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.     

Carotenoid status among preschool children with vitamin A deficiency in the Republic of the Marshall Islands

Although carotenoids are known to be important dietary sources of vitamin A, there have been few epidemiological studies that have characterized the serum concentrations of major dietary carotenoids among preschool children with vitamin A deficiency. We conducted a population-based, cross-sectional study of serum pro-vitamin A carotenoids (alpha -carotene, beta-carotene, beta-cryptoxanthin), non-provitamin A carotenoids (lutein/zeaxanthin, and lycopene), and retinol among 278 children, aged 1-5 y, in the Republic of the Marshall Islands. Vitamin A deficiency was defined as serum retinol <0.70 micromol/L. Geometric mean serum concentrations of carotenoids among children with and without vitamin A deficiency were 0.003 vs 0.006 micromol/L for alpha-carotene (P = 0.0017), 0.011 vs 0.023 micromol/L for beta-carotene (P <0.0001), 0.023 vs 0.034 micromol/L for beta-cryptoxanthin (P = 0.0075), 0.007 vs 0.012 micromol/L for lycopene (P = 0.037), 0.044 vs 0.052 micromol/L for lutein/zeaxanthin (P = 0.2), and 0.045 vs 0.074 micromol/L for total provitamin A carotenoids (P <0.0001) respectively. In a multivariate analysis adjusting for sex, age (Odds Ratio [O.R.] 1.44, 95% confidence interval [C.I.] 1.16-1.78), and serum provitamin A carotenoids (O.R. 0.49, 95% C.I. 0.34-0.71) were associated with vitamin A deficiency, but serum non-provitamin A carotenoids were not associated with vitamin A deficiency (O.R. 0.93, 95% C.I. 0.67-1.28). Preschool children with vitamin A deficiency in the Republic of the Marshall Islands have extremely low serum concentrations of provitamin A carotenoids and interventions are needed to improve the dietary intake of provitamin A carotenoids among Marshallese 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。     

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。     

学龄前儿童贫血患病现状分析

目的了解南宁市江南区儿童平均血红蛋白含量及贫血患病率,为制定干预措施提供依据。方法对2011年3～5月江南区32所幼儿园的6121名儿童进行体格检查和实验室检测。结果 6121名儿童平均血红蛋白含量为(120±10.50)g/L,贫血患病率为4.47%。结论南宁市江南区儿童贫血率低于全国平均水平,不同年龄组血红蛋白含量和贫血率存在显著差异,绝大多数贫血儿童是小细胞低色素性贫血。应采取有效措施,控制贫血、营养不良和肥胖率,保障儿童健康。     

Vitamin A deficiency and anemia among children 12-71 months old in Honduras.

Vitamin A deficiency (VAD) and iron deficiency anemia (IDA) have been recognized as public health problems in Honduras for over 30 years. This paper, based on the 1996 National Micronutrient Survey on 1678 children 12-71 months of age, presents the results for vitamin A status and anemia prevalence, as well as the level of vitamin A in sugar at the household level. The results showed that 14% of the children were subclinically vitamin A deficient (plasma retinol < 20 micrograms/dL) and 32% were at risk of VAD (plasma retinol 20-30 micrograms/dL). These data indicate that VAD is a moderate public health problem in Honduras. Logistic regression analysis showed that children 12-23 months old living in areas other than the rural south of the country were at greatest risk of subclinical VAD. Infection, indicated by an elevated alpha-1-acid-glycoprotein level, increased the risk of subclinical VAD more than three-fold. Children from households that obtained water from a river, stream, or lake were at twice the risk of subclinical VAD compared with other children. That same doubled risk was found for children from a household with an outside toilet. VAD can be controlled by fortifying sugar. Retinol levels in sugar at the household level were about 50% of those mandated by Honduran law. There appears to be significant leakage of unfortified sugar into the market. This is particularly true in the rural north, where 33% of samples contained no retinol. Overall, 30% of children were anemic (Hb < 11 g/dL). Logistic regression analysis showed that children whose fathers lived with them but who had not attended at least grade 4 of primary school were at 33% greater risk of being anemic. Infection and being underweight increased the risk of being anemic by 51% and 21%, respectively. Many of the anemic children had not been given iron supplements, suggesting health care providers may not be aware that anemia is widespread among young children and/or know how to diagnose it.     

Measles outbreak in the Republic of the Marshall Islands, 2003

BACKGROUND: Measles is a highly contagious viral infection. Measles transmission can be prevented through high population immunity (>or=95%) achieved by measles vaccination. In the Republic of the Marshall Islands (RMI), no measles cases were reported during 1989-2002; however, a large measles outbreak occurred in 2003. Reported 1-dose measles vaccine coverage among children aged 12-23 months varied widely (52-94%) between 1990 and 2000. METHODS: RMI is a Pacific island nation (1999 population: 50,840). A measles case was defined as fever, rash, and cough, or coryza, or conjunctivitis, in an RMI resident between July 13 and November 7, 2003. A vaccination campaign was used for outbreak control. RESULTS: Of the 826 reported measles cases, 766 (92%) occurred in the capital (Majuro). There were 186 (23%) cases in infants aged <1 year and 309 (37%) of cases in persons aged >or=15 years. The attack rate was highest among infants (Majuro atoll: 213 cases/1,000 infants). Among cases aged 1-14 years, 281 (59%) reported no measles vaccination before July 2003. There were 100 hospitalizations and 3 deaths. The measles H1 genotype was identified. The vaccination campaign resulted in 93% coverage among persons aged 6 months to 40 years. Interpretation Populations without endemic measles transmission can accumulate substantial susceptibility and be at risk for large outbreaks when measles virus is imported. 'Islands' of measles susceptibility may develop in infants, adults, and any groups with low vaccine coverage. To prevent outbreaks, high population immunity must be sustained by maintaining and documenting high vaccine coverage.     

婴幼儿及学龄前儿童热性惊厥与缺铁性贫血关联的Meta分析

目的通过对已发表的文章进行荟萃分析以明确婴幼儿及学龄前儿童发生热性惊厥与缺铁性贫血的关系。 方法利用PubMed、Web of science、MEDLINE、万方数据知识服务平台、中国知网数据库(CNKI)、维普等数据库数据库(VIP)和Cochrane图书馆数据库等中英文电子数据库，收集1990年1月至2017年9月前已发表的关于3个月至6岁婴幼儿及学龄前儿童发生热性惊厥与缺铁性贫血相关性的文章。按纳入与排除标准由2名研究者阅读全文后进行文献筛选和资料提取，采用纽卡斯尔-渥太华量表(the Newcastle-Ottawa Scale，NOS)进行文献质量评估。Stata SE 12.0软件对缺铁性贫血是否为热性惊厥患儿风险因素进行Meta分析，计算比值比(OR)，并依据缺铁性贫血诊断标准的不同进行亚组分析。 结果本研究共检出相关文献89篇，排除重复和不相关的搜索记录11篇、只有摘要的文章18篇，以及对全文进行排查：综述2篇、缺少数据9篇以及数据雷同2篇剔除，最终纳入符合纳入与排除标准的26篇文献进行Meta分析。分析结果表明：热性惊厥与缺铁性贫血具有相关性[OR＝2.24，95%CI(1.758，2.854)，P<0.05]。 结论缺铁性贫血是婴幼儿及学龄前儿童发生热性惊厥的风险因素之一。     

Vitamin A deficiency among children in Brazil and worldwide

Based on a ten-year literature review, this paper describes important aspects of Vitamin A Deficiency (VAD) among children in Brazil and worldwide. It presents VAD within a clinical and sub-clinical deficiency context, emphasizing this as a public health issue. VAD has been diagnosed in children from several parts of Brazil, especially in the Southeast and Northeast. Worldwide, the highest VAD prevalence is found in parts of parts of Africa: Mali, Ethiopia and Nigeria, and clinical indications noted especially in parts of Asia and Africa. However, no studies of clinical indications were located. Studies point to VAD as a public health issue among children, particularly in the poorest parts of the world.     

Correcting for inflammation changes estimates of iron deficiency among rural Kenyan preschool children

The assessment of iron status where infections are common is complicated by the effects of inflammation on iron indicators and in this study we compared approaches that adjust for this influence. Blood was collected in 680 children (aged 6-35 mo) and indicators of iron status [(hemoglobin (Hb), zinc protoporphyrin (ZP), ferritin, transferrin receptor (TfR), and TfR/ferritin index)] and subclinical inflammation [(the acute phase proteins (APP) C-reactive protein (CRP), and α-1-acid glycoprotein (AGP)] were determined. Malaria parasitemia was assessed. Subclinical inflammation was defined as CRP >5 mg/L and/or AGP >1 g/L). Four groups were defined based on APP levels: reference (normal CRP and AGP), incubation (raised CRP and normal AGP), early convalescence (raised CRP and AGP), and late convalescence (normal CRP and raised AGP). Correction factors (CF) were estimated as the ratios of geometric means of iron indicators to the reference group of those for each inflammation group. Corrected values of iron indicators within inflammation groups were obtained by multiplying values by their respective group CF. CRP correlated with AGP (r = 0.65; P < 0.001), ferritin (r = 0.38; P < 0.001), Hb (r = -0.27; P < 0.001), and ZP (r = 0.16; P < 0.001); AGP was correlated with ferritin (r = 0.39; P < 0.001), Hb (r = -0.29; P < 0.001), and ZP (r = 0.24; P < 0.001). Use of CF to adjust for inflammation increased the prevalence of ID based on ferritin < 12 μg/L by 34% (from 27 to 41%). Applying the CF strengthened the expected relationship between Hb and ferritin (r = 0.10; P = 0.013 vs. r = 0.20; P < 0.001, before and after adjustment, respectively). Although the use of CF to adjust for inflammation appears indicated, further work is needed to confirm that this approach improves the accuracy of assessment of ID.     

血清铁、铁蛋白、转铁蛋白联合检测在儿童营养性缺铁性贫血筛查中的价值

目的探讨血清铁(SI)、铁蛋白(SF)、转铁蛋白(TRF)联合检测在儿童营养性缺铁性贫血筛查中的应用价值,为临床诊治提供参考。方法选取2016年3月-2017年6月在绵阳市中心医院接受诊治的80例营养性缺铁性贫血患儿作为研究组(A组),另选取同期在该院接受诊治的74例非营养性缺铁性贫血患儿作为非缺铁性贫血组(B组),选取同期在该院接受健康体检的70例正常儿童作为对照组(C组),3组儿童均接受SI、SF、TRF检测,对比单独检测与联合检测的敏感性、特异性及准确度。结果A组患儿的血清SI、SF水平均低于B组、C组,B组患儿的血清SI、SF水平均高于C组,差异有统计学意义(P<0.05)。A组患儿的血清TRF高于B组、C组,B组患儿的血清TRF水平高于C组,差异有统计学意义(P<0.05)。联合检测敏感性、准确度均高于血清SI及SF、TRF单独检测,差异有统计学意义(P<0.05)。结论SI、SF、TRF联合检测在儿童营养性缺铁性贫血筛查中应用价值高,能有效反映机体储存、利用铁情况,利于鉴别、诊断营养性缺铁性贫血,提高诊断敏感性、准确性,值得临床推广。     

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...     

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。     

Anemia, iron deficiency, and iron deficiency anemia in 12-36-mo-old children from low-income families

BACKGROUND: Iron deficiency (ID) is the most common nutritional deficiency in the world and remains relatively common in at-risk groups in the United States. The actual prevalence of anemia, ID, and iron deficiency anemia (IDA) in California remains unclear. OBJECTIVE: The objective was to determine the prevalence of anemia, low iron stores, ID, and IDA in children participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) population, and to assess the value of using hemoglobin to predict ID. DESIGN: This was a cross-sectional study of a convenience sample of 12-36-mo-old children from WIC clinics in 2 California counties. RESULTS: The prevalence of anemia was 11.1% (hemoglobin <110 g/L at 12-24 mo or <111 g/L at 24-36 mo). Study- and literature-determined abnormal values for iron measures were as follows: serum ferritin or=8.4 or >10.0 microg/mL, and transferrin saturation or=2 abnormal iron measures) were 16.2% and 8.8%, and of IDA (ID with low hemoglobin) were 3.4% and 3.2% on the basis of study- and literature-determined cutoffs, respectively. Hemoglobin concentration was used to predict study- and literature-determined ID on the basis of receiver operating characteristic curves. The sensitivity of low hemoglobin in predicting study- and literature-determined ID was low (23.2% and 40.0%, respectively). CONCLUSIONS: Anemia and ID were prevalent in this WIC sample, but IDA was uncommon. Low hemoglobin is a poor predictor of ID.     

中国南方10个县级市学龄前儿童贫血流行状况

目的 描述学龄前儿童贫血状况与分布特征。方法 资料来源于“中美预防神经管畸形合作项目”围生保健监测的常规报告及儿童随访研究项目。采用WHO推荐的儿童贫血诊断标准。研究对象为2000年浙江、江苏两省10市64466名3．5～6．5岁儿童，计算患病率并描述其分布特征。结果 贫血患病率为21．39％（13789／64466，95％CI：21．07～21．71），以轻度贫血为主（占99％以上）。贫血患病率，女童高于男童，5岁后显著高于5岁前，母亲文化程度低、职业为农民及新生儿期为人工喂养儿童贫血患病率较高，单胎与多胎、低出生体重与正常出生体重者的贫血患病率比较，差异无显著性（P〉0．05）。结论 我国南方学龄前儿童贫血患病率仍处于较高水平，与母亲文化程度、喂养方式等可干预的因素密切关联。，     

维生素A在铁缺乏及缺铁性贫血治疗中的作用

近几年研究发现维生素A缺乏与铁缺乏具有显著的相关性,维生素A治疗缺铁性贫血和铁缺乏也取得了较好的临床效果.本文就维生素A缺乏与铁缺乏的相关性和作用机制,以及维生素A治疗缺铁性贫血的临床疗效和研究进展进行了综述,为维生素A用于儿童缺铁性贫血的防治提供依据,同时为降低我国儿童缺铁性贫血及铁缺乏的发病率提供更有效的防治措施.