Department of Human Nutrition, University of Otago, Dunedin, New Zealand; Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States; Emory University, Atlanta, GA, United States.
Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA, United States.
J Nutr. 2023 Dec;153 Suppl 1(Suppl 1):S29-S41. doi: 10.1016/j.tjnut.2023.05.032. Epub 2023 Sep 29.
We aim to provide a practical approach to assess anemia and its primary causes, both in clinical settings and in the context of public health programs. Anemia remains a global challenge; thus, to achieve goals for anemia reduction and assess progress, standardized approaches are required for the assessment of anemia and its causes. We first provide a brief review of how to assess anemia, based on hemoglobin concentrations and cutoffs that correspond to age, sex, and physiologic status. Next, we discuss how to assess the likely causes of anemia in different settings. The causes of anemia are classified as non-nutritional (for example, because of infection, inflammation, blood loss, or genetic disorders) or nutrition-specific (for example, because of deficiencies of iron, vitamin A, riboflavin, vitamin B, or folate). There is an important overlap between these 2 categories, such as the increased likelihood of iron deficiency in the context of inflammation. Given the multifaceted nature of anemia etiology, we introduce a framework for anemia assessment based on the "ecology of anemia," which recognizes its many overlapping causes. This conceptual framework is meant to inform what data on anemia causes may need to be collected in population surveys. The framework has a supporting table with information on the diagnostic tests, biomarkers and proposed cutoffs, characteristics, and feasibility of collecting the myriad information that can help elucidate the anemia etiology. We also provide examples of how this framework can be applied to interpret the anemia risk factor data from population-based surveys that can inform decisions about context-specific interventions. Finally, we present research gaps and priorities related to anemia assessment.
我们旨在提供一种实用方法来评估贫血及其主要原因,无论是在临床环境还是公共卫生项目中。贫血仍然是一个全球性挑战;因此,为了实现减少贫血的目标并评估进展情况,需要采用标准化方法来评估贫血及其原因。我们首先简要回顾一下如何根据血红蛋白浓度和与年龄、性别和生理状态相对应的切点来评估贫血。接下来,我们讨论如何在不同环境中评估贫血的可能原因。贫血的原因分为非营养性(例如,由于感染、炎症、失血或遗传疾病)或营养特异性(例如,由于铁、维生素 A、核黄素、维生素 B 或叶酸缺乏)。这两个类别之间存在重要的重叠,例如在炎症情况下缺铁的可能性增加。鉴于贫血病因的多方面性质,我们根据“贫血生态学”引入了一种贫血评估框架,该框架认识到其许多重叠的原因。该概念框架旨在告知人群调查中可能需要收集哪些关于贫血原因的数据。该框架有一个支持表,其中包含有关诊断测试、生物标志物和建议的切点、特征以及收集有助于阐明贫血病因的无数信息的可行性的信息。我们还提供了如何将该框架应用于解释基于人群的调查中贫血风险因素数据的示例,这些数据可用于决策特定于上下文的干预措施。最后,我们提出了与贫血评估相关的研究差距和重点。
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