Decreased Iron Intake Parallels Rising Iron Deficiency Anemia and Related Mortality Rates in the US Population.

BACKGROUND: Prevalence of iron deficiency anemia and its related mortality rate are on the rise in the United States and causes are unclear. OBJECTIVES: The aim was to examine trends and causes of Fe deficiency anemia prevalence and Fe deficiency-related mortality rates in the total US population. METHODS: Changes in daily dietary Fe intake, serum iron concentration, hemoglobin, red cell distribution width (RDW), and mean corpuscular volume (MCV) obtained from the laboratory files of NHANES, Fe deficiency anemia-related mortality rates from the CDC, and iron concentrations of US food products from the USDA between 1999 and 2018 were analyzed. RESULTS: Of food items with revised concentrations in USDA Nutrient Database for Standard Reference [SR28 (2015)], 62.4% had lower Fe concentrations than in SR11 (1999). There was a 15.3% reduction in beef (relatively higher in heme iron) and a 21.5% increase in chicken meat consumption in the American diet between 1999 and 2018. Dietary iron intake decreased by ∼6.6% and ∼9.5% for male and female adults, respectively. Increases of prevalence of estimated anemia in the United States ranged from 10.5% to 106% depending on age and sex. Age-adjusted mortality rates with iron deficiency anemia as the underlying cause of death increased from ∼0.04 to ∼0.08 deaths per 100,000 people, whereas all other anemias as the underlying causes of death decreased by ≥25%. Mean RDW and serum folate concentrations increased, whereas hemoglobin, serum iron concentrations, and MCV, parameters traditionally associated with Fe deficiency anemia, decreased during this period. CONCLUSIONS: Increased iron deficiency anemia and related mortality rates in the US population between 1999 and 2018 were likely related to the decline in dietary iron intake resulting from an Fe concentration decline in US food products and a shift in dietary patterns.

Determinants of Anemia among women in Uganda: further analysis of the Uganda demographic and health surveys.

BACKGROUND: Anemia is a public health problem in many developing countries. It affects a sizable proportion of women of reproductive age. Anemia increases the risk of morbidity and mortality from infectious diseases, and can lead to poor fetal outcomes, and low productivity. This study examined the trends and determinants of anemia among women of reproductive age in Uganda. METHODS: This study analyzed data from the Uganda Demographic and Health Surveys conducted in 2006, 2011, and 2016. The study was based on 10,956 weighted cases of women age 15-49. Bivariate analysis and multiple logistic regression analysis examined the association between the outcome variable and the determinants. Potential determinants of anemia in women were selected based on literature. RESULTS: The results of the analysis show that anemia decreased in Uganda between 2006 and 2016, but with an increase between 2011 and 2016. The overall prevalence of anemia among women was 50, 23, and 32% respectively in 2006, 2011, and 2016. Women who were pregnant at the time of the survey had higher odds of being anemic across the surveys (OR 2.00, 95% CI 1.49-2.67; OR 1.47, 95% CI 1.02-2.10; OR 1.33, 95% CI 1.07-1.65). Women in households with nonimproved sources of drinking water also had higher odds for anemia (OR 1.32, 95% CI 1.09-1.61) in 2016. Wealth index, region and age were also significantly associated with anemia in women. CONCLUSION: In order to reduce anemia in women, there is need to target pregnant women during antenatal and postpartum visits, and ensure that nutrition education during such visits is supported. There is also need to ensure sustainable household access to safe water. This should be combined with interventions aimed at enhancing household wealth.

Investigation of Pediatric Anemia in the Commonwealth of the Northern Mariana Islands.

Objective To report on the prevalence and etiology of pediatric anemia in the Commonwealth of the Northern Mariana Islands (CNMI). Method A retrospective chart review was conducted that included patients up to 19 years of age who presented for well child care and whose hemoglobin or hematocrit was checked in the CNMI from 2014 to 2015. Lab values, diagnoses and treatment plans, patient reported ethnicity, and follow-up results were collected from eligible patients. Results The records for 1483 pediatric patients who had 1584 well child visits were reviewed. The prevalence of anemia amongst all eligible patients was 8.0% (5.4-10.7). This included 292 9 to 18 months old patients, which is estimated to be 40% of the total pediatric population of CNMI in that age group. Among the 9 to 18 months old patients, the prevalence of anemia is 5.5% (2.6-8.4). Etiology of anemia was investigated and of the patients treated with iron, 55.2% had a documented response. The majority of those without documentation of improvement with iron were patients who were lost to follow-up. In addition, a total of 10 patients were found to have an alpha or beta thalassemia variant discovered initially by anemia screening or sibling tracing. Discussion In this United States Commonwealth, prevalence of anemia appears lower than prevalence reported for other independent Pacific Island nations and closer to that of the US. Thalassemia is documented within this population. Limitations to this data were use of a convenient sample that may be hampered by lack of presentation to well-child care. This study will guide future public health studies on anemia prevalence and can guide public health intervention decisions to improve pediatric care in the CNMI.

[Improved effect of comprehensive nutritional intervention of whole covering for Kazak's pregnant women, lactating women and infants in Altay farming and stockbreeding region].

OBJECTIVE: To study the effect of nutritional intervention for Kazak's pregnant women, lactating women and infants in farming and stockbreeding region of Jeminay County, Altay City. METHODS: 24 h record method was conducted to implement dietary survey, and results were used to analyze dietary structure and nutrient intake level of pregnant women, lactating women and infants. Pregnant women, lactating women and infants over 6 months were intervened with iron fortified soy sauce nutrients supplement and Yingyangbao(YYB) for 2. 4 years. Hemoglobin was detected for pregnant women, lactating women and infants by using HemoCue analyzer. RESULTS: The nutrient intakes of the pregnant women, lactating women and infants were averagely lower than that of the recommended levels. In these infants who received breast feeding, the least acceptability diet quality rate was 42. 1%, and in other infants who didn't receive breast feeding, the rate was 25%. After intervention, anemia prevalence of pregnant women, lactating women and infants were significantly reduced compared with the base line levels at 2 survey time points(2014:pregnant women χ~2=26. 27, lactating women χ~2=18. 06, infants χ~2=44. 46, 2015:pregnant women χ~2=35. 62, lactating women χ~2=25. 05, infants χ~2=39. 61;all P<0. 001). CONCLUSION: The nutrition intervention of whole covering could improve nutrition status of Kazak's pregnant women, lactating women and infants.

Effect of directly observed oral iron supplementation during pregnancy on iron status in a rural population in Haryana: A randomized controlled trial.

BACKGROUND: In India, more than half of the pregnant women suffer from anemia. Low compliance to iron supplementation is one of the important reasons. OBJECTIVES: The objective of the study is to estimate the reduction in the prevalence of anemia, improvement in iron status, and to compare the compliance to oral iron supplementation during pregnancy between directly observed iron-folic acid (IFA) supplementation group and control group. METHODS: This was a community-based open labeled parallel block-randomized controlled trial including 400 pregnant women in a rural setting of north India. In the intervention group, the first dose of IFA every week was supervised by ASHA and women were instructed to take the remaining tablets during the week as per the prescription. In control group, IFA tablets were supplemented without direct supervision. RESULTS: After 100 days of IFA supplementation, the reduction in anemia in the intervention group was 6% higher as compared to control group (P = 0.219). The increase in the mean hemoglobin level over and above control group was 0.52 g/dl in intervention group (P < 0.001). However, the mean increase in serum ferritin level in the intervention group was similar to the control group. The mean percentage compliance in the intervention group was almost 9% higher than that of control group (P = 0.001). CONCLUSION: Directly supervised oral iron (IFA) supplementation improves compliance to oral iron (IFA) supplementation and also improves hemoglobin status among pregnant women. However, the mean increase in serum ferritin and reduction in the prevalence of anemia in the intervention group were not higher than the control group.

Prevalence of anemia among reproductive-age females in the Tharu tribe of the Indo-Nepal border region.

Background: India shares the largest number of anemia patients globally. Anemia in reproductive-age female, affects not only the maternal mortality and morbidity but inversely affect the pregnancy outcome also. Tribals in India are geographically isolated and most of them belong to very low socio-economic status. Regarding Tharu tribes, to date, there is no study to find the prevalence of anemia in this community. Aim: We aim to find the prevalence of anemia in the reproductive-age female of the Tharu community. Additionally, we also accessed the severity and possible causes of anemia. Materials and Methods: A total of 440 reproductive age females from the Tharu community were recruited in this study from Tharu predominant Tulsipur tehsil of Balrampur district on 8 December 2019. CBC of each sample was performed by a 3-part basic hematology analyzer. Results: The mean (SD) hemoglobin level of the study group observed was 11.11 (±1.96) gm/dl with a median value of 11.3 gm/dl. Prevalence of anemia was noted in 283 (64.32%) participants. Amongst the anemic subjects, mild, moderate, and severe anemia was noted in 33.57%, 57.24%, and 9.19%, respectively. Microcytic, normocytic, and macrocytic anemia was noted in 53.00%, 44.88%, and 2.12%, respectively. Conclusion: The high prevalence of mild and moderate anemia in reproductive-age women is a matter of concern and should be dealt with priority. Community-based screening for hemoglobinopathies is also needed to evaluate the actual cause of anemia.

Distribution of hemoglobin levels and prevalence of anemia according to sex, age group, and region in 13 Korean cities.

INTRODUCTION: The distribution of hemoglobin (Hb) levels and the prevalence of anemia are significant public health indicators. The aims of this study were to determine the distribution of Hb levels and the prevalence of anemia according to sex, age group, and region throughout Korea. METHODS: The study analyzed data on 1 159 298 subjects who received health checkups at 16 health-promotion centers in 13 Korean cities during 2018. Anemia and its severity were defined according to the World Health Organization classification for Hb levels as follows: mild anemia (11-12.9 g/dL in males and 11-11.9 g/dL in females), moderate anemia (10-10.9 g/dL in both sexes), and severe anemia (<10.0 g/dL in both sexes). RESULTS: The Hb level in the general sample was lower in females (13.25 ± 1.13 g/dL, mean ± SD) than in males (15.29 ± 1.22 g/dL). The overall prevalence of anemia was 6.0% (2.98% in males and 8.56% in females), and the prevalence of severe anemia was 0.92% (0.23% in males and 1.51% in females). While the prevalence of anemia increased monotonically with age in males, it was bimodal in females with two peaks at 40-49 years and ≥80 years. The highest prevalence of anemia in females aged 40-49 years was attributed to microcytic anemia, while increases in anemia prevalence in males aged ≥50 years and females aged ≥70 years were attributed to macrocytic anemia. CONCLUSION: The distribution of Hb levels and the prevalence of anemia overall and by severity differ according to sex, age group, and region throughout Korea.

Investigation of anemia prevalence in 10 674 children in Bincheng District, Binzhou City / 中国输血杂志

【Objective】 To analyze the prevalence of anemia in preschool children in Bincheng District of Binzhou city and its influencing factors, so as to provide reference for formulating new measures to prevent anemia in children. 【Methods】 The health examination results of 10 674 children aged 3~6 from multiple kindergartens in Bincheng District in 2020 were collected, and anemia prevalence was investigated by analyzing the blood routine indicators. 【Results】 The incidence of anemia in 10 674 children was 1.95%, with 1.86%(100/5 375)in boys and 2.04%(108/5 299)in girls(P>0.05), with 3.06%(44/1 439)vs 2.93%(43/1 468), 1.79%(37/2 071)vs 2.04%(43/2 107)and 1.02%(19/1 865)vs1.28%(22/1 724)in boys and girls aged 3, 4 and 5, respectively. No significant difference was noticed in anemia incidence between boys and girls in each age group(P>0.05), while significant difference laid between boys and girls among different age groups(P<0.05). The degree of anemia was mainly mild in both boys and girls, accounting for 98.6%(205/208)of the total anemia. The median Hb of preschool children in Bincheng District was 125 g/L(boys 125 g/L vs girls 124 g/L). The median Hb of 5-year-old boys was 126 g/ L, which was higher than 125 g/L of 5-year-old girls. The Hb values of boys and girls were different by age groups, with statistical significance(P<0.05). 【Conclusion】 The anemia prevalence in children in Bincheng District decreased gradually with the increase of age. The general survey of anemia in children with younger age is an important step for early detection and early intervention.

Fatores associados à anemia em adolescentes escolares do sexo feminino / Factores asociados con la anemia en adolescentes escolares / Factors associated with anemia in female school adolescents

O objetivo deste estudo foi identificar a prevalência da anemia em meninas adolescentes do município de Vespasiano, Minas Gerais, e sua associação com variáveis socioeconômicas, demográficas e biológicas. Foram avaliadas 736 meninas adolescentes na faixa etária de 11 a 16 anos de idade, matriculadas em 8 escolas do ensino fundamental entre fevereiro e março de 2012. A hemoglobina sanguínea foi determinada por punção digital, pelo método da cianometahemoglobina. Também foi aplicado um questionário às meninas escolares para a obtenção de variáveis biológicas, socioeconômicas e demográficas. Considerou-se anemia a concentração de hemoglobina<12,0 g/dL, segundo a Organização Mundial da Saúde. Foram consideradas significativas as diferenças cujo teste associado tivesse p<0,05. A prevalência de anemia na população estudada foi de 7,3%. A idade média e desvio padrão foram 12,9±1,1 anos. As meninas escolares de 14 a 16 anos completos tiveram 1,8 vezes mais chance de serem anêmicas do que suas colegas da faixa etária inferior (p<0,047). Houve associação significativa entre anemia e número de pessoas no domicílio (p<0,001). Esses resultados demonstram que a anemia neste grupo é um leve problema de saúde pública, o que não descarta a necessidade de instituição de mecanismos de vigilância alimentar e nutricional, permitindo uma intervenção precoce no problema e reduzindo o impacto negativo da anemia em meninas escolares.

The objective of this study was to evaluate anemia prevalence in young adolescent girls and their association with socio-economic, demographic and biological variables in the city of Vespasiano, Minas Gerais, Brazil. Adolescent girls (n=736) between 11 and 16 years of age, enrolled in eight elementary schools, were evaluated for anemia between February and March, 2012. Hemoglobin level was assessed on site by fingerprick blood samples using the cyanmethemoglobin method. Additionally, the adolescent girls were asked to respond to a socio-economic, biological and demographic questionnaire. Anemia was defined as a hemoglobin level<12.0 g/dL, according to the World Health Organization. The adopted significance level was 0.05. Prevalence of anemia observed in the adolescent girl population was 7.3%. Mean age and standard deviation were 12.9±1.1. Adolescent girls aged 14 to 16 years were 1.8 times more anemic than their younger classmates (p<0.047). There was a positive association between anemia and the number of family members living at home (p<0.001). The results demonstrated low anemia prevalence in the young adolescent girl population enrolled in public schools. The implementation of mechanisms for ongoing food and nutrition surveillance is highly recommended in this vulnerable group as part of an ongoing anemia control and prevention program.

El objetivo fue evaluar la prevalencia de anemia en las adolescentes y su asociación con variables socioeconómicas, demográficas y biológicas en la ciudad de Vespasiano, Minas Gerais, Brasil. En adolescentes (n=736) entre 11 y 16 años, matriculadas en escuelas primarias, se evaluó la anemia entre febrero y marzo de 2012. La hemoglobina fue evaluada por punción digital en muestras de sangre utilizando el método cianometahemoglobina. Además, a las adolescentes se les pidió responder al cuestionario socioeconómico, biológico y demográfico. La anemia es una concentración de hemoglobina<12,0 g/dL, según la Organización Mundial de la Salud. El nivel de significación fue 0,05. La anemia en las chicas fue del 7,3%. La edad media fue de 12,9. Las adolescentes de entre 14 y 16 años eran 1,8 veces más anémicas que sus compañeras más jóvenes (p<0,047). Se observó una asociación positiva entre la anemia y el número de miembros de la familia (p<0,001). La prevalencia de anemia en las adolescentes fue baja. La implementación de mecanismos para la alimentación continua y vigilancia de la nutrición es recomendable en este grupo como control de la anemia en curso y programa de prevención.

Hemoglobin measured by Hemocue and a reference method in venous and capillary blood: a validation study

Objective. To assess the comparability of hemoglobin concentration (Hb) in venous and capillary blood measured by Hemocue and an automated spectrophotometer (Celldyn) and to document the influence of type of blood (capillary or venous) and analysis method on anemia prevalence estimates. Material and Methods. Between February and May 2000, capillary and venous samples were collected from 72 adults and children at Hospital del Niño Morelense (Morelos State Children's Hospital) in Cuernavaca, Morelos, Mexico, and assessed for Hb using the Hemocue and Celldyn methods. Estimated Hb levels were compared using the concordance correlation coefficient and Student's t test for paired data. The sensitivity and specificity for anemia diagnosis were estimated and compared between type of blood and method of assessment. Results. Capillary blood had higher Hb (+0.5g/dl) than venous blood in adults and children, as did samples assessed by Celldyn compared to Hemocue (+0.3g/dl). Specificity to detect anemia was adequate (>0.90) but sensitivity was low for capillary blood assessed by Hemocue (<0.80). Conclusions. The difference in Hb between venous and capillary blood is likely related to biological variability. Hemoglobin concentration in capillary blood assessed by Hemocue provides an adequate estimation of population anemia prevalence but may result in excess false negative diagnoses among individuals. The results of this study stress the importance of sample collection technique, particularly for children. Method of analysis and sampling site need to be taken into consideration in field studies.

Objetivo. Evaluar la comparabilidad de la concentración de hemoglobina (Hb) en sangre venosa y capilar medida por Hemocue y por espectrofotómetro automatizado (Celldyn), así como documentar la influencia del tipo de sangre (capilar o venosa) y del método de análisis sobre la prevalencia de anemia. Material y métodos. De febrero a mayo de 2000, se recolectaron muestras de sangre capilar y venosa en 72 adultos y niños en el Hospital del Niño Morelense, Cuernavaca, Morelos, México. Se determinaron los niveles de Hb con los métodos Hemocue y Celldyn. Las cifras de Hb estimadas se compararon con el coeficiente de concordancia y la prueba pareada de t de Student. También se comparó la sensibilidad y especificidad para el diagnóstico de anemia, utilizando sangre de los dos tipos y métodos de análisis. Resultados. La Hb fue mayor en sangre capilar comparada con sangre venosa (+0.5g/dl) en adultos y niños, y en las determinaciones por Celldyn comparadas con las de Hemocue (+0.3 g/dl). La especificidad para el diagnóstico de anemia fue adecuada (>0.90), mientras que la sensibilidad fue baja para las muestras capilares medidas por Hemocue (<0.80). Conclusiones. Es probable que la diferencia en la Hb entre sangre venosa y capilar refleje variabilidad biológica. La Hb en sangre capilar medida por Hemocue provee una estimación adecuada de la prevalencia de anemia en poblaciones, pero podría resultar en un exceso de diagnósticos falsos negativos. Los resultados de este estudio ponen énfasis en la importancia de la técnica de recolección de la muestra, particularmente en niños. Los métodos de análisis y tipos de muestra de sangre deben ser tomados en cuenta en estudios de campo.