母乳喂养和辅食对柬埔寨3至24个月儿童血红蛋白和铁蛋白水平的作用：一项横断面研究
Role of Breastfeeding and Complementary Food on Hemoglobin and Ferritin Levels in a Cambodian Cross-Sectional Sample of Children Aged 3 to 24 Months.
作者信息
Reinbott Anika, Jordan Irmgard, Herrmann Johannes, Kuchenbecker Judith, Kevanna Ou, Krawinkel Michael B
机构信息
Justus Liebig University, Wilhelmstr. 20, 35392 Giessen, Germany.
National Maternal and Child Health Center, Phnom Penh, No. 31A, Rue de France (St. 47), 12202 Phnom Penh, France, Phnom Penh, Cambodia.
出版信息
PLoS One. 2016 Mar 14;11(3):e0150750. doi: 10.1371/journal.pone.0150750. eCollection 2016.
BACKGROUND
Iron deficiency derives from a low intake of dietary iron, poor absorption of iron, and high requirements due to growth as well as blood loss. An estimated number of about 50% of all anemia may be attributed to iron deficiency among young children in Cambodia.
METHODS
A cross-sectional survey was conducted in rural Cambodia in September 2012. Villages in pre-selected communes were randomly chosen using stunting as a primary indicator of nutritional status. In total, 928 randomly selected households with children aged 3-23 months were included. Hemoglobin, ferritin, soluble transferrin receptor (sTfR), and retinol binding protein (RBP) were assessed from capillary blood samples. In addition, length/height and weight of mothers and children were taken and data on dietary diversity was collected. A child feeding index (CFI) was created. Associations between biomarkers of iron and vitamin A status and nutritional status or food intake were explored.
RESULTS
Anemia prevalence was highest among 6- to 12-months-olds (71%). Ferritin and sTfR inversely correlated and were significantly associated with hemoglobin concentrations. The consumption of animal source foods (ASF) significantly impacts on the interaction between ferritin, sTfR and hemoglobin. Concentrations of RBP were significantly higher in children who had received a vitamin A supplement. The CFI was associated with sTfR and hemoglobin. Lower length and weight were associated with lower ferritin levels and showed an indirect effect on hemoglobin through ferritin.
CONCLUSION
Nutrition programs targeting children under 2 years of age need to focus on the preparation of complementary foods with high nutrient density to sustainably prevent micronutrient deficiency and generally improve nutritional status. Future assessments of the micronutrient status should include identification of hemoglobinopathies and parasitic infections to better understand all causes of anemia in Cambodian infants and young children.
TRIAL REGISTRATION
German Clinical Trials Register DRKS00004379.
背景
缺铁源于膳食铁摄入量低、铁吸收不良以及因生长和失血导致的高需求。在柬埔寨，估计约50%的幼儿贫血病例可归因于缺铁。
方法
2012年9月在柬埔寨农村地区进行了一项横断面调查。以发育迟缓作为营养状况的主要指标，从预先选定的公社中随机选取村庄。总共纳入了928户随机选择的有3至23个月大儿童的家庭。从毛细血管血样中评估血红蛋白、铁蛋白、可溶性转铁蛋白受体（sTfR）和视黄醇结合蛋白（RBP）。此外，测量了母亲和儿童的身长/身高和体重，并收集了饮食多样性数据。创建了儿童喂养指数（CFI）。探讨了铁和维生素A状态的生物标志物与营养状况或食物摄入量之间的关联。
结果
6至12个月大的婴儿贫血患病率最高（71%）。铁蛋白和sTfR呈负相关，且与血红蛋白浓度显著相关。动物源性食物（ASF）的摄入对铁蛋白、sTfR和血红蛋白之间的相互作用有显著影响。接受维生素A补充剂的儿童RBP浓度显著更高。CFI与sTfR和血红蛋白相关。较低的身长和体重与较低的铁蛋白水平相关，并通过铁蛋白对血红蛋白产生间接影响。
结论
针对2岁以下儿童的营养项目需要专注于制备高营养密度的辅食，以可持续地预防微量营养素缺乏并总体改善营养状况。未来对微量营养素状况的评估应包括识别血红蛋白病和寄生虫感染，以更好地了解柬埔寨婴幼儿贫血的所有原因。
试验注册
德国临床试验注册中心DRKS00004379 。
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