommending high-cost foods to low-income people, may prove to be wholly ineffective. Exploring the possible causal relations between SES and diet quality is the purpose of this review.
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Affiliation(s)
- Nicole Darmon
- INRA, UMR1260, Nutriments Lipidiques et Prévention des Maladies Métaboliques, Marseille, France.
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Ohlund I, Lind T, Hörnell A, Hernell O. Predictors of iron status in well-nourished 4-y-old children. Am J Clin Nutr 2008; 87:839-45. [PMID: 18400705 DOI: 10.1093/ajcn/87.4.839] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Iron status in childhood is influenced by diet. Other factors affecting iron status at that age are unclear. OBJECTIVES The objectives of the study were to evaluate iron status in 4-y-old children, to track that status from infancy to childhood, and to examine the associations of iron status with dietary factors, growth, and heredity. DESIGN This study consisted of a longitudinal follow-up at age 4 y of children (n = 127) from the cohort of a study that began at age 6 mo. Blood samples and anthropometry were assessed in both children and their parents; food records were collected from children only. RESULTS Dietary intake was not significantly correlated with hemoglobin concentrations, whereas the consumption of meat products had a positive effect on serum ferritin concentrations and mean corpuscular volume in boys (P = 0.015 and 0.04, respectively). The prevalences of anemia and iron deficiency were low, affecting 2 (1.8%) and 3 (2.8%) children, respectively; no child had iron deficiency anemia. There was significant within-subject tracking of hemoglobin and mean corpuscular volume from age 6 mo to 4 y. The mother's but not the father's hemoglobin correlated with the child's hemoglobin over time. CONCLUSIONS Food choices had little effect on iron status. Hemoglobin concentrations and mean corpuscular volume were tracked from infancy to childhood. In healthy, well-nourished children with a low prevalence of iron deficiency, the mother's hemoglobin was significantly associated with that of her child, but the underlying mechanism is unclear.
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Affiliation(s)
- Inger Ohlund
- Department of Food and Nutrition and the Division of Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
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Shibukawa AF, Silva EMKD, Ichiki WA, Strufaldi MWL, Puccini RF. Prophylaxis for iron deficiency anemia using ferrous sulfate among infants followed up at a primary healthcare unit in the municipality of Embu-SP (2003/2004). SAO PAULO MED J 2008; 126:96-101. [PMID: 18553031 DOI: 10.1590/s1516-31802008000200006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 03/05/2008] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Iron deficiency anemia is an important public health problem in Brazil. In the municipality of Embu, a population study in 1996 found anemia prevalence of 68.5% among children aged one to two years. From these data, prescription of prophylactic ferrous sulfate was instituted in 1998 for children under two years old followed up within the children's healthcare program. After five years of intervention, the prevalence of anemia and associated factors were investigated among children aged 12 to 18 months to whom guidance for prophylactic ferrous sulfate use had been given. DESIGN AND SETTING Cross-sectional study covering October 2003 to June 2004 at a primary healthcare unit in Embu. METHODS A randomized sample of children aged 12 to 18 months to whom guidance for prophylactic ferrous sulfate use had been given was obtained. Hemoglobin was measured in capillary blood, using HemoCue apparatus. Hemoglobin < 11 g/100 dl was taken to indicate anemia. RESULTS The sample comprised 118 children and anemia was found in 41.5%. There was no statistically significant association between anemia presence and the variables of sex, birth weight, neonatal intercurrences, chronic diseases, breastfeeding or iron supplementation use. There was a statistically significant association (p = 0.03) between anemia presence and per capita income, such that the higher the income was, the lower the prevalence of anemia was. CONCLUSION The prophylaxis program against iron deficiency anemia did not achieve the expected results. New strategies must be considered in the light of the magnitude of the problem.
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Schneider JM, Fujii ML, Lamp CL, Lönnerdal B, Dewey KG, Zidenberg-Cherr S. The use of multiple logistic regression to identify risk factors associated with anemia and iron deficiency in a convenience sample of 12-36-mo-old children from low-income families. Am J Clin Nutr 2008; 87:614-20. [PMID: 18326599 DOI: 10.1093/ajcn/87.3.614] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of iron deficiency (ID) anemia among preschool-age children remains relatively high in some areas across the United States. Determination of risk factors associated with ID is needed to allow children with identifiable risk factors to receive appropriate education, testing, and follow-up. OBJECTIVE We aimed to evaluate risk factors associated with anemia and ID in a sample of children participating in or applying for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). DESIGN The study was a cross-sectional study of a convenience sample of 12-36-mo-old children recruited from WIC clinics in 2 California counties (n = 498). RESULTS Current WIC participation by the child and a greater rate of weight gain were negatively associated, and current maternal pregnancy was positively associated with anemia (hemoglobin < 110 g/L at 12-<24 mo or < 111 g/L at 24-36 mo) after control for age, sex, and ethnicity. Maternal WIC participation during pregnancy, child age, and the intake of > or =125 mL orange or tomato juice/d were negatively associated, and being male and living in an urban location were positively associated with ID (> or =2 of the following abnormal values: ferritin < or = 8.7 microg/L, transferrin receptors > or = 8.4 microg/mL, and transferrin saturation < or = 13.2%). CONCLUSIONS Current WIC participation by the child and maternal WIC participation during pregnancy were negatively associated with anemia and ID, respectively. It is anticipated that the risk factors identified in this study will be included in the development of an educational intervention focused on reducing the risk factors for ID and ID anemia in young children.
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Affiliation(s)
- Julie M Schneider
- Nutrition and Food Sciences Department, California State University, Chico, CA, USA
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Schneider JM, Fujii ML, Lamp CL, Lönnerdal B, Zidenberg-Cherr S. The Prevalence of Low Serum Zinc and Copper Levels and Dietary Habits Associated with Serum Zinc and Copper in 12- to 36-Month-Old Children from Low-Income Families at Risk for Iron Deficiency. ACTA ACUST UNITED AC 2007; 107:1924-9. [DOI: 10.1016/j.jada.2007.08.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Indexed: 11/29/2022]
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Ray A, Ndugwa C, Mmirot F, Ricks MO, Semba RD. Soluble transferrin receptor as an indicator of iron deficiency in HIV-infected infants. ACTA ACUST UNITED AC 2007; 27:11-6. [PMID: 17469727 DOI: 10.1179/146532807x170457] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Iron deficiency is common in human immunodeficiency virus (HIV)-infected infants in sub-Saharan Africa. It is not known whether soluble transferrin receptor (sTfR) is a good indicator of iron deficiency in infants with HIV. METHODS We evaluated sTfR as an indicator of iron deficiency in 134 HIV-infected 9-month-old infants in Kampala, Uganda. Ferritin <12 microg/L and microcytic, hypochromic anaemia were used as indicators of iron deficiency, respectively. The presence of inflammation was indicated by C-reactive protein >5 mg/L or alpha1-acid glycoprotein >1 g/L. RESULTS Receiver operator characteristic curves showed that the area under the curve was 0.67 when sTfR receptor was compared with low ferritin and 0.71 when sTfR was compared with microcytic, hypochromic anaemia. The appropriate calculated cut-offs of sTfR >3.74 microg/mL (43.98 nmol/L) and >3.53 microg/mL (41.55 nmol/L) show adequate specificities of 60% and sensitivities of 63% and 69% for low ferritin and microcytic, hypochromic anaemia, respectively. C-reactive protein and alpha 1-acid glycoprotein were strongly correlated with serum ferritin (r=0.371 and r=0.458, respectively, both p<0.0001) but were not correlated with sTfR (r=0.009 and r= -0.003, respectively, both p=0.9). In all, 78.6% of infants had alpha l-acid glycoprotein >1 g/L and 54.7% had C-reactive protein >5 g/L. CONCLUSIONS Soluble TfR appears to be an adequate indicator of iron deficiency in HIV-infected infants.
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Affiliation(s)
- Amanda Ray
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Hay G, Refsum H, Whitelaw A, Melbye EL, Haug E, Borch-Iohnsen B. Predictors of serum ferritin and serum soluble transferrin receptor in newborns and their associations with iron status during the first 2 y of life. Am J Clin Nutr 2007; 86:64-73. [PMID: 17616764 DOI: 10.1093/ajcn/86.1.64] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Adequate iron status at birth may prevent iron deficiency in early childhood. OBJECTIVES We aimed to identify predictors of serum ferritin (SF) and serum soluble transferrin receptor (sTfR) in healthy newborns and to relate these iron indexes to iron status in the first 2 y of life. DESIGN Using bivariate correlations and linear regression, we related various factors in pregnancy to SF (n=363) and sTfR (n=350) in healthy, term infants. Measurements of cord SF and sTfR were compared with those of SF and sTfR at 6, 12, and 24 mo. All 4 measurements were available for 191 and 169 infants for SF and sTfR, respectively. RESULTS Geometric mean (and 95% CI) cord SF and sTfR measurements were 159 (148, 171) microg/L and 7.3 (7.0, 7.6) mg/L, respectively. Cord SF correlated with sTfR (rho=-0.21, P<0.001). In regression analysis, cord SF correlated with smoking and the use of iron supplements during pregnancy (partial r=-0.12 and 0.16; P<0.05 for both). Cord sTfR was associated with first trimester BMI, gestational age, and male sex (partial r=0.30, 0.24, and 0.19, respectively; P<0.01 for all). Cord SF correlated with SF at 6, 12, and 24 mo (rho=0.45, 0.31, and 0.16 respectively; P<0.05 for all). At age 6 mo, 16 of 17 infants with SF <15 mug/L were boys. CONCLUSIONS Cessation of smoking and adequate iron prophylaxis during pregnancy may improve iron status in infancy. Cord SF is a predictor of iron status in the first 2 y of life. Boys are at particular risk of low iron status in early infancy.
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Affiliation(s)
- Gry Hay
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
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Abstract
PURPOSE OF REVIEW Iron deficiency is a significant public health problem in young children due to their high iron requirements, and iron supplements are therefore often recommended. During the time period in focus for this review (2005-2006), there have been additional advances in our understanding of the molecular mechanisms of iron absorption and metabolism. It has also been suggested that iron supplements may have adverse effects in children. RECENT FINDINGS Recently discovered molecules, for example hepcidin, lactoferrin receptor and heme carrier protein may be important for iron metabolism in children. There are possible metabolic interactions between iron and several other minerals. Many studies show that iron deficiency in young children is associated with impaired neurodevelopment but it is not clear whether this can be prevented by iron supplementation. Oral iron supplements given to young children in malarious regions may lead to increased risk of death or severe infections, especially in those who are iron replete. SUMMARY More research is needed to identify those children who will benefit from iron supplementation and to better determine iron requirements during early life. Clinical trials should include functional outcomes. Better knowledge about molecular mechanisms and nutrient interactions may lead to new diagnostic tests and preventive strategies.
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Affiliation(s)
- Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, SE-90185 Umeå, Sweden.
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Cusick SE, Mei Z, Cogswell ME. Continuing anemia prevention strategies are needed throughout early childhood in low-income preschool children. J Pediatr 2007; 150:422-8, 428.e1-2. [PMID: 17382124 DOI: 10.1016/j.jpeds.2007.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 11/28/2006] [Accepted: 01/02/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess anemia incidence and persistence in low-income preschool children in the United States. STUDY DESIGN Using 2000 to 2004 data from Center for Disease Control and Prevention's Pediatric Nutrition Surveillance System, we constructed 4 cohorts. Children in each cohort had a baseline hemoglobin measurement at either age 12 +/- 2 months (n = 583,149), 18 +/- 2 months (n = 399,223), 24 +/- 2 months (n = 382,605), or 36 +/- 2 months (n = 300,817) and a follow-up hemoglobin measurement 12 +/- 2 months later, when they were approximately 24, 30, 36, or 48 months old. Defining anemia as a hemoglobin level < 11.0 g/dL (< 24 months old) or hemoglobin < 11.1 g/dL (> or = 24 mo), we calculated anemia incidence and persistence in each cohort and used multiple logistic regression to identify associated factors (race, sex, birthweight, height, weight, breastfeeding). RESULTS Anemia incidence declined with age. Persistence remained approximately 30%. In each cohort, 70% of follow-up anemia cases were incident. Compared with white children, black children had greater odds of incident anemia at each follow-up age (odds ratio [OR], 1.84-2.09), while Native American children had lower odds at 36 and 48 months of age (OR, 0.68, 0.65). Both Asian and black children had greater odds of persistent anemia than white children at each age (OR, 1.73-2.60). CONCLUSIONS Most follow-up anemia in each cohort was incident, underscoring the importance of anemia prevention throughout early childhood in this population. Investigation of the causes of anemia is warranted.
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Affiliation(s)
- Sarah E Cusick
- Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Crowell R, Ferris AM, Wood RJ, Joyce P, Slivka H. Comparative effectiveness of zinc protoporphyrin and hemoglobin concentrations in identifying iron deficiency in a group of low-income, preschool-aged children: practical implications of recent illness. Pediatrics 2006; 118:224-32. [PMID: 16818569 DOI: 10.1542/peds.2006-0156] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to assess the influence of recent infection on screening tests for iron depletion (zinc protoporphyrin and hemoglobin) among low-income, preschool-aged children. METHODS This cross-sectional study was conducted at community sites and ambulatory care clinics in Hartford, Connecticut, and included 180 preschool-aged children. Iron depletion was defined as serum ferritin levels of < or = 15 microg/L. Recent illness was defined by parent or guardian (caretaker) report or evidence of elevated C-reactive protein concentrations. History of anemia was determined through medical records review. Sensitivity, specificity and positive predictive values of hemoglobin and zinc protoporphyrin were calculated overall and for children with and without recent illness. RESULTS At enrollment, more than one half of the children had a recent illness, and 57.5% had a history of anemia. More than one third had iron depletion. Serum ferritin levels were significantly higher among recently ill children. Secondary to recent illness, the positive predictive value of elevated zinc protoporphyrin, but not low hemoglobin, was reduced significantly. Zinc protoporphyrin levels of >69 micromol/mol heme identified significantly more iron-deficient children. CONCLUSIONS Compared with anemia, elevated zinc protoporphyrin levels identified significantly more iron-deficient children. Recently ill children were one half as likely to have low serum ferritin levels, compared with children without recent illness. The negative effect of recent illness on the positive predictive value of zinc protoporphyrin when ferritin is used to determine iron status has many practical implications.
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Affiliation(s)
- Rebecca Crowell
- Department of Nutritional Sciences, University of Connecticut, Unit 4017, 3624 Horsebarn Rd Extension, Storrs, Connecticut 06269, USA.
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