Underlying Factors Associated with Anemia in Amazonian Children: A Population-Based, Cross-Sectional Study

Background: Although iron deficiency is considered to be the main cause of anemia in children worldwide, other contributors to childhood anemia remain little studied in developing countries. We estimated the relative contributions of different factors to anemia in a population-based, cross-sectional survey. Methodology: We obtained venous blood samples from 1111 children aged 6 months to 10 years living in the frontier town of Acrelandia, northwest Brazil, to estimate the prevalence of anemia and iron deficiency by measuring hemoglobin, erythrocyte indices, ferritin, soluble transferrin receptor, and C-reactive protein concentrations. Children were simultaneously screened for vitamin A, vitamin B-12, and folate deficiencies; intestinal parasite infections; glucose-6-phosphate dehydrogenase deficiency; and sickle cell trait carriage. Multiple Poisson regression and adjusted prevalence ratios (aPR) were used to describe associations between anemia and the independent variables. Principal Findings: The prevalence of anemia, iron deficiency, and iron-deficiency anemia were 13.6%, 45.4%, and 10.3%, respectively. Children whose families were in the highest income quartile, compared with the lowest, had a lower risk of anemia (aPR, 0.60; 95% CI, 0.37-0.98). Child age (<24 months, 2.90; 2.01-4.20) and maternal parity (>2 pregnancies, 2.01; 1.40-2.87) were positively associated with anemia. Other associated correlates were iron deficiency (2.1; 1.4-3.0), vitamin B-12 (1.4; 1.0-2.2), and folate (2.0; 1.3-3.1) deficiencies, and C-reactive protein concentrations (>5 mg/L, 1.5; 1.1-2.2). Conclusions: Addressing morbidities and multiple nutritional deficiencies in children and mothers and improving the purchasing power of poorer families are potentially important interventions to reduce the burden of anemia.Sao Paulo State Research Agency [FAPESP 07/53042-1]Sao Paulo State Research AgencyNational Research Agency of BrazilNational Research Agency of Brazil [CNPq 470573/2007-4

Effect of cholecalciferol and calcium supplementation on muscle strength and energy metabolism in vitamin D-deficient Asian Indians: a randomized, controlled trial

Vitamin D deficiency is prevalent worldwide. Vitamin D supplementation has shown variable effect on skeletal muscle strength in the elderly with hypovitaminosis D. There is a paucity of similar data in young individuals. Objective: To study the effect of cholecalciferol and calcium supplementation on muscle strength and energy metabolism in young individuals. Subjects: Forty healthy volunteers (24M/16F, mean age (SD) 31·5 &#177; 5·0 year) with hypovitaminosis D were randomized to either oral cholecalciferol (60 000 IU D3/week for 8 weeks followed by 60 000 IU/month for 4 months) with 1 g of elemental calcium daily or dual placebos for 6 months. Measurements: Handgrip and gastro-soleus dynamometry, pinch-grip strength, respiratory pressures, 6-min walk-test and muscle energy metabolism on <SUP>31</SUP>P magnetic resonance spectroscopy were assessed at baseline and after 6 months. Results: The mean serum 25(OH)D in the supplemented and placebo groups at baseline, two and 6 months were 25·4 &#177; 9·9, 94·5 &#177; 53·8 and 56·0 &#177; 17·0 nm, and 21·1 &#177; 9·4, 32·8 &#177; 14·4 and 29·7 &#177; 15·0 nm, respectively. The supplemented group gained a handgrip strength of 2·4 kg (95% C.I. = 1·2-3·6); gastro-soleus strength of 3·0 Nm (95% C.I. = 0·1-5·9) and walking distance of 15·9 m (95% C.I. = 6·3-25·5) over the placebo group after adjustment for age, gender and respective baseline parameters. Muscle energy parameters were comparable at 6 months. Conclusions: Six months of cholecalciferol and calcium supplementation results in enhanced skeletal muscle strength and physical performance despite no change in muscle energy parameters. Cholecalciferol supplementation of 60 000 IU per month could not maintain 25(OH)D levels in the sufficient range