World Journal of Pediatrics

, 5:275

Co-assessment of iron, vitamin A and growth status to investigate anemia in preschool children in suburb Chongqing, China

  • Ke Chen
  • Xuan Zhang
  • Ting-Yu Li
  • Li Chen
  • Ping Qu
  • You-Xue Liu
Article

Abstract

Background

Anemia is a widespread public health problem, which is due to many factors, nutritional or non-nutritional. Iron, vitamin A and growth status were assessed to investigate anemia of preschool children in suburb Chongqing, China.

Methods

A descriptive, cross-sectional survey was performed on 459 preschool children aged 2 to 7 years randomly chosen from the kindergartens in 6 suburban districts of Chongqing. Weight and height levels, hemoglobin, erythrocyte protoporphyrin, serum retinol, and ferritin concentrations were measured to evaluate the anthropometric and nutritional status.

Results

The rates of stunt, underweight, overweight, wasting, obesity, anemia, iron deficiency, vitamin A deficiency (VAD), and marginal VAD were 6.3%, 3.9%, 3.7%, 1.5%, 3.1%, 23.5%, 15.0%, 6.3% and 25.9%, respectively. Serum retinol concentration was significantly lower in children with anemia than in those without anemia (P=0.003), and the retinol concentration was associated with hemoglobin (Pearson’s correlation coefficient, r=0.22, P<0.01). Children with VAD had a significantly increased risk for anemia (odds ratio, 2.56; 95% confident interval, 1.15–5.70). In all 108 children with anemia, only 42 were related to VAD and 12 related to iron deficiency, suggesting that almost half of the anemia children cannot be explained solely by iron deficiency or VAD.

Conclusions

Vitamin A and iron deficiency are still public health problems in some localities of China. Public health interventions in anemia control should be used to eliminate deficiencies of vitamin A, iron, and other micronutrients by deliberate supplementation. Attention must be paid to such deficiencies in high-risk groups, especially in preschool children.

Key words

anemia iron micronutrient deficiency preschool children vitamin A 

References

  1. 1.
    Coutinho GG, Goloni-Bertollo EM, Bertelli EC. Iron deficiency anemia in children: a challenge for public health and for society. Sao Paulo Med J 2005;123:88–92.PubMedGoogle Scholar
  2. 2.
    Semba RD, Bloem MW. The anemia of vitamin A deficiency: epidemiology and pathogenesis. Eur J Clin Nutr 2002;56:271–281.CrossRefPubMedGoogle Scholar
  3. 3.
    Beard JL, Connor JR. Iron status and neural functioning. Annu Rev Nutr 2003;23:41–58.CrossRefPubMedGoogle Scholar
  4. 4.
    Black MM, Baqui AH, Zaman K, Ake Persson L, El Arifeen S, Le K, et al. Iron and zinc supplementation promote motor development and exploratory behavior among Bangladeshi infants. Am J Clin Nutr 2004;80:903–910.PubMedGoogle Scholar
  5. 5.
    Gordon N. Iron deficiency and the intellect. Brain Dev 2003;25:3–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Zimmermann MB, Biebinger R, Rohner F, Dib A, Zeder C, Hurrell RF, et al. Vitamin A supplementation in children with poor vitamin A and iron status increases erythropoietin and hemoglobin concentrations without changing total body iron. Am J Clin Nutr 2006;84:580–586.PubMedGoogle Scholar
  7. 7.
    Hashizume M, Chiba M, Shinohara A, Iwabuchi S, Sasaki S, Shimoda T, et al. Anaemia, iron deficiency and vitamin A status among school-aged children in rural Kazakhstan. Public Health Nutr 2005;8:564–571.CrossRefPubMedGoogle Scholar
  8. 8.
    Al-Mekhlafi MH, Surin J, Atiya AS, Ariffin WA, Mahdy AK, Abdullah HC. Anaemia and iron deficiency anaemia among aboriginal schoolchildren in rural Peninsular Malaysia: an update on a continuing problem. Trans R Soc Trop Med Hyg 2008;102:1046–1052.CrossRefPubMedGoogle Scholar
  9. 9.
    Kurniawan YA, Muslimatun S, Achadi EL, Sastroamidjojo S. Anaemia and iron deficiency anaemia among young adolescent girls from the peri urban coastal area of Indonesia. Asia Pac J Clin Nutr 2006;15:350–356.PubMedGoogle Scholar
  10. 10.
    Li LM, Rao KQ, Kong LZ, Yao CH, Xiang HD, Zhai FY, et al. A description on the Chinese national nutrition and health survey in 2002. Zhonghua Liu Xing Bing Xue Za Zhi 2005;26:478–484. [in Chines]Google Scholar
  11. 11.
    Arroyave G. Biochemical Methodology for the Assessment of Vitamin A Status: International Vitamin A Consultative Group (IVACG) Sl, 1982.Google Scholar
  12. 12.
    Li TY, Qu P, Wang R, Lian XM, Mao CT, Dai Y. Effect of vitamin A-fortified biscuits on preschool children in Chong Qing, China. Sight and life. Newsletter 2003;(2):45–48.Google Scholar
  13. 13.
    Wagner KH, Blauensteiner D, Schmid I, Elmadfa I. The role of fortified foods-situation in Austria. Forum Nutr 2005;(57):84–90.CrossRefPubMedGoogle Scholar
  14. 14.
    Liu ZH. General situation on development of enhancing nutrition. China Food Additives 2002;2:3–8. [in Chinese]Google Scholar
  15. 15.
    Allen LH. To what extent can food-based approaches improve micronutrient status? Asia Pac J Clin Nutr 2008;17Suppl 1:103–105.PubMedGoogle Scholar
  16. 16.
    Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, et al. CDC growth charts: United States. Adv Data 2000;(314):1–27.PubMedGoogle Scholar
  17. 17.
    Recommendations for reference method for haemoglobinometry in human blood (ICSH standard 1986) and specifications for international haemiglobincyanide reference preparation (3rd edition). International Committee for Standardization in Haematology; Expert Panel on Haemoglobinometry. Clin Lab Haematol 1987;9:73–79.Google Scholar
  18. 18.
    Parsons PJ, Meola JR, Mitchell DG. Development of standard materials for use with the hematofluorometer. Clin Chem 1988;34:1062–1066.PubMedGoogle Scholar
  19. 19.
    Rohner F, Zeder C, Zimmermann MB, Hurrell RF. Comparison of manual and automated ELISA methods for serum ferritin analysis. J Clin Lab Anal 2005;19:196–198.CrossRefPubMedGoogle Scholar
  20. 20.
    Miller KW, Yang CS. An isocratic high-performance liquid chromatography method for the simultaneous analysis of plasma retinol, alpha-tocopherol, and various carotenoids. Anal Biochem 1985;145:21–26.CrossRefPubMedGoogle Scholar
  21. 21.
    WHO/UNICEF/UNU, eds. Iron deficiency anaemia assessment, prevention, and control: a guide for programme managers. Geneva, Switzerland: World Health Organization, 2001.Google Scholar
  22. 22.
    Gibson RS. Principles of Nutrition Assessment. Food consuption of individuals. Nueva York: Oxford University Press, 1990: 37, 47.Google Scholar
  23. 23.
    World Health Organization. Indicators for assessing vitamin A deficiency and their application in monitoring and evaluating intervention programmes. Report of a WHO/UNICEF Consultation, Geneva, 9–11 November 1992. Review version. Geneva: WHO, 1994.Google Scholar
  24. 24.
    Wang Y, Moreno LA, Caballero B, Cole TJ. Limitations of the current world health organization growth references for children and adolescents. Food Nutr Bull 2006;27:S175–188.PubMedGoogle Scholar
  25. 25.
    Pinhas-Hamiel O, Newfield RS, Koren I, Agmon A, Lilos P, Phillip M. Greater prevalence of iron deficiency in overweight and obese children and adolescents. Int J Obes Relat Metab Disord 2003;27:416–418.CrossRefPubMedGoogle Scholar
  26. 26.
    Nead KG, Halterman JS, Kaczorowski JM, Auinger P, Weitzman M. Overweight children and adolescents: a risk group for iron deficiency. Pediatrics 2004;114:104–108.CrossRefPubMedGoogle Scholar
  27. 27.
    Moayeri H, Bidad K, Zadhoush S, Gholami N, Anari S. Increasing prevalence of iron deficiency in overweight and obese children and adolescents (Tehran Adolescent Obesity Study). Eur J Pediatr 2006;165:813–814.CrossRefPubMedGoogle Scholar
  28. 28.
    Lin L, Liu Y, Ma G, Tan Z, Zhang X, Jiang J, et al. Survey on vitamin A deficiency in children under-6-years in China. Zhonghua Yu Fang Yi Xue Za Zhi 2002;36:315–319. [in Chinese]PubMedGoogle Scholar
  29. 29.
    Mejia LA, Chew F. Hematological effect of supplementing anemic children with vitamin A alone and in combination with iron. Am J Clin Nutr 1988;48:595–600.PubMedGoogle Scholar
  30. 30.
    Thurnham DI, Northrop-Clewes CA. Optimal nutrition: vitamin A and the carotenoids. Proc Nutr Soc 1999;58:449–457.PubMedGoogle Scholar
  31. 31.
    Albalak R, Ramakrishnan U, Stein AD, Van der Haar F, Haber MJ, Schroeder D, et al. Co-occurrence of nutrition problems in Honduran children. J Nutr 2000;130:2271–2273.PubMedGoogle Scholar
  32. 32.
    de Onis M, Blössner M. The World Health Organization Global Database on Child Growth and Malnutrition: methodology and applications. Int J Epidemiol 2003;32:518–526.CrossRefPubMedGoogle Scholar
  33. 33.
    Jia F, Fu Z. Preliminary analysis of the hemoglobin levels of children under 6 years of age. Wei Sheng Yan Jiu 2000;29:298–299. [in Chinese]PubMedGoogle Scholar
  34. 34.
    Gibson R. Assessment of iron status. In: Gibson R, eds. Principles of Nutritional Assessment. New York: Oxford University Press, 1990: 349–376.Google Scholar
  35. 35.
    Lian XM, Li TY, Qu P, Liu YX. Effect of weekly iron or vitamin A supplementation on improving iron status of preschooler. Chin J Child Health Care 2002;10:368–370. [in Chinese]Google Scholar
  36. 36.
    Khan NC, Ninh NX, Van Nhien N, Khoi HH, West CE, Hautvast JG. Sub clinical vitamin A deficiency and anemia among Vietnamese children less than five years of age. Asia Pac J Clin Nutr 2007;16:152–157.PubMedGoogle Scholar
  37. 37.
    Madatuwa TM, Mahawithanage ST, Chandrika UG, Jansz ER, Wickremasinghe AR. Evaluation of the effectiveness of the national vitamin A supplementation programme among school children in Sri Lanka. Br J Nutr 2007;97:153–159.CrossRefPubMedGoogle Scholar
  38. 38.
    Faruque AS, Khan AI, Malek MA, Huq S, Wahed MA, Salam MA, et al. Childhood anemia and vitamin a deficiency in rural Bangladesh. Southeast Asian J Trop Med Public Health 2006;37:771–777.PubMedGoogle Scholar
  39. 39.
    Underwood BA. Perspectives from micronutrient malnutrition elimination/eradication programmes. Bull World Health Organ 1998;76Suppl 2:34–37.PubMedGoogle Scholar
  40. 40.
    Castejon HV, Ortega P, Amaya D, Gomez G, Leal J, Castejon OJ. Co-existence of anemia, vitamin A deficiency and growth retardation among children 24–84 months old in Maracaibo, Venezuela. Nutr Neurosci 2004;7:113–119.CrossRefPubMedGoogle Scholar
  41. 41.
    Dayrit MM. Report of the workgroup on noninfectious diseases. Bull World Health Organ 1998;76Suppl 2:80–84; discussion 104–108.PubMedGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine and Springer Berlin Heidelberg 2009

Authors and Affiliations

  • Ke Chen
    • 1
    • 2
  • Xuan Zhang
    • 1
  • Ting-Yu Li
    • 1
    • 3
  • Li Chen
    • 1
  • Ping Qu
    • 1
  • You-Xue Liu
    • 1
  1. 1.Child Health Care, Children’s HospitalChongqing Medical UniversityChongqingChina
  2. 2.Chengdu Maternal and Child Health Care HospitalChengduChina
  3. 3.Child Health Care, Children’s HospitalChongqing Medical UniversityChongqingChina

Personalised recommendations