| Peer-Reviewed

Anemia Is Related to Iron Deficiency and Inflammation, But No to Global Overweight in Cuban Preschool Children

Received: 7 November 2022     Accepted: 9 December 2022     Published: 31 January 2023
Views:       Downloads:
Abstract

The main cause of anemia in the preschool population is dietary iron deficiency; however, there are other conditions that can lead to anemia such as diseases that produce chronic inflammation and obesity. The objective was to evaluate the prevalence of anemia and iron deficiency in children aged 6 to 59 months and the association with inflammation, global overweight and maternal educational level. A national sample of cross-sectional study design was carried out. Hemoglobin, ferritin, soluble transferrin receptors, leukocytes, C-reactive protein, and alpha-1 acid glycoprotein were assessed. Nutritional status was evaluated and level of mother education was collected by survey. A total of 1417 children were studied. Anemia prevalence was 22.5% and constitutes a moderate public health problem. Iron deficiency prevalence was 35.6% and erythropoietic dysfunction 13.3%; with elevated inflammation indicators 37.6% and leukocytosis 36.1%. Malnutrition occurred in 1.0% of the children, with a prevalence of overweight in 4.7% and obesity in 2.8%. Anemia was associated with iron storage deficiency OR=2.07 (1.45-2.97) and inflammation OR=2.01 (1.45-2.78). No associations were found between anemia OR=0.68 (95% CI= 0.35-1.32) and iron deficiency OR=0.96 (95% CI= 0.68-1.35) with global overweight. Global overweight does not explain the inflammation found OR=1.13 (95% CI= 0.54-2.37), neither by CRP OR=0.57 (0.24-1.37) or AGP OR=1.14 (0.54-2.42). Low education level of the mother was associated with anemia in the children (χ2 trend= 4.327 p=0.037), but not with iron deficiency (χ2 trend= 0.212 p=0.646). Anemia and iron deficiency in Cuban preschool children was a moderate public health problem associated with inflammation.

Published in Biomedical Sciences (Volume 9, Issue 1)
DOI 10.11648/j.bs.20230901.11
Page(s) 1-8
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Anemia, Iron Deficiency, Inflammation, Preschool Children, Overweight

References
[1] Safiri S, Kolahi AA, Noori M, SeyedNejadghaderi SA, Karamzad N, Bragazzi NL et al. Burden of anemia and its underlying causes in 204 countries and territories, 1990–2019: results from the Global Burden of Disease Study 2019. J Hematol Oncol. 2021; 14: 185 https://doi.org/10.1186/s13045-021-01202-2
[2] Hershko C. Assessment of iron deficiency. Haematologica 2018; 103: 1939–1942. http://doi:10.3324/haematol.2018.205575. Epub 2018 Nov 30. PMID: 31013471; PMCID: PMC6269318.
[3] Walker SP, Wachs TD, Gardner JM, Lozoff B, Wasserman GA, Pollitt E, et al. Child development: risk factors for adverse outcomes in developing countries. Lancet 2007; 369 (9556): 145-57. https://doi: 10.1016/S0140-6736(07)60076-2.
[4] Schumann K, Solomons NW. Perspective: what makes it so difficult to mitigate worldwide anemia prevalence? Adv Nutr Int Rev J. 2017; 8 (3): 401–408. https://doi:10.3945/an.116.013847. PMID: 28507005.
[5] Cepeda-Lopez AC, Baye K., Invited Commentary. Obesity, iron deficiency and anaemia: a complex relationship. Public Health Nutrition 2020; 23 (10): 1703-1704. https://doi:10.1017/S1368980019004981
[6] Balarajan Y, Ramakrishnan U, Ozaltin E, Shankar AH, Subramanian SV. Anaemia in low-income and middle-income countries. Lancet. 2011; 378 (9809): 2123–35. https://doi:10.1016/S0140-6736(10)62304-5. Epub 2011 Aug 1. PMID: 21813172.
[7] Montero-Díaz M, Chávez-Chong C, Rodríguez-Martínez E, Pita-Rodríguez GM, Lambert-Lamazares B, Basabe-Tuero B et al. Adjusting Iron Deficiency for Inflammation in Cuban Children Aged Under Five Years: New Approaches Using Quadratic and Quantile Regression. MEDICC Review. 2022; 24 (3): 10p. https://doi.org/10.37757/MR2022.V24.N3-4.1
[8] Flowers CH, Skikne BS, Covell AM, Cook JD. The clinical measurement of serum transferrin receptor. J Lab Clin Med. 1989; 114: 368-77.
[9] Pita-Rodríguez GM, Chávez-Chong C, Lambert-Lamazares B, Montero-Díaz M, Selgas-Lizano R, Basabe-Tuero B et al. Influence of Inflammation on Assessing Iron-Deficiency Anemia in Cuban Preschool Children. MEDICC Review 2021; 23 (3–4): 37-45 https://doi.org/10.37757/MR2021.V23.N3.7
[10] World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System (VMNIS) [Internet]. Geneva: World Health Organization; 2011 [cited 2013 Feb 4]; [about 6 p.]. Available from: http://apps.who.int/iris/bitstream/10665/85839/3/WHO_NMH_NHD_MNM_11.1_eng.pdf?ua=1
[11] World Health Organization. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 6]. 80 p. Available from: https://apps.who.int/iris/bitstream/handle/10665/331505/9789240000124-eng.pdf?sequence=1&isAllowed=y
[12] Leucocitos. ABX Hematologie Micro 60-OT, ABX Diagnostics, Montpellier, France.
[13] WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva: World Health Organization, 2006 (312 pages). https://www.who.int/childgrowth/standards/technical_report/en/
[14] WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Head circumference-for-age, arm circumference-for-age, triceps skinfold-for-age and subscapular skinfold-for-age: Methods and development. Geneva: World Health Organization, 2007 (217 pages). 2001 [cited 2005 Dec 26] Available from: https://www.who.int/childgrowth/standards/second_set/technical_report_2/en/
[15] World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013 Nov 27; 310 (20): 2191-4. https://doi:10.1001/jama.2013.281053. PMID: 24141714.
[16] Nutrition and Food Hygiene Center (CU). Technical report on the nutritional situation of populations at risk. (Informe técnico sobre situación nutricional de poblaciones de riesgo. Spanish). Havana: National Institute of Hygiene, Epidemiology and Microbiology (CU); 2014.
[17] Pita GM, Jiménez S, Basabe B, García RG, Macías C, Selva L et al. Anemia in Children under Five Years Old in Eastern Cuba, 2005–2011. MEDICC Review. [Internet]. 2014 [cited 2014 Jan 30]; 16 (1): 16-23. Available from: http://www.medicc.org/mediccreview/pdf.php?lang=&id=340
[18] Basabe-Tuero B, Macías-Matos C, Pita-Rodríguez G, Jiménez-Acosta S, Hernández C, Cruz-Jorge M, Herrera-Charro R et al. Vitamin A deficiency and anemia in Cuban preschool children. Ann Nutr Metab 2013; 63 (suppl 1): 648. http://doi.org/10.1159/000354245
[19] Rodríguez Suárez A Country situation analysis for rice fortification: Cuba. Report prepared by the consultant World Food Program Guatemala, August (Análisis de situación de país para la fortificación del arroz: Cuba. Informe preparado por la consultora Programa Mundial de Alimentos Guatemala, Agosto Spanish 2016). [Internet]. 2016 [cited 2022 May 25] Available from: https://sightandlife.org/wp-content/uploads/2017/04/Cuba-FINAL.pdf.
[20] Iglesias Vázquez L, Valera E, Villalobos M, Tous M, Arija V. Prevalence of Anemia in Children from Latin America and the Caribbean and Effectiveness of Nutritional Interventions: Systematic Review and Meta–Analysis. Nutrients 2019, 11, 183; https://doi:10.3390/nu1101018
[21] Stevens GA, Paciorek CJ, Flores-Urrutia MC, Borghi E, Namaste S, Wirth JP et al. National, regional, and global estimates of anaemia by severity in women and children for 2000–19: a pooled analysis of population-representative data. Lancet Glob Health 2022; 10 (5): e627-e639. https://doi:10.1016/S2214-109X(22)00084-5. PMID: 35427520; PMCID: PMC9023869.
[22] Wirth JP, Sesay F, Mbai J, Ibrahim Ali SI, Donkor WES, Woodruff BA et al. Risk factors of anaemia and iron deficiency in Somali children and women: Findings from the 2019 Somalia Micronutrient Survey. Matern Child Nutr. 2021; e13254. wileyonlinelibrary.com/journal/mcn 1 of 14. https://doi.org/10.1111/mcn.13254
[23] Jiménez Acosta SM, Rodríguez Suárez A, Martín González I, Sibero Pérez Y, SilveraTéllez D, Domínguez Ayllón Y, Alfonso Sagué K. Evaluation of the effect of the implementation of the Dietary Guidelines for Cuban children under two years of age, on the knowledge and healthy eating practices of mothers and caregivers and health professionals. Final report. (Evaluación del efecto de la implementación de las Guías Alimentarias para niños y niñas cubanos menores de dos años, sobre el conocimiento y las prácticas alimentarias saludables de madres y cuidadoras y en profesionales de la salud. Informe final Unicef. Spanish) 2019.
[24] Greffeuille V, Fortin S, Gibson R, Rohner F, Williams A, Young MF et al. Associations between Zinc and Hemoglobin Concentrations in Preschool Children and Women of Reproductive Age: An Analysis of Representative Survey Data from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project. J Nutr 2021; 151: 1277–1285. https://doi.org/10.1093/jn/nxaa444.2002;100:2769–77. https://doi: 10.1182/blood-2002-01-0182. PMID: 12351384.
[25] Feldman L, Najle, R, Rivero MA, Rodríguez EM, Estein SM. Inflammatory anemia: pathophysiology, diagnosis and treatment (Anemia inflamatoria: fisiopatología, diagnóstico y tratamiento. Spanish). Acta Bioquímica Clínica Latinoamericana, 2017; 51 (3): 361-374 [cited 2018 Feb 26]: Available from: http://www.redalyc.org/articulo.oa?id=53553013011
[26] Weiss G, Ganz T, Goodnough LT. Anemia of inflammation. Blood 2019; 133 (1): 40–50. https://doi:10.1182/blood-2018-06-856500
[27] Santana Espinosa MC, Esquivel Lauzurique M, Herrera Alcázar VR, Castro Pacheco BL, Machado Lubián MC, Cintra Cala D, et al. Maternal and child health care in Cuba: achievements and challenges (Atención a la salud maternoinfantil en Cuba: logros y desafíos. Spanish). Rev Panam Salud Publica. 2018; 42: e27. https://doi.org/10.26633/RPSP.2018.27
[28] Delaney KZ, Vanstone CA, Weiler HA, Santosa S. Regional adiposity and markers of inflammation in pre-school age children. Scientific Reports. 2018/10/12; 8 (1): 15204. https://doi:10.1038/s41598-018-33054-1. PMID: 30315178; PMCID: PMC6185945.
[29] Nappo A, LiciaIacoviello L, Arno Fraterman A, Gonzalez-Gil EM, Hadjigeorgiou C, StaffanMarildet al. High-sensitivity C-reactive Protein is a Predictive Factor of Adiposity in Children: Results of the Identification and prevention of Dietary- and lifestyle-induced health Effects in Children and InfantS (IDEFICS) Study, J Am Heart Assoc. 2013; 2: e000101 doi: 10.1161/JAHA.113.000101.
[30] Wirth JP, Rajabov T, Petry N, Woodruff BA, ShafiqueNB, MustafaR, Tyler VQ, Rohner F. Micronutrient Deficiencies, Over- and Undernutrition, and Their Contribution to Anemia in Azerbaijani Preschool Children and Non-Pregnant Women of Reproductive Age. Nutrients 2018, 10, 1483: 17p. https://doi:10.3390/nu10101483
[31] Kamruzzaman M. Is BMI associated with anemia and hemoglobin level of women and children in Bangladesh: A study with multiple statistical approaches. PLoS ONE, 2021; 16 (10): e0259116. https://doi.org/10.1371/journal.pone.0259116
[32] Castro Bedriñana JI, Chirinos Peinado DM. Prevalence of childhood anemia and its association with socioeconomic and productive factors in a high Andean community of Peru (Prevalencia de anemia infantil y su asociación con factores socioeconómicos y productivos en una comunidad altoandina del Perú. Spanish) Rev Esp Nutr Comunitaria [Internet]. 2019 [cited 2020 Apr 20]; 25 (3) Available from: http://www.renc.es/imagenes/auxiliar/files/RENC_2019_3_01._J_Castro_Prevalencia_anemia_ninos_pequenos.pdf
Cite This Article
  • APA Style

    Gisela Maria Pita-Rodriguez, Beatriz Basabe-Tuero, Maria Elena Diaz-Sanchez, Karen Alfonso-Sague, Ana Maria Gomez-Alvarez, et al. (2023). Anemia Is Related to Iron Deficiency and Inflammation, But No to Global Overweight in Cuban Preschool Children. Biomedical Sciences, 9(1), 1-8. https://doi.org/10.11648/j.bs.20230901.11

    Copy | Download

    ACS Style

    Gisela Maria Pita-Rodriguez; Beatriz Basabe-Tuero; Maria Elena Diaz-Sanchez; Karen Alfonso-Sague; Ana Maria Gomez-Alvarez, et al. Anemia Is Related to Iron Deficiency and Inflammation, But No to Global Overweight in Cuban Preschool Children. Biomed. Sci. 2023, 9(1), 1-8. doi: 10.11648/j.bs.20230901.11

    Copy | Download

    AMA Style

    Gisela Maria Pita-Rodriguez, Beatriz Basabe-Tuero, Maria Elena Diaz-Sanchez, Karen Alfonso-Sague, Ana Maria Gomez-Alvarez, et al. Anemia Is Related to Iron Deficiency and Inflammation, But No to Global Overweight in Cuban Preschool Children. Biomed Sci. 2023;9(1):1-8. doi: 10.11648/j.bs.20230901.11

    Copy | Download

  • @article{10.11648/j.bs.20230901.11,
      author = {Gisela Maria Pita-Rodriguez and Beatriz Basabe-Tuero and Maria Elena Diaz-Sanchez and Karen Alfonso-Sague and Ana Maria Gomez-Alvarez and Minerva Montero-Diaz and Cristina Chavez-Chong and Ernesto Rodriguez-Martinez and Yoandy Diaz-Fuentes and Elisa Llera-Abreu and Santa Jimenez-Acosta},
      title = {Anemia Is Related to Iron Deficiency and Inflammation, But No to Global Overweight in Cuban Preschool Children},
      journal = {Biomedical Sciences},
      volume = {9},
      number = {1},
      pages = {1-8},
      doi = {10.11648/j.bs.20230901.11},
      url = {https://doi.org/10.11648/j.bs.20230901.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.bs.20230901.11},
      abstract = {The main cause of anemia in the preschool population is dietary iron deficiency; however, there are other conditions that can lead to anemia such as diseases that produce chronic inflammation and obesity. The objective was to evaluate the prevalence of anemia and iron deficiency in children aged 6 to 59 months and the association with inflammation, global overweight and maternal educational level. A national sample of cross-sectional study design was carried out. Hemoglobin, ferritin, soluble transferrin receptors, leukocytes, C-reactive protein, and alpha-1 acid glycoprotein were assessed. Nutritional status was evaluated and level of mother education was collected by survey. A total of 1417 children were studied. Anemia prevalence was 22.5% and constitutes a moderate public health problem. Iron deficiency prevalence was 35.6% and erythropoietic dysfunction 13.3%; with elevated inflammation indicators 37.6% and leukocytosis 36.1%. Malnutrition occurred in 1.0% of the children, with a prevalence of overweight in 4.7% and obesity in 2.8%. Anemia was associated with iron storage deficiency OR=2.07 (1.45-2.97) and inflammation OR=2.01 (1.45-2.78). No associations were found between anemia OR=0.68 (95% CI= 0.35-1.32) and iron deficiency OR=0.96 (95% CI= 0.68-1.35) with global overweight. Global overweight does not explain the inflammation found OR=1.13 (95% CI= 0.54-2.37), neither by CRP OR=0.57 (0.24-1.37) or AGP OR=1.14 (0.54-2.42). Low education level of the mother was associated with anemia in the children (χ2 trend= 4.327 p=0.037), but not with iron deficiency (χ2 trend= 0.212 p=0.646). Anemia and iron deficiency in Cuban preschool children was a moderate public health problem associated with inflammation.},
     year = {2023}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Anemia Is Related to Iron Deficiency and Inflammation, But No to Global Overweight in Cuban Preschool Children
    AU  - Gisela Maria Pita-Rodriguez
    AU  - Beatriz Basabe-Tuero
    AU  - Maria Elena Diaz-Sanchez
    AU  - Karen Alfonso-Sague
    AU  - Ana Maria Gomez-Alvarez
    AU  - Minerva Montero-Diaz
    AU  - Cristina Chavez-Chong
    AU  - Ernesto Rodriguez-Martinez
    AU  - Yoandy Diaz-Fuentes
    AU  - Elisa Llera-Abreu
    AU  - Santa Jimenez-Acosta
    Y1  - 2023/01/31
    PY  - 2023
    N1  - https://doi.org/10.11648/j.bs.20230901.11
    DO  - 10.11648/j.bs.20230901.11
    T2  - Biomedical Sciences
    JF  - Biomedical Sciences
    JO  - Biomedical Sciences
    SP  - 1
    EP  - 8
    PB  - Science Publishing Group
    SN  - 2575-3932
    UR  - https://doi.org/10.11648/j.bs.20230901.11
    AB  - The main cause of anemia in the preschool population is dietary iron deficiency; however, there are other conditions that can lead to anemia such as diseases that produce chronic inflammation and obesity. The objective was to evaluate the prevalence of anemia and iron deficiency in children aged 6 to 59 months and the association with inflammation, global overweight and maternal educational level. A national sample of cross-sectional study design was carried out. Hemoglobin, ferritin, soluble transferrin receptors, leukocytes, C-reactive protein, and alpha-1 acid glycoprotein were assessed. Nutritional status was evaluated and level of mother education was collected by survey. A total of 1417 children were studied. Anemia prevalence was 22.5% and constitutes a moderate public health problem. Iron deficiency prevalence was 35.6% and erythropoietic dysfunction 13.3%; with elevated inflammation indicators 37.6% and leukocytosis 36.1%. Malnutrition occurred in 1.0% of the children, with a prevalence of overweight in 4.7% and obesity in 2.8%. Anemia was associated with iron storage deficiency OR=2.07 (1.45-2.97) and inflammation OR=2.01 (1.45-2.78). No associations were found between anemia OR=0.68 (95% CI= 0.35-1.32) and iron deficiency OR=0.96 (95% CI= 0.68-1.35) with global overweight. Global overweight does not explain the inflammation found OR=1.13 (95% CI= 0.54-2.37), neither by CRP OR=0.57 (0.24-1.37) or AGP OR=1.14 (0.54-2.42). Low education level of the mother was associated with anemia in the children (χ2 trend= 4.327 p=0.037), but not with iron deficiency (χ2 trend= 0.212 p=0.646). Anemia and iron deficiency in Cuban preschool children was a moderate public health problem associated with inflammation.
    VL  - 9
    IS  - 1
    ER  - 

    Copy | Download

Author Information
  • Department of Biochemistry, National Institute of Hygiene, Epidemiology and Microbiology, Havana, Cuba

  • Department of Biochemistry, National Institute of Hygiene, Epidemiology and Microbiology, Havana, Cuba

  • Department of Community Nutrition, National Institute of Hygiene, Epidemiology and Microbiology, Havana, Cuba

  • Department of Community Nutrition, National Institute of Hygiene, Epidemiology and Microbiology, Havana, Cuba

  • Department of Physiological Sciences, Latin American School of Medicine, Havana, Cuba

  • Department of Mathematics, Mathematical Cybernetics and Physics Institute, Havana, Cuba

  • Department of Mathematics, Mathematical Cybernetics and Physics Institute, Havana, Cuba

  • Department of Mathematics, Mathematical Cybernetics and Physics Institute, Havana, Cuba

  • Department of Community Nutrition, National Institute of Hygiene, Epidemiology and Microbiology, Havana, Cuba

  • Department of Community Nutrition, National Institute of Hygiene, Epidemiology and Microbiology, Havana, Cuba

  • Department of Biochemistry, National Institute of Hygiene, Epidemiology and Microbiology, Havana, Cuba

  • Sections