Suboptimal biochemical riboflavin status is associated with lower hemoglobin and higher rates of anemia in a sample of Canadian and Malaysian women of reproductive age

Background: Riboflavin is required for several redox reactions. Clinical riboflavin deficiency occurs mainly in low-income countries, where it is associated with anemia. The functional significance of suboptimal riboflavin status in different populations and its role in anemia is not well understood. Objectives: We assessed the biomarker status of riboflavin and its association with hemoglobin concentration and anemia in women living in Vancouver, Canada, and Kuala Lumpur, Malaysia. Methods: Healthy nonpregnant, nonbreastfeeding women (19-45 y) were recruited from Canada ( n = 206) and Malaysia (n = 210) via convenience sampling. Fasting blood was collected to assess riboflavin status [erythrocyte glutathione reductase activity coefficient (EGRac)], hematological indicators, soluble transferrin receptor (sTfR), ferritin, vitamin A, folate, and vitamin B-12 concentrations. Linear and logistic regression models were used to assess the association of riboflavin status with hemoglobin concentration and anemia. Results: EGRac (mean ± SD) values were higher, indicating poorer riboflavin status, in Malaysian compared with Canadian women (1.49 ± 0.17 compared with 1.38 ± 0.11). Likewise, riboflavin biomarker deficiency (EGRac ≥1.40) was significantly more prevalent among Malaysians than Canadians (71% compared with 40%). More Malaysian than Canadian women were anemic (hemoglobin <120 g/L; 18% compared with 7%). With use of linear regression (pooled sample; n = 416), EGRac values were negatively associated with hemoglobin concentration (r = -0.18; P < 0.001). This relation remained significant (P = 0.029) after adjusting for age, parity, ethnicity, vitamin B-12, folate, sTfR, ferritin, and vitamin A. Women with riboflavin deficiency (EGRac ≥1.40) were twice as likely to present with anemia (adjusted OR: 2.38; 95% CI: 1.08, 5.27) compared with women with EGRac <1.40. Conclusions: Biochemical riboflavin deficiency was observed in Canadian and Malaysian women, with higher rates of deficiency among Malaysian women. Deficient biomarker status of riboflavin was a weak but significant predictor of hemoglobin and anemia, suggesting that the correction of riboflavin deficiency may potentially play a small protective role in anemia, but this requires further investigation

Malaria is a cause of iron deficiency in African children

Malaria and iron deficiency (ID) are common and interrelated public health problems in African children. Observational data suggest that interrupting malaria transmission reduces the prevalence of ID1. To test the hypothesis that malaria might cause ID, we used sickle cell trait (HbAS, rs334), a genetic variant that confers specific protection against malaria2, as an instrumental variable in Mendelian randomization analyses. HbAS was associated with a 30% reduction in ID among children living in malaria-endemic countries in Africa (n = 7,453), but not among individuals living in malaria-free areas (n = 3,818). Genetically predicted malaria risk was associated with an odds ratio of 2.65 for ID per unit increase in the log incidence rate of malaria. This suggests that an intervention that halves the risk of malaria episodes would reduce the prevalence of ID in African children by 49%

Thalassemias in South Asia:clinical lessons learnt from Bangladesh

Abstract Thalassemias are emerging as a global public health concern. Due to remarkable success in the reduction of childhood mortality by controlling infectious diseases in developing countries, thalassemias are likely to be a major public health concern in the coming decades in South Asia. Despite the fact that Bangladesh lies in the world’s thalassemia belt, the information on different aspects (epidemiology, clinical course, mortality, complications and treatment outcomes) of thalassemias is lacking. In this comprehensive review, the aim is to to depict the epidemiological aspects of thalassemias, mutation profile and current treatment and management practices in the country by sharing the experience of dealing with 1178 cases over 2009–2014 time periods in a specialized thalassemia treatment centre. We have also discussed the preventative strategies of thalassemias from the context of Bangladesh which could be effective for other developing countries

Children with Moderate Acute Malnutrition with No Access to Supplementary Feeding Programmes Experience High Rates of Deterioration and No Improvement: Results from a Prospective Cohort Study in Rural Ethiopia

Background: Children with moderate acute malnutrition (MAM) have an increased risk of mortality, infections and impaired physical and cognitive development compared to well-nourished children. In parts of Ethiopia not considered chronically food insecure there are no supplementary feeding programmes (SFPs) for treating MAM. The short-term outcomes of children who have MAM in such areas are not currently described, and there remains an urgent need for evidence-based policy recommendations. Methods: We defined MAM as mid-upper arm circumference (MUAC) of ≥11.0cm and <12.5cm with no bilateral pitting oedema to include Ethiopian government and World Health Organisation cut-offs. We prospectively surveyed 884 children aged 6–59 months living with MAM in a rural area of Ethiopia not eligible for a supplementary feeding programme. Weekly home visits were made for seven months (28 weeks), covering the end of peak malnutrition through to the post-harvest period (the most food secure window), collecting anthropometric, socio-demographic and food security data. Results: By the end of the study follow up, 32.5% (287/884) remained with MAM, 9.3% (82/884) experienced at least one episode of SAM (MUAC <11cm and/or bilateral pitting oedema), and 0.9% (8/884) died. Only 54.2% of the children recovered with no episode of SAM by the end of the study. Of those who developed SAM half still had MAM at the end of the follow up period. The median (interquartile range) time to recovery was 9 (4–15) weeks. Children with the lowest MUAC at enrolment had a significantly higher risk of remaining with MAM and a lower chance of recovering. Conclusions: Children with MAM during the post-harvest season in an area not eligible for SFP experience an extremely high incidence of SAM and a low recovery rate. Not having a targeted nutrition-specific intervention to address MAM in this context places children with MAM at excessive risk of adverse outcomes. Further preventive and curative approaches should urgently be considered

Comparison of a New Multiplex Immunoassay for Measurement of Ferritin, Soluble Transferrin Receptor, Retinol-Binding Protein, C-Reactive Protein and α1-Acid-glycoprotein Concentrations against a Widely-Used s-ELISA Method

Recently, a multiplex ELISA (Quansys Biosciences) was developed that measures ferritin, soluble transferrin receptor (sTfR), retinol-binding protein (RBP), C-reactive protein (CRP), α1-acid glycoprotein (AGP), thyroglobulin, and histidine-rich protein 2. Our primary aim was to conduct a method-comparison study to compare five biomarkers (ferritin, sTfR, RBP, CRP, and AGP) measured with the Quansys assay and a widely-used s-ELISA (VitMin Lab, Willstaett, Germany) with use of serum samples from 180 women and children from Burkina Faso, Cambodia, and Malaysia. Bias and concordance were used to describe the agreement in values measured by the two methods. We observed poor overall agreement between the methods, both with regard to biomarker concentrations and deficiency prevalence estimates. Several measurements were outside of the limit of detection with use of the Quansys ELISA (total n = 42 for ferritin, n = 2 for sTfR, n = 0 for AGP, n = 5 for CRP, n = 22 for RBP), limiting our ability to interpret assay findings. Although the Quansys ELISA has great potential to simplify laboratory analysis of key nutritional and inflammation biomarkers, there are some weaknesses in the procedures. Overall, we found poor comparability of results between methods. Besides addressing procedural issues, additional validation of the Quansys against a gold standard method is warranted for future research

Evaluating the Relative Effectiveness of Two Supplemental Foods for the Treatment of Moderate Acute Malnutrition in Children 6 to 60 Months of Age in Southern Ethiopia

The purpose of this cluster-randomized equivalence trial was to investigate the effectiveness of two supplemental foods in children with moderate malnutrition by comparing: (i) time to recovery by survival analysis, and (ii) recovery rates (after 16 weeks of treatment). A total of 2,600 children 6-60 months of age were randomized by cluster (district) to receive 16 weeks of conventional (Corn-Soya Blended flour, CSB) or intervention (Ready-to-Use Supplemental Food, RUSF) foods. Overall, time to recovery from malnutrition (mean 74 days) and recovery rates (mean 76%) were equivalent with both foods. The time to recovery outcomes were equivalent, independent of location, whereas the recovery rate in children receiving CSB was significantly higher in the more food insecure southern region. Intra-household food sharing was significantly higher in the CSB group compared to RUSF. Overall, the response to the two different supplemental foods was equivalent for the treatment of moderately malnourished children in Ethiopia.MAS

Is iron deficiency a major cause of the high prevalence of anemia in non-pregnant Cambodian women of reproductive age? : evidence from a cross-sectional survey and a randomized controlled trial

Despite a high prevalence of anemia among non-pregnant Cambodian women, recent reports suggest iron deficiency prevalence is low. If true, iron supplementation will not reduce anemia. In Phase I, we investigated factors associated with hemoglobin, ferritin, and soluble transferrin receptor (sTfR) concentrations in 450 women 18-45 years in Prey Veng province. Overall, 54% had a genetic hemoglobin disorder, 29.5% had anemia (hemoglobin 8.3 mg/L), respectively. The hemoglobin E homozygous genotype was associated with 50% (95% CI: 14%, 96%) and 51% (95% CI: 37%, 66%) higher mean ferritin and sTfR concentrations as compared to normal hemoglobin structure. These findings challenged the diagnostic accuracy of ferritin and sTfR to estimate iron deficiency. In Phase II, we measured the effect of oral iron (Fe) with or without multiple micronutrients (MMN) on hemoglobin concentration as a direct way to determine the extent to which iron deficiency (or other micronutrient deficiencies) was a cause of anemia. A total of 809 non-pregnant women 18-45 years with hemoglobin ≤117 g/L (HemoCue®) were recruited from Kampong Chhnang province to a 2x2 factorial double-blind randomized trial. Women received 12 weeks of daily Fe (60 mg), MMN (14 other micronutrients), Fe+MMN, or placebo capsules. Baseline anemia prevalence was 58% (Sysmex analyzer). Mean (95% CI) hemoglobin at 12 weeks did not differ in the Fe and Fe+MMN groups (121 [120, 122] vs. 123 [122, 124] g/L); both were higher than MMN and placebo (both 116 [115, 117] g/L, P<0.05). Mean (95% CI) increase in hemoglobin was 5.6 (3.8, 7.4) g/L (P<0.001) among women who received Fe (n=383) and 1.1 (-0.7, 2.9) g/L (P=0.24) among women who received MMN (n=382), with no interaction between interventions (P=0.61). At 12 weeks, 19% and 30% of women had a hemoglobin response ≥10 g/L in Fe and Fe+MMN groups, compared to 8% and 5% in MMN and placebo, respectively. Daily iron supplementation for 12 weeks increased hemoglobin in non-pregnant Cambodian women; however, MMN did not confer additional benefit. Only ~25% of our predominantly anemic study population was responsive to iron.Land and Food Systems, Faculty ofGraduat

The Biology of The First 1000 Days : Proceedings

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Feasibility of an At-Home Adult Stool Specimen Collection Method in Rural Cambodia

The human microbiome has received significant attention over the past decade regarding its potential impact on health. Epidemiological and intervention studies often rely on at-home stool collection methods designed for high-resource settings, such as access to an improved toilet with a modern toilet seat. However, this is not always appropriate or applicable to low-resource settings. Therefore, the design of a user-friendly stool collection kit for low-resource rural settings is needed. We describe the development, assembly, and user experience of a simple and low-cost at-home stool collection kit for women living in rural Cambodia as part of a randomized controlled trial in 2020. Participants were provided with the stool collection kit and detailed verbal instruction. Enrolled women (n = 480) provided two stool specimens (at the start of the trial and after 12 weeks) at their home and brought them to the health centre that morning in a sterile collection container. User specimen collection compliance was high, with 90% (n = 434) of women providing a stool specimen at the end of the trial (after 12 weeks). This feasible and straightforward method has strong potential for similar or adapted use among adults residing in other rural or low-resource contexts.Land and Food Systems, Faculty ofOther UBCReviewedFacult