Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, MD; College of Health and Human Services, Public Health Program, Missouri State University, Springfield, MO; Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA.
Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, MD.
J Pediatr. 2019 Oct;213:74-81.e1. doi: 10.1016/j.jpeds.2019.06.039. Epub 2019 Aug 8.
To estimate the burden of anemia attributable to malaria, inflammation, and deficiency of iron or vitamin A during low and high malaria seasons among Zambian children.
From a cohort of children (n = 820), 4-8 years of age participating in a randomized controlled trial of pro-vitamin A, we estimated attributable fractions for anemia (hemoglobin of <110 or 115 g/L, by age) owing to current malaria or inflammation (C-reactive protein of >5 mg/L, or α-1 acid glycoprotein of >1 g/L, or both), and current or prior iron deficiency (ID; defined as low ferritin [<12 or 15 μg/L for age <5 or >5 years] or functional ID [soluble transferrin receptor of >8.3 mg/L] or both) and vitamin A deficiency (retinol of <0.7 μmol/L), during low and high malaria seasons, using multivariate logistic regression. Serum ferritin, soluble transferrin receptor, and retinol were adjusted for inflammation.
The burden of anemia independently associated with current malaria, inflammation, ID, and vitamin A deficiency in the low malaria season were 12% (P < .001), 6% (P = .005), 14% (P = .001), and 2% (P = .07), respectively, and 32% (P < .001), 15% (P < .001), 10% (P = .06), and 2% (P = .06), respectively, in the high malaria season. In both seasons, functional ID was independently associated with more anemia (approximately 11%) than low ferritin (approximately 4%). Anemia and ID in the low malaria season, accounted for 20% (P < .001) and 4% (P = .095) of the anemia in the subsequent high malaria season.
Anemia in this population is strongly linked to malaria, inflammation, and functional ID, and to a lesser extent, low iron stores. Integrated control strategies are needed.
估计赞比亚儿童在低疟疾季和高疟疾季中，疟疾、炎症、铁或维生素 A 缺乏导致贫血的负担。
我们从参加维生素 A 前体随机对照试验的儿童队列（n=820）中，估计了当前疟疾或炎症（C 反应蛋白>5mg/L 或α-1 酸性糖蛋白>1g/L，或两者）、当前或既往铁缺乏症（定义为低铁蛋白 [<5 岁或>5 岁时 12 或 15μg/L] 或功能性铁缺乏症 [可溶性转铁蛋白受体>8.3mg/L] 或两者）以及维生素 A 缺乏症（视黄醇 <0.7μmol/L）导致贫血的归因分数（血红蛋白<110 或 115g/L，按年龄划分），采用多变量逻辑回归分析。血清铁蛋白、可溶性转铁蛋白受体和视黄醇均根据炎症进行了调整。
在低疟疾季，与当前疟疾、炎症、铁缺乏症和维生素 A 缺乏症相关的贫血负担分别为 12%（P<0.001）、6%（P=0.005）、14%（P=0.001）和 2%（P=0.07），在高疟疾季，分别为 32%（P<0.001）、15%（P<0.001）、10%（P=0.06）和 2%（P=0.06）。在两个季节中，功能性铁缺乏症均与更多的贫血（约 11%）相关，而与低铁蛋白（约 4%）相比。低疟疾季的贫血和铁缺乏症，占后续高疟疾季贫血的 20%（P<0.001）和 4%（P=0.095）。
本研究人群的贫血与疟疾、炎症和功能性铁缺乏症密切相关，与铁储量较低的关系较小。需要综合控制策略。
