Lower Prevalence Of Iron Deficiency Research Articles

Excessive Erythrocytosis Is Not Associated With Altered Iron Homeostasis in Men From the World's Highest City.

Excessive Erythrocytosis Is Not Associated With Altered Iron Homeostasis in Men From the World's Highest City.

Iron Deficiency in Vegetarian and Omnivorous Individuals: Analysis of 1340 Individuals

The objective of this study was to evaluate the serum levels of ferritin and the prevalence of iron deficiency in vegan and omnivorous individuals by taking into account the presence of elements that cause an elevation of ferritin levels, such as increased homeostatic model assessment of insulin resistance (HOMA-IR), body mass index (BMI), and high-sensitivity C-reactive protein (hs-CRP) values. The parameters were evaluated in 1340 individuals, i.e., 422 men and 225 women who do not menstruate and 693 women who do menstruate, based on omnivorous or vegetarian eating habits. The progressive increase in BMI, HOMA-IR, and inflammation caused an elevation in ferritin concentration, regardless of the eating habits in the groups studied. In the overall sample, omnivores had a higher prevalence of obesity, higher ferritin levels, and a lower prevalence of iron deficiency (ferritin < 30 ng/mL). However, after the exclusion of individuals with inflammation (with overweight/obesity and elevated hs-CRP levels), the actual iron deficiency was assessed and was not higher among vegetarians, except in women with regular menstrual cycles. Our data show that nutritional status and inflammation levels affect ferritin levels and may interfere with the correct diagnosis of iron deficiency in both vegetarian and omnivorous individuals. Compared to vegetarians, women who do not menstruate and men had the same prevalence of iron deficiency when following an omnivorous diet.

Serum ferritin and hematological indices in thalassemia minor and nontransfusion dependent hemoghlobinopathy

BACKGROUND: Iron deficiency is not common in thalassemia minor and nontransfusion dependent hemoglobinophaties. The majority of these patients have normal-to-high serum ferritin.OBJECTIVES: The aims of the study were to evaluate serum ferritin levels in alpha and beta thalassemia minor and intermedia and in, hemoglobin H disease, and sickle cell anemia, and to investigate the effect of iron consumption on increasing serum ferritin levels and the role of Mentzer and Srivastava indices in patients with thalassemia minor and low serum ferritin levels.MATERIALS AND METHODS: In this study, 204 patients with alpha-thalassemia minor, beta-thalassemia minor, nontransfusion-dependent thalassemia intermediate, and sickle cell disease were studied. Serum ferritin levels, Mentzer, Srivastava, and Bordbar's formula were measured using erythrocyte indices.RESULTS: Irrespective of iron deficiency status, which was 5.9% and was more common in women, total iron intake was 39%. Iron deficiency status was 3.3% in alpha thalassemia, 9.8% in beta-thalassemia, and 4.5% in sickle cell disease. High and very high serum ferritin levels are more common in beta intermediate thalassemia and sickle cell anemia. Mentzer and Srivastava indices were not significant for differentiating thalassemia minor and iron deficiency, but the Bordbar's formula in thalassemia minor with iron deficiency was statistically significant (119.75).CONCLUSION: Patients with minor thalassemia and nontransfusion dependent hemoglobinopathy had a lower prevalence of iron deficiency according due to due to serum ferritin levels compared to the general population. High and very high ferritin is more common in intermediate thalassemia, hemoglobin H, and sickle cell patients.

Metabolic syndrome may be associated with a lower prevalence of iron deficiency in Ecuadorian women of reproductive age.

The present study aimed to assess the associations of the stages of Fe deficiency (Fe deficiency without anaemia (ID) and Fe-deficiency anaemia (IDA)) and anaemia with metabolic syndrome (MetS) in Ecuadorian women. A cross-sectional study was conducted in 5894 women aged 20-59 years, based on data from the 2012 Ecuadorian National Health and Nutrition Survey. The sample was stratified by age. A χ2 test was used to assess the possible associations of ID, IDA and anaemia with MetS. The prevalence ratio (PR) for each stage of Fe deficiency and anaemia was estimated considering women without MetS as a reference. The total prevalence of MetS, ID, IDA and anaemia was 32⋅3 % (se 0⋅6), 6⋅2 % (se 0⋅3), 7⋅1 % (se 0⋅3) and 5⋅0 % (se 0⋅3), respectively. In women aged 20-29, 30-39 and 40-49 years, MetS was associated with a lower prevalence of ID (PR (95 % CI; P-value)): 0⋅17 (0⋅06, 0⋅46; P < 0⋅001), 0⋅69 (0⋅48, 0⋅99; P = 0⋅044) and 0⋅44 (0⋅29, 0⋅67; P < 0⋅001), respectively. In women aged 50-59 years, MetS was associated with IDA and anaemia (PR (95 % CI; P-value)): 0⋅12 (0⋅02, 0⋅96; P = 0⋅026) and 0⋅22 (0⋅07, 0⋅64; P = 0⋅002), respectively. In conclusion, Ecuadorian women of reproductive age with MetS have a lower prevalence of ID compared with those without MetS. Furthermore, the MetS and IDA coexist at the population level. These findings require an analysis from a dietary pattern approach, which could provide key elements for developing public policies that simultaneously address all forms of malnutrition.

Delayed iron improves iron status without altering malaria risk in severe malarial anemia

WHO guidelines recommend concurrent iron and antimalarial treatment in children with malaria and iron deficiency, but iron may not be well absorbed or utilized during a malaria episode. We aimed to determine whether starting iron 28 d after antimalarial treatment in children with severe malaria and iron deficiency would improve iron status and lower malaria risk. We conducted a randomized clinical trial on the effect of immediate compared with delayed iron treatment in Ugandan children 18 mo-5 y of age with 2 forms of severe malaria: cerebral malaria (CM; n=79) or severe malarial anemia (SMA; n=77). Asymptomatic community children (CC; n=83) were enrolled as a comparison group. Children with iron deficiency, defined as zinc protoporphyrin (ZPP) ≥ 80 µmol/mol heme, were randomly assigned to receive a 3-mo course of daily oral ferrous sulfate (2 mg · kg-1 · d-1) either concurrently with antimalarial treatment (immediate arm) or 28 d after receiving antimalarial treatment (delayed arm). Children were followed for 12 mo. All children with CM or SMA, and 35 (42.2%) CC, were iron-deficient and were randomly assigned to immediate or delayed iron treatment. Immediate compared with delayed iron had no effect in any of the 3 study groups on the primary study outcomes (hemoglobin concentration and prevalence of ZPP≥80 µmol/mol heme at 6 mo, malaria incidence over 12 mo). However, after 12 mo, children with SMA in the delayed compared with the immediate arm had a lower prevalence of iron deficiency defined by ZPP (29.4% compared with 65.6%, P=0.006), a lower mean concentration of soluble transferrin receptor (6.1 compared with 7.8 mg/L, P=0.03), and showed a trend toward fewer episodes of severe malaria (incidence rate ratio: 0.39; 95% CI: 0.14, 1.12). In children with SMA, delayed iron treatment did not increase hemoglobin concentration, but did improve long-term iron status over 12 mo without affecting malaria incidence.This trial was registered at clinicaltrials.gov as NCT01093989.

Lipid-Based Nutrient Supplementation Reduces Child Anemia and Increases Micronutrient Status in Madagascar: A Multiarm Cluster-Randomized Controlled Trial

Iron deficiency anemia affects hundreds of millions of women and children worldwide and is associated with impaired infant outcomes. Small-quantity lipid-based nutrient supplement (LNS) have been found to reduce the prevalence of anemia and iron deficiency in some trials. We evaluated the effectiveness of daily LNS supplementation on child anemia and micronutrient status in Madagascar within the context of an existing, scaled-up nutrition program. We cluster-randomized 125 communities to (T0) a routine program with monthly growth monitoring and nutrition education; (T1) T0+home visits for intensive nutrition counselling; (T2) T1+LNS for children aged 6-18mo; (T3) T2+LNS for pregnant/lactating women; or (T4) T1+parenting messages. Pregnant women and infants aged <12mo were enrolled in 2014 and followed for 2 y. Child outcome measures included hemoglobin and anemia assessed using the HemoCue 301 system (n=3561), and serum ferritin and soluble transferrin receptor as markers of iron status, retinol-binding protein as a marker of vitamin A status, and C-reactive protein and α-1 acid glycoprotein from a finger stick blood draw among a subsample (n=387). We estimated mean difference using linear regression and prevalence ratios using modified Poisson regression accounting for the clustered design. All analyses were intention-to-treat. Children in the LNS groups (T2 and T3) had ∼40% lower prevalence of anemia and iron deficiency anemia and 25% lower prevalence of iron deficiency than children in the control group (T0) (P<0.05 for all). There were no differences in any of the biomarkers when comparing children in the T4 group with those in T0; nor were there differences between T3 and T2. Our findings suggest the provision of LNS in the context of a large-scale program offers significant benefits on anemia and iron status in young children.This trial was registered at www.isrctn.com as ISRCTN14393738.

Factors associated with anaemia and iron deficiency among women of reproductive age in Northeast Thailand: a cross-sectional study

BackgroundAnaemia and iron deficiency (ID) affect women of reproductive age globally and considered to be a major public health problem in developing countries. This study determines the prevalence of anaemia and ID among women of reproductive age in urban northeast Thailand and examined the relative contribution of various risk factors to anaemia and ID in this population.MethodsThree hundred ninety-nine non-pregnant women, aged 18–45 years, from three universities in northeast Thailand participated in this cross-sectional study. Selected socio-demographic, history of blood loss, usual consumption of red meat and tea/coffee, and anthropometric data were collected. Complete blood count including haemoglobin (Hb) concentration, serum ferritin (SF), C-reactive protein (CRP), and thalassemia were determined. Multiple logistic regressions were applied to identify the risk factors of anaemia and ID.ResultsOverall, 370 participants were included for data analyses after excluding women with severe/intermedia thalassemia diseases and/or those with positive serum CRP. The prevalence of anaemia, ID, and iron deficiency anaemia (IDA) were 28.4, 28.4, and 13.2%, respectively. Women with thalassemia had a higher prevalence of anaemia but a lower prevalence of ID than the women without thalassemia. By multiple regression analysis, ID [adjusted OR (AOR) = 4.9, 95% CI = 2.8–8.3], two α-gene defects (AOR = 8.0, 95% CI = 3.0–21.3) and homozygous Hb E (AOR = 8.5, 95% CI = 3.0–24.3) were identified as the potential risk factors of anaemia. Further, the odds of ID were significantly higher among women who donated blood within the past 3 months (AOR = 6.7, 95% CI = 2.8–16.3), and had moderate to a high amount of blood loss during menstruation (AOR = 2.2, 95% CI = 1.3–3.9).ConclusionThis study found a relatively high but differential prevalence of anaemia and ID among women of reproductive age with or without thalassemia. Only homozygous Hb E and two α-gene defects of thalassemia types and ID were the main factors contributing to anaemia. Recent blood donation, and moderate to a high amount of blood loss during menstruation were potential risk factors of ID in this population.

Iron deficiency and anemia in adolescent girls consuming predominantly plant-based diets in rural Ethiopia

Rapid physical growth and the onset of menstruation during adolescence can increase the risk of iron deficiency (ID) and related adverse effects. However, little is known about the risk of anemia and ID among adolescent girls in Ethiopia. Therefore, we aimed to determine the prevalence of ID, low iron stores, and anemia and characterize selected risk factors in Huruta, Arsi Zone, Oromia Region, Ethiopia. A cross-sectional study was conducted among non-pregnant adolescent girls (15–19 years of age; n = 257). Data on household socio-demographic characteristics, anthropometric measurements, and women’s dietary diversity score (WDDS) were collected. Hemoglobin (Hb) and serum ferritin (SF), C-reactive protein (CRP), and α−1-acid-glycoprotein (AGP) concentrations were measured. Diets were predominantly plant-based, with a low consumption of animal source foods, fruits, and dark-green leafy vegetables. Only 4% of the adolescent girls had adequate dietary diversity (WDDS ≥5), and 35% were underweight. The prevalence of anemia (Hb <11 g/dL, 8.7%) and clinical ID (SF <15 µg/L, 8.7%) was low, but 41% had marginal iron stores (SF <50 µg/L). The low prevalence of ID, despite a predominantly plant-based diet is atypical and calls for adapted strategies to address low iron stores in this and other similar settings of Ethiopia.

Preconceptional factors associated with haemoglobin concentration in early pregnancy: a community-based cohort study in rural northeastern Tanzania.

Maternal anaemia in early pregnancy is associated with poor pregnancy outcomes. Furthermore, preconceptional health can influence the health during pregnancy. The aim of this study was to investigate which preconceptional factors were associated with haemoglobin (Hb) concentration in early pregnancy. In Tanzania, 226 women were followed at preconception and during early pregnancy. Red blood cell (RBC) morphology, serum micronutrient concentration, demographic characteristics and health status were assessed in preconception and in early pregnancy. The association between preconceptional factors and Hb concentration in early pregnancy was investigated using simple and multiple linear regression analyses stratified by preconceptional anaemia status. Mean Hb was 123 and 119g/l before conception and during early pregnancy (median gestational age 53days) respectively. Preconceptional mid-upper arm circumference (MUAC) (adjusted coefficient (AC) 0.35 95% CI 0.9-0.61) and preconceptional Hb concentration (AC 0.45 95% CI 0.36-0.54) were positively associated with early pregnancy Hb concentration, whereas preconceptional microcytic hypochromic RBC morphology (AC -6.00 95% CI -9.56 to -2.44) was negatively associated with early pregnancy Hb concentration. In addition, treatment of preconceptional malaria was positively associated with early pregnancy Hb concentration (AC 6.45 95% CI 0.74-12.2) among women with preconceptional anaemia. In contrast, among preconceptional non-anaemic women, only preconceptional Hb concentration and medium socio-economic status was positively associated with early pregnancy Hb concentration. Mid-upper arm circumference (MUAC) and Hb measurements in preconception can help to detect women at increased risk of low Hb concentration in early pregnancy.

Very low prevalence of iron deficiency among young French children: A national cross-sectional hospital-based survey.

Although iron deficiency (ID) is considered the most frequent micronutrient deficiency in industrialized countries and is associated with impaired neurodevelopment when occurring in early years, accurate recent estimations of its prevalence are lacking. Our objective was to estimate ID prevalence and associated sociodemographic markers in young children in France. The Saturn-Inf national cross-sectional hospital-based survey recruited 3,831 French children <6years old between 2008 and 2009 to assess lead poisoning prevalence and to establish a biobank. This secondary analysis measured serum ferritinemia (SF) in sera kept frozen at -80°C for children with sufficient serum aliquots and C-reactive protein <10mg/L. For the 657 participating children (17% of the Saturn-Inf study), the median age was 3.9years (interquartile range: 2.2-5.1); 52% were boys. The median SF was 44μg/L (interquartile range: 28-71). ID prevalence was 2.8% (95% confidence interval [1.7, 4.7]) and 3.2% (95% confidence interval [2.0, 5.1]) with an SF threshold of 10 and 12μg/L, respectively. Low SF was significantly associated (p<.05) with mother being a migrant (32 vs. 45μg/L for a mother born in France) or unemployed (37 vs. 50μg/L for a mother employed). In this first national cross-sectional hospital-based study in France, ID prevalence was much lower than that in other French and European studies performed in underprivileged populations but close to the lowest values observed in other population-based studies in Europe.

Prevalence and Risk Factors of Iron Deficiency in Healthy Young Children in the Southwestern Netherlands

Iron deficiency (ID) and iron deficiency anemia (IDA), during the first years of life, are associated with delayed motor and neurological development. Many studies evaluated iron status without an assessment of an acute-phase protein to identify infection. Because most indicators of iron status are influenced by infection, these data may underestimate the ID prevalence. A food consumption survey in the Netherlands showed that the mean iron intake of children ages 2 to 3 years was below the advised adequate intake of 7 mg/day. The aim of the study was to investigate iron status in a well-defined, healthy population of young children in the southwestern region of the Netherlands and to identify risk factors for ID. We conducted a multicenter, observational study in healthy children ages 0.5 to 3 years. We defined ID as ferritin <12 μg/L and IDA when, in addition, hemoglobin was <110 g/L. Children with elevated C-reactive protein levels (>5 mg/L) or underlying causes for anemia were excluded. Parents filled in a questionnaire to identify risk factors for ID. We included 400 children in the study. ID and IDA were detected in 18.8% and 8.5% of the children, respectively. The present use of formula and the visit of preschool/day care were associated with a lower prevalence of ID, and a high intake of cow's milk was associated with a higher prevalence of ID, after adjustment for age. ID is present in 18.8% of healthy children ages 0.5 to 3 years and living in the southwestern region of the Netherlands. The present visit of preschool/day care and the use of formula are associated with a reduced risk of ID, whereas a high intake of cow's milk is associated with an increased risk of ID.

Iron-Fortified Wheat Flour and Iron Deficiency among Women

Iron deficiency is estimated to impact more than 1.6 billion individuals worldwide, affecting child, maternal, and perinatal mortality. Iron supplementation, fortification, and dietary diversification are strategies to reduce the prevalence of iron deficiency. However, there are relatively few studies demonstrating the effectiveness of iron-fortified wheat flour as an intervention. To assess the relationship between average monthly per capita household consumption of iron-fortified wheat flour and iron deficiency among women of childbearing age in Oman. Data were obtained from the National Micronutrient Status and Fortified Food Coverage Survey, 2004. Iron deficiency status was compared between women living in households with a monthly per capita consumption of iron-fortified wheat flour of 1 kg or more and women living in households with a monthly per capita consumption of iron-fortified wheat flour of less than 1 kg. The analyses excluded women with elevated or unknown levels of C-reactive protein and controlled for characteristics of the women and household demographics. Consumption of iron-fortified wheat flour was associated with a lower prevalence of iron deficiency among women in our sample (adjusted odds ratio, 0.60), after controlling for age, employment status, marital status, intake of iron or multivitamin supplements, self-reported presence of a blood disorder, household income, educational level of head of household, and family size. These results suggest that women in our study living in households with a greater consumption of iron-fortified wheat flour have a lower prevalence of iron deficiency; however, additional study is needed.

Randomised controlled trial: effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months

The paper “Randomised controlled trial: effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months” by Ola Andersson and colleagues ( BMJ 2011;343:d7157, doi:10.1136/bmj.d7157) Abstract Objective— To investigate the effects of delayed umbilical cord clamping, compared with early clamping, on infant iron status at 4 months of age in a European setting. Design— Randomised controlled trial. Setting—Swedish county hospital. Participants— 400 full term infants born after a low risk pregnancy. Intervention— Infants were randomised to delayed umbilical cord clamping (≥180 seconds after delivery) or early clamping (≤10 seconds after delivery). Main outcome measures— Haemoglobin and iron status at 4 months of age with the power estimate based on serum ferritin levels. Secondary outcomes included neonatal anaemia, early respiratory symptoms, polycythaemia, and need for phototherapy. Results— At 4 months of age, infants showed no significant differences in haemoglobin concentration between the groups, but infants subjected to delayed cord clamping had 45% (95% confidence interval 23% to 71%) higher mean ferritin concentration (117 μg/L v 81 μg/L, P<0.001) and a lower prevalence of iron deficiency (1 (0.6%) v 10 (5.7%), P=0.01, relative risk reduction 0.90; number needed to treat=20 (17 to 67)). As for secondary outcomes, the delayed cord clamping group had lower prevalence of neonatal anaemia at 2 days of age (2 (1.2%) v 10 (6.3%), P=0.02, relative risk reduction 0.80, number needed to treat 20 (15 to 111)). There were no significant differences between groups in postnatal respiratory symptoms, polycythaemia, or hyperbilirubinaemia requiring phototherapy. Conclusions— Delayed cord clamping, compared with early clamping, resulted in improved iron status and reduced prevalence of iron deficiency at 4 months of age, and reduced prevalence of neonatal anaemia, without demonstrable adverse effects. As iron deficiency in infants even without anaemia has been associated with impaired development, …

Low prevalence of iron deficiency and iron deficiency anemia in children attending daycare in a large Canadian city

Children are vulnerable to iron deficiency (ID) and iron deficiency anemia (IDA) due to rapid tissue expansion. Recent Canadian surveys reported that 1–3 y and 4–8 y in Québec had an iron intake of 10.1 mg and 13.7 mg/day respectively; however, iron status was not assessed. This study examined the prevalence of ID and IDA and iron intake in children (n=523) from randomly selected daycares in Montréal. Ferritin was measured using an autoanalyzer (Liason®, DiaSorin) and hemoglobin using a radiometer (ABL80 FLEX Radiometer Medical A/S) in capillary samples. Iron intake over 24 h for 469 children with 72 having a repeat assessment was analyzed using Nutritionist Pro™ (Axxya Systems LLC.) and the Canadian Nutrient File. The data was adjusted for day‐to‐day variation, and all children met the EAR (3 mg/day for 1–3 y, 4 mg/day for 4–5 y olds). Mean daily intake for these age groups was 10.22±5.70 mg (n=272) and 11.06±5.32 mg (n=197), respectively, was similar to national data. ID (ferritin &lt;12 μg/L) was present in 13.4% of children and IDA (hemoglobin &lt;110 g/L) in 2.9% of this population. Corresponding means were 22±13 μg/L and 126±19 g/L. This data complements our recent cross‐sectional study reporting ID in 18.0% and IDA in 5.4% in 3–5 y Inuit children; confirming that urban dwelling preschoolers in a large Canadian city have a lower prevalence of ID and IDA. Supported by the Beef Information Centre.

Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial

Objective To investigate the effects of delayed umbilical cord clamping, compared with early clamping, on infant iron status at 4 months of age in a European setting.Design Randomised controlled trial.Setting...

Micronutrient status in lactating mothers before and after introduction of fortified flour: cross-sectional surveys in Maela refugee camp

BackgroundDeficiency of micronutrients is common in refugee populations.ObjectivesIdentify deficiencies and whether provided supplements and wheat flour fortified with 10 micronutrients impacts upon status among breast-feeding women from Maela refugee camp.MethodsTwo sequential cross-sectional studies were conducted in different groups of lactating mothers at 12 weeks postpartum. The first survey was before and the second 4–5 months after micronutrient fortified flour (MFF) had been provided to the camp (in addition to the regular food basket). Iron status and micronutrients were measured in serum, whole blood, and in breast milk samples.ResultsIron and zinc deficiency and anemia were highly prevalent while low serum retinol and thiamine deficiency were rarely detected. Iron and zinc deficiency were associated with anemia, and their proportions were significantly lower after the introduction of MFF (21 vs. 35% with soluble transferrin receptor (sTfR) >8.5 mg/L, P = 0.042, and 50 vs. 73% with serum zinc <0.66 mg/L, P = 0.001). Serum sTfR, whole-blood thiamine diphosphate (TDP) and serum β-carotene were significant predictors (P < 0.001) of milk iron, thiamine and β-carotene, respectively. Lower prevalence of iron deficiency in the MFF group was associated with significantly higher iron and thiamine in breast milk.ConclusionsHigh whole-blood TDP and breast milk thiamine reflected good compliance to provided thiamine; high prevalence of iron deficiency suggested insufficient dietary iron and low acceptance to ferrous sulfate supplements. MFF as an additional food ration in Maela refugee camp seemed to have an effect in reducing both iron and zinc deficiency postpartum.

Traditional food and monetary access to market-food: correlates of food insecurity among Inuit preschoolers

Objectives. To evaluate correlates of food insecurity among Inuit preschoolers.Study design. Cross-sectional health survey.Methods. Correlates of food insecurity were assessed in 3–5 year old children (n=388) residing in 16 Nunavut communities (2007–2008) in whom a high prevalence of child food insecurity (56%) has been documented. A bilingual team conducted interviews, including 24-hour dietary recalls and past-year food security assessment involving monetary access to market foods.Results. Children residing in child food insecure homes were more likely to have consumed traditional food (TF) (51.7% vs. 39.9%, p≤0.01), and less likely to have consumed any milk (52.2% vs. 73.2%, p≤0.001) compared to children in child food secure homes. Median healthy eating index scores were significantly lower (77.1 vs. 79.9, p≤0.01) and sugar drink intake higher (429 vs. 377 g/day, p≤0.05) in children from child food insecure than food secure households. Children that consumed TF had higher protein and lower carbohydrate intake (p≤0.05) and tendencies for a lower prevalence of iron deficiency (plasma ferritin &12 p≤0.10) regardless of food security status. A borderline significant interaction of TF by food security status (p≤0.10) was observed where the percent of anemia (hemoglobin &110 and &115 g/l for 3–4 and 5 yr. olds, respectively) was highest among children from child food insecure homes who consumed no TF.Conclusions. TF and market food contribute to food security and both need to be considered in food security assessments. Support systems and dietary interventions for families with young children are needed.

In a Randomized Controlled Trial of Iron Fortification, Anthelmintic Treatment, and Intermittent Preventive Treatment of Malaria for Anemia Control in Ivorian Children, only Anthelmintic Treatment Shows Modest Benefit1–4

Anemia is common among children in sub-Saharan Africa and its etiology is multifactorial. Likely causes of anemia are low bioavailability of dietary iron, malaria, and helminth infection. In this study, we aimed to assess the effect of iron fortification, intermittent preventive treatment (IPT) of malaria, and anthelmintic treatment on hemoglobin concentration and anemia prevalence among school children. The study was a 6-mo, randomized, double-blind, controlled trial enrolling 591 6- to 14-y-old school children in Côte d'Ivoire using the following: 1) iron-fortified biscuits providing an additional 20 mg iron/d as electrolytic iron 4 times/wk; 2) IPT of malaria with sulfadoxine-pyrimethamine at 0 and 3 mo; and 3) anthelmintic treatment at 0 and 3 mo as the interventions. Prevalence of anemia, iron deficiency, malaria parasitemia, and helminth infection was 70.4, 9.3, 57.7, and 54.8%, respectively. Iron fortification did not improve iron status, IPT of malaria did not affect malaria burden, and neither had an impact on anemia prevalence. Anthelmintics significantly reduced the burden of helminth infections and decreased anemia prevalence (odds ratio: 0.4, 95% CI: 0.3, 0.7). The low prevalence of iron deficiency and an extended dry season that decreased malaria transmission likely reduced the potential impact of iron fortification and IPT. In this setting, anthelmintic treatment was the only intervention that modestly decreased rates of anemia.

Impact of Maternal Iron Deficiency and Anaemia on Pregnancy and its outcomes in a Nigerian Population

BACKGROUND: Iron deficiency and anaemia during pregnancy, two nutritional disorders of public health importance, are common in developing countries. This study was conducted to investigate the possible contribution and impact of anaemia and iron status on pregnancy and its outcomes in a Nigerian population.METHODS: Three hundred and forty nine (349) pregnant women aged 15-40 years (mean; 27. 04 � 4. 75 years) at gestational age = 25 week (mean 21.77 � 3.14 wks) were analysed for plasma iron and haemoglobin using flame atomic absorption spectrophotometer and Cyanmethaemoglobin method, respectively. The women were followed-up weekly till delivery after which neonatal anthropometrics and other birth outcomes were recorded. RESULTS: Anaemia and iron deficiency were recorded in 252 (72.2%) and 222 (63.6%) of the women, respectively, with 0.3% severely anaemic while 38.4% and 33.5% were moderately and mildly anaemic respectively. An inverse relationship was observed between anaemia and iron deficiency with lower prevalence of iron deficiency found among groups with high prevalence of anaemia. Parity and antenatal attendance have significant (p < 0.05) effect on maternal haemoglobin with multiparous women having higher prevalence of anaemia and more than 10 antenatal attendance being associated with lower anaemia prevalence. On the pregnancy outcomes, neither maternal iron status nor anaemia was related to birth weight. However, higher foetal head circumferences (34.09 � 2.61 vs. 33.41� 2. 68cm, p < 0.05) and more preterm deliveries (< 37wk) were found in anaemic than non-anaemic women (19 vs. 3, p = 0.001). Although no significant difference in maternal concomitant illnesses during pregnancy was found either in the iron or the anaemia groups, surgically delivered babies were significantly (p < 0.05) more in iron deficient than in the iron adequate group (16 vs. 1, p = 0.021). CONCLUSSION: Maternal anaemia was associated with premature delivery, delivery through caesarean section, and infants with lower head circumference. Thus, there is indication that apart from iron deficiency, other factors that predispose pregnant women to the development of anaemia may play important role in determining pregnancy outcomes.

Contribution of histological, serological, and genetic factors to the clinical heterogeneity of adult-onset coeliac disease

Objective. Although the factors predisposing to coeliac disease (CD) are largely understood, it remains unclear what determines the clinical heterogeneity of the disease. The aim of this study was to explore the contribution of histological, serological, and genetic factors to disease presentation. Material and methods. The study was designed as a retrospective chart review of 384 unrelated Caucasian patients diagnosed with CD after the age of 16 at a single UK centre. Results. We found that 8.8% of IgA-competent CD patients were endomysial antibody (EMA)-negative. Compared with the EMA-positive group, EMA-negative CD patients had a lower prevalence of iron deficiency (52.0% versus 72.6%, p=0.03) and Marsh IIIb-c lesions (66.7% versus 85.3%, p=0.03). Histological severity at diagnosis correlated with anaemia (p<0.01), folate deficiency (p<0.01), and iron deficiency (p=0.05), but no other laboratory or clinical features. Compared with human leucocyte antigen (HLA)-DQ2.5-positive patients, those carrying HLA-DQ2.2 were similar in terms of all the characteristics we considered, whereas those carrying HLA-DQ8 had a lower frequency of EMA positivity (62.5% versus 92.6%, p<0.01). The proportion of EMA-positive patients increased with frequency of the HLA-DQB1*0201 allele (76.7% versus 92.3% versus 96.4% for 0 versus 1 versus 2 alleles, p<0.01); no other evidence of a gene–dose effect of HLA-DQB1*0201 was observed. Conclusions. Histological severity at diagnosis of CD is associated with anaemia and some micronutrient deficiencies, but no other clinical features. The proportion of EMA-positive patients is higher amongst those carrying HLA-DQ2 than in those carrying HLA-DQ8, and is highest in HLA-DQ2 homozygotes. We found no correlation between frequency of the HLA-DQ alleles encoding HLA-DQ2.5 and CD severity.