ArticlePDF Available

Zinc Deficiency Is Associated with Anemia Among Children Under 24 Months-of-age in Rural Guatemala (P10-111-19)

Authors:
Ana M Palacios at Georgia Southern University
Ana M Palacios
Kristen Hurley
Kristen Hurley
Kristen Hurley
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Silvia De Ponce
Silvia De Ponce
Silvia De Ponce
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Víctor Alfonso at Autonomous University of Bucaramanga
Víctor Alfonso
Show all 10 authorsHide
Download full-text PDF
Read full-text
Download citation

Abstract

Objectives: Anemia is a major public health problem among young children. In addition to iron deficiency, other micronutrient deficiencies have been associated with anemia. The purpose of this study was to identify biomarkers associated with anemia in children <5 years from rural Guatemala. Methods: A total of 182 infants (6-24 m) and 207 preschoolers (36-60 m) were recruited from community surveillance to participate in a randomized controlled trial of nutrition and child development. Methods included measured weight, length/height and venous blood draws. Inclusion criteria were length/height-for-age z-score <-1.0 and Hb >7.0 g/dL. Cross-sectional analyses using generalized linear mixed models of baseline data examined associations between anemia (Hb <11.0 g/dL) and micronutrient deficiencies, adjusting for maternal, child and sociodemographic variables. Iron deficiency was defined as low ferritin based on inflammation status, and/or high soluble transferrin receptor, ≥1.97 mg/L. Deficiencies for other parameters were designated as: zinc <65 µg/dL; vitamin B12 < 200 pg/mL; and plasma folate <3 ng/mL or erythrocyte folate <100 ng/mL. Results: Prevalence of anemia was 56% in infants and 12% in preschoolers. Among anemic infants/preschoolers, rates of iron, zinc, folate and vitamin B12 deficiencies were 83/75%; 63/18%; 3/4%; and 9/0%, respectively. For infants, the odds of anemia were higher when children were zinc deficient [OR = 3.59;95%CI (1.64-7.85)], after adjusting for community cluster, sex, age, maternal education and household size. No biomarkers were associated with anemia in preschoolers. Conclusions: Iron and zinc are common micronutrient deficiencies in children from low- and middle-income countries. These findings suggest that micronutrient deficiencies coexist among children in Guatemala, and that zinc should be considered as part of the prevention strategies to reduce anemia. In preschoolers, no biomarkers were associated with anemia, suggesting that other biological and psychosocial factors could be influencing anemia in this age group. Funding sources: The Mathile Institute for the Advancement of Human Nutrition, Sackler Institute for Nutrition Science of the New York Academy of Sciences.
Available via license: CC BY-NC-ND 4.0
Content may be subject to copyright.
880 Global Nutrition
Zinc Deciency Is Associated with Anemia Among Children
Under 24 Months-of-age in Rural Guatemala (P10-111-19)
Ana Palacios,1Kristen Hurley,2Silvia De Ponce,3Victor
Alfonso,3Nicholas Tilton,4Kaley Lambden,5Gregory Reinhart,6
Jeanne Freeland-Graves,7Lisa Villanueva,6and Maureen Black8
1Department of Nutritional Sciences, The University of Texas
at Austin; 2Johns Hopkins Bloomberg School of Public Health;
3Asociacion Para la Prevencion y Estudio del VIH/SIDA; 4Department
of Epidemiology and Public Health, University of Maryland School of
Medicine; 5Center for Human Nutrition, Department of International
Health Johns Hopkins Bloomberg School of Pub; 6The Mathile Institute
for the Advancement of Human Nutrition; 7University of Texas at
Austin; and 8University of Maryland School of Medicine
Objectives: Anemia is a major public health problem among young
children. In addition to irondecienc y, other micronutrient deciencies
have been associated with anemia. The purpose of this study was to
identify biomarkers associated with anemia in children <5yearsfrom
rural Guatemala.
Methods: A total of 182 infants (6–24 m) and 207 preschoolers
(36–60 m) were recruited from community surveillance to participate
in a randomized controlled trial of nutrition and child development.
Methods included measured weight, length/height and venous blood
draws. Inclusion criteria were length/height-for-age z-score <-1.0
and Hb >7.0 g/dL. Cross-sectional analyses using generalized linear
mixed models of baseline data examined associations between anemia
(Hb <11.0 g/dL) and micronutrient deciencies, adjusting for maternal,
child and sociodemographic variables. Iron deciency was dened
as low ferritin based on inammation status, and/or high soluble
transferrin receptor, ≥1.97 mg/L. Deciencies for other parameters
were designated as: zinc <65 µg/dL; vitamin B12 <200 pg/mL; and
plasma folate <3 ng/mL or erythrocyte folate <100 ng/mL.
Results: Prevalence of anemia was 56% in infants and 12% in
preschoolers. Among anemic infants/preschoolers, rates of iron, zinc,
folate and vitamin B12 deciencies were 83/75%; 63/18%; 3/4%;
and 9/0%, respectively. For infants, the odds of anemia were higher
when children were zinc decient [OR =3.59;95%CI (1.64–7.85)],
after adjusting for community cluster, sex, age, maternal education
and household size. No biomarkers were associated with anemia in
preschoolers.
Conclusions: Iron and zinc are common micronutrient deciencies
in children from low- and middle-income countries. These ndings
suggest that micronutrient deciencies coexist among children in
Guatemala,andthatzincshouldbeconsideredaspartofthe
prevention strategies to reduce anemia. In preschoolers, no biomarkers
were associated with anemia, suggesting that other biological and
psychosocial factors could be inuencing anemia in this age group.
Funding Sources: The Mathile Institute for the Advancement of
Human Nutrition, Sackler Institute for Nutrition Science of the New
York Academy of Sciences.
CURRENT DEVELOPMENTS IN NUTRITION
... Our study comprised 57.0% females, predominantly in the age group of 20-70 years. This finding aligns with observations from several prior studies that reported a higher prevalence of vitamin B12 deficiency among females compared to males [7,16,17]. Factors such as inadequate dietary intake, overcooking of food, poor absorption, and low socioeconomic status likely contribute to vitamin B12 insufficiency in our community. Additionally, specific life stages and conditions, such as pregnancy and lactation, may further impact vitamin B12 levels in females, making them more susceptible to deficiency [18]. ...
... This functional cobalamin deficiency may arise due to increased binding of vitamin B12 to haptocorrin, leading to a reduction in the delivery of B12 to peripheral cells [20]. Relying solely on serum B12 assays can result in up to a 50% misdiagnosis rate [16]. Serum cobalamin levels may fall within the normal range in patients with clinical signs of cobalamin deficiency. ...
Comparing Holotranscobalamin and Total Vitamin B12 in Diagnosing Vitamin B12 Deficiency in Megaloblastic Anemia Patients
Article
Full-text available
  • Oct 2024
Background Megaloblastic anemia is characterized by abnormally large red blood cells caused by a deficiency in either vitamin B12 or folic acid, both of which are essential for DNA synthesis. Vitamin B12 insufficiency can lead to severe neurological damage, making early identification of vitamin B12 deficiency crucial to prevent irreversible harm. Vitamin B12 deficiency results in decreased levels of holotranscobalamin (Holo-TC) and increased levels of methylmalonic acid (MMA). Methylmalonic acid is considered the gold standard for diagnosing B12 deficiency because it is a specific marker that rises when B12 is insufficient, even when serum B12 levels appear normal. Elevated MMA levels reflect impaired B12 metabolism, making it a critical tool for early detection and intervention. Previous research indicates that Holo-TC, the active form of vitamin B12 available to cells, is a more specific diagnostic tool for early vitamin B12 deficiency than total B12. This study aims to determine the diagnostic validity of total vitamin B12 and Holo-TC using MMA as the gold standard in patients with megaloblastic anemia. Methods A total of 95 megaloblastic anemia patients were selected from Jinnah Hospital and Lahore General Hospital, Lahore, Pakistan, after receiving approval from the ethical review committees. This was a cross-sectional study. Whole blood, serum, and urine samples were collected in ethylenediamine tetraacetic acid (EDTA) vials, gel vials, and urine containers, respectively. The EDTA samples were used for complete blood count measurements using a hematology analyzer (Sysmex-XT 1800i, Sysmex America, Inc., Mundelein, IL), while serum and urine samples were employed for the detection of serum folic acid, cobalamin, Holo-TC, and MMA levels through manual enzyme-linked immunosorbent assay (ELISA) techniques. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of Holo-TC and cobalamin were calculated. Results The majority of patients fell within the age group of 20-70 years, with 57% of them being females and 43% males; Holo-TC exhibited a sensitivity of 98.9% and specificity of 50.00%, with a PPV of 98.90% and NPV of 50%. Vitamin B12 demonstrated a sensitivity of 63% and specificity of 50%, with a PPV of 98.33% and NPV of 2.85%. The diagnostic accuracy of Holo-TC and vitamin B12 was observed to be 97.8% and 63%, respectively. Conclusions Between the two, Holo-TC displays higher diagnostic accuracy than vitamin B12 and can serve as the primary test for patients suspected of having vitamin B12 deficiency.
View
Maternal Level of Education and Nutritional Practices Regarding Iron Deficiency Anemia Among Preschoolers in Jordan
Article
  • Sep 2020
Purpose: This study aims to assess maternal level of education and nutritional practices in order to determine the risk factors related to iron deficiency anemia (IDA) in preschoolers. Design and methods: A descriptive correlational design was adopted. A cross-sectional sample of 100 anemic preschool children aged 36-59 months (47 girls, 53 boys) was recruited. Data were collected in structured interviews with their mothers. Results: Almost half of children (47%) were moderately anemic and 53% were mildly anemic. Pearson's chi-squared test showed a significant statistical relationship between maternal educational level and hemoglobin level (χ2 = 8.820, p = 0.012). Exclusive breast feeding for the first six months was not associated significantly with low level of hemoglobin 10(χ2 = 2.696, p = 0.101). Complementary feeding had been initiated at 4 months for 30% of children with mild anemia and 24% with moderate anemia (p = 0.122). In the last 24 h there had been minimal consumption of iron absorption enhancers and relatively high consumption of iron absorption inhibitors. Conclusion: Our results support the relationship between level of maternal education and level of hemoglobin. However, breastfeeding was not associated with low hemoglobin level since mother had poor nutritional practices regarding breastfeeding. Practical implications: Health care providers in the southern region of Jordan are recommended to assess the level of maternal knowledge concerning IDA in preschoolers, and conduct educational sessions pertaining to IDA for those with low educational levels. Influencing factors associated with IDA among preschool children in Karak city could be elucidated by a comparative study of anemic and nonanemic preschoolers, which may give a clearer picture of the maternal nutritional practices.
View
ResearchGate has not been able to resolve any references for this publication.