Iron Deficiency Anaemia

Iron deficiency anaemia as the most common nutrition disorder has only marginal reduction globally during recent decades, with the highest burden in pregnant women and young children. Insufficient iron storage and/or excessive loss of iron are common causes of iron deficiency anaemia. Therefore, understanding the complexity of the regulatory network required to maintain iron homeostasis and identifying the functional variants associated with iron metabolism should be fundamental and crucial to control and treat the iron deficiency anaemia. Sensitive and inexpensive measures to distinguish iron deficiency anaemia from the other kinds of anaemia should be developed for precise treatment. Original disease treatments combined with oral or intravenous iron therapy are key approaches in clinical practices. The integrated, multifactorial and multi‐sectoral approach with food‐based strategy and iron supplementation as the leading public health inventions is required to achieve iron deficiency anaemia control target. This chapter will focus on the advanced knowledge associated with iron metabolism, disease burden and health consequences of iron deficiency anaemia in different life course, newly parameters development in the diagnosis of iron deficiency anaemia, therapy choice in clinical practice and public health strategies to reduce iron deficiencies in high‐burden areas

Status of cardiovascular health among adults in a rural area of Northwest China: Results from a cross-sectional study.

The aim of this study was to assess the status of cardiovascular health among a rural population in Northwest China and to determine the associated factors for cardiovascular health.A population-based cross-sectional study was conducted in the rural areas of Hanzhong in Northwest China. Interview, physical examination, and fasting blood glucose and lipid measurements were completed for 2693 adults. The construct of cardiovascular health and the definitions of cardiovascular health metrics proposed by the American Heart Association were used to assess cardiovascular health. The proportions of subjects with cardiovascular health metrics were calculated, adjusting for age and sex. The multiple logistic regression model was used to evaluate the association between ideal cardiovascular health and its associated factors.Only 0.5% (0.0% in men vs 0.9% in women, P = 0.002) of the participants had ideal cardiovascular health, whereas 33.8% (18.0% in men vs 50.0% in women, P < 0.001) and 65.7% (82.0% in men vs 49.1% in women, P < 0.001) of the participants had intermediate and poor cardiovascular health, respectively. The prevalence of poor cardiovascular health increased with increasing age (P < 0.001 for trend). Participants fulfilled, on average, 4.4 (95% confidence interval: 4.2-4.7) of the ideal cardiovascular health metrics. Also, 22.2% of the participants presented with 3 or fewer ideal metrics. Only 19.4% of the participants presented with 6 or more ideal metrics. 24.1% of the participants had all 4 ideal health factors, but only 1.1% of the participants had all 4 ideal health behaviors. Women were more likely to have ideal cardiovascular health, whereas adults aged 35 years or over and those who had a family history of hypertension were less likely to have ideal cardiovascular health.The prevalence of ideal cardiovascular health was extremely low among the rural population in Northwest China. Most adults, especially men and the elderly, had a poor cardiovascular health status. To improve cardiovascular health among the rural population, efforts, especially lifestyle improvements, education and interventions to make healthier food choices, reduce salt intake, increase physical activities, and cease smoking, will be required at the individual, population, and social levels

The Contribution of the Underlying Factors to Socioeconomic Inequalities in Obesity: A Life Course Perspective

Objectives: Socioeconomic disparities in obesity have been observed in both childhood and adulthood. However, it remains unclear how the role of risk factors influencing these inequalities has evolved over time. Methods: Longitudinal data on 2,866 children and adolescents (6–17 years old) from the China Health and Nutrition Survey were used to track their BMI during childhood, adolescence, and adulthood. Concentration Index was utilized to measure socioeconomic inequalities in obesity, while Oaxaca decomposition was employed to determine the share of different determinants of inequality. Results: The concentration index for obesity during childhood and adulthood were 0.107 (95% CI: 0.023, 0.211) and 0.279 (95% CI: 0.203, 0.355), respectively. Changes in baseline BMI (24.6%), parental BMI (10.4%) and socioeconomic factors (6.7%) were found to be largely responsible for the increasing inequality in obesity between childhood and adulthood. Additionally, mother’s education (−7.4%) was found to contribute the most to reducing these inequalities. Conclusion: Inequalities in obesity during childhood and adulthood are significant and growing. Interventions targeting individuals with higher BMI, especially those who are wealthy, can significantly reduce the gap

Geographical variations in maternal dietary patterns during pregnancy associated with birth weight in Shaanxi province, Northwestern China

The geographical variation of maternal dietary patterns related to birth outcomes is important for improving the health of mothers and children; however, it is currently unknown. Thus, the objective of the study was to investigate geographical variations of maternal dietary pattern during pregnancy, and evaluate the spatial varying association of maternal dietary patterns in pregnancy with abnormal birth weight. A population-based cross-sectional study was conducted in Shaanxi province in Northwest China in 2013 to evaluate the relationship between abnormal birth weight and dietary pattern using the Geographically Weighted Logistic Regression (GWLR). Three dietary patterns during pregnancy were extracted through factor analysis, explaining approximately 45.8% of the variability of food intake. Approximately 81.6% of mothers with higher scores on the equilibrium pattern was more unlikely to have small for gestational age (SGA) infants, with the lower OR observed in Central and South Shaanxi. The snacks pattern was positively associated with low birth weight (LBW) for 23.2% of participants, with the highest OR in Central Shaanxi. Among about 80.0% of participants with higher scores on the snacks pattern living in South and Central Shaanxi, there was a higher risk for SGA. The OR values tend to descend from South to North Shaanxi. The OR values of the negative association between prudent pattern and LBW decreased from South to North Shaanxi among approximately 59.3% of participants. The prudent pattern was also negatively associated with the increasing risk of fetal macrosomia among 19.2% of participants living mainly in South Shaanxi. The association of maternal dietary patterns during pregnancy with abnormal birth weight varied geographically across Shaanxi province. The findings emphasize the importance of geographical distribution to improve the dietary patterns among disadvantaged pregnant women

Life-course social disparities in body mass index trajectories across adulthood: cohort study evidence from China health and nutrition survey

Background: The social disparities in obesity may originate in early life or in adulthood, and the associations of socioeconomic position (SEP) with obesity could alter over time. It is unclear how lifetime-specific and life-course SEP influence adult obesity development in China. Methods: Based on the China Health and Nutrition Survey (CHNS), three SEP-related indicators, including the father’s occupational position and the participant’s education and occupational position, were obtained. The life-course socioeconomic changes and a cumulative SEP score were established to represent the life-course SEP of the participants in the study. The growth mixture modeling was used to identify BMI trajectories in adulthood. Multinomial logistic regression was adopted to assess the associations between SEP and adult BMI trajectories. Results: A total of 3,138 participants were included in the study. A positive correlation was found between the paternal occupational position, the participants’ occupational position, education, and obesity in males, whereas an inverse correlation was observed among females. Males who experienced social upward mobility or remained stable high SEP during the follow-up had 2.31 and 2.52-fold risks of progressive obesity compared to those with a stable-low SEP. Among females, stable high SEP in both childhood and adulthood was associated with lower risks of progressive obesity (OR = 0.63, 95% CI: 0.43–0.94). Higher risks of obesity were associated with the life-course cumulative SEP score among males, while the opposite relationship was observed among females. Conclusions: The associations between life-course SEP and BMI development trajectories differed significantly by gender. Special emphasis should be placed on males experiencing upward and stable high socioeconomic change

Effects of potential risk factors on the development of cardiometabolic multimorbidity and mortality among the elders in China

Objectives: To examine the impact of demographic, socioeconomic, and behavioral factors on the development of cardiometabolic multimorbidity and mortality in Chinese elders. Methods: Data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2002–2018 was used in the study. Cardiometabolic multimorbidity was defined as the presence of two or more cardiometabolic disorders, such as hypertension, diabetes, cardiovascular disease (CVD), heart disease, or stroke. Cox regression model and multi-state Markov model were developed to evaluate the association of the study factors with the progression of cardiometabolic conditions and mortality. The outcomes included three states (first cardiometabolic disease, cardiometabolic multimorbidity, and all-cause mortality) and five possible transitions among the three states. Results: Of the 13,933 eligible individuals, 7,917 (56.8%) were female, and 9,540 (68.50%) were over 80 years old. 2,766 (19.9%) participants had their first cardiometabolic disease, 975 (7.0%) participants suffered from cardiometabolic multimorbidity, and 9,365 (67.2%) participants died. The progression to cardiometabolic multimorbidity was positively associated with being female (HR = 1.42; 95%CI, 1.10 − 1.85), living in the city (HR = 1.41; 95%CI, 1.04 − 1.93), overweight (HR = 1.43; 95%CI, 1.08 − 1.90), and obesity (HR = 1.75; 95% CI, 1.03 − 2.98). A higher risk for the first cardiometabolic disease was associated with being female (HR = 1.26; 95% CI, 1.15 − 1.39), higher socioeconomic status (SES, HR = 1.17; 95%CI, 1.07 − 1.28), lack of regular physical activity (HR = 1.13; 95%CI, 1.04 − 1.23), smoking (HR = 1.20; 95%CI, 1.08 − 1.33), ≤ 5 h sleep time (HR = 1.15; 95%CI, 1.02 − 1.30), overweight (HR = 1.48; 95% CI, 1.32 − 1.66), and obesity (HR = 1.34; 95%CI, 1.06 − 1.69). It also should be noted that not in marriage, lower SES and unhealthy behavioral patterns were risk factors for mortality. Conclusion: This study emphasized the importance of lifestyle and SES in tackling the development of cardiometabolic conditions among Chinese elders and provided a reference for policy-makers to develop a tailored stage-specific intervention strategy

Associations between trajectories of cardiovascular risk factor change and cognitive impairment in Chinese elderly: A nationwide cohort study

Objectives: This study aimed to investigate the relationship between long-term trajectories of changes in cardiovascular risk factors (CVRFs) and the risk of cognitive impairment among Chinese adults over 60 years old. Methods: Data were obtained from the Chinese Longitudinal Healthy Longevity Survey 2005–2018. Cognitive function was evaluated longitudinally through the Chinese version of the Mini-Mental State Examination (C-MMSE), and cognitive impairment (C-MMSE ≤23) was used as the main outcome variable. The cardiovascular risk factors, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), and body mass index (BMI), were continuously measured in the follow-up duration. The patterns of trajectories of changes in CVRFs were derived from the latent growth mixture model (LGMM). The Cox regression model was used to evaluate the cognitive impairment hazard ratio (HR) across different CVRF trajectories. Results: A total of 5,164 participants aged ≥60 years with normal cognitive function at baseline were included in the study. After a median follow-up of 8 years, 2,071 participants (40.1%) developed cognitive impairment (C-MMSE ≤ 23). The four-class trajectories of SBP and BMI were obtained by means of LGMM, and the trajectories of DBP, MAP, and PP were grouped into a three-class subgroup. In the final adjusted Cox model, the lowered SBP [adjusted HR (aHR): 1.59; 95% CI: 1.17–2.16], lowered PP (aHR: 2.64; 95% CI: 1.66–4.19), and progressively obese (aHR: 1.28; 95% CI: 1.02–1.62) and stable slim (aHR: 1.13; 95% CI: 1.02–1.25) were associated with the higher risk of cognitive impairment. Low stable DBP (aHR: 0.80; 95% CI: 0.66–0.96) and elevated PP (aHR: 0.76; 95% CI: 0.63–0.92) decreased the risk for cognitive impairment among participants. Conclusion: Lowered SBP, lowered PP, progressive obesity, and stable slim increased the risk for cognitive impairment in the Chinese elderly. Low stable DBP and elevated PP were protective against cognitive impairment, but more DBP lowering and ≥25 mmHg growth in PP contributed to a higher risk of cognitive impairment. The findings have important implications for preventing cognitive impairment in elder adults based on the long-term trajectories of changes in CVRFs

Association of antenatal vitamin B complex supplementation with neonatal vitamin B12 status: evidence from a cluster randomized controlled trial

Purpose Evidence about the effect of maternal vitamin B12 supplementation on offspring’s vitamin B12 status is limited. The present interventional study sought to evaluate the association of antenatal vitamin B complex supplementation with neonatal vitamin B12 status. Methods In an ongoing cluster randomized controlled trial conducted in three rural counties in northwest China, pregnant women < 20 weeks of gestation were randomized to three treatment groups: blank control, iron supplements, or vitamin B complex supplements. All women were administered folic acid supplements during the periconceptional period. In a sub-study, we collected cord blood samples of 331 participants from the control or vitamin B complex groups in the Xunyi county from January 2017 to December 2017. Plasma concentrations of folate, vitamin B12, and homocysteine were measured. Linear mixed models with a random intercept for cluster were used to compare biochemical indexes between groups after controlling for covariates. Results Compared with newborns whose mothers were in the control group, newborns of the vitamin B complex-supplemented women had significantly higher cord plasma vitamin B12 (P = 0.001) and lower homocysteine concentrations (P = 0.043). The association of antenatal vitamin B complex supplementation with cord blood vitamin B12 concentrations appeared to be more pronounced among newborns with high folate status than those with low folate status (Pinteraction = 0.060). Conclusions Maternal vitamin B complex supplementation during pregnancy was associated with better neonatal vitamin B12 status in rural northwest China

Associations of B Vitamin-Related Dietary Pattern during Pregnancy with Birth Outcomes: A Population-Based Study in Northwest China

This study aimed to derive a maternal dietary pattern to explain the variation in B vitamins during pregnancy and to investigate this pattern in relation to birth outcomes. A total of 7347 women who gave birth to live newborns less than one year were included. Their dietary pattern during pregnancy was derived using the reduced-rank regression method with six B vitamins as response variables. Associations between dietary pattern score and birth weight, gestational age at delivery, birth weight Z score, low birth weight, preterm, and small-for-gestational-age (SGA) were estimated using generalised linear mixed models. We identified a high B-vitamin dietary pattern characterised by high intakes of animal foods, vegetables, fungi and algae, legumes, and low intakes of oils and cereals. Women in the highest quartile of this pattern score had newborns with a 44.5 g (95% CI: 13.8, 75.2 g) higher birth weight, 0.101 (95% CI: 0.029, 0.172) higher birth weight Z score, and 27.2% (OR: 0.728; 95% CI: 0.582, 0.910) lower risk of SGA than those in the lowest quartile. Our study suggested that adherence to the high B-vitamin dietary pattern during pregnancy was associated with a higher birth weight and a lower risk of SGA

Hypoallergenic and anti-inflammatory feeds in children with complicated severe acute malnutrition: an open randomised controlled 3-arm intervention trial in Malawi

Intestinal pathology in children with complicated severe acute malnutrition (SAM) persists despite standard management. Given the similarity with intestinal pathology in non-IgE mediated gastrointestinal food allergy and Crohn’s disease, we tested whether therapeutic feeds effective in treating these conditions may benefit children with complicated SAM. After initial clinical stabilisation, 95 children aged 6–23 months admitted at Queen Elizabeth Central Hospital, Blantyre, Malawi between January 1 st and December 31 st , 2016 were allocated randomly to either standard feeds, an elemental feed or a polymeric feed for 14 days. Change in faecal calprotectin as a marker of intestinal inflammation and the primary outcome was similar in each arm: elemental vs. standard 4.1 μg/mg stool/day (95% CI, −29.9, 38.15; P = 0.81) and polymeric vs. standard 10 (−23.96, 43.91; P = 0.56). Biomarkers of intestinal and systemic inflammation and mucosal integrity were highly abnormal in most children at baseline and abnormal values persisted in all three arms. The enteropathy in complicated SAM did not respond to either standard feeds or alternative therapeutic feeds administered for up to 14 days. A better understanding of the pathogenesis of the gut pathology in complicated SAM is an urgent priority to inform the development of improved therapeutic interventions