Iron deficiency anemia in infants in Sousa (PB), Brazil: an association with nutritional status

Abstract

OBJECTIVE:The aim of this study was to describe the prevalence of anemia and iron deficiency anemia (IDA) in infants and verify the association of iron deficiency with nutritional status. METHODS: This cross-sectional and observational study included 104 infants aged between 7 and 9 months, assisted from August to September 2021 by the Family Health Strategy program in Sousa municipality (Paraíba, Brazil). Clinical and anthropometric data were collected, and a 24-h food recall questionnaire was applied using the DietPro software (version 5.0) in order to verify food consumption and assess iron intake. Variables associated with iron deficiency (p<0.05) were analyzed using multiple logistic regression. RESULTS: Anemia and IDA were observed in 40.4% and 19.2% of infants, respectively. Only one infant was taking prophylactic supplementation (ferrous sulfate). Infants with IDA presented reduced hemoglobin (p<0.001) and ferritin (p<0.001) and increased Z-scores of body mass index-forage (Z-BMI) (p=0.027), weight-for-height (p=0.007), and weight-for-age (p=0.032). All Z-scores were inversely correlated with ferritin (Z-BMI [rho: -0.37; p<0.001], weight-for-height [rho: -0.37; p<0.001], and weight-for-age [rho: -0.29; p=0.002]). Ferritin was also directly correlated with daily iron intake (rho: 0.22; p=0.018). Finally, multiple logistic regression showed a significant and direct association of iron deficiency with weight-forheight Z-score (odds ratio: 2.86; 95% confidence interval: 1.38-5.64; p=0.004). CONCLUSION: About 60% of infants presented anemia or IDA. Iron deficiency was associated with the weight-for-height Z-score, showing the vulnerability of infants during the introduction of complementary feeding.

Overnutrition is a risk factor for iron, but not for zinc or vitamin A deficiency in children and young people: a systematic review and meta-analysis

“…However, very few studies (n=4 out of 23 studies that used ferritin with or without other biomarkers to define ID) measured and excluded participants with elevated CRP level 46 104 105 107. Only one study measured AGP108 and only two studies from Colombia85 and Brazil109 used the higher thresholds for ferritin to define ID in the context of inflammation. Interestingly, the WHO serum ferritin concentration thresholds were based on expert opinion,44 and a recent analysis of serial cross-sectional National Health and Nutrition Examination Survey data concluded thresholds for ferritin for iron-deficient erythropoiesis should be higher, at least for healthy American children and women 110.…”

Overnutrition is a risk factor for iron deficiency in children and young people: a systematic review and meta-analysis of micronutrient deficiencies and the double burden of malnutrition

“…However, very few studies (n=4 out of 23 studies that used ferritin with or without other biomarkers) to define ID) measured and excluded participants with elevated CRP level 94 98 99 101 . Only one study measured AGP 102 and only 2 studies from Colombia 79 and Brazil 103 utilised the higher thresholds for ferritin to define ID in the context of inflammation. Interestingly, the WHO serum ferritin concentration thresholds were based on expert opinion 44 , and a recent analysis of serial cross-sectional NHANES data concluded thresholds for ferritin for iron-deficient erythropoiesis should be higher, at least for healthy American children and women 104 .…”