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Relationship of vitamin A deficiency, iron deficiency, and inflammation to anemia among preschool children in the Republic of the Marshall Islands


Introduction: Although vitamin A deficiency, iron deficiency, and inflammation may contribute to anemia, their relative contribution to anemia has not been well characterized in preschool children in developing countries.

Objective: To characterize the contributions of vitamin A and iron deficiencies and inflammation to anemia among preschool children in the Republic of the Marshall Islands.

Subjects and methods: A community-based survey, the Republic of the Marshall Islands Vitamin A Deficiency Study, was conducted among 919 preschool children. The relationship of vitamin A and iron status and markers of inflammation, tumor necrosis factor-α, α1-acid glycoprotein, and interleukin-10, to anemia were studied in a subsample of 367 children.

Results: Among the 367 children, the prevalence of anemia was 42.5%. The prevalence of severe vitamin A deficiency (serum vitamin A <0.35 μmol/l) and iron deficiency (serum ferritin <12 μg/dl) were 10.9 and 51.7%, respectively. The respective prevalence of iron deficiency anemia (hemoglobin <110 g/l and iron deficiency), anemia with inflammation (anemia with TNF-α>2 pg/ml and/or AGP >1000 mg/l), and severe vitamin A deficiency combined with anemia was 26.7, 35.6, and 7.6%. In multivariate linear regression models that adjusted for age, sex, and inflammation, both iron deficiency (odds ratio (OR) 1.74, 95% confidence interval (CI) 1.08–2.83, P=0.023) and severe vitamin A deficiency (OR 4.85, 95% CI 2.14–10.9, P<0.0001) were significantly associated with anemia.

Conclusions: Both iron and vitamin A deficiencies were independent risk factors for anemia, but inflammation was not a significant risk factor for anemia among these preschool children.

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We thank the health care workers in the Republic of the Marshall Islands, especially Laling Riklon, Grace Heine, Kenya Amles, and Ailon Moses, for their diligent assistance, and Dana Totin for her assistance in interpretation of the data. This study was supported in part by the Pacific Health Research Institute, UNICEF, the Fergussen Foundation Hawaii, the Hawaii Community Foundation, Ministry of Health and Environment, Republic of the Marshall Islands, the National Institute of Child Health and Human Development (HD30042), the National Institutes of Health, and the United States Agency for International Development (Cooperative Agreement HRN A-0097-00015-00).

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Gamble, M., Palafox, N., Dancheck, B. et al. Relationship of vitamin A deficiency, iron deficiency, and inflammation to anemia among preschool children in the Republic of the Marshall Islands. Eur J Clin Nutr 58, 1396–1401 (2004).

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  • anemia
  • ferritin
  • hemoglobin
  • inflammation
  • iron deficiency
  • retinol
  • vitamin A deficiency

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