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Biomarkers and factors associated with anaemia in infants and toddlers ages 6 to 24 months from Retalhuleu, Guatemala
Source publication
One in four children younger than age five in Guatemala experiences anaemia (haemoglobin <11.0 g/dl). This study characterized the factors and micronutrient deficiencies associated with anaemia in a baseline cross-sectional sample of 182 Guatemalan infants/toddlers and 207 preschoolers, using generalized linear mixed models. Associations between an...
Citations
... This relationship has not been extensively studied in clinical settings, particularly in children under five years of age. The high prevalence of anemia among participants, often co-occurring with ZnD, further suggests inadequate zinc intake, as reported in earlier studies from developing countries [19,20]. ...
Introduction
Zinc deficiency (ZnD) impairs the development of acquired immunity and contributes to growth failure in children under five years of age. However, the prevalence of ZnD and its association with immunity in this age group in Uganda have not been well explored. This study aimed to determine the prevalence of ZnD and explore the associations between low serum zinc levels and total white blood cell count, differential cell counts, and levels of IL-1 and IL-2 in children aged 12 to 59 months.
Methods
In this cross-sectional study, we enrolled children aged 12 to 59 months upon admission to the pediatrics ward of Masaka Regional Referral Hospital (MRRH), located in Masaka City, Southern Uganda. Anthropometric measurements were taken and interpreted using the WHO growth standards charts for age and sex. Whole blood cell counts, serum zinc levels, CRP, and IL-2 and IL-4 were measured. Student’s t-test, Mann-Whitney test, and correlation coefficients were used to assess relationships between variables.
Results
A total of 40 children (mean age 27.8 (SD 10.6) months; 50% boys) were enrolled. Nearly a third (13/40) of the children were malnourished (22.5% stunted and 12.5% wasted), and 82.5% had anemia (Hb <11.0 g/dL). The prevalence of ZnD was 40.6%. Serum zinc levels showed a positive correlation with total white blood cell count (rs = 0.41, p = 0.02) and lymphocyte count (rs = 0.43, p = 0.01). However, no association was found between ZnD and levels of IL-2 or IL-4.
Conclusions
The study revealed a high prevalence of ZnD, with serum zinc levels correlating with both total white blood cell and T cell counts, but not with IL-2 levels, in children under five years of age at the time of admission. We recommend the routine inclusion of ZnD assessment and treatment in the care of sick children in the region. Additionally, a larger multicenter longitudinal study is needed to further evaluate the association between malnutrition and health outcomes in this age group.
... An "assets" variable was computed by adding all positive answers indicating ownership or possession of the item. Higher scores indicate more assets in the household [18]. ...
... For continuous outcomes: haz, zwfl, and zwaz, linear mixed models with repeated measures were used to baseline-to 6-and baseline to 12-month changes. Models included factors for group, time, and group-by-time interaction, using a difference-in-difference approach, and models were adjusted by baseline measures of outcome variables, infant sex, maternal education, household asset scores, infant age, breastfeeding status, and the number of adults at home, as number of adults appears to be associated with better nutritional outcomes in similar contexts in the region [18]. Community-cluster was included as a random effect to avoid an inflation of type I error rates in the results from this study [22]. ...
Objective
This community-public-private-academic coalition project implemented and evaluated the effectiveness of a rural, community-based egg intervention that aimed to support the nutrition and health of children living in rural, poor communities from Intibucá, Honduras, during the COVID-19 pandemic.
Design
This investigator-blind, non-randomized, controlled study was informed by a community health improvement process and participatory research. Women from 13 communities were given a microloan to start an egg farm that supplied 1 egg daily to 201 children ages 6–24 months for 1 year (intervention group). Control communities (n = 14) were selected from neighboring municipalities with similar sociodemographic backgrounds based on size. Sociodemographic-, anthropometric-, and morbidity data were collected biannually between January 2021 to January 2022. Outcome changes were compared with linear-, generalized- or Poisson- mixed models adjusted by sex, age, maternal education, breastfeeding status, assets, adults living at home, baseline outcomes, and community-cluster.
Results
Baseline to 6- and 12-month weekly frequency of egg intake significantly increased in the intervention vs. the control group: 6-month change = 1.86; 95%CI (1.61, 2.14); 12-month change = 1.63; 95%CI (1.42, 1.87 p<0.001), respectively. Baseline to 12-month changes in the intervention group were not significant for length/height-for-age-z-scores = 0.12, p = 0.187; weight-for-length/height-z-scores = -0.02, p = 0.78; and diarrhea prevalence, AOR = 1.69; 95%CI (0.53, 5.42), p = 0.378. Lower odds of respiratory infections were observed for the intervention vs. the control group at 6- and 12-month post: AOR = 0.28; 95%CI (0.12, 0.63), p = 0.002; AOR = 0.30; 95%CI (0.12, 0.75), p = 0.010, respectively.
Conclusions and relevance
Children in the intervention group reported consuming eggs more days per week relative to the control group. Lower odds of respiratory infections were observed in the intervention group throughout the study. Ongoing follow-up will offer more insights on the intervention’s effectiveness in linear growth, dietary diversity, food security, and other nutritional outcomes.
... Both indicators are affected significantly by the deficiency of key micronutrients including iron (Black et al., 2008;Locks et al., 2023;Mutumba et al., 2023) and zinc (Greffeuille et al., 2021;Imdad et al., 2023;Palacios et al., 2020;Umeta et al., 2000;Wastney et al., 2018). Dietary intake of these micronutrients, however, is ...
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.
... ) remain a significant contributor to childhood anaemia in Bangladesh [11,12]. Studies in other settings have found that zinc deficiency may be a new determinant of anaemia [13][14][15]. Zinc involves several coenzyme systems, DNA synthesis, and lots of biochemical mechanisms in the human body, and its deficiency may adversely affect the different body systems, including the hemopoietic system [16][17][18]. Zinc deficiency in Bangladesh is a major micronutrient disorder with a high (48.6%) ...
... In addition to supplying iron, vitamin A, folate, and vitamin B 12 are micronutrients of interest when considering supplementation as an intervention to address anemia. Although zinc and iron share common transport mechanisms in the gastrointestinal tract, the role of zinc deficiency in causation of anemia remains a gap in the knowledge, although the coexistence of zinc and iron deficiency can be explained although biological mechanisms [198] and is also seen in population studies [199]. Foy and Mbaya [200] also identify riboflavin as a vitamin whose severe deficiency leads to anemia. ...
Anemia is a multifactorial condition; approaches to address it must recognize that the causal factors represent an ecology consisting of internal (biology, genetics, and health) and external (social/behavioral/demographic and physical) environments. In this paper, we present an approach for selecting interventions, followed by a description of key issues related to the multiple available interventions for prevention and reduction of anemia. We address interventions for anemia using the following 2 main categories: 1) those that address nutrients alone, and, 2) those that address nonnutritional causes of anemia. The emphasis will be on interventions of public health relevance, but we also consider the clinical context. We also focus on interventions at different stages of the life course, with a particular focus on women of reproductive age and preschool-age children, and present evidence on various factors to consider when selecting an intervention—inflammation, genetic mutations, nutrient delivery, bioavailability, and safety. Each section on an intervention domain concludes with a brief discussion of key research areas.
... Deficiencies of several other metal nutrients, such as zinc (Zn), magnesium (Mg) and copper (Cu), may also be associated with anemia (13)(14)(15). In addition, deficiencies of these metal nutrients increase the risk of anemia in children, adolescents, adults and older adults (14,16,17). ...
... Deficiencies of several other metal nutrients, such as zinc (Zn), magnesium (Mg) and copper (Cu), may also be associated with anemia (13)(14)(15). In addition, deficiencies of these metal nutrients increase the risk of anemia in children, adolescents, adults and older adults (14,16,17). However, there has been little examination of associations between concentrations of metal nutrients during pregnancy and postpartum anemia, and some of these non-Fe metal nutrients (e.g., Zn and Cu) may interact with Fe metabolism and affect the development of anemia (13,18,19). ...
Background and Aims
The association between serum concentrations of metal nutrients in pregnancy and postpartum anemia has not been widely studied. This study aimed to determine this association in a large retrospective cohort study.
Methods
We included 14,829 Chinese women with singleton pregnancies. Serum concentrations of metals before 28 weeks of gestation, the occurrence of postpartum anemia and other potential covariates were obtained from their laboratory or medical records. Cox regression and restricted cubic spline regression models were used to explore the relationship between serum concentrations of metal nutrients in pregnancy and postpartum anemia.
Results
After adjustment for covariates, higher concentrations of iron (Fe), magnesium (Mg) and zinc (Zn) and lower concentrations of copper (Cu) were associated with a lower risk of postpartum anemia. Compared with those whose serum concentrations of metal nutrients were in the bottom quintile (Q1), the hazard ratios (HRs) of those whose serum concentrations of metal nutrients were in the top quintile (Q5) were 0.57 (95% confidence interval (CI): 0.50, 0.64) for Fe, 0.67 (95% CI: 0.60, 0.76) for Mg, 0.82 (95% CI: 0.73, 0.93) for Zn, and 1.44 (95% CI: 1.28, 1.63) for Cu. L-shaped curve relationships were found between increasing concentrations of Fe, Mg, and Zn and incidence of postpartum anemia. Higher serum concentrations of Cu were associated with an increased risk of postpartum anemia. Serum concentrations of Fe in Q5 were associated with a lower risk of postpartum anemia when they coincided with serum concentrations of Mg in Q5, Zn in Q5, or Cu in Q1.
Conclusion
Higher serum concentrations of Fe, Mg, and Zn, and lower serum concentrations of Cu were associated with a lower risk of postpartum anemia among pregnant women.
... Nutrient deficiency and inflammation are the most common causes of anemia in children [2]. Among nutrients, particularly iron, vitamin B12, vitamin A, folate, zinc and protein deficiencies are associated with anemia [2][3][4]. Unfortunately, the diets of children under two of age in Africa and South Asia usually lack or poorly provide these nutrients [5,6]. Children in Africa, East Asia, and the Pacific and South Asia rank the highest in one or more of the deficiencies of iron, zinc, and vitamin A [7]. ...
Cereal-based diets contribute to anemia in Ethiopian children. Eggs have nutrients to boost hemoglobin levels as well as counter concurrent anemia and stunting (CAS) and morbidity status. A community trial, targeting 6-18 months old children, was conducted in Halaba. Two clusters were randomly selected and allocated to intervention (N = 122) and control (N = 121) arms. Intervention group (IG) children received egg-laying hens with caging in a cultural ceremony declaring child ownership of the chickens. Parents promised to feed eggs to the child. Health and agriculture extension workers promoted egg feeding, poultry husbandry, and sanitation to IG families. Control group (CG) had standard health and agriculture education. At baseline, groups were not different by hemoglobin, anemia, CAS, and morbidity status. Mean hemoglobin was 11.0 mg/dl and anemia prevalence was 41.6%. About 11.9% of children had CAS and 52.3% were sick. Using generalized estimating equations, the intervention increased hemoglobin by 0.53 g/dL (ß:0.53; p < 0.001; 95% CI: 0.28-0.79). IG children were 64% (p < 0.001; odds ratio [OR]:0.36; 95% CI: 0.24-0.54) and 57% (p = 0.007; OR: 0.43; 95% CI: 0.21-0.73) less likely to be anemic and have CAS, respectively, than CG, with no difference in morbidity. Child-owned poultry intervention is recommended in settings where anemia is high and animal-source food intake is low.
... Our finding is consistent with other studies on the Mexican children, which have shown that the Mexican children have ZnD [49][50][51][52]. Likewise, other studies performed on the Latin American population showed similar results [53][54][55][56][57]. On the other hand, our results did not show significant differences in the age and sex distribution between the population studied with and without ZnD. ...
Zinc (Zn) participates as a cofactor for many enzymes in the cellular metabolism, and its serum levels have been associated with different metabolic diseases, especially obesity (OB). Nevertheless, its associations are not clear in the children population. The objective of this study is to evaluate the association between serum Zn levels (SZn) with overweight/obesity status (OW/OB), as well as its cardiometabolic traits in a population of children in Mexico City. Anthropometrical data (body mass index z score (BMIz)), demographic variables (age and sex), and cardiometabolic traits (total cholesterol (TC), high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), triglycerides (TG), fasting plasma glucose (FPG), and insulin) were analyzed in this cross-sectional study. SZn were measured by inductively coupled plasma mass spectrometry (ICP–MS). The population included 210 children from Mexico City (girls (n = 105) and boys (n = 105)) between ages 6 and 10 years. Normal-weight (NW) schoolchildren had higher SZn concentrations (66 µg/dL; IQR: 48 to 91) compared to OW or OB schoolchildren (61 µg/dL; IQR: 45 to 76). The data showed a significant negative association between SZn and BMIz without sex exclusion (r = − 0.181 and p = 0.009). The boy’s population did not show an association between the SZn and BMIz compared to the girl’s population which showed a significant negative association (r = − 0.277 and p = 0.004). In addition, other associations were found between SZn and TC (boys (r = 0.214 and p = 0.025), LDLc (boys (r = 0.213 and p = 0.029), and TG (girls (r = − 0.260 and p = 0.007)). Moreover, 38.6% of the total children in our population study had Zn deficiency (ZnD). NW schoolchildren had higher SZn concentrations compared to OW or OB schoolchildren. A diet low in Zn can be a factor to evaluate in the development of childhood OB in Mexico. However, further studies need to be performed on the children Mexican population to replicate and confirm our findings.
... Three additional studies support associations between zinc status and anemia. A recent study in Guatemala found a strong association between zinc de ciency and anemia in infants/toddlers aged 6-24 months: The odds of anemia were >3 times greater for infants and toddlers with zinc de ciency (OR = 3.40; 95% CI [1.54, 7.47]) [19]. Another recent study in schoolchildren in Turkey that examined the relationship between zinc status, ferritin and hemoglobin, together with other estimates of anemia, found that zinc de ciency was the strongest predictor of observed anemia [20]. ...
Zinc could play a causal role in the etiology of anemia because of its many required functions in iron metabolism and immune health. Zinc deficiency and anemia often coexist, especially in low-income settings, where there are low intakes of iron and zinc, high intakes of phytates, and increased risk of inflammation. Although it is unknown to what degree zinc deficiency can exacerbate or even independently cause anemia, there are several steps in which zinc is required in the regulation of hematopoiesis. Directly, decreased zinc availability could impair expression of iron transporters and other regulatory proteins important for iron homeostasis and erythroid development. Indirectly, decreased zinc availability could alter immune response and increase oxidative stress, both of which can interfere with hemoglobin production. However, zinc supplementation studies with cell lines, animals, and humans have not consistently shown an increase in hemoglobin concentrations. Therefore, the degree to which zinc affects anemia, if any, remains unclear and needs further investigation.
... Several studies have shown zinc's anti-cancerous effects, including prevention and treatment of hair loss, enhancement of immune system activity, wound healing, and acne improvement (1,2,10). Previous studies have also reported that zinc can prevent molecular degeneration and, therefore, is very useful in treating arthritic rheumatoid and Wilson disease (11)(12)(13)(14). In addition, some studies have highlighted the need for a large amount of zinc in treating enteropathic acrodermatitis, alcoholism, diabetes mellitus, kidney disease, and inflammatory bowel disease (3,4,15). ...
... In addition, some studies have highlighted the need for a large amount of zinc in treating enteropathic acrodermatitis, alcoholism, diabetes mellitus, kidney disease, and inflammatory bowel disease (3,4,15). Zinc deficiency is considered a very serious health problem since it is the fifth most important cause of disease, leading to morbidity and mortality (11)(12)(13). Many studies have shown that zinc deficiency in humans causes postponed growth, skin lesions, and sexual dysfunction in adolescents (16)(17)(18)(19). ...
... Zinc deficiency causes more than 800,000 annual deaths in children around the world. Zinc deficiency in humans is caused by reduced dietary intake, poor absorption, increased loss, or increased body system consumption (11,14). According to the World Health Organization (WHO), the prevalence of zinc deficiency has reached 31% in the world (14,20,21 through fish, meat, dairy foods, cereals, and supplements (22,23). ...
Background: Zinc and vitamin B12 are the foremost important micronutrients. About a quarter of Iranian households have a zinc deficiency. Objectives: Considering the importance of these micronutrients, this study aimed to investigate the association between zinc deficiency and vitamin B12 in people of different ages who had their blood tested in the Pasteur laboratory in Ahvaz. Methods: In this cross-sectional study, serum levels of zinc and vitamin B12 were measured using atomic absorption spectrophotometry and electro-chemiluminescence, respectively. Then, samples were divided into normal and zinc-deficient groups based on serum zinc levels. Serum vitamin B12 levels were also compared between two defined groups. The correlation between age and both zinc and vitamin B12 were determined through statistical tests. Results: In 60.5% of samples, serum zinc was lower than in the normal group. However, the two groups had no statistically significant difference in zinc levels (P = 0.085). Findings showed that with increasing one year of age, serum zinc level decreases by 0.13 units, and serum level of vitamin B12 increases by 0.19 units. Although the serum level of vitamin B12 in the group with normal zinc levels was higher than in the zinc-deficient group, this difference was not statistically significant (P = 0.743). Conclusions: Zinc and Vitamin B12 serum levels can have a clinically positive correlation, and zinc deficiency might be effective in manipulating vitamin B12 status in the body.
