Engle-Stone Reina, Aaron Grant J, Huang Jin, Wirth James P, Namaste Sorrel Ml, Williams Anne M, Peerson Janet M, Rohner Fabian, Varadhan Ravi, Addo O Yaw, Temple Victor, Rayco-Solon Pura, Macdonald Barbara, Suchdev Parminder S
Department of Nutrition, University of California, Davis, CA.
Global Alliance for Improved Nutrition, Geneva, Switzerland.
Am J Clin Nutr. 2017 Jul;106(Suppl 1):402S-415S. doi: 10.3945/ajcn.116.142323. Epub 2017 Jun 14.
A lack of information on the etiology of anemia has hampered the design and monitoring of anemia-control efforts. We aimed to evaluate predictors of anemia in preschool children (PSC) (age range: 6-59 mo) by country and infection-burden category. Cross-sectional data from 16 surveys ( = 29,293) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project were analyzed separately and pooled by category of infection burden. We assessed relations between anemia (hemoglobin concentration <110 g/L) and severe anemia (hemoglobin concentration <70 g/L) and individual-level (age, anthropometric measures, micronutrient deficiencies, malaria, and inflammation) and household-level predictors; we also examined the proportion of anemia with concomitant iron deficiency (defined as an inflammation-adjusted ferritin concentration <12 μg/L). Countries were grouped into 4 categories on the basis of risk and burden of infectious disease, and a pooled multivariable logistic regression analysis was conducted for each group. Iron deficiency, malaria, breastfeeding, stunting, underweight, inflammation, low socioeconomic status, and poor sanitation were each associated with anemia in >50% of surveys. Associations between breastfeeding and anemia were attenuated by controlling for child age, which was negatively associated with anemia. The most consistent predictors of severe anemia were malaria, poor sanitation, and underweight. In multivariable pooled models, child age, iron deficiency, and stunting independently predicted anemia and severe anemia. Inflammation was generally associated with anemia in the high- and very high-infection groups but not in the low- and medium-infection groups. In PSC with anemia, 50%, 30%, 55%, and 58% of children had concomitant iron deficiency in low-, medium-, high-, and very high-infection categories, respectively. Although causal inference is limited by cross-sectional survey data, results suggest anemia-control programs should address both iron deficiency and infections. The relative importance of factors that are associated with anemia varies by setting, and thus, country-specific data are needed to guide programs.
缺乏关于贫血病因的信息阻碍了贫血控制工作的设计与监测。我们旨在按国家和感染负担类别评估学龄前儿童（年龄范围：6 - 59个月）贫血的预测因素。对来自反映贫血的炎症和营养决定因素（BRINDA）项目的16项调查（n = 29,293）的横断面数据进行了单独分析，并按感染负担类别进行汇总。我们评估了贫血（血红蛋白浓度<110 g/L）和重度贫血（血红蛋白浓度<70 g/L）与个体水平（年龄、人体测量指标、微量营养素缺乏、疟疾和炎症）及家庭水平预测因素之间的关系；我们还检查了伴有缺铁（定义为炎症校正铁蛋白浓度<12 μg/L）的贫血比例。根据传染病的风险和负担将国家分为4类，并对每组进行汇总多变量逻辑回归分析。在超过50%的调查中，缺铁、疟疾、母乳喂养、发育迟缓、体重不足、炎症、低社会经济地位和卫生条件差均与贫血相关。通过控制与贫血呈负相关的儿童年龄，母乳喂养与贫血之间的关联减弱。重度贫血最一致的预测因素是疟疾、卫生条件差和体重不足。在多变量汇总模型中，儿童年龄、缺铁和发育迟缓独立预测贫血和重度贫血。炎症在高感染和极高感染组中通常与贫血相关，但在低感染和中等感染组中并非如此。在患有贫血的学龄前儿童中，低、中、高和极高感染类别中分别有50%、30%、55%和58%的儿童伴有缺铁。尽管横断面调查数据限制了因果推断，但结果表明贫血控制项目应同时解决缺铁和感染问题。与贫血相关的因素的相对重要性因环境而异，因此，需要特定国家的数据来指导项目。
