Gosdin Lucas, Addo O Yaw, Palmieri Mireya, Mesarina Karla, Mazariegos Dora Inés, Martínez Carolina, Santizo Maria Claudia, Guzmán Lizet, Alfaro Yma, Flores-Ayala Rafael, Jefferds Maria Elena D
International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States.
Nutrition and Micronutrients Unit, Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala.
Curr Dev Nutr. 2023 Jul 20;7(8):101970. doi: 10.1016/j.cdnut.2023.101970. eCollection 2023 Aug.
Food fortification and micronutrient supplementation are public health strategies to improve micronutrient status in Guatemala; their population effectiveness has not been evaluated in recent years.
We evaluated trends in food fortification, micronutrient supplementation, anemia, and iron deficiency among nonpregnant women aged 15-49 y [women of reproductive age (WRA)] and children 6-59 aged mo [preschool age children (PSC)].
Nationally representative serial cross-sectional surveys were used to assess changes in hemoglobin, anemia, ferritin, iron deficiency, iron deficiency anemia, and self-reported consumption of fortifiable foods and micronutrient supplements during 2008/2009, 2013, 2015, 2016, 2017/2018, and 2018/2019. Predictors of hemoglobin and ferritin were assessed using generalized linear mixed models adjusted for survey year as random effects, and the consumption of fortifiable foods, supplements, and other potential confounders were fixed effects.
Multiple micronutrient powder consumption among PSC during the previous 3 mo was 53.3% (95% CI: 49.4, 57.2) in 2013 and 33.6% (28.8, 38.4) in 2018/2019. Anemia among PSC was 11.3% (8.0, 14.5) in 2008/2009 and 6.1% (3.6, 8.6) in 2018/2019. Anemia among WRA was 10.7% (7.2, 14.2) in 2008/2009 and 3.9% (2.7, 5.2) in 2018/2019. Iron deficiency among PSC was 15.5% (12.1, 19.0) in 2008/2009 and 10.9% (7.4, 14.5) in 2016 (lowest), but 17.1 (13.3, 21.0) in 2017/2018 (highest). Iron deficiency among WRA was 14.9% (11.6, 18.2) in 2008/2009, 13.8% (11.8, 15.8) in 2013 (lowest), and 18.9% (16.3, 21.6) in 2017/2018 (highest). Wheat flour/bread consumption was positively associated with hemoglobin among PSC, and sugar consumption was positively associated with hemoglobin among WRA. The reported consumption of fortifiable foods was not associated with ferritin among PSC or WRA.
Guatemala has implemented multiple food fortification strategies, and anemia has declined. Increases in iron deficiency in 2017-2019 warrant further attention. Secular trends toward poverty alleviation, education, and development might be responsible for changes not explained by the micronutrient interventions evaluated.
食品强化和微量营养素补充是危地马拉改善微量营养素状况的公共卫生策略；近年来尚未对其人群效果进行评估。
我们评估了15 - 49岁非孕妇[育龄妇女（WRA）]和6 - 59月龄儿童[学龄前儿童（PSC）]中食品强化、微量营养素补充、贫血和缺铁的趋势。
采用具有全国代表性的系列横断面调查来评估2008/2009年、2013年、2015年、2016年、2017/2018年和2018/2019年期间血红蛋白、贫血、铁蛋白、缺铁、缺铁性贫血以及可强化食品和微量营养素补充剂的自我报告摄入量的变化。使用广义线性混合模型评估血红蛋白和铁蛋白的预测因素，将调查年份作为随机效应进行调整，可强化食品、补充剂及其他潜在混杂因素的摄入量作为固定效应。
2013年，PSC在过去3个月中多种微量营养素粉的摄入量为53.3%（95%CI：49.4，57.2），2018/2019年为33.6%（28.8，38.4）。2008/2009年PSC贫血率为11.3%（8.0，14.5），2018/2019年为6.1%（3.6，8.6）。2008/2009年WRA贫血率为10.7%（7.2，14.2），2018/2019年为3.9%（2.7，5.2）。2008/2009年PSC缺铁率为15.5%（12.1，19.0），2016年为10.9%（7.4，14.5）（最低），但2017/2018年为17.1%（13.3，21.0）（最高）。2008/2009年WRA缺铁率为14.9%（11.6，18.2），2013年为13.8%（11.8，15.8）（最低），2017/2018年为18.9%（16.3，21.6）（最高）。PSC中面粉/面包摄入量与血红蛋白呈正相关，WRA中糖摄入量与血红蛋白呈正相关。PSC或WRA中可强化食品的报告摄入量与铁蛋白无关。
危地马拉已实施多种食品强化策略，贫血率有所下降。2017 - 2019年缺铁率上升值得进一步关注。减贫、教育和发展的长期趋势可能是所评估的微量营养素干预措施无法解释的变化的原因。
