Four years after implementation of a national micronutrient powder program in Kyrgyzstan, prevalence of iron deficiency and iron deficiency anemia is lower, but prevalence of vitamin A deficiency is higher

Lundeen, Elizabeth A.; Lind, Jennifer N.; Clarke, Kristie E N; Aburto, Nancy; Imanalieva, Cholpon; Mamyrbaeva, Tursun; Ismailova, A Z; Timmer, Arnold; Whitehead, Ralph D.; Praslova, Larissa; Samohleb, Galina; Minbaev, Muktar; Addo, O Yaw; Serdula, Mary K.

doi:10.1038/s41430-018-0368-7

Cited by 11 publications

(11 citation statements)

References 16 publications

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“…The child’s age (date of birth), gender (male/female), maternal age (years of life), parents’ schooling (full years), skin color (self-reported by guardians), per capita family income and economic class [ 25 ] were recorded. Additionally, hemoglobin (anaemia < 11 g/dL) [ 26 ], C-reactive protein (CRP) (presence of inflammation > 0.5 mg/dL) [ 27 , 28 ], alpha-1 acid glycoprotein (AGA) (presence of inflammation > 100 mg/dL) [ 27 , 28 ], serum ferritin (ID in the presence of inflammation: <30 ng/mL and in the absence of inflammation <12 ng/mL) [ 28 ], and transferrin soluble receptor (sTfR; ID > 1.76 mg/L; value attained from the analysis kit) were determined.…”

Section: Methodsmentioning

confidence: 99%

Effect of Fortification with Multiple Micronutrient Powder on the Prevention and Treatment of Iron Deficiency and Anaemia in Brazilian Children: A Randomized Clinical Trial

et al. 2021

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Fortification with multiple micronutrient powder has been proposed as a public health intervention able to reduce micronutrient deficiencies in children. Our objective was to compare the effectiveness of fortification with multiple micronutrient powder with drug supplementation in the prevention and treatment of iron deficiency and anaemia. This was a cluster trial with anemic and non-anaemic children between six and 42 months old, in randomization data. Non anaemic children received fortification with multiple micronutrient powder or standard drug supplementation of ferrous sulfate associated with folic acid in a prevention dose. Anaemic children who were randomized to receive multiple micronutrient powder also received the recommended iron complementation for anaemia treatment. A total of 162 children were evaluated. The prevalence of anaemia decreased from 13.58 to 1.85%. Iron deficiency decreased from 21.74% to 7.89% (by serum ferritin) and iron deficiency decreased from 66.81 to 38.27% (by soluble transferrin receptor). No difference was identified between interventions for hemoglobin (p = 0.142), serum ferritin (p = 0.288), and soluble transferrin receptor (p = 0.156). Fortification with multiple micronutrient powder was effective in preventing iron deficiency and anaemia in children aged six to 48 months. In anaemic children; it was necessary to supplement the dose of multiple micronutrient powder with ferrous sulfate.

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Section: Methodsmentioning

confidence: 99%

Effect of Fortification with Multiple Micronutrient Powder on the Prevention and Treatment of Iron Deficiency and Anaemia in Brazilian Children: A Randomized Clinical Trial

et al. 2021

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“…Flour fortification and Gulazyk (micronutrient powder for children under 3 and 5) have been introduced to improve the nutritional status of different parts of the population [5]. Gulazyk showed a positive result for reducing iron deficiency but was insufficient for diminishing anaemia levels for Kyrgyzstan [5,6]. This might be due to the worsening of households' food security [5] and the growing availability of fast foods [7].…”

Section: Introductionmentioning

confidence: 99%

The Transformation of Food Culture on the Case of Kyrgyz Nomads—A Historical Overview

2021

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The society in Kyrgyzstan experiences a triple burden of malnutrition which occurs when undernutrition, overnutrition and micronutrient deficiency coexists, straining the public health system. This research investigates historical trends of nutrition transition of nomadic and semi-nomadic Kyrgyz and foods consumed earlier before industrialisation and intensification of agriculture started. Qualitative research design inspired by historical analysis and sociological methods were employed. Saturation sampling was used to conduct 15 semi-structural interviews and informal conversations with non-participant observation. Secondary data analysis was conducted based on Kyrgyz nomads’ scientific studies from history and anthropology, agricultural politics and nutrition studies. Results suggest that Kyrgyz nomads have undergone several periods of change of social and political order since the mid-19th century till nowadays from nomadic tribe-based system to predominantly sedentarism and limited semi-nomadic lifestyle. The collectivisation of farms, urbanisation and planned type of economy led to shifts in lifestyle and diets. Furthermore, with trade liberalisation and open economy policies, the entrance of food corporations impacted the nutritional status of the population. The study also reveals several traditional foods rich in nutrients. Consumption of forgotten and neglected plants might improve the nutrition status of the current population. Nutrition intervention programs should definitely consider locally available foods as part of public nutrition.

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“…A linear regression is used to adjust the concentrations of the iron and vitamin A biomarkers to account for the effects of inflammation along the continuum of inflammation. Since the release of the BRINDA approach, it has been applied for diverse purposes, such as estimating the magnitude and risk factors for micronutrient deficiencies ( 12 , 13 ), linking micronutrient status with functional outcomes ( 14 ), efficacy trials ( 15 ), and program evaluations ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

Adjusting iron and vitamin A status in settings of inflammation: a sensitivity analysis of the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) approach

Namasté

Williams

et al. 2020

The American Journal of Clinical Nutrition

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Background Accurate assessment of iron and vitamin A status is needed to inform public health decisions, but most population-level iron and vitamin A biomarkers are independently influenced by inflammation. Objectives We aimed to assess the reproducibility of the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) regression approach to adjust iron [ferritin, soluble transferrin receptor (sTfR)] and vitamin A [retinol-binding protein (RBP), retinol] biomarkers for inflammation (α-1-acid glycoprotein and C-reactive protein). Methods We conducted a sensitivity analysis comparing unadjusted and adjusted estimates of iron and vitamin A deficiency using the internal-survey regression approach from BRINDA phase 1 (16 surveys in children, 10 surveys in women) and 13 additional surveys for children and women (BRINDA phase 2). Results The relations between inflammation and iron or vitamin A biomarkers were statistically significant except for vitamin A biomarkers in women. Heterogeneity of the regression coefficients across surveys was high. Among children, internal-survey adjustments increased the estimated prevalence of depleted iron stores (ferritin <12 µg/L) by a median of 11 percentage points (pp) (24 pp and 9 pp in BRINDA phase 1 and phase 2, respectively), whereas estimates of iron-deficient erythropoiesis (sTfR >8.3 mg/L) decreased by a median of 15 pp (15 pp and 20 pp in BRINDA phase 1 and phase 2, respectively). Vitamin A deficiency (RBP <0.7 µmol/L or retinol <0.7 µmol/L) decreased by a median of 14 pp (18 pp and 8 pp in BRINDA phase 1 and phase 2, respectively) in children. Adjustment for inflammation in women resulted in smaller differences in estimated iron deficiency than in children. Conclusions Our findings are consistent with previous BRINDA conclusions that not accounting for inflammation may result in an underestimation of iron deficiency and overestimation of vitamin A deficiency. Research is needed to understand the etiology of the heterogeneity in the regression coefficients before a meta-analyzed regression correction can be considered.

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Four years after implementation of a national micronutrient powder program in Kyrgyzstan, prevalence of iron deficiency and iron deficiency anemia is lower, but prevalence of vitamin A deficiency is higher

Cited by 11 publications

References 16 publications

Effect of Fortification with Multiple Micronutrient Powder on the Prevention and Treatment of Iron Deficiency and Anaemia in Brazilian Children: A Randomized Clinical Trial

Effect of Fortification with Multiple Micronutrient Powder on the Prevention and Treatment of Iron Deficiency and Anaemia in Brazilian Children: A Randomized Clinical Trial

The Transformation of Food Culture on the Case of Kyrgyz Nomads—A Historical Overview

Adjusting iron and vitamin A status in settings of inflammation: a sensitivity analysis of the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) approach

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