Risk Of Anemia Research Articles

Neoadjuvant immune checkpoint inhibitor reduced recurrence in operable NSCLC patients with pathological complete response: a retrospective analysis

BackgroundThis study aimed to evaluate if neoadjuvant immune checkpoint inhibitor (ICI) plus chemotherapy (CT) reduced tumor recurrence after surgery than neoadjuvant CT alone in non–small cell lung cancer (NSCLC) patients with pathologic complete response (pCR).MethodsFrom January 1st 2019 to April 30th 2022, 16 NSCLC patients with pCR who received both neoadjuvant ICI and CT were designated as ICI/CT group. Another 8 patients, who received neoadjuvant CT alone, were designated as CT group. The tumor recurrence and patients’ survival status were analyzed.ResultsSquamous cell carcinoma was the predominant histology type in both groups. The CT group had higher percentage of patients who received adjuvant CT than the ICI/CT group (100% vs. 75%, p = 0.046). All patients had been followed up for at least 20 months. At 20 months after surgery, the ICI/CT group had a tumor recurrence rate of 6.25%, which was significantly lower than 37.5% recurrence rate of the CT group. One patient of the CT group died of gastrointestinal hemorrhage and severe anemia at 11 months after surgery, and no patient in the ICI/CT group died. During adjuvant therapy, the ICI/CT group had significantly lower risk of anemia (12.5% vs. 50%) than the CT group (p = 0.046).ConclusionThe study found that in NSCLC patients with pCR, neoadjuvant ICI reduced tumor recurrence rate. This indicated that like in advanced stage NSCLC, the ICI might bring similar long-term anti-tumor effect in operable NSCLC patients.

Trends and inequalities in anaemia prevalence among children aged 6–59 months in Ghana, 2003–2022

BackgroundAnaemia, characterised by a deficiency in red blood cells or haemoglobin, is a public health issue in Ghana, particularly among children. The prevalence of anaemia in this age group has been a longstanding concern due to its adverse effects on cognitive development, physical growth, and well-being. This study examined the trends and inequalities in anaemia prevalence among children aged 6–59 months in Ghana between 2003 and 2022.MethodsData from the Ghana Demographic Health Survey conducted between 2003 and 2022 was used to analyse the prevalence of anaemia in children aged 6–59 months. The World Health Organization’s Health Equity Assessment Toolkit software calculated several inequality measures, including difference, ratio, population-attributable risk, and population-attributable percentage. An inequality assessment was performed for six stratifiers: child’s age, mother’s economic status, maternal educational level, place of residence, child’s sex, and sub-national region.ResultsAnaemia prevalence among children aged 6–59 months in Ghana declined from 76.1% in 2003 to 48.9% by 2022. The results revealed an age-related inequality in anaemia prevalence among children in Ghana, with younger age group ( 6–11 months) consistently showing higher rates. The age-related inequality Difference was 24.6 percentage points in 2022, indicating that age is crucial to understanding anaemia risk. Economic-related inequality between children of mothers in Quintile 5 (richest) and Quintile 1 (poorest) increased from a Difference of 21.1 percentage points in 2003 to 32.7 percentage points in 2022 highlighting the stark inequalities across wealth quintiles. Education inequality between children of mothers with higher education and no education decreased from a Difference of 29.4 percentage points in 2003 to 25.3 percentage points in 2022, suggesting that children from less educated households are still at higher risk. Place of residence inequality between children of mothers living in urban areas and rural areas increased from a Difference of 12.3 percentage points in 2003 to 14.8 percentage points in 2022 reflecting urban-rural disparities. Sex-related inequality between male and female children decreased from a Difference of -0.3 percentage points in 2003 to -5.5 percentage points in 2022 indicating the absence of inequality based on sex of the child. Lastly, regional inequalities are pronounced, as indicated by an increase in the Difference from 21.2 percentage points in 2003 to 34.0 percentage points in 2022, highlighting that children in certain regions like the Northern and Upper East are more affected by anaemia.ConclusionThe decline in anaemia prevalence among children aged 6–59 months in Ghana, reflects substantial progress; however, notable inequalities persist across age, economic status, education, place of residence, and region. To address these disparities, strategies such as enhancing access to healthcare services in underserved regions, implementing community education programs to raise awareness about nutrition and health, and promoting economic empowerment initiatives can be effective. Additionally, community education can play a crucial role in offsetting the effects of low household education levels, fostering a more informed population that can advocate for better health practices and policies. By addressing these key areas, we can work towards reducing anaemia prevalence and improving child health outcomes across all populations in Ghana.

Adverse maternal and fetal outcomes among tribal pregnant women suffering from sickle cell disease: A retrospective cohort study in a community-based hospital situated in a tribal block of Gujarat, India.

The study presents the risk of the maternal-fetal morbidity and mortality among one of the largest cohort of sickle cell disease (SCD) pregnancies in India and reports the epidemiology of the maternal morbidity. This was a retrospective cohort study conducted at Kasturba Maternity Hospital, SEWA Rural, in the tribal area of Gujarat, India. All pregnant women admitted to the Hospital between 2016 and 2021 were screened for SCD, and their maternal-fetal morbidities were recorded throughout the pregnancy. We quantified risk of maternal-fetal morbidity and mortality among SCD, trait and normal pregnancies after adjusting for potential confounders using Poisson and logistic regression. A total of 24 256 delivered during the study period, with 354 (1.5%) and 4216 (17.4%) suffering from SCD and trait, respectively. After adjusting for potential confounders, the women with SCD pregnancy had higher risk of maternal death (adjusted-odds-ratio [AOR] 13.7, 95% CI: 4.5-42.7), anemia (AOR 6.8, 95% CI: 4.5-10.2), severe anemia (AOR 4.3, 95% CI: 3.3-5.6), preterm delivery (AOR 4.5, 95% CI: 3.6-5.7), cesarean section (AOR 5.5, 95% CI: 4.7-7.0), stillbirth (AOR 3.4, 95% CI: 2.3-5.3), and low birth weight (AOR 3.1, 95% CI: 2.4-39) compared to normal pregnancies. Maternal morbidities occurred throughout the pregnancy; however, the risk was highest during the last month of pregnancy. Pregnant women who had severe manifestation of SCD before the pregnancy were at higher risk of developing maternal morbidities. We concluded that SCD might be an independent risk-factor for developing maternal-fetal morbidities. The SCD pregnancies with prior severe manifestations must be carefully managed during the last month of pregnancy when the risk is highest.

Olaparib-associated toxicity in cancer patients: a systematic review and meta-analysis.

To investigate the characteristics of olaparib-associated adverse events (AEs) in cancer patients. Databases were searched for phase II and III randomized controlled trials (RCTs) involving olaparib treatment up to March 2024. A systematic assessment was performed. Twenty-seven RCTs involving 9542 patients were included. This meta-analysis indicates that olaparib could significantly increase the risk of developing any all-grade (RR, 1.08; 95% CI, 1.03-1.13; p = 0.001) and high-grade (RR, 1.45; 95% CI, 1.19-1.77; p = 0.0003) AEs in cancer patients. Olaparib could increase the risk of dose reduction (RR, 3.00; 95% CI, 1.59-5.70; p = 0.0007) and treatment discontinuation (RR, 2.00; 95% CI, 1.28-3.14; p = 0.002). Hematologic toxicities and gastrointestinal toxicities commonly occur in patients receiving olaparib. Anemia, nausea, and fatigue were the most frequent AEs, with olaparib increasing the risk of both all-grade and high-grade occurrences of these events. Patients with longer treatment durations tend to have a higher risk of anemia. Patients with urinary system tumors tend to have a higher risk of nausea, while those with breast cancer tend to have a higher risk of fatigue. Olaparib maintenance therapy may be associated with a higher risk of fatigue. Olaparib could increase other AEs such as diarrhea, vomiting, decreased appetite, dyspepsia, dysgeusia, dizziness, headache, back pain, urinary tract infection, dyspnea, and cough. Olaparib-containing therapy could increase the occurrence of specific AEs in patients with cancer. Clinicians should be aware of these risks and conduct regular monitoring.

Compliance with weekly iron folic acid supplementation and associated factors among secondary school adolescent girls, in Jimma Arjo District, West Ethiopia, 2022: A mixed method cross-sectional Study

Background: Iron deficiency anemia is a prevalent and major public health problem in low- and middle-income countries among adolescent girls. The risk of Iron deficiency anemia and its consequences are prevented by taking and complying with a weekly iron-folic acid supplement. However, there was no information regarding compliance and its associated factors in Ethiopia. The study aimed to determine the magnitude of compliance with weekly Iron-folic acid supplementation and associated factors among Jimma Arjo secondary school adolescent girls. Methods: Institutional-based cross-sectional study was conducted on 417 adolescent girls in three secondary schools of Jimma Arjo, West Ethiopia from March 1st to 31st, 2022 using interviewer-administered structured and semi-structured questionnaires. Bivariable and multivariable logistic regression analyses were used to determine the association of variables. Results: Compliance with iron-folic acid supplementation was 29.3% with 95% CI (24.9, 33.3). Mother`s secondary level of education (AOR=4.94 (95% CI:2.45,9.94)), awareness of anemia (AOR=4.23 (95% CI:2.35,7.61)), good knowledge about iron-folic acid supplementation (AOR=3.96 (95% CI:2.17,7.22)), lack of iron-folic acid supplementation (AOR=0.42 (95% CI:0.23,0.75)), and iron-folic acid supplementation side effects (AOR=0.17 (95% CI:0.08,0.37)) were factors significantly associated with iron-folic acid supplementation compliance. Misconceptions about iron-folic acid supplementation, forgetfulness of tablet, lack of access to drinking water, and irregularity of school weekly iron-folic acid supplementation days were identified as the main barriers to adolescent girls' compliance with iron-folic acid supplementation in a qualitative study. Conclusions: Weekly iron-folic acid supplementation compliance was low at 29.3%. Scheduled health education, parental participation in the program, access to drinking water, refresher training for school focal persons, and fixed weekly iron-folic acid supplementation days can improve compliance with iron-folic acid supplementation and are recommended.

Intervention on Anemia prevention among adolescent girls: A quasi-experimental study on providing meatballs chips modified to increase hemoglobin levels

Adolescent girls are at higher risk of anemia due to menstrual cycle, with iron deficiency from daily food intake being the most common cause. Therefore, this study aimed to determine the effect of fried meatballs modified with a combination of local ingredients, such as chicken liver flour, moringa oleifera leaves, soybean tempeh flour, and mackerel fish, abbreviated as Tioek chips, on changes in haemoglobin levels on adolescent girls in Kupang City and Kupang Regency. The results show that foods modified with nutritious local ingredients such as Tioek chips can be classified as an affordable and delicious alternative to healthy snacks to prevent anemia.

Prevalent and incident anemia in PARAGON-HF

Abstract Background Anemia is a common comorbidity in patients with heart failure (HF) and is associated with adverse prognosis. Renin-angiotensin system inhibitors (RASi) have been shown to lower hemoglobin levels, potentially related to direct reductions in erythropoetin levels and hematopoiesis. We examined whether sacubitril/valsartan might attenuate this effect of RASi alone on incident anemia in patients with HF with mildly reduced or preserved ejection fraction. Methods PARAGON-HF was a global, multicenter randomized clinical trial of sacubitril/valsartan versus the RASi valsartan in patients with HF and left ventricular ejection fraction≥45%. Anemia was defined as hemoglobin <120 g/L in women and <130 g/L in men. We evaluated changes in hemoglobin, risks of incident anemia and new oral iron initiation during follow-up. We also assessed treatment effects on the primary composite endpoint of total HF hospitalizations (HFH) and cardiovascular (CV) death according to anemia status. Results Among 4,795 participants with a hemoglobin measurement available, 1,111 (23.2%) had anemia at randomization of which 3.5%, 77.7%, and 18.8% were characterized as micro-, normo-, and macrocytic anemia. 5.6% were treated with oral iron at baseline. Over a 2.7-year median follow-up period, patients with anemia were at nearly twice the risk of the primary outcome (21.6 vs. 11.5 per 100py; rate ratio 1.90; 95% CI: 1.62-2.21; P<0.001). Compared with valsartan, sacubitril/valsartan significantly slowed the decline in hemoglobin levels by 1.4 g/L (95% CI: 0.4-2.4 g/L; P = 0.005; Figure 1 Panel A). Participants treated with sacubitril/valsartan were at significantly lower risk of developing anemia (30.3% vs. 37.6%; HR 0.76; 95% CI: 0.68-0.85; P<0.001; Figure 1 Panel B) and starting oral iron therapy (8.1% vs. 10.0%; HR 0.81; 95% CI: 0.67-0.97; P = 0.026; Figure 2). Treatment effects of sacubitril/valsartan vs. valsartan on the primary endpoint were consistent among patients with and without anemia (Pinteraction=1.00). Conclusions Among patients with HF with mildly reduced or preserved ejection fraction, treatment with sacubitril/valsartan resulted in slower declines in hemoglobin, lower rates of incident anemia, and fewer new initiations of iron therapy compared with RASi.

Linezolid Pharmacokinetic-Anemia Modeling in Children with Rifampicin-Resistant Tuberculosis.

Linezolid, an important component of rifampicin- and multidrug-resistant tuberculosis (RR/MDR-TB) treatment, is associated with treatment-limiting toxicities, including anemia. Patient-level and linezolid pharmacokinetic risk factors for anemia have not been well described in children treated for RR/MDR-TB. We evaluated the pharmacokinetics of linezolid and longitudinal hemoglobin data to validate an existing population linezolid pharmacokinetic model. We assessed the impact of linezolid pharmacokinetics and the risk of developing anemia in a prospectively enrolled cohort of children. The validation of a previously published population pharmacokinetic linezolid model used nonlinear mixed effects modeling. A multivariable ordinal logistic regression model was built to predict the incidence of anemia. A total of 112 children, median age 7.2 (IQR: 2.2-16.3) years, were included from South Africa (n=87) and India (n=25). Of these, 24 children contributed new linezolid pharmacokinetic data. The population pharmacokinetic model which informs the currently recommended linezolid dosing in children (10-15 mg/kg) was validated with these additional new data. For every 1 g/dL lower baseline hemoglobin, the odds of developing grade 3 or 4 anemia increased by 2.64 (95% CI 1.98-3.62). For every 1 mg/L*h higher linezolid area under the concentration-time curve (AUC), the odds of developing a grade 3 or 4 anemia increased by 1.012 (95% CI 1.007-1.017). These data taken together, confirm currently recommended linezolid doses in children. The risk of anemia in children should be carefully considered and monitored throughout. Initiating linezolid in children with low baseline hemoglobin increases the probability of experiencing grade 3 or 4 anemia.

Real-world safety profile of zanubrutinib: a disproportionality analysis based on the FAERS database

ObjectiveZanubrutinib is a second-generation Bruton’s tyrosine kinase inhibitor that has been approved for the treatment of several B cell malignancies. The aim of this study was to evaluate adverse events...

Nonlinearity association of blood cobalt with the risk of anemia among middle-aged and older adults: National Health and Nutrition Examination Survey

ABSTRACT Objective The use of cobalt alloys in medical implants poses a high risk of cobalt exposure, yet there is a lack of evidence regarding the association between blood cobalt levels and anemia. This study aimed to explore the link between blood cobalt levels and the onset of anemia and to identify potential threshold levels of blood cobalt that could affect anemia. Methods The US National Health and Nutrition Examination Survey data from 2017 to 2020 were analyzed for this cross-sectional study. This study primarily employed multivariate logistic regression, stratified interaction analysis, restricted cubic splines (RCS), and threshold effect analysis to explore the relationship between blood cobalt concentration and anemia. Results The study included 5510 participants and among them 12.2% were diagnosed with anemia. Logistic regression model indicates a positive correlation between blood cobalt levels and the risk of anemia. RCS shows that the relationship between ln cobalt concentration and anemia was non-linear (J-shaped). The ln cobalt inflection point was approximately 0.81. The odds ratio of anemia with ln cobalt ≥ 0.81 was 4.00 (95% CI: 2.95–5.43, p < 0.001), the odds ratio of anemia with ln cobalt < 0.81 was 0.73 (95% CI: 0.45–1.18, p = 0.201). Conclusions The analysis unveiled a non-linear relationship, indicating that elevated blood cobalt levels were linked to a heightened likelihood of developing anemia in middle-aged and older adults; the cut-off value of ln cobalt was approximately 0.81. The findings of this study warrant further investigation.

Association between changes in depressive symptoms and risk of anemia: from the China Health and Retirement longitudinal study

BackgroundPrevious studies have reported that anemia was associated with depression, but the association between changes in depressive symptoms and the risk of anemia was unclear. This study aimed to explore whether changes in depressive symptoms were associated with anemia among the middle-aged and elderly adults.MethodsA total of 6112 patients aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS) were included in this analysis. Elevated Depression Symptoms (EDS) was defined as the Center for Epidemiological Studies Depression Scale-10 score ≥ 10. Depression status was defined as no depressive symptom [no EDS at Wave 1 (2011–2012) and Wave 2 (2013–2014)], decreasing depressive symptoms (EDS at Wave 1, no EDS at Wave 2), increasing depressive symptoms (no EDS at Wave 1, EDS at Wave 2), persistent depressive symptoms (EDS at Wave 1 and Wave 2). Multivariable logistic regression analyses were conducted to estimate the relationships between depressive symptoms and the changes and risk of anemia.ResultsDuring the follow-up of Wave 1 and Wave 3 (2015–2016), 906 participants (14.82%) developed anemia, the multivariable-adjusted odds ratio for the depressive symptom compared with the no depressive symptom was 1.24 (95% CI, 1.12–1.58) for anemia. From Wave 2 to Wave 3, there were 828 participants (14.62%) diagnosed with anemia. Compared to participants with no depressive symptom, those with persistent depressive symptoms during Wave 1 and Wave 2 had the significantly elevated risk of anemia (odds ratio 1.44, 95% CI 1.21–1.84).ConclusionsThe present study demonstrated that baseline depressive symptoms and changes in depressive symptoms were associated with increased risks of anemia.

Trends and predictors of severe and moderate anaemia among children aged 6–59 months in India: an analysis of three rounds of National Family Health Survey (NFHS) data

BackgroundChildhood anaemia remains a significant public health problem in India, as it adversely affects child development and overall health outcomes. This study aimed to analyse the prevalence of severe and moderate anaemia among children aged 6–59 months and identify consistent predictors of this condition over the past 15 years.MethodsData from the three most recent rounds of the NFHS were used for this analysis. The final weighted sample included 40,331 children from the NFHS-3 (2005–2006), 200,093 from the NFHS-4 (2015–2016), and 178,909 from the NFHS-5 (2019–2021). Descriptive and bivariate analyses were conducted, followed by binary logistic regression to identify factors associated with severe and moderate anaemia in children aged 6–59 months. All statistical analyses were performed using Stata version 14.ResultsOver the past 15 years, the prevalence of severe and moderate anaemia among children in India has shown a slight decline. However, the influence of various predictors has changed over time. Young children (aged 6–23 months), those from Scheduled Caste (SC) and Scheduled Tribe (ST) communities, and children born to mothers with high parity and low educational attainment remain particularly vulnerable to anaemia. Additionally, short-term illness significantly increases the risk of anaemia. Furthermore, women’s autonomy, indicated by higher education and lower fertility rates, along with maternal nutrition education, have emerged as key factors in reducing anaemia burden in the future. Notably, children whose mothers had no education were 1.4 times more likely to suffer from severe or moderate anaemia. Similarly, children born to mothers with four to five children (OR 1.1, p < 0.05) and those with six or more children (OR 1.2, p < 0.05) had an elevated risk of anaemia.ConclusionThe findings highlight three key areas for programmatic focus to accelerate anaemia reduction in India: [1] targeting young children (aged 6–23 months); [2] ensuring the inclusion of SC and ST communities in all relevant interventions; and [3] promoting women’s autonomy. These strategies are essential for reducing the burden of anaemia across the country.

Low-Dose Aspirin and Risk of Anaemia in Older Adults: Insights from a Danish Register-based Cohort Study.

To assess the risk of anaemia among low-dose aspirin (LDA) exposure in Danish older individuals in a real-world setting. Population based-cohort study conducted using Danish registers. The study population included older individuals (≥65 years) exposed to LDA between 2008 and 2013 for primary or secondary prevention of cardiovascular events. Over a five-year follow-up, outcomes included anaemia incidence based on haemoglobin values and hematinic deficiency incidence based on antianemic prescriptions. Among the 313 508 individuals included in the study population, those exposed to LDA (n = 59 869, 19.1%) had an incidence of hematinic deficiency determined by the use of antianemic treatment of 9.6%, with an incidence rate ratio of 9.11 (95% Confidence Interval, CI: 8.81-9.41) when compared to non-users of LDA (n = 253 639, 80.9%), who had an incidence of 3.7%. Anaemia determined by haemoglobin value measurements was observed in 5.9% of those exposed to LDA, with an incidence rate ratio of 7.89 (95% CI: 7.58-8.21) when compared to non-users of LDA. Approximately one in five individuals (n = 2 422, 21.5%) who experienced anaemia also experienced bleeding. Severe anaemia was observed in 1.3% of those exposed to LDA compared to 0.6% of those not exposed. Among the exposed, the reduction in haemoglobin and ferritin levels was associated with the severity of anaemia. These findings indicate that in a real-world setting, anaemia with LDA can occur in 6 to 10 older individuals out of every 100 LDA users during the first 5 years of treatment.

Determinants of Prevalence and Factors Associated with Anemia among Pregnant Women in Gambia: A Multivariate Analysis using DHS Data

Background Anemia is a prevalent public health concern in The Gambia and other developing nations. While previous studies relied on binary logistic regression, the Multinomial Survey Logistic Regression Model was developed to address complexities in survey design, including sampling weights, stratification, and clustering. Multiple Imputation with Chained Equations (MICE) was employed to address missing data in variables such as anemia level, contraceptive use, and malaria drug intake during pregnancy. Aim/Objective This study aims to determine the prevalence and factors of anemia among pregnant women across eight local government areas in The Gambia. The research focuses on Kanifing, Kuntaur, Mansakonko, Kerewan, Janjanbureh, Basse, Brikama, and Banjul. Given the limited research on anemia among pregnant women in The Gambia, there is a need for further investigation into this topic. Methods MICE were utilized to address missing data due to their validity in handling uncertainty. This method generates multiple reasonable datasets for imputation and analyzes them accurately. A survey logistic regression model was employed to assess data fitness, considering the complex sample design. Anemia levels were measured among 11,865 pregnant women aged 15 to 49 using a systematic questionnaire. The multinomial survey logistic regression model was utilized to account for sampling weights, stratification, and clustering, relaxing the premise of observation independence violated by conventional logistic regression. Results The study involved 11,865 expectant mothers, revealing mild, moderate, and severe cases of anemia with a prevalence of 44.6%. Factors associated with anemia included place of residence, local government area, contraceptive use, age, literacy level, and current pregnancy status. Conclusion Socio-economic, demographic, and environmental factors significantly impact anemia levels among reproductive women in The Gambia. Addressing factors such as place of residence, local government areas, contraceptive use, literacy level, and current pregnancy status is crucial in mitigating anemia risk. Government initiatives, such as improving access to sanitation facilities and offering free check-ups, could effectively address this public health concern.

Exploring Associations and Mediating Factors between Multiple Trace Metals with Anemia in US Adults: Insight from NHANES 2017-2020.

Anemia significantly contributes to the global disease burden, with its incidence potentially influenced by the trace metal content within the body. This study aims to examine the associations between trace metals and anemia risk, with a particular focus on investigating the potential mediating roles of iron status and inflammation in these associations. Five trace metals (Ni, Co, Mn, Se, and Mo) were examined in 1274 US adults, utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020. The individual and combined effects of these metals on anemia were assessed using logistic regression, quantile g-computation (QGC), and Bayesian kernel machine regression (BKMR). A sex-stratified analysis was conducted to discern any gender-specific susceptibilities. Additionally, mediation analysis was employed to explore the potential mediating roles of iron status and inflammation in the associations between these metals and anemia. Increased risks of anemia were positively associated with Co and Ni levels but negatively correlated with Se and Mn levels (all with p < 0.05). The trace metal mixture was negatively associated with anemia, with the highest weights of Co and Se in different directions in both the QGC and BKMR models. In the sex-specific analysis, we observed less pronounced protective effects from trace metals in females. Moreover, the mediating proportion of the iron status and inflammation in these relationships ranged from 10.29% to 58.18%. Our findings suggest that the trace element mixture was associated with decreased anemia risk, among which Se was a protective factor while Co was a risk factor, and females were more susceptible. The effects of these trace metals on anemia may be mediated by the iron status and inflammation.

Prevalence and determinants of stunting and anaemia in children aged 6-23 months: A multilevel analysis from rural Ethiopia.

Low- and middle-income countries shoulder the greatest burden of stunting and anaemia in children. This calls for prompt and effective intervention measures, while the contributing factors are not fully understood. This study evaluates determinants spanning from individual-, household- and community levels including agroecology and antinutrients as unique sets of predictors. Primary data were collected from 660 rural households representing the midland (ML), highland, and upper highland (UHL) agroecological zones from northern Ethiopia. The study relates several predictors to stunting and anaemia in children aged 6-23 months. We found 49.1% and 49.7% of children were stunted and anaemic, respectively. Children living in the ML are approximately twice more likely to be stunted adjusted odds ratio (AOR: 1.869; 95% CI: 1.147-3.043) than in the UHL. The risk of stunting increases by 16.3% and 41.9% for every unit increase in phytate-to-zinc and phytate-to-iron molar ratios, respectively. A 10% increase in mean aggregated crop yield was observed to reduce the likelihood of stunting occurrence by 13.6%. Households lacking non-farm income-generating opportunities, travel longer time to access the marketplace and poor health service utilisation were associated with increased risk of stunting. Low diversity of child's diet, age of the child (18-23 months) and mothers at a younger age are significantly associated with stunting. Risk of anaemia in children is high amongst households with unimproved water, sanitation, and hygiene practices, younger age (6-11 months) and mostly occurs amongst boys. Children in the ML had a 55% reduced risk of being anaemic (AOR: 0.446; 95% CI: 0.273-0.728) as compared to the UHL. Therefore, the influence of these factors should be considered to tailor strategies for reducing undernutrition in children of 6-23 months in rural Ethiopia. Interventions should go beyond the administrative boundaries into targeting agroecological variation.

Pre- and Postnatal Vitamin A Deficiency Impairs Motor Skills without a Consistent Effect on Trace Mineral Status in Young Mice

Pregnant women and children are vulnerable to vitamin A deficiency (VAD), which is often compounded by concurrent deficiencies in other micronutrients, particularly iron and zinc, in developing countries. The study investigated the effects of early-life VAD on motor and cognitive development and trace mineral status in a mouse model. C57BL/6J dams were fed either a vitamin A-adequate (VR) or -deficient (VD) diet across two consecutive gestations and lactations. Offspring from both gestations (G1 and G2) continued the same diets until 6 or 9 weeks of age. Behavioral assays were conducted to evaluate motor coordination, grip strength, spatial cognition, and anxiety. Hepatic trace minerals were analyzed. A VD diet depleted hepatic retinoids and reduced plasma retinol across all ages and gestations. Retracted rear legs and abnormal gait were the most common clinical manifestations observed in VD offspring from both gestations at 9 weeks. Poor performance on the Rotarod test further confirmed their motor dysfunction. VAD didn’t affect hemoglobin levels and had no consistent effect on hepatic trace mineral concentrations. These findings highlight the critical role of vitamin A in motor development. There was no clear evidence that VAD alters the risk of iron deficiency anemia or trace minerals.

Anaemia and glucose-6-phosphate dehydrogenase deficiency in pregnant women in Ghana

Background/Aims Glucose-6-phosphate dehydrogenase deficiency worsens the risk of anaemia and complicates gestation and birth if poorly managed. This study investigated the prevalence and factors associated with anaemia and this deficiency in pregnant women. Methods This cross-sectional study was conducted among 369 pregnant women at the Cape Coast Metropolitan Hospital, Ghana. Multiple logistic regression was used to investigate the relationship between anaemia and various sociodemographic variables. Results The prevalence of anaemia was 41.2% at 13 weeks' and 66.7% at 36 weeks' gestation. Overall, 29.8% of participants were glucose-6-phosphate dehydrogenase deficient. Age (P=0.024)and marital status (P=0.009) were significantly associated with anaemia at 13 weeks. Gravidity (P=0.014) and employment status (P=0.001) were significantly associated with anaemia at 36 weeks. Conclusions There was a high prevalence of co-morbid anaemia and glucose-6-phosphate dehydrogenase deficiency at 13 and 36 weeks' gestation. Future studies should consider genetic and dietary factors that may contribute to gestational anaemia. Implications for practice Clinicians and midwives should be aware of the factors that can affect anaemia and glucose-6-phosphate dehydrogenase deficiency, particularly in areas where deficiency is prevalent. Early detection could allow individualised treatment.

Micronutrient intake and status in young vegans, lacto-ovo-vegetarians, pescatarians, flexitarians, and omnivores.

Whether youth who follow plant-based diets in Nordic countries meet their dietary needs for micronutrients remains unclear. This study aims to evaluate micronutrient intake and status in Norwegian youth following vegan, lacto-ovo-vegetarian, pescatarian, flexitarian and omnivore diets. Cross-sectional design, with healthy 16-to-24-year-olds (n = 165). Participants were asked to complete a questionnaire and four 24-hour dietary recalls. Dried blood spots (DBS) and spot-urine samples were collected for analysis of methyl malonic acid (MMA) (n = 65), haemoglobin (Hb) (n = 164) and urinary iodine concentration (UIC) (n = 163). Vegans reported highest habitual supplement usage of multivitamin (58%), B12 (90%) and macroalgae consumption (32%), while flexitarians reported highest habitual usage of omega-3 supplements (56%). For daily supplement usage, vegans reported highest use of multivitamins (42%), B12 (79%), iodine (37%) and iron (63%). Increased risk of inadequate intake (energy-adjusted) were found for vitamin D (60% within lacto-ovo-vegetarians), selenium (70% within lacto-ovo-vegetarians, 65% within omnivores), and iodine (63% within vegans). Median MMA levels suggest low risk of insufficient B12 status across all groups (MMA 0.04‒0.37µmol/l) and 2% had MMA levels indicating possible B12 deficiency and 8% had elevated levels. Median Hb levels indicated low risk of anemia across all groups (≥ 12.0 females, ≥ 13.0g/dl males), though 7% had Hb values indicating risk of mild anemia and 4% risk of moderate anemia. The median UIC indicates mild iodine deficiency in all groups (UIC < 100µg/l), except vegans, who were moderately iodine deficient (UIC < 50µg/l). Our study indicated that the participating youth had low risk of inadequate intake of most micronutrients, partly due to high supplement usage. However, for iodine, vitamin D, and selenium higher risk of inadequate intake was found. UIC corroborated the low iodine intake among vegans. Thus, we suggest iodine status of youth in Norway should be monitored, especially among young fertile women who omits dietary iodine sources, until a mandatory iodine fortification program is implemented. Furthermore, we suggest that food education on how to secure sufficient nutrients from food in general should be provided to the Norwegian youth population, especially how to secure adequate intake of vitamin D, selenium and iodine.

Enhancing referral practices: A bariatric department's education initiative to reduce unnecessary referrals to hematology oncology.

82 Background: Bariatric surgery patients face an elevated risk of iron deficiency anemia. Referrals from the Bariatric department to Hematology Oncology for work up of these anemias strain clinic resources and delay timely care for cancer patients. We initiated a targeted education program to reduce unnecessary referrals from the Bariatric department to Hematology Oncology by raising awareness among staff about appropriate referral criteria. Methods: We developed a curriculum highlighting the differences between symptoms of bariatric surgery complications and hematologic malignancies. Interactive training sessions were held with Bariatric department staff, supplemented by informational materials. Case studies and real-world examples reinforced understanding and decision-making. Staff were also educated on managing iron deficiency anemia internally. Referral rates were tracked before and after the intervention. Results: Baseline data were collected from July 2023 to November 2023, showing an average of 17 referrals per month (85 total over 5 months). The educational initiative included three sessions in December 2023 on anemia management and referral criteria. These sessions highlighted the distinction between symptoms of bariatric complications and hematologic malignancies, as well as education to the bariatric surgery providers on management of hematologic diagnoses resulting from bariatric surgery. Post-intervention data from January 2024 to May 2024 showed a substantial reduction in referrals for bariatric-related iron deficiency anemias to an average of 4.4 referrals per month (22 total over 5 months), indicating a 74% reduction. Improved internal management of iron deficiency anemia contributed to this outcome. The percentage of cancer patients receiving a consult within 7 days of referral contemporaneously improved from 85.7% to 88.1%, indicating improved access to oncology care. Conclusions: The educational intervention significantly reduced unnecessary referrals from the Bariatric department to Hematology Oncology, improving access for cancer patients. Empowering staff with the knowledge to make informed referral decisions and manage common hematologic issues internally improved patient care and clinic efficiency, reducing healthcare costs and patient burden in both departments.