Body Composition, Anemia, and Kidney Function among Guatemalan Sugarcane Workers

Daniel Pilloni,Alex Cruz,Lee S. Newman,Hillary Yoder,Claudia Asensio,Miranda Dally,Lyndsay Krisher,Diana Jaramillo,Elisa Sinibaldi,Jaime Butler-Dawson,Lynn Dexter,Karen Schlosser

doi:10.3390/nu13113928

Abstract

Rates of anemia among agricultural workers, who are also at risk for kidney injury and chronic kidney disease of unknown cause (CKDu), are unknown. We evaluated body composition through the sum of three skinfolds among 203 male sugarcane cutters and assessed the relationship of variables related to nutrition, anemia (hemoglobin < 13 g/dL), and elevated hemoglobin A1c (HbA1c ≥ 5.7%) with estimated glomerular filtration rate (eGFR) using linear regression. Eleven percent of workers were at the level of essential body fat (2–5%). Anemia was present among 13% of workers, 70% of which were normochromic normocytic, a type of anemia suggesting potential underlying chronic disease. Anemia was more common among those with lower BMI and fat free mass. The prevalence of elevated HbA1c was 21%. A moderate negative correlation was found between hemoglobin and HbA1c (Pearson’s r = −0.32, p < 0.01) which suggests that HbA1c values should be interpreted with caution in populations that have high rates of anemia. Twelve percent of workers had reduced kidney function with an eGFR < 90 mL/min/1.73 m2. On average, the eGFR was 18 mL/min per 1.73 m2 lower [(95% CI:−24, −12), p < 0.01)] for those with anemia than those without, and 8 mL/min per 1.73 m2 lower among those with elevated HbA1c [(95% CI: −13, −2), p < 0.01]. Results will inform future studies examining the role of anemia in the evaluation of CKDu and interventions to improve nutrition for workers in low-resource settings.

Highlights

Guatemala faces challenges in regard to nutrition, including around food insecurity, lack of healthy food access and anemia that have resulted in the highest rates of chronic malnutrition, or stunting in Latin America [1,2,3]
Anemia is a known comorbidity of chronic kidney disease (CKD) as well as a risk factor for acute kidney injury (AKI), inadequate renal recovery, CKD progression, and associated mortality [4,5,6,7,8]
Investigations are underway to address an epidemic of kidney injury and chronic kidney disease of unknown origin (CKDu) that affects agricultural workers, in particular sugarcane workers, who labor under conditions of high heat and humidity, including in Guatemala [11,12,13,14,15]

Summary

Introduction

Guatemala faces challenges in regard to nutrition, including around food insecurity, lack of healthy food access and anemia that have resulted in the highest rates of chronic malnutrition, or stunting (low height-for-age) in Latin America [1,2,3]. Anemia is a known comorbidity of chronic kidney disease (CKD) as well as a risk factor for acute kidney injury (AKI), inadequate renal recovery, CKD progression, and associated mortality [4,5,6,7,8]. Investigations are underway to address an epidemic of kidney injury and chronic kidney disease of unknown origin (CKDu) that affects agricultural workers, in particular sugarcane workers, who labor under conditions of high heat and humidity, including in Guatemala [11,12,13,14,15]. In a study of Nicaraguan agricultural workers, anemia was a major risk factor for progression from acute renal injury to CKDu [8,17]. Anemia has not been investigated as a risk factor for kidney dysfunction among workers in Guatemala, a region of high CKDu endemicity

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