Anderson Victoria P, Jack Susan, Monchy Didier, Hem Neang, Hok Phearom, Bailey Karl B, Gibson Rosalind S
Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand.
Asia Pac J Clin Nutr. 2008;17(1):72-9.
The prevalence of malnutrition in Cambodia is among the highest in Southeast Asia, and diarrhea and pneumonia are the leading causes of death among children. Whether these adverse health outcomes are associated with co-existing micronutrient deficiencies is uncertain. We have determined the prevalence of anaemia, as well as iron, zinc, and vitamin A deficiency and their co-existence among stunted children (77 females; 110 males) aged 6-36 mos. Non-fasting morning venipuncture blood samples were taken and analyzed for haemoglobin (Hb), serum ferritin (via IMx system), retinol (via HPLC), and Zn (via AAS), C-reactive protein (CRP) (via turbidimetry) and Hb type (AA, AE, or EE) (via Hb gel electrophoresis). Children with CRP>or=5.0 mg/L (n=34) were excluded. Zinc deficiency defined as serum Zn<9.9 micromol/L had the highest prevalence (73.2%), followed by anaemia (71%) (Hb<110 g/L), and then vitamin A deficiency (28.4%) (serum retinol<0.70 micromol/L). Of the anaemic children, only 21% had iron deficiency anaemia, and 6% had depleted iron stores. Age, log serum ferritin, and Hb type were significant predictors of Hb in the AA and AE children. Serum retinol was unrelated to haemoglobin or serum zinc. The prevalence of two or more micronutrient deficiencies (low Hb, serum retinol, and/or serum zinc) was 44%. Nearly 10% had low values for all three indices, and 18% had just one low value. In conclusion, anaemia, and deficiencies of iron, zinc, and vitamin A are severe public health problems among these stunted Cambodian children. Intervention strategies addressing multiple micronutrient deficiencies are needed.
柬埔寨的营养不良患病率在东南亚地区位居前列，腹泻和肺炎是儿童死亡的主要原因。这些不良健康后果是否与同时存在的微量营养素缺乏有关尚不确定。我们测定了6至36个月大的发育迟缓儿童（77名女性；110名男性）中贫血、铁、锌和维生素A缺乏的患病率及其并存情况。采集非空腹晨间静脉血样，分析血红蛋白（Hb）、血清铁蛋白（通过IMx系统）、视黄醇（通过高效液相色谱法）、锌（通过原子吸收光谱法）、C反应蛋白（CRP）（通过比浊法）和Hb类型（AA、AE或EE）（通过Hb凝胶电泳）。CRP≥5.0mg/L的儿童（n=34）被排除。血清锌<9.9微摩尔/升定义为锌缺乏，其患病率最高（73.2%），其次是贫血（71%）（Hb<110g/L），然后是维生素A缺乏（28.4%）（血清视黄醇<0.70微摩尔/升）。在贫血儿童中，只有21%患有缺铁性贫血，6%的儿童铁储备耗尽。年龄、血清铁蛋白对数和Hb类型是AA和AE儿童Hb的重要预测因素。血清视黄醇与血红蛋白或血清锌无关。两种或更多微量营养素缺乏（低Hb、血清视黄醇和/或血清锌）的患病率为44%。近10%的儿童三项指标值均低，18%的儿童只有一项指标值低。总之，贫血以及铁、锌和维生素A缺乏是这些柬埔寨发育迟缓儿童中严重的公共卫生问题。需要采取针对多种微量营养素缺乏的干预策略。
