Diarrhea and fever as risk factors for anemia among children under age five living in urban slum areas of Indonesia

SummaryObjectivesTo characterize diarrhea and fever as risk factors for anemia among children in developing countries.MethodsWe characterized risk factors for anemia in a sample of 32873 children, aged 6–59 months, from poor families in urban slum areas of Indonesia from 2000 to 2003.ResultsThe prevalence of anemia was 58.7%. In separate multivariate models, after adjusting for age, sex, stunting, maternal age and education, and weekly per capita household expenditure, current diarrhea (OR 1.20, 95% CI 1.07–1.35, p=0.002), current fever (OR 1.44, 95% CI 1.18–1.75, p<0.0001), and a history of diarrhea in the previous seven days (OR 1.12, 95% CI 1.03–1.23, p=0.024) were associated with an increased risk of anemia.ConclusionsDiarrhea and fever are important risk factors for anemia among young children living in urban slum communities in Indonesia

Vitamin A deficiency and inflammatory markers among preschool children in the Republic of the Marshall Islands

BACKGROUND: The exclusion of individuals with elevated acute phase proteins has been advocated in order to improve prevalence estimates of vitamin A deficiency in surveys, but it is unclear whether this will lead to sampling bias. The purpose of the study was to determine whether the exclusion of individuals with elevated acute phase proteins is associated with sampling bias and to characterize inflammation in children with night blindness. METHODS: In a survey in the Republic of the Marshall Islands involving 281 children, aged 1–5 years, serum retinol, C-reactive protein (CRP), and α(1)-acid glycoprotein (AGP) were measured. RESULTS: Of 281 children, 24 (8.5%) had night blindness and 165 (58.7%) had serum retinol <0.70 μmol/L. Of 248 children with AGP and CRP measurements, 123 (49.6%) had elevated acute phase proteins (CRP >5 mg/L and/or AGP >1000 mg/L). Among children with and without night blindness, the proportion with serum retinol <0.70 μmol/L was 79.2% and 56.8% (P = 0.03) and with anemia was 58.3% and 35.7% (P = 0.029), respectively. The proportion of children with serum retinol <0.70 μmol/L was 52.0% after excluding children with elevated acute phase proteins. Among children with and without elevated acute phase proteins, mean age was 2.8 vs 3.2 years (P = 0.016), the proportion of boys was 43.1% vs. 54.3% (P = 0.075), with no hospitalizations in the last year was 11.0% vs 23.6% (P = 0.024), and with anemia was 43.8% vs 31.7% (P = 0.05), respectively. CONCLUSIONS: Exclusion of children with inflammation in this survey of vitamin A deficiency does not improve prevalence estimates for vitamin A deficiency and instead leads to sampling bias for variables such as age, gender, anemia, and hospitalization history

Status of carotenoids, vitamin A, and vitamin E in the mother-infant dyad and anthropometric status of infants in Malawi

This prospective study was carried out during February 2000-April 2003 to characterize the relationship between the status of carotenoids, vitamin E, and retinol and anthropometric status in apparently healthy infants and their mothers in Blantyre, Malawi. Anthropometric status of infants and concentrations of carotenoids (α-carotene, β-carotene, β-cryptoxanthin, lutein, zeaxanthin, and lycopene), retinol, and α-tocopherol in plasma were measured in 173 infants at 12 months of age, and concentrations of carotenoids, retinol, and α-tocopherol in plasma were measured in their mothers two weeks postpartum. In multivariate analyses, concentrations of retinol, total carotenoids, non-provitamin A carotenoids, and α-tocopherol in infants were associated with under-weight (p=0.05). Concentrations of α-tocopherol were associated with wasting (p= 0.04). Concentrations in mothers and infants were all correlated (correlation coefficients from0.230to0.502,p<0.003). The findings suggest that poor status of carotenoids, retinol, and α-tocopherol in infants is associated with their poor anthropometric status, and status of carotenoids, retinol, and α-tocopherol in mothers and infants has a low-to-moderate association in the mother-infant dyad

Carotenoid status among preschool children with vitamin A deficiency in the Republic of the Marshall Islands

Although carotenoids are known to be important dietary sources of vitamin A, there have been few epidemiological studies that have characterized the serum concentrations of major dietary carotenoids among preschool children with vitamin A deficiency. We conducted a population-based, cross-sectional study of serum provitamin A carotenoids (α-carotene, β-carotene, β-cryptoxanthin), non-provitamin A carotenoids (lutein/ zeaxanthin, and lycopene), and retinol among 278 children, aged 1-5 y, in the Republic of the Marshall Islands