Subclinical inflammation influences the association between vitamin A- and iron status among schoolchildren in Ghana

Abstract

Background and objectiveIn resource-poor settings, micronutrient deficiencies such as vitamin A deficiency may co-exist with iron-deficiency. In this study we assessed the iron and vitamin A status of schoolchildren and the association between vitamin A and iron status.MethodsA cross-sectional design using the baseline data of a dietary intervention trial conducted among randomly selected 5–12 years old schoolchildren (n = 224) from 2 rural schools in northern Ghana. Hemoglobin (Hb), serum ferritin (SF) and serum transferrin receptor (sTfR) concentrations were used as measures of iron status. Retinol binding protein (RBP) was used as a measure of vitamin A status. Subclinical inflammation (SCI) was measured using C-reactive protein (CRP) and α1-acid glycoprotein (AGP) concentrations. We examined the cross-sectional association between vitamin A and iron status biomarkers with multiple linear regressions.ResultsThe proportions of schoolchildren with anemia (WHO criteria), iron-deficiency (ID, SF <15μg/l and/or sTfR >8.5mg/l) and iron-deficiency anemia (IDA, concurrent anemia and ID) were 63.8%, 68.3% and 46.4% respectively. Low or marginal vitamin A status (0.70 μmol/l ≤ RBP < 1.05μmol/l) was present in 48.2% while 37.5% of the schoolchildren had vitamin A deficiency (VAD, RBP <0.70 μmol/l). The prevalence of SCI as well as concurrent VAD and ID were 48.7% and 25% respectively. RBP was associated with Hb (β = 7.2, P = 0.05) but not SF (β = 20.7, P = 0.33) and sTfR concentration (β = 12.0, P = 0.63). In the presence of SCI, RBP was not associated with hemoglobin status but a significant positive association was observed among children without SCI.ConclusionsThe study shows that RBP is significantly associated with Hb concentration but not with SF and sTfR. The observed relationship between RBP and Hb is only significant in the absence of SCI.

Agro‐ecological zone and farm diversity are factors associated with haemoglobin and anaemia among rural school‐aged children and adolescents in Ghana

“…Number of months household consumed food from own production 6.9 ± 4.2 7.5 ± 3.9 6. In prevalence rate (64%) than our study among 5-to 12-year-old rural SAC (Abizari et al, 2017). Although the apparent differences with our findings may be related to differences in sample size and socioeconomic conditions among others, the results suggest a variation in the prevalence of anaemia based on geographic/contextual circumstances.…”

“…Compared with our results, a recent study in the transition zone of Ghana reported a lower prevalence rate (30.8%) of anaemia among rural 6‐ to 12‐year‐old SAC (Egbi et al, ). However, two recent studies in the Northern Savannah zone of Ghana reported a higher prevalence rate (64%) than our study among 5‐ to 12‐year‐old rural SAC (Abizari et al, ). Although the apparent differences with our findings may be related to differences in sample size and socio‐economic conditions among others, the results suggest a variation in the prevalence of anaemia based on geographic/contextual circumstances.…”

“…Furthermore, intakes of vitamin A-rich and iron-rich foods are well-recognized predictors of anaemia (Zimmermann et al, 2005), yet it was not possible to evaluate the contribution of dietary intake to the improvement of Hb in the present study as we lacked data on intakes of these foods specifically. Malaria is another factor that may contribute to anaemia (Leenstra et al, 2004;WHO, 2001), and a high prevalence of malaria among Ghanaian children has previously been reported (Abizari et al, 2017;Otupiri et al, 2012). Although we did not include malaria incidence in our statistical models, child sickness in the last 7 days preceding the survey was captured, which we presume, may have sufficiently accounted for any malaria incidence.…”

“…In Ghana, about 73.6% and 44% of rural young children (<5 years) and women are anaemic, respectively (Ghana Statistical Service/Ghana Health Service, ). About two thirds of Ghanaian adolescent girls and SAC are reportedly anaemic (Abizari, Azupogo, & Brouwer, ; UNICEF, ), suggesting anaemia is a severe public health problem in Ghana requiring urgent attention and context‐appropriate policies.…”

Anemia is associated with the risk of Crohn’s disease, not ulcerative colitis: A nationwide population-based cohort study

“…Malnutrition and malabsorption via inflamed gastrointestinal tract could cause anemia. A recent study reported that subclinical inflammation may affect iron status and hemoglobin concentrations [29]. However, it remains unclear whether the predictive role of anemia in the detection of CD differs according to the etiology of anemia.…”