Lead exposure and iron deficiency among Jammu and New Delhi children

In order to examine the prevalence of lead exposure and iron deficiency in Jammu, blood lead (B-Pb) and erythrocyte protoporphyrin (EP-ZnPP) levels were measured in a group of 125 children and compared with B-Pb and EP levels of 46 New Delhi children. The mean B-Pb level of Jammu children was 15 μg/dl and ZnPP level 46 μg/dl. The frequency distribution of B-Pb in Jammu children according to the 1997 CDC stratification showed that only 33% were below the 10 μg/dl “normal” threshold levels and 50.5% were between 10–19 μg/dl, an increasing level of concern. The remaining 16.5% were in the medical intervention lead poisoned level between 20–87 μg/dl with corresponding EP levels between 29–160 μg/dl. The mean B-Pb and ZnPP levels for New Delhi children were 14 μg/dl and 55 μg/dl respectively. This study on Jammu children shows a modest increase in mean B-Pb and EP levels from those in 1985; the percentage of children with higher levels of B-Pb>10 μg/dl have significantly increased. Moreover, the continued underlying high prevalence of iron deficiency among these children predisposes them to increased lead absorption from various sources thus aggravating further, the detrimental effects of lead. Therefore, a more extensive screening of all children below 10 years of age and an ongoing B-Pb and EP monitoring and iron supplementation programme for Jammu and New Delhi is essential. An environmental assessment of the sources leading to serious lead intoxication problem in Jammu, a rapidly growing and overpopulated city of the state of Jammu and Kashmir is strongly recommended.     

Blood lead and efythrocyte protoporphyrin levels in Kazakhstan

A pilot study was conducted to examine the extent of lead exposure and prevalence of iron deficiency in 3 major cities of Kazakhstan. Blood lead (B-Pb.) and erythrocyte protoporphyrin (ZnPP) levels of 475 children, age range 6 months to 7 yeas were measured. The mean B-Pb. levels in the different cities ranged from 4–7 ug/dl (minimum 1 to max 29 ug/dl) and similarly the mean ZnPP levels ranged from 26–32 ug/dl (minimum 12 and maximum 95 ug/dl), thus confirming low level lead poisoning of children at some sites. One to four year olds had greater than 10 ng/dl B-Pb in 18–27% cases compared with 3–7% cases in five to seven year olds. Prevalence of iron deficiency in 6 months to 4 year old children was the highest ranging from 28–86% compared with 4 to 15% in 4–7 year olds. However, there was remarkably low prevalence (4%) of iron deficiency in a group of 5–6 years olds. This study suggests that a targeted B-Pb and ZnPP monitoring together with an iron supplementation programme in the 3 cities of Kazakhstan is essential. Environmental education appears to have had a positive impact in lowering B-Pb at one site and should thus be expanded nationwide.     

Blood lead levels of children with pica and surma use

Blood lead levels of 253 Delhi children were estimated by dithizone method. In 82 (controls) children with no symptoms mean blood lead level was 9.6 μg/dl (±SD 6.8: median 10 μg); only 6 had high levels between 30–33 μg/dl. In 88 children with pica, the mean blood lead level was 23.0 μg/dl (±SD 13.82; median 17 μg) which was significantly higher than the control; 26 had high levels between 30–92 μg/dl. Sixteen children with pica and surma- use and 46 children suspected of lead poisoning showed lead level patterns like the pica group. However, 21 surma-using children without pica resembled the control group. Children with pica were significantly more anemic than the controls and showed higher prevalence of abdominal-neurological symptoms. Because, in India, blood lead cannot be estimated in most of the hospitals, it is suggested that children with severe pica, anemia, abdominal-neurological symptoms and exposure to surma or lead, be suspected of lead poisoning, kept in lead-free environment with corrected nutrition, and be given a short cautious therapeutic trial with oral penicillamine.     

Supplemental food may not prevent iron-deficiency anemia in infants

Objective  The present study evaluates the role of supplementary food and medicinal iron intake in preventing irondeficiency anemia in children aged between 4 to 6 months. Methods  During a case-control study in “Tabriz Children Hospital”, nutritional and medicinal-iron intake of 60 consecutivelyselected patients with iron-deficiency anemia were compared with 60 non-anemic children of similar age and sex distributions. Results  The mean hemoglobin concentration, corpuscular volume and serum iron were 9.11 g/dl, 65.41 fL and 19.33 μg/dl, in case group; and 12.6 g/dl, 75.18 fL and 78.28 μg/dl, in control group, respectively. There was no statistically significant difference between age of case and control groups when complementary-semisolid foods were started (P=0.058), but the mean of received medicinal iron in case group was significantly lower than control group (P<0.001). Conclusion  Supplementary food intake alone is not efficient to prevent iron deficiency anemia since the age of 4–6 months. So, regular administration of medicinal iron is crucial to prevent iron-deficiency anemia in children aged 4–6 months.     

Plasma zinc levels in children with chronic diarrhoea

We measured the plasma zinc concentration in a group of children with chronic diarrhoea. Fifteen patients with untreated coeliac disease had a mean plasma zinc level significantly lower than that of healthy children (69μg/dl vs 96μg/dl). In patients with chronic post-enteritic diarrhoea (n=70) the mean plasma zinc level was in the normal range (100μg/dl). The latter result suggests that our country a secondary zine deficiency is not a feature of chronic post-enteritic diarrhoea.     

Association between lower hair zinc levels and Neural Tube Defects

Though folic acid supplementation has reduced the incidence of Neural Tube Defects (NTD), NTD still constitutes one of the important congenital malformations having wide medical, social and ethical implications. Zinc deficiency has been reported to produce NTD in animals. This study was designed to evaluate zinc status of the newborn babies with NTD and their mothers. Eighty newborn babies with NTD and their mothers served as cases. Eighty apparently normal newborn babies and their mothers served as controls. Serum and scalp hair zinc levels were analyzed by atomic absorption spectrophotometry. The mean (± SD) serum and hair levels in normal mothers were 74.1 ± 4.1 μg/dl and 142.3 ± 8.0 μg/g respectively. The mean (± SD) serum and hair levels of the mothers who delivered NTD babies were 75.7 ± 5.6 μg/dl and 129.9 ± 5.3 μg/g respectively. The mean (± SD) serum and hair levels in normal newborn babies were 77.8 ± 5.3 μg/dl and 188.8 ± 6.2 μg/g respectively. The mean (± SD) serum and hair levels in NTD babies were 80.1 ± 12.9 μg/dl and 174.2 ± 10.7 μg/g respectively. The hair zinc levels of the affected babies and their mothers were significantly lower (P< 0.001) than the controls. This study has found association between NTD and decreased hair zinc levels and large population based studies are recommended to confirm the association between zinc and NTD and to investigate whether zinc supplementation would reduce the overall incidence of NTD.     

Erythrocyte protoporphyrin screening for lead poisoning in Bedouin children. A study from Kuwait

Screening for lead poisoning can be performed by measuring either blood lead (PbB) or a haematological indicator such as erythrocyte protoporphyrin (EP). We have screened 902 infants and children aged from 3 months to 5 years amongst those attending three primary health care centres in AI Jahra governorate of Kuwait. Blood specimens were collected by finger prick on Guthrie filter paper and the dried blood samples were mailed to the Central Laboratory of the Children's Hospital, Buffalo, USA. One hundred and eighty-four (20 per cent) had an elevated EP (greater than 50 micrograms/dl). Of those 11 had values above 159 micrograms/dl; 140 children were further tested for blood lead levels (PbB) haemoglobin, mean cell volumes, and percentage of transferrin saturation; 41 had blood lead levels greater than 25 micrograms/dl which is the current definition of elevated blood lead levels. Two children (2 per cent) were in Class IV, 17 (15 per cent) and 16 (14 per cent) were in Class II and Class III, respectively. There was a significant correlation between EP and PbB (r = 0.686; P = less than 0.001). Of 72 children with elevated EP and normal PbB, 32 were anaemic (Hb less than 11 g/dl) and 20 had iron deficiency. The role of tribal practices using lead contaminated preparations and their contribution to elevated blood lead levels is discussed.     

Study of serum zinc in neonates and their mothers in Shimla Hills (Himachal Pradesh)

Serum zinc level in cord blood of 159 neonates was estimated by atomic absorption spectrophotometer. The cases were classified according to birth weight and gestation of babies as Term appropriate for date (TAFD), Term small for date (TSFD), Term large for date (TLFD), Preterm appropriate for date (PAFD), Preterm small for date (PSFD) and Preterm large for date (PLFD). The zinc level were also estimated in mothers of these groups at the time of delivery, and compared with cord blood levels of those in non-pregnant mothers. Mean serum zinc level in infants born full term AFD, full term SFD, full term LFD, preterm AFD, preterm SFD and preterm LFD were 79.6±17.8 μg/dl, 58.2±13.4 μg/dl, 84.1±21.1 μg/dl, 81±25.2 μg/dl, 51.2±51.7 μg/dl and 76±14.7 μg/dl respectively. The maternal zinc levels in respective groups were 67±9.6 μg/dl, 56.5±7.5 μg/dl, 63.6±14.4 μg/dl, 62.7±21.1 μg/dl, 54.5±5.4 μg/dl, and 58.2±2.7 μg/dl. The mean serum zinc values in mothers and babies in birth weight group ranging from 1500–2000 gm were 55.3±4.3 μg/dl and 60±23.1 μg/dl, 2001–2500 gm were 59.5±11.3 and 65.8±17 μg/dl, 2501–3000 gm were 69.2±9.5 and 84.7±14 μg/dl, 3001–3500 gm were 65.8±12.7 μg/dl, 82.2±20.8 μg/dl and 3501 and above were 70.5±8.2 μg/dl and 85±14.3 μg/dl respectively. Statistically significant low zinc levels were observed in SFD babies and their mothers. The zinc levels in non-pregnant mothers were 82.2±11.6 μg/dl which were significantly higher from the levels obtained for pregnant mothers. Statistically significant low levels were observed in mothers as well as in babies of low birth weight group.     

Serum copper in newborns and their mothers

Serum copper levels in the cord blood of 100 newborns and the respective maternal serum copper at the time of delivery was estimated by atomic absorption spectrophotometer. The cases were classified into term AGA, term SGA, term LGA, preterm AGA and preterm SGA. The mean maternal serum copper level 152.42 ± 2.06 μg/Jdl) was significantly higher than the mean cord serum copper level (39.84 ±1.19 μg/dl). There was positive correlation between the maternal serum copper level and cord serum copper level. The mean serum copper level of term neonates was (44.42 ± 1.26 μgJdl) significantly higher (p < 0.001) than that of preterm neonates (30.30 ± 1.14 μg/dl). There was a positive correlation between cord serum cooper level and gestational age. The mean cord serum copper levels of term AGA, term SGA, preterm AGA and preterm SGA neonates was 45.42 ± 1.44 μg/dl, 39.22 ± 2.45 μg/dl, 31.00 ± 2.11 udJdl and 29.47 ± 2.08 μg/dl respectively. There was no statistically significant difference in the mean serum copper level, of AGA and SGA group of both term and preterm noenates. The difference amongst mean maternal serum copper level of various neonatal groups was not significant.     

Blood lead and erythrocyte zinc protoporphyrin in mothers and newborn infants

Blood lead (B-Pb) and erythrocyte zinc protoporphyrin (ZPP) were measured in 78 mothers at delivery and in cord blood from 48 infants living in an area with low atmospheric Pb pollution. Median B-Pb was 35 g/l (range 6–63) in mothers and 20 g/l (range 6–50) in infants (P<0.001), and the values were significantly correlated (r _s=0.73, P<0.0001). Mean B-Pb infant/B-Pb mother ratio was 0.7 (range 0.2–1.4). Mothers had lower ZPP (median 1.6 g/g Hb) than infants (median 2.9) (P<0.0001). ZPP in mothers showed a stronger relation to iron status (serum transferrin, serum ferritin) than to B-Pb (r _s=0.22, P<0.05). B-Pb was correlated to serum iron both in mothers (r _s=0.28, P<0.02) and infants (r _s=0.33, P<0.03). The present B-Pb levels are lower than previously reported in Scandinavia, probably due to the general decline in atmospheric Pb pollution.Abbreviations B-Pb blood lead - Hb haemoglobin - ZPP erythrocyte zinc protoporphyrin     

Zinc levels in women and newborns

Zinc is an important trace element having a definitive role in the metabolism, growth and development and reproduction. During pregnancy the requirements for zinc increase. This study was designed to evaluate the zinc status of normal women, normal pregnant women and their new-born babies. Forty normal adult females, 40 normal pregnant women and their newborn babies were randomly selected and their serum and hair zinc levels were analysed using atomic absorption spectrophotometer. The mean serum and hair zinc levels in normal women were 69.47 ±1.4 μg/dl and 147.45 ± 6.12 μg/g respectively. The mean serum and hair zinc levels in normal pregnant women were 69.0 ± 3.22 μg/dl and 142.83 ± 4.39 μg/g respectively while the mean serum (cord blood) and hair levels in normal new born babies were 72.77 ±5.14 μg/dl and 188.36 ±4.12 μg/g respectively. There was a significant (p < 0.001) decrease in hair zinc levels during pregnancy. There was a significant (p < 0.05) decrease in zinc levels in new born babies when the time interval between the previous delivery and the present delivery was less than 3.4 years. The results of the present study reinforce the need for zinc supplementation during pregnancy especially if the interval between pregnancies is short.     

Vitamin A deficiency and child feeding in Beijing and Guizhou, China

Background  Vitamin A deficiency (VAD) is one of the three major micronutrient deficiencies in the world. In order to investigate the status of VAD and child feeding in China, we conducted the survey in Beijing city and Guizhou province. Methods  We included a high socioeconomic area (Beijing) and a low socioeconomic area (Guizhou province) in China in our study. Participants included 1236 randomly selected children aged 0-71 months from stratified clusters (628 in Beijing and 608 in Guizhou), 409 from urban and 827 from rural areas. A food intake frequency questionnaire was used for dietary assessment. Fluorescence microanalysis was carried out to measure serum retinol concentrations. Serum retinol cut-off values of less than 20 μg/dl and 30 μg/dl were defined as sub-clinical VAD and suspected sub-clinical VAD, respectively. Results  No xerophthalmia or night blindness was found. The mean concentration of serum retinol was 31.5 μg/dl in the high socioeconomic group, and 26.5 μg/dl in the low socioeconomic group. Rural infants had lower concentrations of serum retinol compared with the urban ones (26.9±8.1 μg/dl vs 31.8±7.3 μg/dl). The prevalence of sub-clinical VAD among all the children was 7.8%, and increased to 15.7% in children from the low socioeconomic group. In infants from the high socioeconomic area, the prevalence of suspected subclinical VAD was 38.0%, increasing to 59.5% in infants from the low socioeconomic area. The children from the low socioeconomic area had significantly lower frequency of intake of meat than the children in other groups. The prevalence of suspected sub-clinical VAD was higher in the children with lower consumption frequency of vitamin A rich foods than the children with higher consumption frequency of vitamin A rich foods. Conclusions  VAD appears to be a moderate public health problem in certain areas of China. In areas with low socioeconomic status, VAD in childrean is more severe, and infants may be the group at the highest risk for VAD. Inadequate intake of vitamin A rich foods may result in VAD. A comprehensive long-term national strategy needs to be fostered in China for the treatment and prevention of the deficiency.     

Developmental changes in erythrocyte protoporphyrin: roles of iron deficiency and lead toxicity

Iron deficiency and lead toxicity both result in increased erythrocyte protoporphyrin. The purpose of this study was to determine the differences in EP concentration, according to age and sex, obtained in the 2nd National Health and Nutrition Examination Survey of the United States and to determine the extent to which EP differences might be related to iron deficiency or lead toxicity. The highest EP concentrations were found in infants and children. Among adults, women had higher EP values than men. Lead toxicity (blood lead greater than 30 micrograms/dl) and low serum iron concentration/total iron binding capacity (Fe/TIBC less than 16%), often in combination, were associated with elevated EP values in infants and children. In women, elevated EP concentration were related primarily to low Fe/TIBC values, whereas in men there was only a weak association with elevated blood lead concentration. Age/sex differences in EP values diminished markedly when the influences of lead toxicity and iron deficiency were excluded by the above criteria.     

The prevalence and etiology of anemia among HIV-infected children in India

In this report, the prevalence and multifactorial etiology of anemia among Indian human immunodeficiency virus (HIV)-infected children are described. HIV-infected children aged 2–12 years were prospectively enrolled in 2007–2008. Measured parameters included serum ferritin, vitamin B₁₂, red-cell folate, soluble transferrin receptor, and C-reactive protein. Children received antiretroviral therapy (ART), iron and, folate supplements as per standard of care. Among 80 enrolled HIV-infected children (mean age 6.8 years), the prevalence of anemia was 52.5%. Etiology of anemia was found to be iron deficiency alone in 38.1%, anemia of inflammation alone in 38.1%, combined iron deficiency and anemia of inflammation alone in 7.1%, vitamin B₁₂ deficiency in 7.1%, and others in 9.5%. Median iron intake was 5.7 mg/day (recommended dietary allowance 18–26 mg/day). Compared to nonanemic children, anemic children were more likely to be underweight (weight Z-score −2.5 vs. -1.9), stunted (height Z-score −2.6 vs. -1.9), with lower CD4 counts (18% vs. 24%, p < 0.01), and higher log viral load (11.1 vs. 7.1, p < 0.01). Hemoglobin (Hb) improved significantly among those who started ART (baseline Hb 11.6 g/dl, 6-month Hb 12.2 g/dl, p = 0.03). Children taking ART combined with iron supplements experienced a larger increase in Hb compared to those receiving neither ART nor iron supplements (mean Hb change 1.5 g/dl, p < 0.01). Conclusion Anemia, particularly iron deficiency anemia and anemia of inflammation, is highly prevalent among children with HIV infection. Micronutrient supplements combined with ART improved anemia in HIV-infected children.     

THE DIAGNOSIS OF IRON DEFICIENCY BY ERYTHROCYTE PROTOPORPHYRIN AND SERUM FERRITIN ANALYSES

ABSTRACT. Free erythrocyte protoporphyrin (FEP) and serum ferritin have been determined in 57 healthy children and in 25 children with varying degrees of iron deficiency. FEP was found to be inversely correlated to the concentration of hemoglobin (r=-0.80) as well as to serum ferritin (r=-0.64). Elevated FEP was found in children with hemoglobin less than 12.5 g/dl, or serum ferritin less than 8 μg/l. In a group of apparently hematologically normal children between the age of 10–14 years (hemoglobin≥ 12.5 g/dl), a 2-month-trial of iron medication resulted in an increase in hemoglobin and ferritin, and a decrease in FEP, indicating suboptimal supply of iron for hemoglobin synthesis before iron medication. In a patient with iron deficiency (FEP 15.3 μmole/l, hemoglobin 5.2 g/dl), iron therapy was followed by a rapid fall in FEP before any changes in hemoglobin, serum iron transferrin saturation and ferritin could be detected. The rapid fall in FEP during start of treatment in iron deficiency makes FEP a sensitive biochemical parameter on iron homeostasis in iron deficiency anemia.     

Vitamin A status of socio-economically backward children

A comprehensive survey was carried out to asses the Vitamin A status of pre-school (0–6 yrs.) and school age (6–12 yrs.) children of socio-economically backward families from slums of Bombay and its suburbs. The Vitamin A, protein, calories and iron from the rice and dal based diet was found to be below recommended dietary allowances (RDA). Among the 1956 children surveyed 20% of the children showed low (<20 μg/dl) serum vitamin A levels. 4.8% of the children were suffering from one or the other signs of Vitamin A deficiency. Rose Bengal stain test (RBST) and conjuctival impression cytology (CIC) indicted the signs of mild conjuctival xerosis and of early epithelial changes which were correlated with serum vitamin A levels. Serum iron, PCV, Hb and RBC levels were below normal. The anthropometric measurements of these children were below 50th percentile of Indian Council of Medical Research (ICMR) standards. Due to lack of proper nutrition, the overall growth of children is either retarded or not upto the standard levels as was noted in majority of the children.     

Low plasma zinc and iron in pica

Objective : To determine role of trace elements in causation of pica with specific reference to zinc and iron we studied plasma levels of iron (Fe), Zinc (Zn), calcium (Ca) and magnesium (Mg) and blood lead (Pb) levels by atomic absorption spectrophotometer in 31 children with pica (Pica Group) and 60 controls matched for age, sex and nutrition (Control Group) in an observational case and control study in the settings of outpatient clinic of a tertiary care, teaching hospital.Methods : Data from each group were further stratified by hemoglobin level &lt;9 and >9 g/dl into two subgroups pica-1 and pica-2, and control-1 and control-2 respectively, to control for confounding effect of iron deficiency anemia.Results : The plasma Fe level (mean ±SD) in children with pica (42.7 ±9.2) mg/dl) was about 20% lower than that in controls (51.5 ±10.0 mg/dl, p&lt;0.001). Plasma Zn levels in the pica group (60 ±4.4 mg/dl) was about 45% lower than those in controls (110.2±8.5 mg/dl, p&lt;0.001). Correlation of Zn and Fe levels with pica-related variables such as age at onset, duration and frequency and number of inedible objects ingested was not significant.Conclusion : These findings suggest that hypozincemia with low iron levels may be the possible cause of pica and contradict the contention that low levels of plasma Zn and Fe could be an effect of pica.     

An unknow risk group of lead poisoning: The gypsy children

The differences in average blood lead levels (PbB) between iron-deficient children of both gypsy and Caucasian origin were determined. PbB were assayed in 89 irondeficient children (Group ID): 25 gypsies and 64 Caucasians. Two sub-groups were established: sub-group ID1, 57 iron-deficent children without anaemia (11 gypsies, 46 Caucasians), and sub-group ID2, 32 children with iron deficiency anaemia (14 gypsies; 18 Caucasians). Group IS composed of 41 iron-sufficient children (11 gypsies and 30 Caucasians) served as controls. Blood counts, red-cell indices, serum iron concentrations, serum ferritin, and PbB were determined for the intire study population. The average PbB for gypsy and Caucasian iron-deficient children, were 14.25 and 7.25 g/dl (P<0.001) respectively. The prevalerence of iron-deficient children with toxic PbB (>20g/dl) was higher in gypsies (24%) than in Caucasians (1.5%) (P<0.001). A difference in average PbB between the two ethnic groups was also seen in children with normal iron metabolism (average PbB, 10.23 vs 5.65 g/dl for gypsies and Caucasians, respectively,P<0.001).Conclusion Gypsy children should be considered as a population group at risk of lead poisoning in our environment.     

Zinc therapy in Indian childhood cirrhosis

Fifty five histopathologically proved cases of Indian childhood cirrhosis (ICC) were studied for the effect of oral zinc oxide/zinc sulphate therapy both in doses of 120 mg/day. Twenty six patients were given zinc oxide, 19 were given zinc sulphate and 10 cases served as control. Serum zinc was estimated by atomic absorption spectrophotometer (ASS). Serum zinc was low in all the stages of ICC and was directly related to the severity of the disease. Serum zinc was 72±11μg/dl in stage I; 65±14μg/dl in stage II; 57±18 μg/dl in stage III compared with 123±23μg/dl in normal children. Inspite of oral zinc therapy clinical condition and liver histopathology advanced in all patients and they expired due to hepatic coma. It is concluded that hypozincemia in ICC is a nonspecific finding and zinc therapy has no role in its management. This study was carried out by research grant from Medical Research Center, Bombay Hospital Trust, Bombay—20.     

Physical growth in children with reflux nephropathy with normal or mildly impaired renal function

Ten children aged 11 months to 10 years (means 5.7 years) with reflux nephropathy, vesicoureteric reflux (VUR) and normal or mildly impaired renal function having GFR more than 50 ml/min/1.72 m², were included in the study. The hematological and biochemical parameters were within normal limits. Height standard deviation score (HZ score) was reduced at entry and, decreased further during follow-up (−2.2 and −2.6 at 0 and 12 months, respectively). Weight for height index (WHI) improved significantly (p=0.0004) during follow-up. The basal and stimulated peak growth hormone levels of these patients were found to be elevated, 18.53 ± 11.36 μg/L and 34.20 ± 5.86 μg/L, respectively. The IGF-1 levels were low ranging from 45.00 to 84.40 ng/dl (mean ± SD 61.54 ± 10.21 ng/dl) compared to 51.80 to 247.50 ng/dl (mean ± SD111.20 ± 70.24 ng/dl) in age and sex matched controls, indicating partial insensitivity to growth hormone.