Low Prevalence of Iron and Vitamin A Deficiency among Cambodian Women of Reproductive Age

Abstract

Nearly half of women of reproductive age (WRA) in Cambodia are anemic. To guide interventions, national data on nutritional causes of anemia, including iron deficiency and vitamin A deficiency, are needed. In 2012, a national household survey in WRA on antibodies to routine vaccine-preventable disease immunity was performed. We used serum samples from this survey to estimate the prevalence of iron and vitamin A deficiency in 2112 Cambodian WRA, aged 15 to 39 years. Iron deficiency was classified as low or marginal iron stores (ferritin concentrations corrected for inflammation <15 μg/L and <50 μg/L respectively; Fer), iron deficient erythropoiesis (soluble transferrin receptor concentrations >8.3 mg/L; sTfR), or low total body iron (TBI) derived from Fer and sTfR concentrations (<0 mg/kg). Vitamin A status was classified using retinol binding protein (RBP) concentrations corrected for inflammation as deficient (<0.70 μmol/L) or marginal (<1.05 μmol/L. Overall, the prevalence of low iron stores, low TBI and iron deficient erythropoiesis was 8.1%, 5.0% and 9.3% respectively. Almost 40% of the women had marginal iron stores. Iron status was better in women living in urban areas compared to rural areas (p < 0.05 for TBI and sTfR). The prevalence of vitamin A deficiency was <1%. These findings suggest that the contribution of iron and vitamin A deficiency to the high prevalence of anemia in Cambodian WRA may be limited. The etiology of anemia in Cambodia needs to be elucidated further to guide current policies on anemia.

Nutritional and Micronutrient Status of Female Workers in a Garment Factory in Cambodia

“…No evidence of VitA (0.0%) or VitB12 deficiency (0.5%) was found among subjects and the prevalence of marginal deficiencies for both were <10% (7.4% marginal VitA deficiency; 5.6% marginal VitB12 deficiency), which is in line with national representative data [24,28]. It is concluded, that the VitA and the VitB12 status of participants is not of concern and is not likely contributing significantly to the anemia burden in the studied women [9].…”

“…These figures are higher compared to representative prevalence rates for Cambodian women (iron deficiency <10%; marginal iron stores ~40%) [24,28]. In addition, 10.1% showed tissue iron deficiency.…”

“…Currently, the contributors to the high prevalence of anemia in Cambodia are still not fully understood [28]. In the past, iron deficiency was regarded as the most important factor, however, recent studies have shown a low prevalence of iron deficiency and concluded a low impact on hemoglobin concentrations among Cambodian women [24,28]. Genetic hemoglobin disorders lead to lower hemoglobin concentrations and an increased risk of anemia [27].…”

“…RBP values were likewise adjusted for the presence of inflammation by correction factors for each stage of inflammation [23]. VitA deficiency was defined by adjusted serum RBP < 0.70 μmol/L and marginal VitA deficiency by adjusted serum RBP values ≥ 0.70 and < 1.05 μmol/L [22,24]. …”

Improved Sanitation Facilities are Associated with Higher Body Mass Index and Higher Hemoglobin Concentration Among Rural Cambodian Women in the First Trimester of Pregnancy

“…Further, as more than 80% of women reported taking an IFA supplement at the time of the survey, the lack of association between IFA supplementation and Hb concentration was unexpected. Though we did not measure biochemical markers of iron status (e.g., serum ferritin, transferrin saturation, and soluble transferrin receptor), the weak associations between IFA and Hb concentration and IFA and anemia in our study support the growing evidence 11,12 that iron deficiency may not be the primary cause of anemia in Cambodian women.…”