Dataset Information

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.

ABSTRACT:

Background

Anemia is a worldwide concern. Nutritional deficiencies and inflammation are considered main contributors, but zinc deficiency has only recently been associated with anemia.

Objectives

In this study we assessed associations between zinc status and hemoglobin (Hb) concentrations and anemia in preschool children 6-59 mo old (PSC) and nonpregnant women of reproductive age 15-49 y old (WRA) in population-based nutrition surveys.

Methods

Cross-sectional data from 13 (PSC) and 12 (WRA) countries within the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project were used. Multivariable linear models were constructed that included zinc status (plasma/serum zinc concentrations), Hb concentrations and anemia, iron status, age, sex, and inflammation (C-reactive protein and α-1-acid glycoprotein). Zinc was adjusted for inflammation in PSC according to the BRINDA algorithm.

Results

Data were available for 18,658 PSC and 22,633 WRA. Prevalence of anemia ranged from 7.5% to 73.7% and from 11.5% to 94.7% in PSC and WRA, respectively. Prevalence of zinc deficiency ranged from 9.2% to 78.4% in PSC and from 9.8% to 84.7% in WRA, with prevalence of zinc deficiency >20% in all countries except Azerbaijan (PSC), Ecuador (PSC), and the United Kingdom (WRA). Multivariable linear regression models showed that zinc concentrations were independently and positively associated with Hb concentrations in 7 of 13 countries for PSC and 5 of 12 countries for WRA. In the same models, ferritin concentration was also significantly associated with Hb among PSC and WRA in 9 and 10 countries, respectively. Zinc deficiency was significantly associated with anemia in PSC and WRA in 5 and 4 countries respectively.

Conclusions

Zinc deficiency was prevalent in most countries and associations between zinc and Hb in roughly half of the countries examined suggesting that strategies to combat zinc deficiency may help reduce anemia prevalence. More research on mechanisms by which zinc deficiency is associated with anemia and the reasons for the heterogeneity among countries is warranted.

SUBMITTER: Greffeuille V

PROVIDER: S-EPMC8454198 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Abstract Objectives To assess the effectiveness of a nutrition intervention with a multi-micronutrient fortified corn-soy blend (MMC) (ChapuditosTM) vs. standard of care (SOC) in anemia and hemoglobin (Hb) in 6 to 12-mo-old infants from four rural municipalities in La Libertad, El Salvador. Methods A two-arm, clustered randomized evaluation was implemented between September 2015 and November 2017. A total of n = 384 infants met eligibility criteria: ages 6 to ≤ 12 mo, permanent resident of study locations, no genetic, health conditions or disability, parental consent, having attended 2 consecutive well-child visits. Clinicaltrials.gov registration NCT02567981. A total of n = 195 received SOC: 3 lb of corn-soy blend with dry milk with 18 micronutrients including 1.8 mg of zinc and 3.6 mg of iron per serving, equivalent to 30 daily servings; + 100,000 IU of vitamin A every 6 mo, and 12.5 mg of elemental iron per day via ferrous sulphate. A total of n = 189 received “MMC”: 3 lb of corn-soy blend with 21 micronutrients and high concentrations of chelated zinc (9 mg) and iron (12 mg) per serving, equivalent to 72 daily servings. Capillary blood was drawn at baseline (Bl) and 3 mo. Linear and generalized linear mixed models with binary outcomes were used to assess Bl – 3 mo changes in Hb and anemia, respectively. Models were adjusted by age, sex, Bl outcomes, and cluster. Both nutrition interventions were provided at the scheduled well-child visits. Results Preliminary analyses showed that Hb tended to improve from Bl to 3 mo in both groups [Bl-MMC = 10.47g/dL; 95% CI (10.32–10.61), Bl-SOC = 10.26 g/dL; 95% CI (10.12–10.40); 3 mo MMC = 10.88g/dL; 95% CI (10.72–11.04); 3 mo-SOC = 10.43g/dL; 95% CI (10.28–10.60)]. Changes in Hb were significant for the MMC vs. SOC group, [mean difference = 0.41g/dL, P ≤ 0.001; and 0.180g/dL, P = 0.228, respectively]. The odds of anemia were 63% lower in the MMC group, relative to SOC, [OR: 0.37, 95% CI (0.17–0.82)]. Conclusions A multi-micronutrient cereal with 21 micronutrients and elevated concentrations of chelated zinc and iron may be an effective alternative to current practices in alleviating anemia and improving Hb in this population. Consolidating different multiple-micronutrient delivery methods into one product may simplify provision and adherence, resulting in improved anemia and Hb status. Funding Sources This study was funded by the Mathile Institute for the Advancement of Human Nutrition.