Iron deficiency and anemia in pregnant women from Chaco,Argentina

Aiming at their prevention, to determine the prevalence of gestational iron deficiency and anemia, considering access to health care and associations with social and biological variables in the Province of el Chaco, Argentina. Three hundred and sixty four, randomly selected pregnant women from the whole province participated. Mean Hemoglobin (Hb) +/- SD dropped progressively from 118.4 +/- 11.0 to 112.1 +/- 11.5 g/L (p = 0.015) between the 1st and the 3rd gestational trimesters. Anemia prevalence (Hb < 110 g/L) was 17.4, 26.5 and 35.8%. From the 1st to the 3rd trimesters. Second trimester prevalence was 14.1% using Hb < 105 g/L as recently suggested. The ferritin geometric mean during the progressive gestational trimesters were 28.9; 16.0 and 11.1 micrograms/L. 21.7, 40.5 and 60.5% had ferritins < 12 micrograms/L, and 39.1, 58.9 and 83.2% had ferritins < 20 micrograms/L in these respective trimesters (p < 0.004 between trimesters in both cases). Both iron deficiency and anemia were significantly greater in women with unfinished primary education and with interpregnancy interval < 1 year. Seventy five percent of women had adequate number of antenatal visits but only 23% were taking iron supplements and 10% had stopped taking them. The prevention and correction of gestational iron deficiency and anemia must focus on the preconceptional period (inter-pregnancy spacing and increasing iron intake using all available means) as well as during pregnancy improving adherence to iron supplements by means of motivation of health workers and community.     

Efficacy of iron fortification compared to iron supplementation among Vietnamese schoolchildren

The effect of iron fortification is generally assumed to be less than iron supplementation; however, the magnitude of difference in effects is not known. The present study aims to compare the efficacy of these two strategies on anaemia and iron status. After screening on low Hb, 425 anaemic children in six primary schools in Tam Nong district of Phu Tho province were included in a randomized, placebo-controlled trial comparing two groups receiving iron fortified instant noodles or iron supplementation for 6 months and a control group, with children in all groups having been dewormed. Blood samples were collected before and after intervention for haemoglobin, serum ferritin (SF), serum transferrin receptor (TfR), C-reactive protein (CRP), and haemoglobinopathies analysis. Regression analysis was used to assess the effect of iron fortification and iron supplementation on haemoglobin concentration, SF, TfR, body iron, and anaemic status as outcome variables. The improvement of haemoglobin, SF, and body iron level in the group receiving iron fortification was 42% (2.6 g/L versus 6.2 g/L), 20% (23.5 μg/L versus 117.3 μg/L), and 31.3% (1.4 mg/kg versus 4.4 mg/kg) of that in the iron supplementation group. The prevalence of anaemia dropped to 15.1% in the control group, with an additional reduction of anaemia of 8.5% in the iron supplementation group. The additional reduction due to iron fortification was 5.4%, which amounts to well over 50% of the impact of supplementation. In conclusion, the efficacy of iron fortification based on reduction of prevalence of anaemia, and on the change in haemoglobin level, is about half of the maximum impact of supplementation in case of optimal compliance. Thus, in a population of anaemic children with mild iron deficiency, iron fortification should be the preferred strategy to combat anaemia.     

Prevalence of anemia during pregnancy: results of Valencia (Venezuela) anemia during pregnancy study

To determine the prevalence of anemia during pregnancy in Venezuelan pregnant women. By using a cross-sectional study, 630 Venezuelan pregnant women in their third trimester at labor from the Valencia Anemia during Pregnancy Study were studied. Anemia during pregnancy was defined according to WHO guidelines (Hb < 11 g/dl), iron deficiency was considered when serum ferritin level was < 12 ng/ml, and when serum folate level was < 3 ng/ml, it was considered as folate deficiency. 630 pregnant women (mean [+/- SD] age, 24 +/- 6.4 years) having an average of Hb 11.38 +/- 1.47 g/dl [95%CI = 11.27 to 11.50] were studied. No patient had hemolytic anemia nor clinical infections. Almost all patients were from low or very low socioeconomic status. Prevalence of anemia was 34.44% (severe: 1.8%, moderate: 15.2%, and mild: 83%). Iron deficiency anemia (IDA) was present in 39.2% (95%CI = 32.7 to 45.7), prevalence of folate deficiency anemia (FDA) was 11.98% (95%CI = 7.6% to 16.3%). Combined anemia (IDA and FDA) occurred in 11.52% (95%CI = 7.27% to 15.7%). Multivariate analysis showed that multiparous (odds ratio -OR-: 1.95, 95%CI = 1.28 to 2.97, p = .002) and supplement use of iron (OR: .55 (95%CI = .33 to .91, p = .02) are associated with IDA. The factors associated with FDA were: supplement use of folic acid (OR: .37 (95%CI = .19 to .71, p = .003) and appropriate prenatal control (OR: .51 95%CI = .27 to .96, p = .04). Prevalence of anemia during pregnancy was found to be high. Educational efforts should be stressed in order to encourage improvements in the prenatal care visits.     

Prevalence of nutritional anemia in women of reproductive age. Costa Rica. National nutrition survey, 1996

In 1996, The Ministry of Health and Inciensa conducted the latest National Nutrition Survey, to provide support and guidance to the national policies, plans and programs in the field of food and nutrition. The present paper reports the results for the prevalence of anemia estimated in a total of 884 women of reproductive age, in three areas: metropolitan area, other urban areas and rural areas. Anemia was determined through measurements of hemoglobin, plasma ferritin and plasma folates. In addition, hemoglobin patterns were determined by electrophoresis. The cutt-off points used were those recommended by the WHO. Anemia was present in 18.6% of the women. Severe to moderate deficiency of iron (< 12 ng/dl) and of folates (< 6 ng/dl) were found in 43.2 and 24.7% of women respectively, with statistically significant differences by area of residence. The magnitude of the problem for anemia can be classified as mild, for iron deficiency as severe, and for folate deficiency as moderate. In conclusion, Anemia represents a public health problem for Costa Rica that has remained constant throughout the last decade. In women of reproductive age, iron deficiency is the main cause of Anemia, followed by folates deficiency, and in a small percentage hemoglobinopathies. Intestinal parasites are not longer a mayor cause of Anemia. Prevalence of Anemia is influenced by place of residence, but not by age. In summary, despite the favorable health conditions present in Costa Rica, the prevalence of Anemia and of iron deficiency are similar to those of the Latin-American region. To improve this situation, public health interventions are necessary.     

Profile of nutritional risk in pregnant adolescents

A sample of 215 adolescents (16.9 +/- 0.7 y; 13-18 y) from a low socioeconomic level of Valencia, Venezuela, at their first trimester of pregnancy were studied in order to identify nutritional risk. Socioeconomic, anthropometrical, hematological and dietary characteristic were assessed. Pregestational weight, actual weight, height, arm circumference (AC), triceps skin fold (TS), fat and muscle area (FA/MA) and pregestational body mass index (PBMI) were determined. Hemoglobin (Hb) and ferritin were measured by colorimetric and ELISA methods. Two 24 hour recalls were obtained. According to age, two groups were created. Pregnant adolescents were grouped by age: Group 1, 13 to 15 years old and Group 2, 16 to 18 years old. Nutritional risk was defined as: Gynecological age lower than 4 years since menarche. PBMI < 19.8 kg/m2, height below 10th Percentile of reference, Hb below 11 g/dL and ferritin < 12 micrograms/L. Almost all the adolescents (96.3%) were in poverty. 83.3% were single, 83.3% were at elementary school before pregnancy but 84.1% were attending house chores at the time of exam. There were significant differences (p < 0.001) for gynecological age and menarche age, but not for anthropometrical, hematological and dietary variables when Group 1 was compared to group 2. 35.3% of the adolescents had a gynecological age lower than 4 years, 23.3% were below 10th percentile for height, 36.3% had a PBMI lower than 19.8 kg/m2, 26.5% were below 10th percentile for arm circumference, anemia was present in 13.7% and low levels of ferritin in 18.4% of the adolescents. Calorie intake was below recommendation in 87.3% and adequacy for vitamin A and C, calcium and zinc were below 2/3 of recommendation in 36.3%. 25.9%, 88.7% and 73.5% of the adolescents respectively. Studied adolescents had a high prevalence of risk factors for nutritional deficiencies (short age, poverty, low weight, anemia and deficient intake). Early assessment of this conditions allows to identify the risk, to establish interventions and to monitor pregnancy evolution.     

Prevalence and factors associated to anemia and iron deficiency in 18-to 24-month old infants

A transversal study was carried out with 101 18-to 24-month old infants, attended at public health services in Vi?osa, MG, Brazil, The objective of this study was to verify the prevalence and factors associated to anemia and iron deficiency among infants. Data were obtained by interviews of the infants' parents or guardians at their households. Hemoglobin and ferritin analyses were peformed using an automatic counter and the immunometric dosage method, respectively. Feces samples were analyzed by the Hoffman, Faust and Ritchie methods. Anemia was characterized by hemoglobin concentration and iron deficiency by ferritin. For dietary practice, the 24-hour recall was used. Linear regression and logistics analyses were conducted to evaluate the variables associated to hemoglobin and iron deficiency, respectively. Anemia, iron deficiency and intestinal parasite prevalences were 30.1; 38.4, and 21%, respectively. The number of household members, age infants were introduced to juices/or fruit, mother's level of instruction, and total breastfeeding period were associated to the levels of hemoglobin plasma. The associated variables for iron deficiency were milk consumption near meals and number of household members.     

Hemoglobin-fortified biscuits: bioavailability and its effect on iron nutriture in school children

School-age children in Chile received 30 g of wheat-flour biscuits daily through a National School Lunch Program. To improve iron nutrition, these biscuits were fortified with 6% of a bovine hemoglobin concentrate. Hemoglobin iron bioavailability, measured with a double isotope technique, showed that heme-iron absorption in fortified biscuits was high (19.7%). In a pilot field trial, a cohort of 215 school-children received fortified biscuits (30 g) daily during two school periods, and their iron nutrition status was compared with that of children who received non-fortified biscuits (n = 212). Acceptability of both types of biscuits was excellent. Initially, both groups had comparably good iron nutrition. The fortified children presented higher mean ferritin values at the end of the first and second school periods. Good iron stores (serum ferritin greater than or equal to 20 micrograms/lt) were present in 92% and 79% of the fortified and control subjects, respectively (P less than 0.004). The high-iron bioavailability, the good organoleptic characteristics and the biological effect on iron nutriture make this product an appealing alternative to combat iron deficiency.     

Anemias in preschool children: diagnosis, treatment and evaluation, Recife-PE, Brazil]

The diagnosis and the effects of treatment of anemia were assessed in children aged 6-71 months. A total of 1,161 preschool children from a health center of INAMPS (Instituto Nacional de Assistência Médica e Previdência Social) in Recife, Pernambuco, was studied. Hemoglobin was determined by the method described by Hainline. WHO criteria were used to identify anemia. According to their age, nutritional status and family income, the children were divided into groups, and those with anemia were treated with ferrous sulphate and an anti-helminthic (mebendazole). Anemia prevalence was substantially higher in children aged 2 years, and a statistically significant association (0.01 level) was found between anemia and nutritional status and family income. After treatment, hemoglobin values were normal in 40% of the anemic children; simultaneously, mean hemoglobin values increased from 9.11 to 10.3 g/dl which was statistically significant (p less than 0.001). This investigation is part of a collaborative study performed in four Brazilian states to offer "know-how" to a national program for combating iron deficiency anemia.     

Maternal anemia in Concepción province, Chile: association with maternal nutritional status and fetal growth

Previous studies in Santiago, Chile have established that anemia in the earliest stages of pregnancy is a public health issue. The situation in other parts of the country is unknown. The purpose of this study is to establish the prevalence of anemia in pregnant women in the province of Concepcion and evaluate its association with maternal nutricional status and fetal growth. The study included 1782 women with singleton pregnancies who began prenatal check-ups in 2004 at the public primary health care centers. Anemia was established using the following criteria: from WHO (Hb < 11 g / dl) and from the USA Center for Disease Control (CDC) (Hb < percentile 5 for each gestational week). Anemia prevalence was compared in relation to independent study variables: maternal age, parity, morbidity and smoking habit, and mother and child anthropometry. A multivariable logistic regression model studied the possible effect of anemia on fetal growth. The prevalence of anemia was 10.9% and 14.5% using the WHO and CDC criteria, respectively. The mother's nutritional status was significantly associated with anemia. However, anemia according to WHO and CDC criteria at the beginning of pregnancy was not significantly associated to fetal growth in the univariate and multivariate analyses. The prevalence of anemia in the province of Concepcion constitutes a public health problem that needs to be addressed and it is slightly higher to that recently observed in the county of Puente Alto, Santiago.     

Prevalence of anemia and deficiencies of iron, folic acid and vitamin B12 in an indigenous community from the Venezuelan Amazon with a high incidence of malaria

The objective of this work was to determine the prevalence of anemia and deficiencies of iron, folic acid and vitamin B12 in Betania del Topocho, a Piaroa community from Estado Amazonas, Venezuela, a zone with a high incidence of malaria. The group studied included 184 subjects of all ages that assisted to the local health center for malaria diagnosis. Analysis performed included hematology by coulter counter, ferritin quantification by ELISA with monoclonal antibodies and folic acid and vitamin B12 determinations by an immunoradiometric assay. It was found that the prevalence of anemia was 89.6% and deficiencies of iron, folic acid and vitamin B12 affected 37.1,70.3 and 12.4% of the population studied, respectively. Plasmodium infection was detected by molecular diagnosis in 53.2% of the cases, and 86% of them were anemic. The highest incidence of anemia was found in children, with a prevalence of 100% in infants of both sexes. The high prevalence of anemia, iron and folic acid deficiencies found, indicates an important health and nutrition problem that should be immediately and properly addressed. The number of cases of anemia due to iron deficiency could be underestimated, since ferritin concentration increased as a acute phase protein, although prevalence data was also analyzed with a cutoff point of 30 microg/L for ferritin concentration.     

Prevalence of anemia, iron and folate deficiency in children 7 years smaller. Costa Rica, 1996

In 1996, were studied in Costa Rica 961 children with ages between one and six years, with representation for metropolitan, urban and rural zones of the country. The classification approaches applied were emitted by the Pan-American Health Organization and the World Health Organization. The preschooler population presented in the national environment a prevalence of anemia of 26.3% (children from 1 to 4 years with hemoglobin < 11.0 g/dL and those from 5 to 6 years old with hemoglobin < 12.0 g/dL). The prevalence of Iron depletion (Ferritin < 12 ng/mL) and iron deficiency (Ferritin < 24 ng/mL) were 24.4% and 53.8%, respectively. The folate deficiency (< 6.0 ng/mL) was 11.4%. The iron deficiency was higher in children smaller than 4 years, being the maximum deficiency in the 1 year-old (75%). More than 40% of the preschool children presented sub-clinical deficiency of iron; of them, 10% showed severe deficiency of iron without presence of anemia. The children from the rural area presented the highest prevalence of anemia and iron depletion, while the metropolitan area met more frequency with iron deficiency. The nutritional anemias still constitute a moderate problem of public health in Costa Rica. The main cause is iron deficiency, associated in small proportion with folate deficiency and other factors associated with the erythropoiesis.     

Prevention of iron deficiency in infants by fortified milk. Field study of a low-fat milk

Healthy term infants were given a low-fat powdered milk fortified with 15 mg/100g of iron, as ferrous sulphate, for one year, starting at three months of age. The control group received non-fortified milk. A total of 510 infants entered the study, and 314 could be studied at the age of 15 months. Consumption of the fortified formulas was monitored through iron determinations in stools. Groups had a comparable hemoglobin concentration at the age of three months. Hemoglobin was higher in the fortified group at nine months (11.7 +/- 1.0 vs 11.4 +/- 1.1 g/dl, p less than 0.02), and 15 months (12.0 +/- 1.1 vs 11.4 +/- 1.2, p less than 0.001). The percentage of subjects with anemia (Hb less than 11.0 g/dl) was lower in the fortified group: 14.8% vs 27.7% of the controls at nine months and 7.0% vs 35.3% at 15 months. Percentages of subjects with iron deficiency (Fe/TIBC less than 9%) were lower in the fortified group: 28.0% vs 49.1% of the controls at nine months, and 20.0% vs 41.8% at 15 months. Although the fortified milk markedly improved iron nutrition, deficiency of this mineral was still high in the group receiving it. This was probably due to the low bioavailability of iron when administered with non-modified milks.     

Vitamin A deficiency among preschool children: a re-emerging problem in Costa Rica?

Based on the 1996 National Nutrition Survey, this study shows the prevalence of Vitamin A deficiency (VAD) among 567 Costa Rican urban and rural 12-83 months old-children. In overall, the prevalence of VAD (plasma retinol < or = 20 micrograms/dl) was 8.8%. No difference was found even when data were analyzed by area and gender. Around 30% of preschool children were at risk of VAD (plasma retinol between 20.1-30 micrograms/dl). The proportion of children at risk for retinol deficiency was significantly higher in rural area in comparison with urban area (38.9% and 28.0% respectively, p < 0.05). Lineal regression analysis showed that plasma retinol levels were negatively related to the number of family members and positively related to mother's schooling. Our results suggest a possible impairment in vitamin A status of preschool children.     

Protective factors for iron deficiency anemia: prospective study in low-income infants

This study was performed to assess both risk and protective factors associated with iron deficiency anemia in 130 infants with age below 24 months, with low socio-economic status and followed since their births by a primary health care program in the city of S?o Paulo, Brazil. Growth, morbidity and dietary factors were analysed as well as hemoglobin levels (Hb) at regular intervals (6, 9, 12, 18 and 24 months). The portable Hemocue photometer was employed to measure hemoglobin levels and anemia was considered when Hb values were below 11 g/dL. Simple logistic regression was used with socio-economic variables, age group, nutritional status, morbidity, breastfeeding and food intake. Risk factors for anemia in the studied group were intake of cow's milk at 4 months and who has 3 or more old brothers (OR approximately = 2). The protective factors for anemia were age between 18 and 24 months and intake of infant formula, vitamin C, meat and beans at 6 months (OR approximately = 0.5). The prevention of iron deficiency anemia includes encouraging healthy feeding practices starting at 6 months of life.     

Is Correction of Iron Deficiency a New Addition to the Treatment of the Heart Failure?

Anemia is present in about 40% of heart failure (HF) patients. Iron deficiency (ID) is present in about 60% of the patients with anemia (about 24% of all HF patients) and in about 40% of patients without anemia (about 24% of all HF patients). Thus ID is present in about half the patients with HF. The ID in HF is associated with reduced iron stores in the bone marrow and the heart. ID is an independent risk factor for severity and worsening of the HF. Correction of ID with intravenous (IV) iron usually corrects both the anemia and the ID. Currently used IV iron preparations are very safe and effective in treating the ID in HF whereas little information is available on the effectiveness of oral iron. In HF IV iron correction of ID is associated with improvement in functional status, exercise capacity, quality of life and, in some studies, improvement in rate of hospitalization for HF, cardiac structure and function, and renal function. Large long-term adequately-controlled intervention studies are needed to clarify the effect of IV iron in HF. Several heart associations suggest that ID should be routinely sought for in all HF patients and corrected if present. In this paper we present our approach to diagnosis and treatment of iron deficiency in heart failure.     

Pre-cooked corn flour intake and its contribution of iron and vitamin A in low income preschoolers

The objective of this study was to determine whether the addition of iron and vitamin A (VA) to corn flour, supplied through a national enrichment program since 1993, allows preschoolers to achieve an adequate intake of these nutrients. Data from the assessment of 196 children (4-6 year old) from Valencia, Venezuela is presented, including socio-demographic, anthropometric, anemia, VA deficiency (by conjunctival impression cytology (CIC) and serum retinol), and food intake. 92% of the children lived in poverty. 12% were below the norm for weight-for-height. 13% had anemia, 9% had VA deficiency according to CIC, and 0.5% according to serum retinol (< 0.70 mumol/L), 30% were at risk of VA deficiency (0.70-1.05 mmol/L). 17%, 37%, and 5% of the sample had an insufficient intake (< 80% of RDA) of energy, iron, and VA, respectively. When excluding from the analysis the amount of iron and VA from corn flour enrichment, an additional 38% and 10% of the sample showed deficient intakes of each nutrient, respectively. According to the weight-for-height indicator, iron intake was significantly lower in undernourished children (p < 0.05) than in those normal or above the norm; this was not so for VA. It is concluded that iron enrichment contributes to the improvement of the intake of this nutrient but is not enough to provide an adequate amount of it; and that the addition of VA does not seem to have an important effect on the diet of this age group.     

Requirements of nutrients which participate in erythropoiesis

Proteins, some minerals and vitamins, play important roles in erythropoiesis and the survival of the red blood cell. This article deals specifically with the physiological requirements and recommended intakes of iron, folate and vitamin B12. A comparison of the physiologic iron requirements according to age and sex, and the amount of iron which is actually absorbed from the diets consumed by the lower socioeconomic strata of the Venezuelan population; indicates that these diets do not satisfy the requirements at all ages. Such disparity is most marked in children below three years of age, in adolescents and in women during their reproductive age. Failure to do so leads to varying degrees of iron deficiency. This low bioavailability of the Venezuelan diet is also observed in other Latin American diets consumed by the same low socioeconomic strata, which explains the high prevalence of iron-deficiency anemia in the vulnerable groups. The low intake of fruits and vegetables by the lower socioeconomic strata of the Latin American population prevents these sectors from consuming an adequate intake of folate, failing to fulfill the daily recommended intake (3.3 - 3.6 micrograms/kg body weight). This situation is aggravated in pregnant and lactating women who require an additional intake of 300 micrograms and 100 micrograms, respectively. Prevalence of folate deficiency in the first stage may be in the order of 30% in some regions. In the second stage of deficiency, characterized by megaloblastic changes in the bone marrow and an erythrocyte folate concentration of less than 50 micrograms/lt, it could be as high as 40% in pregnant women. Nutritional vitamin B12 deficiency does not constitute a health problem in Latin America. Various surveys in the lower socioeconomic strata have reported normal or higher than normal serum B12 concentrations, compared to well-nourished populations.