European Journal of Epidemiology

, Volume 20, Issue 3, pp 277–284

Anemia as a risk factor for infectious diseases in infants and toddlers: Results from a prospective study

  • Amalia Levy
  • Drora Fraser
  • Shirley D. Rosen
  • Ron Dagan
  • Richard J. Deckelbaum
  • Christian Coles
  • Lechaim Naggan
Article

Abstract

Anemia due to iron deficiency is the most prevalent form of micronutrient malnutrition in the world, however, the causal relationship between anemia and infection remains unclear. We examined prospectively, the association between anemia and infection among Bedouin infants. We recruited 293 families and newborns from the Bedouin population, which is ongoing major lifestyle changes, during the periods of 1989–1992 and 1994–1997 and followed them to age 18 months. The number of diarrhea and respiratory disease episodes as well as total days of diarrhea were ascertained weekly. Hemoglobin levels were obtained at age 6 months. Additional data on feeding practices, environmental, household and demographic characteristics were obtained throughout the 18 months. Diarrhea before 6 months of age was found to be a risk factor for diarrhea after that age. After controlling for early morbidity < 6 months, anemia (Hb < 11 g/dl) at 6 months was an independent risk factor for diarrhea and respiratory illness from 7 to 18 months of age. This associations remained significant even after controlling, in addition, for environmental and socio-economic factors. In the multivariable models, anemia at age 6 months increased the risk for diarrhea after that age by 2.9-fold (95 confidence interval 1.6–5.3; p = 0.001) and that of respiratory disease by 2-fold (1.1–3.7; p = 0.03). Our findings suggest that anemia may increase the rates of infections in toddlers. The possibility that reducing anemia in infants may be a preventive measure to lower disease burden from infectious disease in this and other vulnerable populations should be tested in further studies.

Keywords

Children Cohort study Diarrhea Negev Bedouins Respiratory diseases 

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References

  1. 1.
    Moy, RJD, Early, AR 1999Iron deficiency in childhoodJ R Soc Med92234236PubMedGoogle Scholar
  2. 2.
    Olivares, M, Walter, T, Hertrampf, E, Pizarro, F 1999Anemia and iron deficiency disease in childrenBr Med Bull55534543PubMedGoogle Scholar
  3. 3.
    Gupta, S, Venkateswaran, R, Gorenflo, DW, Eyler, AE. 1999Childhood iron deficiency anemia, maternal nutritional knowledge, and maternal feeding practices in a high-risk populationPrev Med29152156PubMedGoogle Scholar
  4. 4.
    Viteri, EF 1998

    Prevention of iron deficiency

    Howson, CPKennedy, ETHorowitz, A eds. Prevention of micronutrient deficiencies, tools for policymakers and public health workersNational Academy PressWashington: DC4583
    Google Scholar
  5. 5.
    Palti, H, Adler, B, Reshef, A 1977A semilongitudinal study of food intake, anemia rate and measurements of 6 to 24-months-old children in a Jerusalem communityAm J Clin Nutr30268274PubMedGoogle Scholar
  6. 6.
    Lavon, B, Tulchinsky, TH, Preger, M, Said, R, Kaufman, S. 1985Iron deficiency anemia among Jewish and Arab infants at 6 and 12 months of age in Hadera. IsraelIsr J Med Sci21107112PubMedGoogle Scholar
  7. 7.
    Levy, A. The interrelationship between infants feeding practices, morbidity and hemoglobin levels in infants of North African extraction. Ph.D. thesis. Ben-Gurion University of the Negev, Beer-Sheva, 1993Google Scholar
  8. 8.
    Gofin, R, Palti, H, Adler, B 1992Time trends of hemoglobin levels and anemia prevalence in infancy in a total communityPublic Health106811Google Scholar
  9. 9.
    Kaluski, DN, Leventhal, A, Averbuch, Y, Rishpon, S, Cohen-Dar, M, Habib, S, Bellmaker, I, Rubin, L, Rachmiel, S, Amitai, Y, Palti, H 2001Five decades of trends in anemia in Israeli infants: implications for food fortification policyEur J Clin Nutr558287PubMedGoogle Scholar
  10. 10.
    Bilenko N, Dagan R, Fraser D, Coles C, Zamir O, Belmaker I. Association between anemia, Vitamin A, Vitamin E and Zn-deficiency, and growth in young Bedouin children. Annual conference of Public Health Physicians Union. Zichron-Yakov, Israel, 21–23.10 2004Google Scholar
  11. 11.
    Hotz, C, Peerson, JM, Brown, KH 2003Suggested lower cutoffs of serum zinc concentrations for assessing zinc status: reanalysis of the second National Health and Nutrition Examination Survey data (1976–1980)Am J Clin Nutr78756764PubMedGoogle Scholar
  12. 12.
    Levy, A, Fraser, D, Vardi, H, Dagan, R 1998Hospitalization for infectious disease in Jewish and Bedouin children in southern IsraelEur J Epidemiol14179186PubMedGoogle Scholar
  13. 13.
    World Health Organization. Division of Epidemio logical Surveillance and Health Situation and Trend Assessment. Global estimates for health situation assessment and projections, 1990. Geneva: World Health Organization, 1990.Google Scholar
  14. 14.
    Claeson, RI, Merson, MH 1990Global progress in the control of diarrheal diseasesPediatr Infect Dis J9345355PubMedGoogle Scholar
  15. 15.
    Glass, RI, Lew, JF, Gangarosa, RE, LeBaron, CW, Ho, MS 1991Estimates of morbidity and mortality rates for diarrheal diseases in American childrenJ Pediatr118S27S33PubMedGoogle Scholar
  16. 16.
    Walter, T, Olivares, M, Pizarro, F, Munoz, C 1997Iron, anemia, and infectionNutr Rev55111124PubMedCrossRefGoogle Scholar
  17. 17.
    Oppenheimer, SJ 2001Iron and its relation to immunity and infectious diseaseJ Nutr131616s635sPubMedGoogle Scholar
  18. 18.
    Central Bureau of statistics. Statistical abstracts of Israel, No. 47. Jerusalem: Hemed Press 1996Google Scholar
  19. 19.
    Fraser, D, Dagan, R, Porat, N, el-On, J, Alkrinawi, S, Deckelbaum, RJ, Naggan, L 1998Persistent diarrhea in a cohort of Israeli Bedouin infants: role of enteric pathogens and family and environmental factorsJ Infect Dis17810811088PubMedGoogle Scholar
  20. 20.
    WHO technical report series No. 405. Nutritional anemia: report of WHO scientific group (1968)Google Scholar
  21. 21.
    Abshire, TC 1996The anemia of inflammation. A common cause of childhood anemiaPediatr Clin North Am43623637PubMedGoogle Scholar
  22. 22.
    Olivares, M, Walter, T, Osorio, M, Chadud, P, Schlesinger, L 1989Anemia of a mild viral infection: The measles vaccine as a modelPediatrics84851855PubMedGoogle Scholar
  23. 23.
    Hulthen, L, Lindstedt, G, Lundberg, P-A, Hallberg, L 1998Effect of a mild infection on serum ferritin concentration – clinical and epidemiological implicationsEur J Clin Nutr52376379PubMedGoogle Scholar
  24. 24.
    Means, RT, Krantz, SB 1992Progress in understanding the pathogenesis of the anemia of chronic diseaseBlood8016391647PubMedGoogle Scholar
  25. 25.
    Dagan, R, Sofer, S, Klish, WJ, Hundet, G, Saltz, H, Moses, SW 1983Growth and nutritional status of Bedouin infants in the Negev desert, Israel: Evidence for marked stunting in the present of only mild malnutritionAm J Clin Nutr38747756PubMedGoogle Scholar
  26. 26.
    Forman, MR, Hundt, GL, Berendes, HW, Abu-Saad, K, Zangwill, L, Chang, D, Bellmaker, I, Abu-Saad, I, Graubard, BI 1995Undernutrition among Bedouin Arab children: A follow up of the Bedouin infant feeding studyAm J Clin Nutr61495500PubMedGoogle Scholar
  27. 27.
    Dagan, R, Landau, D, Haikin, H, Tal, A 1993Hospitalization of Jewish and Bedouin infants in southern Israel for bronchiolitis caused by respiratory syncytial virusPediatr Infect Dis J12381386PubMedGoogle Scholar
  28. 28.
    Dagan, R, Bar-David, Y, Sarov, B, Katz, M, Kassis, I, Greenberg, D, Glass, RI, Margolis, CZ, Sarov, I 1990Rotavirus diarrhea in Jewish and Bedouin children in the Negev region of Israel: Epidemiology, clinical aspects and possible role of malnutrition in severity of illnessPediatr Infect Dis J9314321PubMedCrossRefGoogle Scholar
  29. 29.
    Dewey, KG, Domellof, M, Cohen, RJ, Landa Rivera, L, Hernell, O, Lonnerdal, B 2002Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and HondurasJ Nutr3232493255Google Scholar
  30. 30.
    Levy, J 1998Immunonutrition: The pediatric experienceNutrition14641647PubMedGoogle Scholar
  31. 31.
    Miller, V, Swaney, S, Deinard, AS 1985Impact of the WIC program on the iron status of infantsPediat75100105Google Scholar
  32. 32.
    Reeves, J, Yip, R, Cal, VA, Dallman, PR 1984Iron deficiency in infants; the influence of antecedent infectionJ Ped105874879Google Scholar
  33. 33.
    Golz, A, Netzer, A, Goldenberg, D, Westerman, ST, Westerman, LM, Joachims, HM 2001The association between iron-deficiency anemia and recurrent acute otitis mediaAm J Otolaryngol22391394PubMedGoogle Scholar
  34. 34.
    Kaplan, KM, Oski, F 1980Anemia with Haemophilus influenzae meningitisPediatrics6511011104PubMedGoogle Scholar
  35. 35.
    Kochan, I 1973The role of iron in bacterial infections with special consideration of host-tubercle bacillus interactionCurr Top Microbiol Immunol01630Google Scholar
  36. 36.
    Weinberg, ED 1978Iron and infectionMicrobiol Rev424566PubMedGoogle Scholar
  37. 37.
    Yip, R, Binkin, NJ, Fleshood, L, Trowbridge, FL 1987Declining prevalence of anemia among low-income children in the United StatesJAMA25816191623PubMedGoogle Scholar
  38. 38.
    CDC. Recommendations to Prevent and Control Iron Deficiency in the United States. MMWR. April 3, 1998/Vol. 47/No. RR-3. Pgs 1–36. Center for Disease Control and Prevention.Google Scholar
  39. 39.
    Conway, SP, Phillips, RR, Panday, S 1990Admission to hospital with gastroenteritisArch Dis Child65579584CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Amalia Levy
    • 1
  • Drora Fraser
    • 1
    • 2
  • Shirley D. Rosen
    • 1
  • Ron Dagan
    • 1
  • Richard J. Deckelbaum
    • 1
  • Christian Coles
    • 1
  • Lechaim Naggan
    • 1
  1. 1.Department of Epidemiology, Pediatric Infectious Disease Unit, Presbyterian HospitalS. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, Soroka University Medical Center, Columbia UniversityBeer-Sheva, New YorkIsrael, USA
  2. 2.Department of EpidemiologyBen-Gurion University of the NegevBeer-SgevaIsrael

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