Background - The first 1000 days of life (from conception to two years of age) is a critical period of
nutritional vulnerability, affecting lifelong health. Iron deficiency (ID) and iron
deficiency anaemia (IDA) are considered major public health problems that
adversely affect development and growth, impair immunity, and increase morbidity
and mortality in infants. ID and IDA in sub-Saharan Africa can be attributed to poor
dietary, socioeconomic and disease conditions. One of the major obstacles in
determining the prevalence of ID, using serum ferritin (SF) as marker of iron status,
is that it not only reflects the amount of iron that is stored in the body, but also
functions as an acute phase reactant that is raised in the presence of infection or
inflammation.
Aim - We conducted a re-analysis of the International Research on Infant Supplementation
(IRIS) study’s baseline data to determine a more accurate estimation of the ID
prevalence in apparently healthy four to thirteen-month-old infants from rural
KwaZulu-Natal while accounting for the effect of chronic and acute inflammation on
SF.
Study design and methods - A cross-sectional analysis was performed on the baseline data (192 infants) of the
IRIS study that was conducted in 2000. Infants’ haemoglobin (Hb), SF, C-reactive
protein (CRP) and alpha-1 glycoprotein (AGP) concentrations were interpreted to
determine the prevalence of ID. Literature of the past four years served as a guide to
compare the ID prevalence obtained from four methods that account for the
influence of inflammation on SF concentrations, to a reference method that does not
take inflammation into consideration, and to what was reported in the original IRIS
study. Weight and recumbent length measurements were converted to z-scores to
interpret subjects’ anthropometric nutritional status. Results - A high prevalence of inflammation (52.6%) was present, with 11.5% of the subjects
being in the incubation, 17.2% in the early convalescent, and 24% in the late
convalescent phase of inflammation. SF was significantly associated with both CRP
(ß = 0.200; P = 0.005) and AGP (ß = 0.223; P = 0.002) when adjusting for gender
and age. The IRIS study reported an ID prevalence of 18.3%, whereas the results of
this study ranged from 17.2 to 52.1%. We derived an IDA prevalence that ranged
from 12 to 24.5% according to the different methods. The prevalence of stunting
[length-for-age Z-score <-2SD] was 12.5%; while 25.1% of infants were
overweight/obese [weight-for-length z-score >2SD].
Conclusion - A double burden of malnutrition was evident from the high prevalence of both
overweight and ID, together with inflammation. The disconcertingly large variance in
ID prevalence observed between the different methods that were employed
highlights that iron supplementation interventions to treat anaemia must be based
upon accurate estimates of IDA prevalence, otherwise they pose an increased risk
of adverse effects to susceptible, iron-replete, but anaemic infants. Given the
detrimental consequences of ID, it is imperative that governments, health care
providers and parents must act to prevent or treat ID and IDA among vulnerable
infants. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2014
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:nwu/oai:dspace.nwu.ac.za:10394/10798 |
| Date | January 2014 |
| Creators | Nel, Elsmari |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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