Abstract
Anemia has been identified as a severe public health concern among young children in India, however, information on the prevalence of anemia attributed to micronutrient deficiencies is lacking. We aimed to assess multiple micronutrient status (iron, zinc, selenium, vitamin A, vitamin D, folate and vitamin B12) in young Indian children and to investigate the role of these seven micronutrients and other non-nutritional factors on hemoglobin concentrations and anemia. One-hundred and twenty children aged 12 to 23 months were included in a cross-sectional nutritional assessment survey, of which 77 children provided a blood sample. Hemoglobin (Hb), serum ferritin, soluble transferrin receptor (sTfR), total body iron, zinc, selenium, retinol binding protein (RBP), folate, vitamin B12 and 25-hydroxyvitamin D (25(OH)D) were measured, and adjusted for inflammation using C-reactive protein (CRP) and α-1-acid glycoprotein (AGP), where appropriate. Predictors for hemoglobin and anemia were identified in multiple regression models. Most of the children were classified as anemic, of which 86 to 93% was associated with iron deficiency depending on the indicator applied. Deficiencies of folate (37%), and notably vitamin D (74%) were also common; fewer children were classified with deficiencies of vitamin B12 (29%), zinc (25%), and vitamin A (17%) and selenium deficiency was nearly absent. Multiple micronutrient deficiencies were common with over half (57%) deficient in three or more micronutrients, and less than 10% of children were classified with adequate status for all the micronutrients measured. Iron status was found to be the only nutritional factor statistically significantly inversely associated with anemia (P = 0.003) in multivariate analysis after controlling for sex. A coordinated multi-micronutrient program is urgently needed to combat the co-existing micronutrient deficiencies in these young children to improve micronutrient status and reduce the high burden of childhood anemia.
Highlights
Anemia has been identified as a severe public health concern and in India, recent national anemia prevalence estimates are nearly 60% in children younger than five years [1, 2]
Recent efforts led by the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project have focused on methods for adjusting micronutrient status to account for the effects of inflammation using regression modeling and two acute phase proteins, C-reactive protein (CRP) and α-1-acid glycoprotein (AGP) [14, 16, 19,20,21,22,23]
In this cross-sectional survey of young Indian children aged 12 to 24 months, we aimed to assess the prevalence of anemia and multiple micronutrient deficiencies, adjusted for inflammation where appropriate; and, to investigate the role of these seven micronutrients and other non-nutritional factors on hemoglobin concentrations and anemia
Summary
Anemia has been identified as a severe public health concern (global childhood prevalence 40%) and in India, recent national anemia prevalence estimates are nearly 60% in children younger than five years [1, 2]. While iron deficiency is thought to be a major cause of anemia, other micronutrients most notably folate, vitamin B12, vitamin A, and more recently, zinc, selenium, and vitamin D, have been associated with childhood anemia [3,4,5,6]. Despite several reports of micronutrient deficiencies of vitamin A, zinc, vitamin B12, folate, iron and vitamin D among young Indian children, their relative contribution to the prevalence of anemia remains unknown [7,8,9,10,11,12,13]. Infection and inflammation are known to alter several micronutrient biomarkers, including ferritin, zinc, retinol or retinol binding protein (RBP), and possibly selenium [14, 15]. Recent efforts led by the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project have focused on methods for adjusting micronutrient status to account for the effects of inflammation using regression modeling and two acute phase proteins, C-reactive protein (CRP) and α-1-acid glycoprotein (AGP) [14, 16, 19,20,21,22,23]
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