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Rahman S, Lee P, Biswas NU, Khan MR, Ahmed F. Role of Low Amount of Iron Intake from Groundwater for Prevention of Anemia in Children: A Cross-Sectional Study in Rural Bangladesh. Nutrients 2024; 16:2844. [PMID: 39275162 PMCID: PMC11396907 DOI: 10.3390/nu16172844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/15/2024] [Accepted: 08/21/2024] [Indexed: 09/16/2024] Open
Abstract
In Bangladesh, groundwater, the principal source of drinking water, contains predominantly high levels of iron. Drinking groundwater is associated with good iron status in populations. Against this backdrop, iron supplementation is often associated with side effects, which reduces its intake compliance. However, the level of iron in groundwater is not consistent, and low levels exist in many areas of the country. In the present study, we examined the role of groundwater with a low concentration of iron in the prevention of anemia in Bangladeshi children. In 2018, a cross-sectional study was conducted in Bangladesh among children aged 2-5 years (n = 122) who drank groundwater containing a low level of iron (0-<2 mg/L). The combined intake of iron was calculated from the key sources-diet, groundwater, and the simulated intake of MNPs. The intakes of iron were compared against the standard reference intake. The children's hemoglobin levels were measured using a photometer. The combined intake of iron from diet, groundwater with low levels of iron, and the simulated consumption of low-iron MNP in children was 5.8 ± 2.0 and 6.9 ± 2.5 mg/day, comprising 193% and 169% of the Estimated Average Requirements in the 2-3-year-old and 4-5-year-old subgroups, respectively. The combined intake of bioavailable iron from dietary and low-iron groundwater was 0.42 ± 0.023 and 0.22 ± 0.019 mg/day in children exposed to groundwater concentrations of 0.8-<2.0 mg/L and 0.0-<0.8 mg/L, respectively (p < 0.001). The mean concentration of hemoglobin in the respective groups was 12.17 ± 0.94 g/dL and 11.91 ± 0.91 g/dL (p = 0.30). The combined intake of iron from diet and the low-iron groundwater was associated with maintenance of hemoglobin concentration at the non-anemic level in > 90% of the children. The findings highlight the protective influence of the low concentration of iron in the drinking groundwater against childhood anemia in Bangladesh.
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Affiliation(s)
- Sabuktagin Rahman
- Department of Public Health, American International University-Bangladesh, 408/1 Kuratoli, Khilkhet, Dhaka 1229, Bangladesh
| | - Patricia Lee
- School of Medicine and Dentistry, Public Health, Gold Coast Campus, Griffith University, Parklands Dr., Gold Coast, QLD 4222, Australia
| | - Nezam Uddin Biswas
- Bangladesh National Nutrition Council, Mohakhali, Dhaka 1212, Bangladesh
| | - Moududur Rahman Khan
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka 1000, Bangladesh
| | - Faruk Ahmed
- School of Medicine and Dentistry, Public Health, Gold Coast Campus, Griffith University, Parklands Dr., Gold Coast, QLD 4222, Australia
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Rahman S, Lee P, Khan MR, Ahmed F. Thalassemia carrier status and groundwater iron: Implication for iron supplementation program for children in Bangladesh. J Public Health Res 2023; 12:22799036231191036. [PMID: 37602276 PMCID: PMC10439722 DOI: 10.1177/22799036231191036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 07/09/2023] [Indexed: 08/22/2023] Open
Abstract
Background Thalassemia, a congenital disorder of hemoglobin synthesis is characterized by low hemoglobin and high iron status, is prevalent in Bangladesh. Iron, consumed through drinking groundwater also increases the population iron status in Bangladesh. The study examined the effect of iron containing micronutrient powder (MNP) on the hemoglobin and ferritin status in Bangladeshi children with thalassemia and their non-thalassemia peers exposed to a high concentration of iron from drinking groundwater. Design and methods Three hundred twenty-seven children aged 2-5 years were recruited for an MNP efficacy trial. A sub sample (n = 222) were screened for thalassemia. Hemoglobin and ferritin levels were measured in children with and without thalassemia. Intake of iron from the key sources-diet, groundwater and MNP was measured. Mann Whitney and t-test were employed to compare the groups. Results Hemoglobin concentration of the children with thalassemia at the endpoint remained unchanged relative to the baseline; 11.56 ± 0.59 g/dL (Endpoint) versus 11.6 ± 0.54 g/dL (Baseline), p = 0.83. In children without thalassemia hemoglobin tended to increase; 12.54 ± 0.72 g/dL (Endpoint) versus 12.41 ± 0.72 g/dL (baseline), p = 0.06. Baseline reserve of body iron was significantly (p = 0.03) higher in thalassemia carriers (594 gm) compared to their non-carrier peers (558 gm). The increase of the infection-adjusted ferritin from baseline to the endpoint was 7.37% (p = 0.7) and 10.17% (p = 0.009) in the carrier and non-carrier groups respectively. Conclusions In Bangladesh, the coexistence of thalassemia and the exposure to a high concentration of iron from drinking groundwater renders anemia prevention program with a low iron MNP potentially lesser hazardous to the thalassemia carriers.
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Affiliation(s)
- Sabuktagin Rahman
- Department of Nutrition and Food Engineering, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
| | - Patricia Lee
- Public Health, School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | | | - Faruk Ahmed
- Public Health, School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
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Rahman S, Shaheen N. Behind the scene of the prevalence of anaemia: an extended way of reporting. Public Health Nutr 2023; 26:1115-1124. [PMID: 36847280 PMCID: PMC10346090 DOI: 10.1017/s1368980023000393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 12/12/2022] [Accepted: 02/02/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To develop the methods for an extended reporting of anaemia and to measure the status of the key contextual underlying factors of anaemia. DESIGN Statistical appraisal of Hb v. key influencers of anaemia in Bangladesh – the intake of animal source food (ASF), concentration of Fe in the drinking groundwater (GWI) and the prevalence of congenital Hb disorder (CH) are conducted. The primary data of the National Micronutrient Survey 2011–2012 and the British Geological Survey 2001 are analysed to assess the intake of ASF and the GWI concentration, respectively. The prevalence of thalassaemia from a national survey is used to appraise the CH. ASF is evaluated relative to the 97·5th percentile intake and group scores are assigned. Association of the GWI and Hb is examined by the linear fit and the mspline fit and the group scores are allocated. Group score is allocated for the prevalence of thalassaemia. Inflammation-adjusted ferritin is considered to report Hb. SETTING A nationwide survey in Bangladesh. PARTICIPANTS Preschool children (6–59 months), school-age children (6–14 years) and non-pregnant non-lactating women (NPNLW, 15–49 years). RESULTS The extended reporting to the prevalence of anaemia in Bangladeshi preschool children, school children and women is – anaemia 33 % (ASF: 2·08; GWI: 1·75; CH: 2), anaemia 19 % (ASF: 1·98; GWI: 1·56; CH: 2) and anaemia 26 % (ASF: 2·16; GWI: 1·58; CH: 2), respectively. CONCLUSION The extended reporting of anaemia is a useful tool to understand the status of the key influencers of anaemia, to design the context-customised intervention and to monitor the intervention.
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Affiliation(s)
- Sabuktagin Rahman
- Department of Nutrition and Food Engineering, Faculty of Allied Health Sciences, Daffodil International University, Birulia, Savar, Dhaka-1216, Bangladesh
- Griffith University, Public Health, School of Medicine and Dentistry, Gold Coast, QLD, Australia
| | - Nazma Shaheen
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
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Balashova EA, Shadrina IL, Pogodina AA. Gastrointestinal side effects of iron supplements: potential effects on gut microbiota. ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII (RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS) 2022. [DOI: 10.21508/1027-4065-2022-67-5-18-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Iron deficiency anemia remains a significant problem in pediatric practice with its prevalence of 6–40% in the Russian Federation. Oral iron supplementation is the most common first-line treatment especially in outpatient setting. Despite adequate efficacy of oral supplementation, the problem of its side effects and, primarily, gastrointestinal toxicity remains. This review examines the issue of the potential effect of iron supplementation on gut microbiota composition, presents data from studies in animal models and in clinical studies.
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Affiliation(s)
| | - I. L. Shadrina
- Samara State Medical University;
Samara City Hospital No. 7
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Rahman S, Saha N, Sarwar S, Shamim AA, Shaheen N. Can guava (Psidium guajava) leaf extracts develop an indigenous, simplified tool for a semi-quantitative assessment of iron in groundwater? JOURNAL OF WATER AND HEALTH 2022; 20:1644-1653. [PMID: 36448614 DOI: 10.2166/wh.2022.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Iron present in the drinking groundwater is attributed to the low burden of iron deficiency (ID) in Bangladesh. The supplemental anemia prevention strategies involving iron need a cautious approach due to the excess load of iron and the side effects. The present pilot study examined the potential of the guava leaf extracts to use as a natural reagent for the assessment of iron in groundwater. Eighteen households with the drinking source of groundwater were randomly selected. Guava leaves were crushed and the shreds of the leaves were mixed with the water sample. Changes of water color were photographed. Five groups were identified - 'whitish', 'shades of pink', 'shades of purple', 'light black' and the 'frank black'. The iron concentration was measured by a test kit device. Each color group was assigned a number on the ordinal scale 1-5. Statistical correlation and agreements were performed between the methods. The positive correlation (Kendall's tau b: 0.89, p < 0.000) and the agreements (Kappa: 0.77, p < 0.000; rho_c: 0.73, p < 0.000) were observed. Guava leaf extracts may standardize an indigenous tool for a semi-quantitative measurement of groundwater iron content. Validation of the tool thus may aid in the design and evaluation of the iron supplementation and fortification programs.
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Affiliation(s)
- Sabuktagin Rahman
- Department of Nutrition and Food Engineering, Faculty of Allied Health Science, Daffodil International University, Ashulia, Dhaka 1341, Bangladesh E-mail:
| | - Nobonita Saha
- Department of Nutrition and Food Engineering, Faculty of Allied Health Science, Daffodil International University, Ashulia, Dhaka 1341, Bangladesh E-mail:
| | - Sneha Sarwar
- Department of Nutrition and Food Engineering, Faculty of Allied Health Science, Daffodil International University, Ashulia, Dhaka 1341, Bangladesh E-mail:
| | - Abu Ahmed Shamim
- Department of Nutrition and Food Engineering, Faculty of Allied Health Science, Daffodil International University, Ashulia, Dhaka 1341, Bangladesh E-mail:
| | - Nazma Shaheen
- Department of Nutrition and Food Engineering, Faculty of Allied Health Science, Daffodil International University, Ashulia, Dhaka 1341, Bangladesh E-mail:
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Abstract
OBJECTIVE Phytate, an important component of plant origin foods, works as a chelator for mineral nutrients such as iron. Estimating the phytate-iron molar ratio is a traditional method to assess the bioavailability of dietary iron, and a ratio >1 is suggestive of poor absorption of iron through the intestinal mucosa. In Bangladesh, the ratio is considerably higher; nonetheless, the haemoglobin and ferritin status are satisfactory. Hence, we appraised phytate-iron molar ratios and concomitant haemoglobin and ferritin status. METHODS Dietary intake of iron and phytate was estimated in non-pregnant non-lactating women and school-age children from a nationally representative survey. The phytate-iron molar ratios were estimated. Linear regressions on haemoglobin for the phytate-iron molar ratios and on molar ratios predicting inflammation-adjusted ferritin were performed. RESULTS The median ratios were 6.12 in women and 5.47 in children, with corresponding haemoglobin concentrations of 12.6 and 12.5 g/dl. Hypothetical lowering of the ratios by ~50% revealed a nominal increment of haemoglobin and ferritin. CONCLUSION The standard cut-off phytate-iron molar ratio of >1 is inconsistent with the iron and haemoglobin status of the Bangladeshi population. One plausible explanation for the inconsistency is a non-dietary environmental factor-groundwater iron. Isotope studies incorporating the iron from dietary and the drinking groundwater sources are needed to establish a ratio which might better explain iron bioavailability.
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Affiliation(s)
- Sabuktagin Rahman
- Public Health, School of MedicineGriffith University, Gold Coast CampusSouthportQueenslandAustralia
| | - Nazma Shaheen
- Institute of Nutrition and Food ScienceUniversity of DhakaDhakaBangladesh
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Choudhury N, Siddiqua TJ, Ahmed SMT, Haque MA, Ali M, Dil Farzana F, Naz F, Rahman SS, Faruque ASG, Rahman S, Ahmed T. Iron content of drinking water is associated with anaemia status among children in high groundwater iron areas in Bangladesh. Trop Med Int Health 2021; 27:149-157. [PMID: 34905267 DOI: 10.1111/tmi.13710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Iron in groundwater provides a good source of absorbable iron for humans and can contribute to optimal iron and haemoglobin (Hb) status among populations. We aimed to examine the relationship between the iron content of groundwater and anaemia status among 12- to 23-month-old children in a rural area of Bangladesh. METHOD A cross-sectional study was conducted in 80 randomly selected unions (the lowest administrative unit) in Sylhet and Moulvibazar districts of Bangladesh. A total of 800 children aged 12-23 months were selected via a systematic random sampling method. The child's age, sex, stunting status, consumption of iron-rich or iron-fortified food, maternal age and maternal body mass index (BMI) and the type of terrain were subjected to multiple logistic regression analysis to observe the independent relationships between groundwater iron content and anaemia in children. RESULTS In total, 50.4% of children were anaemic. The odds of children being anaemic were 1.51-fold higher [OR: 1.51 (95% CI: 1.09, 2.09)] among households consuming water with an iron content <2 mg/L than in households consuming water with an iron content ≥2 mg/L. Childhood stunting, child's sex, child's age and the type of terrain were also significantly associated with anaemia among children. CONCLUSION Groundwater with a high iron concentration was significantly associated with a decreased risk of childhood anaemia. This study provides evidence of the importance of groundwater iron to protect impoverished young children from anaemia.
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Affiliation(s)
- Nuzhat Choudhury
- Nutrition and Clinical Services Division, ICDDR,B, Dhaka, Bangladesh
| | | | | | - Md Ahshanul Haque
- Nutrition and Clinical Services Division, ICDDR,B, Dhaka, Bangladesh
| | - Mohammad Ali
- Nutrition and Clinical Services Division, ICDDR,B, Dhaka, Bangladesh
| | | | - Farina Naz
- Nutrition and Clinical Services Division, ICDDR,B, Dhaka, Bangladesh
| | | | - A S G Faruque
- Nutrition and Clinical Services Division, ICDDR,B, Dhaka, Bangladesh
| | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, ICDDR,B, Dhaka, Bangladesh
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Rahman S, Kortman GAM, Boekhorst J, Lee P, Khan MR, Ahmed F. Effect of low-iron micronutrient powder (MNP) on the composition of gut microbiota of Bangladeshi children in a high-iron groundwater setting: a randomized controlled trial. Eur J Nutr 2021; 60:3423-3436. [PMID: 33634319 PMCID: PMC8354964 DOI: 10.1007/s00394-021-02523-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/16/2021] [Indexed: 12/25/2022]
Abstract
Purpose Adverse effects of iron fortification/supplements such as Micronutrient Powder (MNP) on gut microbiota have previously been found in infection-prone African settings. This study examined the adversaries of a low-iron MNP compared with the standard MNP on the composition of gut microbiota in Bangladeshi children exposed to a high concentration of iron from potable groundwater. Methods A randomized controlled trial was conducted in 2- to 5-year-old children, drinking groundwater with a high concentration of iron (≥ 2 mg/L). Children were randomized to receive one sachet per day of either standard MNP (12.5 mg iron) or low-iron MNP (5 mg iron), for 2 months. A sub-sample of 53 children was considered for paired assessment of the gut microbiome by 16S rRNA amplicon sequencing. Results At baseline, the gut microbiota consisted of Bifidobacteriaceae (15.6%), Prevotellaceae (12.2%), Lactobacillaceae (3.6%), Clostridiaceae (4.1%) and Enterobacteriaceae (2.8%). Overall, there was no significant treatment effect of the low-iron MNP compared to the standard MNP. However, an apparent treatment effect was observed in children with a relative adult-like microbiota, with a higher relative abundance of potentially pathogenic Enterobacteriaceae after receiving the standard MNP compared to the low-iron MNP. This effect, however, was statistically non-significant (p = 0.07). Conclusion In Bangladeshi children drinking iron-rich groundwater, a low-iron MNP supplementation did not have a significant impact on their gut microbiota profile/composition compared to the standard MNP. The trial registration number is ISRCTN60058115; Date of registration 03/07/2019; retrospectively registered. Supplementary Information The online version of this article (10.1007/s00394-021-02523-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sabuktagin Rahman
- Public Health, School of Medicine, Griffith University, Gold Coast Campus, Parklands Dr., Gold Coast, QLD, 4222, Australia
| | | | - Jos Boekhorst
- NIZO Food Research B.V., Ede, The Netherlands
- Host-Microbe Interactomics Group, Wageningen University & Research, Wageningen, The Netherlands
| | - Patricia Lee
- Public Health, School of Medicine, Griffith University, Gold Coast Campus, Parklands Dr., Gold Coast, QLD, 4222, Australia
| | - Moududur R Khan
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Faruk Ahmed
- Public Health, School of Medicine, Griffith University, Gold Coast Campus, Parklands Dr., Gold Coast, QLD, 4222, Australia.
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