Use of combined measures from capillary blood to assess iron deficiency in rural Kenyan children

Community-based surveys of iron deficiency (ID) require simple, accurate methods that can be used in remote areas. The objective of this study was to assess iron status in rural Kenya using "field-friendly" methods for capillary blood, including an improved dried blood spot assay for transferrin receptor (TfR). A single finger stick was used to obtain capillary blood from 275 school-age children. Whole blood was applied directly to filter paper, dried, and later analyzed for TfR, as well as C-reactive protein (CRP), an acute-phase protein that serves as a general marker of inflammation. Capillary blood was also used to measure hemoglobin (Hb) concentration and the ratio of zinc protoporphyrin to heme (ZPP:H). The Hb concentration alone provides the lowest estimate of the prevalence of ID (8.0%). Because ZPP:H is reported to be elevated in the presence of inflammation, we constructed a preliminary diagnostic model based on elevated ZPP:H and normal CRP level, estimating the prevalence of ID at 25.9%. When TfR is added to a multiple criteria model (elevated ZPP:H in the absence of elevated CRP and/or elevated TfR level) the prevalence of ID is estimated to be 31.2%. This study demonstrates the diagnostic utility of combining TfR with other indexes of iron status, enabling the detection of ID in both the presence and absence of infection. Furthermore, this study is the first field application of TfR blood-spot methods, and it demonstrates their feasibility in remote field settings.     

Relationship of vitamin A deficiency, iron deficiency, and inflammation to anemia among preschool children in the Republic of the Marshall Islands

INTRODUCTION: Although vitamin A deficiency, iron deficiency, and inflammation may contribute to anemia, their relative contribution to anemia has not been well characterized in preschool children in developing countries. OBJECTIVE: To characterize the contributions of vitamin A and iron deficiencies and inflammation to anemia among preschool children in the Republic of the Marshall Islands. SUBJECTS AND METHODS: A community-based survey, the Republic of the Marshall Islands Vitamin A Deficiency Study, was conducted among 919 preschool children. The relationship of vitamin A and iron status and markers of inflammation, tumor necrosis factor-alpha, alpha1-acid glycoprotein, and interleukin-10, to anemia were studied in a subsample of 367 children. RESULTS: Among the 367 children, the prevalence of anemia was 42.5%. The prevalence of severe vitamin A deficiency (serum vitamin A < 0.35 micromol/l) and iron deficiency (serum ferritin < 12 microg/dl) were 10.9 and 51.7%, respectively. The respective prevalence of iron deficiency anemia (hemoglobin < 110 g/l and iron deficiency), anemia with inflammation (anemia with TNF-alpha > 2 pg/ml and/or AGP > 1000 mg/l), and severe vitamin A deficiency combined with anemia was 26.7, 35.6, and 7.6%. In multivariate linear regression models that adjusted for age, sex, and inflammation, both iron deficiency (odds ratio (OR) 1.74, 95% confidence interval (CI) 1.08-2.83, P = 0.023) and severe vitamin A deficiency (OR 4.85, 95% CI 2.14-10.9, P < 0.0001) were significantly associated with anemia. CONCLUSIONS: Both iron and vitamin A deficiencies were independent risk factors for anemia, but inflammation was not a significant risk factor for anemia among these preschool children.     

幽门螺杆菌感染与儿童铁缺乏的相关性研究

【目的】　探讨无症状幽门螺杆菌感染与儿童铁缺乏的关系。　【方法】　对475名2~7岁儿童进行膳食调查、外周血血细胞分析、血清铁蛋白及幽门螺杆菌(H.pylori,Hp)抗体检测。对Hp血清学阳性的个体进行粪抗原检测,进行Hp感染与血红蛋白(hemo globin,Hb)、红细胞平均容积(mean corpuscular volume,MCV)、红细胞平均血红蛋白量(mean corpuscular hemoglobin,MCH)、红细胞平均血红蛋白浓度(mean corpuscular hemoglobin concen tration,MCHC)、红细胞分布宽度(red blood cell distri bution width index,RDW)、血清铁蛋白、发铁、膳食中铁摄入量等反映铁营养指标的单因素分析,初步了解Hp感染与儿童铁水平之间的关系。　【结果】　Hp感染儿童64 例,非感染儿童305例。Hp感染可影响儿童的Hb、MCV、MCH、MCHC 、RDW水平。Hp感染组的血清铁蛋白水平明显低于非感染组;Hp感染组的发铁缺乏率则高于阴性组(P<0.05);Hp感染组与阴性对照组的铁摄入量并无不同。　【结论】　Hp感染儿童机体铁水平降低,无症状Hp感染是造成或加重儿童机体铁营养不良的因素。     

Self-regulation of food intake among rural Mexican preschool children

Access to food and the amount consumed were investigated within a group of 45 children aged 33 to 60 months, among whom growth stunting was common. Children were observed throughout 1 day; all foods offered and consumed were weighed, and food-related behaviors noted. Children ate frequently, at least 2 meals and an average of 7.4 +/- 2.6 snacks daily. Children had access to 2029 +/- 575 kcal (8493 +/- 2407 kJ) yet only consumed 1528 +/- 343 kcal (6396 +/- 1436 kJ) daily; thus food availability was not restricting intake. A higher proportion of snacks than meals (85 per cent vs. 71 per cent) was consumed. Children requested foods frequently (x = 9.2 +/- 4.3) and 76 per cent of requests were fulfilled. Neither amount of accessible food nor amount consumed differed by age, gender, or socioeconomic status. The importance of the child's role in determining food intake, and of snacking to overall food consumption, was demonstrated.     

Vitamin A deficiency,iron deficiency,and anemia among preschool children in the Republic of the Marshall Islands

OBJECTIVE: We investigated the co-occurrence of vitamin A deficiency, iron deficiency, and anemia among young children in the Republic of the Marshall Islands. METHODS: Hemoglobin, serum retinol, and serum ferritin were assessed in the Republic of the Marshall Islands Vitamin A Deficiency Study, a community-based survey that involved 919 children ages 1 to 5 y. RESULTS: The proportion of children with vitamin A deficiency (serum retinol concentrations < 0.70 microM/L) was 59.9%. The prevalences of anemia (hemoglobin < 110 g/L), iron deficiency (serum ferritin < 12 microg/L), and iron deficiency anemia (iron deficiency and anemia) were 36.4%, 53.5%, and 23.8%, respectively. The proportion of children who had co-occurrence of vitamin A and iron deficiencies was 33.2%. The mean ages of children with and without vitamin A deficiency were 3.2 +/- 1.4 and 2.9 +/- 1.5 y, respectively (P = 0.01), and the mean ages of those with and without iron deficiency were 2.7 +/- 1.3 and 3.5 +/- 1.4 y, respectively (P < 0.0001).CONCLUSIONS: Children in the Republic of the Marshall Islands, ages 1 to 5 y, are at high risk of anemia, vitamin A deficiency, and iron deficiency, and one-third of these children had the co-occurrence of vitamin A and iron deficiencies. Further investigation is needed to identify risk factors and evaluate interventions to address vitamin A and iron deficiencies among children.     

学龄前儿童膳食营养与缺铁性贫血的关系研究

[目的]探讨学龄前儿童膳食营养与缺铁性贫血(IDA)的关系。[方法]采用配对t检验分析儿童膳食营养与IDA_的关系；采用因子分析和Logistic回归模型分析膳食中营养素与IDA的关系。[结果]贫血儿童与非贫血儿童(动物类 蔬菜 水果类食物)／(谷类 豆类食物)的比值、(蔬菜 水果类)／(谷类 豆类食物)的比值的差别有统计学意义(分别为Z=2．17，P=0．03和Z=2．04，P=0．04)。贫血组儿童两种比值的中位数为1．4l和0．84，P2.5～P97．5为0．43～7．99和0．07～6．03；非贫血组儿童两种比值的中位数为1．57和1．00，P25～P97．5为0．42～10．71B和0．18～6．32，贫血组比值较非贫血组低；贫血组儿童两种比值的Qu-QL为1．34和0．96，而非贫血组儿重为1．21和0．95；贫血组儿童两种比值的QU-QL较非贫血组儿童高，离散度较大。膳食中VitA、VitB2、VitC的摄人越多，患贫血的危险性越低。[结论]学龄前儿重多食动物类食物及蔬菜、水果类食物，且它们与谷类和豆制品类食物必须达到一定的比例。膳食中VitA、VitB2、VitC的摄人越多，患贫血的危险性越低。     

安徽农村学龄前儿童缺铁性贫血及膳食营养相关因素分析

目的 运用学龄前儿童膳食平衡指数(DBI_C)评价安徽省部分学龄前儿童的膳食质量,为科学指导该人群合理膳食和防治IDA提供实证依据.方法 2018年9-12月,选择安徽省有完整膳食调查资料的3～6岁留守儿童306名和非留守儿童598名作为研究对象,利用DBI_C的总分(TS)、负端分(LBS)、正端分(HBS)和膳食质...     

Micronutrient deficiencies and anemia among preschool children in rural Vietnam

The prevalence of trace elements deficiencies, vitamin A deficiency, anemia, and their relationships were investigated in a cross sectional study involving 243 children aged from 12 to 72 months in rural Vietnam. Serum levels of copper, zinc, selenium and magnesium were determined by inductively coupled plasma mass spectrometer and that of retinol by high performance liquid chromatography. Hemoglobin concentration in whole blood was measured by the cyanmethemoglobin method. The prevalence of deficiencies in zinc, selenium, magnesium, and copper was 86.9%, 62.3%, 51.9%, and 1.7%, respectively. On the other hand, 55.6% were anemic and 11.3% had vitamin A deficiency. Deficiency in two or more micronutrient was found in 79.4% of the children. Parameters associated significantly with anemia were selenium deficiency (OR 2.80 95% CI 1.63-4.80, p=0.0002) and serum retinol<1.05 micromol/L (OR 1.83, 95% CI 1.10-3.05, p=0.021). Magnesium deficiency (OR 3.09 95% CI 1.36-7.03) was found to be a risk factor for zinc deficiency and vice versa. The results indicate that micronutrient deficiencies are prevalent among preschool children in Vietnam. In addition, the results also demonstrate a strong relationship between selenium deficiency and anemia. Clearly, sustainable strategies are urgently required to overcome the problems in the country.     

应用FEP/Hb评估学龄前儿童中的隐性缺铁

[目的 ]　了解城区学龄前儿童中隐性缺铁的发生情况。 [方法 ]　每年 3月和 9月调查上海市城区 2个监测点 2～ 6岁儿童的Hb和FEP ,用FEP/Hb动态观察儿童铁营养状况。 [结果 ]　集体托幼儿童隐性缺铁检出率为 2 2 .9%～2 8.3 % ,各年龄组的检出率在膳食营养状况良好的情况下 ,差异无显著性 (P >0 .0 5 )。新入托 2岁儿童隐性缺铁率最高(46 .5 % ) ,但入托后半年降为 16 .8% (P <0 .0 1) ,而 4岁儿童隐性缺铁率最低 (11.7% ) ,入园后半年升高到 36 .4% ,入园后1年半降为 9.8%。 [结论 ]　铁缺乏的食疗防治虽已收到成效 ,但常规监测工作仍需不断改进。     

学龄前儿童血清铁水平及影响因素分析

目的 调查深圳市学龄前儿童血清铁营养素状况及其影响因素，为制定保护儿童健康措施提供科学依据。方法 采用分阶段整群随机抽样方法，抽取深圳市3所托幼机构的300名学龄前儿童作为调查对象，进行问卷调查和血清铁检测。用SPSS10．0统计分析软件进行描述性分析和单因素、多因素非条件Logistic逐步回归分析。结果 (1)深圳市学龄前儿童血清铁的平均水平中位数为12．60μmol／L，最小值为4．20μmol／L，最大值为49．00μmol／l。。男女性别间有显著性差异(t=2．369，P=0．018)，男性高于女性；不同年龄间差异无显著性意义(F=1．090。P=0．353)。(2)血清铁含量低于正常水平的占37．54％，男女性别间无显著性差异(χ2=0．4586，P=0．498)。(3)影响血清铁营养状况有6个主要因素，其中添加铁剂、添加鱼肝油、母乳喂养方式和母亲文化程度高是保护因素；近半年曾患贫血和近2月曾患呼吸道疾病是危险因素。结论 深圳市学龄前儿童中存在不同程度的血清铁缺乏状况，血清铁缺乏与多种因素有关。     

山东省农村学龄前儿童饮食行为问题的干预研究

目的通过对农村学龄前儿童饮食行为进行干预,改善农村学龄前儿童的饮食行为。方法采用多阶段分层抽样方法选取研究对象。按照人均GDP水平将聊城市辖下的所有乡镇分为发达、中等及欠发达三类,每类抽取2个大体类似的乡镇,将6个乡镇随机分为干预组和对照组。最后在抽取的每个乡镇样本中随机抽取50户3~6岁的学龄前儿童的家庭。针对干预组的家长采取为期一年的干预,对照组不采取任何措施。结果经过一年的干预,干预组经常吃零食(31.1%vs 59.4%)、吃饭看电视(51.7%vs 66.5%)的儿童检出率低于对照组(P均0.05);定期了解儿童膳食情况(53.6%vs 34.7%)、支持开展营养教育的家长的比例(100.0%vs 97.1%)高于对照组(P均0.05)。干预组中经常吃零食的儿童由基线的73人(48.3%)下降到47人(31.1%)(P0.05);经常不吃早餐的儿童由基线的28人(18.5%)下降到12人(8.0%)(P0.05);边吃边玩的儿童由基线的101人(66.9%)下降到78人(51.7%)(P0.05);厌食的儿童由基线的66人(43.7%)下降到25人(16.6%)(P0.05);给儿童服用保健品的家长由干预前43人(28.5%)下降到28人(18.5%)(P0.05)。结论此次通过对农村学龄前儿童的家长进行干预从而改善儿童饮食行为的干预措施取得一定的成效,农村学龄前儿童的饮食行为得到改善。     

营养干预对儿童缺铁性贫血的干预效果评价

目的探讨营养干预对儿童缺铁性贫血（IDA）的干预效果。方法选取2012年1—12月在南京医科大学附属淮安第一医院门诊确诊的3~6岁的IDA患儿160例,根据＂不平衡指数最小的原则＂随机分为对照组和观察组,每组80例,对照组采取常规药物治疗,观察组采取常规药物治疗加营养干预,干预10个月后评价营养干预对儿童缺铁性贫血的干预效果。结果干预前,观察组患儿家属IDA病因（73.8%）、临床表现（66.3%）等相关知识知晓率与对照组相比差异无统计学意义;观察组患儿轻度贫血（77.5%）、中度贫血（22.5%）与对照组相比差异无统计学意义（P〉0.05）;观察组患儿经常吃铁强化制品（63.8%）、经常吃肉蛋鱼类等动物制品（76.3%）等饮食行为应答率与对照组相比差异无统计学意义（P〉0.05）。干预后观察组患儿家属对IDA病因（96.3%）、临床表现（97.5%）、危害（96.3%）、治疗（97.5%）、预防（93.8%）、定期复查的重要性（97.5%）相关知识知晓率均高于自身干预前及干预后对照组（P〈0.01）。观察组患儿轻度贫血（7.5%）、中度贫血（1.3%）的患病率均低于自身干预前及对照组（P〈0.01）。观察组患儿经常吃铁强化制品（91.3%）、经常吃肉蛋鱼类等动物制品（93.8%）、经常吃新鲜蔬菜（92.5%）、经常吃新鲜水果（96.3%）、经常吃豆类及豆制品（91.3%）和经常吃奶类及奶制品（97.5%）饮食行为应答率均高于自身干预前及对照组（P〈0.01）。结论营养干预能改善儿童缺铁性贫血。     

Vitamin A deficiency among preschool children in a rural area of Egypt: the results of dietary assessment and biochemical assay

Vitamin A status was evaluated among a cohort of preschool children (mean age 43 months) pertinent to a traditional society in rural Egypt. The Helen Keller International food frequency questionnaire, the 7-day 24-h dietary recall method and serum vitamin A concentrations were the criteria used for the evaluation. Mean values of 280 and 382 retinol equivalents (RE) were the daily estimates of vitamin A intakes among male and female children, respectively. Animal foods made up 39 and 54% of the total vitamin A intake among male and female children, respectively. The afore-mentioned estimates of total vitamin A intakes were 58 and 81%, respectively, of the FAO/WHO requirements (35 RE/kg). Children from high socio-economic class had significantly higher (P < 0.05) mean vitamin A intake compared with the respective mean intake obtained with poor children. Serum vitamin A concentrations correlated significantly with the respective vitamin A intakes. A 10-week vitamin A intervention trial using either pharmaceutical vitamin A preparations or a food-based strategy consisting of carrot jam led to significant improvement in the growth velocity of the beneficiaries compared with the control group.     

Vitamin A deficiency among preschool children in a rural area of Egypt: the results of dietary assessment and biochemical assay

Vitamin A status was evaluated among a cohort of preschool children (mean age 43 months) pertinent to a traditional society in rural Egypt. The Helen Keller International food frequency questionnaire, the 7-day 24-h dietary recall method and serum vitamin A concentrations were the criteria used for the evaluation. Mean values of 280 and 382 retinol equivalents (RE) were the daily estimates of vitamin A intakes among male and female children, respectively. Animal foods made up 39 and 54% of the total vitamin A intake among male and female children, respectively. The aforementioned estimates of total vitamin A intakes were 58 and 81%, respectively, of the FAO/WHO requirements (35 RE/kg). Children from high socio-economic class had significantly higher (P < 0.05) mean vitamin A intake compared with the respective mean intake obtained with poor children. Serum vitamin A concentrations correlated significantly with the respective vitamin A intakes. A 10-week vitamin A intervention trial using either pharmaceutical vitamin A preparations or a food-based strategy consisting of carrot jam led to significant improvement in the growth velocity of the beneficiaries compared with the control group.     

Studies in iron supplementation of preschool children

1. The effect of daily supplements of 20-30 mg inorganic iron as ferrous sulphate on the growth, activity and haematological status of preschool children was studied for 3.5, 7 and 12 months and compared to that of children who served as controls. All children were given their daily requirements of energy and protein. In addition, they received 5 microgram cyanocobalamin and 200 microgram folic acid. 2. Fe supplementation increased the haemoglobin, serum Fe and percentage saturation of transferrin and reduced the unsaturated Fe-binding capacity significantly compared to corresponding values for the controls. 3. Height and activity were unaffected by Fe supplements. 4. Of the children 45% had haemoglobin values below 110 g/l at the end of 7-12 months of Fe supplementation.