Willows N D, Morel J, Gray-Donald K
School of Dietetics and Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Que.
CMAJ. 2000 Feb 8;162(3):323-6.
Anemia is common among First Nation infants in Canada, often as a result of iron deficiency, which places them at risk for psychomotor impairment. Prevalence data are unavailable, and the risk factors are unknown. This study assessed the prevalence of anemia and associated risk factors among 9-month-old Cree infants in northern Quebec.
Between January 1995 and October 1998, 6 of 9 Cree villages in the James Bay region adopted a screening protocol for anemia in 9-month-old infants. Cross-sectional data were obtained from medical charts. The data for babies of very low birth weight and those with fever or infection were excluded. Among the 386 babies whose hemoglobin concentration was known, the type of milk consumed at the time of screening was known for 354. Associations between hemoglobin concentration and mean cell volume at 9 months, and milk type and weight gain since birth were analysed.
The mean hemoglobin concentration of the 386 infants was 114.1 (standard deviation [SD] 10.6) g/L. The prevalence of anemia was 31.9% (95% confidence interval [CI] 27.2%-36.7%) with a hemoglobin cutoff value of 110 g/L, 17.6% 95% CI 13.9%-21.7%) with a cutoff value of 105 g/L, and 7.8% (95% CI 5.3%-10.9%) with a cutoff value of 100 g/L. Babies exclusively fed formula at 9 months had a higher mean hemoglobin concentration (118.5 [SD 9.9] g/L) than those exclusively fed breast milk (109.9 [SD 10.0] g/L), cow's milk (112.5 [SD 10.1] g/L) or more than one type of milk (112.0 [SD 10.8] g/L) (p < 0.05). Compared with formula, the odds ratio (OR) for anemia was 7.9 (95% CI 3.4-18.2) for breast milk, 5.0 (95% CI 2.0-12.7) for cow's milk and 5.2 (95% CI 1.9-14.6) for mixed milks. Infants fed formula and those fed cow's milk had significantly greater weight gains since birth, by 724 g and 624 g respectively, than breast-fed infants (p < 0.05). When milk type was controlled for, weight gain since birth was significantly associated with the presence of microcytic erythrocytes (OR comparing highest tertile of weight gain to lowest tertile 2.9, 95% CI 1.2-6.6).
Iron-deficiency anemia is highly prevalent among James Bay Cree infants. Measures to increase iron intake are required.
贫血在加拿大原住民婴儿中很常见，通常是缺铁所致，这使他们面临精神运动发育受损的风险。目前尚无患病率数据，危险因素也不明。本研究评估了魁北克北部9个月大的克里族婴儿贫血患病率及相关危险因素。
1995年1月至1998年10月期间，詹姆斯湾地区9个克里族村庄中的6个采用了针对9个月大婴儿的贫血筛查方案。从病历中获取横断面数据。排除极低出生体重儿以及发热或感染婴儿的数据。在386名血红蛋白浓度已知的婴儿中，354名婴儿筛查时所食用的牛奶类型已知。分析了9个月时血红蛋白浓度与平均红细胞体积之间的关联，以及牛奶类型与自出生以来体重增加之间的关联。
386名婴儿的平均血红蛋白浓度为114.1（标准差[SD]10.6）g/L。血红蛋白临界值为110 g/L时，贫血患病率为31.9%（95%置信区间[CI]27.2%-36.7%）；临界值为105 g/L时，患病率为17.6%（95%CI 13.9%-21.7%）；临界值为100 g/L时，患病率为7.8%（95%CI 5.3%-10.9%）。9个月时纯母乳喂养的婴儿平均血红蛋白浓度（109.9[SD 10.0]g/L）低于纯配方奶喂养的婴儿（118.5[SD 9.9]g/L）、纯牛奶喂养的婴儿（112.5[SD 10.1]g/L）或多种奶混合喂养的婴儿（112.0[SD 10.8]g/L）（p<0.05）。与配方奶相比，母乳喂养婴儿患贫血的比值比（OR）为7.9（95%CI 3.4-18.2），牛奶喂养婴儿为5.0（95%CI 2.0-12.7），混合奶喂养婴儿为5.2（95%CI 1.9-14.6）。自出生以来，配方奶喂养婴儿和牛奶喂养婴儿体重增加显著更多，分别比母乳喂养婴儿多724 g和624 g（p<0.05）。在控制牛奶类型后，自出生以来的体重增加与小细胞红细胞的存在显著相关（将体重增加最高三分位数与最低三分位数进行比较的OR为2.9，95%CI 1.2-6.6）。
缺铁性贫血在詹姆斯湾克里族婴儿中非常普遍。需要采取措施增加铁摄入量。
