Villamor E, Mbise R, Spiegelman D, Ndossi G, Fawzi W W
Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
Am J Trop Med Hyg. 2000 May;62(5):590-7. doi: 10.4269/ajtmh.2000.62.590.
The associations of hemoglobin, hematocrit, and packed cell volume with socioeconomic factors, malaria, human immunodeficiency virus (HIV) infection, and nutritional status were examined among 687 children admitted to hospital with pneumonia participating in a double blind, placebo-controlled trial of vitamin A supplementation. Children were randomized to receive 2 doses of vitamin A (200,000 IU) or placebo at baseline, and additional doses at 4 and 8 months after discharge from hospital. Hemoglobin levels were measured at enrollment and, on a subset of 161 children, during follow-up. At baseline, hemoglobin concentration was positively associated with the number of possessions in the household, maternal level of education and quality of water supply, and inversely related to malaria infection after controlling for potential confounding variables. Children infected with HIV experienced a significant fall in mean hemoglobin levels over time. The risk of developing severe anemia (< 7 g/dL) during follow-up was lower for children who were breastfed for longer than 18 months as compared to those with less than 6 months of breastfeeding (adjusted prevalence ratio = 0.14, 95% confidence interval [CI] = 0.02, 0.93; P = 0.04), and higher for children over two years of age as compared to 6 to 11 months-old infants (adjusted prevalence ratio = 8.11, 95% CI = 1.2, 55.8; P = 0.03). Children with repeated diagnoses of malaria had 4.1 times the risk of developing severe anemia than did children without the diagnosis (95% CI = 1.3, 13.5; P = 0.02). Vitamin A supplements were associated with an overall nonsignificant reduction of 14% in the risk of developing severe anemia (adjusted prevalence ratio = 0.86, 95% CI = 0.37, 1.99; P = 0.73). We conclude that malaria, HIV infection, low socioeconomic status, and short duration of breastfeeding are strong and independent determinants of adverse hematologic profiles in this population.
在一项针对687名因肺炎住院并参与维生素A补充剂双盲、安慰剂对照试验的儿童中，研究了血红蛋白、血细胞比容和红细胞压积与社会经济因素、疟疾、人类免疫缺陷病毒（HIV）感染及营养状况之间的关联。儿童在基线时被随机分为接受2剂维生素A（200,000国际单位）或安慰剂，并在出院后4个月和8个月接受额外剂量。在入组时测量血红蛋白水平，并在161名儿童的子集中进行随访期间测量。在基线时，在控制潜在混杂变量后，血红蛋白浓度与家庭财产数量、母亲教育水平和供水质量呈正相关，与疟疾感染呈负相关。感染HIV的儿童随着时间的推移平均血红蛋白水平显著下降。与母乳喂养少于6个月的儿童相比，母乳喂养超过18个月的儿童在随访期间发生严重贫血（<7 g/dL）的风险较低（调整患病率比=0.14，95%置信区间[CI]=0.02，0.93；P=0.04），与6至11个月大的婴儿相比，两岁以上儿童的风险较高（调整患病率比=8.11，95%CI=1.2，55.8；P=0.03）。反复诊断为疟疾的儿童发生严重贫血的风险是未诊断儿童的4.1倍（95%CI=1.3，13.5；P=0.02）。维生素A补充剂与发生严重贫血风险总体上非显著降低14%相关（调整患病率比=0.86，95%CI=0.37，1.99；P=0.73）。我们得出结论，疟疾、HIV感染、低社会经济地位和母乳喂养时间短是该人群不良血液学特征的强有力且独立的决定因素。
