Department of Epidemiology, Gillings School of Public Health, The University of North Carolina, Chapel Hill, NC, USA.
Universidad Galileo, Guatemala, Guatemala.
Matern Child Health J. 2022 Jan;26(1):156-167. doi: 10.1007/s10995-021-03257-6. Epub 2021 Oct 12.
Folate and vitamin B12 deficiencies can impair proper growth and brain development in children. Data on the folate and vitamin B12 status of children aged 6-59 months in Guatemala are scarce. Identification of factors associated with higher prevalence of these micronutrient deficiencies within the population is needed for national and regional policymakers.
To describe national and regional post-fortification folate and vitamin B12 status of children aged 6-59 months in Guatemala.
A multistage, cluster probability study was carried out with national and regional representation of children aged 6-59 months. Demographic and health information was collected for 1246 preschool children, but blood samples for red blood cell (RBC) folate and vitamin B12 were collected and analyzed for 1,245 and 1143 preschool children, respectively. We used the following deficiency criteria as cutoff points for the analyses: < 305 nmol/L for RBC folate, < 148 pmol/L for vitamin B12 deficiency, and 148-221 pmol/L for marginal vitamin B12 deficiency. Prevalence of RBC folate deficiency and vitamin B12 deficiency and marginal deficiency were estimated. Prevalence risk ratios of RBC folate and vitamin B12 deficiency were estimated comparing subpopulations of interest.
The national prevalence estimates of RBC folate deficiency among children was 33.5% [95% CI 29.1, 38.3]. The prevalence of RBC folate deficiency showed wide variation by age (20.3-46.6%) and was significantly higher among children 6-11 months and 12-23 months (46.6 and 37.0%, respectively), compared to older children aged 48-59 months (20.3%). RBC folate deficiency also varied widely by household wealth index (22.6-42.0%) and geographic region (27.2-46.7%) though the differences were not statistically significant. The national geometric mean for RBC folate concentrations was 354.2 nmol/L. The national prevalences of vitamin B12 deficiency and marginal deficiency among children were 22.5% [95% CI 18.2, 27.5] and 27.5% [95% CI 23.7, 31.7], respectively. The prevalence of vitamin B12 deficiency was significantly higher among indigenous children than among non-indigenous children (34.5% vs. 13.1%, aPRR 2.1 95% CI 1.4, 3.0). The prevalence of vitamin B12 deficiency also significantly varied between the highest and lowest household wealth index (34.3 and 6.0%, respectively). The national geometric mean for vitamin B12 concentrations was 235.1 pmol/L. The geometric means of folate and B12 concentrations were significantly lower among children who were younger, had a lower household wealth index, and were indigenous (for vitamin B12 only). Folate and vitamin B12 concentrations showed wide variation by region (not statistically significant), and the Petén and Norte regions showed the lowest RBC folate and vitamin B12 concentrations, respectively.
In this study, a third of all children had RBC folate deficiency and half were vitamin B12 deficient. Folate deficiency was more common in younger children and vitamin B12 deficiency was more common in indigenous children and those from the poorest families. These findings suggest gaps in the coverage of fortification and the need for additional implementation strategies to address these gaps in coverage to help safeguard the health of Guatemalan children.
叶酸和维生素 B12 缺乏会影响儿童的正常生长和大脑发育。危地马拉 6-59 月龄儿童的叶酸和维生素 B12 状况数据稀缺。需要了解与该人群中这些微量营养素缺乏症较高流行率相关的因素，以便为国家和区域政策制定者提供信息。
描述危地马拉 6-59 月龄儿童强化后的叶酸和维生素 B12 状况。
采用多阶段、聚类概率研究方法，对全国和地区具有代表性的 6-59 月龄儿童进行研究。为 1246 名学龄前儿童收集了人口统计学和健康信息，但仅对 1143 名学龄前儿童采集和分析了红细胞（RBC）叶酸和维生素 B12 血样。我们使用以下缺乏标准作为分析的截止值：RBC 叶酸<305nmol/L、维生素 B12 缺乏<148pmol/L、边缘性维生素 B12 缺乏 148-221pmol/L。估计了 RBC 叶酸缺乏症和维生素 B12 缺乏症以及边缘性缺乏症的流行率。比较了感兴趣的亚人群，估计了 RBC 叶酸和维生素 B12 缺乏的流行率风险比。
全国范围内，儿童 RBC 叶酸缺乏症的流行率估计为 33.5%[95%置信区间（CI）29.1-38.3]。RBC 叶酸缺乏症的流行率随年龄（20.3-46.6%）而变化很大，与 48-59 月龄的儿童（20.3%）相比，6-11 月龄和 12-23 月龄的儿童（分别为 46.6%和 37.0%）明显更高。RBC 叶酸缺乏症也因家庭财富指数（22.6-42.0%）和地理区域（27.2-46.7%）而有很大差异，但差异无统计学意义。RBC 叶酸浓度的全国几何平均值为 354.2nmol/L。儿童中维生素 B12 缺乏症和边缘性缺乏症的全国流行率分别为 22.5%[95%CI 18.2-27.5]和 27.5%[95%CI 23.7-31.7]。与非土著儿童相比，土著儿童的维生素 B12 缺乏症明显更高（34.5% vs. 13.1%，调整后的流行率比[aPRR]2.1[95%CI 1.4-3.0]）。维生素 B12 缺乏症也在最高和最低家庭财富指数之间显著不同（34.3%和 6.0%）。维生素 B12 浓度的全国几何平均值为 235.1pmol/L。在年龄较小、家庭财富指数较低和土著儿童中，叶酸和 B12 浓度的几何平均值较低（仅针对维生素 B12）。叶酸和维生素 B12 浓度在地区之间存在显著差异（无统计学意义），Petén 和 Norte 地区的 RBC 叶酸和维生素 B12 浓度分别最低。
在这项研究中，三分之一的儿童存在 RBC 叶酸缺乏症，一半的儿童存在维生素 B12 缺乏症。叶酸缺乏症在年龄较小的儿童中更为常见，而维生素 B12 缺乏症在土著儿童和最贫困家庭的儿童中更为常见。这些发现表明，强化覆盖范围存在差距，需要采取更多的实施策略来解决这些覆盖差距，以帮助保障危地马拉儿童的健康。
