The impact of a planned health educational program on the compliance and knowledge of Jordanian pregnant women with anemia.

Iron deficiency anemia is a major public health problem among pregnant women in developing countries. This study aimed to use a randomized controlled trial to evaluate the effectiveness of a health information package in Jordanian anemic pregnant women's knowledge regarding anemia, compliance with iron supplementation, and hemoglobin level. Two hundred pregnant anemic women were recruited and randomly assigned into intervention or control group from April to July 2016. The intervention group received a video presentation of the Health Information Package Program (HIPP), narrated by a midwife, combined with PowerPoint slides to educate women about anemia in pregnancy. The participants in the control group received standard care in antenatal clinics, including iron supplementation. No significant differences were observed between the groups in age, gestational age, health problems, and total income. Only education and source of information differed significantly between the groups. Women in the intervention group had higher scores on the compliance checklist, knowledge, food selection ability, and hemoglobin level than women in the control group. The health information package program was effective. Policymakers should adopt a health information package program and apply it as a comprehensive national strategy for the prevention of anemia during pregnancy.

Micronutrient status differs among Maasai and Kamba preschoolers in a supplementary feeding programme in Kenya.

Since 2001, ChildFund Kenya has supplied micronutrient fortified school meals to preschoolers from two tribes (Kamba and Maasai) attending early childhood development (ECD) centres in Emali, S.E. Kenya. Lack of information on the micronutrient status of the preschoolers prompted a cross-sectional assessment of micronutrient (iron, zinc, selenium, vitamin A, vitamin D) status and prevalence of deficiencies among the two tribes. Data on sociodemographic, health, anthropometric status, and micronutrient supply from preschool meals were collected from 287 Kamba and 213 Maasai children aged 3 to 5 years attending 23 ECD centres. Nonfasting blood samples were collected for haemoglobin and plasma biomarkers of iron, zinc, selenium, vitamin A, vitamin D, C-reactive protein (CRP), α1 -acid glycoprotein, and immunoglobin G. The prevalence of anaemia was significantly higher in Maasai children than Kamba (38%, 95% CI [31%, 45%], vs. 5%, [3%, 9%]), as well as iron deficiency and its various stages (P < 0.001). No differences were seen in the prevalence of zinc, selenium, vitamin A, or vitamin D deficiencies (all P > 0.05). Body iron, CRP, and age were significant predictors of haemoglobin concentrations for both tribes (all P < 0.006) and plasma 25-OHD for Maasai children only. The higher prevalence of iron deficiency among Maasai than Kamba children was possibly attributed to the high consumption of cow's milk (low in bioavailable iron) in place of micronutrient fortified meals together with a higher prevalence of chronic inflammation and intestinal damage.

Concurrent iron and zinc deficiencies in lactating mothers and their children 6-23 months of age in two agro-ecological zones of rural Ethiopia.

PURPOSE: The aim of this study is to examine the co-occurrences of low serum ferritin and zinc and anaemia among mothers and their children in two agro-ecological zones of rural Ethiopia. METHODS: Data were collected from 162 lactating mothers and their breast fed children aged 6-23 months. The data were collected via a structured interview, anthropometric measurements, and blood tests for zinc, ferritin and anaemia. Correlation, Chi-square and multivariable analysis were used to determine the association between nutritional status of mothers and children, and agro-ecological zones. RESULTS: Low serum levels of iron and zinc, anaemia and iron deficiency anaemia were found in 44.4, 72.2, 52.5 and 29.6% of children and 19.8, 67.3, 21.8, 10.5% of mothers, respectively. There was a strong correlation between the micronutrient status of the mothers and the children for ferritin, zinc and anaemia (p < 0.005). Deficiency in both zinc and ferritin and one of the two was observed in 19.1, and 53.7% of the mothers and 32.7 and 46.3%, of their children, respectively. In the 24 h before the survey, 82.1% of mothers and 91.9% of their infants consumed foods that can decrease zinc bioavailability while only 2.5% of mothers and 3.7% of their infants consumed flesh foods. CONCLUSION: This study shows that micronutrient deficiencies were prevalent among lactating mothers and their children, with variation in prevalence across the agro-ecological zones. This finding calls for a need to design effective preventive public health nutrition programs to address both the mothers' and their children's needs.

Evaluation of serum ferritin and thyroid function in the second trimester of pregnancy.

Ferritin is a universal intracellular protein that acts as an iron carrier. Several studies have indicated that iron deficiency affects thyroid function in non-pregnant women. Our objective was to assess the relationship between serum ferritin levels and thyroid function in pregnant women during the second trimester. Pregnant women with sufficient iodine intake and normal antithyroid antibodies during the second trimester were recruited from the obstetric outpatient department of the Fifth People's Hospital of Fudan University. Serum ferritin (SF) levels, thyroid function, anti-thyroid antibodies and vitamin B12 were determined by electrochemiluminescence immunoassay kit. Maternal serum iron (Fe), unsaturated iron binding capacity (UIBC), hemoglobin (Hb), creatinine (Cr), fasting blood glucose (FBG), and alanine aminotransferase (ALT) were also evaluated. Stepwise regressions performed to evaluate the associations between SF and other maternal parameters. In the second trimester, 11.4% pregnant women had a SF concentration less than 12 µg/L, and 7.6% pregnant women were anemic. SF levels were negatively correlated with serum TSH levels (r = -0.219, p < 0.05), and positively correlated with FT4 levels (r = 0.203, p < 0.05). Linear regression analysis showed only SF, age, week of gestation were significant predictors of regression with TSH as the dependent variable (ß: -0.007, -0.059, and 0.118 respectively; all p < 0.05). However consistent relation between the SF levels and FT4 was not observed in stepwise linear regression. Maternal iron status is a determinant of TSH concentrations during pregnancy in pregnant women during the second trimester.

Community approval required for periconceptional adolescent adherence to weekly iron and/or folic acid supplementation: a qualitative study in rural Burkina Faso.

BACKGROUND: Iron deficiency remains a prevalent adolescent health problem in low income countries. Iron supplementation is recommended but improvement of iron status requires good adherence. OBJECTIVES: We explored factors affecting adolescent adherence to weekly iron and/or folic acid supplements in a setting of low secondary school attendance. METHODS: Taped in-depth interviews were conducted with participants in a randomised, controlled, periconceptional iron supplementation trial for young nulliparous women living in a rural, malaria endemic region of Burkina Faso. Participants with good, medium or poor adherence were selected. Interviews were transcribed and analysed thematically. RESULTS: Thirty-nine interviews were conducted. The community initially thought supplements were contraceptives. The potential benefits of giving iron supplementation to unmarried "girls" ahead of pregnancy were not recognised. Trial participation, which required parental consent, remained high but was not openly admitted because iron supplements were thought to be contraceptives. Unmarried non-school attenders, being mobile, were often sent to provide domestic labour in varied locations. This interrupted adherence - as did movement of school girls during vacations and at marriage. Field workers tracked participants and trial provision of free treatment encouraged adherence. Most interviewees did not identify health benefits from taking supplements. CONCLUSIONS: For success, communities must be convinced of the value of an adolescent intervention. During this safety trial, benefits not routinely available in iron supplementation programmes were important to this low income community, ensuring adolescent participation. Nevertheless, adolescents were obliged to fulfil cultural duties and roles that interfered with regular adherence to the iron supplementation regime. TRIAL REGISTRATION: Trial Registration at clinicaltrials.gov : NCT01210040.

Caregiver-infant's feeding behaviours are associated with energy intake of 9-11 month-old infants in rural Ethiopia.

Inappropriate complementary feeding, both in quantity and quality, is a major determinant of undernutrition. However, little is known about how infant-caregiver's feeding behaviours affect infants' energy intake. Therefore, the objective of this study was to characterize infant-caregiver feeding behaviours and investigate their association with infants' energy intake. The study involved 106 mother-child pairs recruited from seven randomly selected kebeles of Mecha district, West Gojam, Ethiopia. The feeding styles were assessed through observations of 1-day, in-home, feeding episodes that were videotaped and coded into self-feeding, responsive, active, distracting, and social feeding behaviours. Infants' haemoglobin and anthropometric measurements were taken. The association between feeding behaviour scores and energy intake per meal was investigated. The mean food intake of the infants was very low (11.4 ± 7.0 g/kg body weight per meal) compared to the minimum theoretical gastric capacity (30 g/kg body weight per meal). Infants' haemoglobin concentration was negatively associated with energy intake (ρ = 0.178, p = .03). Infants' responsive and active positive feeding styles were positively associated with energy intakes (ρ = 0.258 and 0.432, p = .004 and p < .001, respectively) as well as caregivers' responsive positive feeding styles (ρ = 0.237, p = .007). Both haemoglobin concentrations and feeding styles were associated with infant's energy intake. Anaemia prevention and control measures should be reinforced. Current nutrition education programmes should give emphasis on ways to effectively incorporate culturally adapted responsive feeding messages in this and similar settings.

Genome-wide admixture and association study of serum iron, ferritin, transferrin saturation and total iron binding capacity in African Americans.

Iron is an essential component of many important proteins and enzymes, including hemoglobin, which is responsible for carrying oxygen to the cells. African Americans (AAs) have a greater prevalence of iron deficiency compared with European Americans. We conducted genome-wide admixture-mapping and association studies for serum iron, serum ferritin, transferrin saturation (SAT) and total iron binding capacity (TIBC) in 2347 AAs participating in the Jackson Heart Study (JHS). Follow-up replication analyses for JHS iron-trait associated SNPs were conducted in 329 AA participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span study (HANDLS). Higher estimated proportions of global African ancestry were significantly associated with lower levels of iron (P = 2.4 × 10(-5)), SAT (P = 0.0019) and TIBC (P = 0.042). We observed significant associations (P < 5 × 10(-8)) between serum TIBC levels and two independent SNPs around TF on chromosome 3, the first report of a genome-wide significant second independent signal in this region, and SNPs near two novel genes: HDGFL1 on chromosome 6 and MAF on chromosome 16. We also observed significant associations between ferritin levels and SNPs near GAB3 on chromosome X. We replicated our two independent associations at TF and our association at GAB3 in HANDLS. Our study provides evidence for both shared and unique genetic risk factors that are associated with iron-related measures in AAs. The top two variants in TF explain 11.2% of the total variation in TIBC levels in AAs after accounting for age, gender, body mass index and background ancestry.

Prevalence of iron-deficiency anaemia and risk factors in 1010 adolescent girls from rural Maharashtra, India: a cross-sectional survey.

OBJECTIVE: Iron-deficiency anaemia (IDA) is the most common nutritional disorder observed in adolescent girls in India. Our aim was to investigate the prevalence and risk factors associated with IDA in rural Maharashtra, India, to address current evidence gaps. STUDY DESIGN: Cross-sectional survey. METHODS: The study recruited 13- to 17-year-old adolescent girls living in 34 villages of Osmanabad district. Data were collected on individual health, dietary, sociodemographic factors, and anthropometric measurements were taken. Haemoglobin (Hb) levels were measured using Sahli's haemometer. Logistic and linear regressions were used to identify risk factors associated with IDA and Hb levels, respectively. RESULTS: Among 1010 adolescent girls (response rate 97.5%), the mean Hb was 10.1 g/dl (standard deviation = 1.3), and 87% had anaemia (Hb < 12 g/dl). The prevalence of mild (11.0-11.9 g/dl), moderate (8.0-10.9 g/dl) and severe (Hb ≤ 7.9 g/dl) anaemia was 17%, 65% and 5%, respectively. Anaemia likelihood increased significantly with age (odds ratio (OR): 1.41 per year, 95% confidence interval (CI): 1.17-1.70). Factors associated with decreased anaemia risk were mid-upper arm circumference (MUAC) ≥22 cm (OR: 0.51, 95% CI: 0.31-0.82), ≥3 days/week consumption of fruit (OR: 0.35, 95% CI: 0.23-0.54) or rice (OR: 0.39, 95% CI: 0.17-0.91), and incomplete schooling (OR: 0.47, 95% CI: 0.24-0.91). In the final model lower age, MUAC and fruit consumption were significantly associated with Hb level. CONCLUSION: Anaemia prevalence was extremely high among adolescent girls in rural areas of Maharashtra. Whilst we identified risk factors that could be used for targeting interventions, there is urgent need of comprehensive preventative interventions for the whole adolescent girl population.

Mother and child nutrition among the Chakhesang tribe in the state of Nagaland, North-East India.

Despite the importance of the nutritional status and food systems of Indigenous Peoples, the subject has received very little attention, especially in North-East India. Therefore, a community-based cross-sectional descriptive study was carried out among Chakhesang mothers with children under 5 years of age to evaluate their nutritional status and prevalence of chronic diseases in the context of their dietary habits. From 558 households (HHs), 661 children and 540 mothers were covered using standard anthropometric measurements as well as blood collection for haemoglobin and vitamin A. Data were collected from mothers on HH socio-demographic particulars and infant and young child feeding practices. The results showed that the prevalence of underweight, stunting, and wasting among children <5 years of age was 14%, 22%, and 7%, respectively. The prevalence of anaemia and vitamin A deficiency was 26% and 33% among children <5 years, whereas it was 33% and 26%, respectively, among mothers. Hypertension was observed in 16% of women, whereas diabetes was seen in 0.8%. Approximately 35% and 24% of HHs suffered mild or moderate food insecurity, respectively, which was associated with literacy of the parents, per capita income, and family size. Utilization of the rich agrobiodiversity and wild foods by the Chakhesangs appears to be a strong reason for their better nutritional and health status as compared to the rest of India. Therefore, this Indigenous knowledge and food system must be documented and kept vital, especially in policies and intervention programmes addressing food and nutrition security among the Chakhesangs.

Nutritional status, food insecurity, and biodiversity among the Khasi in Meghalaya, North-East India.

A community-based cross-sectional study was carried out with 603 children ages 5 and under and 500 of their mothers from 510 households to examine the prevalence of undernutrition and chronic diseases among the Khasis of North-East India. Anthropometric measurements including Mid-Upper Arm Circumference, height, and weight were taken. Dry blood spots to estimate haemoglobin and vitamin A were collected from children and women separately by finger prick. Mothers provided data about household socio-demographic particulars and infant and young child feeding practices. The prevalence in children of underweight was 31%, stunting was 57%, and wasting was 10%. Undernutrition was higher among boys as compared to girls. Nutrient intakes were below recommended levels. The prevalence of anaemia among children ages 1 to 5 years old was 68%, and vitamin A deficiency was 59%, and they were 83% and 48%, respectively, among women. Hypertension was observed in 15% of women, whereas diabetes was less than 1%. Only about 20% of households were food secure, and this was associated with parental literacy, per capita income, and family size. Undernutrition was unacceptably high among the Khasis despite rich food biodiversity. Proper implementation of nutritional intervention programs such as Integrated Child Development Services, Mid Day Meal, and the Public Distribution System will improve the nutrient intake and nutritional status of the population. Additionally, preservation of forest lands and products paired with judicious use of the rich food biodiversity available will promote dietary diversity and ultimately better nutrition and health.

[IS THERE A WAY TO REDUCE IRON DEFICIENCY ANEMIA RATES IN THE SECOND YEAR OF LIFE OF BEDOUIN CHILDREN IN THE NEGEV?]

INTRODUCTION: Iron deficiency anemia is the most common worldwide nutritional deficiency contributing to childhood morbidity and mortality. According to the official health policy in Israel, providing iron for all babies from the age of 4 months to the age of one year old is recommended. This policy also recommends providing iron supplementation for an additional 6 months for toddlers (who are one year old) with anemia (hemoglobin<11mg/dl). Despite this policy, there is still a high rate of anemia in the Negev's two year old children, especially in the Bedouin population. OBJECTIVES: Assessment of the intervention program to reduce iron deficiency anemia rates, that provides iron supplementation to Bedouin toddlers with no anemia, from the age of 1 year to 18 months and maternal knowledge about the prevention of anemia. METHODS: Type of Research: Community intervention trial study. Population study: A total of 251 toddlers aged one year old with no anemia from 6 recognized and unrecognized Bedouin villages. Intervention group: 250 toddlers who received iron supplementation; Prophylactic dosage (15 mg per day) for 6 months from the age of 1 year. Control group: 101 toddlers who did not receive iron supplementation. The hemoglobin (Hb) level was measured before and after the intervention for both groups. RESULTS: At the beginning of the study, at the age of one year there was no difference between the two groups in the average Hb level (11.8±0.5mg/dl). After the intervention of 6 months, an Hb decrease was observed in both groups: 11.5±0.8 mg/dl compared to 11.0±1.0 mg/dl in the intervention group and in the control group (p<0.001), respectively. At the study endpoint the rates of anemia in the intervention group were lower compared to the control group: 40.6% and 15.3% (p<0.001), respectively. A positive correlation was found between the toddlers Hb level and the amount of iron supplementation received through the study. CONCLUSIONS: Providing iron supplementation, from the age of 1 year for 6 months reduces the anemia risk during the second year of life. We suggest changing the recommendation to continue iron supplementation for toddlers (beyond one year old) only for children with anemia to a new policy and propose continuing iron supplementation beyond one year old to all toddlers at this age.

Comparing and Contrasting Three Cultural Food Customs from Nigeria and Analyzing the Nutrient Content of Diets from These Cultures with the Aim of Proffering Nutritional Intervention.

Nigeria is a multicultural country with a diverse cultural food. Most Nigerians' cultural diet is based on staple food accompanied by stew. In the South West and Eastern region (where Yorubas and Igbos are the dominant ethnic groups), staple foods are yam and cassava by-product (garri, fufu and lafun) with vegetables prepared as stew, often over cooked, thereby losing essential micronutrients. In Northern Nigeria (where the Hausas and Fulanis are the dominant ethnic groups), grains such as sorghum, millet form the main diet; these are served with palm oil based soup made with tomatoes and okra. Meat is sometimes added. Among the Hausas, meat is usually reserved for special occasions. Various types of malnutrition prevalent in developing countries such as Nigeria are iron deficiency anemia (ID/A), protein-energy malnutrition (PEM), Vitamin A deficiency (VAD), iodine deficiency disorder (IDD). The proposed long-term measure by the Federal government of Nigeria for the resolution of these various types of malnutrition is dietary diversification. A review of the literature on Nigerian cultural diets identified gaps in knowledge with respect to the nutritional values of Nigerian ethnic diets.

Association between predominantly plant-based diets and iron status in Chinese adults: a cross-sectional analysis.

Current evidence of the relationship between diets and Fe status is mostly derived from studies in developed countries with Western diets, which may not be translatable to Chinese with a predominantly plant-based diet. We extracted data that were nationally sampled from the 2009 wave of China Health and Nutrition Survey; dietary information was collected using 24-h recalls combined with a food inventory for 3 consecutive days. Blood samples were collected to quantify Fe status, and log-ferritin, transferrin receptor and Hb were used as Fe status indicators. In total, 2905 (1360 males and 1545 females) adults aged 18-50 years were included for multiple linear regression and stratified analyses. The rates of Fe deficiency and Fe-deficiency anaemia were 1·6 and 0·7 % for males and 28·4 and 10·7 % for females, respectively. As red meat and haem Fe consumption differed about fifteen to twenty times throughout the five groups, divided by quintiles of animal protein intake per 4·2 MJ/d, only Fe status as indicated by log-ferritin (P=0·019) and transferrin receptor (P=0·024) concentrations in males was shown to be higher as intakes of animal foods increased. Log-ferritin was positively associated with intakes of red meat (B=0·3 %, P=0·01) and haem Fe (B=12·3 %, P=0·010) in males and with intake of non-haem Fe in females (B=2·2 %, P=0·024). We conclude that diet has a very limited association with Fe status in Chinese adults consuming a traditional Chinese diet, and a predominantly plant-based diet may not be necessarily responsible for poor Fe status.

Effect of vitamin D3 supplementation on iron status: a randomized, double-blind, placebo-controlled trial among ethnic minorities living in Norway.

BACKGROUND: Both vitamin D and iron deficiencies are widespread globally, and a relationship between these deficiencies has been suggested. However, there is a paucity of randomised controlled trials assessing the effect of vitamin D supplementation on iron status. PURPOSE: We aimed to investigate whether 16 weeks of daily vitamin D3 supplementation had an effect on serum ferritin, haemoglobin, serum iron and transferrin saturation. METHODS: Overall, 251 participants from South Asia, Middle East and Africa aged 18-50 years who were living in Norway were randomised to receive daily oral supplementation of 10 µg vitamin D3, 25 µg vitamin D3, or placebo for 16 weeks during the late winter. Blood samples from baseline and after 16 weeks were analysed for serum 25-hydroxyvitamin D (s-25(OH) D), serum ferritin, haemoglobin and serum iron. In total, 214 eligible participants completed the intervention (86 % of those randomised). Linear regression analysis were used to test the effect of vitamin D3 supplementation combined (10 or 25 µg) and separate doses 10 or 25 µg compared to placebo on change (T2-T1) in each outcome variable adjusted for baseline s-25(OH)D values. RESULTS: There was no difference in change in the levels of s-ferritin (1.9 µg/L, 95 % CI: -3.2, 7.0), haemoglobin (-0.02 g/dL, 95 % CI: -0.12, 0.09), s-iron (0.4 µg/L, 95 % CI: -0.5, 1.3) or transferrin saturation (0.7 %, 95 % CI: -0.6.1, 2.0) between those receiving vitamin D3 or those receiving placebo. Serum 25-hydroxyvitamin D increased from 29 nmol/L at baseline to 49 nmol/L after the intervention, with little change in the placebo group. CONCLUSIONS: In this population of healthy ethnic minorities from South Asia, the Middle East and Africa who had low vitamin D status, 16 weeks of daily supplementation with 10 or 25 µg of vitamin D3 did not significantly affect the haemoglobin levels or other markers of iron status.

[Iron status of first-year junior high school students in rural boarding school among nine provinces in China].

OBJECTIVE: To assess the iron status among boarding school students in a cross-sectional study performed in 9 provinces which were Beijing, Guangdong, Guangxi, Zhejiang, Tianjin, Ningxia, Sichuan, Shanghai and Shandong provinces. METHODS: A multi-stage cluster sampling survey on iron status of first-year junior high school students in rural boarding school in 9 provinces was used. Iron status was defined utilising biochemical indicators. Hemoglobin was measured by cyanmethemoglobin method. WS/T441-2013's hemoglobin thresholds used to define anemia. Immunoturbidimetric assay was used as analytical method for serum ferritin( SF), Serum soluble transferrin receptor( sTfR) and high sensitive C-reactive protein( hsCRP). BI was calculated by SF andsTfR. Storage iron depletion( SID) was defined as low SF( SF < 25 ng/mL) and low sTfR( sTfR < 4. 4 mg/L) without anemia. Iron deficient erythropoiesis( IDE) was defined as low SF( SF < 25 ng/mL) and high sTfR( sTfR > 4. 4 mg/L) without anemia. Iron deficiency anemia( IDA) was defined as low SF( SF < 25 ng/mL) with anemia. Subjects with indication of inflammation( hsCRP > 5 mg/L) were excluded from the analyses. RESULTS: A total of 1263 adolescents aged 10-18 years( 696 boys and 567 girls) were involved. The levels of hemoglobin, serum ferritin, sTfR and BI concentration were( 144. 6 ± 13. 2) g/L, 52. 2 ng/mL, 3. 34 mg/L and( 6. 72 ± 2. 61) mg/kg for students, respectively. The overall prevalence of anemia was 4. 8%. The percentage of iron deficiency was 10. 5%, significantly higher in girls compared with boys. The overall percentage of SID, IDE and IDA was 6. 6%, 2. 5% and 1. 4%, respectively, with significant differences between boys and girls. CONCLUSION: To ensure adequate iron stores, specific attention should be given to girls to ensure that their dietary intake of iron is adequate.

GWAS of blood cell traits identifies novel associated loci and epistatic interactions in Caucasian and African-American children.

Hematological traits are important clinical indicators, the genetic determinants of which have not been fully investigated. Common measures of hematological traits include red blood cell (RBC) count, hemoglobin concentration (HGB), hematocrit (HCT), mean corpuscular hemoglobin (MCH), MCH concentration (MCHC), mean corpuscular volume (MCV), platelet count (PLT) and white blood cell (WBC) count. We carried out a genome-wide association study of the eight common hematological traits among 7943 African-American children and 6234 Caucasian children. In African Americans, we report five novel associations of HBE1 variants with HCT and MCHC, the alpha-globin gene cluster variants with RBC and MCHC, and a variant at the ARHGEF3 locus with PLT, as well as replication of four previously reported loci at genome-wide significance. In Caucasians, we report a novel association of variants at the COPZ1 locus with PLT as well as replication of four previously reported loci at genome-wide significance. Extended analysis of an association observed between MCH and the alpha-globin gene cluster variants demonstrated independent effects and epistatic interaction at the locus, impacting the risk of iron deficiency anemia in African Americans with specific genotype states. In summary, we extend the understanding of genetic variants underlying hematological traits based on analyses in African-American children.

Associations between low consumption of fruits and vegetables and nutritional deficiencies in Brazilian schoolchildren.

OBJECTIVE: We examined associations between the frequency of fruit and vegetable (F&V) consumption and nutritional deficiencies among Brazilian schoolchildren. DESIGN: A cross-sectional, population-based study was performed. A short FFQ was used to assess consumption of fruits and vegetables (F&V) over the past month. The prevalence ratios (PR) and 95 % confidence intervals for stunting, obesity, anaemia, vitamin A and folate deficiencies, vitamin E and vitamin D insufficiencies were estimated for low F&V consumption frequency (vegetables ≤ 3 times/month and fruits ≤ 3 times/week) and compared with children with usual F&V consumption frequency (vegetables ≥ 1 time/week and fruits ≥ 4 times/week). SETTING: Acrelândia, Western Brazilian Amazon. SUBJECTS: A total of 702 children aged 4-10 years. RESULTS: Only 5 % of children consumed F&V ≥ 5 times/d. Prevalence of deficiency was 31 %, 15 %, 9 % and 2 % for vitamins D, A, E and folate, respectively. Overall, 6.3% of children were anaemic, 3.3% were stunted, 2.7% were obese and 33 % had multiple nutritional deficiencies. Low frequency of F&V consumption was associated with lower plasma concentrations of carotenoids and vitamin E. Nutritional deficiencies were higher among non-consumers of F&V when compared with usual consumers: anaemia (PR=1.9; 95 % CI 1.0, 3.7), vitamin E insufficiency (PR=2.5; 95% CI 1.5, 4.2), vitamin D insufficiency (PR=1.5; 95% CI 1.1, 1.9) and stunting (PR=2.6; 95% CI 1.1, 6.1). CONCLUSIONS: In our study, the occurrence of nutritional deficiencies in children with low F&V consumption was twice as high as in children with usual F&V consumption, reinforcing the importance of effective actions to promote the consumption of F&V.

Iron deficiency is uncommon among lactating women in urban Nepal, despite a high risk of inadequate dietary iron intake.

The main objective of the present study was to examine the association between dietary Fe intake and dietary predictors of Fe status and Hb concentration among lactating women in Bhaktapur, Nepal. We included 500 randomly selected lactating women in a cross-sectional survey. Dietary information was obtained through three interactive 24 h recall interviews including personal recipes. Concentrations of Hb and plasma ferritin and soluble transferrin receptors were measured. The daily median Fe intake from food was 17·5 mg, and 70% of the women were found to be at the risk of inadequate dietary Fe intake. Approximately 90% of the women had taken Fe supplements in pregnancy. The prevalence of anaemia was 20% (Hb levels < 123 g/l) and that of Fe deficiency was 5% (plasma ferritin levels < 15 µg/l). In multiple regression analyses, there was a weak positive association between dietary Fe intake and body Fe (ß 0·03, 95% CI 0·014, 0·045). Among the women with children aged < 6 months, but not those with older infants, intake of Fe supplements in pregnancy for at least 6 months was positively associated with body Fe (P for interaction < 0·01). Due to a relatively high dietary intake of non-haem Fe combined with low bioavailability, a high proportion of the women in the present study were at the risk of inadequate intake of Fe. The low prevalence of anaemia and Fe deficiency may be explained by the majority of the women consuming Fe supplements in pregnancy.

Food insecurity among Iraqi refugees living in Lebanon, 10 years after the invasion of Iraq: data from a household survey.

Iraqi refugees in Lebanon are vulnerable to food insecurity because of their limited rights and fragile livelihoods. The objective of the present study was to assess household food insecurity among Iraqi refugees living in Lebanon, almost 10 years after the invasion of Iraq. A representative survey of 800 UN High Commissioner for Refugees-registered refugee households in Lebanon was conducted using multi-stage cluster random sampling. We measured food insecurity using a modified US Department of Agriculture household food security module. We collected data on household demographic, socio-economic, health, housing and dietary diversity status and analysed these factors by food security status. Hb level was measured in a subset of children below 5 years of age (n 85). Weighted data were used in univariate and multivariate analyses. Among the Iraqi refugee households surveyed (n 630), 20·1% (95% CI 17·3, 23·2) were found to be food secure, 35·5% (95% CI 32·0, 39·2) moderately food insecure and 44·4% (95% CI 40·8, 48·1) severely food insecure. Severe food insecurity was associated with the respondent's good self-reported health (OR 0·3, 95% CI 0·2, 0·5), length of stay as a refugee (OR 1·1, 95% CI 1·0, 1·2), very poor housing quality (OR 3·3, 95% CI 1·6, 6·5) and the number of children in the household (OR 1·2, 95% CI 1·0, 1·4), and resulted in poor dietary diversity (P< 0·0001). Anaemia was found in 41% (95% CI 30·6, 51·9) of children below 5 years of age, but was not associated with food insecurity. High food insecurity, low diet quality and high prevalence of anaemia in Iraqi refugees living in Lebanon call for urgent programmes to address the food and health situation of this population with restricted rights.

The influence of vitamin A status on iron-deficiency anaemia in anaemic adolescent schoolgirls in Myanmar.

OBJECTIVE: The present study was conducted to investigate reasons for the high prevalence of anaemia among adolescent schoolgirls and to elucidate the role of vitamin A in contributing to Fe-deficiency anaemia (IDA). DESIGN: Among 1269 schoolgirls who were previously screened for anaemia (Hb < 120 g/l), 391 anaemic girls were further assessed for Fe, vitamin A and subclinical inflammation status. Fe and vitamin A indicators were corrected for inflammation and were compared in the Fe-deficient and non-deficient groups as well as between those with and without inflammation. Logistic regression was done to determine whether vitamin A status and subclinical inflammation were risk factors for Fe deficiency. The differences in Fe status among tertiles of vitamin A concentrations were assessed using ANOVA. SETTING: Myanmar. SUBJECTS: Adolescent schoolgirls (n 391). RESULTS: One-third of the anaemia (30·4%) was IDA. Prevalence of low vitamin A status (serum retinol <1·05 µmol/l) was 31·5%. Fe and vitamin A status were significantly different between the IDA and non-IDA groups and also based on their inflammation status. Logistic regression showed that low vitamin A status was a significant predictor for being Fe deficient (OR = 1·81; 95% CI 1·03, 3·19 and OR = 2·31; 1·31, 4·07 in the middle (1·056-1·298 µmol/l) and low (≤1·056 µmol/l) vitamin A tertiles, respectively). ANOVA showed that better Fe status was associated with a higher concentration of serum retinol but only in IDA. CONCLUSIONS: Fe deficiency was not the main cause of anaemia in the present population. The role of vitamin A as well as other micronutrients should be taken into account in addressing the problem of anaemia.