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印度 1-19 岁儿童和青少年常见贫血类型的特征：一项基于人群的研究。

Characterisation of the types of anaemia prevalent among children and adolescents aged 1-19 years in India: a population-based study.

机构信息

Population Council, New Delhi, India.

出版信息

Lancet Child Adolesc Health. 2020 Jul;4(7):515-525. doi: 10.1016/S2352-4642(20)30094-8.

DOI:10.1016/S2352-4642(20)30094-8

PMID:32562633

Abstract

BACKGROUND

Anaemia is a serious public health concern in India. However, national estimates for its prevalence are not available for the 5-14 years age group, nor are estimates available for the types of anaemia among children and adolescents (1-19 years). We aimed to assess the prevalence of anaemia among children and adolescents in India and to categorise types of anaemia on the basis of micronutrient deficiencies.

METHODS

We assessed the prevalence of anaemia among children (1-4 years and 5-9 years) and adolescents (10-19 years) using nationally representative data from the Comprehensive National Nutrition Survey. Anaemia was classified on the basis of age and sex-specific WHO cutoffs and serum ferritin, soluble transferrin receptor, folate, cyanocobalamin, and C-reactive protein concentrations as iron deficiency anaemia, folate or vitamin B12 deficiency anaemia, dimorphic anaemia (iron deficiency anaemia and folate or vitamin B12 deficiency anaemia), anaemia of other causes (anaemia not classified as iron deficiency anaemia and folate or vitamin B12 deficiency anaemia), and anaemia of inflammation.

FINDINGS

We included 26 765 children (11 624 aged 1-4 years and 15 141 aged 5-9 years) and 14 669 adolescents. In the weighted sample, anaemia prevalence was 40·5% (4553 of 11 233) among 1-4 year-olds, 23·4% (3439 of 14 664) among 5-9 year-olds, and 28·4% (4064 of 14 300) among adolescents. Among 2862 children aged 1-4 years, iron deficiency anaemia (1045 [36·5%]) was the most prevalent type, followed by anaemia of other causes (702 [24·5%]), folate or vitamin B12 deficiency anaemia (542 [18·9%]), dimorphic anaemia (387 [13·5%]), and anaemia of inflammation (186 [6·5%]). Among 2261 children aged 5-9 years, anaemia of other causes was the most common (986 [43·6%]), followed by folate or vitamin B12 deficiency anaemia (558 [24·6%]), iron deficiency anaemia (353 [15·6%]), dimorphic anaemia (242 [10·7%]), and anaemia of inflammation (122 [5·4%]). 861 (31·4%) of 2740 adolescents had anaemia of other causes, 703 (25·6%) had folate or vitamin B12 deficiency anaemia, 584 (21·3%) had iron deficiency anaemia, 498 (18·2%) and dimorphic anaemia, and 94 (3·4%) had anaemia of inflammation.

INTERPRETATION

Iron deficiency anaemia is the most common form of anaemia among younger children and anaemia of other causes among 5-9-year-old children and adolescents. Folate or vitamin B12 deficiency anaemia accounts for more than a third of anaemia prevalence. Anaemia prevention efforts should focus on strengthening the existing iron and folate supplementation programmes and prevention of folate or vitamin B12 deficiency anaemia.

FUNDING

The Mittal Foundation.

摘要

背景

贫血是印度严重的公共卫生问题。然而，目前尚缺乏印度 5-14 岁儿童贫血的全国估计数据，也缺乏儿童和青少年（1-19 岁）各种类型贫血的估计数据。本研究旨在评估印度儿童和青少年贫血的流行情况，并根据微量营养素缺乏情况对贫血类型进行分类。

方法

我们使用全国代表性的综合国家营养调查数据评估了儿童（1-4 岁和 5-9 岁）和青少年（10-19 岁）的贫血患病率。根据年龄和性别特异性世界卫生组织（WHO）截断值以及血清铁蛋白、可溶性转铁蛋白受体、叶酸、氰钴胺和 C 反应蛋白浓度，将贫血分为缺铁性贫血、叶酸或维生素 B12 缺乏性贫血、双相性贫血（缺铁性贫血和叶酸或维生素 B12 缺乏性贫血）、其他原因引起的贫血（不能归类为缺铁性贫血和叶酸或维生素 B12 缺乏性贫血的贫血）和炎症性贫血。

结果

我们纳入了 26765 名儿童（11233 名 1-4 岁儿童和 15141 名 5-9 岁儿童）和 14669 名青少年。在加权样本中，1-4 岁儿童贫血患病率为 40.5%（4553/11233），5-9 岁儿童为 23.4%（3439/14664），青少年为 28.4%（4064/14300）。在 2862 名 1-4 岁儿童中，缺铁性贫血（1045 例[36.5%]）是最常见的类型，其次是其他原因引起的贫血（702 例[24.5%]）、叶酸或维生素 B12 缺乏性贫血（542 例[18.9%]）、双相性贫血（387 例[13.5%]）和炎症性贫血（186 例[6.5%]）。在 2261 名 5-9 岁儿童中，其他原因引起的贫血最为常见（986 例[43.6%]），其次是叶酸或维生素 B12 缺乏性贫血（558 例[24.6%]）、缺铁性贫血（353 例[15.6%]）、双相性贫血（242 例[10.7%]）和炎症性贫血（122 例[5.4%]）。在 2740 名青少年中，861 名（31.4%）患有其他原因引起的贫血，703 名（25.6%）患有叶酸或维生素 B12 缺乏性贫血，584 名（21.3%）患有缺铁性贫血，498 名（18.2%）和双相性贫血，94 名（3.4%）患有炎症性贫血。