Anemia and its associated factors among Adolescents in Kuwait

Abstract

We estimated the prevalence of anemia among school children and investigated factors associated with this problem in Kuwait. A cross-sectional study was conducted on 1415 adolescents randomly selected from middle schools in Kuwait. Hemoglobin, iron, ferritin, folate and vitamin B 12 , in addition to many other laboratory indicators, were measured in a venous blood sample. Data on risk factors for anemia were collected from parents and adolescents. Multiple logistic regression was used to investigate factors associated with anemia. The prevalence of anemia was 8.06% (95% CI: 6.69-9.60%), which was significantly higher among females compared to males (10.96% vs. 5.04%; p < 0.001). Mean (SD) Hb level was 133.7 (9.89) g/L and 130.00 (10.48) g/L among males and females, respectively (p < 0.001). The prevalence of mild, moderate and severe anemia was 5.94%, 1.91% and 0.21%, respectively. Gender, age, iron concentration and ferritin were associated with anemia in multivariable analysis. These data indicate that anemia among school children in Kuwait is of mild public health significance. Further reduction in anemia in school girls should focus on correcting iron deficiency. Surveillance systems for anemia may consider using a cutoff point that is specific for the method of blood sampling and the method of Hb measurement. Anemia is characterized by hemoglobin (Hb) concentration being lower than a specific threshold, and thus creating an impairment in meeting the oxygen demands of tissues 1. It is a major public health problem with around 1,620 million people worldwide diagnosed with anemia 2. Generally, a quarter of the world's population is considered anemic but the prevalence of anemia varies considerably between high-income countries (around 9%) and low-income countries (around 43%) 2. Due to physiological reasons, pregnant women, women of childbearing age and young children are particularly vulnerable 3. Anemia has significant implications in terms of mortality 4 , as well as impaired work capacity and economic development 5. Anemia during childhood has been linked to growth delay, high risk of infections, and poor cognitive and motor development, which may lead to loss of work productivity later in life 3,6. In fact, anemia is among the top leading causes of disability-adjusted life years lost among adolescents 7. Anemia can result from decreased erythrocyte production or increased blood loss, either through hemolysis, bleeding or both. These are determined by nutritional, infectious or genetic factors 8. Genetic factors are responsible for hemoglobinopathies, such as sickle cell anemia and thalassemia, while in some settings infectious diseases like malaria, soil-transmitted helminths and schistosomiasis are major contributors to anemia. Nutritional anemia results from insufficient nutrients that are needed during Hb synthesis and erythropoiesis. These particularly include iron deficiency (assumed to be responsible for 50% of all anemias 4), folic acid deficiency, vitamin B 12 deficiency, vitamin A deficiency and p...

Alterations in glutathione redox homeostasis among adolescents with obesity and anemia

“…Adolescence is a critical period for the development and expression of obesity-related comorbidities in both sexes 51 . The prevalence of anemia in adolescents in the present study is in line with that mentioned in previous reports showing that anemia in adolescents is of mild public health significance, particularly in girls, as per the WHO classification (5.0–19.9%) 33 , 52 . There was, however, a disproportionately high prevalence of anemia in those with OWOB, which shows a clear coexistence of anemia and OWOB in this adolescent cohort.…”

“…The coexistence of both anemia and obesity was particularly high in girls, as the proportion of girls who were both overweight and anemic was more than twice that of boys. Increased iron loss in the menstrual blood and inadequate dietary iron intake have been suggested to contribute to a higher prevalence of anemia in girls 33 , 48 . The higher prevalence of both anemia and OWOB in adolescent girls, compared with that in boys, could be explainable by the higher consumption of energy-dense foods (sweets, cakes and donuts, burgers, French fries, and hot dogs), lower consumption of fruits and vegetables 48 , 49 , 57 , 58 , lower consumption of iron rich foods such as animal protein 59 , and lack of physical activity 48 .…”

“…One tube (EDTA-containing) was centrifuged at 16,000 × g for 10 min; plasma and buffy coats were separated, and the sedimented erythrocytes (1 mL) were collected in Eppendorf tubes and stored at − 80 °C for the redox status analysis. Classification of anemia was made according to hemoglobin (Hb) levels as described earlier 33 . Anemia was defined as Hb < 115 g/L in boys and girls aged younger than 12 years; Hb < 120 g/L in the 12–14 years age group; Hb < 130 g/L in boys aged 15 years or older; and Hb < 120 g/L in girls aged 15 years or older 64 .…”

“…The Kuwait Nutritional Surveillance System has consistently reported a 15–20% prevalence of anemia among school-age children 32 . A more recent study conducted on a nationally representative sample of adolescents reported the prevalence of anemia as 8.1% (11% in girls and 5% in boys) 33 . These reports provide preliminary support for the coexistence of both obesity and anemia in adolescents in Kuwait.…”

Prevalence of lead toxicity in adolescents in Kuwait

“…Higher prevalence of anemia, and the use of “kohl” and other cosmetics, that may be contaminated with Pb, could contribute to EBLL in girls compared to boys [ 52 – 54 ]. Anemia is this study population was 11% in females and 5% in males [ 55 ].…”