Relationship of vitamin A deficiency, iron deficiency, and inflammation to anemia among preschool children in the Republic of the Marshall Islands

• Published in: European journal of clinical nutrition 2004-10, Vol.58 (10), p.1396-1401
• Main Authors: Gamble, M.V, Palafox, N.A, Dancheck, B, Ricks, M.O, Briand, K, Semba, R.D
• Format: Article
• Language: English
• Subjects: Anemia; anemia (disease); Anemia - epidemiology; Anemia - etiology; Anemia, Iron-Deficiency - epidemiology; Anemia, Iron-Deficiency - etiology; Anemias. Hemoglobinopathies; Biological and medical sciences; biomarkers; Child, Preschool; Children; Clinical Nutrition; Confidence Intervals; Developing countries; disease prevalence; Diseases of red blood cells; epidemiological studies; Epidemiology; Female; Ferritin; Ferritins - blood; Glycoproteins; Hematologic and hematopoietic diseases; Hemoglobin; Hemoglobins - analysis; human diseases; Humans; Inflammation; Inflammation - complications; Inflammation - epidemiology; Interleukin 10; Internal Medicine; Iron; Iron - deficiency; Islands; LDCs; Linear Models; Male; Marshall Islands Vitamin A Deficiency Study; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Metals (hemochromatosis...); Micronesia; Multivariate Analysis; nutrient deficiencies; Nutrient deficiency; Nutritional Status; Odds Ratio; original-communication; Other metabolic disorders; Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...); Preschool children; Prevalence; Public Health; Regression analysis; Regression models; Retinene; Risk analysis; Risk Factors; Statistical analysis; Tumor necrosis factor-TNF; Tumor necrosis factor-α; tumor necrosis factors; Vitamin A; Vitamin A Deficiency - complications; Vitamin A Deficiency - epidemiology
• ISSN: 0954-3007; 1476-5640
• DOI: 10.1038/sj.ejcn.1601982

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 microgram/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.