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Infant Anemia and Micronutrient Status: Studies of Early Determinants in Rural Bangladesh
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Anemia and micronutrient deficiencies in infancy are common in low-income settings. These are partly due to maternal malnutrition and may impair child health and development. We studied the impact of maternal food and micronutrient supplementation, duration of exclusive breastfeeding (EBF), growth and infection on infant anemia and micronutrient status.

In the MINIMat trial in Matlab, Bangladesh, pregnant women were randomized to Early or Usual promotion of enrolment in a food supplementation program and to one of three daily micronutrient supplements. Capsules containing 400µg folic acid and (a) 30 mg iron (Fe30Fol), (b) 60 mg iron (Fe60Fol), (c) 30 mg iron and other micronutrients (MMS) were provided from week 14 of gestation. Capsule intake was assessed with the eDEM device recording supplement container openings. Blood samples (n=2377) from women at week 14 and 30 were analyzed for hemoglobin (Hb). Duration of EBF and infant morbidity was based on monthly maternal recalls. Infants were weighed and measured monthly. Blood samples (n=1066) from 6-months-old infants were analyzed for Hb and plasma ferritin, zinc, retinol, vitamin B12 and folate.

In women, Hb increase per capsule reached a plateau at 60 Fe60Fol capsules, indicating that nine weeks of daily supplementation produced maximum Hb response. Anemia was common (36%) at capsule intakes >60 indicating other causes of anemia than iron deficiency.

In infants, vitamin B12 deficiency prevalence was lower in the MMS (26.1%) than in the Fe30Fol group (36.5%), (p=0.003) and zinc deficiency prevalence was lower in the Usual than in the Early group. There were no other differential effects of food or micronutrient supplementation on infant anemia or micronutrient status. Infants exclusively breast-fed for 4-6 months had a higher mean plasma zinc concentration (9.9±2.3 µmol/L) than infants exclusively breast-fed for <4 months (9.5±2.0 µmol/L), (p< 0.01). No other differences in anemia, iron or zinc status were observed between EBF categories. Infection, low birth weight and iron deficiency were independent risk factors for infant anemia. Regardless of studied interventions, prevalence of anemia (43%), deficiency of zinc (56%), vitamin B12, vitamin A (19%) and iron (22%) in infancy was high and further preventive strategies are needed.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2011. , p. 52
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 638
Keywords [en]
Micronutrients, Anemia, Iron Deficiency, Zinc Deficiency, Vitamin A Deficiency, Vitamin B12 Deficiency, Folic Acid Deficiency, Infant, Pregnancy, Dietary Supplementation, Hemoglobin, Dose-Response Relationship, Exclusive Breast Feeding, Bangladesh
National Category
Medical and Health Sciences
Research subject
International Health
Identifiers
URN: urn:nbn:se:uu:diva-143058ISBN: 978-91-554-7992-3 (print)OAI: oai:DiVA.org:uu-143058DiVA, id: diva2:391672
Public defence
2011-03-09, Rosénsalen, Akademiska sjukhuset, Ing 95/96 nbv, Uppsala, 13:15 (English)
Opponent
Supervisors
Projects
MINIMatAvailable from: 2011-02-16 Created: 2011-01-19 Last updated: 2011-03-21Bibliographically approved
List of papers
1. Dose-effect of iron-folic acid and multiple micronutrient supplementation on hemoglobin concentration in pregnancy
Open this publication in new window or tab >>Dose-effect of iron-folic acid and multiple micronutrient supplementation on hemoglobin concentration in pregnancy
(English)Manuscript (preprint) (Other academic)
Abstract [en]



Maternal multiple micronutrient supplementation has been suggested as an alternative to the 60 mg iron-folic acid supplementation recommended by the WHO. The effect on hemoglobin (Hb) concentration during pregnancy per capsule of multiple micronutrients has not been evaluated. To investigate the response of type of prenatal supplement on Hb concentration in pregnancy we used data from the MINIMat trial, Bangladesh, where pregnant women were randomized to food and micronutrient interventions. The daily micronutrient supplements starting at week 14 (baseline) were: 60 mg iron+ 400 µg folic acid (Fe60Fol), 30 mg iron+ 400 µg folic acid (Fe30Fol) and 30 mg iron+ 400 µg folic acid+ 13 other micronutrients (MMS). Hb was measured at baseline and week 30 (follow-up) by HemoCue® (n=2377). Intake of capsules was estimated by a device (eDEM®) recording the number of openings of the cap of the supplement bottles.We evaluated dose-effect associations in linear regression models and adjusted for potential confounding. Disregarding type of supplement, the Hb concentration increased with increasing capsule intake (β=0.09, p<0.001). The dose response levelled out at 60 capsules of Fe60Fol. Both anemic and non anemic women responded to supplementation but Hb increase per capsule was higher in anemic women (β=0.065, p=0.19 for interaction between anemia and capsule intake). Despite that the maximum potential Hb was reached, both for anemic and non-anemic women at intakes above 60 capsules, prevalence of anemia was high after supplementation (36%) indicating other causes of anemia than iron deficiency.

Keywords
anemia, hemoglobin, dose-response relationship, dietary supplements, micronutrients, pregnancy, prenatal nutritional physiological phenomena
National Category
Medical and Health Sciences
Research subject
Nutrition
Identifiers
urn:nbn:se:uu:diva-143055 (URN)
Available from: 2011-01-25 Created: 2011-01-19 Last updated: 2011-03-21
2. Maternal multiple micronutrient supplementation has limited impact on micronutrient status of Bangladeshi infants compared with standard iron and folic acid supplementation
Open this publication in new window or tab >>Maternal multiple micronutrient supplementation has limited impact on micronutrient status of Bangladeshi infants compared with standard iron and folic acid supplementation
Show others...
2010 (English)In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 140, no 3, p. 618-624Article in journal (Refereed) Published
Abstract [en]

Knowledge about the impact of maternal food and micronutrient supplementation on infant micronutrient status is limited. We examined the effect of maternal food and micronutrient supplementation on infant micronutrient status in the Maternal and Infant Nutrition Interventions in Matlab Trial. Pregnant women (n = 4436) were randomized to Early or Usual promotion of enrollment in a food supplementation program. In addition, they were randomly allocated to 1 of the following 3 types of daily micronutrient supplements provided from wk 14 of gestation to 3 mo postpartum: 1) folic acid and 30 mg iron (Fe30Fol); 2) folic acid and 60 mg iron; or 3) a multiple micronutrient including folic acid and 30 mg iron (MMS). At 6 mo, infant blood samples (n = 1066) were collected and analyzed for hemoglobin and plasma ferritin, zinc, retinol, vitamin B-12, and folate. The vitamin B-12 concentration differed between the micronutrient supplementation groups (P = 0.049). The prevalence of vitamin B-12 deficiency was lower in the MMS group (26.1%) than in the Fe30Fol group (36.5%) (P = 0.003). The prevalence of zinc deficiency was lower in the Usual food supplementation group (54.1%) than in the Early group (60.2%) (P = 0.046). There were no other differential effects according to food or micronutrient supplementation groups. We conclude that maternal multiple micronutrient supplementation may have a beneficial effect on vitamin B-12 status in infancy.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-126112 (URN)10.3945/jn.109.111740 (DOI)000274807800027 ()20053938 (PubMedID)
Available from: 2010-06-03 Created: 2010-06-03 Last updated: 2017-12-12Bibliographically approved
3. Duration of exclusive breast-feeding and infant iron and zinc status in rural Bangladesh
Open this publication in new window or tab >>Duration of exclusive breast-feeding and infant iron and zinc status in rural Bangladesh
Show others...
2009 (English)In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 139, no 8, p. 1562-1567Article in journal (Refereed) Published
Abstract [en]

There is a concern that exclusive breast-feeding (EBF) for 6 mo may lead to iron and zinc deficiency in low-birth weight (LBW) infants. We assessed the association between duration of EBF and infant iron and zinc status in the Maternal and Infant Nutrition Interventions in Matlab trial, Bangladesh, stratified for normal birth weigh (NBW) and LBW. Duration of EBF was classified into EBF <4 mo and EBF 4-6 mo based on monthly recalls of foods introduced to the infant. Blood samples collected at 6 mo were analyzed for plasma zinc (n = 1032), plasma ferritin (n = 1040), and hemoglobin (Hb) (n = 791). Infants EBF 4-6 mo had a higher mean plasma zinc concentration (9.9 +/- 2.3 micromol/L) than infants EBF <4mo (9.5 +/- 2.0 micromol/L) (P < 0.01). This association was apparent in only the NBW strata and was not reflected in a lower prevalence of zinc deficiency. Duration of EBF was not associated with concentration of plasma ferritin, Hb concentration, or prevalence of iron deficiency or anemia in any strata. Regardless of EBF duration, the prevalence of zinc deficiency, iron deficiency, and anemia was high in infants in this population and strategies to prevent deficiency are needed.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-107966 (URN)10.3945/jn.109.104919 (DOI)000268362000020 ()19535419 (PubMedID)
Available from: 2009-09-02 Created: 2009-09-02 Last updated: 2017-12-13Bibliographically approved
4. Infant anaemia is associated with infection, low birthweight and iron deficiency in rural Bangladesh
Open this publication in new window or tab >>Infant anaemia is associated with infection, low birthweight and iron deficiency in rural Bangladesh
2011 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 2, p. 220-225Article in journal (Refereed) Published
Abstract [en]

Aim: To estimate the prevalence of infant anaemia and its association with iron deficiency, growth, infection and other micronutrient deficiencies. Methods: Using data from MINIMat, a randomized maternal food and micronutrient supplementation trial, we assessed the associations between anaemia (haemoglobin < 105 g/L) in 580 infants at 6 months and deficiencies of iron, vitamin A, vitamin B12, zinc and folate, infection and anthropometric indices. Variables associated with anaemia in bivariate analyses were evaluated in logistic regression models, adjusting for potential confounders. Results: Anaemia was found in 46% of the infants, and among these, 28% had iron deficiency (plasma ferritin <9 μg/L). Elevated C-reactive protein (>10mg/L) (OR = 2.7, 95% CI: 1.6, 4.7), low birthweight (OR = 2.3, 95% CI: 1.5, 3.5) and iron deficiency (OR = 2.2, 95% CI: 1.4, 3.6) were independently associated with increased risk for anaemia. We also observed a seasonal variation in anaemia not mediated through the other factors studied. Conclusion: In a cohort in rural Bangladesh, anaemia at age 6 months was common and associated with infection, low birthweight and iron deficiency.

Keywords
Bangladesh, Infant anaemia, Iron deficiency, Low birthweight, Micronutrient deficiencies
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-132037 (URN)10.1111/j.1651-2227.2010.02011.x (DOI)000285971100014 ()20868371 (PubMedID)
Available from: 2010-10-13 Created: 2010-10-13 Last updated: 2017-12-12Bibliographically approved

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