Iron deficiency.
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Anemia, Iron-Deficiency↗
Biomedical subjects
R Yip
Publications and source records attributed to R Yip.
Impact of a social marketing campaign promoting dark-green leafy vegetables and eggs in central Java, Indonesia.
In order to work towards further reduction of vitamin A deficiency in central Java, Indonesia, a social marketing campaign promoting eggs and dark-green leafy vegetables was initiated in March 1996. The nutritional surveillance system (December 1995-December 1996) found the following. The campaign's messages were well noticed. Consumption of at least one egg in the past week increased from 80% to 92% in mothers and from 78% to 92% in children 12-36 months old. It increased in all socio-economic groups and was independent of ownership of chickens. Most eggs had been purchased. The quantity of vegetables prepared increased from 93 to 111 g/person daily and most was purchased. Vitamin A intake increased from 335 to 371 RE/d for mothers and from 130 to 160 RE/d for children. Serum retinol levels increased after the start of the campaign, and were related to egg consumption and vitamin A intake. Because 1. data were collected in such a way that respondents were not aware of the link between data collected and the campaign, and 2. vitamin A status increased and was related to increased consumption of eggs and vitamin A intake, we conclude that the social marketing campaign was successful.
Adult↗
Pervasive occult gastrointestinal bleeding in an Alaska native population with prevalent iron deficiency. Role of Helicobacter pylori gastritis.
OBJECTIVE: To confirm prevalent iron deficiency among Yupik Eskimos living in Alaska and to explore the frequency of and potential lesions accounting for occult gastrointestinal bleeding. DESIGN: Descriptive survey. SETTING: Rural Arctic community. SUBJECTS: A total of 140 adult volunteers from 3 villages in the Yukon-Kuskokwim Delta region of western Alaska. MAIN OUTCOME MEASURES: Daily iron intake, hematologic and biochemical indexes of iron status, fecal hemoglobin levels, stool parasites, and endoscopic findings. RESULTS: While dietary iron intake by Yupiks was similar to that of a reference population, iron deficiency prevalence was increased 13-fold in Yupik men and 4-fold in Yupik women. Fecal hemoglobin levels were elevated in 90% of subjects contrasted with only 4% of a reference group; median levels were 5.9 and 0.5 mg of hemoglobin per gram of stool, respectively. Among 70 Yupik subjects with elevated fecal hemoglobin levels who had endoscopy performed, 68 (97%) had an abnormal gastric appearance consisting of erythema, mucosal thickening, diffuse mucosal hemorrhages, erosions, or ulcerations. Gastric biopsies revealed chronic active gastritis with associated Helicobacter pylori in 68 (99%) of 69. No other hemorrhagic gastrointestinal disease was detected. CONCLUSIONS: Based on this study sample, occult gastrointestinal bleeding appears to be pervasive in the Yupik population and likely underlies the prevalent iron deficiency. An atypical hemorrhagic gastritis associated with H pylori infection is present almost universally and may represent the bleeding source.
Adult↗
Continuation of decline in prevalence of anemia in low-income children: the Vermont experience.
OBJECTIVE: To examine whether the prevalence of childhood anemia in white low-income children has continued to decline into the 1990s. DESIGN: An examination of 14 years of hematocrit data from the Centers for Disease Control and Prevention's Pediatric Nutrition Surveillance System in Vermont from 1981 through 1994. SETTING: Public health clinics for the Special Supplemental Nutrition Program for Women, Infants, and Children in Vermont. The same screening method and criteria for identifying and defining anemia and the same quality-assurance procedures were used during the 14 years. The program eligibility criteria were also consistent except for part of 1991 and 1992. MAIN OUTCOME MEASURE: The annual prevalence of anemia. RESULTS: Between 1981 and 1994, the prevalence of anemia halved (from 7.9% to 3.6%, P<.001). For children aged 6 to 24 months, this decline was from 7.8% to 4.6% (P<.001); for children aged 2 to 5 years, the decline was from 7.9% to 3.1% (P<.001). CONCLUSION: The decline in the prevalence of anemia among low-income children observed by the Centers for Disease Control and Prevention's Pediatric Nutrition Surveillance System up to the mid-1980s has continued into the 1990s in Vermont. This finding indicates that iron nutrition in infancy and early childhood is still improving.
Anemia↗
Factors associated with anemia in refugee children.
A nutrition survey was performed in 1990 among children 6 through 35 mo of age living in Palestinian refugee camps in Syria, Jordan, the West Bank, Gaza Strip and Lebanon. Overall, 67% [95% confidence interval (CI): 66, 68] were anemic (hemoglobin <110 g/L), ranging from 54% in the West Bank to 75% in Syria. The following factors were significantly associated with anemia in one or more of three age groups (6-11.9, 12-23.9 and 24-35.9 mo) by logistic regression: living in Syria, Lebanon, or Gaza [with prevalence odds ratios (POR) in the range of 1.4-2.6 depending on the age group and area, relative to children living in Jordan]; never having been breast-fed (POR = 1.7); male sex (POR = 1.2); maternal illiteracy (POR = 1.4 relative to those with >/=6 y of education); having a recent (within 2 wk) or current episode of fever or diarrhea; and stunting. Recent or current illness and stunting interacted in two age groups with the general trend of stunted children with recent or current illness having high POR. Early childhood anemia is associated with factors reflecting poor socioeconomic status and recent diarrheal and febrile illnesses in Palestinian refugee camps.
Aging↗
Risk of diarrhea related to iron content of infant formula: lack of evidence to support the use of low-iron formula as a supplement for breastfed infants.
BACKGROUND: Concern has been raised by infant feeding experts that supplementing breastfed infants with iron-fortified formula rather than low-iron formula may have an undesirable impact on their gastrointestinal flora. Thus far, there have been no clinical studies to address this issue directly. We compared the reported frequency of diarrhea for breastfed infants given iron-fortified formula with those fed low-iron formula. METHODS: Mothers participating in a mail panel provided feeding and diarrhea information on their infants at 2, 3, 4, 5, 6, 7, 9, and 12 months (n = 1743). Infants were grouped into five feeding categories: (1) breast milk only, (2) breast milk and low-iron formula, (3) breast milk and iron-fortified formula, (4) low-iron formula only, and (5) iron-fortified formula only. We calculated the number of diarrheal episodes per week for each feeding category and used rate ratios to estimate the relative impact of low-iron and iron-fortified formulas. RESULTS: Among infants who received both breast milk and formula, the rate ratio for iron-fortified formula versus low-iron formula was 1.06 (confidence interval, 0.84 to 1.34), indicating that the type of formula a breastfed infant receives does not significantly affect the frequency of diarrhea. CONCLUSIONS: We found no evidence to support the hypothesis that breastfed infants given iron-fortified formula are at greater risk of having diarrhea. This, in addition to the fact that iron-fortified formula has played a major role in preventing childhood iron deficiency anemia, supports the current recommendation that any formula given to infants be fortified with iron.
Breast Feeding↗
Quality assessment of fetal death records in Georgia: a method for improvement.
OBJECTIVES: Although more fetal deaths than neonatal deaths occur, routinely collected fetal death data are seldom used for perinatal epidemiologic research because of data quality concerns. We developed a strategy for identifying and correcting errors in birthweight and gestational age in fetal death records. METHODS: Using data from Georgia for 1989 and 1990, we detected singleton fetal death records having improbable or missing birthweight or gestational age by comparing these values with referent values. To verify the questionable values, we contacted 100 reporting hospitals in 1992. RESULTS: In 817 of 2226 records, values were either improbable (60.1%) or missing (39.9%). We were able to contact the hospitals to verify data for 716 (88%) of these records. Verification resulted in corrections to 405 (57%) records, and 48% of unreported birthweights were obtained. CONCLUSIONS: Many errors in recorded gestational age and birthweight were identified by this method. Rather than deleting or inputting problem data for analyses, researchers should consider efforts to verify them. Efforts to improve this information should include improved reporting, strict quality assurance, and procedures for routine verification and correction of records.
Birth Weight↗
The development of MUAC-for-age reference data recommended by a WHO Expert Committee.
Low mid-upper-arm circumference (MUAC), determined on the basis of a fixed cut-off value, has commonly been used as a proxy for low weight-for-height (wasting). The use of a fixed cut-off value was based on the observation that MUAC showed small age- and sex-specific differences. However, in 1993, a WHO Expert Committee concluded that age independence is not reflected in the true pattern of mid-upper arm growth, recommended the use of MUAC-for-age, and presented age- and sex-specific MUAC reference data developed with observations obtained from a representative sample of children in the USA aged 6-59 months. In this article, we explain the methodology for the development of these data, present age- and sex-specific growth curves and tables and discuss the applications and limitations of MUAC as a nutritional indicator. To develop the reference data, estimates were first obtained for the mean and standard deviation of MUAC for each month of age using 7-month segmental regression equations; a 5th-degree and a 3rd-degree polynomial in age was then used to describe the mean and standard deviation, respectively, of MUAC-for age. These curves show important age-specific differences, and significant sex-specific differences for boys and girls < 24 months of age. Correct interpretation of MUAC with regard to nutritional status requires the use of MUAC-for-age reference data such as those presented here.
Age Factors↗
The development of a MUAC-for-height reference, including a comparison to other nutritional status screening indicators.
Mid-upper-arm circumference (MUAC) based on a single cut-off value for all the children less than 5 years of age has been used for many years as an alternative nutritional status index for children during famines or refugee crises, and as an additional screening tool in nonemergencies. However, it has recently been questioned whether MUAC is age- and sex-independent. After reviewing the scientific evidence underlying the use and interpretation of MUAC, a WHO Expert Committee recommended a new MUAC-for-age reference for under-5-year-olds. In some settings, however, it is difficult to assess a child's age and in such circumstances MUAC-for-height may be a good alternative. The height-based QUAC stick is a simple means of adjusting MUAC cut-offs according to height, and the MUAC-for-height reference and the construction and use of the QUAC stick are described in this article. Described also is the use of the receiver operating characteristic (ROC) curve method to evaluate the performance of MUAC, MUAC-for-age, and MUAC-for-height in screening malnourished children.
Age Factors↗
Assessment of potential indicators for protein-energy malnutrition in the algorithm for integrated management of childhood illness.
Potential indicators were assessed for the two classifications of protein-energy malnutrition in the guidelines for integrated management of childhood illness: severe malnutrition, which requires immediate referral to hospital, and very low weight, which calls for feeding assessment, nutritional counselling and follow-up. Children aged < 2 years require feeding assessment and counselling as a preventive intervention. For severe malnutrition, we examined 1202 children admitted to a Kenyan hospital for any association of the indicators with mortality within one month. Bipedal oedema indicating kwashiorkor, and two marasmus indicators (visible severe wasting and weight-for-height (WFH) Z-score of < -3) were associated with a significantly increased mortality risk (odds ratios, 3.1-3.9). Very low weight-for-age (WFA) (Z-score of < -4.4) was not associated with an increased risk of mortality. Because first-level health facilities generally lack length-boards, bipedal oedema and visible severe wasting were chosen as indicators of severe malnutrition. To assess potential WFA thresholds for the very low weight classification, our primary source of data came from 1785 Kenyan outpatient children, but we also examined data from surveys in Nepal, Bolivia, and Togo. We examined the performance of WFA at various thresholds to identify children with low WFH and, for children aged < or = 2 years, low height-for-age (HFA). Use of a WFA threshold Z-score of < -2 identified a considerable proportion of children (from 13% in Bolivia to 68% in Nepal) which, in most settings, would pose an enormous burden on the health facility. Among ill children in Kenya, a threshold WFA Z-score of < -3 had a sensitivity of 89-100% to detect children with WFH Z-scores of < -3, and, with an identification rate of 9%, would avoid overburdening the clinics. Potential modifications include use of a more restrictive cut-off in countries with high rates of stunting, or the elimination of the WFA screen in order to concentrate efforts on intervention for all children below the 2-year age cut-off. Key issues in every country include the capacity to provide counselling for many children and linkage to nutritional improvement programmes in the community.
Age Factors↗
Comparison of birth weight by gestational age between China and the United States.
OBJECTIVE: To probe into the similarities and differences of birth weight by gestational age between China and the United States by a comparative study. METHODS: For China, we used the records of 24,150 single livebirth neonates. These records were collected between February 1986 and May 1987 from 43 hospitals and health care units in 15 large and middle cities in the South and North of China. For the United States, we used the natal records of National Center for Health Statistics from 1980 to 1987, selecting infants whose parents were coded as white and with higher socioeconomic backgrounds in the birth records. A total of 6,295,102 singleton livebirth neonates were selected. We used a method based on probability plots to define birth weight distributions. RESULTS: The 50th and 95th percentiles of birth weights by gestational age of American newborns with white parents were more than those of Chinese newborns. The 50th percentile values of birth weights of American male and female newborns were 357 g and 277 g (about 10% and 8% respectively of the birth weight of a term newborn) more than those of Chinese male and female newborns respectively at 40 weeks of GA. CONCLUSIONS: American white newborns were heavier than Chinese newborns. The differences were mainly due to race-specific influences, and were related to the differences in socioeconomic and educational background. We suggest that the references of birth weight by gestational age should be formulated separately in China and in the U.S.
Asian People↗
The challenge of improving iron nutrition: limitations and potentials of major intervention approaches.
Various approaches to improving iron status are discussed. Success in controlling iron deficiency worldwide will require the exploration and demonstration of all possible options. The approaches, which are not mutually exclusive, include iron supplementation, nutrition education, reducing intestinal parasites (particularly hookworm), expanding fortification of processed foods, and developing crops that are more iron bioavailable. Coordination with existing health and nutrition programs can enhance progress toward better overall nutrition. For example, in the development of food fortification or of crops with higher nutritional value, the combination of multiple micronutrients can be considered. Within the primary health care system, iron supplementation and deworming can be coordinated with other health care activities. The ultimate success in control of iron deficiency will depend on how well the various intervention approaches can be integrated within the current framework of public health, food processing, and agriculture development.
Adult↗
Iron supplementation during pregnancy: is it effective?
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Anemia, Iron-Deficiency↗
Iron deficiency anemia among Alaska Natives may be due to fecal loss rather than inadequate intake.
To define more fully the nature of a persistently high prevalence of iron deficiency anemia observed among Alaska Native children, we examined dietary iron intake, hemoglobin concentrations, and storage iron (serum ferritin) based on multiple cross-sectional surveys of Alaska Natives between 1983 and 1989. Approximately 30 to 50% of the children studied < 12 y of age had depleted iron stores. Anemia and depleted iron stores also were prevalent among adult men and women, about twice as prevalent as in the U.S. population based on the Second National Health and Nutrition Examination Survey (NHANES II). The higher rate of iron deficiency, occurring even when the dietary assessment found Alaska Native iron intake to be higher than the U.S. average with an ample intake of food high in bioavailable iron, suggests blood loss as a possible cause of the unusual pattern of iron deficiency observed. In a pilot study of stool blood loss in two villages, 65% of the samples had a significantly elevated stool heme concentration. Further investigation of iron deficiency due to gastrointestinal blood loss for the Alaska Native is warranted.
Adolescent↗
The WHO growth chart: historical considerations and current scientific issues.
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Adolescent↗
Hemoquant determination of hookworm-related blood loss and its role in iron deficiency in African children.
Iron deficiency remains the most prevalent form of human malnutrition, and current interventions to control it have not decreased the global prevalence. Hookworm control activities are becoming more widely implemented, but the importance of these efforts to prevent anemia in populations is not well-defined. We studied the relationships among hookworm infection, intestinal blood loss, and iron status of 203 Zanzibari school children. Helminth infection intensity was quantified by fecal egg counts, and iron deficiency anemia was defined by low hemoglobin and serum ferritin concentrations. Intestinal blood loss was quantified by measuring fecal heme and heme breakdown products as porphyrin, a noninvasive method that has not been used previously to assess hookworm blood loss. Intestinal blood loss was strongly and linearly related to hookworm egg counts. The degree of degradation of fecal heme indicated that blood loss occurred in the upper gastrointestinal tract, compatible with the behavior of hookworms. Trichuris trichiura and Ascaris lumbricoides infections were also common, but did not contribute significantly to intestinal blood loss in this population. The prevalence of iron deficiency anemia increased steadily as hookworm infection intensity and intestinal blood loss increased. In the context of a poor diet, as exists in Zanzibar and many tropical countries, hookworm-related blood loss contributes dramatically to anemia. In such contexts, hookworm control is a feasible and essential component of anemia control. Determination of fecal heme is relatively simple and noninvasive and may be a useful tool for measuring the impact of hookworm control activities.
Anemia, Iron-Deficiency↗
Iodization: case report: Indonesia.
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Adolescent↗
Gestational weight gain among average-weight and overweight women--what is excessive?
OBJECTIVE: Our purpose was to determine the association between increased gestational weight gain and birth weight outcomes for low-income women. STUDY DESIGN: A total of 53,541 single, live infants delivered from 1990 to 1991 to white, black, and Hispanic women in eight states were evaluated. Multiple logistic regression was used to calculate risk of low and high (> 4500 gm) birth weight, adjusting for selected factors. RESULTS: The association between gestational weight gain and birth weight varied by prepregnancy body mass index. Risk for low birth weight decreased with increasing weight gain for average-weight women. There was no reduction in risk for low birth weight, however, beyond weight gains of 30 to 34 pounds for overweight women and 15 to 19 pounds for very-overweight women. Risk for high birth weight, however, increased with increasing weight gain in all three groups. CONCLUSION: Very-overweight women (body mass index > 29 kg/m2) may benefit from an upper guideline of 25 pounds of weight gain to help reduce risk for high birth weight.
Adolescent↗