印度农村地区幼儿贫血的决定因素。

Determinants of anemia among young children in rural India.

机构信息

Nossal Institute for Global Health, University of Melbourne, Parkville, Victoria, Australia.

出版信息

Pediatrics. 2010 Jul;126(1):e140-9. doi: 10.1542/peds.2009-3108. Epub 2010 Jun 14.

DOI:10.1542/peds.2009-3108

PMID:20547647

Abstract

OBJECTIVE

More than 75% of Indian toddlers are anemic. Data on factors associated with anemia in India are limited. The objective of this study was to determine biological, nutritional, and socioeconomic risk factors for anemia in this vulnerable age group.

METHODS

We conducted a cross-sectional study of children aged 12 to 23 months in 2 rural districts of Karnataka, India. Children were excluded if they were unwell or had received a blood transfusion. Hemoglobin, ferritin, folate, vitamin B(12), retinol-binding protein, and C-reactive protein (CRP) levels were determined. Children were also tested for hemoglobinopathy, malaria infection, and hookworm infestation. Anthropometric measurements, nutritional intake, family wealth, and food security were recorded. In addition, maternal hemoglobin level was measured.

RESULTS

Anemia (hemoglobin level < 11.0 g/dL) was detected in 75.3% of the 401 children sampled. Anemia was associated with iron deficiency (low ferritin level), maternal anemia, and food insecurity. Children's ferritin levels were directly associated with their iron intake and CRP levels and with maternal hemoglobin level and inversely associated with continued breastfeeding and the child's energy intake. A multivariate model for the child's hemoglobin level revealed associations with log(ferritin level) (coefficient: 1.20; P < .001), folate level (0.05; P < .01), maternal hemoglobin level (0.16; P < .001), family wealth index (0.02; P < .05), child's age (0.05 per month; P < .005), hemoglobinopathy (-1.51; P < .001), CRP level (-0.18; P < .001), and male gender (-0.38; P < .05). Wealth index and food insecurity could be interchanged in this model.

CONCLUSIONS

Hemoglobin level was primarily associated with iron status in these Indian toddlers; however, maternal hemoglobin level, family wealth, and food insecurity were also important factors. Strategies for minimizing childhood anemia must include optimized iron intake but should simultaneously address maternal anemia, poverty, and food insecurity.

摘要

目的

超过 75%的印度幼儿贫血。印度有关贫血相关因素的数据有限。本研究的目的是确定这个脆弱年龄段儿童贫血的生物学、营养和社会经济风险因素。

方法

我们在印度卡纳塔克邦的 2 个农村地区进行了一项 12 至 23 个月龄儿童的横断面研究。如果儿童身体不适或接受过输血，则将其排除在外。测定血红蛋白、铁蛋白、叶酸、维生素 B(12)、视黄醇结合蛋白和 C 反应蛋白（CRP）水平。还对儿童进行了血红蛋白病、疟疾感染和钩虫感染检测。记录了人体测量指标、营养摄入、家庭财富和粮食安全情况。此外，还测量了产妇的血红蛋白水平。

结果

在 401 名抽样儿童中，发现 75.3%存在贫血（血红蛋白水平<11.0 g/dL）。贫血与铁缺乏症（低铁蛋白水平）、产妇贫血和粮食不安全有关。儿童的铁蛋白水平与铁摄入量和 CRP 水平呈正相关，与持续母乳喂养和儿童能量摄入呈负相关。儿童血红蛋白水平的多元模型显示与 log（铁蛋白水平）（系数：1.20；P<0.001）、叶酸水平（0.05；P<0.01）、产妇血红蛋白水平（0.16；P<0.001）、家庭财富指数（0.02；P<0.05）、儿童年龄（每月增加 0.05；P<0.005）、血红蛋白病（-1.51；P<0.001）、CRP 水平（-0.18；P<0.001）和性别（男性为-0.38；P<0.05）有关。在该模型中，可以互换财富指数和粮食不安全。