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Khamphikham P, Hanmanoviriya O, Wongpalee SP, Munkongdee T, Paiboonsukwong K, Jopang Y, Wangchauy C, Sancharernsook C, Jinorose N, Pornprasert S. Development of molecular diagnostic platform for α 0 -thalassemia 44.6 kb (Chiang Rai, -- CR ) deletion in individuals with microcytic red blood cells across Thailand. Ann Hum Genet 2023; 87:137-145. [PMID: 36709419 DOI: 10.1111/ahg.12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The α0 -thalassemia 44.6 kb or Chiang Rai (--CR ) deletion has been reported in northern Thailand and is capable of causing hemoglobin (Hb) H disease and a lethal α-thalassemia genotype, Hb Bart's hydrops fetalis, in this region. However, there are no current data regarding the frequency of --CR nationwide due to a lack of effective diagnostic assay. Therefore, this study aimed to develop a reliable platform for simultaneous genotyping of --CR and two common α0 -thalassemias in Thailand (--SEA and --THAI ) and investigate the frequency of --CR across Thailand. METHODS Multiplex gap-PCR assay and five renewable plasmid DNA controls for --CR , --SEA , --THAI , α2-globin (HBA2), and β-actin (ACTB) were newly developed and validated with reference methods. The developed assay was further tested on 1046 unrelated individuals with a reduced mean corpuscular volume (MCV) of less than 75 fl for investigating genotypic and allelic spectrum of --CR . RESULTS Our developed assay showed 100% concordance with reference methods. The results were valid and reproducible throughout hundreds of reactions. Comparison of the genotypic and allelic spectra revealed that heterozygous --SEA (--SEA /αα) and --SEA alleles were dominant with the frequency of 22.85% (239/1046) and 13.34% (279/2092), respectively. Of these, --THAI and --CR were relatively rare in this population and comparable to each other with the allelic frequency of 0.14% (3/2092). CONCLUSION This study successfully established a reliable molecular diagnostic platform for genotyping of --CR , --SEA , and --THAI in a single reaction. Additionally, we demonstrated the frequency of --CR in Thailand for the first time and provided knowledge basis for the planning of severe α-thalassemia prevention and control programs in Thailand, where thalassemia is endemic.
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Affiliation(s)
- Pinyaphat Khamphikham
- Division of Clinical Microscopy, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.,Hematology and Health Technology Research Center, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Oravee Hanmanoviriya
- Division of Clinical Microscopy, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Somsakul Pop Wongpalee
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Thongperm Munkongdee
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Kittiphong Paiboonsukwong
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Yupin Jopang
- Regional Health Promotion Center 9 Nakhon Ratchasima, Department of Health, Ministry of Public Health, Nakhon Ratchasima, Thailand
| | - Chaowanee Wangchauy
- Hematology Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Charan Sancharernsook
- Department of Medical Technology, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | | | - Sakorn Pornprasert
- Division of Clinical Microscopy, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.,Hematology and Health Technology Research Center, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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Anemia, iron deficiency, and thalassemia among the Thai population inhabiting at the Thailand-Lao PDR-Cambodia triangle. Sci Rep 2022; 12:18643. [PMID: 36333424 PMCID: PMC9636127 DOI: 10.1038/s41598-022-22016-3] [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: 06/07/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Anemia is a major public health problem in many areas of Southeast Asia. Ascertaining anemia and defining its underlying causes is essential for providing appropriate care, management, and establishment of a control program. Limited studies on these have been carried out on people living at the borders of Thailand, Lao PDR, and Cambodia. This cross-sectional study was done in four areas along the borders of Thailand, Lao PDR, and Cambodia. Blood specimens were collected from subjects aged 15-18 years in four districts including Kantharalak, Si Sa Ket province (n = 36), Nam Khun (n = 109), Nam Yuen (n = 98), and Na Chaluai (n = 128), Ubon Ratchathani province, Thailand. RBC parameters were recorded, and serum ferritin (SF) level was measured. Diagnosis of thalassemia and hemoglobinopathies was based on hemoglobin (Hb) and DNA analyses. Measurement of C-reactive protein was performed to exclude false-negative result of iron deficiency. The prevalence of anemia was found to be 25.1%. ID accounted for only 10.5%. Various types of thalassemia were identified in 67.7% of the subjects. The overall prevalence of thalassemia included 3.5% α0-thalassemia, 0.8% β-thalassemia, 47.7% Hb E, and 53.6% α+-thalassemia. The proportions of ID, thalassemia and combined ID and thalassemia among anemic subjects were 6.5%, 66.6%, and 20.4%, respectively. The results indicate that thalassemia and hemoglobinopathies rather than ID are major causes of anemia in Thailand-Lao PDR-Cambodia triangle. This information should prove useful for implementing an anemia control program in the regions.
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Boonrusmee S, Thongkhao A, Wongchanchailert M, Mo-Suwan L, Sangsupawanich P. Coexisting Iron Deficiency Anemia and Thalassemia Traits in Infants: Implication for an Anemia Screening Program. J Trop Pediatr 2022; 68:6609145. [PMID: 35708565 DOI: 10.1093/tropej/fmac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To study the prevalence of anemia among healthy infants, and outcomes of giving a therapeutic trial of iron to anemic infants in thalassemia-endemic area. METHODS A cross sectional study was conducted in 6-9-month-old, full-term healthy infants who attended the well child clinics at 2 tertiary care centers in southern Thailand. Complete blood count and serum ferritin were performed in every infant, and hemoglobin typing was performed only in anemic cases. All anemic infants were given a therapeutic trial of iron and categorized into either; iron responder (hemoglobin increased ≥ 1 g/dL) or iron non-responder (hemoglobin increased <1 g/dL) groups after one month of the therapeutic trial. Mean levels of hematological parameters, including the Mentzer index, were compared within the groups. RESULTS A total of 620 infants were included in the study. From this, 230 infants (37%) were anemic for which iron deficiency contributed for 80% of the etiology. The iron responder group showed significant improvement in hematological parameters after a trial of iron, while there was no improvement in the iron non-responder group. Among iron responders, there were 31 out of 186 infants (16.6%) who had coexisting abnormal hemoglobin typing, and their post-treatment complete blood count still showed a mean corpuscular volume < 70, with a Mentzer index < 13. CONCLUSION Iron deficiency remains a major cause of anemia among infants, and a therapeutic trial of iron is beneficial in this age group, even though thalassemia trait/hemoglobinopathy can co-exist.
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Affiliation(s)
- Sasivara Boonrusmee
- Faculty of Medicine, Division of Ambulatory Pediatrics, Department of Pediatrics, Prince of Songkla University, Songkhla 90110, Thailand
| | - Arunwan Thongkhao
- Faculty of Medicine, Division of Ambulatory Pediatrics, Department of Pediatrics, Prince of Songkla University, Songkhla 90110, Thailand
| | - Malai Wongchanchailert
- Faculty of Medicine, Division of Ambulatory Pediatrics, Department of Pediatrics, Prince of Songkla University, Songkhla 90110, Thailand
| | - Ladda Mo-Suwan
- Faculty of Medicine, Division of Ambulatory Pediatrics, Department of Pediatrics, Prince of Songkla University, Songkhla 90110, Thailand
| | - Pasuree Sangsupawanich
- Faculty of Medicine, Division of Ambulatory Pediatrics, Department of Pediatrics, Prince of Songkla University, Songkhla 90110, Thailand
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Association between nutritional and physical factors and anemia among schoolchildren aged 5 to 11 years in Beijing. Chin Med J (Engl) 2021; 134:1629-1631. [PMID: 34116528 PMCID: PMC8280090 DOI: 10.1097/cm9.0000000000001600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Rattanawan C, Cheloh S, Maimahad A, Tayeh M. Prevalence and Associated Factors of Anemia among Muslim Students, Nakhon Si Thammarat, Thailand: A Cross-Sectional Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211013476. [PMID: 33928798 PMCID: PMC8114253 DOI: 10.1177/00469580211013476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anemia is a global public health problem. The prevalence of anemia among different ages, genders or ethnic groups must be clarified in order to solve problems. This study proposed to determine the prevalence and factors related to anemia among the Muslim school-age population in Nakhon Si Thammarat, Thailand. Socio-demographic and anthropometric data were collected by a structured questionnaire. Blood samples were collected from 200 school-age subjects. The thalassemia screening was performed with KKU-OF and KKU-DCIP reagents. The prevalence of anemia in this study was 36.5%, divided into males and females, 33.3% and 39.1%, respectively. The means of Hb, Hct, MCV, MCH, and MCHC in the anemic group were significantly lower. The positive results for KKU-OF or KKU-DCIP or both were 15.0%, 2.5%, and 1.0%, respectively. The result of positive OF test was a significantly independent factor for anemia. The number of family members was 5 to 7 and more than 7 persons are related factors for anemia in this study. In summary, the contribution of thalassemia and socio-economic factor are associated factors to anemia in this population. These findings should be addressed in public health strategies for the control of anemia of school-aged Muslims in the region.
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Affiliation(s)
| | | | | | - Malatee Tayeh
- Walailak University, Thai Buri, Nakhon Si Thammarat, Thailand
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Abstract
PURPOSE OF REVIEW Anaemia affects up to 50% of pregnancies worldwide, and is associated with maternal and neonatal morbidity and mortality. Prevention and management of anaemia remains a priority. Despite this, there is ongoing debate on the optimal approach to identifying anaemia in pregnant women and the best strategies for prevention and management. The objective of this review is to describe the current landscape of haemoglobin testing in pregnancy in low and high-income countries. RECENT FINDINGS Current definitions of anaemia in pregnancy comprise a laboratory threshold of haemoglobin below which treatment is offered. Haemoglobin measurement is not sensitive in detecting iron deficiency - the most common cause of maternal anaemia. Furthermore, these historical thresholds were derived from heterogeneous populations comprising men and women. Women with anaemia in pregnancy are offered iron therapy, without testing for the underlying cause. This may be appropriate in high-income settings, where iron deficiency is the likely cause, but may not address the complex causes of anaemia in other geographical areas. SUMMARY Current thresholds of haemoglobin defining anaemia in pregnancy are under review. Further research and policy should focus on optimal strategies to identify women at risk of anaemia from all causes.
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Williams BA, Cochrane KM, Fischer JAJ, Aljaadi AM, McAnena L, Ward M, McNulty H, Kroeun H, Green TJ, Whitfield KC, Karakochuk CD. The Homozygous Hemoglobin EE Variant Is Associated with Poorer Riboflavin Status in Cambodian Women of Reproductive Age. J Nutr 2020; 150:1943-1950. [PMID: 32433728 PMCID: PMC7330481 DOI: 10.1093/jn/nxaa119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/10/2020] [Accepted: 04/06/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Riboflavin is required for erythropoiesis, which is increased in people with hemoglobinopathies due to increased hemolysis and erythrocyte turnover. Dietary intake and status of riboflavin is poor in Cambodia, where hemoglobinopathies are common. OBJECTIVE We assessed the association between genetic hemoglobin disorders and riboflavin status in women of reproductive age in Cambodia. METHODS Venous blood samples from 515 Cambodian women of reproductive age, 18-45 y, were analyzed for biomarker status of riboflavin [erythrocyte glutathione reductase activation coefficient (EGRac)], genetic hemoglobin (Hb) disorders, and hematological indices. Linear regression analysis was used to estimate the association between EGRac with Hb, ferritin, and Hb genotypes. EGRac was log transformed in the analyses, and the regression coefficients represent the geometric mean differences. RESULTS Genetic Hb disorders were present in 57% of the population, with the homozygous hemoglobin E variant (Hb EE) occurring in ∼10% of women (n = 53). Deficient (EGRac ≥1.40) or marginal riboflavin status (EGRac ≥1.30 and <1.40) was observed in 92% (n = 475) of women. The variant Hb EE genotype was associated with 18% (95% CI: 9%, 28%) higher geometric mean EGRac values than the normal Hb AA genotype (P < 0.001). CONCLUSIONS Although riboflavin biomarker deficiency or marginal status is widely prevalent in Cambodian women, lower riboflavin status was observed more frequently in women with the Hb EE genotype than in women with normal Hb AA. The relation between genetic Hb disorders and riboflavin warrants further investigation. This trial was registered at clinicaltrials.gov as NCT01593423 and NCT02481375.
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Affiliation(s)
- Brock A Williams
- Department of Food, Nutrition and Health, the University of British Columbia, Vancouver, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Kelsey M Cochrane
- Department of Food, Nutrition and Health, the University of British Columbia, Vancouver, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Jordie A J Fischer
- Department of Food, Nutrition and Health, the University of British Columbia, Vancouver, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Abeer M Aljaadi
- Department of Food, Nutrition and Health, the University of British Columbia, Vancouver, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Liadhan McAnena
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | - Hou Kroeun
- Helen Keller International, Phnom Penh, Cambodia
| | - Tim J Green
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kyly C Whitfield
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Crystal D Karakochuk
- Department of Food, Nutrition and Health, the University of British Columbia, Vancouver, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, Canada
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Zeng W, Malla P, Xu X, Pi L, Zhao L, He X, He Y, Menezes LJ, Cui L, Yang Z. Associations among Soil-Transmitted Helminths, G6PD Deficiency and Asymptomatic Malaria Parasitemia, and Anemia in Schoolchildren from a Conflict Zone of Northeast Myanmar. Am J Trop Med Hyg 2020; 102:851-856. [PMID: 32043453 DOI: 10.4269/ajtmh.19-0828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In tropical areas of developing countries, the interactions among parasitic diseases such as soil-transmitted helminths (STHs) and malaria, and glucose-6-phosphate dehydrogenase deficiency (G6PDd), are complex. Here, we investigated their interactions and impact on anemia in school students residing in a conflict zone of northeast Myanmar. A cross-sectional survey was conducted between July and December 2015 in two schools located along the China-Myanmar border. Stool samples from the schoolchildren were analyzed for STH infections, whereas finger-prick blood samples were analyzed for G6PDd, hemoglobin concentrations, and Plasmodium infections. Among 988 enrolled children, Plasmodium vivax, Plasmodium falciparum, hookworm, Ascaris lumbricoides, and Trichuris trichiura infections occurred in 3.3%, 0.8%, 31.5%, 1.2%, and 0.3%, respectively. Glucose-6-phosphate dehydrogenase deficiency was present in 16.9% of the children, and there was a very high prevalence of anemia (73%). Anthropometric measures performed on all children showed that 50% of the children were stunted and 25% wasted. Moderate to severe anemia was associated with STH infections, stunting, and wasting. In addition, children had increasing odds of anemia with increasing burden of infections. This study revealed a high prevalence of G6PDd, STHs, and anemia in schools located in a conflict zone. In areas where malnutrition and STH infections are rampant, testing for both glucose-6-phosphate dehydrogenase and anemia should be considered before treating vivax malaria with 8-aminoquinolines.
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Affiliation(s)
- Weilin Zeng
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Pallavi Malla
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Xin Xu
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Liang Pi
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Luyi Zhao
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Xi He
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
| | - Yongshu He
- Department of Cell Biology and Medical Genetics, Kunming Medical University, Kunming, China
| | - Lynette J Menezes
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Zhaoqing Yang
- Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, China
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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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Brimson S, Suwanwong Y, Brimson JM. Nutritional anemia predominant form of anemia in educated young Thai women. ETHNICITY & HEALTH 2019; 24:405-414. [PMID: 28669237 DOI: 10.1080/13557858.2017.1346188] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 05/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Anaemia is one of the most common health problems worldwide, with a high prevalence in Africa and South East Asia, including Thailand. Thai women of childbearing age have an increased risk of anaemia due to several factors including underlying health problems, lifestyles and poor diet. Therefore, we investigated the prevalence of anaemia among female students of Chulalongkorn University (aged 18-22) and categorized causes of the anaemia. DESIGN 400 Thai female student-volunteers, without known underlying diseases were subjected to blood tests; complete blood count, Haemoglobin typing and serum ferritin level. Bloods, having haemoglobin under 12 g/dl and hematocrit under 36%, were designated as anaemia. Then causes of anaemia are categorized into 3 groups; Iron deficiency, Thalassemia and Others. RESULTS We found that 21% of the volunteers were anaemic. In 85 anaemic volunteers, they were classified as Iron deficiency anaemia (IDA); with low serum ferritin levels 42.4%, Thalassemia; total of 6 types 25.9%, IDA and Thalassemia 2.3% and Others 29.4% in which haemoglobin typing and serum ferritin level were normal. CONCLUSION Iron deficiency anaemia (IDA) is the major cause of anaemia in Thai female students in our study. Several students were gradually developing anaemia where their haematocrit (Hct) and haemaglobin (Hb) were within reference range but mean corpuscular volume (MCV), mean corpuscular haemaglobin (MCH) and serum ferritin fell below reference range, indicating latent iron deficiency. A few volunteers had both IDA and Thalassemia and also Thalassemia with iron overloaded where health can be deteriorated without knowledge of having these conditions or proper health care. To improve their health, universities or public organizations should provide education and/or screen for anaemia. With the knowledge and understanding of their health issues or underling diseases, students themselves can prevent serious health conditions, improve university performances, and improve their quality of life.
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Affiliation(s)
- Sirikalaya Brimson
- a Department of Clinical Microscopy, Faculty of Allied Health Sciences , Chulalongkorn University , Bangkok , Thailand
| | - Yaneenart Suwanwong
- a Department of Clinical Microscopy, Faculty of Allied Health Sciences , Chulalongkorn University , Bangkok , Thailand
| | - James M Brimson
- b Department of Clinical Chemistry, Faculty of Allied Health Sciences , Chulalongkorn University , Bangkok , Thailand
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Kadegasem P, Songdej D, Lertthammakiat S, Chuansumrit A, Paisooksantivatana K, Mahaklan L, Wongwerawattanakoon P, Tangbubpha N, Sirachainan N. Reticulocyte hemoglobin equivalent in a thalassemia-prevalent area. Pediatr Int 2019; 61:240-245. [PMID: 30593711 DOI: 10.1111/ped.13775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/07/2018] [Accepted: 12/28/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Reticulocyte hemoglobin equivalent (Ret-He), a direct measure of the hemoglobin (Hb) in the young red blood cells, has been reported to be useful in the diagnosis of iron deficiency anemia (IDA) but may have some limitations in thalassemia trait. This study evaluated the differences in Ret-He in school-aged children, and assessed the diagnostic value of Ret-He in identifying IDA in a thalassemia-prevalent area. METHODS Blood samples underwent complete blood count analysis, including Ret-He, ferritin, serum iron and total iron binding capacity. Blood samples also underwent Hb typing and a molecular study for α-thalassemia. Receiver operating characteristic analysis was performed to determine the predictive capacity of Ret-He in the diagnosis of IDA. ID was defined as serum ferritin <30 ng/mL and/or transferrin saturation (TSAT) <16%; IDA was defined as serum ferritin <12 ng/mL and/or TSAT <16% with low Hb for age. Normal healthy children (normal controls: NC) had normal iron study, without the thalassemia trait. RESULTS Ninety-eight children with a mean age of 12.9 ± 0.6 years were included. Ret-He in the thalassemia trait group (26.7 ± 2.4 pg), ID group (29.0 ± 2.9 pg), IDA group (25.4 ± 2.7 pg), ID + thalassemia trait group (26.6 ± 2.8 pg), and the IDA + thalassemia trait group (24.6 ± 2.3 pg) was significantly lower than in the NC group (30.8 ± 1.7 pg; P < 0.001, 0.01, 0.006, 0.002 and <0.001, respectively). Ret-He had an area under the curve of 0.904 in diagnostic ability for IDA, while a cut-off ≤27 pg had a sensitivity of 91.7% and a specificity of 81%. CONCLUSION Ret-He was lowest in subjects with IDA + thalassemia trait. A Ret-He cut-off ≤27 pg was suggestive of IDA in the present study.
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Affiliation(s)
- Praguywan Kadegasem
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi District, Bangkok, Thailand
| | - Duantida Songdej
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi District, Bangkok, Thailand
| | - Surapong Lertthammakiat
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi District, Bangkok, Thailand
| | - Ampaiwan Chuansumrit
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi District, Bangkok, Thailand
| | - Karan Paisooksantivatana
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi District, Bangkok, Thailand
| | - Lalita Mahaklan
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi District, Bangkok, Thailand
| | - Pakawan Wongwerawattanakoon
- Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi District, Bangkok, Thailand
| | - Noppawan Tangbubpha
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi District, Bangkok, Thailand
| | - Nongnuch Sirachainan
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi District, Bangkok, Thailand
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Visser M, Van Zyl T, Hanekom SM, Baumgartner J, van der Hoeven M, Taljaard-Krugell C, Smuts CM, Faber M. Nutrient patterns and their relation to anemia and iron status in 5- to 12-y-old children in South Africa. Nutrition 2019; 62:194-200. [PMID: 30925444 DOI: 10.1016/j.nut.2019.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/27/2018] [Accepted: 01/23/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to assess nutrient patterns and their relation to anemia and iron status of school children using pooled data from three study populations in South Africa. METHODS Data from 5- to 12-y-old children (N = 578) from three independent studies conducted in two provinces in South Africa were pooled. Data used in the analysis were dietary intake, hemoglobin, and plasma ferritin concentrations. Nutrient patterns were determined using factor analysis. Logistic regression analysis was performed to determine relationships of nutrient patterns with anemia and iron deficiency. RESULTS In the pooled group, 13.8% of the children were anemic and 27.7% were iron deficient (ID). More than half of children did not meet the Estimated Average Requirement for various nutrients, including vitamins A, C, B12, folate, and zinc, although only 17.7% of children had an iron intake below the requirements. Median intakes for vitamins A and C were lower for anemic than non-anemic children (P = 0.03 and 0.02, respectively) and for ID versus non-ID children (P = 0.03 and 0.046, respectively). Four nutrient patterns were identified: plant protein, carbohydrate, iron, and B vitamins; animal protein and saturated fat; vitamins A and B12; and calcium and fiber. The vitamin A and B12 nutrient pattern was associated with lower odds of being anemic (odds ratio, 0.63; 95% confidence interval, 0.49-0.91; P = 0.035). CONCLUSION The present results highlighted the potential role of the combination of dietary vitamin A and B12 in the etiology of nutritional anemia in school-age children in South Africa. Nutrient pattern analysis may improve the understanding of the synergistic role of nutrients related to anemia and may assist in planning intervention strategies.
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Affiliation(s)
- Marina Visser
- Centre of Excellence for Nutrition, North-West University, South Africa.
| | - Tertia Van Zyl
- Centre of Excellence for Nutrition, North-West University, South Africa
| | - Susanna M Hanekom
- Centre of Excellence for Nutrition, North-West University, South Africa
| | | | - Marinka van der Hoeven
- Centre of Excellence for Nutrition, North-West University, South Africa; Infectious Disease and Public Health, Vrije University, The Netherlands
| | | | - Cornelius M Smuts
- Centre of Excellence for Nutrition, North-West University, South Africa
| | - Mieke Faber
- Centre of Excellence for Nutrition, North-West University, South Africa; Non-Communicable Diseases Research Unit, South African Medical Research Council, South Africa
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13
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Onyeneho NG, Corsi DJ, Kurpad A, Subramanian SV. Intergenerational influences on childhood anaemia. MATERNAL AND CHILD NUTRITION 2018; 15:e12673. [PMID: 30207425 DOI: 10.1111/mcn.12673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 06/07/2018] [Accepted: 07/20/2018] [Indexed: 12/20/2022]
Abstract
Prior research on assessing intergenerational influences on child anaemia has largely approached it from purely maternal perspective. Although there is much merit to focus on that, it is an extremely limited/reductionist view of understanding intergenerational influences. We expanded the intergenerational influences to include the fathers and overall of intergenerational household transfers. We analysed a sample of 19,619 mother-father-offspring trios from the 2015-2016 Indian National Fertility and Health Survey with available data on haemoglobin (Hb). Multinomial logistic regression models were used to establish associations between parent anaemia, household characteristics, and categories of offspring anaemia. Maternal and paternal Hb was measured as in children using a finger prick blood sample. The primary outcome was child's Hb level (in g/dl) and grades of anaemia defined as mild (10-10.9 g/dl), moderate (7-9.9 g/dl), and severe (<7 g/dl). Mean Hb was 10.1 g/dl for children, 14.2 g/dl among fathers, and 11.4 g/dl among mothers. Hb correlation was 0.1 between fathers and offspring and 0.2 between mothers and offspring (P < 0.001 for all correlations). Maternal-paternal Hb correlations were consistent across quintiles of wealth index. Maternal anaemia was associated with odds ratio of 1.3 (95% CI [1.1, 1.4]) and 1.6 (95% CI [1.4, 1.7]) for childhood mild and moderate/severe anaemia, respectively. Paternal mild anaemia was associated with an odds ratio of 1.1 (95% CI [0.9, 1.4]) and 1.4 (95% CI [1.2, 1.7]) for child moderate/severe anaemia. The clustering of poor circumstances suggests that public health strategies target social deprivation at the household level. A comprehensive perspective will provide holistic interventions to control childhood anaemia.
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Affiliation(s)
- Nkechi G Onyeneho
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Takemi Program in International Health, Boston, Massachusetts.,Department of Sociology/Anthropology, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Daniel J Corsi
- OMNI Research Group, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
| | - Anura Kurpad
- Department of Physiology, St. John's Medical College, Bangalore, India
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts
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14
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Barker MK, Henderson AM, Naguib K, Vercauteren SM, Devlin AM, Albert AY, Bahizire E, Tugirimana PL, Akilimali PZ, Boy E, Green TJ, Karakochuk CD. Serum Soluble Transferrin Receptor Concentrations Are Elevated in Congolese Children with Glucose-6-Phosphate Dehydrogenase Variants, but Not Sickle Cell Variants or α-Thalassemia. J Nutr 2017; 147:1785-1794. [PMID: 28768839 DOI: 10.3945/jn.117.252635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/02/2017] [Accepted: 06/23/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Anemia is common in Congolese children, and inherited blood disorders may be a contributing cause. The presence of sickle cell variants, X-linked glucose-6-phosphate dehydrogenase (G6PD) deficiency and α-thalassemia, has been previously reported. G6PD A- deficiency is characterized by the co-inheritance of G6PD 376 and 202 variants and is common in sub-Saharan Africa.Objective: We aimed to measure the associations between inherited blood disorders and hemoglobin, ferritin, and soluble transferrin receptor (sTfR) concentrations in Congolese children.Methods: Venous blood was collected from 744 children aged 6-59 mo from 2 provinces. We measured biomarkers of nutritional and inflammation status and malaria. Pyrosequencing was used to detect sickle cell variants. Polymerase chain reaction was used to detect G6PD variants and α-thalassemia deletions.Results: Overall, 11% of children had a sickle cell variant, 19% of boys were G6PD A- hemizygotes, 12% and 10% of girls were G6PD A- hetero- or homozygotes, respectively, and 12% of children had α-thalassemia. Multivariable linear regression models (adjusted for age, province, altitude, malaria, and biomarkers of nutritional and inflammation status) showed that G6PD A- hemizygous boys and G6PD 376 homozygous girls had higher sTfR concentrations [geometric mean ratios (95% CIs): 1.20 (1.03, 1.39) and 1.25 (1.02, 1.53), respectively] than children with no G6PD variants. Hemoglobin and ferritin concentrations were not independently associated with any of the inherited blood disorder genotypes.Conclusions: We found that 2 G6PD variant genotypes were associated with elevated sTfR concentrations, which limits the accuracy of sTfR as a biomarker of iron status in this population.
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Affiliation(s)
- Mikaela K Barker
- Food, Nutrition, and Health and.,British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Amanda M Henderson
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Karimah Naguib
- Food, Nutrition, and Health and.,British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Suzanne M Vercauteren
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Hematopathology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Angela M Devlin
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Arianne Y Albert
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Esto Bahizire
- Faculty of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo.,Center of Research in Epidemiology, Biostatistics and Clinical Research, Free University of Brussels, Brussels, Belgium
| | | | - Pierre Z Akilimali
- Department of Nutrition, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Erick Boy
- HarvestPlus, International Food Policy Research Institute, Washington, DC
| | - Tim J Green
- Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; and.,Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia
| | - Crystal D Karakochuk
- Food, Nutrition, and Health and .,British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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15
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Hossain MS, Raheem E, Sultana TA, Ferdous S, Nahar N, Islam S, Arifuzzaman M, Razzaque MA, Alam R, Aziz S, Khatun H, Rahim A, Morshed M. Thalassemias in South Asia: clinical lessons learnt from Bangladesh. Orphanet J Rare Dis 2017; 12:93. [PMID: 28521805 PMCID: PMC5437604 DOI: 10.1186/s13023-017-0643-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/27/2017] [Indexed: 12/20/2022] Open
Abstract
Thalassemias are emerging as a global public health concern. Due to remarkable success in the reduction of childhood mortality by controlling infectious diseases in developing countries, thalassemias are likely to be a major public health concern in the coming decades in South Asia. Despite the fact that Bangladesh lies in the world’s thalassemia belt, the information on different aspects (epidemiology, clinical course, mortality, complications and treatment outcomes) of thalassemias is lacking. In this comprehensive review, the aim is to to depict the epidemiological aspects of thalassemias, mutation profile and current treatment and management practices in the country by sharing the experience of dealing with 1178 cases over 2009–2014 time periods in a specialized thalassemia treatment centre. We have also discussed the preventative strategies of thalassemias from the context of Bangladesh which could be effective for other developing countries.
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Affiliation(s)
- Mohammad Sorowar Hossain
- Biomedical Research Foundation, House #7, Apartment# 1A, Road# 1/B, Banani, Chairman Bari, Dhaka-1213, Bangladesh. .,Faculty of Basic Sciences, Bangladesh University of Health Sciences, Dhaka, Bangladesh. .,School of Environmental Science and Management, Independent University, Dhaka, Bangladesh.
| | - Enayetur Raheem
- Biomedical Research Foundation, House #7, Apartment# 1A, Road# 1/B, Banani, Chairman Bari, Dhaka-1213, Bangladesh
| | - Tanvira Afroze Sultana
- Biomedical Research Foundation, House #7, Apartment# 1A, Road# 1/B, Banani, Chairman Bari, Dhaka-1213, Bangladesh
| | - Shameema Ferdous
- Biomedical Research Foundation, House #7, Apartment# 1A, Road# 1/B, Banani, Chairman Bari, Dhaka-1213, Bangladesh
| | - Nusrat Nahar
- Thalassemia Foundation Hospital, Dhaka, Bangladesh
| | | | - Mohammad Arifuzzaman
- Biomedical Research Foundation, House #7, Apartment# 1A, Road# 1/B, Banani, Chairman Bari, Dhaka-1213, Bangladesh
| | - Mohammad Abdur Razzaque
- Biomedical Research Foundation, House #7, Apartment# 1A, Road# 1/B, Banani, Chairman Bari, Dhaka-1213, Bangladesh.,Trinity College, Dublin, Ireland
| | - Rabiul Alam
- Biomedical Research Foundation, House #7, Apartment# 1A, Road# 1/B, Banani, Chairman Bari, Dhaka-1213, Bangladesh
| | - Sonia Aziz
- Department of Economics & Business, Moravian College, Bethlehem, USA
| | | | - Abdur Rahim
- Thalassemia Foundation Hospital, Dhaka, Bangladesh
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16
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Wah ST, Yi YS, Khin AA, Plabplueng C, Nuchnoi P. Prevalence of Anemia and Hemoglobin Disorders Among School Children in Myanmar. Hemoglobin 2017; 41:26-31. [PMID: 28367656 DOI: 10.1080/03630269.2017.1289103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The prevalence of anemia is high in the population of Myanmar and hypochromic microcytic anemia (HMA) is predominant. The objective of our study was to determine the prevalence of anemia and causes of HMA among school children. A cross-sectional study was conducted on 239 children from Thanlyin and Insein Townships, Yangon Region, Myanmar. Complete blood count (CBC) and blood film morphology was examined on venous blood samples. Hypochromic microcytic anemia cases were subsequently analyzed for serum ferritin and cellulose acetate hemoglobin (Hb) electrophoresis. The prevalence of anemia was 46.4%; 27.6% had mild, while 18.8% had moderate anemia, and no case of severe anemia was detected. The mean Hb concentration was 11.7 ± 0.9 g/dL. The younger age group (8-11 years) had a significantly higher prevalence of anemia than the older age group (12-15 years) (p = 0.029). Blood film morphology revealed a 50.6% red blood cell (RBC) disorder; HMA was the most common type (70.2%). Out of 85 children with HMA, three children (3.5%) had iron deficiency and all had comorbidity with Hb AE (βA/βE) (Hb E trait). Hemoglobin electrophoresis illustrated that Hb AA (βA/βA) (31, 36.5%) and Hb AE (βA/βE) trait (31, 36.5%) were the most common types followed by β-thalassemia (β-thal) trait (19, 22.3%) and Hb EE (βE/βE) (homozygous Hb E; HBB: c.79G>A) (three, 3.5%). Hematocrit [or packed cell volume (PCV)], mean corpuscular volume (MCV), mean corpuscular Hb (MCH) and mean corpuscular Hb concentration (MCHC), showed a significant difference between Hb AE, Hb EE and β-thal trait (p = 0.029, 0.023, 0.015 and 0.01, respectively). Our findings will provide valuable information for the management of anemia in the Myanmar school-age population.
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Affiliation(s)
- Saw Thu Wah
- a Department of Clinical Microscopy, Faculty of Medical Technology , Mahidol University , Bangkok , Thailand.,b Department of Medical Laboratory Technology , University of Medical Technology , Yangon , Myanmar
| | - Yoon Shwe Yi
- b Department of Medical Laboratory Technology , University of Medical Technology , Yangon , Myanmar
| | - Aye Aye Khin
- b Department of Medical Laboratory Technology , University of Medical Technology , Yangon , Myanmar
| | - Chotiros Plabplueng
- a Department of Clinical Microscopy, Faculty of Medical Technology , Mahidol University , Bangkok , Thailand.,c Center for Research and Innovation, Faculty of Medical Technology , Mahidol University , Bangkok , Thailand
| | - Pornlada Nuchnoi
- a Department of Clinical Microscopy, Faculty of Medical Technology , Mahidol University , Bangkok , Thailand.,c Center for Research and Innovation, Faculty of Medical Technology , Mahidol University , Bangkok , Thailand
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17
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Wray K, Allen A, Evans E, Fisher C, Premawardhena A, Perera L, Rodrigo R, Goonathilaka G, Ramees L, Webster C, Armitage AE, Prentice AM, Weatherall DJ, Drakesmith H, Pasricha SR. Hepcidin detects iron deficiency in Sri Lankan adolescents with a high burden of hemoglobinopathy: A diagnostic test accuracy study. Am J Hematol 2017; 92:196-203. [PMID: 27883199 PMCID: PMC5324588 DOI: 10.1002/ajh.24617] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 12/23/2022]
Abstract
Anemia affects over 800 million women and children globally. Measurement of hepcidin as an index of iron status shows promise, but its diagnostic performance where hemoglobinopathies are prevalent is unclear. We evaluated the performance of hepcidin as a diagnostic test of iron deficiency in adolescents across Sri Lanka. We selected 2273 samples from a nationally representative cross-sectional study of 7526 secondary schoolchildren across Sri Lanka and analyzed associations between hepcidin and participant characteristics, iron indices, inflammatory markers, and hemoglobinopathy states. We evaluated the diagnostic accuracy of hepcidin as a test for iron deficiency with estimation of the AUCROC , sensitivity/specificity at each hepcidin cutoff, and calculation of the Youden Index to find the optimal threshold. Hepcidin was associated with ferritin, sTfR, and hemoglobin. The AUCROC for hepcidin as a test of iron deficiency was 0.78; hepcidin outperformed Hb and sTfR. The Youden index-predicted cutoff to detect iron deficiency (3.2 ng/mL) was similar to thresholds previously identified to predict iron utilization and identify deficiency in African populations. Neither age, sex, nor α- or β-thalassemia trait affected diagnostic properties of hepcidin. Hepcidin pre-screening would prevent most iron-replete thalassemia carriers from receiving iron whilst still ensuring most iron deficient children were supplemented. Our data indicate that the physiological relationship between hepcidin and iron status transcends specific populations. Measurement of hepcidin in individuals or populations could establish the need for iron interventions. Am. J. Hematol. 92:196-203, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Katherine Wray
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford; Oxford UK
- BRC Blood Theme; NIHR Oxford Biomedical Research Centre; Oxford UK
| | - Angela Allen
- Liverpool School of Tropical Medicine; Centre for Tropical and Infectious Diseases; Liverpool UK
| | - Emma Evans
- Department of Biochemistry and Immunology; Birmingham Heartlands Hospital; Birmingham UK
| | - Chris Fisher
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford; Oxford UK
| | | | - Lakshman Perera
- Department of Medicine; University of Kelaniya; Colombo Sri Lanka
| | - Rexan Rodrigo
- Department of Medicine; University of Kelaniya; Colombo Sri Lanka
| | | | - Lebbe Ramees
- Department of Medicine; University of Kelaniya; Colombo Sri Lanka
| | - Craig Webster
- Department of Biochemistry and Immunology; Birmingham Heartlands Hospital; Birmingham UK
| | - Andrew E Armitage
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford; Oxford UK
| | - Andrew M Prentice
- MRC Unit The Gambia, MRC Keneba; The Gambia
- MRC International Nutrition Group, London School of Hygiene and Tropical Medicine; London UK
| | - David J Weatherall
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford; Oxford UK
| | - Hal Drakesmith
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford; Oxford UK
- BRC Blood Theme; NIHR Oxford Biomedical Research Centre; Oxford UK
| | - Sant-Rayn Pasricha
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford; Oxford UK
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18
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Sirachainan N, Chuansumrit A, Kadegasem P, Sasanakul W, Wongwerawattanakoon P, Mahaklan L. Normal hemostatic parameters in children and young adults with α-thalassemia diseases. Thromb Res 2016; 146:35-42. [DOI: 10.1016/j.thromres.2016.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/11/2016] [Accepted: 08/21/2016] [Indexed: 11/16/2022]
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19
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Harvey-Leeson S, Karakochuk CD, Hawes M, Tugirimana PL, Bahizire E, Akilimali PZ, Michaux KD, Lynd LD, Whitfield KC, Moursi M, Boy E, Foley J, McLean J, Houghton LA, Gibson RS, Green TJ. Anemia and Micronutrient Status of Women of Childbearing Age and Children 6-59 Months in the Democratic Republic of the Congo. Nutrients 2016; 8:98. [PMID: 26901219 PMCID: PMC4772060 DOI: 10.3390/nu8020098] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 01/26/2016] [Accepted: 02/05/2016] [Indexed: 01/11/2023] Open
Abstract
Little is known about the micronutrient status of women and children in the Democratic Republic of the Congo, which is critical for the design of effective nutrition interventions. We recruited 744 mother-child pairs from South Kivu (SK) and Kongo Central (KC). We determined hemoglobin (Hb), serum zinc, vitamin B12, folate, ferritin, soluble transferrin receptor (sTfR), retinol binding protein (RBP), C-reactive protein, and α-1 acid glycoprotein concentrations. Anemia prevalence was determined using Hb adjusted for altitude alone and Hb adjusted for both altitude and ethnicity. Anemia prevalence was lower after Hb adjustment for altitude and ethnicity, compared to only altitude, among women (6% vs. 17% in SK; 10% vs. 32% in KC), children 6–23 months (26% vs. 59% in SK; 25% vs. 42% in KC), and children 24–59 months (14% vs. 35% in SK; 23% vs. 44% in KC), respectively. Iron deficiency was seemingly higher with sTfR as compared to inflammation-adjusted ferritin among women (18% vs. 4% in SK; 21% vs. 5% in KC), children 6–23 months (51% vs. 14% in SK; 74% vs. 10% in KC), and children 24–59 months (23% vs. 4% in SK; 58% vs. 1% in KC). Regardless of indicator, iron deficiency anemia (IDA) never exceeded 3% in women. In children, IDA reached almost 20% when sTfR was used but was only 10% with ferritin. Folate, B12, and vitamin A (RBP) deficiencies were all very low (<5%); RBP was 10% in children. The prevalence of anemia was unexpectedly low. Inflammation-adjusted zinc deficiency was high among women (52% in SK; 58% in KC), children 6–23 months (23% in SK; 20% in KC), and children 24–59 months (25% in SK; 27% in KC). The rate of biochemical zinc deficiency among Congolese women and children requires attention.
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Affiliation(s)
- Sarah Harvey-Leeson
- Food, Nutrition and Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
| | - Crystal D Karakochuk
- Food, Nutrition and Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
| | - Meaghan Hawes
- Food, Nutrition and Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
| | - Pierrot L Tugirimana
- Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo.
- Department of Clinical Biology, College of Medicine and Heath Science, University of Rwanda, Kigali, Rwanda.
| | - Esto Bahizire
- Faculty of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo.
- Center of Research in Natural Sciences of Lwiro, Bukavu, Democratic Republic of the Congo.
| | - Pierre Z Akilimali
- Department of Nutrition, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
| | - Kristina D Michaux
- Food, Nutrition and Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
| | - Larry D Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
| | - Kyly C Whitfield
- Food, Nutrition and Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
| | - Mourad Moursi
- International Food Policy Research Institute, Washington, DC 20006, USA.
| | - Erick Boy
- International Food Policy Research Institute, Washington, DC 20006, USA.
| | - Jennifer Foley
- Food, Nutrition and Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
| | - Judy McLean
- Food, Nutrition and Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand.
| | - Rosalind S Gibson
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand.
| | - Tim J Green
- Food, Nutrition and Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
- South Australian Health and Medical Research Institute, and the Women's and Children's Health Research Institute, Adelaide 5000, Australia.
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20
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Sirachainan N, Wijarn P, Chuansumrit A, Kadegasem P, Wongwerawattanakoon P, Soisamrong A. Aspirin resistance in children and young adults with splenectomized thalassemia diseases. Thromb Res 2015; 135:916-22. [DOI: 10.1016/j.thromres.2015.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 01/15/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
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21
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Jani R, Salian N, Udipi S, Ghugre P, Lohia N, Haas J, Boy E. Folate Status and Intake of Tribal Indian Adolescents Aged 10 to 17 Years. Food Nutr Bull 2015; 36:14-23. [DOI: 10.1177/156482651503600102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Adequate folate intake and levels are advisable throughout life but are of particular importance during adolescence, a period of rapid growth. However, folate insufficiency in economically deprived Indian adolescents is understudied. Objective This cross-sectional study examined the prevalence of folate deficiency and adequacy of folate intake of 224 tribal Indian adolescents (10 to 17 years of age). The secondary aim was to study the association between anemia status and folate status. Methods Radioimmunoassay, multiple-pass 24-hour dietary recall, and HemoCue were used to measure red blood cell (RBC) folate, folate intake, and anemia status, respectively. Results The geometric mean (95% CI) RBC folate concentration (nmol/L) was 360.2 (329.7 to 393.6), and the mean ± SD folate intake (μg/day) and hemoglobin level (g/L) were 159.9 ± 44.7 and 125.4 ± 13.0, respectively. Almost half of boys and girls aged 10 to 12 and 13 to 15 years and 66.7% of girls aged 16 to 17 years were deficient in RBC folate (< 340 nmol/L). The mean ± SD folate intake (μg/day) of girls (139.4 ± 34.5) was lower than that of boys (173.8 ± 45.5) ( p < .001). With respect to adequacy of folate intake, a greater proportion of girls in the age group of 13–15 years (78.5% vs 38.6%, p < 0.001) and 16–17 years (100.0% vs 76.9%, p = 0.04) had intakes below their Recommended Dietary Allowance (RDA). No association was observed between folate intake and RBC folate deficiency or between anemia status and RBC folate deficiency. Conclusions Folate insufficiency was widespread in tribal Indian adolescents. There is an urgent need to develop culturally sensitive strategies for improvement.
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22
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Karakochuk CD, Whitfield KC, Barr SI, Lamers Y, Devlin AM, Vercauteren SM, Kroeun H, Talukder A, McLean J, Green TJ. Genetic hemoglobin disorders rather than iron deficiency are a major predictor of hemoglobin concentration in women of reproductive age in rural prey Veng, Cambodia. J Nutr 2015; 145:134-42. [PMID: 25527668 DOI: 10.3945/jn.114.198945] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Anemia is common in Cambodian women. Potential causes include micronutrient deficiencies, genetic hemoglobin disorders, inflammation, and disease. OBJECTIVES We aimed to investigate factors associated with anemia (low hemoglobin concentration) in rural Cambodian women (18-45 y) and to investigate the relations between hemoglobin disorders and other iron biomarkers. METHODS Blood samples were obtained from 450 women. A complete blood count was conducted, and serum and plasma were analyzed for ferritin, soluble transferrin receptor (sTfR), folate, vitamin B-12, retinol binding protein (RBP), C-reactive protein (CRP), and α1 acid glycoprotein (AGP). Hemoglobin electrophoresis and multiplex polymerase chain reaction were used to determine the prevalence and type of genetic hemoglobin disorders. RESULTS Overall, 54% of women had a genetic hemoglobin disorder, which included 25 different genotypes (most commonly, hemoglobin E variants and α(3.7)-thalassemia). Of the 420 nonpregnant women, 29.5% had anemia (hemoglobin <120 g/L), 2% had depleted iron stores (ferritin <15 μg/L), 19% had tissue iron deficiency (sTfR >8.3 mg/L), <3% had folate deficiency (<3 μg/L), and 1% had vitamin B-12 deficiency (<150 pmol/L). Prevalences of iron deficiency anemia (IDA) were 14.2% and 1.5% in those with and without hemoglobin disorders, respectively. There was no biochemical evidence of vitamin A deficiency (RBP <0.7 μmol/L). Acute and chronic inflammation were prevalent among 8% (CRP >5 mg/L) and 26% (AGP >1 g/L) of nonpregnant women, respectively. By using an adjusted linear regression model, the strongest predictors of hemoglobin concentration were hemoglobin E homozygous disorder and pregnancy status. Other predictors were 2 other heterozygous traits (hemoglobin E and Constant Spring), parity, RBP, log ferritin, and vitamin B-12. CONCLUSIONS Multiple biomarkers for anemia and iron deficiency were significantly influenced by the presence of hemoglobin disorders, hence reducing their diagnostic sensitivity. Further investigation of the unexpectedly low prevalence of IDA in Cambodian women is warranted.
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Affiliation(s)
- Crystal D Karakochuk
- Food, Nutrition, and Health, Departments of The Child and Family Research Institute, Vancouver, Canada
| | - Kyly C Whitfield
- Food, Nutrition, and Health, Departments of The Child and Family Research Institute, Vancouver, Canada
| | | | - Yvonne Lamers
- Food, Nutrition, and Health, Departments of The Child and Family Research Institute, Vancouver, Canada
| | - Angela M Devlin
- Pathology and Laboratory Medicine, and Pediatrics, University of British Columbia, Vancouver, Canada; The Child and Family Research Institute, Vancouver, Canada
| | - Suzanne M Vercauteren
- Pathology and Laboratory Medicine, and The Child and Family Research Institute, Vancouver, Canada; Division of Hematopathology, Children and Women's Health Centre of British Columbia, Vancouver, Canada; and
| | - Hou Kroeun
- Helen Keller International, Cambodia Country Office, Phnom Penh, Cambodia
| | | | | | - Timothy J Green
- Food, Nutrition, and Health, Departments of The Child and Family Research Institute, Vancouver, Canada;
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Htet MK, Fahmida U, Dillon D, Akib A, Utomo B, Thurnham DI. The influence of vitamin A status on iron-deficiency anaemia in anaemic adolescent schoolgirls in Myanmar. Public Health Nutr 2014; 17:2325-32. [PMID: 24128336 PMCID: PMC10282611 DOI: 10.1017/s1368980013002723] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 08/22/2013] [Accepted: 09/02/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The present study was conducted to investigate reasons for the high prevalence of anaemia among adolescent schoolgirls and to elucidate the role of vitamin A in contributing to Fe-deficiency anaemia (IDA). DESIGN Among 1269 schoolgirls who were previously screened for anaemia (Hb < 120 g/l), 391 anaemic girls were further assessed for Fe, vitamin A and subclinical inflammation status. Fe and vitamin A indicators were corrected for inflammation and were compared in the Fe-deficient and non-deficient groups as well as between those with and without inflammation. Logistic regression was done to determine whether vitamin A status and subclinical inflammation were risk factors for Fe deficiency. The differences in Fe status among tertiles of vitamin A concentrations were assessed using ANOVA. SETTING Myanmar. SUBJECTS Adolescent schoolgirls (n 391). RESULTS One-third of the anaemia (30·4%) was IDA. Prevalence of low vitamin A status (serum retinol <1·05 μmol/l) was 31·5%. Fe and vitamin A status were significantly different between the IDA and non-IDA groups and also based on their inflammation status. Logistic regression showed that low vitamin A status was a significant predictor for being Fe deficient (OR = 1·81; 95% CI 1·03, 3·19 and OR = 2·31; 1·31, 4·07 in the middle (1·056-1·298 μmol/l) and low (≤1·056 μmol/l) vitamin A tertiles, respectively). ANOVA showed that better Fe status was associated with a higher concentration of serum retinol but only in IDA. CONCLUSIONS Fe deficiency was not the main cause of anaemia in the present population. The role of vitamin A as well as other micronutrients should be taken into account in addressing the problem of anaemia.
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Affiliation(s)
- Min Kyaw Htet
- South East Asian Ministers of Education Organization, Regional Center for Food and Nutrition, University of Indonesia, Salemba Raya 6, Jakarta 10430, Indonesia
- Department of Health, Ministry of Health, Nay Pyi Taw, Myanmar
| | - Umi Fahmida
- South East Asian Ministers of Education Organization, Regional Center for Food and Nutrition, University of Indonesia, Salemba Raya 6, Jakarta 10430, Indonesia
| | - Drupadi Dillon
- South East Asian Ministers of Education Organization, Regional Center for Food and Nutrition, University of Indonesia, Salemba Raya 6, Jakarta 10430, Indonesia
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Arwin Akib
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Budi Utomo
- Faculty of Public Health, University of Indonesia, Depok, Indonesia
| | - David I Thurnham
- Northern Ireland Centre for Food and Health, School of Biomedical Science, University of Ulster, Coleraine, UK
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Lander RL, Bailey KB, Lander AG, Alsaleh AA, Costa-Ribeiro HC, Mattos AP, Barreto DL, Houghton LA, Morison IM, Williams SM, Gibson RS. Disadvantaged pre-schoolers attending day care in Salvador, Northeast Brazil have a low prevalence of anaemia and micronutrient deficiencies. Public Health Nutr 2014; 17:1984-92. [PMID: 24008015 PMCID: PMC11108718 DOI: 10.1017/s1368980013002310] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 06/23/2013] [Accepted: 07/25/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the micronutrient status of disadvantaged pre-schoolers from Northeast Brazil, following the introduction of pro-poor policies, by assessing the prevalence of anaemia and micronutrient deficiencies and the role of sociodemographic factors, genetic Hb disorders and parasitic infections. DESIGN In a cross-sectional study, data on sociodemographic status, health, growth, genetic Hb disorders, parasites and nutrient supply from day-care meals were obtained. Fasting blood samples were collected and analysed for Hb, serum ferritin, transferrin receptor, folate, vitamin B₁₂, retinol, Zn and Se. SETTING Seven philanthropic day-care centres serving urban slums in Salvador, Northeast Brazil. SUBJECTS Pre-schoolers aged 3-6 years from disadvantaged households. RESULTS Of the 376 sampled children, 94 % were of black or mixed race; 33 % and 29 % had at least one genetic Hb disorder and intestinal parasite, respectively. Stunting and underweight were ≤5 %; 14 % were overweight. Day-care centres supplied micronutrient-dense meals and snacks each weekday. Less than 10 % of pre-schoolers had anaemia and micronutrient deficiencies. Predictors (P < 0·05) of Hb were α(3·7) thalassaemia, Se and retinol (but not ferritin). Micronutrient predictors (P < 0·05) were: elevated α₁-glycoprotein for ferritin, Hb AS and BMI Z-score >1 for transferrin receptor, Zn and elevated α₁-glycoprotein for retinol, sex and helminths for Se, helminths for vitamin B₁₂, and Giardia intestinalis infection for serum folate. CONCLUSIONS Impaired growth, anaemia and micronutrient deficiencies were uncommon among these disadvantaged pre-schoolers attending day care. A range of interventions including provision of micronutrient-dense, fortified day-care meals, deworming and vitamin A supplementation likely contributed to improved micronutrient status, suggesting expanded coverage of these programmes.
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Affiliation(s)
- Rebecca L Lander
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Karl B Bailey
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Alastair G Lander
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand
| | | | - Hugo C Costa-Ribeiro
- Hospital Universitário Professor Edgard Santos, Fima Lifshitz Research Unit, Salvador, Bahia, Brazil
| | - Angela P Mattos
- Hospital Universitário Professor Edgard Santos, Fima Lifshitz Research Unit, Salvador, Bahia, Brazil
| | - Danile L Barreto
- Hospital Universitário Professor Edgard Santos, Fima Lifshitz Research Unit, Salvador, Bahia, Brazil
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Ian M Morison
- Department of Pathology, University of Otago, Dunedin, New Zealand
| | - Sheila M Williams
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Rosalind S Gibson
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand
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Khanh Van T, Burja K, Thuy Nga T, Kong K, Berger J, Gardner M, Dijkhuizen MA, Hop LT, Tuyen LD, Wieringa FT. Organoleptic qualities and acceptability of fortified rice in two Southeast Asian countries. Ann N Y Acad Sci 2014; 1324:48-54. [PMID: 25154778 DOI: 10.1111/nyas.12506] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/27/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
Abstract
Fortified rice has the potential to improve the micronutrients status of vulnerable populations. However, fortified rice has to have acceptable organoleptic--the sensory properties of a particular food--qualities. Few data exist on the acceptability of fortified rice in Asia. To assess the acceptability of two types of fortified rice (cold and hot extruded) in Vietnam and Cambodia, triangle tests were conducted in Vietnam (53 women) and Cambodia (258 adults), testing fortified rice against conventional rice, with participants being asked to score the organoleptic qualities. In addition, Cambodian schoolchildren (n = 1700) were given conventional rice and two types of fortified rice for two week periods as part of a World Food Program school meal program, with intake monitored. Fortified rice differed significantly in organoleptic qualities from conventional rice, with most subjects correctly identifying fortified rice (P < 0.001). However, fortified rice was found to be highly acceptable in both countries. In Cambodia, schoolchildren consuming fortified rice had higher intakes than when consuming conventional rice (176 g/child/day and 168 g/child/day, respectively; P < 0.05). This study shows that fortified rice is acceptable in two countries in Southeast Asia. However, specific information is needed to explain the organoleptic qualities of fortified rice as perceived by end-users.
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Affiliation(s)
- Tran Khanh Van
- National Institute of Nutrition, Ministry of Health, Hanoi, Vietnam
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Nutritional status and dietary intakes of children aged 6 months to 12 years: findings of the Nutrition Survey of Malaysian Children (SEANUTS Malaysia). Br J Nutr 2013; 110 Suppl 3:S21-35. [DOI: 10.1017/s0007114513002092] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The dual burden of malnutrition reportedly coexists in Malaysia; however, existing data are scarce and do not adequately represent the nutritional status of Malaysian children. The Nutrition Survey of Malaysian Children was carried out with the aim of assessing the nutritional status in a sample of nationally representative population of children aged 6 months to 12 years. A total of 3542 children were recruited using a stratified random sampling method. Anthropometric measurements included weight, height, mid-upper arm circumference, and waist and hip circumferences. Blood biochemical assessment involved analyses of Hb, serum ferritin, and vitamins A and D. Dietary intake was assessed using semi-quantitative FFQ, and nutrient intakes were compared with the Malaysian Recommended Nutrient Intakes (RNI). The prevalence of overweight (9·8 %) and obesity (11·8 %) was higher than that of thinness (5·4 %) and stunting (8·4 %). Only a small proportion of children had low levels of Hb (6·6 %), serum ferritin (4·4 %) and vitamin A (4·4 %), but almost half the children (47·5 %) had vitamin D insufficiency. Dietary intake of the children was not compatible with the recommendations, where more than one-third did not achieve the Malaysian RNI for energy, Ca and vitamin D. The present study revealed that overnutrition was more prevalent than undernutrition. The presence of high prevalence of vitamin D insufficiency and the inadequate intake of Ca and vitamin D are of concern. Hence, strategies for improving the nutritional status of Malaysian children need to consider both sides of malnutrition and also put emphasis on approaches for the prevention of overweight and obesity as well as vitamin D insufficiency.
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Impact of inflammation on the biomarkers of iron status in a cross-sectional survey of Lao women and children. Br J Nutr 2013; 110:2285-97. [PMID: 23778021 DOI: 10.1017/s000711451300158x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anaemia is prevalent in South East Asia and Fe deficiency (ID) is considered to be the main cause, but the role of subclinical inflammation in the aetiology is uncertain. In the present study, we determined the influence of inflammation on the biomarkers of Fe status in women and children, and herein, we discuss the proportion of anaemia associated with ID. As part of the 2006 Lao People's Democratic Republic (The Lao PDR) National Nutrition Survey, blood collected from 482 young children and 816 non-pregnant women was analysed. Plasma ferritin, transferrin receptor (sTfR), Hb, C-reactive protein (CRP) and α-1-acid glycoprotein (AGP) concentrations were measured. ID was assessed using ferritin concentrations ( < 12 (children) or < 15 (adults) μg/l), sTfR concentrations (>8.3 mg/l) and body Fe stores (BIS < 0). Elevated CRP (>5 mg/l) and/or AGP (>1 g/l) concentrations were used to categorise inflammation status in order to correct the Fe biomarkers for inflammation. Inflammation was present in 14% of adults and 43% of children. Anaemia was present in 37.6% of both women (Hb concentrations < 120 g/l) and children (Hb concentrations < 110 g/l). Correcting ferritin concentrations for inflammation increased the prevalence of ID from 24.3 to 26% for women and from 18 to 21% for children (P< 0.001 for both). Ferritin concentrations were more helpful in detecting ID than sTfR concentrations or BIS, but regression analysis found that sTfr concentrations explained more of the variance in Hb concentrations in both women (20%) and children (17%) than ferritin concentrations (5 and 1.4%, respectively). Nevertheless, the total variance in Hb concentrations explained was only 26 and 18 % in women and children, respectively, and other factors may be more important than ID in contributing to anaemia in The Lao PDR.
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Abstract
Abstract
Despite worldwide economic and scientific development, more than a quarter of the world’s population remains anemic, and about half of this burden is a result of iron deficiency anemia (IDA). IDA is most prevalent among preschool children and women. Among women, iron supplementation improves physical and cognitive performance, work productivity, and well-being, and iron during pregnancy improves maternal, neonatal, infant, and even long-term child outcomes. Among children, iron may improve cognitive, psychomotor, and physical development, but the evidence for this is more limited. Strategies to control IDA include daily and intermittent iron supplementation, home fortification with micronutrient powders, fortification of staple foods and condiments, and activities to improve food security and dietary diversity. The safety of routine iron supplementation in settings where infectious diseases, particularly malaria, are endemic remains uncertain. The World Health Organization is revising global guidelines for controlling IDA. Implementation of anemia control programs in developing countries requires careful baseline epidemiologic evaluation, selection of appropriate interventions that suit the population, and ongoing monitoring to ensure safety and effectiveness. This review provides an overview and an approach for the implementation of public health interventions for controlling IDA in low- and middle-income countries, with an emphasis on current evidence-based recommendations.
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Pinkaew S, Winichagoon P, Hurrell RF, Wegmuller R. Extruded rice grains fortified with zinc, iron, and vitamin A increase zinc status of Thai school children when incorporated into a school lunch program. J Nutr 2013; 143:362-8. [PMID: 23303870 DOI: 10.3945/jn.112.166058] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Iron (Fe), zinc (Zn), and vitamin A (VA) deficiencies are common among children in developing countries and often occur in the same individual. Rice is widely consumed in the developing countries of Asia and the low phytate in polished rice makes it ideal for Zn and Fe fortification. Triple-fortified rice grains with Zn, Fe, and VA were produced using hot extrusion technology. The main objective of the present study was to determine the impact of triple-fortified extruded rice on Zn status in school children in Southern Thailand. Although serum zinc was the main outcome indicator, Fe and VA status were also assessed. School children with low serum zinc (n = 203) were randomized to receive either triple-fortified rice (n = 101) or natural control rice (n = 102) as a component of school lunch meals for 5 mo. Serum Zn, hemoglobin, serum ferritin, serum retinol, and C-reactive protein were measured at baseline and at the end of the study. After the intervention, serum Zn increased (P < 0.05) in both the fortification (11.3 ± 1.3 μmol/L) and control (10.6 ± 1.4 μmol/L) groups, most likely due to the proper implementation of the school lunch and school milk programs, with the increase greater in the group receiving the triple-fortified rice (P < 0.05). Because the children were not Fe or VA deficient at baseline, there was no change in Fe or VA status. We conclude that Zn fortification of extruded rice grains is efficacious and can be used to improve Zn status in school children.
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Affiliation(s)
- Siwaporn Pinkaew
- Laboratory for Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland
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30
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Kosalaraksa P, Bunupuradah T, Vonthanak S, Wiangnon S, Hansudewechakul R, Vibol U, Kanjanavanit S, Ngampiyaskul C, Wongsawat J, Luesomboon W, Lumbiganon P, Sopa B, Apornpong T, Chuenyam T, Cooper DA, Ruxrungtham K, Ananworanich J, Puthanakit T. Prevalence of anemia and underlying iron status in naive antiretroviral therapy HIV-infected children with moderate immune suppression. AIDS Res Hum Retroviruses 2012; 28:1679-86. [PMID: 22734817 DOI: 10.1089/aid.2011.0373] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Anemia is common in HIV-infected children and iron deficiency is thought to be a common cause. This study investigates the prevalence of anemia, thalassemia, and underlying iron status in Thai and Cambodian children without advanced HIV disease to determine the necessity of routine iron supplementation. Antiretroviral (ARV)-naive HIV-infected Asian children aged 1-12 years, with CD4 15-24%, CDC A or B, and hemoglobin (Hb) ≥7.5 g/dl were eligible for the study. Iron studies, serum ferritin, Hb typing, and C-reactive protein were assessed. Anemia was defined as Hb <11.0 g/dl in children <5 years of age or <11.5 g/dl in children 5-12 years. We enrolled 299 children; 57.9% were female and the mean (SD) age was 6.3 (2.9) years. The mean (SD) CD4% and HIV-RNA were 20% (4.6) and 4.6 (0.6) log(10) copies/ml, respectively. The mean (SD) Hb and serum ferritin were 11.2 (1.1) g/dl and 78.3 (76.4) μg/liter, respectively. The overall iron deficiency anemia (IDA) prevalence was 2.7%. One hundred and forty-eight (50%) children had anemia, mostly of a mild degree. Of these, 69 (46.6%) had the thalassemia trait, 62 (41.8%) had anemia of chronic disease (ACD), 9 (6.1%) had thalassemia diseases, 3 (2.0%) had iron deficiency anemia, and 5 (3.4%) had IDA and the thalassemia trait. The thalassemia trait was not associated with increased serum ferritin levels. Mild anemia is common in ARV-naïve Thai and Cambodian children without advanced HIV. However, IDA prevalence is low; with the majority of cases caused by ACD. A routine prescription of iron supplement in anemic HIV-infected children without laboratory confirmation of IDA should be discouraged, especially in regions with a high prevalence of thalassemia and low prevalence of IDA.
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Affiliation(s)
- Pope Kosalaraksa
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Surapon Wiangnon
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Ung Vibol
- National Pediatric Hospital, Phnom Penh, Cambodia
| | | | | | - Jurai Wongsawat
- Bamrasnaradura Infectious Diseases Institute, Nonthaburi, Thailand
| | | | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Bunruan Sopa
- HIV-NAT, Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | | | | | - David A. Cooper
- Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Kiat Ruxrungtham
- HIV-NAT, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jintanat Ananworanich
- HIV-NAT, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanyawee Puthanakit
- HIV-NAT, Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn Univiersity, Bangkok, Thailand
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Association between vitamin B12intake and EURRECA's prioritized biomarkers of vitamin B12in young populations: a systematic review. Public Health Nutr 2012; 16:1843-60. [DOI: 10.1017/s1368980012003953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AbstractObjectiveTo review evidence on the associations between vitamin B12intake and its biomarkers, vitamin B12intake and its functional health outcomes, and vitamin B12biomarkers and functional health outcomes.DesignA systematic review was conducted by searching electronic databases, until January 2012, using a standardized strategy developed in the EURRECA network. Relevant articles were screened and sorted based on title and abstract, then based on full text, and finally included if they met inclusion criteria. A total of sixteen articles were included in the review.SettingArticles covered four continents: America (n4), Europe (n8), Africa (n1) and Asia (n3).SubjectsPopulation groups included healthy infants, children and adolescents, and pregnant and lactating women.ResultsFrom the total number of 5815 papers retrieved from the initial search, only sixteen were eligible according to the inclusion criteria: five for infants, five for children and adolescents, and six for pregnant and lactating women.ConclusionsOnly one main conclusion could be extracted from this scarce number of references: a positive association between vitamin B12intake and serum vitamin B12in the infant group. Other associations were not reported in the eligible papers or the results were not provided in a consistent manner. The low number of papers that could be included in our systematic review is probably due to the attention that is currently given to research on vitamin B12in elderly people. Our observations in the current systematic review justify the idea of performing well-designed studies on vitamin B12in young populations.
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Pasricha SR. Should we screen for iron deficiency anaemia? A review of the evidence and recent recommendations. Pathology 2012; 44:139-47. [PMID: 22198251 DOI: 10.1097/pat.0b013e32834e8291] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Worldwide, over 1.6 billion people are anaemic. The prevalence of anaemia and contribution of iron deficiency to this burden is heterogeneous between different populations. Iron deficiency anaemia (IDA) is associated with impaired development in children, adverse effects on cognitive and physical performance in adults, and poorer maternal and infant outcomes in pregnancy. Causes of anaemia other than iron deficiency are important in developed countries and where malaria, thalassaemia or haemoglobinopathy are prevalent. Haemoglobin is the most commonly used screening test for iron deficiency, but may have inadequate sensitivity and specificity to determine iron status in many settings. Screening for anaemia during pregnancy is widely recommended. In children, studies evaluating screening programs have found problems with implementation, acceptability and follow-up of testing, and most international authorities do not support this practice. Nevertheless, certain groups with a particularly high pre-test probability of IDA may benefit from testing following clinical evaluation. Further research is required to define the role of screening and improve available tests for IDA in both developed and developing settings. In this review, the rationale, evidence, experience and expert guidelines regarding screening for IDA, especially among pregnant and paediatric populations, will be evaluated.
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Affiliation(s)
- Sant-Rayn Pasricha
- Nossal Institute for Global Health, and Department of Medicine, The Royal Melbourne Hospital, Australia.
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Wongprachum K, Sanchaisuriya K, Sanchaisuriya P, Siridamrongvattana S, Manpeun S, Schlep FP. Proxy indicators for identifying iron deficiency among anemic vegetarians in an area prevalent for thalassemia and hemoglobinopathies. Acta Haematol 2012; 127:250-5. [PMID: 22572177 DOI: 10.1159/000337032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 01/25/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS The study aimed to determine the proportion of iron deficiency (ID) anemia (IDA) among vegans in northeast Thailand and to explore whether mathematical formulas derived from red blood cell (RBC) indices are applicable for IDA screening in the study population. METHODS Blood samples from 234 individuals (age 6-45 years) living in a vegan community were taken. Complete blood cell count, serum ferritin, hemoglobin profiles and DNA analysis for α-thalassemia were determined. Anemia was defined using the WHO criteria adjusted for age and sex. Serum ferritin <15 ng/ml was considered as ID. A number of mathematical formulas derived from RBC indices were applied to screen ID among anemic individuals. RESULTS Anemia was found in 41.5% (95% CI = 35.1-48.1%) of the study participants. The overall proportion of thalassemia and hemoglobinopathies was 56.4% (95% CI = 49.8-62.9%). Of the anemic participants, 45.4% had ID. Based on the receiver-operating characteristic curve analysis, 4 formulas were applicable for predicting ID among anemic individuals (highest sensitivity of 86.4%). CONCLUSIONS The proposed formulas might be used as proxy indicators for the identification of ID among anemic children and adult vegans if more sophisticated laboratory determinations are not available due to limited financial resources.
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Affiliation(s)
- Kasama Wongprachum
- Center for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Thailand
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Cardoso MA, Scopel KKG, Muniz PT, Villamor E, Ferreira MU. Underlying factors associated with anemia in Amazonian children: a population-based, cross-sectional study. PLoS One 2012; 7:e36341. [PMID: 22574149 PMCID: PMC3344855 DOI: 10.1371/journal.pone.0036341] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 03/30/2012] [Indexed: 11/29/2022] Open
Abstract
Background Although iron deficiency is considered to be the main cause of anemia in children worldwide, other contributors to childhood anemia remain little studied in developing countries. We estimated the relative contributions of different factors to anemia in a population-based, cross-sectional survey. Methodology We obtained venous blood samples from 1111 children aged 6 months to 10 years living in the frontier town of Acrelândia, northwest Brazil, to estimate the prevalence of anemia and iron deficiency by measuring hemoglobin, erythrocyte indices, ferritin, soluble transferrin receptor, and C-reactive protein concentrations. Children were simultaneously screened for vitamin A, vitamin B12, and folate deficiencies; intestinal parasite infections; glucose-6-phosphate dehydrogenase deficiency; and sickle cell trait carriage. Multiple Poisson regression and adjusted prevalence ratios (aPR) were used to describe associations between anemia and the independent variables. Principal Findings The prevalence of anemia, iron deficiency, and iron-deficiency anemia were 13.6%, 45.4%, and 10.3%, respectively. Children whose families were in the highest income quartile, compared with the lowest, had a lower risk of anemia (aPR, 0.60; 95%CI, 0.37–0.98). Child age (<24 months, 2.90; 2.01–4.20) and maternal parity (>2 pregnancies, 2.01; 1.40–2.87) were positively associated with anemia. Other associated correlates were iron deficiency (2.1; 1.4–3.0), vitamin B12 (1.4; 1.0–2.2), and folate (2.0; 1.3–3.1) deficiencies, and C-reactive protein concentrations (>5 mg/L, 1.5; 1.1–2.2). Conclusions Addressing morbidities and multiple nutritional deficiencies in children and mothers and improving the purchasing power of poorer families are potentially important interventions to reduce the burden of anemia.
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Affiliation(s)
- Marly A Cardoso
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
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Hettiarachchi M, Liyanage C. Coexisting micronutrient deficiencies among Sri Lankan pre-school children: a community-based study. MATERNAL & CHILD NUTRITION 2012; 8:259-66. [PMID: 21166995 PMCID: PMC6860677 DOI: 10.1111/j.1740-8709.2010.00290.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Assessing micronutrient status in children may also have the benefit of addressing the problems of various micronutrient deficiencies with a unified programmatic approach on a public health scale. A cross-sectional survey in the Galle district of the micronutrient and anthropometric status of 248 children of ages 3-5 years was performed to determine the prevalence of micronutrient deficiencies [iron, zinc (Zn), folate, calcium, caeruloplasmin, iodine, vitamin A and vitamin D] and the extent to which multiple micronutrient deficiencies coexist. The prevalence of anaemia [haemogbolin (Hb) < 110.0 g L⁻¹] was 34.0% in males and 33.0% in females (overall 33.5%, gender difference, P = 0.92). In anaemic children, 7.0% of males and 15.0% of females were iron deficient (serum ferritin < 15.0 µg L⁻¹). Folate deficiency (<3.00 ng mL⁻¹) was found in 41.0% and 33.0% of male and female, respectively, whereas Zn deficiency (<9.95 µmol L⁻¹) occurred in 57.0% and 50.0% of male and female, respectively. Serum vitamin D deficiency (<35.0 nmol L⁻¹) was found in 26% and 25% of male and female, respectively. Anaemic males had a 3.0-fold (95% confidence interval (CI) 1.1-8.3) and 2.3-fold (95% CI 0.8-6.6) greater risk of being underweight and thin, whereas the risk among anaemic females was 0.7-fold (95% CI 0.3-1.8) and 0.9-fold (95% CI 0.3-2.6) for being underweight and thin. Only 7.3% of the subjects did not have any micronutrient deficiency, 38.3% were deficient in two micronutrients, 17.7% had three micronutrient deficiencies and 6.0% had four or more micronutrient deficiencies. Multiple micronutrient deficiencies are prevalent in Sri Lankan pre-school children and established baseline data for future studies.
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George J, Yiannakis M, Main B, Devenish R, Anderson C, An US, Williams SM, Gibson RS. Genetic hemoglobin disorders, infection, and deficiencies of iron and vitamin A determine anemia in young Cambodian children. J Nutr 2012; 142:781-7. [PMID: 22378325 PMCID: PMC3301994 DOI: 10.3945/jn.111.148189] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In Cambodia, many factors may complicate the detection of iron deficiency. In a cross-sectional survey, we assessed the role of genetic hemoglobin (Hb) disorders, iron deficiency, vitamin A deficiency, infections, and other factors on Hb in young Cambodian children. Data on sociodemographic status, morbidity, and growth were collected from children (n = 3124) aged 6 to 59 mo selected from 3 rural provinces and Phnom Penh municipality. Blood samples were collected (n = 2695) for complete blood count, Hb type (by DNA analysis), ferritin, soluble transferrin receptor (sTfR), retinol-binding protein (RBP), C-reactive protein, and α(1)-acid glycoprotein (AGP). Genetic Hb disorders, anemia, and vitamin A deficiency were more common in rural than in urban provinces (P < 0.001): 60.0 vs. 40.0%, 58.2 vs. 32.7%, and 7.4 vs. 3.1%, respectively. Major determinants of Hb were age group, Hb type, ferritin, sTfR, RBP, AGP >1.0 g/L (P < 0.001), and rural setting (P < 0.05). Age group, Hb type, RBP, elevated AGP, and rural setting also influenced ferritin and sTfR (P < 0.02). Multiple factors affected anemia status, including the following: age groups 6-11.99 mo (OR: 6.1; 95% CI: 4.3, 8.7) and 12-23.99 mo (OR: 2.7; 95% CI: 2.1, 3.6); Hb type, notably Hb EE (OR: 18.5; 95% CI: 8.5, 40.4); low ferritin (OR: 3.2; 95% CI: 2.2, 4.7); elevated AGP (OR: 1.4; 95% CI: 1.2,1.7); rural setting (OR: 2.3; 95% CI: 1.7, 3.1); low RBP (OR: 3.6; 95% CI: 2.2, 5.9); and elevated sTfR (OR: 2.1; 95% CI: 1.7, 2.7). In Cambodia, where a high prevalence of genetic Hb disorders exists, ferritin and sTfR are of limited use for assessing the prevalence of iron deficiency. New low-cost methods for detecting genetic Hb disorders are urgently required.
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Affiliation(s)
| | - Miriam Yiannakis
- Nutrition Center of Expertise, World Vision International, Mississauga, Ontario
| | - Barbara Main
- World Vision Canada, Mississauga, Ontario, Canada Mississauga, Ontario, Canada
| | | | - Courtney Anderson
- World Vision Canada, Mississauga, Ontario, Canada Mississauga, Ontario, Canada
| | - Ung Sam An
- National Institute of Public Health, Phnom Penh, Cambodia; and Departments of
| | | | - Rosalind S. Gibson
- Human Nutrition, University of Otago, Dunedin, New Zealand,To whom correspondence should be addressed. E-mail: or
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Ngui R, Lim YAL, Chong Kin L, Sek Chuen C, Jaffar S. Association between anaemia, iron deficiency anaemia, neglected parasitic infections and socioeconomic factors in rural children of West Malaysia. PLoS Negl Trop Dis 2012; 6:e1550. [PMID: 22413027 PMCID: PMC3295806 DOI: 10.1371/journal.pntd.0001550] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 01/12/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Given that micronutrient deficiency, neglected intestinal parasitic infections (IPIs) and poor socioeconomic status are closely linked, we conducted a cross-sectional study to assess the relationship between IPIs and nutritional status of children living in remote and rural areas in West Malaysia. METHODS/FINDINGS A total of 550 children participated, comprising 520 (94.5%) school children aged 7 to 12 years old, 30 (5.5%) young children aged 1 to 6 years old, 254 (46.2%) boys and 296 (53.8%) girls. Of the 550 children, 26.2% were anaemic, 54.9% iron deficient and 16.9% had iron deficiency anaemia (IDA). The overall prevalence of helminths was 76.5% comprising Trichuris trichiura (71.5%), Ascaris lumbricoides (41.6%) and hookworm infection (13.5%). It was observed that iron deficiency was significantly higher in girls (p = 0.032) compared to boys. Univariate analysis demonstrated that low level of mother's education (OR = 2.52; 95% CI = 1.38-4.60; p = 0.002), non working parents (OR = 2.18; 95% CI = 2.06-2.31; p = 0.013), low household income (OR = 2.02; 95% CI = 1.14-3.59; p = 0.015), T. trichiura (OR = 2.15; 95% CI = 1.21-3.81; p = 0.008) and A. lumbricoides infections (OR = 1.63; 95% CI = 1.04-2.55; p = 0.032) were significantly associated with the high prevalence of IDA. Multivariate analysis confirmed that low level of mother's education (OR = 1.48; 95 CI% = 1.33-2.58; p<0.001) was a significant predictor for IDA in these children. CONCLUSION It is crucial that a comprehensive primary health care programme for these communities that includes periodic de-worming, nutrition supplement, improved household economy, education, sanitation status and personal hygiene are taken into consideration to improve the nutritional status of these children.
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Affiliation(s)
- Romano Ngui
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yvonne Ai Lian Lim
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Liam Chong Kin
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chow Sek Chuen
- School of Science, Monash University, Jalan Lagoon Selatan, Selangor Darul Ehsan, Malaysia
| | - Shukri Jaffar
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Pongcharoen T, DiGirolamo AM, Ramakrishnan U, Winichagoon P, Flores R, Martorell R. Long-term effects of iron and zinc supplementation during infancy on cognitive function at 9 y of age in northeast Thai children: a follow-up study. Am J Clin Nutr 2011; 93:636-43. [PMID: 21270383 DOI: 10.3945/ajcn.110.002220] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Iron and zinc are important micronutrients for child growth and development. One would expect that iron and zinc supplementation in infancy would affect long-term cognitive development and school achievement, but this has not been evaluated. OBJECTIVE We investigated the effect of iron or zinc supplementation or both during infancy on cognitive performance 8 y later. DESIGN A follow-up study was performed in 560 children aged 9 y or 92% of those who had participated in a randomized controlled trial involving 4 groups who received daily iron, zinc, iron plus zinc, or a placebo at 4-6 mo of age for 6 mo. Cognitive performance was assessed by using the Wechsler Intelligence Scale for Children-Third Edition (Thai version), the Raven's Colored Progressive Matrices (CPM), and school performance tests. General linear mixed models were used to assess long-term effects. RESULTS No significant differences in any of the outcomes at 9 y of age were observed at follow-up between the 4 groups. Mean intelligence quotients ranged across groups from 92.9 to 93.7 for full scale, 93.9-95.4 for verbal, and 93.1-94.0 for performance. The Raven's CPM score ranged from 21.4 to 22.4. CONCLUSION Supplementation with iron or zinc or both during infancy does not lead to long-term cognitive improvement in 9-y-old children. This trial was registered at clinicaltrials.gov as NCT00824304.
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Affiliation(s)
- Tippawan Pongcharoen
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA 30322, USA
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Pansuwan A, Fucharoen G, Fucharoen S, Himakhun B, Dangwiboon S. Anemia, iron deficiency and thalassemia among adolescents in Northeast Thailand: results from two independent surveys. Acta Haematol 2011; 125:186-92. [PMID: 21228565 DOI: 10.1159/000322666] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 11/09/2010] [Indexed: 11/19/2022]
Abstract
The prevalence of adolescent anemia, iron deficiency and thalassemia were examined in 2 provinces of northeast Thailand. Blood specimens were collected from adolescent subjects aged 15-17 years in 2 areas; 185 (85 males and 100 females) in Mukdahan province and 313 (116 males and 197 females) in Roi-Et. RBC parameters, serum ferritin levels, Hb and DNA analyses for the identification of common thalassemia genes in Thailand were investigated. The prevalences of anemia were found to be 21.1% (8.1 in male and 13.0 in female) and 16.6% (8.9 in male and 7.7 in female) in Mukdahan and Roi-Et province, respectively. Iron deficiency was observed to be 24.3% in Mukdahan and 14.7% in Roi-Et. Various types of thalassemia were identified in 62.2 and 58.8% of the subject populations, respectively. The proportions of iron deficiency, thalassemia and combined thalassemia and iron deficiency among anemic subjects were 10.2, 53.8 and 30.8% in Mukdahan, and 7.7, 67.3 and 9.6% in Roi-Et. Hematological characteristics were analyzed and are presented. It is concluded that thalassemia and hemoglobinopathies rather than iron deficiency are major causes of adolescent anemia which should be taken into account in public health strategies for the control of anemia in the region.
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Panomai N, Sanchaisuriya K, Yamsri S, Sanchaisuriya P, Fucharoen G, Fucharoen S, Schelp FP. Thalassemia and iron deficiency in a group of northeast Thai school children: relationship to the occurrence of anemia. Eur J Pediatr 2010; 169:1317-22. [PMID: 20490546 DOI: 10.1007/s00431-010-1218-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 04/30/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED The cross-sectional study assessed anemia, thalassemia, and hemoglobinopathies, as well as iron deficiency, among 190 northeastern Thai school children aged 10 to 11 years. The aim was to analyze the reasons for anemia among the group. Hemoglobin concentration and other hematological parameters were determined using an automated blood cell counter. Beta-thalassemia and other hemoglobinopathies were identified by high performance liquid chromatography (HPLC) analysis of hemoglobin. Alpha-thalassemia was identified by polymerase chain reaction (PCR) and related techniques. Iron deficiency was assessed using serum ferritin (SF) <20 ng/ml as indicator. Based on the WHO criteria, anemia was defined by hemoglobin (Hb) level <11.5 g/dl. Twenty five out of 190 children (13.2%; 95% CI = 8.7-18.8%) were anemic. Iron deficiency was found in only two out of 190 children (1.0%; 95% CI = 0.1-3.8%), but the two iron deficient children were not anemic. The proportion of thalassemia and hemoglobinopathies among the group was 61.1% (95% CI = 53.7-68.0%). As underlying reasons for anemia, thalassemia and hemoglobinopathies were found in 22 out of 25 (88.0%) anemic children. Beta-thalassemia and homozygous Hb E seem to be important, while this was less obvious for heterozygous α-thalassemia and heterozygous Hb E. CONCLUSION The results suggest that thalassemia and hemoglobinopathies may be major contributing factors to the occurrence of anemia in this area among the children's population.
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Low prevalence of iron-deficiency anaemia among Inuit preschool children: Nunavut Inuit Child Health Survey, 2007–2008. Public Health Nutr 2010; 14:1415-23. [DOI: 10.1017/s1368980010002429] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractObjectiveTo report the prevalence rates and correlates for anaemia, iron deficiency (ID) and iron-deficiency anaemia (IDA) among Inuit preschool-aged children.DesignA cross-sectional study assessed iron intake, demographic information, medical history, anthropometrics, Hb, ferritin, C-reactive protein and antibodies toHelicobacter pylori.SettingSixteen selected Inuit communities in Nunavut Territory, Canada.SubjectsInuit (n388) aged 3–5 years randomly recruited from communities.ResultsAnaemia (3–4 years: Hb < 110 g/l; 5 years: Hb < 115 g/l) was prevalent in 16·8 % of children. The prevalence of ID (ferritin < 12 μg/l) was 18·0 % and that of IDA was 5·4 %. When ID was defined as ferritin <10 μg/l, 10·8 % of children were iron deficient and 3·3 % had IDA. In multiple logistic regression, boys were more likely to be iron deficient (OR = 2·28, 95 % CI 1·17, 8·25), but no other risk factor emerged for ID. Three- to 4-year-olds were less likely than 5-year-olds to have anaemia from causes other than ID (OR = 0·11, 95 % CI 0·08, 0·58). Anaemia from other causes was more common among children residing in crowded homes (OR = 2·30, 95 % CI 1·37, 12·31) and those treated for past-year ear infection (OR = 1·35, 95 % CI 1·05, 7·21).ConclusionsThe low prevalence of ID and IDA is encouraging, but efforts are still needed to reduce rates as they continue to be higher than general population rates. Household crowding and infections may contribute to anaemia and warrant further research.
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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: 165] [Impact Index Per Article: 11.8] [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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Kazi TG, Kandhro GA, Afridi HI, Kazi N, Baig JA, Arain MB, Shah AQ, Syed N, Kumar S, Kolachi NF, Khan S. Interaction of copper with iron, iodine, and thyroid hormone status in goitrous patients. Biol Trace Elem Res 2010; 134:265-79. [PMID: 19693445 DOI: 10.1007/s12011-009-8478-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Accepted: 07/17/2009] [Indexed: 10/20/2022]
Abstract
In many developing countries, men and women are at high risk of goiter and iron deficiency. The aim of the recent study is to assess the interaction of (Cu), with iron (Fe), iodine/iodide (I), and thyroid hormones in goitrous patients. Sixty goitrous male (GMPs) and 72 female patients (GFPs) were evaluated for the Cu, Fe, I, and thyroid hormones status in biological samples (serum and urine), and compared to non-goitrous subjects of both genders (M = 106, F = 120). The biological samples were analyzed for Cu and Fe concentration using atomic absorption spectrometer, while I was measured by the potentiometric method, prior to microwave-assisted acid digestion (MD). Quality control for the method was established with certified samples. Significantly higher mean values of Cu in serum, and urine samples of GMPs and GFPs, while lower value of Fe and I were observed as compared to control subjects (p < 0.015), respectively. The mean values of free triiodothyronine (FT3) and free thyroxin (FT4) were found to be lower in goitrous patients of both genders than in the age-matched healthy controls (p < 0.006 and 0.002), respectively, in contrast high mean values of thyroid-stimulating hormone (TSH) were detected in patients (p < 0.009), as compared to non-goitrous subjects. It was observed that the deficiencies of Fe, I, and thyroid hormone in goitrous patients could be influenced by efficiency of Cu.
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Affiliation(s)
- Tasneem Gul Kazi
- National Centre of Excellence in Analytical Chemistry, Sindh University, Jamshoro, Pakistan.
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Osei A, Houser R, Bulusu S, Joshi T, Hamer D. Nutritional Status of Primary Schoolchildren in Garhwali Himalayan Villages of India. Food Nutr Bull 2010; 31:221-33. [DOI: 10.1177/156482651003100205] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Anemia and micronutrient deficiencies are common among Indian schoolchildren. However, past studies have narrowly focused on only a few micronutrients and have not carefully evaluated the association between sociodemographic factors and nutritional status of schoolchildren. Objective To assess the nutritional status of schioolchildren in Himalayan villages of India and to determine the relationships between their nutritional status, intestinal helminth infection, and sociodemographic characteristics. Methods A random sample of 499 children 6 to 10 years of age from 20 public primary schools was selected. Household sociodemographic data and morbidity data on children were collected through interviews with their caretakers. Height and weight were measured, and venous blood was drawn for assessment of hemoglobin, serum ferritin, soluble transferrin receptor, retinol, zinc, folic acid, vitamin B12, and C-reactive protein. Stool samples were analyzed for parasitic infections. Results Underweight, stunting, and wasting were present in 60.9%, 56.1%, and 12.2% of schoolchildren, respectively. Anemia, iron-deficiency anemia, and low serum concentrations of ferritin, zinc, retinol, folate, and vitamin B12 were found in 36.7%, 10.2%, 24.1%, 57.1%, 56.1%, 67.9%, and 17.4% of the children, respectively. One-fifth of the children had intestinal parasites. Being underweight was associated with lower household wealth ( p < .05). Helminth infection was associated with stunting, anemia, and low serum retinol ( p < .05). Living at higher altitude was associated with low serum levels of ferritin, retinol, and vitamin B12. There were no associations between any sociodemographic variables and serum zinc or folate. Conclusions Growth impairment and micronutrient deficiencies are prevalent among schoolchildren in Himalayan villages of India.
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Krittaphol W, Bailey KB, Pongcharoen T, Winichagoon P, Gibson RS. Low zinc, iron, and calcium intakes of Northeast Thai school children consuming glutinous rice-based diets are not exacerbated by high phytate. Int J Food Sci Nutr 2009; 57:520-8. [PMID: 17162330 DOI: 10.1080/09637480601040989] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Phytate, a salt of phytic acid (myo-inositol 1,2,3,4,5,6-hexakisphosphate), is found in certain plant-based foods. It strongly chelates minerals, forming insoluble complexes in the small intestine that cannot be digested or absorbed. Information on the phytate content of rice-based diets of children in Northeast Thailand is limited. In this study 1-day weighed duplicate diet composites were collected from 40 Northeast Thai children (age 6-13 years) randomly selected from participants (n=567) of an efficacy trial in Ubon Ratchathani province. Diet composites were analyzed for zinc, iron, and calcium by atomic absorption spectrophotometry, and for phytate (as inositol penta-phosphate and hexa-phosphate) by high-performance liquid chromatography; the accuracy and precision were established using a certified reference material for the minerals and an inter-laboratory comparison for phytate. The median (1st, 3rd quartiles) zinc, iron, and calcium contents of the diet composites were 4.3 (3.7, 6.1), 4.3 (3.2, 6.5) and 130 (82, 216) mg/day, respectively. The inositol penta-phosphate and hexa-phosphate levels were so low they were below the detection limit, attributed in part to leaching of water-soluble potassium and magnesium phytate from glutinous rice after soaking overnight before cooking. Clearly, phytate will not compromise mineral absorption from these diets. Instead, low zinc intakes are probably primarily responsible for the low zinc status of these children. In contrast, although intakes of dietary iron appear low, the prevalence of biochemical iron deficiency was also low, suggesting that iron absorption may have been higher than previously assumed. Whether the low calcium intakes compromise optimal bone health in these growing Northeast Thai school children is unknown.
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von Drygalski A, Andris DA. Anemia after bariatric surgery: more than just iron deficiency. Nutr Clin Pract 2009; 24:217-26. [PMID: 19321896 DOI: 10.1177/0884533609332174] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Bariatric surgery for morbid obesity is rapidly gaining popularity. Restrictive and/or malabsorptive surgical interventions result in dramatic weight loss with significantly decreased obesity-related morbidity and mortality. Anemia, which may affect as many as two-thirds of these patients, is of concern and generally thought to be caused by iron deficiency. Although iron deficiency in this population may be frequent given pouch hypoacidity, defunctionalized small bowel, and red meat intolerance, it may not account for all anemias seen. First, there is increasing evidence that obesity creates a state of chronic inflammation. Both iron deficiency anemia and anemia of chronic inflammation present with low serum iron levels. Most studies reporting anemia after bariatric surgery lack serum ferritin determinations so that the relative contribution of inflammation to anemia cannot be assessed. Second, a significant number of anemias after bariatric surgery remain unexplained and may be attributable to less frequently seen micronutrient deficiencies such as copper, fatsoluble vitamins A and E, or an imbalance in zinc intake. Third, although deficiencies of folate and vitamin B(12) are infrequent, study observation periods may be too short to detect anemia attributable to vitamin B(12) deficiency because vitamin B(12) storage depletion takes many years. This review is intended to increase awareness of the mechanisms of anemia above and beyond iron deficiency in the bariatric patient and provide healthcare providers with tools for a more thoughtful approach to anemia in this patient population.
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Affiliation(s)
- Annette von Drygalski
- VA San Diego Healthcare System, La Jolla Medical Center, 3350 La Jolla Village Dr, 111E, San Diego, CA 92161, USA.
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Kandhro GA, Kazi TG, Afridi HI, Kazi N, Baig JA, Arain MB, Sirajuddin, Shah AQ, Sarfraz RA, Jamali MK, Syed N. Effect of zinc supplementation on the zinc level in serum and urine and their relation to thyroid hormone profile in male and female goitrous patients. Clin Nutr 2009; 28:162-8. [PMID: 19250719 DOI: 10.1016/j.clnu.2009.01.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 12/23/2008] [Accepted: 01/26/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND & AIMS Zinc (Zn) is an essential element involved in many basic biochemical reactions in thyroid. The aims of present study is to evaluate the Zn status in biological samples and thyroid hormones levels in 60 goitrous male (GMPs) and 72 female patients (GFPs), before and after 6 months treatment with Zn supplementation and compared with non-goitrous subjects of both genders (M=106, F=120) of age range 16-30 years. METHODS The biological samples were analyzed for Zn concentration using flame atomic absorption spectrophotometer, following their microwave assisted acid digestion. Quality control for the methodology was established with certified samples and with those obtained by conventional wet acid digestion method on the same CRMs and real samples. RESULTS The results showed that the significantly lower mean values of Zn in serum, while high level urine samples of GMPs and GFPs were observed as compared to control subjects (p<0.005 and 0.007) respectively. The mean values of free triiodothyronine and thyroxin were found to be lower in goitrous patients of both genders than in the age matched healthy control (p<0.006 and 0.002) respectively, in contrast high mean values of thyroid stimulating hormone were detected in GMPs and GFPs (p<0.009). CONCLUSION It was observed that Zn status and serum thyroid hormone levels were improved in goitrous patients after six months treatment with Zn supplementation.
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Affiliation(s)
- Ghulam Abbas Kandhro
- National Centre of Excellence in Analytical Chemistry, University of Sindh, Jamshoro 76080, Sindh, Pakistan.
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Chaparro CM. Setting the stage for child health and development: prevention of iron deficiency in early infancy. J Nutr 2008; 138:2529-33. [PMID: 19022984 DOI: 10.1093/jn/138.12.2529] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Iron deficiency is estimated to be the most common nutritional deficiency worldwide and is particularly persistent among infants and children. The high prevalence of anemia in 6- to 9-mo-old children raises the concern that birth iron stores in some infants are inadequate to sustain growth and development through the first 6 mo of life, and postnatal factors are contributing to early depletion of iron stores and development of anemia. At the same time, there are concerns about negative effects of excess iron in infants. Maternal iron status, infant birth weight and gestational age, as well as the timing of umbilical cord clamping at birth all contribute to the establishment of adequate total body iron at birth. Postnatally, feeding practices and growth rate are factors that will affect how quickly birth iron is depleted during the first 6 mo of life. Under conditions in which maternal iron status, birth weight, gestational age, and umbilical cord clamping time are optimal, and exclusive breast-feeding is practiced, infants should have adequate iron stores for the first 6-8 mo of life. Under suboptimal conditions, infants may not reach this goal and may need to be targeted for iron supplementation before 6 mo of age.
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von Drygalski A, Biller J. Anemia in Cystic Fibrosis: Incidence, Mechanisms, and Association With Pulmonary Function and Vitamin Deficiency. Nutr Clin Pract 2008; 23:557-63. [DOI: 10.1177/0884533608323426] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Annette von Drygalski
- From the Department of Medicine and Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. AvD is presently at Division of Hematology/Oncology, Department of Medicine, University of California at San Diego, California
| | - Julie Biller
- From the Department of Medicine and Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. AvD is presently at Division of Hematology/Oncology, Department of Medicine, University of California at San Diego, California
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Al-Mekhlafi MH, Surin J, Atiya AS, Ariffin WA, Mahdy AKM, Abdullah HC. Anaemia and iron deficiency anaemia among aboriginal schoolchildren in rural Peninsular Malaysia: an update on a continuing problem. Trans R Soc Trop Med Hyg 2008; 102:1046-52. [PMID: 18617209 DOI: 10.1016/j.trstmh.2008.05.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Revised: 05/16/2008] [Accepted: 05/19/2008] [Indexed: 10/21/2022] Open
Abstract
A cross-sectional study to determine the current prevalence of anaemia and iron deficiency anaemia (IDA) and to investigate the possible risk factors for IDA was carried out on 241 aboriginal schoolchildren (120 boys, 121 girls) aged 7-12 years and living in remote areas in Pos Betau, Pahang, Malaysia. Haemoglobin (Hb) level was measured and serum iron status was assessed by serum ferritin (SF), serum iron (SI) and total iron binding capacity measurements. Socioeconomic data were collected using pre-tested questionnaires. All children were screened for intestinal parasitic infections. Overall, 48.5% (95% CI 42.3-54.8) of children were anaemic (Hb<12 g/dl). The prevalence of IDA was 34% (95% CI 28.3-40.2), which accounted for 70.1% of the anaemia cases. The prevalence of IDA was significantly higher in females than males. Low levels of mothers' education and low household income were identified as risk factors for IDA. Severe trichuriasis also found to be associated with low SF and SI. Logistic regression confirmed low levels of mothers' education and gender as significant risk factors for IDA. Improvement of socioeconomic status and health education together with periodic mass deworming should be included in public health strategies for the control and prevention of anaemia and IDA in this population.
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Affiliation(s)
- M Hesham Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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