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A cross-sectional study of the prevalence of iron and vitamin A deficiency in normal pregnant women in West Java, Indonesia, was carried out. Of the 318 women studied, 49.4% were anemic and, according to multiple criteria, 43.5% had iron-deficiency anemia, 22.3% had iron-deficient erythropoiesis, and 6.6% had iron depletion. Serum retinol values re...
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Citations
... A physiological interdependence between vitamin A deficiency and low iron status has been documented [56]. Vitamin A has been proposed to play a role in regulating plasma iron levels, with decreasing vitamin A levels resulting in decreasing plasma iron [12,13]. Some studies have shown that combined vitamin A and iron supplementation was effective in improving ID [56][57][58]. ...
Anaemia continues to be a persistent concern among South African women of reproductive age (WRA), yet population specific information on its determinants remains sparse. We used baseline data from the Healthy Lives Trajectory Initiative a randomised trial (n = 480) to quantify factors associated with anaemia in Soweto, South Africa aged 18–25 years. We used multivariable logistic regression to describe associations with anaemia and used structural equation modelling to assess a theoretical model, which tested three categories socioeconomic status (household asset score, education level), nutritional factors (food security, leafy green vegetable and chicken and beef consumption, iron status and vitamin A status) and biodemographic factors (parity, age at start of menarche, HIV status, contraception use, anthropometry, and inflammation status). The multiple logistic regression showed that ID (OR: 2.62, 95% CI: 1.72, 3.98), iron deficiency erythropoiesis (IDE) (OR: 1.62, 95% CI: 1.07, 2.46), and elevated CRP (OR: 1.69, 95% CI: 1.04, 2.76), increased the odds of being anaemic. SEM analysis revealed Hb was directly and positively associated with adjusted ferritin (0.0031 per mg/dL; p≤0.001), and CRP (0.015 per mg/dL; p≤0.05), and directly and negatively associated with soluble transferrin receptor sTfR (-0.042 per mg/dL; p≤0.001). While contraception use had both a direct (0.34; p≤0.05) and indirect (0.11; p≤0.01) positive association with Hb. Additionally, chicken and beef consumption had a positive indirect association with Hb concentrations (0.15; p≤0.05) through adjusted ferritin. Iron deficiency was the main anaemia risk factor in this low resource setting. However, anaemia of inflammation is present. Therefore, we suggest that in our setting, WRA anaemia control programs that include interventions to reduce ID and inflammation should be tested.
... The biological causes for anaemia as outlined by the WHO framework ((10) include iron, other micronutrient de ciencies (vitamin A, vitamin B12 and folate) and genetic disorders (11). Vitamin A has been proposed to play a role in regulating plasma iron levels, with decreasing vitamin A levels resulting in decreasing plasma iron (12)(13)(14). The presence of in ammation in an individual may also result in anaemia by causing poor iron absorption, loss of erythrocytes and/or ineffective erythropoiesis (15,16). ...
... Nonetheless, a physiological interdependence between vitamin A de ciency and low iron status has been documented (53). Vitamin A has been proposed to play a role in regulating plasma iron levels, with decreasing vitamin A levels resulting in decreasing plasma iron (12)(13)(14). Some studies have shown that combined vitamin A and iron supplementation was effective in improving ID(14, 54-58) 71-78). ...
Background – Anaemia continues to be a major public health problem among women of reproductive age (WRA). A thorough understanding of anaemia risk factors is necessary to design better interventions. This paper examines the determinants of anaemia among WRA in South Africa.
Methods- We included baseline data from 480 women participating in the pilot-phase of a randomized controlled trial (HeLTI). We measured haemoglobin (Hb) status using the Hemocue. Plasma iron status markers (ferritin and soluble transferrin receptor (sTfR)), markers of inflammation (C-reactive protein (CRP)) and alpha-1-acid glycoprotein (AGP)) and retinol binding protein (RBP) were assessed using the multiplex method. We used multivariate logistic regression to describe associations with anaemia and structural equation modelling (SEM) to characterise direct and indirect pathways influencing haemoglobin concentrations.
Results- The prevalence of anaemia, iron deficiency (ID), and iron deficiency anaemia (IDA) was 39.4%, 38.1% and 21.6% respectively. The multiple logistic regression showed that ID (OR: 2.62, 95% CI: 1.72, 3.98), iron deficiency erythropoiesis (IDE) (OR: 1.62, 95% CI: 1.07, 2.46), and elevated CRP (OR: 1.69, 95% CI: 1.04, 2.76), increased the odds of being anaemic. SEM analysis revealed Hb was directly and positively associated with adjusted ferritin (0.0031 per mg/dl; p≤0.001), and CRP (0.015 per mg/dl; p≤0.05), and directly and negatively associated with soluble transferrin receptor sTfR (-0.042 per mg/dl; p≤0.001). While contraception use had both a direct (0.34; p≤0.05) and indirect (0.11; p≤0.01) positive association with Hb. Additionally, chicken and beef consumption had a positive indirect association with Hb concentrations (0.15; p≤0.05) through adjusted ferritin.
Conclusion-A key driver of anaemia in our setting is ID, however the presence of inflammation also increases the risk of anaemia. To address anaemia, interventions should aim to improve the diet quality of women, in particular access to iron rich foods. We recommend the use of multi-micronutrient supplements with a lower dose of iron and other micronutrients which would ensure that women receive the same benefits as with iron folic acid, while alleviating anaemia of inflammation.
... Indonesia began vitamin A supplementation in the 1970s to combat vitamin A deficiency, 17 essentially eradicated severe "clinical" deficiency, although "subclinical" deficiency is estimated to affect approximately 21% of children in Indonesia. 1 Additionally, earlier reports suggest that vitamin A deficiency is prevalent among Indonesian women. [18][19][20] On the other hand, estimates around folate and B12 deficiencies are scarce. While folate is involved in the synthesis and methylation of DNA, vitamin B12 is an important cofactor in folate metabolism. ...
Background:
Anemia is a public health problem among adolescents in Indonesia. Strategies to prevent or treat anemia should be tailored to local conditions, taking into account its specific etiology and prevalence in a given setting and population group.
Objective:
This review aims to (1) identify and synthesize the current knowledge on the etiology of anemia among adolescents in Indonesia, (2) reveal knowledge gaps in this area, and (3) suggest directions for future research and programmatic work.
Methods:
We systematically searched PubMed, Web of Science, Scopus, Medline, and WorldCat databases for peer-reviewed journal articles to identify which etiological factors were related to anemia among Indonesian adolescents. Research papers were reviewed and included in the review according to inclusion criteria.
Results:
Of 13 studies, 8 showed that anemia was associated with iron deficiency; 4 are suggestive of vitamin A deficiency; and 2 of folic acid deficiency. Five studies underscore different etiological determinants for anemia, such as malaria, protein and energy malnutrition, vitamin B2 deficiency, calcium, and vitamin C deficiency. Based on these findings, we developed a framework on knowledge gaps on the etiology of anemia among adolescents in Indonesia, divided in 3 levels of knowledge: (1) significant knowledge gaps, (2) knowledge gaps, and (3) established knowledge.
Conclusions:
The knowledge gaps around the etiology of anemia among Indonesian adolescents are significant. Our framework emphasizes the need for further research across all etiological factors, namely inadequate nutritional intake and absorption, genetic hemoglobin disorders, infection and inflammation, and menstrual disorders.
... Two common indicators of VAD are circulating (serum or plasma) retinol (R) concentration, and the focus of this review, the relative dose-response (RDR) and modified-RDR (MRDR) tests, herein referred to as RDRs. The RDRs have been used during all major life stages including infancy (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21), childhood , lactation (4,6,(62)(63)(64)(65)(66), pregnancy (66)(67)(68)(69)(70)(71), and old age (72)(73)(74) in the United States and at least 30 other countries. ...
Vitamin A (VA) is an essential nutrient often lacking in the diets of people in developing countries. Accurate biomarkers of VA status are vital to inform public health policy and monitor interventions. The relative dose-response (RDR) and modified-RDR (MRDR) tests are semi-quantitative screening tests for VA deficiency that have been used in Demographic and Health Surveys and VA intervention studies. A systematic review and meta-analysis of sensitivity and specificity were conducted to summarize the physiological evidence to support the RDR tests as methods to assess VA status and investigate the impact of different pathological and physiological states on the tests. A total of 190 studies were screened for inclusion, with 21 studies comparing the RDR tests with the gold-standard biomarker, liver VA concentration (68% and 80% sensitivity and 85% and 69% specificity for the RDR and MRDR, respectively). Nearly all studies with VA interventions in VA-deficient populations demonstrated a response of the tests to VA intake that would be expected to improve VA status. The impacts of chronic liver disease, protein malnutrition, age, pregnancy and lactation, infection and inflammation, and various other conditions were examined in 51 studies. The RDR and MRDR tests were reported to have been used in 39 observational studies, and the MRDR has been used in at least 6 national micronutrient surveys. The RDR and MRDR are sensitive tests for determining population VA status and assessing VA interventions. Although they are robust to most physiological and pathological states, caution may be warranted when using the tests in neonates, individuals with chronic liver disease, and those with protein or iron malnutrition. Research on further improvements to the tests to increase accessibility, such as sampling breast milk instead of blood or using intramuscular doses in subjects with malabsorption, will allow wider adoption. This review was registered with PROSPERO as CRD42019124180.
... The occurrence of this interaction remains debatable 9,10,12,31 . Some studies found no hematological changes in individuals with retinol deficiency, probably due to the hemoglobin levels of patients with VAD 31,32 , while others showed that vitamin A supplementation improved hemoglobin levels 26,33 . ...
OBJECTIVE: The aim of this study was to investigate the association between anemia and vitamin A deficiency in women of childbearing age in Pernambuco, a state in the Brazilian Northeast. METHODS: A cross-sectional study was conducted making a secondary database analysis of"The Third State Survey on Health and Nutrition" done from May to September 2006. Data were collected from 761 women of childbearing age (10-49 years). RESULTS: The simultaneous occurrence of the two deficiencies was found in only seven women (0.9%). The prevalence of anemia was of 15.1%, and of vitamin A deficiency, 8.2%. There was no association between the two conditions (p=0.380), although a positive correlation was found between retinol levels and hemoglobin concentration (r=0.13). CONCLUSION: Anemia and vitamin A deficiency did not coexist. Anemia was considered a mild public health problem, while vitamin A deficiency was not considered an epidemiological problem.
... Significantly lower mean Hb% among pregnant women with VAD compared to healthy women and significant positive correlations between maternal serum retinol and maternal Hb% were reported in previous studies [20][21][22]. Women with VAD had 1.8 times greater risk of being anemic than did the women without VAD [23]. Vitamin A supplementation was found to improve hemoglobin concentrations [9] and reduces maternal anemia for women who live in areas where VAD is common [24]. ...
Background. Vitamin A deficiency (VAD) during pregnancy represents a major public health problem in developing countries. Anemia is a common consequence of VAD. We aimed to measure serum retinol concentrations of a sample of poor Egyptian mothers and correlate it with their Hb% and cord Hb%. Methods. This cross-sectional study included 200 healthy mothers and their healthy full term newborns. Maternal and cord blood samples were collected for CBC and measurement of serum retinol concentrations. Results. Forty-seven mothers (23.5%) had VAD and 50% were anemic. Mothers with VAD had a significantly lower mean Hb% and a significantly higher frequency of anemia (95.7%) compared to mothers without VAD (35.9%). The relative risk for anemia among mothers with VAD was 2.7 (CI = 2.12-3.3). Newborns of mothers with VAD had a significantly lower mean cord Hb% compared to newborns of mothers without VAD. Maternal serum retinol concentrations were positively correlated with maternal Hb% and cord Hb%. Conclusion. Maternal VAD during pregnancy among poor mothers is associated with maternal anemia and lower Hb% of newborns at birth. Vitamin A supplementation is highly recommended for this vulnerable group.
... [12][13][14] Four main developments contributed to a re-awakening of interest in the role of VA supplementation during pregnancy: (1) recognition that maternal supplementation during pregnancy and lactation could be an opportunity to improve the VA status and health of infants, (2) findings from a large trial in Nepal that VA and bC supplementation during pregnancy was associated with a 40% reduction in risk of pregnancy-related mortality, 15 (3) observations that low serum retinol levels were associated with increased risk of mother-to-child transmission of HIV, and the hypothesis that VA, by virtue of its role in epithelial integrity or immune-modulating properties might help to reduce transmission, 16 and (4) recognition that VA might have a role in improving haematological status during pregnancy. 17 The objective of our review was to consolidate knowledge about the effects of supplementation on multiple outcomes related to maternal, perinatal and infant health to inform policy in low-income countries and to identify research priorities. ...
Vitamin A (VA) deficiency during pregnancy is common in low-income countries and a growing number of intervention trials have examined the effects of supplementation during pregnancy on maternal, perinatal and infant health outcomes. We systematically reviewed the literature to identify trials isolating the effects of VA or carotenoid supplementation during pregnancy on maternal, fetal, neonatal and early infant health outcomes. Meta-analysis was used to pool effect estimates for outcomes with more than one comparable study. We used GRADE criteria to assess the quality of individual studies and the level of evidence available for each outcome. We identified 23 eligible trials of which 17 had suitable quality for inclusion in meta-analyses. VA or beta-carotene (βC) supplementation during pregnancy did not have a significant overall effect on birthweight indicators, preterm birth, stillbirth, miscarriage or fetal loss. Among HIV-positive women, supplementation was protective against low birthweight (<2.5 kg) [risk ratio (RR) = 0.79 [95% confidence interval (CI) 0.64, 0.99]], but no significant effects on preterm delivery or small-for-gestational age were observed. Pooled analysis of the results of three large randomised trials found no effects of VA supplementation on neonatal/infant mortality, or pregnancy-related maternal mortality (random-effects RR = 0.86 [0.60, 1.24]) although high heterogeneity was observed in the maternal mortality estimate (I(2) = 74%, P = 0.02). VA supplementation during pregnancy was found to improve haemoglobin levels and reduce anaemia risk (<11.0 g/dL) during pregnancy (random-effects RR = 0.81 [0.69, 0.94]), also with high heterogeneity (I(2) = 52%, P = 0.04). We found no effect of VA/βC supplementation on mother-to-child HIV transmission in pooled analysis, although some evidence suggests that it may increase transmission. There is little consistent evidence of benefit of maternal supplementation with VA or βC during pregnancy on maternal or infant mortality. While there may be beneficial effects for certain outcomes, there may also be potential for harm through increased HIV transmission in some populations.
... O diagnóstico da anemia ferropriva, é melhor verificado quando duas ou três anormalidades indexadas para o status de ferro (ferritina sérica e transferrina sérica) são constatadas, pois são mais específicas que o uso isolado da concentração de hemoglobina 35 . Entretanto, a avaliação dos níveis séricos de hemoglobina tem sido sistematicamente empregada no diagnóstico da anemia, pois é de metodologia rápida e fácil, e cujos pontos de corte para o diagnóstico têm sido recentemente revisados 36 , tendo sido empregada para diagnóstico de anemia no presente estudo. ...
OBJETIVO: Investigar a associação entre intercorrências gestacionais e níveis de retinol e carotenóides em puérperas atendidas em maternidade pública do Rio de Janeiro. MÉTODOS: A amostra foi constituída por 262 puérperas atendidas na Maternidade Escola da Universidade Federal do Rio de Janeiro. O estado nutricional antropométrico foi avaliado pelo do índice de massa corporal pré-gestacional e pelo ganho ponderal gestacional, e foram coletadas informações sobre intercorrências gestacionais nos registros médicos dos prontuários. Foram adotados os pontos de corte 1,05µmol/L e 80µg/dL para definir inadequação dos níveis de retinol e carotenóides séricos, respectivamente. RESULTADOS: Quarenta e dois vírgula sete por cento da amostra foi acometida por intercorrências gestacionais, destacando-se anemia (29,0%), inadequação dos níveis de retinol (24,4%), e síndromes hipertensivas da gravidez (5,7%). Observou-se maior proporção de obesidade pré-gestacional entre mulheres com síndromes hipertensivas da gravidez, em comparação com as não portadoras de tal intercorrência. Verificou-se menor nível médio de carotenóides séricos entre as que desenvolveram síndromes hipertensivas da gravidez e 91,7% destas apresentaram inadequação destes nutrientes. CONCLUSÃO: Os resultados revelam acometimento importante de mulheres por intercorrências gestacionais e por deficiências nutricionais. Além disso, apontam a obesidade pré-gestacional como um possível fator de risco para o desenvolvimento de síndromes hipertensivas da gravidez e sugerem uma associação entre baixos níveis de carotenóides e tal intercorrência.
... O diagnóstico da anemia ferropriva, é melhor verificado quando duas ou três anormalidades indexadas para o status de ferro (ferritina sérica e transferrina sérica) são constatadas, pois são mais específicas que o uso isolado da concentração de hemoglobina 35 . Entretanto, a avaliação dos níveis séricos de hemoglobina tem sido sistematicamente empregada no diagnóstico da anemia, pois é de metodologia rápida e fácil, e cujos pontos de corte para o diagnóstico têm sido recentemente revisados 36 , tendo sido empregada para diagnóstico de anemia no presente estudo. ...
OBJECTIVE: The objective was to investigate an association between pregnancy complications and serum retinol and carotenoid levels in puerpere seen at a public maternity of Rio de Janeiro. METHODS: The sample consisted of 262 puerpere seen at the Maternity School of the Federal University of Rio de Janeiro. Nutritional status was assessed by determining the body mass index before pregnancy and by the weight gained during pregnancy. Information on pregnancy complications was collected from the medical records. Low levels of serum retinol and carotenoids were defined as those below the cut-off points of 1.05mmol/L and 80mg/dL respectively. RESULTS: Almost half the sample (42.7%) had pregnancy complications which included anemia (29.0%), low retinol levels (24.4%) and gestational hypertension (5.7%). Women with gestational hypertension were more likely to be obese before pregnancy when compared with those without gestational hypertension. The mean serum levels of carotenoids were also found to be lower among women who developed gestational hypertension and 91.7% of these women had inadequate levels of these nutrients. CONCLUSION: The results show that many women suffer pregnancy complications and have nutritional deficiencies. Furthermore, they indicate that pregestational obesity may be a risk factor for the development of gestational hypertension and suggest an association between low serum carotenoid levels and gestational hypertension.
... Nesse sentido, alguns estudos têm mostrado que a suplementação com vitamina A eleva os níveis de ferro em mulheres durante a gestação 6,7 , em crianças jovens 8-10 e em adolescentes 11 , independentemente do fornecimento de ferro. A suplementação dietética com vitamina A oferecida a crianças menores de 9 anos na Tailândia, por curto período de tempo (2 semanas) e por período mais longo (4 meses), aumentou os estoques de ferro e a resistência às infecções 9,10,12 . ...
OBJECTIVE: The objective of this study was to verify the relationship between vitamin A and the biochemical markers of iron status. METHODS: A total of 178 individuals aging from 7 to 17 years participated in this study, all living in Jequié, BA. The individuals were submitted to blood tests to dose retinol and biochemical iron markers. Furthermore, anthropometric measurements and stool analyses were done and dietary information regarding iron intake, socio-environmental and home conditions of the family were collected. Multiple linear regression analysis was done to assess the association of interest. RESULTS: A positive and statistically significant association was found between the levels of serum retinol and hemoglobin (p=0.007), serum iron (p=0.010) and iron-saturated tranferrin (p=0.027). These findings remained unchanged after adjusting the models for demographic variables, parasitic infections (Schistosoma mansoni, Trichiura trichuris, Ascaris lumbricoides and ancylostomiasis), consumption of bioavailable dietary iron and environmental and home conditions. CONCLUSION: Vitamin A seems to contribute to the increase of organic iron of the population, especially in areas were deficiency of vitamin A and iron-deficiency anemia coexist.
