High prevalence of iron deficiency anemia in infants attending a well-baby clinic in northwestern Saudi Arabia

Prevalence and Associated Factors of Anemia among Newborns at Jimma Medical Center, South-west Ethiopia

Background

Newborn anemia is among the most common hematological problems and it can cause asymptomatic or severe to acute life-threatening events. It leads to impairment in brain maturation and development, tissue hypoxia, and stunted growth and then arrested growth if left untreated. The prevalence of anemia among newborns ranges from 23.4-66% in sub-Saharan Africa. But, there is limited information in Ethiopia regarding the prevalence of newborn anemia and its risk factors. Therefore, this study aimed to determine the prevalence of newborn anemia and its associated factors at Jimma Medical Center (JMC), South-west Ethiopia.

Methods

A hospital-based cross-sectional study design was implemented from January 14 to February 28, 2021, involving 288 full-term newborns by employing consecutive convenient sampling technique for study participant selection. Socio-demographic data and other associated factors were collected through interviews and a review of medical records by a structured questionnaire. Three mL umbilical cord blood samples from each newborn were collected and analyzed for a complete blood count by an automated hematological analyzer. Data were entered into Epi Data version 3.1 and exported to Statistical Package for Social Science version 20 for analysis. Binary logistic regression were used to identify the predictors of newborn anemia.

Results

The overall prevalence of anemia among newborns was 26.4%; of them, 65.8%, 25%, and 9.2% were mild, moderate, and severe anemia types, respectively. Maternal vegetable consumption habit (AOR = 0.26, 95% CI: 0.11, 0.62) and maternal anemia (AOR = 0.34, 95% CI: 0.17, 0.69) were significantly associated with anemia in newborns.

Conclusion

In general, newborn anemia in this study was a moderate public health problem. Based on this study, early screening of anemia among newborns may reduce further complications. Prevention of maternal anemia during pregnancy by improving their nutritional status especially vegetable consumption had a positive impact on reducing anemia among newborns.

Prevalence and risk factors for newborn anemia in southwestern Uganda: a prospective cohort study

Introduction

The global prevalence of anemia in pregnancy is about 42%, and in sub-Saharan Africa, the prevalence of newborn anemia ranges from 25-30%. Anemia in newborn babies may cause complications such as delayed brain maturation and arrested growth. However, there is limited data on prevalence of newborn anemia and its risk factors in people living in resource-limited settings.

Objectives

We determined the prevalence and risk factors for newborn anemia and its correlation with maternal anemia in southwestern Uganda.

Methods

This was a prospective cohort study of 352 pregnant women presenting to Mbarara Regional Referral Hospital for delivery. We collected maternal blood in labor and umbilical cord blood from the placental vein, as a proxy for newborn hemoglobin. We estimated hemoglobin using a point-of-care Hemocue machine. We used summary statistics to characterize the cohort, and compared demographic characteristics and outcomes using Chi-square, t-test, and Wilcoxon Ranksum analyses. We defined newborn anemia as umbilical cord hemoglobin < 13g/dl and estimated the relationship between maternal and umbilical cord hemoglobin using linear regression analysis, adjusting for potential confounders.

Results

The prevalence of newborn anemia was 17%. The average maternal parity was significantly higher for anemic and non-anemic newborns (3.5 versus 2.8, P = 0.01). Mean age [SD] was significantly lower for participants with umbilical cord hemoglobin < 13g/dl than those > = 13 g/dl, (26 [5.6] versus 28 [6.3], P = 0.01). In multivariable linear regression analysis, a 1-point decrease in maternal hemoglobin was associated with a 0.14-point decrease in umbilical cord hemoglobin (P = 0.02). Each one-unit increase in maternal parity was associated with a 0.25-point decrease in umbilical cord hemoglobin (P = 0.01). Cesarean delivery was associated with a 0.46-point lower umbilical cord hemoglobin level compared to vaginal delivery (P = 0.03).

Conclusions

We found a significant correlation between maternal and newborn hemoglobin levels, underscoring the importance of preventing and correcting maternal anemia in pregnancy. Furthermore, maternal anemia should be considered a risk factor neonatal anemia.

Complementary feeding practices among mothers having children less than two years old attending well-baby clinics in Jazan City, Saudi Arabia

Introduction

infant feeding practices are important determinants of growth and development not only in infancy but also in later life. The main objective of this study is to describe infant feeding practices and the factors affecting complementary feeding (CF) among mothers in Jazan City.

Methods

an observational cross-sectional study was conducted among 400 mothers having children less than 24 months old, attending the well-baby clinics in Primary Health Care Centers (PHCCs) in Jazan City, Saudi Arabia. A structured questionnaire was used to collect data in a face-to-face interview.

Results

on the mother's level of knowledge regarding proper infant feeding, 49% scored high, 41% scored medium, and 9.75% scored low. The mother's educational level, working status, family income, and knowledge source played a significant role in the knowledge scores (p < 0.05 for all). Overall, 15.8% of the mothers never breastfed (BF) their children, 39.8% BF less than six months, 17.5% BF 6-12 months, and 27% BF over 12 months. Breastfeeding feeding (BF) duration is significantly associated with maternal literacy and family income (p = 0.006 for both). Overall, approximately one-third of the women (36.2%) started CF at six months or later, while 63.8% started CF at 4-6 months.

Conclusion

Jazan women use some positive infant feeding practices, including breastfeeding. One-third of the women started CF at six months or later, which is considered the optimal time for the CF introduction. More nutrition education is necessary to raise maternal awareness regarding appropriate infant feeding and weaning practices.

Evaluation of Minimal Optimal Dose of Intravenous Ferric Carboxymaltose for Treatment of Iron Deficiency Anemia and Risk of Transient Hyperferritinemia

BACKGROUND

Iron supplementation is administered orally or intravenously to treat iron-deficiency anemia (IDA). Ferric Carboxymaltose (FCM) "Ferinject®" is an intravenous (IV) iron preparation that has emerged as a safe therapeutic option for treating IDA in the past decade.

AIM

This study aimed to evaluate safety and efficacy of carboxymaltose in a cohort of patients with IDA not responding to oral therapy.

METHODS

This 12-month retrospective study included 106 patients with IDA, with-or without bariatric surgery, who received (single or multiple doses) of Carboxymaltose 500mg/10mL. Data points included patients' demographics, baseline data for Hb, platelet, ferritin, and MCV pre-and at 1, 2, and 3 months following different doses of IV-Carboxymaltose. Changes in Hb, MCV, platelets, and ferritin levels were recorded in response to Carboxymaltose to assess the optimal dose, risk of hyperferritinemia, and hypophosphatemia.

RESULTS

At three months (95 days) follow-up, the median change pre-and post-therapy in hemoglobin was from 9.5 to 11.9g/dL (p < 0.01), MCV 73.6-80.5fL (p < 0.01), and ferritin 5.3-93.8ng/mL. A significant difference was observed between platelet count of patients who underwent bariatric surgery and those who did not. An optimal ferritin response (>30ng/mL) was observed in 87.8% of patients who received first dose, and none of the full three doses showed no response. 37% of patients who received two doses developed hyperferritinemia. Serum phosphate levels were assessed in 28 cases, and hypophosphatemia was observed in 25% of these patients.

CONCLUSION

Carboxymaltose is a reliable option for IDA. IV-FCM therapy helps achieve significant improvement in hemoglobin concentration and MCV from the first dose carrying a low reversible risk of hyperferritinemia following multiple doses. An interesting finding of this study is the discovery of a population of IDA patients requiring periodic assessment for iron reinfusion to sustain normal levels, mostly post-bariatric surgery. Changes in serum phosphate levels reported to occur consecutively with FCM treatment should be further studied.

Association of SNPs within TMPRSS6 and BMP2 genes with iron deficiency status in Saudi Arabia

BACKGROUND

Globally, iron-deficiency anemia (IDA) remains a major health obstacle. This health condition has been identified in 47% of pre-school students (aged 0 to 5 years), 42% of pregnant females, and 30% of non-pregnant females (aged 15 to 50 years) worldwide according to the WHO. Environmental and genetic factors play a crucial role in the development of IDA; genetic testing has revealed the association of a number of polymorphisms with iron status and serum ferritin.

AIM

The current study aims to reveal the association of TMPRSS6 rs141312 and BMP2 rs235756 with the iron status of females in Saudi Arabia.

METHODS

A cohort of 108 female university students aged 18-25 years was randomly selected to participate: 50 healthy and 58 classified as iron deficient. A 3-5 mL sample of blood was collected from each one and analyzed based on hematological and biochemical iron status followed by genotyping by PCR.

RESULTS

The genotype distribution of TMPRSS6 rs141312 was 8% (TT), 88% (TC) and 4% (CC) in the healthy group compared with 3.45% (TT), 89.66% (TC) and 6.89% (CC) in the iron-deficient group (P = 0.492), an insignificant difference in the allelic distribution. The genotype distribution of BMP2 rs235756 was 8% (TT), 90% (TC) and 2% (CC) in the healthy group compared with 3.45% (TT), 82.76% (TC) and 13.79% (CC) in iron-deficient group (P = 0.050) and was significantly associated with decreased ferritin status (P = 0.050). In addition, TMPRSS6 rs141312 is significantly (P<0.001) associated with dominant genotypes (TC+CC) and increased risk of IDA while BMP2 rs235756 is significantly (P<0.026) associated with recessive homozygote CC genotypes and increased risk of IDA.

CONCLUSION

Our finding potentially helps in the early prediction of iron deficiency in females through the genetic testing.

Prevalence, diagnosis, and management of iron deficiency and iron deficiency anemia among Syrian children in a major outpatient center in Damascus, Syria

Background

Given the public health significance of anemia, the long-term sequelae of iron deficiency anemia (IDA) on children, the expected effect of war on the trends of anemia in Syrian society, and the lack of assessment on the national burden of anemia and/or iron deficiency (ID) data, there is a vital need to investigate all-cause anemia, ID, and IDA in Syria during the crisis.

Objective

To investigate the prevalence of ID and IDA in Syrian children, the effectiveness of oral iron supplements in the management of ID, and the diagnostic effectiveness of conventional iron markers.

Methods

We conducted a retrospective study on hemoglobin (Hb) levels in 4-month-old to 14-year-old children and a prospective study on hematological (complete blood count, reticulocytes, and reticulocyte Hb content) and biochemical iron indices (serum ferritin, iron, and total iron-binding capacity) of infants visiting the primary care clinic at Children's Hospital in Damascus, Syria.

Results

Of the 1128 children in the retrospective study, 648 children (57%) were found to be anemic, with 417 (37%) moderately-severely anemic. The prevalence of ID and IDA in the 135 children of the prospective study was 71.85% and 55.55%, respectively. Infants with ID who underwent a 4-8-week course of oral iron supplementation demonstrated good responsiveness. Except mean corpuscular hemoglobin (MCH), conventional iron markers (i.e., ferritin) routinely used to assess iron status proved unreliable.

Conclusion

This study reveals a high prevalence of anemia, ID, and IDA among a group of apparently healthy Syrian children. Our findings necessitate a framework of urgent public health interventions that can address two major limitations; the poor follow-up by the parents and unreliability of the conventional iron diagnostic markers. MCH may represent a simple and cheap ID screening index in children.

Iron Deficiency and Iron Deficiency Anemia Are Common Epidemiological Conditions in Saudi Arabia: Report of the National Epidemiological Survey

Iron deficiency is the most prevalent nutritional deficiency worldwide. According to an estimate by the World Health Organization, up to 27% of the world's population experience iron deficiency anemia (IDA). Studies conducted in the Middle East, including Saudi Arabia, have suggested that IDA is the most common cause of anemia, especially among females. This study aimed to determine the prevalence of IDA and iron deficiency (ID) among apparently healthy young university students from four regions in Saudi Arabia. Students were asked to complete a simple survey questionnaire; blood samples were then collected and analyzed after obtaining informed consent. A total of 981 students completed the survey, with 11% of the participants reporting symptoms of anemia; 34% of participants were diagnosed with IDA and 6% reported a diagnosis of hemoglobinopathy. Blood analysis confirmed the prevalence of ID and IDA in 28.6% and 10.7% of the participants, respectively; those with ID and IDA were mostly females (88.5% and 94%, resp.). Thalassemia trait and sickle cell trait were detected in 1.3% and 7% of participants, respectively. Our findings from a national survey among young university in Saudi Arabia indicate a high prevalence of ID and IDA.

Hospital-Based Prevalence of Iron Deficiency Anemia among Pre-School Children in Dubai

INTRODUCTION

Iron deficiency anemia (IDA) is an internationally recognized leading cause of disability and contributes to childhood morbidity and mortality. The prevalence of IDA is higher in developing countries, especially in Arab countries, compared to the west.

METHODS

To assess the prevalence of IDA, we analyzed the data of children aged between one to five years seen at Dr. Sulaiman Al-Habib Medical Group's tertiary care hospital in Dubai, United Arab Emirates (UAE) from 2016 to 2018.

RESULTS

We found a high occurrence of IDA in male children and non-Emirati children.

CONCLUSION

Appropriate screening and iron supplementation are required to see a decline in the rate of IDA. Further nationwide studies are required to identify the highly prevalent and high-risk areas of IDA in the UAE.

Prevalence and associated factors of anemia among full-term newborn babies at University of Gondar comprehensive specialized hospital, Northwest Ethiopia: a cross-sectional study

BACKGROUND

Anemia in newborn babies causes asymptomatic to an acute life-threatening event. If untreated, it leads to a delay in brain maturation, tissue hypoxia, and stunted growth. In Sub-Saharan Africa, its burden ranges 23-66%. However, in Ethiopia, there is limited information regarding the prevalence and associated factors of newborn anemia. Thus, this study was aimed to assess the prevalence and associated factors of anemia among full-term newborn babies.

METHOD

Cross-sectional study was conducted from February 1 to April 30, 2019, among 192 full-term newborn babies. A systematic random sampling technique was employed to select study participants. Socio-demographic characteristics were collected through interviews. Clinical data were collected by reviewing medical records. Cord blood was collected from the clumped cord. Complete blood count was analyzed by using the Sysmex KX-21 N hematology analyzer. SPSS 20 was used to analyze the data. Bivariable and multivariable binary logistic regression were used to identify associated factors. P-value < 0.05 was considered a statistically significant association.

RESULT

The median (interquartile range) of cord hemoglobin was 15 g/dL (13.93-16.2 g/dL). From the total, 25% (95% CI: 18.9, 31.1%) of the newborns were anemic. From anemic 89.5, 6.3, and 4.2% were mild, moderate and severe anemia type, respectively. Maternal vegetable consumption habit (AOR = 0.34, 95%CI: 0.17, 0.69) were significant associated with anemia.

CONCLUSION

Anemia among newborn babies found to be a moderate public health problem. Based on the finding early screening of newborn anemia may reduce further complications.

Iron Status of Infants in the First Year of Life in Northern Taiwan

Iron deficiency (ID) and iron deficiency anemia (IDA) typically occur in developing countries. Notably, ID and IDA can affect an infant’s emotion, cognition, and development. Breast milk is considered the best food for infants. However, recent studies have indicated that breastfeeding for more than six months increases the risk of ID. This study investigated the prevalence of ID and IDA, as well as the association between feeding type and iron nutritional status in northern Taiwan. A cross-sectional study was conducted on infants who returned to the well-baby clinic for routine examination from October 2012 to January 2014. Overall, 509 infants aged 1–12 months completed the iron nutritional status analysis, anthropometric measurement, and dietary intake assessment, including milk and complementary foods. The results revealed that 49 (10%) and 21 (4%) infants in their first year of life had ID and IDA, respectively, based on the World Health Organization criteria. Breastfed infants had a higher prevalence rate of ID and IDA than mixed-fed and formula-fed infants (p < 0.001). Regarding biomarkers of iron status, plasma hemoglobin (Hb), ferritin, and transferrin saturation (%) levels were significantly lower in ID and IDA groups. The prevalence of ID and IDA were 3.7% and 2.7%, respectively, in infants under six months of age, but increased to 20.4% and 6.6%, respectively, in infants above six months of age. The healthy group had a higher total iron intake than ID and IDA groups, mainly derived from infant formula. The total dietary iron intake was positively correlated with infants’ Hb levels. Compared with formula-fed infants, the logistic regression revealed that the odds ratio for ID was 2.157 (95% confidence interval [CI]: 1.369–3.399) and that for IDA was 4.196 (95% CI: 1.780–9.887) among breastfed infants (p < 0.001) after adjusted for all confounding factors (including gestational week, birthweight, sex, body weight percentile, body length percentile, age of infants, mothers’ BMI, gestational weight gain, education level, and hemoglobin level before delivery). In conclusion, our results determined that breastfeeding was associated with an increased the prevalence of ID and/or IDA, especially in infants above six months. This suggests that mothers who prolonged breastfeed after six months could provide high-quality iron-rich foods to reduce the prevalence of ID and IDA.

Anemia and Dietary Behaviors among Young Adults in Riyadh, Saudi Arabia

Objective

The study sought to assess the prevalence and the risk factors associated with anemia among male and female young adults in (Riyadh city, Saudi Arabia).

Methods

A cross-sectional study was conducted at King Saud University and Alfaisal University in September 2016 among young adults aged 18 to 28 years old. Data were collected using an interview questionnaire. Additionally, the respondents were evaluated clinically and via laboratory testing for anemia.

Results

Our study population showed a higher percentage of men as compared to women participants. About half of our study sample had a lightly active lifestyle, and more than one-third of the study participants were overweight (34.7%). The average age of the respondents was 22.08 ± 1.98 years. The only factor significantly associated with anemia was gender, in that female gender showed a positive association with anemia.

Conclusion

The most explicit risk factor for anemia among Saudi individuals of college and young professional ages was the female gender. Dietary lifestyle, heavy menstruation, pregnancy, and intake of non-steroidal anti-inflammatory drugs were additional important risk factors among these individuals, but they were statistically not significant.

An assessment for diagnostic and therapeutic modalities for management of pediatric Iron defficiency Anemia in Saudi Arabia: a crossectional study

Introduction

Iron deficiency anemia (IDA) is a global public health issue that affect more than 2 billion individuals worldwide. However evidence for optimal management of IDA is lacking.

Methods

To assess the diagnostic criteria and therapeutic modalities for pediatric IDA employed by physicians in a major public healthcare facility in Riyadh, a validated questionnaire including demographic data and patient case-scenarios related to diagnosis and treatment of IDA was employed. Robust regression analysis was used to identify factors associated with overall score of participants.

Results

Of the 166 physicians surveyed 147(88.6%) were included in the study. Wide variability was observed in IDA diagnosis and therapy practises. For nutritional IDA, only 15.6% recommended no other laboratory tests in addition to CBC. The majority preferred treatment with ferrous sulfate (77.6%) divided into two doses (57.1%), but the total daily elemental iron doses varied widely from 2 to 6 mg/kg. For intravenous iron, 42.9% recommended iron dextran, 32.7% iron sucrose, and 13.4% would continue oral iron. Of all assessed factors, median score was significantly highest in pediatric hematologists compared with pediatricians, family medicine specialists and GPs; p = 0.007, and those work in tertiary care compared with those in primary care; p = 0.043. However, in multivariate robust regression analysis, overall score was only significantly associated with professional qualification [pediatric hematologist β = 13.71,95%CI 2.48–24.95, p = 0.017; pediatrician β = 1.77,95%C (− 6.05–9.59, p = 0.66; family medicine β = 2.66,95%CI-4.30-9.58, p = 0.45 compared with general practitioner].

Conclusion

Wide variations exist among physicians in diagnosis and treatment of pediatric IDA. Intervention programs and national guidelines are urgently needed.

Practices of Introduction of Complementary Feeding and Iron Deficiency Prevention in the Middle East and North Africa

BACKGROUND

Iron deficiency (ID) with or without anemia is associated with impaired mental and psychomotor development. Given the paucity of information on physicians' knowledge and practices on iron (Fe) supplementation and impact of ID in the Middle East and North Africa, it was felt important to conduct a survey.

METHOD

A group of expert physicians developed a questionnaire that was randomly distributed among Middle East and North Africa doctors to assess their knowledge and practices on introduction of complementary feeding, impact of ID, its prevention, and their impression on prevalence of ID. Descriptive statistics were used.

RESULTS

We received 2444 completed questionnaires. Thirty-nine percent of physicians do not follow the European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines regarding age of introduction of complementary feedings. Approximately 62% estimate the prevalence of ID anemia to be 40% to 70%; however, only 17% always monitor hemoglobin between 9 and 12 months of age, 43% do so "almost" always, whereas 36% do so "rarely" or (4%) "never." For the prevention of ID in infants older than 6 months of age, almost all recommend introducing Fe supplements. Ninety-seven percent agree that untreated ID during infancy may have long-term negative effects on cognitive function, whereas 53.26% consider that Fe-enriched infant cereals result in staining of the baby teeth, constipation, and dark stools.

CONCLUSIONS

Although there is awareness of the impact of ID, there are some misconceptions regarding age of introduction of complementary feedings, surveillance of Fe status, and side effects of Fe-enriched infant cereals. There is a need for educational initiatives focusing on prevention of Fe deficiency.

The Prevalence and Predictors of Iron Deficiency Anemia among Rural Infants in Nablus Governorate

BACKGROUND

Iron deficiency anemia (IDA) in infants and young children remains a significant public health problem in most developing countries. IDA had short and long-term adverse impacts on infants' health and development. We aimed to assess the frequency of IDA and associated risk factors among infants aged between 9-12 months in rural areas of Nablus Governorate.

STUDY DESIGN

A cross-sectional study.

METHODS

The study was conducted between Jan and Mar 2015. A random sample of 654 infants aged 9-12 months were selected from thirty villages in Nablus Governorate, Central Highlands of the West Bank, north of Jerusalem. Data were collected using pre-designed structured interviewing questionnaire, complete blood count analysis and anthropometric measurements were done.

RESULTS

The prevalence of anemia and IDA among infants was 34.6%, and 32.6%, respectively. Predictors of IDA were increased in infants' age OR=1.19 (95% CI: 1.02, 1.40), maternal anemia during the third trimester OR=2.39 (95% CI: 1.55, 3.71), birth spacing less than three years OR=2.86 (95%CI: 1.58, 5.18), exclusive breastfeeding during the first six months OR=2.40 (95% CI: 1.46, 3.95), early OR=1.64 (95%CI: 1.03, 2.613) and late introduction of complementary feeding OR=2.26 (95% CI: 1.27, 4.05), and non-compliance to iron supplement in the correct frequency and duration during pregnancy OR=1.81 (95% CI: 1.19, 2.75).

CONCLUSIONS

Different dietary and non-dietary risk factors for IDA should be considered for any intervention aimed to reduce the prevalence of IDA among infants.

Reference Value Profile for Healthy Individuals From the Aljouf region of Saudi Arabia

Background

Many factors influence hematological values such as sex, age, ethnic origin, geographic location, season, and genetic disease. The aim of this study was to detect the hematological reference value profile for healthy adults from the Aljouf region of Saudi Arabia.

Methods

The project was carried out on 2,040 healthy individuals, 1,152 males and 888 females, with ages ranging from 17 to 28 years. A group of participants were recruited from the higher secondary schools, university students and premarital centers of Aljouf cities. Hematological reference value profile, hemoglobin (Hb) concentration, red blood cell (RBC) count, RBC indices, white blood cell (WBC) count, differential WBC and platelet (Plt) count were measured. Moreover, a peripheral blood film was prepared in order to detect abnormalities of RBC and all samples were examined for liver function tests (LFTs) and renal function test (RFT) performed, along with a lipid profile.

Results

Hb concentration, hematocrit (Hct) and RBCs were found to be significantly higher in males than in females (P < 0.01). On the contrary, Plt ranges were significantly lower in male as compared to female (P < 0.01). No significant differences in the study population were determined in the other hematological parameters (P > 0.05).

Conclusion

Our findings reflect that healthy adults from the Aljouf region have some hematological parameters differing quantitatively from Caucasians. The hematological reference value profile reported here can be used as normal reference values for Saudi people of the Aljouf region to help in diagnosis and consequently treatment of individuals with hematological disorders.

The Prevalence of Micronutrient Deficiencies and Inadequacies in the Middle East and Approaches to Interventions

Micronutrient deficiencies and inadequacies constitute a global health issue, particularly among countries in the Middle East. The objective of this review is to identify micronutrient deficits in the Middle East and to consider current and new approaches to address this problem. Based on the availability of more recent data, this review is primarily focused on countries that are in advanced nutrition transition. Prominent deficits in folate, iron, and vitamin D are noted among children/adolescents, women of childbearing age, pregnant women, and the elderly. Reports indicate that food fortification in the region is sporadic and ineffective, and the use of dietary supplements is low. Nutrition monitoring in the region is limited, and gaps in relevant information present challenges for implementing new policies and approaches to address the problem. Government-sponsored initiatives are necessary to assess current dietary intakes/patterns, support nutrition education, and to reduce food insecurity, especially among vulnerable population groups. Public-private partnerships should be considered in targeting micronutrient fortification programs and supplementation recommendations as approaches to help alleviate the burden of micronutrient deficiencies and inadequacies in the Middle East.

Early deterioration of iron status among a cohort of Bolivian infants

Iron deficiency (ID) and iron deficiency anemia (IDA) are major contributors to infant and maternal morbidity worldwide. There is limited longitudinal data on iron status in young infants and on methods to adjust iron biomarkers for inflammation. We aimed to quantify the prevalence of inflammation-adjusted ID, anemia, and IDA over the first year in a cohort of Bolivian infants and their mothers. Healthy mother-infant dyads were recruited from two peri-urban hospitals. Infants provided three blood draws (2, 6-8, and 12-18 months; N = 160); mothers provided two blood draws (1 and 6-8 months postpartum [plus third anemia measurement at 12-18 months]; N = 250). Blood was analyzed for hemoglobin, ferritin, soluble transferrin receptor, C-reactive protein (CRP), and alpha(1)-acid glycoprotein (AGP). Iron biomarkers were adjusted for inflammation using CRP and AGP; hemoglobin cutoffs were adjusted for altitude. Inflammation (elevated CRP or AGP) was 17% among toddlers 12-18 months of age. ID (inflammation-adjusted ferritin) increased with age (<1%, 56%, and 79% at each blood draw), as did anemia and IDA (anemia: 70%, 76%, and 81%; IDA: <1%, 46%, and 68%). Maternal ID declined from the first to second assessment (39% vs. 27%). Inflammation-adjusted ID prevalence was up to 15 percentage points higher than unadjusted estimates. The high prevalence of ID, anemia, and IDA in this cohort of Bolivian infants beginning at 6-8 months of age suggests that early interventions may be necessary in vulnerable populations.