1
|
Kirichuk AA, Skalny AV, Schaumlöffel D, Kovaleva IA, Korobeinikova TV, Kritchenkov AS, Aschner M, Mansouri B, Skalny AA, Tinkov AA. Assessment of trace element and mineral levels in students from Turkmenistan in comparison to Iran and Russia. J Trace Elem Med Biol 2024; 84:127439. [PMID: 38579500 PMCID: PMC11167282 DOI: 10.1016/j.jtemb.2024.127439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 04/07/2024]
Abstract
THE OBJECTIVE Of the present study was to assess essential trace element and mineral levels in serum, hair, and urine of healthy first-year students from Turkmenistan (n = 73) in comparison to students from Iran (n = 78) or Russia (n = 95). MATERIALS AND METHODS Examination of foreign students was performed within two days after arrival to Russia during medical examination prior admission to RUDN University. Serum, hair, and urine trace element and mineral levels were assessed with inductively coupled plasma-mass spectrometry (ICP-MS). RESULTS The data demonstrate that the levels of trace elements and minerals in students from Turkmenistan share high similarity to elemental profiles of students from Iran. In comparison to students from Russia, subjects originating from Iran and Turkmenistan are characterized by lower serum cobalt (Co), chromium (Cr), copper (Cu), manganese (Mn), molybdenum (Mo), selenium (Se), vanadium (V), zinc (Zn) levels, higher urinary Cr, Cu, Fe, Mn, V, and Zn, lower urinary Co and hair Mo, Se, and Zn content. Concomitantly, students from Turkmenistan were characterized by lower urinary Cr and Cu, serum Cu and V levels, higher circulating Zn concentration, as well as the lower hair Cr, Cu, iodine (I) and magnesium (Mg) content in comparison to Iranian subjects. The discriminant analysis demonstrated that hair, serum, and urinary trace element and mineral levels contributed to complete discrimination between the groups of students from different countries. CONCLUSIONS The high similarity of trace element and mineral status of students from Turkmenistan and Iran is expected to be mediated by similar geochemical conditions in the bordering countries.
Collapse
Affiliation(s)
- Anatoly A Kirichuk
- Department of Human Ecology and Bioelementology, Department of Medical Elementology, Peoples' Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, Moscow 117198, Russia.
| | - Anatoly V Skalny
- Department of Human Ecology and Bioelementology, Department of Medical Elementology, Peoples' Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, Moscow 117198, Russia; Center of Bioelementology and Human Ecology, IM Sechenov First Moscow State Medical University (Sechenov University), Moscow 119435, Russia
| | - Dirk Schaumlöffel
- Department of Human Ecology and Bioelementology, Department of Medical Elementology, Peoples' Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, Moscow 117198, Russia; CNRS, Université de Pau et des Pays de l'Adour, E2S UPPA, Institut des Sciences Analytiques et de Physico-Chimie pour l'Environnement et les Matériaux (IPREM), UMR 5254, Pau 64000, France
| | - Irina A Kovaleva
- Department of Human Ecology and Bioelementology, Department of Medical Elementology, Peoples' Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, Moscow 117198, Russia
| | - Tatiana V Korobeinikova
- Department of Human Ecology and Bioelementology, Department of Medical Elementology, Peoples' Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, Moscow 117198, Russia; Center of Bioelementology and Human Ecology, IM Sechenov First Moscow State Medical University (Sechenov University), Moscow 119435, Russia
| | - Andrey S Kritchenkov
- Department of Human Ecology and Bioelementology, Department of Medical Elementology, Peoples' Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, Moscow 117198, Russia
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Borhan Mansouri
- Substance Abuse Prevention Research Center, Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Andrey A Skalny
- Department of Human Ecology and Bioelementology, Department of Medical Elementology, Peoples' Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, Moscow 117198, Russia
| | - Alexey A Tinkov
- Department of Human Ecology and Bioelementology, Department of Medical Elementology, Peoples' Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, Moscow 117198, Russia; Center of Bioelementology and Human Ecology, IM Sechenov First Moscow State Medical University (Sechenov University), Moscow 119435, Russia; Laboratory of Ecobiomonitoring and Quality Control, Yaroslavl State University, Yaroslavl 150003, Russia.
| |
Collapse
|
2
|
Alhammad R, Abu-Farha M, Rahman A, Thanaraj TA, Shaban L, Alsabah R, Hamad S, Hammad MM, Channanath A, Al-Mulla F, Abubaker J. LRG1 Associates with Iron Deficiency Anemia Markers in Adolescents. Nutrients 2023; 15:3100. [PMID: 37513518 PMCID: PMC10384480 DOI: 10.3390/nu15143100] [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: 05/17/2023] [Revised: 06/11/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
Leucine-rich α-2 glycoprotein1 (LRG1) has been shown to be associated with several health conditions; however, its association with iron deficiency anemia, especially in children, has not been previously explored. In this study, we investigated the association between LRG1 and several iron deficiency anemia markers, including hemoglobin (Hb), albumin, red cell distribution width (RDW), iron, ferritin, and Hb transferrin saturation. A total of 431 participants were included in this analysis aged between 11 and 14 years. Higher LRG1 levels were observed in children diagnosed with anemia [31.1 (24.6, 43.2) µg/mL] compared to non-anemic children [29.2 (22.7-35.95) µg/mL]. Statistically significant differences of LRG1 level across the three groups (tertiles) of Hb, iron, transferrin saturation, albumin, RDW, ferritin, and WBC were observed. Strong negative correlations were observed between LRG1 and Hb (Spearman's rho = -0.11, p = 0.021), albumin (Spearman's rho = -0.24, p < 0.001), iron (Spearman's rho = -0.25, p < 0.001), and Hb transferrin saturation (Spearman's rho = -0.24, p < 0.001), whereas circulating LRG1 levels were positively associated with RDW (Spearman's rho = 0.21, p < 0.001). In conclusion, our findings demonstrate for the first time the strong association between iron deficiency anemia markers and LRG1 in otherwise healthy school-aged children. However, further studies are needed to corroborate those results and to look for similar associations in other population subgroups.
Collapse
Affiliation(s)
- Rashed Alhammad
- Department of Pharmacology, Faculty of Medicine, Kuwait University, Kuwait City 13110, Kuwait
| | - Mohamed Abu-Farha
- Biochemistry and Molecular Biology Department, Dasman Diabetes Institute, Kuwait City 15462, Kuwait
| | - Abdur Rahman
- Department of Food Science and Nutrition, College of Life Sciences, Kuwait University, Kuwait City 13110, Kuwait
| | - Thangavel Alphonse Thanaraj
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Kuwait City 13110, Kuwait
| | - Lemia Shaban
- Department of Food Science and Nutrition, College of Life Sciences, Kuwait University, Kuwait City 13110, Kuwait
| | - Reem Alsabah
- Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Kuwait City 13110, Kuwait
| | - Samar Hamad
- Biochemistry and Molecular Biology Department, Dasman Diabetes Institute, Kuwait City 15462, Kuwait
| | - Maha M Hammad
- Biochemistry and Molecular Biology Department, Dasman Diabetes Institute, Kuwait City 15462, Kuwait
| | - Arshad Channanath
- Genetics and Bioinformatics Department, Dasman Diabetes Institute, Kuwait City 15462, Kuwait
| | - Fahd Al-Mulla
- Genetics and Bioinformatics Department, Dasman Diabetes Institute, Kuwait City 15462, Kuwait
| | - Jehad Abubaker
- Biochemistry and Molecular Biology Department, Dasman Diabetes Institute, Kuwait City 15462, Kuwait
| |
Collapse
|
3
|
Bayesian spatio-temporal modelling of child anemia in Ethiopia using conditional autoregressive model. Sci Rep 2022; 12:20297. [PMID: 36434074 PMCID: PMC9700834 DOI: 10.1038/s41598-022-24475-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022] Open
Abstract
Anemia is a common health problem for women and under five children in low income countries. According to the WHO, anemia is considered a serious public health problem when the prevalence is greater than 40%. The prevalence of anemia among children under five in Ethiopia changes over time, and is spatially correlated because it is influenced by environmental, socio-economic and other related factors. However, to our knowledge, there is no small area level estimates of anemia among children under five in Ethiopia. Therefore, this study aimed to assess zonal level estimates of anemia using a Bayesian spatio-temporal conditional autoregressive modeling approach. The data for the study was extracted from the Ethiopian Demographic and Health Surveys (EDHS) from 2005 to 2016. A sample of 18,939 children aged 6-59 months were considered for this study. A Bayesian spatio-temporal conditional autoregressive model was implemented to identify the risk of child anemia. Smoothed relative risks along with the 95% credible interval were reported. The queen's adjacency matrix method was used in spatial smoothing and in estimating the relative risk. The prevalence of anemia among children aged 6-59 months in Ethiopia was 54% in 2005, 44% in 2011 and 57% in 2016. This study showed that low maternal education, low socio-economic status of women, and maternal anemia at zone level were strongly associated with child anemia in Ethiopia. Therefore, enhancing education for women, improving women's socioeconomic status, and mitigating maternal anemia are crucial to reduce the prevalence of childhood anemia in Ethiopia.
Collapse
|
4
|
Du Y, Durstenfeld A, Dill SE, Wang Q, Zhou H, Xue H, Kache S, Medina A, Rozelle S. Prevalence of Anemia and Associated Factors among Infants under Six Months in Rural China. Public Health Nutr 2022; 26:1-27. [PMID: 35920295 PMCID: PMC9989709 DOI: 10.1017/s1368980022001616] [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: 05/31/2021] [Revised: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine haemoglobin level and anaemia status among infants under six months of age in rural China. DESIGN A cross-sectional survey collected data among infants under six months and their primary caregivers in Sichuan, China. Anaemia was defined using both the WHO and China Pediatrics Association thresholds. Multivariable linear regression was used to identify relevant factors among two age groups (<4 months; 4-5 months). SETTING 80 townships were selected in Sichuan, China from November to December 2019. PARTICIPANTS 942 infants under six months, while haemoglobin level were tested for 577 infants. RESULTS The overall mean (±SD) haemoglobin level was 106.03 (± 12.04) g/L. About 62.6% (95%CI: 58.5, 66.6) of sample infants were anemic using the WHO threshold, and 20.5% (95%CI: 17.3, 24.1) were anemic using the China Pediatrics Association thresholds. Anaemia rates rose with increasing age in months. Multivariable linear regressions revealed that lower haemoglobin levels were significantly associated with lower birth weight (<4 months: b = 4.14, 95% CI: 0.19, 8.08; 4-5 months: b = 6.60, 95% CI: 2.94, 10.27) and delivery by cesarean section (<4 months: b = -4.64, 95%CI: -7.79, -1.49; 4-5 months: b = -4.58, 95%CI: -7.45, -1.71). CONCLUSION A large share of infants under six months in rural western China are anemic. Infants with low-birth-weight and cesarean-delivered should be prioritized for anaemia testing. Future studies should move the point of focus forward to at least 4 months of age and examine the link between cesarean-section and anaemia to promote health and development in infancy.
Collapse
Affiliation(s)
- Yefan Du
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 Section 3 South Renmin Road, Chengdu, Sichuan610041, People’s Republic of China
| | - Anne Durstenfeld
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Stanford University, Palo Alto, CA, USA
| | - Sarah-Eve Dill
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
| | - Qingzhi Wang
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 Section 3 South Renmin Road, Chengdu, Sichuan610041, People’s Republic of China
| | - Huan Zhou
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 Section 3 South Renmin Road, Chengdu, Sichuan610041, People’s Republic of China
| | - Hao Xue
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
| | - Saraswati Kache
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
| | - Alexis Medina
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
| | - Scott Rozelle
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
| |
Collapse
|
5
|
Dumrongwongsiri O, Winichagoon P, Chongviriyaphan N, Suthutvoravut U, Grote V, Koletzko B. Zinc and iron adequacy and relative importance of zinc/iron storage and intakes among breastfed infants. MATERNAL & CHILD NUTRITION 2022; 18:e13268. [PMID: 34498371 PMCID: PMC8710112 DOI: 10.1111/mcn.13268] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/26/2021] [Accepted: 08/17/2021] [Indexed: 12/27/2022]
Abstract
Neonatal nutrient storage and supplies from breast milk contribute to nutrient status and growth of infants during their early life. This study investigated the adequacy of zinc and iron intakes among breastfed infants during the first 4 months and determined the relative importance of zinc/iron storage versus nutrient intakes with infant's biochemical status and growth. A longitudinal study followed lactating women and their breastfed infants from birth to 4 months postpartum. Cord zinc and ferritin concentrations, as indicators of nutrient storages, were determined. Zinc and iron intakes from breast milk were determined by measurement of breast milk volume together with milk zinc and iron concentrations at 2 and 4 months postpartum. Inadequacy of nutrient intakes was determined using average requirement (AR) which were 1.6 and 0.24 mg/day for zinc and iron respectively. Infant's serum zinc and ferritin were determined at 4 months of age. The data were collected from 64 and 56 participants at 2 months and 4 months postpartum. Inadequate zinc intake was found in 14.5 and 40% of infants at 2 and 4 months old, respectively. The prevalence of biochemical zinc and iron deficiency in infants were 76 and 11%, respectively. Iron endowment was significantly associated with serum ferritin at 4 months. The cumulative zinc intake was positively associated with weight gain and weight-for-length Z-score, but not length. This study provides quantitative data on zinc and iron intakes, and demonstrates the relative importance of nutrient storage versus intakes on biochemical status and growth of breastfed infants.
Collapse
Affiliation(s)
- Oraporn Dumrongwongsiri
- Center for International Health, Ludwig-Maximilians-Universitaet Munich, Munich, Germany.,Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Nalinee Chongviriyaphan
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Umaporn Suthutvoravut
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Veit Grote
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universitaet Munich, Munich, Germany
| | - Berthold Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universitaet Munich, Munich, Germany
| |
Collapse
|
6
|
Liyanage G, Anupama KGIS, Sudarshini MLP. Acceptability of home fortification with multiple micro-nutrients among Sri Lankan children. PLoS One 2021; 16:e0261516. [PMID: 34936678 PMCID: PMC8694412 DOI: 10.1371/journal.pone.0261516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 12/04/2021] [Indexed: 11/30/2022] Open
Abstract
Micronutrient deficiencies are mostly hidden; clinically less visible compared to macronutrient deficiencies. Food fortification with multiple micronutrients (MMN) is provided for children between 6-23 months, daily for two months at three-time points. We assessed the acceptance and adherence of this nutritional intervention in an urban community setting in Sri Lanka. This cross-sectional study enrolled caregivers of children aged 7 to 23 months with a cluster sampling method. Caregivers ' acceptance of taste and smell, health gains, ease of use, and need perception (Cronbach's reliability: 0.801) were assessed. Also, anemia knowledge (Cronbach's reliability: 0.642), MMN knowledge, and reported adherence (number of sachets consumed per month) were evaluated through a self-administered questionnaire. Adequate adherence was defined as the use of ≥80% sachets. The univariate and multivariate statistical analysis examined the association of acceptability, adherence, and anemia knowledge with independent variables (socio-demographic, household characteristics, and knowledge). The survey included 153 respondents. The Median (range) age of children was 12 months (7-23). The mean (SD) acceptability score was 66.82% (9.78%). Acceptance of sensory qualities (smell/taste) had a lower score than perceived health benefit. Most consumed MMN adequately (72.5%). The mean (SD) anemia knowledge score was 62.20% (25.79%). In multivariate analysis, child's age (OR: -0.360, 95% CI:-0.510,-0.211) and father's education (OR: 2.148, 95% CI: 0.439, 3.857) were independently associated with acceptability. Child's age (OR: -0.108, 95% CI:0.818, 0.985), anemia knowledge (OR:0.016, 95% CI: 1.003, 1.031) and acceptability (OR:0.236, 95% CI:1.140, 1.406) were significant determinants of adherence. Anemia knowledge was significantly associated with the mother's education and household income when adjusted. In conclusion, unpleasant smell/taste and daily schedule were reported as barriers to MMN use. Yet, perception and trust regarding health benefits were encouraging. Reported adherence was somewhat high. Improving acceptability and anemia knowledge could enhance adherence further in this population.
Collapse
Affiliation(s)
- G. Liyanage
- Department of Paediatrics, Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | - K. G. I. S. Anupama
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | - M. L. P. Sudarshini
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| |
Collapse
|
7
|
Tesema GA, Tessema ZT, Angaw DA, Tamirat KS, Teshale AB. Geographic weighted regression analysis of hot spots of anemia and its associated factors among children aged 6-59 months in Ethiopia: A geographic weighted regression analysis and multilevel robust Poisson regression analysis. PLoS One 2021; 16:e0259147. [PMID: 34735486 PMCID: PMC8568114 DOI: 10.1371/journal.pone.0259147] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Anemia among children aged 6-59 months remains a major public health problem in low-and high-income countries including Ethiopia. Anemia is associated with significant consequences on the health of children such as under-five morbidity and mortality, increased risk of infection, and poor academic performance. The prevalence of anemia in Ethiopia has varied across areas. Therefore, this study aimed to investigate the geographic weighted regression analysis of anemia and its associated factors among children aged 6-59 months in Ethiopia. METHODS This study was based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 8482 children aged 6-59 months was included. For the spatial analysis, Arc-GIS version 10.7 and SaTScan version 9.6 statistical software were used. Spatial regression was done to identify factors associated with the hotspots of anemia and model comparison was based on adjusted R2 and Corrected Akaike Information Criteria (AICc). For the associated factors, the multilevel robust Poisson regression was fitted since the prevalence of anemia was greater than 10%. Variables with a p-value < 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable multilevel robust Poisson regression analysis, the adjusted prevalence ratio with the 95% confidence interval was reported to declare the statistical significance and strength of association. RESULTS The prevalence of anemia among children aged 6-59 months was 57.56% (95%CI: 56.50%, 58.61%) with significant spatial variation across regions in Ethiopia. The significant hot spot areas of anemia among children aged 6-59 months were detected in the central, west, and east Afar, Somali, Dire Dawa, Harari, and northwest Gambella regions. Mothers who had anemia, a child aged 23-59 months, mothers aged 15-19 years, and coming from a household with a poorer or poorest household were significant predictors of the spatial variations of anemia among children aged 6-59 months. In the multilevel robust Poisson analysis, born to mothers aged 30-39 (APR = 0.84, 95% CI: 0.76, 0.92) and 40-49 years (APR = 0.73, 95% CI: 0.65, 0.83), mothers who didn't have formal education (APR = 1.10, 95% CI: 1.00, 1.20), Children in the poorest household wealth index (APR = 1.17, 95% CI: 1.06, 1.29), being 4-6 (APR = 1.08, 95% CI: 1.02, 1.13) and above 6 order of birth (APR = 1.15, 95% CI: 1.07, 1.23), children born to anemic mothers (APR = 1.24, 95% CI: 1.19, 1.29), children aged 24-59 months (APR = 0.70, 95% CI: 0.68, 0.73), stunted children (APR = 1.09, 95% CI: 1.04, 1.13) and underweight children (APR = 1.07, 95% CI: 1.03, 1.13) were significantly associated with anemia among children aged 6-59 months. CONCLUSION AND RECOMMENDATION Anemia is still a public health problem for children in Ethiopia. Residing in a geographic area where a high proportion of children born to mothers aged 15-19 years, a child aged 6-23 months, coming from a household with poorer or poorest wealth index, and mothers with anemia increased the risk of experiencing anemia among children aged 6-59 months. Maternal education, maternal age, child age, household wealth, stunting, underweight, birth order, and maternal anemia were significant predictors of anemia among children. The detailed map of anemia hot spots among children aged 6-59 months and its predictors could assist program planners and decision-makers to design targeted public health interventions.
Collapse
Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
8
|
Albaroudi IN, Khodder M, Al Saadi T, Turk T, Youssef LA. Prevalence, diagnosis, and management of iron deficiency and iron deficiency anemia among Syrian children in a major outpatient center in Damascus, Syria. Avicenna J Med 2021; 8:92-103. [PMID: 30090748 PMCID: PMC6057158 DOI: 10.4103/ajm.ajm_169_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Issam N Albaroudi
- Program of Clinical and Hospital Pharmacy, Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, Damascus University, Damascus, Syria
| | - Majed Khodder
- Department of Hematology, Children's Hospital, Damascus, Syria.,Department of Pediatrics, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Tareq Al Saadi
- Department of Internal Medicine, Damascus University, Damascus, Syria
| | - Tarek Turk
- Department of Internal Medicine, Damascus University, Damascus, Syria
| | - Lama A Youssef
- Program of Clinical and Hospital Pharmacy, Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, Damascus University, Damascus, Syria
| |
Collapse
|
9
|
Wei YH, He YZ, Guo XY, Lin XY, Zhu HB, Guo XJ. Investigation and Analysis of Iron-Deficiency Anemia Complicated by Splenomegaly. Int J Gen Med 2021; 14:4155-4159. [PMID: 34385835 PMCID: PMC8352643 DOI: 10.2147/ijgm.s324164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/23/2021] [Indexed: 12/29/2022] Open
Abstract
Objective This study aimed to determine the incidence of iron-deficiency anemia (IDA) complicated by splenomegaly in our hospital over the past 6 years and to analyze the possible causes of this result. Methods This is a retrospective study. In total, 668 patients with IDA who were hospitalized in the hematology department of our hospital from 2013 to 2019 were selected as the research subjects and included in the IDA group, and 3201 patients who underwent outpatient physical examinations in our hospital during the same period were included in the control group. The incidences of splenomegaly in the IDA and control groups were calculated, and the difference was analyzed by means of statistical methods. Results Among the 668 IDA patients, 46 (6.9%) had splenomegaly, and among the 3201 patients in the control group, 21 had splenomegaly (0.7%). The incidence of splenomegaly was significantly higher in the IDA group than in the control group, and the severity of anemia in the IDA group was associated with the occurrence of splenomegaly. Specifically, the incidence of splenomegaly was 12.4% among patients with severe anemia and as high as 50% among patients with extremely severe anemia. Conclusion IDA is correlated with the incidence of splenomegaly, and the incidence of splenomegaly significantly increases as the severity of IDA increases. This is considered to be caused by extramedullary hematopoiesis.
Collapse
Affiliation(s)
- Yan-Hui Wei
- Department of Graduate School, Xinxiang Medical University, Xinxiang, Henan Province, 453003, People's Republic of China
| | - Yu-Zhuo He
- Department of Hematology, Puyang Oilfield General Hospital, Puyang, Henan Province, 457000, People's Republic of China
| | - Xiao-Yan Guo
- Department of Graduate School, Xinxiang Medical University, Xinxiang, Henan Province, 453003, People's Republic of China
| | - Xiao-Yan Lin
- Department of Hematology, Puyang Oilfield General Hospital, Puyang, Henan Province, 457000, People's Republic of China
| | - Hong-Bin Zhu
- Department of Hematology, Puyang Oilfield General Hospital, Puyang, Henan Province, 457000, People's Republic of China
| | - Xue-Jun Guo
- Department of Hematology, Puyang Oilfield General Hospital, Puyang, Henan Province, 457000, People's Republic of China
| |
Collapse
|
10
|
Pasqualino MM, Thorne-Lyman AL, Manohar S, KC A, Shrestha B, Adhikari R, Klemm RD, West KP. The Risk Factors for Child Anemia Are Consistent across 3 National Surveys in Nepal. Curr Dev Nutr 2021; 5:nzab079. [PMID: 34104851 PMCID: PMC8178108 DOI: 10.1093/cdn/nzab079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/08/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Anemia is an etiologically heterogeneous condition affecting over half of preschool-aged children in South Asia. An urgent need exists to elucidate context-specific causes of anemia to effectively address this issue. OBJECTIVES This study investigated national trends and stability in the prevalence of child anemia and associated risk factors from 2013 to 2016 in Nepal. METHODS Same-season national surveys were administered in 2013, 2014, and 2016 in 63 sites across 21 districts, selected using multistage random sampling, representing the mountains, hills, and Tarai (plains). Among consenting households with children aged 6-59 mo, a random sample of capillary blood was selected each year for anemia assessment using an Hb 201+ hemoglobinometer, with n = 835, 807, and 881 children assessed, respectively. Prevalence of child anemia, defined as hemoglobin <11.0 g/dL with adjustment for altitude, was estimated each year and disaggregated by region and child age. Prevalence ratios were estimated using log-binomial regression models with robust SE or robust Poisson regression when models failed to converge. Interaction terms between each risk factor and year were created to test for consistencies in associations over time. RESULTS The national prevalence of child anemia decreased from 63.3% (95% CI: 59.0%, 67.5%) in 2013 to 51.9% (95% CI: 46.5%, 57.2%) in 2014 and increased to 59.3% (95% CI: 54.7%, 63.8%) in 2016. Across years, prevalence was highest in the Tarai (58.4-70.2%), followed by the mountains (53.0-61.1%) and hills (37.5-51.4%). Nationally and across time, child age and maternal anemia were significantly associated with child anemia. Child diarrhea and stunting, maternal thinness, and poor water and sanitation conditions also showed consistent trends toward higher anemia prevalence. CONCLUSIONS Anemia affects more than half of Nepalese children aged 6-59 mo. Although prevalence varies year to year, the stability of observed risk factors suggests the need to focus on reducing gastrointestinal infection, promoting adequate household sanitation, and improving maternal and child health.
Collapse
Affiliation(s)
- Monica M Pasqualino
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew L Thorne-Lyman
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Swetha Manohar
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Angela KC
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ramesh Adhikari
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Rolf D Klemm
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Helen Keller International, New York, NY, USA
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
11
|
Shi H, Yang Y, Yin X, Li J, Fang J, Wang X. Determinants of exclusive breastfeeding for the first six months in China: a cross-sectional study. Int Breastfeed J 2021; 16:40. [PMID: 34001155 PMCID: PMC8130252 DOI: 10.1186/s13006-021-00388-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 05/06/2021] [Indexed: 11/26/2022] Open
Abstract
Background Breast milk is the best source of essential nutrients and bioactive components for infants under 6 months. However, little is known about what affects breastfeeding intentions and practices of Chinese mothers. With measures of individual, setting, and sociocultural factors, this study examined determinants of exclusive breastfeeding in the first 6 months of infancy in China. Methods Data were obtained from a national cross-sectional survey in China in 2018 that included 5237 infants under 6 months with available measurements of breastfeeding. A 24-h reported food recall method was applied to assess breastfeeding and complementary food intake in the past 24 h. Potential breastfeeding determinants categorized into six aspects were measured: (1) infant health, (2) maternal sociodemographic characteristics, (3) maternal health, (4) breastfeeding support from family, friends, and workplace, (5) social support for breastfeeding, and (6) maternal breastfeeding experiences and knowledge. Reasons for non-commencement or early cessation of breastfeeding were evaluated for non-breastfed infants. For breastfed infants, multivariate logistic regression was used to explore the determinants of exclusive breastfeeding. Results About 30 % (29.5%) of infants under 6 months were exclusively breastfed; 2.3% (2.3%) had never been breastfed and 3.2% had ceased breastfeeding. No breast milk (60.7%), maternal illness (13.9%), and infant illness (13.1%) were the top three reasons for non-commencement of breastfeeding. Insufficient breast milk was the reason given for ceasing breastfeeding early by almost two thirds of caregivers who had stopped breastfeeding. The following factors were associated with exclusive breastfeeding: maternal higher education, formal employment with ≥6 months of paid maternity leave, support of the husband and best friends for breastfeeding, a breastfeeding-supportive society, and better breastfeeding knowledge and experiences (a previous successful breastfeeding experience ≥6 months and early initiation of breastfeeding). Maternal age of ≥40 years, caesarean delivery, and infant disease history were associated with non-exclusive breastfeeding. Conclusions The exclusive breastfeeding rate is still very low in China. Multidimensional barriers contribute to this situation. A comprehensive intervention framework is needed to increase optimal breastfeeding and achieve substantial public health gains.
Collapse
Affiliation(s)
- Huifeng Shi
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.,Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China
| | - Yumei Yang
- School of Economics and Management, Beijing Forestry University, Beijing, China
| | - Xiaohan Yin
- Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China
| | - Jia Li
- China Development Research Foundation, Beijing, China
| | - Jin Fang
- China Development Research Foundation, Beijing, China.
| | - Xiaoli Wang
- Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China. .,National Health Commission Key Laboratory of Reproductive Health, Beijing, China.
| |
Collapse
|
12
|
Chemical Composition and Nutritional Value of Different Species of Vespa Hornets. Foods 2021; 10:foods10020418. [PMID: 33672798 PMCID: PMC7917720 DOI: 10.3390/foods10020418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 01/31/2023] Open
Abstract
We genetically identified three different species of hornets and analyzed the nutrient compositions of their edible brood. Samples were collected from a commercial production unit in Shizong province of China and from forests near Andong City in Korea. The species were identified as Vespa velutina, V. mandarinia, and V. basalis from China and V. velutina from Korea. Farmed V. velutina and V. mandarinia were found to have similar protein contents, i.e., total amino acids, whereas V. basalis contained less protein. The V. velutina brood collected from the forest contained the highest amount of amino acids. Altogether 17 proteinogenic amino acids were detected and quantified with similar patterns of distribution in all three species: leucine followed by tyrosine and lysine being predominant among the essential and glutamic acid among the non-essential amino acids. A different pattern was found for fatty acids: The polyunsaturated fatty acid proportion was highest in V. mandarinia and V. basalis, but saturated fatty acids dominated in the case of V. velutina from two different sources. The high amounts of unsaturated fatty acids in the lipids of the hornets could be expected to exhibit nutritional benefits, including reducing cardiovascular disorders and inflammations. High minerals contents, especially micro minerals such as iron, zinc, and a high K/Na ratio in hornets could help mitigate mineral deficiencies among those of the population with inadequate nutrition.
Collapse
|
13
|
Verna G, Sila A, Liso M, Mastronardi M, Chieppa M, Cena H, Campiglia P. Iron-Enriched Nutritional Supplements for the 2030 Pharmacy Shelves. Nutrients 2021; 13:378. [PMID: 33530485 PMCID: PMC7912282 DOI: 10.3390/nu13020378] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 12/18/2022] Open
Abstract
Iron deficiency (ID) affects people of all ages in many countries. Due to intestinal blood loss and reduced iron absorption, ID is a threat to IBD patients, women, and children the most. Current therapies can efficiently recover normal serum transferrin saturation and hemoglobin concentration but may cause several side effects, including intestinal inflammation. ID patients may benefit from innovative nutritional supplements that may satisfy iron needs without side effects. There is a growing interest in new iron-rich superfoods, like algae and mushrooms, which combine antioxidant and anti-inflammatory properties with iron richness.
Collapse
Affiliation(s)
- Giulio Verna
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Italy
| | - Annamaria Sila
- National Institute of Gastroenterology “S. de Bellis”, Institute of Research, 70013 Castellana Grotte, Italy; (A.S.); (M.L.); (M.M.); (M.C.)
| | - Marina Liso
- National Institute of Gastroenterology “S. de Bellis”, Institute of Research, 70013 Castellana Grotte, Italy; (A.S.); (M.L.); (M.M.); (M.C.)
| | - Mauro Mastronardi
- National Institute of Gastroenterology “S. de Bellis”, Institute of Research, 70013 Castellana Grotte, Italy; (A.S.); (M.L.); (M.M.); (M.C.)
| | - Marcello Chieppa
- National Institute of Gastroenterology “S. de Bellis”, Institute of Research, 70013 Castellana Grotte, Italy; (A.S.); (M.L.); (M.M.); (M.C.)
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri I.R.C.C.S, 27100 Pavia, Italy
| | - Pietro Campiglia
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Italy
| |
Collapse
|
14
|
Singh H, Thakur S, Sahajpal NS, Singh H, Singh A, Sohal HS, Jain SK. Recent Advances in the Novel Formulation of Docosahexaenoic Acid for Effective Delivery, Associated Challenges and Its Clinical Importance. Curr Drug Deliv 2020; 17:483-504. [DOI: 10.2174/1567201817666200512103402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/03/2020] [Accepted: 02/02/2020] [Indexed: 11/22/2022]
Abstract
Docosahexaenoic Acid (DHA) is an essential polyunsaturated omega-3 fatty acid, and a fundamental structural component of the phospholipid membranes, especially of neural and retinal cells. DHA is found to be critical for the normal development and functioning of neurons and synaptogenesis in the brain, and is required during pre- and post-natal stages of life. DHA has also been observed to exhibit neuroprotective, cardioprotective, and anti-inflammatory properties. However, geographical dietary variations and poor economic conditions lead to insufficient DHA levels resulting in various health deficits like improper brain development, cognitive disorders, and other clinical complications. Thus, to prevent its deficiency-induced derangements, several authorities recommend DHA as a supplement during pregnancy, infancy, and throughout adulthood. In past decades, the soft gelatin capsule was only feasible resolute of DHA, but due to their limitations and invention of new technologies; it led to the development of new dosage forms with improved physicochemical characteristics of DHA. This article will discuss in detail about the role of DHA in brain development, microalgae oil as an emerging source of DHA, clinical- and pharmacological-activities of DHA, issues related to DHA oil, current formulation of DHA along with their application, limitations, and strategies used for improvement and future prospectives.
Collapse
Affiliation(s)
- Harmanpreet Singh
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar 143105, Punjab, India
| | - Shubham Thakur
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar 143105, Punjab, India
| | - Nikhil Shri Sahajpal
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar 143105, Punjab, India
| | - Harjeet Singh
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar 143105, Punjab, India
| | - Amrinder Singh
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar 143105, Punjab, India
| | - Harminder Singh Sohal
- Department of Orthopaedics, Government Medical College, Amritsar 143001, Punjab, India
| | - Subheet Kumar Jain
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar 143105, Punjab, India
| |
Collapse
|
15
|
Kumar A, Gupta S, Meena LP, Meher MP, Rai M, Kumar S, Bharti A. Study to evaluate the etiology of iron deficiency anemia at a teaching hospital in northeastern part of India. J Family Med Prim Care 2020; 9:3076-3081. [PMID: 32984176 PMCID: PMC7491828 DOI: 10.4103/jfmpc.jfmpc_3_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/06/2020] [Accepted: 03/26/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction The causes of iron deficiency may be either due to excessive loss or, less frequently, decrease absorption. Data related to etiology are not available from this part of the country. Objective A study to evaluate the etiology of iron-deficiency anemia at a teaching hospital in the northeastern part of India. Materials and Methods In this cross-sectional study, cases of iron-deficiency anemia were selected from the OPD and indoor, after taking proper written consent. Iron-deficiency anemia was diagnosed by sending the complete hematological investigations. Other specific investigations including imaging were done in selected patients as per indications. Results A total of 102 patients of iron-deficiency anemia were included in the study. The age of the selected population was between 18 and 80 years. 37.3% were male and 62.7% were female patients. Upper gastrointestinal endoscopy was done in 56, out of these, 9.7% had antral gastritis and 2.9% had a duodenal ulcer. Lower gastrointestinal endoscopy was done in 30 patients and out of these seven patients had hemorrhoids, one patient had multiple ulcers in the colon, one had ulcers in the sigmoid colon, and one had ulceroproliferative mass in the transverse colon. Biopsy through the upper gastrointestinal endoscopy showed chronic duodenitis in three patients (2.9%), carcinoma stomach in one (0.98%), and periampullary carcinoma in one (0.98%). Biopsy after lower gastrointestinal endoscopy showed one case each of carcinoma colon, ulcerative colitis, nonspecific colitis, and nonspecific enteritis. Conclusion Diagnosis of iron-deficiency anemia is not sufficient without the diagnosis of underlying etiology. Special concern will be taken to gastrointestinal malignancies like colorectal cancers in which iron-deficiency anemia may be the only manifestation and diagnosis that can be missed if we do not investigate properly.
Collapse
Affiliation(s)
- Abhishek Kumar
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Saumya Gupta
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Lalit P Meena
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mukti P Meher
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Madhukar Rai
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sandip Kumar
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anju Bharti
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| |
Collapse
|
16
|
Verna G, Liso M, De Santis S, Dicarlo M, Cavalcanti E, Crovace A, Sila A, Campiglia P, Santino A, Lippolis A, Serino G, Fasano A, Chieppa M. Iron Overload Mimicking Conditions Skews Bone Marrow Dendritic Cells Differentiation into MHCII lowCD11c +CD11b +F4/80 + Cells. Int J Mol Sci 2020; 21:ijms21041353. [PMID: 32079304 PMCID: PMC7072937 DOI: 10.3390/ijms21041353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/14/2020] [Accepted: 02/15/2020] [Indexed: 12/21/2022] Open
Abstract
Iron overload is an undesired effect of frequent blood transfusions or genetic diseases. Myelodysplastic syndrome (MDS) patients become transfusion dependent, but due to the combination of ineffective haematopoiesis and repeated blood transfusions they are often subject to iron overload. In this study, we demonstrate that iron-overload mimicking condition alters bone marrow progenitor differentiation towards dendritic cells (DCs). Cells cultured in iron-enriched culture medium for seven days fail to differentiate into conventional CD11c+MHCIIhi DCs and fail to efficiently respond to LPS (Lipopolysaccharides). Cells appear smaller than control DCs but vital and able to perform FITC-dextran (Fluorescein isothiocyanate-dextran) endocytosis. At molecular level, cells cultured in iron-enriched conditions show increased ARG1 and PU.1, and decreased IRF8 expression.
Collapse
Affiliation(s)
- Giulio Verna
- National Institute of Gastroenterology “S. de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (G.V.); (M.L.); (M.D.); (E.C.); (A.C.); (A.S.); (A.L.); (G.S.)
- Department of Immunology and Cell Biology, European Biomedical Research Institute of Salerno (EBRIS), 84125 Salerno, Italy; (P.C.); (A.F.)
| | - Marina Liso
- National Institute of Gastroenterology “S. de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (G.V.); (M.L.); (M.D.); (E.C.); (A.C.); (A.S.); (A.L.); (G.S.)
| | - Stefania De Santis
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Italy;
- Department of Pharmacy-Drug Science, University of Bari Aldo Moro, 70126 Bari, Italy
| | - Manuela Dicarlo
- National Institute of Gastroenterology “S. de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (G.V.); (M.L.); (M.D.); (E.C.); (A.C.); (A.S.); (A.L.); (G.S.)
| | - Elisabetta Cavalcanti
- National Institute of Gastroenterology “S. de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (G.V.); (M.L.); (M.D.); (E.C.); (A.C.); (A.S.); (A.L.); (G.S.)
| | - Alberto Crovace
- National Institute of Gastroenterology “S. de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (G.V.); (M.L.); (M.D.); (E.C.); (A.C.); (A.S.); (A.L.); (G.S.)
| | - Annamaria Sila
- National Institute of Gastroenterology “S. de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (G.V.); (M.L.); (M.D.); (E.C.); (A.C.); (A.S.); (A.L.); (G.S.)
| | - Pietro Campiglia
- Department of Immunology and Cell Biology, European Biomedical Research Institute of Salerno (EBRIS), 84125 Salerno, Italy; (P.C.); (A.F.)
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Italy;
| | - Angelo Santino
- Unit of Lecce, Institute of Sciences of Food Production C.N.R., via Monteroni, 73100 Lecce, Italy;
| | - Antonio Lippolis
- National Institute of Gastroenterology “S. de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (G.V.); (M.L.); (M.D.); (E.C.); (A.C.); (A.S.); (A.L.); (G.S.)
| | - Grazia Serino
- National Institute of Gastroenterology “S. de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (G.V.); (M.L.); (M.D.); (E.C.); (A.C.); (A.S.); (A.L.); (G.S.)
| | - Alessio Fasano
- Department of Immunology and Cell Biology, European Biomedical Research Institute of Salerno (EBRIS), 84125 Salerno, Italy; (P.C.); (A.F.)
- Harvard Medical School Division of Pediatric Gastroenterology and Nutrition and Mucosal Immunology and Biology Research Center, Massachusetts General Hospital for Children, Boston, MA 02114, USA
| | - Marcello Chieppa
- National Institute of Gastroenterology “S. de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (G.V.); (M.L.); (M.D.); (E.C.); (A.C.); (A.S.); (A.L.); (G.S.)
- Department of Immunology and Cell Biology, European Biomedical Research Institute of Salerno (EBRIS), 84125 Salerno, Italy; (P.C.); (A.F.)
- Correspondence:
| |
Collapse
|
17
|
Zehner E, Champeny M, Huffman SL. Marketing and infant and young child feeding in rapidly evolving food environments. MATERNAL AND CHILD NUTRITION 2020; 15 Suppl 4:e12810. [PMID: 31225711 PMCID: PMC6618061 DOI: 10.1111/mcn.12810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 01/16/2023]
Affiliation(s)
| | | | - Sandra L Huffman
- Consultant to Helen Keller International, New York, New York, USA
| |
Collapse
|
18
|
Pérez-Escamilla R, Buccini GS, Segura-Pérez S, Piwoz E. Perspective: Should Exclusive Breastfeeding Still Be Recommended for 6 Months? Adv Nutr 2019; 10:931-943. [PMID: 31147672 PMCID: PMC6855974 DOI: 10.1093/advances/nmz039] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The WHO recommends exclusive breastfeeding of infants for the first 6 mo of life (EBF-6). We reviewed the evidence behind concerns related to this recommendation. The risk of iron deficiency among EBF-6 infants can be significantly reduced if delayed cord clamping is performed in all newborns. At the moment there is no population-level evidence indicating that exclusive breastfeeding for 6 mo compared with <6 mo increases the risk of developing food allergies. Mild to moderate maternal undernutrition may reduce amounts of some nutrients in breast milk but does not directly diminish milk volume. Persistent reports of insufficient milk by women globally are likely to be the result of lack of access to timely lactation counseling and social support rather than primary biological reasons. All newborns should have their growth, hydration status, and development carefully monitored. In instances where formula supplementation is required, it should be done under the guidance of a qualified provider taking into account that early introduction of breast-milk supplements is a risk factor for early termination of exclusive breastfeeding and any breastfeeding. We found no evidence to support changes to the EBF-6 public health recommendation, although variability in inter-infant developmental readiness is recognized. We suggest that infant and young feeding guidelines make clear that complementary foods should be introduced at around 6 mo of age, taking infant developmental readiness into account.
Collapse
Affiliation(s)
| | | | | | - Ellen Piwoz
- Bill & Melinda Gates Foundation, Seattle, WA
| |
Collapse
|
19
|
Charuvila S, Davidson SE, Thachil J, Lakhoo K. Surgical decision making around paediatric preoperative anaemia in low-income and middle-income countries. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:814-821. [PMID: 31447408 DOI: 10.1016/s2352-4642(19)30197-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 11/18/2022]
Abstract
Prevalence of anaemia is high among children in low-income and middle-income countries. Anaemia is an important factor to consider preoperatively as low haemoglobin concentrations can have a negative effect on surgical outcomes and can also lead to surgeries being cancelled or postponed, which can have adverse health implications and stretch already limited resources in these countries. Additionally, blood transfusions to correct anaemia exposes children to safety issues. Therefore, where anaemia is known to be prevalent and resources are scarce, a contextually appropriate and relatively safe minimum haemoglobin concentration for proceeding to surgery could substantially improve patient management and efficiency of the health system. In this Review, we consider why paediatric anaemia is a major public health issue in low-income and middle-income countries, the value of preoperative testing of anaemia, and methods of optimising haemoglobin concentrations in the context of paediatric surgeries taking place in resource-limited settings.
Collapse
Affiliation(s)
- Somy Charuvila
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
| | - Sarah E Davidson
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Jecko Thachil
- Department of Haematology Manchester University, Manchester, UK
| | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
20
|
Longer Breastfeeding Associated with Childhood Anemia in Rural South-Eastern Nigeria. Int J Pediatr 2019; 2019:9457981. [PMID: 31281394 PMCID: PMC6590490 DOI: 10.1155/2019/9457981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/14/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Child mortality rate in sub-Saharan Africa is 29 times higher than that in industrialized countries. Anemia is one of the preventable causes of child morbidity. During a humanitarian medical mission in rural South-Eastern Nigeria, the prevalence and risk factors of anemia were determined in the region in order to identify strategies for reduction. Methods A cross-sectional study was done on 96 children aged 1-7 years from 50 randomly selected families. A study questionnaire was used to collect information regarding socioeconomic status, family health practices, and nutrition. Anemia was diagnosed clinically or by point of care testing of hemoglobin (Hb) levels. Results 96 children were selected for the study; 90 completed surveys were analyzed (43% male and 57% females). Anemia was the most prevalent clinical morbidity (69%), followed by intestinal worm infection (53%) and malnutrition (29%). Mean age (months) at which breastfeeding was stopped was 11.8 (±2.2) in children with Hb <11mg/dl (severe anemia), 10.5±2.8 in those with Hb = 11-11.9mg/dl (mild-moderate anemia), and 9.4±3.9 in children with Hb >12mg/dl (no anemia) (P=0.0445). Conclusions The longer the infant was breastfed, the worse the severity of childhood anemia was. Childhood anemia was likely influenced by the low iron content of breast milk in addition to maternal anemia and poor nutrition. A family-centered preventive intervention for both maternal and infant nutrition may be more effective in reducing childhood anemia and child mortality rate in the community.
Collapse
|
21
|
Cordero D, Aguilar AM, Casanovas C, Vargas E, Lutter CK. Anemia in Bolivian children: a comparative analysis among three regions of different altitudes. Ann N Y Acad Sci 2019; 1450:281-290. [PMID: 30883800 DOI: 10.1111/nyas.14038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/22/2019] [Accepted: 01/30/2019] [Indexed: 11/30/2022]
Abstract
Here, we analyzed four population-based demographic and health surveys conducted in Bolivia between 1998 and 2016 to understand trends in anemia in children from 6 to 59 months of age by selected sociodemographic characteristics and three categories of altitude: low, medium, and high. Over the 18-year period, the prevalence of anemia was virtually unchanged while that in children living at high altitude increased. Anemia in children living at all three altitude categories is more than 40% and a severe public health problem according to the World Health Organization. We did not identify a single consistent risk factor for anemia in children living at high altitude compared with those living at medium or low altitude. The most consistent characteristic associated with childhood anemia across the three altitude categories was diarrhea in the last 2 weeks. Low length/height for age, an adolescent or anemic mother, a mother with no or little education, and a mother who speaks Quechua or Aymara were also risk factors. We conclude that it is necessary to review anemia policies and programs and prioritize children who are at greatest risk of developing anemia, particularly those living at high altitude. As iron deficiency appears to explain only a small part of childhood anemia, there is also a need to better understand its other causes and develop appropriate interventions.
Collapse
Affiliation(s)
| | - Ana Maria Aguilar
- Instituto de Investigación en Salud y Desarrollo, Universidad Mayor de San Andres, La Paz, Bolivia
| | - Carmen Casanovas
- Facultad de Medicina, Universidad Mayor de San Andres, La Paz, Bolivia
| | | | - Chessa K Lutter
- Division of Food Security and Agriculture, RTI International, Washington DC.,University of Maryland School of Public Health, College Park, Maryland
| |
Collapse
|
22
|
Prieto-Patron A, Van der Horst K, Hutton ZV, Detzel P. Association between Anaemia in Children 6 to 23 Months Old and Child, Mother, Household and Feeding Indicators. Nutrients 2018; 10:E1269. [PMID: 30205553 PMCID: PMC6163758 DOI: 10.3390/nu10091269] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 01/01/2023] Open
Abstract
In Low and Lower-Middle-Income countries, the prevalence of anaemia in infancy remains high. In early childhood anaemia cause irreversible cognitive deficits and represents a higher risk of child mortality. The consequences of anaemia in infancy are a major barrier to overcome poverty traps. The aim of this study was to analyse, based on a multi-level approach, different factors associated with anaemia in children 6⁻23 months old based on recent available Standard Demographic Health Surveys (S-DHS). We identified 52 S-DHS that had complete information in all covariates of interest in our analysis between 2005 and 2015. We performed traditional logistic regressions and multilevel logistic regression analyses to study the association between haemoglobin concentrations and household, child, maternal, socio-demographic variables. In our sample, 70% of the 6⁻23 months-old children were anaemic. Child anaemia was strongly associated with maternal anaemia, household wealth, maternal education and low birth weight. Children fed with fortified foods, potatoes and other tubers had significantly lower rates of anaemia. Improving overall household living conditions, increasing maternal education, delaying childbearing and introducing iron rich foods at six months of age may reduce the likelihood of anaemia in toddlerhood.
Collapse
Affiliation(s)
- Alberto Prieto-Patron
- Nestlé Research Center, Vers-Chez-les-Blanc, Route du Jorat 57, Case Postale 44, 1000 Lausanne-26, Switzerland.
| | - Klazine Van der Horst
- Division of Nutrition and Dietetics, Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, CH-3008 Bern, Switzerland.
| | - Zsuzsa V Hutton
- Nestlé Research Center, Vers-Chez-les-Blanc, Route du Jorat 57, Case Postale 44, 1000 Lausanne-26, Switzerland.
| | - Patrick Detzel
- Nestlé Research Center, Vers-Chez-les-Blanc, Route du Jorat 57, Case Postale 44, 1000 Lausanne-26, Switzerland.
| |
Collapse
|
23
|
Castberg FC, Maretty L, Staalsoe T, Hempel C, Clasen-Linde E, Hviid L, Kurtzhals JAL. Increased Plasmodium chabaudi malaria mortality in mice with nutritional iron deficiency can be reduced by short-term adjunctive iron supplementation. Malar J 2018; 17:34. [PMID: 29338760 PMCID: PMC5771219 DOI: 10.1186/s12936-018-2186-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 01/10/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Iron deficiency is the most widespread nutrient deficiency and an important cause of developmental impairment in children. However, some studies have indicated that iron deficiency can also protect against malaria, which is a leading cause of childhood morbidity and mortality in large parts of the world. This has rendered interventions against iron deficiency in malaria-endemic areas controversial. METHODS The effect of nutritional iron deficiency on the clinical outcome of Plasmodium chabaudi AS infection in A/J mice and the impact of intravenous iron supplementation with ferric carboxymaltose were studied before and after parasite infection. Plasma levels of the iron status markers hepcidin and fibroblast growth factor 23 were measured in animals surviving and succumbing to malaria, and accompanying tissue pathology in the liver and the spleen was assessed. RESULTS Nutritional iron deficiency was associated with increased mortality from P. chabaudi malaria. This increased mortality could be partially offset by carefully timed, short-duration adjunctive iron supplementation. Moribund animals were characterized by low levels of hepcidin and high levels of fibroblast growth factor 23. All infected mice had extramedullary splenic haematopoiesis, and iron-supplemented mice had visually detectable intracellular iron stores. CONCLUSIONS Blood transfusions are the only currently available means to correct severe anaemia in children with malaria. The potential of carefully timed, short-duration adjunctive iron supplementation as a safe alternative should be considered.
Collapse
Affiliation(s)
- Filip C Castberg
- Centre for Medical Parasitology, Department of Clinical Microbiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.,Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lasse Maretty
- Centre for Medical Parasitology, Department of Clinical Microbiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Trine Staalsoe
- Centre for Medical Parasitology, Department of Clinical Microbiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Casper Hempel
- Centre for Medical Parasitology, Department of Clinical Microbiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.,Department of Micro- and Nanotechnology, Technical University of Denmark, Lyngby, Denmark
| | - Erik Clasen-Linde
- Department of Pathology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Lars Hviid
- Centre for Medical Parasitology, Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.,Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen A L Kurtzhals
- Centre for Medical Parasitology, Department of Clinical Microbiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark. .,Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
24
|
Moraleda C, Rabinovich NR, Menéndez C. Are Infants Less than 6 Months of Age a Neglected Group for Anemia Prevention in Low-Income Countries? Am J Trop Med Hyg 2017; 98:647-649. [PMID: 29260649 PMCID: PMC5930890 DOI: 10.4269/ajtmh.17-0487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Anemia is a major public health problem that affects mainly children, predominantly in low-income countries and most often due to iron deficiency (ID). Administration of iron supplements to prevent and treat ID anemia in malaria endemic areas has been controversial for decades; however, recent World Health Organization guidelines recommend universal iron supplementation for children in highly prevalent anemia settings, including those where malaria is endemic. However, infants younger than 6 months of age have been exempted from this recommendation because ID is not considered prevalent at this age and because of assumptions-without evidence-that they are protected from ID through breast milk. To achieve full impact of anemia prevention targeting infants less than 6 months of age who are at highest risk of ID, operational studies that conclusively demonstrate the effectiveness and safety of delivering iron supplements to young infants in settings with a high burden of infectious diseases, including malaria, are needed.
Collapse
Affiliation(s)
- Cinta Moraleda
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - N Regina Rabinovich
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Clara Menéndez
- Manhiça Health Research Center (CISM), Manhiça, Mozambique.,ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
25
|
Tang M, Frank DN, Hendricks AE, Ir D, Esamai F, Liechty E, Hambidge KM, Krebs NF. Iron in Micronutrient Powder Promotes an Unfavorable Gut Microbiota in Kenyan Infants. Nutrients 2017; 9:E776. [PMID: 28753958 PMCID: PMC5537890 DOI: 10.3390/nu9070776] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 07/14/2017] [Accepted: 07/16/2017] [Indexed: 12/25/2022] Open
Abstract
Iron supplementation may have adverse health effects in infants, probably through manipulation of the gut microbiome. Previous research in low-resource settings have focused primarily on anemic infants. This was a double blind, randomized, controlled trial of home fortification comparing multiple micronutrient powder (MNP) with and without iron. Six-month-old, non- or mildly anemic, predominantly-breastfed Kenyan infants in a rural malaria-endemic area were randomized to consume: (1) MNP containing 12.5 mg iron (MNP+Fe, n = 13); (2) MNP containing no iron (MNP-Fe, n = 13); or (3) Placebo (CONTROL, n = 7), from 6-9 months of age. Fecal microbiota were profiled by high-throughput bacterial 16S rRNA gene sequencing. Markers of inflammation in serum and stool samples were also measured. At baseline, the most abundant phylum was Proteobacteria (37.6% of rRNA sequences). The proteobacterial genus Escherichia was the most abundant genus across all phyla (30.1% of sequences). At the end of the intervention, the relative abundance of Escherichia significantly decreased in MNP-Fe (-16.05 ± 6.9%, p = 0.05) and CONTROL (-19.75 ± 4.5%, p = 0.01), but not in the MNP+Fe group (-6.23 ± 9%, p = 0.41). The second most abundant genus at baseline was Bifidobacterium (17.3%), the relative abundance of which significantly decreased in MNP+Fe (-6.38 ± 2.5%, p = 0.02) and CONTROL (-8.05 ± 1.46%, p = 0.01), but not in MNP-Fe (-4.27 ± 5%, p = 0.4445). Clostridium increased in MNP-Fe only (1.9 ± 0.5%, p = 0.02). No significant differences were observed in inflammation markers, except for IL-8, which decreased in CONTROL. MNP fortification over three months in non- or mildly anemic Kenyan infants can potentially alter the gut microbiome. Consistent with previous research, addition of iron to the MNP may adversely affect the colonization of potential beneficial microbes and attenuate the decrease of potential pathogens.
Collapse
Affiliation(s)
- Minghua Tang
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Daniel N Frank
- Division of Infectious Disease, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Audrey E Hendricks
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO 80204, USA.
- Department of Biostatistics and Bioinformatics, Colorado School of Public Health, University of Colorado Denver, Aurora, CO 80045, USA.
| | - Diana Ir
- Division of Infectious Disease, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Fabian Esamai
- School of Medicine, Moi University, P.O. Box 4606, Eldoret 30100, Kenya.
| | - Edward Liechty
- School of Medicine, Indiana University, 705 Riley Hospital Drive, Room 5900, Indianapolis, IN 46202, USA.
| | - K Michael Hambidge
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Nancy F Krebs
- Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| |
Collapse
|
26
|
Abbeddou S, Yakes Jimenez E, Somé JW, Ouédraogo JB, Brown KH, Hess SY. Small-quantity lipid-based nutrient supplements containing different amounts of zinc along with diarrhea and malaria treatment increase iron and vitamin A status and reduce anemia prevalence, but do not affect zinc status in young Burkinabe children: a cluster-randomized trial. BMC Pediatr 2017; 17:46. [PMID: 28152989 PMCID: PMC5288861 DOI: 10.1186/s12887-016-0765-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/21/2016] [Indexed: 12/14/2022] Open
Abstract
Background We assessed the effects of providing a package of interventions including small-quantity lipid-based nutrient supplements (SQ-LNS) containing 0, 5 or 10 mg zinc and illness treatment to Burkinabe children from 9 to 18 months of age, on biomarkers of zinc, iron and vitamin A status at 18 months and compared with a non-intervention cohort (NIC). Methods Using a two-stage cluster randomized trial design, communities were randomly assigned to the intervention cohort (IC) or NIC, and extended family compounds within the IC were randomly assigned to different treatment groups. IC children (n = 2435) were provided with 20 g SQ-LNS/d containing 0, 5 or 10 mg zinc, 6 mg of iron and 400 μg of vitamin A along with malaria and diarrhea treatment. NIC children (n = 785) did not receive the intervention package. At 9 and 18 months, hemoglobin (Hb), zinc, iron and vitamin A status were assessed in a sub-group (n = 404). Plasma concentrations of zinc (pZC), ferritin (pF), soluble transferrin receptor (sTfR) and retinol-binding protein (RBP) were adjusted for inflammation. Results At baseline, 35% of children had low adjusted pZC (<65 μg/dL), 93% were anemic (Hb <110 g/L), 25% had low adjusted pF (<12 μg/L), 90% had high adjusted sTfR (>8.3 mg/L) and 47% had low adjusted RBP (<0.94 μmol/L), with no group-wise differences. Compared with the NIC, at 18 months IC children had significantly lower anemia prevalence (74 vs. 92%, p = 0.001) and lower iron deficiency prevalence (13% vs. 32% low adjusted pF and 41% vs. 71% high adjusted sTfR, p < 0.001), but no difference in pZC. Mean adjusted RBP was greater at 18 months in IC vs. NIC (0.94 μmol/L vs. 0.86 μmol/L, p = 0.015), but the prevalence of low RBP remained high in both cohorts. Within the IC, different amounts of zinc had no effect on the prevalence of low pZC or indicators of vitamin A deficiency, whereas children who received SQ-LNS with 10 mg zinc had a significantly lower mean pF at 18 months compared to children who received SQ-LNS with 5 mg zinc (p = 0.034). Conclusions SQ-LNS regardless of zinc amount and source provided along with illness treatment improved indicators of iron and vitamin A status, but not pZC. Trial registration NCT00944281 (July 21, 2009).
Collapse
Affiliation(s)
- Souheila Abbeddou
- Department of Nutrition, Program in International and Community Nutrition, University of California, One Shields Avenue, Davis, CA, 95616, USA
| | - Elizabeth Yakes Jimenez
- Center for Education Policy Research, University of New Mexico, Albuquerque, NM, USA.,Pacific Institute for Research and Evaluation, Albuquerque, NM, USA
| | - Jérome W Somé
- Department of Nutrition, Program in International and Community Nutrition, University of California, One Shields Avenue, Davis, CA, 95616, USA.,Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | | | - Kenneth H Brown
- Department of Nutrition, Program in International and Community Nutrition, University of California, One Shields Avenue, Davis, CA, 95616, USA.,Nutrition and Global Development, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Sonja Y Hess
- Department of Nutrition, Program in International and Community Nutrition, University of California, One Shields Avenue, Davis, CA, 95616, USA.
| |
Collapse
|
27
|
Séraphin MN, Xinguang C, Ayoya MA, Ngnie-Teta I, Boldon E, Mamadoultaibou A, Saint-Fleur JE, Pierre I. Childhood anemia in Rural Haiti: the potential role of community health workers. Glob Health Res Policy 2017; 2:3. [PMID: 29202071 PMCID: PMC5683206 DOI: 10.1186/s41256-016-0022-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/12/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Childhood iron deficiency anemia (IDA) is an important contributor to under-five mortality in the developing world. There is evidence that Community Health Worker (CHW) delivered programs to increase maternal knowledge of child health practices may decrease childhood IDA. This study reports findings on the association between a long standing CHW intervention and childhood anemia status in rural Haiti. METHODS Using structural equations and mediation analyses on data from a household-based survey of 621 mother/child dyads, we tested the hypothesis that CHW would have a direct positive effect on maternal knowledge and an indirect effect on childhood anemia in rural Haiti. RESULTS CHW contact was significantly associated with maternal knowledge of key child health practices (β = 0.193, SE = 0.058, p = 0.001). However, knowledge was not associated with childhood anemia (β = -0.008, SE = 0.009, p = 0.382). Maternal knowledge categories significantly affected by CHW contact included diarrheal prevention knowledge (β = 0.111, SE = 0.045, p = 0.013) and signs of malnutrition (β = 0.217, SE = 0.071, p = 0.002). There was no significant association with knowledge of vitamin A and iron rich foods (β = 0.057, SE = 0.032, p = 0.074), which is the intervention most likely to impact childhood anemia. In all path models tested, we identified the control variables low household socio-economic status, mothers' anemia status, and child's age less than 24 months as significant predictors of childhood anemia. CONCLUSIONS CHWs delivered interventions are associated with improved maternal knowledge of child health practices in rural Haiti; however, this knowledge is not associated with improved childhood anemia. Concurrently with CHW-delivered programs, interventions household poverty are implied to impact childhood health outcomes in resource poor settings.
Collapse
Affiliation(s)
- Marie N. Séraphin
- Department of Medicine, Division of Infectious Diseases and Global Medicine, University of Florida, 2055 Mowry Road, Suite 250, PO Box 103600, Gainesville, FL 32610-3600 USA
- Department of Epidemiology, College of Public Health and Health Professions and the College of Medicine, University of Florida, Gainesville, FL USA
| | - Chen Xinguang
- Department of Epidemiology, College of Public Health and Health Professions and the College of Medicine, University of Florida, Gainesville, FL USA
| | - Mohamed Ag Ayoya
- UNICEF Country Office, 125 Rue Faubert, Petionville, Port-au-Prince Haiti
| | - Ismael Ngnie-Teta
- UNICEF Country Office, 125 Rue Faubert, Petionville, Port-au-Prince Haiti
| | - Ellen Boldon
- St. Boniface Haïti Foundation, 12 Rue E. Guello, Fond des Blancs, Haiti
| | | | | | - Inobert Pierre
- St. Boniface Haïti Foundation, 12 Rue E. Guello, Fond des Blancs, Haiti
| |
Collapse
|
28
|
Effect of Vitamin E With Therapeutic Iron Supplementation on Iron Repletion and Gut Microbiome in US Iron Deficient Infants and Toddlers. J Pediatr Gastroenterol Nutr 2016; 63:379-85. [PMID: 27548249 PMCID: PMC4994979 DOI: 10.1097/mpg.0000000000001154] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Iron therapy induces inflammation, which could decrease iron absorption. Increased exposure of iron in the gut could also alter microbiome file. Providing antioxidants such as vitamin E with iron therapy has been associated with reduced oxidative potential. OBJECTIVE The aim of the present study was to test the efficacy of adding vitamin E to therapeutic iron therapy on iron repletion, inflammation markers, and gut microbiome in iron-deficient infants and toddlers. DESIGN This was a randomized, double-blind, control trial in which infants and toddlers (Denver, CO metro area) who were at risk of iron deficiency were screened. Eligible participants were randomized to receive iron therapy (6 mg · kg · day) plus placebo (n = 22) or iron (6 mg · kg · day) and vitamin E (18 mg/day, n = 14) for 8 weeks. Iron and inflammation status, and gut microbiome (16S sequencing) were analyzed in all participants before and after the treatment. RESULTS After 8 weeks of treatment, average serum ferritin level returned to normal for both iron + placebo and iron + vitamin E groups at 33.3 ± 20.2 and 33.5 ± 21.5 μg/L, respectively. Serum vitamin E concentration increased in iron + vitamin E group. No change over time was observed regarding serum interleukin-4, tumor necrosis factor-α, or fecal calprotectin. The relative abundance of the genus Roseburia (phylum Firmicutes), a butyrate producer, increased in the Fe + E group (Δ1.3%, P < 0.01). Also at the genus level, the genus Escherichia decreased by 1.2% on average among all participants (effect of time P = 0.01). CONCLUSIONS Using a therapeutic iron dose of 6 mg · kg · day is effective in treating iron deficiency during an 8-week period, without inducing persistent inflammatory response. Changes of the gut microbiome raised the possibility that antioxidant therapy in conjunction with therapeutic iron supplementation could potentially improve microbial community profiles in the intestinal tract.
Collapse
|
29
|
Abstract
Children, especially infants, are highly vulnerable to iron-deficiency anemia because of their rapid growth of the brain and the rest of the body. The objectives of this study were to compare the prevalence of iron-deficiency anemia in infants born from HIV-positive mothers and HIV-negative mothers and to identify the determinants of iron-deficiency anemia in infants.A comparative cross-sectional study was conducted in Bahir Dar city. Simple random sampling technique was used to select the study participants. Mothers were interviewed; blood samples were collected from mothers and infants to measure the hemoglobin level and anthropometric indicators were obtained from the infants using world health organization standards. Descriptive statistics were used to estimate the prevalence of infantile anemia. Binary logistic regression and multiple linear regressions were used to identify the determinants of infant anemia.A total of 1459 infants born from HIV-positive and HIV-negative mothers were included. The prevalence of iron-deficiency anemia in infants born from HIV-positive and HIV-negative mothers was 41.9% (95% CI: 39-44). Infantile iron-deficiency anemia was associated with maternal HIV infection (adjusted odds ratio [AOR] 2.54 [95% CI: 1.65-3.9]), stunting (AOR 3.46 [95% CI: 2.41-4.97]), low income (AOR 2.72 [95% CI: 2-3.73]), maternal malaria during pregnancy (AOR 1.81 [95% CI: 1.33-2.47]), use of cow milk before 6 month (AOR 1.82 [95% CI: 1.35-2.45]), residence (AOR 0.09 [95% CI: 0.06-0.13]), history of cough or fever 7 days preceding the survey (AOR 2.71 [95% CI: 1.99-3.69]), maternal hemoglobin (B 0.65 [95% CI: 0.61-0.68]), educational status of mother (B 0.22 [95% CI: 0.2-0.23]), age of the mother (B -0.03 [95% CI: -0.03, -0.02]), and family size (B -0.14 [95% CI: -0.18,-0.11]).
Collapse
Affiliation(s)
- Berhanu Elfu Feleke
- Department of Epidemiology and Biostatistics, Bahir Dar University, Bahir Dar, Ethiopia
- Correspondence: Berhan Elfu Feleke, Bahir Dar University, Bahir Dar, Ethiopia (e-mail: ;)
| |
Collapse
|
30
|
Factors associated with anemia in children under three years of age in Perú: analysis of the Encuesta Demográfica y de Salud Familiar, ENDES, 2007-2013. BIOMEDICA 2016; 36:220-9. [PMID: 27622483 DOI: 10.7705/biomedica.v36i2.2896] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/18/2015] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Despite the reduction of poverty in Perú, the prevalence of anemia in the country remains high. OBJECTIVE To identify socio-demographic, child and maternal-child care factors associated with anemia in children between 6 and 35 months in Perú. MATERIALS AND METHODS We conducted an analytical and descriptive study that included registered data from the national survey on demography and family health, 2007-2013, on children between 6 and 35 months old, including the measurement of blood hemoglobin. Anemia was confirmed by hemoglobin-altitude corrected values below 11 mg/dl. We used multivariate logistic regression models to assess potential associated factors for anemia. RESULTS Anemia prevalence was high (47.9%). Twelve factors were independently associated with anemia in children: Socio-demographic factors such as living outside Lima and Callao, in a low socioeconomic household, and having an adolescent mother with low education level; child-related factors as being male, younger than 24 months of age, and having fever in the previous two weeks, and maternal-child care factors such as lack of prenatal control in the first trimester of pregnancy, lack or short period of iron supplementation during pregnancy, house delivery, anemia detection at the moment of the survey, and lack of intestinal anti-parasite preventive treatment in the child. CONCLUSIONS The analysis of survey data provided valuable information about factors associated with anemia in children between 6 and 35 months, which can be used to increase the coverage and effectiveness of maternal-child care practices.
Collapse
|
31
|
Matos TA, Arcanjo FPN, Santos PR, Arcanjo CC. Prevention and Treatment of Anemia in Infants through Supplementation, Assessing the Effectiveness of Using Iron Once or Twice Weekly. J Trop Pediatr 2016; 62:123-30. [PMID: 26672608 PMCID: PMC4886117 DOI: 10.1093/tropej/fmv085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The objective of this study was to compare the effect of once weekly iron supplementation (IS) versus twice weekly, on hemoglobin (Hb) levels and anemia prevalence. METHODS In this cluster-randomized clinical trial study, we evaluated infants aged 6-18 months. Length of intervention: 16 weeks. Infants were cluster randomized to either 25 mg elemental iron once weekly (Group-A) or twice weekly (Group-B). Primary outcome variables were change in Hb concentration and anemia prevalence. Two biochemical evaluations were performed to determine Hb concentrations, before and after intervention. RESULTS For Group-A, at baseline, mean Hb concentration was 10.8 ± 1.18 g/dl and after intervention 11.2 ± 1.07 g/dl,p = 0.12; anemia prevalence was 52.5% at baseline and 37.5% after intervention,p = 0.18; Group-B, mean baseline Hb was 10.7 ± 1.04 g/dl, and 11.3 ± 0.91 g/dl after intervention,p = 0.002; anemia prevalence reduced from 57.9 to 36.8%. CONCLUSIONS Both once and twice weekly IS increased mean Hb concentration; however, twice weekly supplementation provided more significant results.
Collapse
|
32
|
Nel E, Kruger HS, Baumgartner J, Faber M, Smuts CM. Differential ferritin interpretation methods that adjust for inflammation yield discrepant iron deficiency prevalence. MATERNAL & CHILD NUTRITION 2015; 11 Suppl 4:221-8. [PMID: 25721990 PMCID: PMC6860295 DOI: 10.1111/mcn.12175] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We reassessed the iron deficiency (ID) prevalence in a South African trial that formed part of the International Research on Infant Supplementation study by comparing four methods that account for the high prevalence of acute (28.6%) and chronic (41.8%) inflammation observed in the study. Serum ferritin (SF) was measured as marker of iron status in 192 apparently healthy, 4-13-month-old infants. Alpha-1 glycoprotein and C-reactive protein concentrations were determined to indicate chronic and acute inflammation, respectively. The ID prevalence was obtained by four methods that adjust for inflammation: (1) excluding infants with inflammation; (2) using a higher cut-off (SF < 30 μg L(-1) ); (3) using different cut-offs for infants with vs. without inflammation (SF < 30 μg L(-1) vs. SF < 12 μg L(-1) ); and (4) adjusting SF concentrations with correction factors (CFs) were compared with a reference method (SF < 12 μg L(-1) ) not accounting for inflammation. Using the higher SF cut-off method resulted in the highest ID prevalence (52.1%), followed by using two different cut-offs (31.8%), using CFs (21.9%) and excluding subjects with inflammation (17.6%). The CF method showed the best agreement with the reference method. Disregarding inflammation resulted in a significantly lower ID prevalence (17.2%). ID anaemia (IDA) prevalence ranged from 13.2% to 24.5%, with the lowest prevalence (12.0%) for the reference method. Our analysis highlights the challenge of assessing ID and IDA using only SF as marker of iron status in the presence of inflammation. We demonstrate the importance of measuring inflammation markers to account for their elevating effect on SF.
Collapse
Affiliation(s)
- Elsmari Nel
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Herculina S Kruger
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Jeannine Baumgartner
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Mieke Faber
- Non-communicable Diseases Research Unit, Medical Research Council, Tygerberg, South Africa
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| |
Collapse
|
33
|
Stativa E, Rus AV, Stanescu A, Pennings JS, Parris SR, Wenyika R. Prevalence and predictors of anaemia in Romanian infants 6-23 months old. J Public Health (Oxf) 2015; 38:e272-e281. [PMID: 26493935 DOI: 10.1093/pubmed/fdv145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Anaemia is a public health problem that can lead to a variety of detrimental effects on physical and neurodevelopment in young children. The present study explored the epidemiology of anaemia among infants in Romania, identified risk factors and created a model for predicting it. METHODS Data from 1532 infants aged 6-24 months were selected from a larger nationally representative cross-sectional survey. Demographic predictor variables and haemoglobin concentration were extant variables in the data set. Multiple logistic regression was used to determine the best predictors of anaemia. RESULTS Overall, 46% of 6-24 month olds in the sample had anaemia (Hb < 11.0 g/dl). A variety of risk factors were associated with significantly greater odds of anaemia, but a five-factor model best predicted it (67.9% accuracy). These predictors included being male, living in a rural area, being third born or later, being a Hungarian and living in the South, South-West or West region of Romania. CONCLUSIONS While data indicate a modest decrease in anaemia from earlier Romanian studies, it remains a significant problem. Models like this one have the potential to improve identification and treatment of anaemia in young children.
Collapse
Affiliation(s)
- E Stativa
- The Institute for Mother and Child Care 'Alfred Rusescu', Bucharest, Romania
| | - A V Rus
- Department of Social and Behavioral Sciences, Southwestern Christian University, 7210 NW 39th Expressway, Bethany, OK 73008, USA
| | - A Stanescu
- The Institute for Mother and Child Care 'Alfred Rusescu', Bucharest, Romania
| | | | - S R Parris
- Institute of Child Development, Texas Christian University, Fort Worth, TX 76129, USA
| | - R Wenyika
- African Institute of Biomedical Sciences and Technology, Harare, Zimbabwe
| |
Collapse
|
34
|
Rezaeian A, Ghayour-Mobarhan M, Mazloum SR, Yavari M, Jafari SA. Effects of iron supplementation twice a week on attention score and haematologic measures in female high school students. Singapore Med J 2015; 55:587-92. [PMID: 25631970 DOI: 10.11622/smedj.2014156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Iron deficiency, associated with a decline in cognitive function, is the most common nutritional deficiency globally. The present study aimed to identify the impact of weekly iron supplements on the attention function of female students from a high school in North Khorasan Province, Iran. METHODS This was a blind, controlled, clinical trial study, involving 200 female students who were chosen using the stratified randomised sampling method. First, laboratory studies were performed to detect iron consumption limitations. Next, the 200 students were divided randomly and equally into case and control groups. The case group was treated with 50 mg of ferrous sulfate twice a week for 16 weeks. We compared both groups' data on attention, iron status and erythrocyte indices. Questionnaires were used to collect demographic data, while clinical data was collected using complete blood count and Toulouse-Piéron tests. Data was analysed using descriptive statistics, as well as paired and independent t-tests. RESULTS The mean attention scores of the case and control groups were 104.8 ± 7.0 and 52.7 ± 9.6, respectively (p < 0.001). The mean haemoglobin levels of the two groups were 12.5 ± 0.9 and 11.2 ± 1.0, respectively (p < 0.001). Compared to the control group, the attention scores and haemoglobin concentrations of the case group were found to be improved by approximately 90% and 10%, respectively. CONCLUSION Oral iron supplements (50 mg twice a week for 16 weeks) were able to improve the attention span and haematologic indices of female high school students.
Collapse
Affiliation(s)
| | | | | | - Mehri Yavari
- Education Development Office, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Ibn Sina Street, Mashhad, Iran.
| | | |
Collapse
|
35
|
Characterisation of anaemia and associated factors among infants and pre-schoolers from rural India. Public Health Nutr 2015; 19:861-71. [DOI: 10.1017/s1368980015002050] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AbstractObjectiveIn India, national databases indicate anaemia prevalence of 80 % among 6–35-month-old children and 58 % among 36–59-month-old children. The present study aimed to characterise anaemia and the associated factors among infants and pre-schoolers living in rural India.DesignMultivariate logistic regression analysis of data collected prior to an intervention trial. Fe-deficiency with anaemia (IDA), Fe deficiency with no anaemia (IDNA) and anaemia without Fe deficiency were defined. Serum ferritin, soluble transferrin receptor (sTfR) and sTfR/log ferritin index were used to indicate Fe status.SettingTwenty-six villages of Nalgonda district, Telangana, India. Data were collected in community sites.ParticipantsFour hundred and seventy-six infants (aged 6–12 months), 316 pre-schoolers (aged 29–56 months) and their mothers.ResultsPrevalence of anaemia among infants and pre-schoolers was 66·4 and 47·8 %, prevalence of IDA was 52·2 and 42·1 %, prevalence of IDNA was 22·2 and 29·8 %, prevalence of anaemia without Fe deficiency was 14·2 and 5·7 %. Among infants, anaemia was positively associated with maternal anaemia (OR=3·31; 95 % CI 2·10, 5·23;P<0·001), and sTfR/log ferritin index (OR=2·21; 95 % CI 1·39, 3·54;P=0·001). Among pre-schoolers, anaemia was positively associated with maternal anaemia (OR=3·77; 95 % CI 1·94, 7·30;P<0·001), sTfR/log ferritin index (OR=5·29; 95 % CI 2·67, 10·50;P<0·001), high C-reactive protein (OR=4·39; 95 % CI 1·91, 10·06,P<0·001) and young age (29–35 months: OR=1·92; 05 % CI 1·18, 3·13,P=0·009).ConclusionsAnaemia prevalence continues to be high among infants and pre-schoolers in rural India. Based on sTfR/ferritin index, Fe deficiency is a major factor associated with anaemia. Anaemia is also associated with inflammation among pre-schoolers and with maternal anaemia among infants and pre-schoolers, illustrating the importance of understanding the aetiology of anaemia in designing effective control strategies.
Collapse
|
36
|
Haimi M, Lerner A. Nutritional deficiencies in the pediatric age group in a multicultural developed country, Israel. World J Clin Cases 2014; 2:120-125. [PMID: 24868510 PMCID: PMC4023304 DOI: 10.12998/wjcc.v2.i5.120] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 03/18/2014] [Indexed: 02/05/2023] Open
Abstract
Nutrient deficiencies are prevalent worldwide. Diseases and morbid conditions have been described to result from nutritional deficiencies. It is essential to address nutrient deficiencies as these may lead to chronic long-term health problems such as rickets, iron deficiency anemia, goiter, obesity, coronary heart disease, type 2 diabetes, stroke, cancer and osteoporosis. In the present review we surveyed the extent and severity of nutritional deficiencies in Israel through a selective and comprehensive Medline review of previous reports and studies performed during the last 40 years. Israeli populations have multiple nutritional deficiencies, including iron, calcium, zinc, folic acid, and vitamins B12, C, D and E, spanning all age groups, several minorities, and specific regions. In Israel, some of the nutrients are mandatorily implemented and many of them are implemented voluntarily by local industries. We suggest ways to prevent and treat the nutritional deficiencies, as a step to promote food fortification in Israel.
Collapse
|
37
|
Kwon HJ, Ramasamy R, Morgan A. "How often? How much? Where from?" knowledge, attitudes, and practices of mothers and health workers to iron supplementation program for children under five in rural Tamil Nadu, south India. Asia Pac J Public Health 2013; 26:378-89. [PMID: 24357609 DOI: 10.1177/1010539513514435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Iron deficiency anemia (IDA) affects 70% of under-5 children in India. The primary prevention strategy is regular iron supplementation. Little is known about what helps families adhere to daily iron supplementation. Our study explored the knowledge, attitudes, and practices of mothers and village health workers (VHWs) involved in a community health program in one hill district of Tamil Nadu. We conducted 30 semistructured interviews and 3 group discussions involving mothers, VHWs, and community stakeholders. Knowledge of IDA was widespread, yet no children were receiving the iron supplementation as recommended. The main determinants to adherence included the perception of its need, the ease of access, and the activity of VHWs. Preventive care requiring daily supplements is challenging. Our study suggests that increasing community awareness of mild anemia, simplifying dosage instructions, and further strengthening the supportive environment for VHWs would help in reducing the prevalence of IDA.
Collapse
Affiliation(s)
- Hye Jin Kwon
- University of Melbourne, Carlton, Victoria, Australia
| | | | - Alison Morgan
- University of Melbourne, Carlton, Victoria, Australia
| |
Collapse
|
38
|
Boffetta P, Islami F, Vedanthan R, Pourshams A, Kamangar F, Khademi H, Etemadi A, Salahi R, Semnani S, Emadi A, Abnet CC, Brennan P, Pharoah PD, Dawsey SM, Malekzadeh R. A U-shaped relationship between haematocrit and mortality in a large prospective cohort study. Int J Epidemiol 2013; 42:601-15. [PMID: 23569195 DOI: 10.1093/ije/dyt013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Only a limited number of studies have investigated the correlation between haematocrit (HCT) and mortality in the general population, and few of those studies have had data on a wide range of low and high levels of HCT. We investigated the association between baseline HCT and mortality in a prospective cohort study of 49,983 adult subjects in Iran with a broad spectrum of HCT values. METHODS Data on socio-demographic and life-style factors, past medical history, and levels of HCT were collected at enrollment. During a mean follow-up of 5 years (follow-up success rate ~99%), 2262 deaths were reported. Cox proportional hazards regression models were used to estimate hazard ratios and corresponding 95% confidence intervals. RESULTS There was a U-shaped relationship between categories of HCT and mortality in both sexes: both low and high levels of HCT were associated with increased overall mortality and mortality from cardiovascular disease. The U-shaped relationship persisted after several sensitivity analyses were done, including analyses restricted to non-smokers and non-users of opium; analyses excluding deaths from accidents and other external causes as well as deaths of persons with self-reported ischemic heart disease at the baseline interview for the study; and analyses excluding the first 2 years of follow-up. Self-reported past medical history and lack of data about lipids and other cellular blood components were the major limitations of the study. CONCLUSIONS Low and high levels of HCT are associated with increased mortality in the general population. The findings in the present study can be of particular importance for low- and middle-income countries in which a substantial proportion of the population lives with suboptimal levels of HCT.
Collapse
Affiliation(s)
- Paolo Boffetta
- Institute for Transitional Epidemiology and the Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY 10029, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Iron deficiency anemia as a risk factor for cerebrovascular events in early childhood: a case-control study. Ann Hematol 2013; 93:571-6. [PMID: 24141332 DOI: 10.1007/s00277-013-1922-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 10/01/2013] [Indexed: 12/25/2022]
Abstract
In recent years, iron-deficiency anemia (IDA) has been suggested to have an association with childhood-onset ischemic stroke in otherwise healthy children, but few cases have proven it thus far. In this study, we aimed to investigate whether iron-deficiency anemia is a risk factor for cerebrovascular events and childhood-onset ischemic stroke in previously healthy children. This was a case-control study that included 21 stroke cases with patients who had previously been generally healthy, and matched with age and gender of 100 healthy control subjects. Patients were included if a diagnosis of definite stroke had been made and other known etiologies of childhood onset stroke were excluded. For all subjects, iron parameters including serum iron, ferritin, transferrin, total iron binding capacity, and transferrin saturation were assessed. We screened all case patients for prothrombotic factors including level of hemoglobin S, protein C, protein S, antithrombin III, lupus anticoagulant, factor V Leiden, and prothrombin gene mutation (G20210A). Brain magnetic resonance images (MRI), magnetic resonance angiography (MRA), and magnetic resonance venography (MRV) were performed to all case patients. All case patients have normal results regarding functional, immunological, and molecular assay for prothrombotic factors screening. Our results showed that IDA was disclosed in 57.1 % of stroke cases with no identified cause, as compared to 26 % of controls. Our study suggest that previously healthy children who developed stroke are 3.8 times more likely to have IDA than healthy children, who do not develop stroke (OR, 3.8; 95 % CI:1.3-11.2 P = 0.005). In addition, there was significant interaction between IDA and thrombocytosis among studied cases (OR, 10.5; 95 % CI, 1.0-152 P = 0.02). There were nonsignificant differences between stroke patients with IDA and those with normal iron parameters regarding stroke subtype (P > 0.05). Public health messages on the importance of early detection of iron-deficiency anemia in young children, especially in our developing countries so that it can be treated before a life-threatening complication like stroke develops.
Collapse
|
40
|
Thorisdottir AV, Gunnarsdottir I, Palsson GI, Gretarsson SJ, Thorsdottir I. Iron status and developmental scores in 6-year-olds highlights ongoing need to tackle iron deficiency in infants. Acta Paediatr 2013; 102:914-9. [PMID: 23772831 DOI: 10.1111/apa.12316] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 05/15/2013] [Accepted: 06/10/2013] [Indexed: 11/30/2022]
Abstract
AIM To investigate iron status and developmental scores at 6 years of age in a population with decreased prevalence of iron deficiency in infancy. Iron status at 6 years and tracking from 12 months were also studied. METHODS Children (n = 143) born in Iceland in 2005 were followed up at the age of six. Motor and verbal development was assessed by a parental questionnaire, and iron status was assessed by Hb, MCV and serum ferritin (SF). Iron depletion was defined as SF <15 μg/L and deficiency as MCV <76 fL and SF <15 μg/L. RESULTS Iron depletion was observed in 5.6% of 6-year-olds, and 1.4% were iron deficient. Self-help (subset in motor development) differed by -4.14 (95% CI = -7.61, -0.67), between those iron depleted at 12 months (n = 6) and those nondepleted (n = 102), adjusted for maternal education. The combined motor developmental score seemed lower in iron depleted infants, although of borderline significance (p = 0.066). MCV concentration tracked from 12 months to 6 years (r = 0.31, p < 0.002), but Hb and SF did not. CONCLUSION Improved iron status at 12 months and 6 years has diminished the public health threat associated with iron depletion in the population studied, but iron depletion and development still associate weakly. Action to prevent iron depletion in infancy remains important.
Collapse
Affiliation(s)
- Asa Vala Thorisdottir
- Unit for Nutrition Research; Faculty of Food Science and Nutrition; School of Health Sciences; University of Iceland & Landspitali - University Hospital of Iceland; Reykjavik Iceland
| | - Ingibjorg Gunnarsdottir
- Unit for Nutrition Research; Faculty of Food Science and Nutrition; School of Health Sciences; University of Iceland & Landspitali - University Hospital of Iceland; Reykjavik Iceland
| | - Gestur I. Palsson
- Children's Hospital; Landspitali - University Hospital of Iceland; Reykjavik Iceland
| | | | - Inga Thorsdottir
- Unit for Nutrition Research; Faculty of Food Science and Nutrition; School of Health Sciences; University of Iceland & Landspitali - University Hospital of Iceland; Reykjavik Iceland
| |
Collapse
|
41
|
Pasricha SR, Hayes E, Kalumba K, Biggs BA. Effect of daily iron supplementation on health in children aged 4-23 months: a systematic review and meta-analysis of randomised controlled trials. LANCET GLOBAL HEALTH 2013; 1:e77-e86. [PMID: 25104162 DOI: 10.1016/s2214-109x(13)70046-9] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND About 47% of preschool children worldwide are anaemic. Daily oral iron supplementation is a commonly recommended intervention for treatment and prevention of anaemia, but the efficacy and safety of iron supplementation programmes is debated. Thus, we systematically reviewed the evidence for benefit and safety of daily iron supplementation in children aged 4-23 months. METHODS We searched Scopus and Medline, from inception to Feb 5, 2013, WHO databases, theses repositories, grey literature, and references. Randomised controlled trials that assigned children 4-23 months of age to daily oral iron supplementation versus control were eligible. We calculated mean difference (MD) or standard MD (SMD) for continuous variables, risk ratios for dichotomous data, and rate ratios for rates. We quantified heterogeneity with the I(2) test and synthesised all data with a random-effects model. This review is registered with the International Prospective Register of Systematic Reviews, number CRD42011001208. FINDINGS Of 9533 citations identified by the search strategy, 49 articles from 35 studies were eligible; these trials included 42,306 children. Only nine studies were judged to be at low risk of bias. In children receiving iron supplements, the risk ratio for anaemia was 0·61 (95% CI 0·50-0·74; 17 studies, n=4825), for iron deficiency was 0·30 (0·15-0·60; nine studies, n=2464), and for iron deficiency anaemia was 0·14 (0·10-0·22; six studies, n=2145). We identified no evidence of difference in mental (MD 1·65, 95% CI -0·63 to 3·94; six studies, n=1093) or psychomotor development (1·05, -1·36 to 3·46; six studies, n=1086). We noted no significant differences in final length or length-for-age, or final weight or weight-for-age. Children randomised to iron had slightly lesser length (SMD -0·83, -1·53 to -0·12; eight studies, n=868) and weight gain (-1·12, -1·19 to -0·33) over the course of the studies. Vomiting (risk ratio 1·38, 95% CI 1·10-1·73) and fever (1·16, 1·02-1·31) were more prevalent in children receiving iron. INTERPRETATION In children aged 4-23 months, daily iron supplementation effectively reduces anaemia. However, the adverse effect profile of iron supplements and effects on development and growth are uncertain. Adequately powered trials are needed to establish the non-haematological benefits and risks from iron supplementation in this group. FUNDING Victoria Fellowship (Government of Victoria, Australia); CRB Blackburn Scholarship (Royal Australasian College of Physicans); Overseas Research Experience Scholarship, University of Melbourne.
Collapse
Affiliation(s)
- Sant-Rayn Pasricha
- Nossal Institute for Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, VIC, Australia; Department of Medicine, Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia; Thalassaemia Service, Monash Medical Centre, Clayton, VIC, Australia.
| | - Emily Hayes
- Thalassaemia Service, Monash Medical Centre, Clayton, VIC, Australia
| | - Kongolo Kalumba
- Monash Specialists Women's and Children's, Clayton, VIC, Australia
| | - Beverley-Ann Biggs
- Department of Medicine, Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
42
|
Abstract
Iron deficiency anemia arises when the balance of iron intake, iron stores, and the body's loss of iron are insufficient to fully support production of erythrocytes. Iron deficiency anemia rarely causes death, but the impact on human health is significant. In the developed world, this disease is easily identified and treated, but frequently overlooked by physicians. In contrast, it is a health problem that affects major portions of the population in underdeveloped countries. Overall, the prevention and successful treatment for iron deficiency anemia remains woefully insufficient worldwide, especially among underprivileged women and children. Here, clinical and laboratory features of the disease are discussed, and then focus is placed on relevant economic, environmental, infectious, and genetic factors that converge among global populations.
Collapse
Affiliation(s)
- Jeffery L Miller
- Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
| |
Collapse
|
43
|
Khabour OF, Soudah OA, Aaysh MH. Genotoxicity assessment in iron deficiency anemia patients using sister chromatid exchanges and chromosomal aberrations assays. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2013; 750:72-6. [DOI: 10.1016/j.mrgentox.2012.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 09/11/2012] [Accepted: 09/16/2012] [Indexed: 12/11/2022]
|
44
|
Iron status of one-year-olds and association with breast milk, cow's milk or formula in late infancy. Eur J Nutr 2012; 52:1661-8. [PMID: 23212531 DOI: 10.1007/s00394-012-0472-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 11/21/2012] [Indexed: 01/14/2023]
Abstract
PURPOSE Studies on iron status in infancy and early childhood have shown contradicting results concerning prolonged breast-feeding and cow's milk intake. The aim of the present study was to investigate associations between iron status among one-year-olds and feeding, with focus on the type of milk. METHODS Randomly selected healthy infants were prospectively investigated until 1 year of age in two cohorts born 1995-1996 (n = 114) and 2005 (n = 140). Information on birth data, feeding and growth until 12 months and iron status at 12 months was collected. Data from the two cohorts were pooled and the infants categorized into three groups according to their predominant milk consumption at 9 months of age, that is, breast milk, cow's milk or follow-on formula. RESULTS The prevalence of iron deficiency was highest in the cow's milk group and lowest in the follow-on formula group. According to a linear model, adjusted for gender, birth weight and exclusive breast-feeding duration, cow's milk consumption was negatively associated with serum ferritin (SF) and formula positively, but breast milk not. Predicted SF (μg/l) = 11.652(intercept) - 5.362(boy) + 0.005 × birth weight (g) + 2.826(exclusively breastfed ≥ 4 months) + 0.027 × formula (ml) - 0.022 × cow's milk (ml) + 0.005 × breast milk (ml). Correction for other dietary factors did not change these results. CONCLUSION In this pooled analysis, cow's milk intake in late infancy associated negatively, and follow-on formula positively, with iron status. Prolonged partial breast-feeding does not seem to be of importance for iron status. Fortified food seems to improve iron status in late infancy.
Collapse
|
45
|
Muñoz P, Humeres A. Iron deficiency on neuronal function. Biometals 2012; 25:825-35. [PMID: 22639188 DOI: 10.1007/s10534-012-9550-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 04/06/2012] [Indexed: 11/26/2022]
Abstract
Because of the intrinsic ability of iron to catalyze the formation of reactive oxygen species, it has been associated with oxidative stress and neurodegenerative diseases. However, iron deficiency (ID) also negatively impacts various functions of the brain, suggesting that iron plays an important physiological role in neuronal processes such as myelination, synaptogenesis, behavior and synaptic plasticity (SP). ID not only produces changes in the hippocampus, striatum, amygdale or prefrontal cortex, it also affects the interaction among these systems. In both humans and rodents, the perturbations of these structures are associated to cognitive deficits. These cognitive alterations have been well correlated with changes in neural plasticity, the possible cellular substrate of memory and learning. Given that SP is strongly affected by early ID and the lasting-neurological consequences remain even after ID has been corrected, it is important to prevent ID as well as to seek effective therapeutic interventions that reduce or reverse the long-term effects of the ID in the nervous system. This review will give an overview of the literature on the effects of iron deficit in neuronal functions such as behavior, neurotransmission and SP. We also discuss our recent data about the possible oxidative effect of iron on the mechanisms involved in neural plasticity.
Collapse
Affiliation(s)
- Pablo Muñoz
- Centro Interdisciplinario de Neurociencias de Valparaíso, Universidad de Valparaíso, Valparaiso, Chile.
| | | |
Collapse
|
46
|
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.
Collapse
Affiliation(s)
- Marly A Cardoso
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
| | | | | | | | | |
Collapse
|
47
|
Hawamdeh HM, Rawashdeh M, Aughsteen AA. Comparison Between Once Weekly, Twice Weekly, and Daily Oral Iron Therapy in Jordanian Children Suffering From Iron Deficiency Anemia. Matern Child Health J 2012; 17:368-73. [DOI: 10.1007/s10995-012-0981-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
48
|
Cameron BM, Neufeld LM. Estimating the prevalence of iron deficiency in the first two years of life: technical and measurement issues. Nutr Rev 2012; 69 Suppl 1:S49-56. [PMID: 22043883 DOI: 10.1111/j.1753-4887.2011.00433.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
National-level data on iron deficiency is not available for most countries and many rely on the prevalence of anemia as a proxy estimate, assuming that approximately 50% of anemia cases are caused by iron deficiency. Anemia, however, has multiple causal factors and the risk attributable to any one cause will depend on its relative importance in a population in relation to other causes. The present review summarizes current estimates on the prevalence of iron deficiency and anemia in children younger than 2 years and evaluates the strengths and weaknesses of currently available indicators of iron deficiency in children. Anemia prevalence is insufficient to estimate the prevalence of iron deficiency in children younger than 2 years. The methods widely used to assess iron deficiency at the population level rely on venous blood samples and are complicated and costly to implement.
Collapse
|
49
|
Shak JR, Sodikoff JB, Speckman RA, Rollin FG, Chery MP, Cole CR, Suchdev PS. Anemia and Helicobacter pylori seroreactivity in a rural Haitian population. Am J Trop Med Hyg 2011; 85:913-8. [PMID: 22049049 DOI: 10.4269/ajtmh.2011.11-0101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Anemia is a significant health concern worldwide and can be the result of nutritional, environmental, social, and infectious etiologies. We estimated the prevalence of anemia in 336 pre-school children and 132 adults in the rural Central Plateau of Haiti and assessed associations with age, sex, household size, water source, sanitation, and Helicobacter pylori seroreactivity using logistic regression analysis; 80.1% (269/336) of children and 63.6% (84/132) of adults were anemic. Among children, younger age was associated with increased prevalence of anemia (adjusted odds ratio [aOR] = 4.1, 95% confidence interval [CI] = 1.5-11.1 for children 6-11 months compared with children 48-59 months). Among adults, 50.8% were H. pylori-seropositive, and seropositivity was inversely associated with anemia (aOR = 0.4, 95% CI = 0.2-0.9). Anemia prevalence in this region of Haiti is very high and not attributable to sanitary conditions or a high prevalence of H. pylori infection.
Collapse
Affiliation(s)
- Joshua R Shak
- Emory University School of Medicine, Atlanta, Georgia 30322, USA.
| | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
Anaemia affects a quarter of the global population, including 293 million (47%) children younger than 5 years and 468 million (30%) non-pregnant women. In addition to anaemia's adverse health consequences, the economic effect of anaemia on human capital results in the loss of billions of dollars annually. In this paper, we review the epidemiology, clinical assessment, pathophysiology, and consequences of anaemia in low-income and middle-income countries. Our analysis shows that anaemia is disproportionately concentrated in low socioeconomic groups, and that maternal anaemia is strongly associated with child anaemia. Anaemia has multifactorial causes involving complex interaction between nutrition, infectious diseases, and other factors, and this complexity presents a challenge to effectively address the population determinants of anaemia. Reduction of knowledge gaps in research and policy and improvement of the implementation of effective population-level strategies will help to alleviate the anaemia burden in low-resource settings.
Collapse
Affiliation(s)
- Yarlini Balarajan
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02115-6096, USA
| | | | | | | | | |
Collapse
|