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Micronutrients Associated With Anemia in School-age Children and Adolescents 2005-2018: Biomarkers Reflecting
Rochelle Werner1, Hanqi Luo1, Lei Liu1
1Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States.
Insights
Anemia affects 16% of children aged 5-19, particularly adolescent females. Iron and vitamin A deficiencies are key drivers, highlighting the need for targeted micronutrient interventions.
Area of Science:
- Nutritional Epidemiology
- Global Public Health
- Pediatric Health
Background:
- School-age children and adolescents face anemia risks due to increased micronutrient demands for growth and maturation.
- Anemia prevalence varies significantly across countries, with higher rates observed in specific age groups and sexes.
Purpose of the Study:
- To analyze the global burden of anemia in children and adolescents (5-19 years).
- To investigate associations between anemia and micronutrient deficiencies (iron, vitamin A, folate, B12, zinc), inflammation, and BMI.
- To examine how these associations vary by age, sex, and geographic location.
Main Methods:
- Analysis of data from 54,534 children across 17 surveys in 16 countries (Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia - BRINDA Project).
- Hemoglobin, micronutrient, and inflammation biomarkers were assessed.
- Multivariable modified Poisson regression models were used to determine factors associated with anemia prevalence.
Main Results:
- Overall anemia prevalence was 16%, with significant variation (5%-59%) by country. Adolescent females (15-19 years) had the highest prevalence (24%).
- Anemia was strongly associated with iron deficiency (PR: 1.6-14.2) and vitamin A deficiency (PR: 1.8-3.0).
- Inflammation also showed a consistent association (PR: 1.4-2.4), while folate, vitamin B12, zinc, and BMI had weaker, variable associations.
Conclusions:
- Iron and vitamin A deficiencies are consistently linked to anemia in this age group.
- Inflammation and other micronutrient associations are context-dependent, varying by country, age, and sex.
- Comprehensive assessment of multiple micronutrients and risk factors is crucial for effective anemia control strategies.
Background:
School-age children and adolescents may be at risk of anemia through demands on micronutrients required for growth and maturation.
Objectives:
This multicountry analysis examined the burden of anemia in children aged 5-19 y by sex and age category and associations with micronutrient deficiencies, inflammation, and BMI.
Methods:
Children aged 5-19 y from surveys in the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project were included with hemoglobin, ≥1 micronutrient (iron, vitamin A, folate, vitamin B12, or zinc) and inflammation biomarker, and n > 100 per survey. Factors with bivariate relationships with anemia (P < 0.1) were included in multivariable modified Poisson regression models to examine the attributable burden of anemia.
Results:
This analysis included 54,534 children from 17 surveys in 16 countries (16 surveys for 15-19 y; 9 surveys for 10-14 y; 8 surveys for 5-9 y). Median overall anemia prevalence was 16% (range: 5% in Ecuador, United Kingdom, and United States to 59% in Côte d'Ivoire) with the highest burden in 15-19-y-old females (24%). In most surveys, anemia prevalence did not differ by sex for children aged 5-14 y, and median anemia prevalence was lower in children aged 10-14 y (7%) than in those aged 5-9 y (9%) or 15-19 y (22%). In most surveys, higher anemia prevalence was associated (P < 0.05) with iron deficiency (15%) [prevalence ratio (PR): 1.6-14.2; 5-9 y, 4/7 surveys; 10-14 y, 6/6 surveys; 15-19 y, 13/14 surveys), vitamin A deficiency (2%) (PR: 1.8-3.0; 5-9 y, 2/2 surveys; 10-14 y, 2/3 surveys; 15-19 y, 2/3 surveys), and inflammation (13%) (PR: 1.4-2.4: 5-9 y, 4/4 surveys; 10-14 y, 2/4 surveys; 15-19 y, 6/8 surveys). Folate, vitamin B12, zinc, and BMI had weak, variable associations with anemia.
Conclusions:
Iron deficiency and vitamin A deficiency are consistently associated with anemia in school-age children and adolescents, whereas inflammation and other micronutrients had context-dependent associations. This research underscores the importance of examining multiple micronutrients associated with anemia in the context of factors such as country, age, and sex.
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