Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Nutrição. São Paulo, SP, Brasil.
Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, Brasil.
Rev Saude Publica. 2024 Feb 26;57Suppl 2(Suppl 2):6s. doi: 10.11606/s1518-8787.2023057005637. eCollection 2024.
This study aimed to describe the prevalence and predictors of childhood anemia in an Amazonian population-based birth cohort study.
Prevalence of maternal anemia was estimated at delivery (hemoglobin [Hb] concentration < 110 g/L) in women participating in the MINA-Brazil birth cohort study and in their children, examined at ages one, two (Hb < 110 g/L), and five (Hb < 115 g/L). Moreover, ferritin, soluble transferrin receptor, and C-reactive protein concentrations were measured in mothers at delivery and in their 1- and 2-year-old children to estimate the prevalence of iron deficiency and its contribution to anemia, while adjusting for potential confounders by multiple Poisson regression analysis (adjusted relative risk [RRa]).
The prevalence 95% confidence interval (CI) of maternal anemia, iron deficiency, and iron-deficiency anemia at delivery were 17.3% (14.0-21.0%), 42.6% (38.0-47.2%), and 8.7% (6.3-11.6)%, respectively (n = 462). At one year of age (n = 646), 42.2% (38.7-45.8%) of the study children were anemic, 38.4% (34.6-42.3%) were iron-deficient, and 26.3 (23.0-29.9) had iron-deficiency anemia. At two years of age (n = 761), these values decreased to 12.8% (10.6-15.2%), 18.1% (15.5-21.1%), and 4.1% (2.8-5.7%), respectively; at five years of age (n = 655), 5.2% (3.6-7.2%) were anemic. Iron deficiency (RRa = 2.19; 95%CI: 1.84-2.60) and consumption of ultra-processed foods (UPF) (RRa = 1.56; 95%CI: 1.14-2.13) were significant contributors to anemia at 1 year, after adjusting for maternal schooling. At 2 years, anemia was significantly associated with maternal anemia at delivery (RRa: 1.67; 95%CI: 1.17-2.39), malaria since birth (2.25; 1.30-3.87), and iron deficiency (2.15; 1.47-3.15), after adjusting for children's age and household wealth index.
Anemia continues to be highly prevalent during pregnancy and early childhood in the Amazon. Public health policies should address iron deficiency, UPF intake, maternal anemia, and malaria to prevent and treat anemia in Amazonian children.
本研究旨在描述亚马逊地区一项基于人群的出生队列研究中儿童贫血的患病率和预测因素。
在 MINA-Brazil 出生队列研究中，对参与研究的女性在分娩时（血红蛋白[Hb]浓度<110g/L）的贫血患病率进行了估计，并对其 1 岁、2 岁（Hb<110g/L）和 5 岁（Hb<115g/L）的儿童进行了检查。此外，在母亲分娩时以及 1 岁和 2 岁的儿童中测量了铁蛋白、可溶性转铁蛋白受体和 C 反应蛋白浓度，以估计铁缺乏症的患病率及其对贫血的影响，并通过多泊松回归分析（调整后的相对风险[RRa]）调整潜在混杂因素的影响。
分娩时母亲贫血、铁缺乏症和缺铁性贫血的患病率（95%置信区间[CI]）分别为 17.3%（14.0-21.0%）、42.6%（38.0-47.2%）和 8.7%（6.3-11.6%）（n=462）。在 1 岁时（n=646），42.2%（38.7-45.8%）的研究儿童贫血，38.4%（34.6-42.3%）铁缺乏，26.3%（23.0-29.9%）缺铁性贫血。在 2 岁时（n=761），这些值分别下降至 12.8%（10.6-15.2%）、18.1%（15.5-21.1%）和 4.1%（2.8-5.7%）；在 5 岁时（n=655），5.2%（3.6-7.2%）贫血。调整母亲教育程度后，铁缺乏症（RRa=2.19；95%CI：1.84-2.60）和超加工食品（UPF）摄入（RRa=1.56；95%CI：1.14-2.13）是 1 岁时贫血的显著危险因素。在 2 岁时，贫血与分娩时母亲贫血（RRa：1.67；95%CI：1.17-2.39）、出生以来疟疾（2.25；1.30-3.87）和铁缺乏症（2.15；1.47-3.15）显著相关，在调整了儿童年龄和家庭财富指数后。
在亚马逊地区，怀孕期间和儿童早期贫血仍然高度流行。公共卫生政策应解决铁缺乏症、超加工食品摄入、母亲贫血和疟疾问题，以预防和治疗亚马逊地区儿童贫血。
