Male gender is an important clinical risk factor for iron deficiency in healthy infants

Author's personal copy ; Acknowledgements to the children and families who were involved in this study, and to BH Pathology Clinic Dpt.Background & aims: To identify ID risk factors in infancy, and try to explore why ID is more prevalent in boys than in girls in the first year of life. Methods: A multiple logistic regression was performed on data of 201 infants, with ferritin<12 ng/ml as the dependent variable and months of breastfeeding, weight gain from birth to 9 months (WG), and gender as independent variables. To compare haematological parameters we used Manne-Whitney and t test. Results: From the 39 infants with IDA (19.4%), 24 (61.5%) were male and of the 162 infants without IDA, 50% were male (p ¼ 0.195). The median(minimum; maximum) ferritin concentrations in male infants at 9 months was of 9.8 ng/ml (0.5e67.0 ng/ml) and in females 14 ng/ml (0.5e74.5 ng/ml), p < 0.001. The average (±SD) WG was of 5863.3 g (±855.4 g) in male infants and 5556.9 g (±1054.3 g) in female infants (p = 0.027). A multiple logistic regression (OR; 95%CI) showed that male gender was the most important risk factor (OR: 3.3; 1.7e6.3; p < 0.001), followed by a higher weight increase (OR: 1.6; CI [1.1; 2.2]; p = 0.016) and longer breastfeeding time (OR: 1.1; CI [0.98; 1.2]; p = 0.099). Comparison of other haematological parameters at 9 months in relation to gender (males (M): 105; females (F): 96) showed significant differences in: mean ± SD, Mean Corpuscular Haemoglobin (M: 25.0 ± 2.1; F: 25.8 ± 2.4 pg, p = 0.001), Mean Corpuscular Volume (M: 73.4 ± 4.1; F: 75.3 ± 4.2 fl, 0.009), RDW (M: 14.6 ± 1.5; F: 14.1 ± 1.6%, p = 0.048), Plaquelets (M: 324.9 ± 77.9; F: 350.5 ± 81.4 x 10³/µl, p = 0.026). Conclusions: ID was significantly more frequent in male infants, independent of rapid growth or longer breastfeeding duration. The clinical risk profile for ID in infants includes male gender and not only rapid growth, and longer breastfeeding duration.This study received a scholarship from the Foment Commission for Investigation in Health Care, from the Health Ministry P.I. nº 87/07

Cluster‐randomized trial on complementary and responsive feeding education to caregivers found improved dietary intake, growth and development among rural Indian toddlers

Inadequate feeding and care may contribute to high rates of stunting and underweight among children in rural families in India. This cluster‐randomized trial tested the hypothesis that teaching caregivers appropriate complementary feeding and strategies for how to feed and play responsively through home‐visits would increase children's dietary intake, growth and development compared with home‐visit‐complementary feeding education alone or routine care. Sixty villages in Andhra Pradesh were randomized into three groups of 20 villages with 200 mother–infant dyads in each group. The control group (CG) received routine Integrated Child Development Services (ICDS); the complementary feeding group (CFG) received the ICDS plus the World Health Organization recommendations on breastfeeding and complementary foods; and the responsive complementary feeding and play group (RCF&PG) received the same intervention as the CFG plus skills for responsive feeding and psychosocial stimulation. Both intervention groups received bi‐weekly visits by trained village women. The groups did not differ at 3 months on socioeconomic status, maternal and child nutritional indices, and maternal depression. After controlling for potential confounding factors using the mixed models approach, the 12‐month intervention to the CFG and RCF&PG significantly ( P  < 0.05) increased median intakes of energy, protein, Vitamin A, calcium (CFG), iron and zinc, reduced stunting [0.19, confidence interval (CI): 0.0–0.4] in the CFG (but not RCF&PG) and increased ( P  < 0.01) Bayley Mental Development scores (mean = 3.1, CI: 0.8–5.3) in the RCF&PG (but not CFG) compared with CG. Community‐based educational interventions can improve dietary intake, length (CFG) and mental development (RCF&PG) for children under 2 years in food‐secure rural Indian families.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94697/1/mcn413.pd

Protein deficiency balance as a predictor of clinical outcome in hereditary spherocytosis

Vertical and horizontal interactions between membrane constituents account for integrity, strength and deformability of the erythrocyte. Disruption of vertical interactions caused by membrane protein deficiencies in hereditary spherocytosis (HS), favor membrane vesiculation with development of spherocytic cells. Our aim was to evaluate the hematological and clinical presentation of HS according to the type and amount of protein deficiency. We studied 81 Portuguese individuals, 71 belonging to 21 families plus 10 unrelated subjects, and found that 51 of them were HS patients. Patients were classified as presenting mild, typical or severe HS, according to laboratory results and clinical follow-up. We performed screening tests and the standardized electrophoretic membrane protein analysis to identify and quantify protein deficiencies. We found band 3 and ankyrin deficiencies as the major causes for HS. The ratios between the value of the primary and/or secondary protein deficiencies showed significantly different values according to the severity of HS, and a significant inverse correlation with the severity of HS was observed. In mild HS, the ratios between protein deficiencies reflected equivalent protein deficiencies, while an unbalance was observed in typical HS, which was enhanced in severe HS. Our data suggest that the relative quantification of each major membrane protein and of the ratios between the values of protein deficiencies may be helpful in providing additional data about the clinical outcome of HS