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Is anemia an accurate predictor of vitamin A status in Pakistani children?
A Molla1, M Khurshid, A M Molla
1Department of Pathology, Aga Khan University Medical Centre, Karachi, Pakistan.
Insights
Anemia is common in Pakistani children, but hemoglobin levels are poor indicators of vitamin A deficiency. Higher cutoff points improve hemoglobin test sensitivity for detecting marginal vitamin A status.
Area of Science:
- Nutritional Biochemistry
- Pediatric Hematology
- Public Health Nutrition
Background:
- Anemia is a prevalent nutritional deficiency in children worldwide.
- Vitamin A deficiency poses significant health risks, particularly in developing regions.
- Understanding the relationship between anemia and vitamin A status is crucial for effective interventions.
Purpose of the Study:
- To assess serum retinol and hemoglobin levels in Pakistani children.
- To determine the prevalence of anemia and its morphological classification.
- To evaluate the predictive value of hemoglobin levels for vitamin A deficiency.
Main Methods:
- Cross-sectional study involving 532 children (6-60 months) in Karachi, Pakistan.
- Hemoglobin and red blood cell indices measured to diagnose and classify anemia.
- Serum retinol levels analyzed to assess vitamin A status.
Main Results:
- 67% of children had anemia (hemoglobin < 11 g/dl).
- Anemia was predominantly microcytic and hypochromic.
- Hemoglobin levels showed significant correlation with retinol, but anemia was a poor predictor (2.5% PPV) of vitamin A deficiency (<10 µg/dl).
- Using a 20 µg/dl cutoff for marginal vitamin A status increased PPV to 54% and sensitivity to 75%.
Conclusions:
- Anemia is widespread in urban Pakistani children.
- Hemoglobin testing alone is insufficient for diagnosing vitamin A deficiency.
- Adjusting cutoff points for vitamin A status may improve the utility of hemoglobin screening.
Abstract:
Serum retinol and hemoglobin levels were determined in 532 children aged 6-60 months living in urban slums of Karachi, Pakistan. Overall 67% (358 of 532) of children had hemoglobin levels of less than 11 g/dl, the World Health Organization definition of anemia for this age group. Estimations for red blood cell indices (hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red blood cell count) were done on a sample of 391 children to classify anemia morphologically. A similar percentage (69.8% [273 of 391 children]) of anemia was found in this group. The anemia was predominantly microcytic and hypochromic. Normocytic normochromic anemia was present in only 16.5%. Serum retinol levels were significantly correlated with hemoglobin (P < 0.002), hematocrit (P < 0.01), and red blood cell (P < 0.001) levels. However, anemia was found to be a poor predictor (positive predictive value [PPV] = 2.5%) for the presence of vitamin A deficiency (retinol < 10 micrograms/dl). The PPV increased to 54% if 20 micrograms/dl, which is an indicator of marginal vitamin A status, was used as the cutoff point. The sensitivity of the hemoglobin test was found to be 75% in correctly identifying vitamin A deficiency when retinol levels of 10 micrograms/dl and 20 micrograms/dl were both used as the cutoff points for deficiency. The specificity for the hemoglobin test varied from 33% to 40% when levels of 10 micrograms/dl and 20 micrograms/dl were used as the cutoff points for vitamin A deficiency.(ABSTRACT TRUNCATED AT 250 WORDS)