Prevalence of Anemia and Iron Deficiency in Women of Reproductive Age in Cuba and Associated Factors.

This study aims to evaluate the prevalence of anemia and iron deficiency in women of reproductive age and the association with inflammation, global overweight, adiposity, and menorrhagia. A sample design of women of reproductive age from the Eastern, Central, and Havana Regions was carried out. Biochemical determinations of hemoglobin, serum ferritin, soluble transferrin receptors, leukocytes, C-reactive protein, alpha-1 acid glycoprotein, and homocysteine were performed. Serum ferritin was also adjusted by inflammation. Nutritional status was assessed, and menstrual characteristics were collected by survey. A total of 742 women were studied. The prevalence of anemia was 21.4%, iron storage deficiency at 16.0%, and erythropoietic dysfunction at 5.4%, with inflammation at 47.0% and elevated homocysteine at 18.6%. Global overweight was 46.2% and increased adiposity at 58.4%. Anemia is associated with iron deposition deficiency (OR = 3.023 (1.816-5.033)) and with erythropoietic deficiency (OR = 5.62 (3.03-10.39)), but not with inflammation, global overweight, and adiposity. Global overweight was found to be associated with inflammation (OR = 2.23 (1.41-3.53)). Anemia was associated with heavy menstrual bleeding (OR = 1.92 (1.34-2.76)). Homocysteine was associated with inflammation (OR = 2.05 (1.08-3.90)), but not with anemia. In conclusion, anemia in Cuba is classified as a moderate public health problem, but not iron deficiency. A high prevalence of overweight and obesity was found, associated with inflammation, but not with anemia or iron deficiency. Heavy menstrual bleeding is a factor associated with anemia.

Anemia, deficiencia de hierro y factores asociados en niños cubanos de 6 a 59 meses

Introducción: La principal causa de anemia en los preescolares es la deficiencia dietética de hierro, pero existen otras condiciones asociadas y no evaluadas. Objetivo: Estimar la prevalencia de anemia y deficiencia de hierro en niños de 6 a 59 meses y su asociación con inflamación, sobrepeso global, ingestión de alimentos y nivel de instrucción materno. Métodos: Se realizó un estudio transversal nacional, con determinaciones de hemoglobina, ferritina, receptores de transferrina, proteína C reactiva y alfa-1 glicoproteína ácida. Se evaluó el estado nutricional, dieta y nivel de instrucción de la madre. Resultados: Se estudiaron 1417 niños. La prevalencia de anemia fue de un 22,5 %, la de deficiencia de hierro, de un 35,6 % y la de disfunción eritropoyética, de un 13,3 %; con inflamación 37,6 % y prevalencia de sobrepeso global 7,5 %. La anemia estuvo asociada al déficit de hierro OR = 2,07(1,45-2,97) y la inflamación OR = 2,01(1,45-2,78). No se encontraron asociaciones entre la anemia y el déficit de hierro con el sobrepeso global. El bajo consumo de huevos OR = 1,84 (IC95 %1,39-2,43), frutas OR = 1,73 (IC95 %1,29-2,34) y leguminosas OR = 1,68 (IC95 %1,25-2,25) resultaron ser un factor de riesgo de anemia. El análisis de regresión logística mostró que la anemia estaba asociada al grupo menor de 2 años, deficiencia de hierro, inflamación y bajo consumo de frutas; y el sobrepeso global fue un factor de protección. Conclusiones: La anemia y deficiencia de hierro clasifican como problemas de salud pública moderados asociados a la inflamación. El grupo menor de dos años y el bajo consumo de frutas resultó ser un factor de riesgo y el sobrepeso global resultó un factor de protección para la anemia.

Introduction: The main cause of anemia in preschoolers is dietary iron deficiency, nonetheless there are other associated and unevaluated conditions. Objective: To estimate the prevalence of anemia and iron deficiency in children aged 6 to 59 months and the association with inflammation, overall overweight, food intake and maternal educational level. Methods: A national cross-sectional study was carried out, with determinations of hemoglobin, ferritin, transferrin receptors, C-reactive protein and alpha-1 acid glycoprotein. The nutritional status, diet and educational level of the mother were evaluated. Results: One thousand four hundred and seventeen children were studied. The prevalence of anemia was 22.5%, 35.6% of iron deficiency, and 13.3% of erythropoietic dysfunction. 37.6% of cases presented inflammation and 7.5% presented global overweight prevalence. Anemia was associated with iron deficiency OR = 2.07(1.45-2.97) and inflammation OR = 2.01(1.45-2.78). No associations were found between anemia and iron deficiency with overall overweight. Low consumption of eggs OR = 1.84 (95% CI 1.39-2.43), fruits OR = 1.73 (95% CI 1.29-2.34) and legumes OR = 1.68 (CI 95% 1.25-2.25) were found to be a risk factor for anemia. The logistic regression analysis showed that anemia was associated with the group under two years of age. Conclusions: Anemia and iron deficiency classify as moderate public health problems associated with inflammation. The group under two years of age and low fruit consumption turned out to be a risk factor and overall overweight turned out to be a protective factor for anemia.

[Impact of the actions for the sustainable elimination of iodine deficiency in Cuba]. / Impacto de las acciones para la eliminación sostenible de la deficiencia de yodo en Cuba.

OBJECTIVES: To assess the effectiveness of the Sustainable Elimination of Iodine Deficiency Program through determination of urinary iodine and goiter prevalence. MATERIALS AND METHODS: A cross-sectional study was conducted in Cuban school children aged 6 to 11 years old in 2011-2012. A stratified multistage sample was used in which the levels of iodine excretion in urine (urinary iodine) and the presence of goiter were determined. RESULTS: The median urinary iodine was 176.3 µg/L; 7.6% of the students showed some deficiency of iodine, only 2.2% were below 50 µg/L (severe deficiency), and 15.3% had urinary iodine above 300 µg/L. The percentage of school children with optimal iodine nutrition was 43.5%, this category showed a significantly higher frequency (p=0.03) in the mountain areas (52.5%). Goiter prevalence was 17.6% which corresponds to a mild endemic. However, in the mountain area the prevalence was 32.6% (severe endemic). CONCLUSIONS: The comprehensive analysis of the impact of iodine deficiency control measures assessed by urinary iodine excretion and goiter prevalence reflects that it is no longer a population health problem in urban and rural areas of Cuba, attributable to a proper process of salt iodization. Nevertheless, high goiter prevalence is still observed in the mountain area of Cuba.

Impacto de las acciones para la eliminación sostenible de la deficiencia de yodo en Cuba / Impact of the actions for the sustainable elimination of iodine deficiency in Cuba

Objetivos: Evaluar la efectividad del “Programa de Eliminación Sostenible de Deficiencia de Yodo” mediante determinación de yoduria y prevalencia de bocio. Materiales y métodos. Se realizó un estudio transversal en el cual se incluyó a la población escolar cubana de 6 a 11 años que cursaba estudios en el periodo 2011-2012. Se empleó un muestreo estratificado polietápico. En el cual se determinaron los niveles de excreción de yodo en la orina (yoduria) y la presencia de bocio. Resultados. La mediana de yoduria fue de 176,3 µg/L; el 7,6% de los escolares presentaron alguna deficiencia de yodo, solo el 2,2% estaba por debajo de 50 µg/L (deficiencia severa) y el 15,3% tenía yodurias por encima de 300 µg/L. El porcentaje de escolares con nutrición óptima de yodo fue de 43,5%, esta categoría presentó una frecuencia significativamente mayor ( p=0,03) en el estrato montaña (52,5%). La prevalencia de bocio encontrada fue de 17,6%, que corresponde a una endemia ligera. Sin embargo, en el estrato montaña se encontró una prevalencia de 32,6 % (endemia severa). Conclusiones. El análisis integral del impacto de las acciones de control de la deficiencia de yodo evaluado a través de la excreción urinaria de yodo y la prevalencia de bocio refleja que ha dejado de ser un problema de salud poblacional en los estratos urbano y rural de Cuba, atribuible a un adecuado proceso de yodación de la sal. Sin embargo, aún se observa una alta prevalencia de bocio en la zona de montaña de Cuba.

Objectives: To assess the effectiveness of the Sustainable Elimination of Iodine Deficiency Program through determination of urinary iodine and goiter prevalence. Materials and methods. A cross-sectional study was conducted in Cuban school children aged 6 to 11 years old in 2011-2012. A stratified multistage sample was used in which the levels of iodine excretion in urine (urinary iodine) and the presence of goiter were determined. Results. The median urinary iodine was 176.3 µg/L; 7.6% of the students showed some deficiency of iodine, only 2.2% were below 50 µg/L (severe deficiency), and 15.3% had urinary iodine above 300 µg/L. The percentage of school children with optimal iodine nutrition was 43.5%, this category showed a significantly higher frequency (p=0.03) in the mountain areas (52.5%). Goiter prevalence was 17.6% which corresponds to a mild endemic. However, in the mountain area the prevalence was 32.6% (severe endemic). Conclusions. The comprehensive analysis of the impact of iodine deficiency control measures assessed by urinary iodine excretion and goiter prevalence reflects that it is no longer a population health problem in urban and rural areas of Cuba, attributable to a proper process of salt iodization. Nevertheless, high goiter prevalence is still observed in the mountain area of Cuba.