Iron nutritional status of preschool children

Haematological Status of Preschool and School-Age Children in Urban and Rural Areas of Guatemala

We studied the prevalence of low haematocrit values (defined as <38%) in 1,253 children from urban and rural areas of Guatemala, to examine any urban-rural or age-related trends. Though the crude prevalences of low haematocrit for all the children showed a significant difference between urban and rural residents, the significance disappeared when these values were adjusted for differences in the age profiles of the two groups. As expected, preschool children had significantly more low haematocrits (32.0%) than school-age children (6.0%) (p < .05). Ferritin levels were available for 35.9% of the preschool children (one urban and one rural location); of these, 51.8% had levels below 12 mg/l, indicating iron deficiency. These values were used to determine the predictive value of haematocrit compared with ferritin values, and the cut-off at which haematocrit reaches optimum sensitivity and specificity to diagnose iron depletion. A cut-off of 39% had a sensitivity of 61% and a specificity of 45% in urban preschoolers, and a cut-off of 38% had a sensitivity of 75% and specificity of 42% in rural preschoolers.

Prevalence of iron deficiency anemia in chronic diarrhoea and celiac disease - a western UP experience

AIM

To study the prevalence of iron deficiency anaemia in chronic diarrhoea and celiac disease.

METHODOLOGY

Cases included 45 children between 1-12 years with chronic diarrhoea, who underwent investigations like haemogram with GBP, RBC indices, serum iron and TIBC. After a course of antibiotic therapy for 6 weeks with iron and folic acid with no improvement noted within 2 weeks, they were subjected to duodenal biopsy. If biopsy showed features of celiac disease, then anti-endomysial antibody test was performed to substantiate the diagnosis.

RESULTS

30 cases (66.7%) were males and 15 (33.3%) females. 8 cases (17.8%) had watery diarrhoea, 20 (44.4%) semiformed and 17 (37.8%) had watery and semiformed diarrhoea. Bloody diarrhoea was present in 5 (11.1%) and abdominal distension in 21 cases (46.7%). Pallor seen in all the cases. The mean age of the cases was 55 ± 1.5 months and mean duration of diarrhoea was 18 ± 1.4 months. Mean haemoglobin observed was 8.1 ± 1.6 gm%. MCV, MCH and MCHC were 79.1 ± 8.6 fl, 26.9 ± 3 pg and 29.6 ± 2.3 g/dl respectively. Mean serum iron was 32.1 ± 1.2 g/ dl and TIBC was 432 ± 3.2 g/ dl. On peripheral smear, 28 cases (82.4%) showed microcytic hypochromic anaemia. 26 cases showed evidence of celiac disease on duodenal biopsy. Anti endomysial antibody (AEA) test was positive in 15 of the 19 celiac cases on which performed. Mean duration of diarrhoea (23.5 months) was significantly more in celiacs as compared to non-celiacs (11.6 months).

CONCLUSIONS

Better awareness of the clinical profile and early detection of celiac disease would help detection and management of iron deficiency anaemia associated with celiac disease.

Nutritional anemia and its control

Available studies on prevalence of nutritional anemia in India show that 65% infant and toddlers, 60% 1-6 years of age, 88% adolescent girls (3.3% had hemoglobin < 7.0 g/dl; severe anemia) and 85% pregnant women (9.9% having severe anemia) were anemic. The prevalence of anemia was marginally higher in lactating women as compared to pregnancy. The commonest is iron deficiency anemia. National programmes to control and prevent anemia have not been successful. Experiences from other countries in controlling moderately-severe anemia guide to adopt long-term measures i.e. fortification of food items like milk, cereal, sugar, salt with iron. Use of iron utensils in boiling milk, cooking vegetables etc may contribute significant amount of dietary iron. Nutrition education to improve dietary intakes in family for receiving needed macro/micro nutrients as protein, iron and vitamins like folic acid, B12, A and C etc. for hemoglobin synthesis is important. As an immediate measure medicinal iron is necessary to control anemia. Addition of folate with iron controls anemia and is neuroprotective. Evidence in early childhood suggests vitamin B12 deficiency anemia; thus it may also be given along with iron and folate.

Influence of malaria on markers of iron status in children: implications for interpreting iron status in malaria-endemic communities

To investigate Fe nutritional indices in malaria infection in children, haematology (blood haemoglobin, plasma ferritin, transferrin, Fe, and transferrin saturation), acute phase markers (albumin and caeruloplasmin) and liver function tests were studied in fifty consecutive cases of severe and mild falciparum malaria, fifty matched controls and twenty-three cases of asymptomatic malaria. Blood haemoglobin and transferrin were lower, while ferritin and transferrin saturation were higher, in groups with symptomatic malaria in comparison with the control group. The differences were greatest with the severest form of the disease. There were no differences between any of the groups in plasma Fe. Plasma transferrin correlated directly with albumin in asymptomatic, mild and severe malaria groups (r 0.48, 0.65 and 0.83; P < 0.05, P < 0.05, P < 0.01 and P < 0.001 respectively), and inversely with caeruloplasmin (r -0.65, -0.34 and -0.43; P < 0.01, P < 0.05 and P < 0.01 respectively). For ferritin, the correlation was inverse with albumin (r -0.65, -0.57 and -0.64; P < 0.01, P < 0.001 and P < 0.001 respectively and direct with caeruloplasmin (r 0.83, 0.21 and 0.49, P < 0.001, NS and P < 0.001 respectively). Multiple regression analysis on data from all patients combined indicated that albumin, and to a lesser extent alanine aminotransferase (EC 2.6.1.2) activity, explained 62 % of the variance in transferrin. Caeruloplasmin, parasite count and albumin explained 59 % of the variance in ferritin, and transferrin and unconjugated bilirubin explained 62 % of the variance in Fe values. In conclusion, these data suggest that low transferrin and high ferritin values are primarily due to the acute phase response. High transferrin saturation and lack of differences in plasma Fe between the groups are probably due to Fe released from lysed erythrocytes. Finally, in both symptomatic and asymptomatic malaria, indices of Fe status can be misleading and may be especially problematic in community studies in malaria-endemic areas where asymptomatic malaria may be common.