Anemia in the Turks and Caicos Islands: exploring the dietary link.

OBJECTIVE: To conduct the first national dietary survey and examine inter-island differences in and relationships between iron consumption and reports of anemia. DESIGN AND METHODS: A total of 144 households, randomly selected from electoral lists for Grand Turk (n=48), Providenciales (n=46), and Middle Caicos (n=50), participated in the survey. Food consumption (via food frequency questionnaire), self-reported health history, and sociodemographic data were collected from female household-heads during home interviews. Data on frequency of consumption and tabulated iron score for each "normal" food portion size were used to calculate each household's iron-intake-score. Chi-squared analyses were used to compare inter-island intake score categories. RESULTS: Households were assigned to low (<100), medium (100-160), or high (>160) iron-intake-score categories. The proportion of households with low scores was lower on Grand Turk (<5%) and Providenciales (0%) compared to Middle Caicos (20%), the least developed island. CONCLUSION: Suboptimal iron intakes, especially on Middle Caicos, support the prevailing view that anemia in vulnerable groups could be of dietary origin. Findings highlight the need for additional research to determine how various factors (eg, diet, supplement use, physiology, and environment) impact iron status. In the short term, we must identify and treat cases and provide culturally appropriate nutrition education to increase dietary iron intake and promote safe use of multivitamin/mineral supplements. National dependence on imported foods makes this the most viable public health intervention option until the etiology of anemia is fully determined.

Dietary patterns with respect to iron intake in the Turks and Caicos Islands - abstract

Cohen et al (1974) found a high prevalence of anaemia amongst 0-13 year-old children in the Turks and Caicos Islands. There was a marked inter-island variation with 69 percent of 5-year-old children on Middle Caicos and 28 percent on Grand Turk being anaemic. They ascribed this anaemia as probably being due to iron deficiency. A food frequency questionnaire was designed and weighted so that household iron consumption could be computed as a score. The method was pretested and the score calibrated against 24-hr recalls for three days in 10 individuals: a correlation coefficient of r=0.93 was obtained between the two methods. The questionnaire was administered to the female household head of 144 households on Grand Turk (48), Provodentiales (46) and Middle Caicos (50), selected at random from the register of voters. The foods consumed formed a series of Guttman scales for each of the eight food groups. Chicken, fish, rice, bread and evaporated milk were most frequently consumed. The dietaries were very restricted on each island, with Middle Caicos only having eight major items consumed more than three times per week, by more than 25 percent of households. The households were divided into low, medium and high iron intake categories based on iron scores which correspond to ó7.5, 7.6 to 12.9 and o13mg Fe/d. Grand Turk and Provodentiales were similar with 1 percent of families in the low iron group and 76 percent in the high group. In contrast, 20 percent of families in Middle Caicos were in the low, and only 44 percent in the high iron intake group. The iron equivalent of the overall scores for the three islands were 15.2ñ2.1, 14.6ñ1.7 and 11.8ñ2.7mg/d respectively. The mean RDA for iron for this population's age/sex structure is 10.1 mg/d. When the contributions to the total iron intake from each food group were calculated, Middle Caicos households had significantly lower intakes in each category. These data add support to the hypothesis that dietary iron deficiency is responsible for the high prevalence of anaemia in the Turks & Caicos Islands. Bread and rice were consumed more than 3 times weekly by 98 and 93 percent of households on each island: these were the only items which would be suitable for iron fortification. As the flour and rice are entirely imported from the U.S.A., in relatively small quantities (total population 7,700), it is probably more cost-effective to distribute prophylactic iron supplements than to fortify a dietary constituent (AU)