Predictors of anemia in women of reproductive age: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project

Wirth, James P.; Woodruff, Bradley A.; Engle‐Stone, Reina; Namasté, Sorrel; Temple, Victor J; Petry, Nicolai; Macdonald, Barbara; Suchdev, Parminder S.; Rohner, Fabian; Aaron, Grant J

doi:10.3945/ajcn.116.143073

Cited by 73 publications

(5 citation statements)

References 37 publications

(50 reference statements)

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“…For instance, the higher prevalence of SMA among illiterate, rural, and economically poor among both pregnant and non-pregnant women indicates the persistence inequalities in the health status of women which could be due to the inequalities in coverage and access to anaemia control interventions among these groups. These findings corroborate with several other studies carried out in India and other less-developed and developing countries that indicate that anaemia disproportionately affect the rural, poor, less educated and other socially vulnerable population [41][42][43][44]. The NFHS indicated a higher prevalence of SMA among women without any children, however, it indicated an increasing trend with number of children.…”

Section: Plos Onesupporting

confidence: 90%

Trends in prevalence and determinants of severe and moderate anaemia among women of reproductive age during the last 15 years in India

Marimuthu

Mani

Asirvatham³

et al. 2023

PLoS ONE

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Background Anaemia is a serious global public health problem that disproportionally affects children, adolescent girls, and women of reproductive age, especially pregnant women. Women of reproductive age are more vulnerable to anaemia, particularly severe and moderate anaemia leads to adverse outcomes among pregnant women. Despite continuous Government efforts, anaemia burden still poses a serious challenge in India. The objective of this study is to assess the trends in prevalence and determinants of severe and moderate anaemia among women of reproductive age between 15 and 49 years. Method We used three rounds of the large-scale National Family Health Survey (NFHS) India, conducted on a representative sample of households using a cross-sectional design across the country in 2005–06, 2015–16 and 2019–2021. We included all the women aged 15 to 49 years in our analysis. We used the same haemoglobin (Hb) cut-off values for all the three rounds of surveys to ensure comparability. Generalized linear regression analyses with log link were done. Survey weights were incorporated in the analysis. Results The prevalence of severe or moderate Anaemia (SMA) in non-pregnant women was 14.20%, 12.43% and 13.98%; it was 31.11%, 25.98% and 26.66% for pregnant women in 2006, 2016 and 2021 respectively. The decline in SMA prevalence was 1.54% in non-pregnant women, whereas it was 14.30% in pregnant women in 15 years. Women who were poor, and without any formal education had a higher risk for severe and moderate Anaemia. Conclusion Despite the intensive anaemia control program in India, SMA has not declined appreciably in non-pregnant women during the last two decades. Despite the decline, the prevalence of SMA was about 26% in pregnant women which calls for a comprehensive review of the existing anaemia control programmes and there must be targeted programmes for the most vulnerable and high-risk women such as rural, poor and illiterate women of reproductive age to reduce the burden of anaemia among them.

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Section: Plos Onesupporting

confidence: 90%

Trends in prevalence and determinants of severe and moderate anaemia among women of reproductive age during the last 15 years in India

Marimuthu

Mani

Asirvatham³

et al. 2023

PLoS ONE

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“…In population studies, anemia and iron deficiency are often used interchangeably because of the high global prevalence of iron deficiency [2,8]. Accordingly, we expected to find that iron supplementation would be associated with decreased odds of anemia, low ferritin, and/or low serum iron.…”

Section: Discussionmentioning

confidence: 94%

“…Anemia of malnutrition has also been associated with both protein and calorie malnutrition [6,7]. In lactating women in developing countries, chronic infection-related inflammation [8] contributes to anemia [7,9]. Anemia of chronic inflammation manifests as low serum iron with normal iron stores [10].…”

Section: Introductionmentioning

confidence: 99%

Multiple Indicators of Undernutrition, Infection, and Inflammation in Lactating Women Are Associated with Maternal Iron Status and Infant Anthropometry in Panama: The MINDI Cohort

et al. 2022

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Maternal infections, nutrient deficiencies, and inflammation (MINDI) co-exist in lactating indigenous women in Panama, but their impact on maternal iron status and infant growth is unknown. For this secondary analysis of cross-sectional data of lactating mothers from our MINDI cohort, we investigated associations of MINDI variables with maternal anemia, elevated serum transferrin receptor (sTfR), low serum iron, hepcidin, ferritin, and infant weight-for-age (WAZ), length-for-age (LAZ), and head-circumference-for-age (HCAZ) Z-scores in 99 mother-infant dyads. A bootstrapping resampling procedure preselected covariates for inclusion in multivariable regressions models from chronic maternal infections and nutritional status [folate, vitamins A, D, retinol-binding protein (RBP), insulin-growth factor-1 (IGF-1)] and inflammation [C-reactive protein (CRP), cytokines, platelet indices] indicators. Anemia was prevalent (53.5%) but underestimated due to widespread low plasma volume (<2.2 L, 79.9%) and was associated with indicators of malnutrition [lower IGF-1, body mass index (BMI), vitamin D, and intake of green/leafy vegetables], but not inflammation. Higher CRP was associated with lower serum iron, and higher hepcidin and ferritin, whereas maternal platelets were associated with lower HCAZ (β = −0.22), WAZ (β = −0.17), and LAZ (β = −0.17). Higher LAZ was also associated with maternal serum vitamin D (β = 0.23), whereas maternal iron supplementation lowered LAZ (β = −0.22). Assessment of iron status in this MINDI cohort is complex and supplementation strategies must consider consequences for both the mother and the infant.

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“…Moreover, iron status indicators are themselves modified by other nutritional deficiencies and by inflammation [ 10 ]. This may underscore why public health efforts directed towards iron supplementation have not decreased iron deficiency in resource-poor settings [ 11 ] and have led to the re-evaluation in the last decade of the concept that anemia is synonymous with iron deficiency, particularly after studies showed that the co-occurrence of infections with micronutrient deficiencies contribute to anemia in developing settings [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Multiple Infections, Nutrient Deficiencies, and Inflammation as Determinants of Anemia and Iron Status during Pregnancy: The MINDI Cohort

González-Fernández,

Nemeth,

Pons

et al. 2024

Nutrients

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In pregnant women with multiple infections, nutrient deficiencies, and inflammation (MINDI), the study of anemia and iron status is limited. For this cross-sectional study (n = 213 Panamanian indigenous women), we investigated if hemoglobin, anemia (Hb < 110 g/L), ferritin, serum iron, serum transferrin receptor, and hepcidin were associated with (1) maternal nutritional status and supplementation practices, (2) biomarkers of inflammation, and (3) presence/absence of infections. Hierarchical generalized linear and logistic regression models and dominance analyses identified the relative importance of these predictors. Anemia (38%), which was likely underestimated due to low plasma volume (95%), was associated with lower ferritin, vitamin A, and weight-for-height, suggesting anemia of undernutrition. Inflammation was not associated with Hb or anemia; nevertheless, higher CRP was associated with increased odds of low serum iron and higher ferritin and hepcidin, indicating iron restriction due to inflammation. The length of iron supplementation did not enter models for anemia or iron indicators, but a multiple nutrient supplement was associated with higher ferritin and hepcidin. Moreover, iron supplementation was associated with higher odds of vaginal trichomoniasis but lower odds of caries and bacterial vaginosis. The complex pathogenesis of anemia and iron deficiency in MINDI settings may require other interventions beyond iron supplementation.

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Predictors of anemia in women of reproductive age: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project

Cited by 73 publications

References 37 publications

Trends in prevalence and determinants of severe and moderate anaemia among women of reproductive age during the last 15 years in India

Trends in prevalence and determinants of severe and moderate anaemia among women of reproductive age during the last 15 years in India

Multiple Indicators of Undernutrition, Infection, and Inflammation in Lactating Women Are Associated with Maternal Iron Status and Infant Anthropometry in Panama: The MINDI Cohort

Multiple Infections, Nutrient Deficiencies, and Inflammation as Determinants of Anemia and Iron Status during Pregnancy: The MINDI Cohort

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