Drupadi Dillon

The influence of vitamin A status on iron-deficiency anaemia in anaemic adolescent schoolgirls in Myanmar.

OBJECTIVE The present study was conducted to investigate reasons for the high prevalence of anaemia among adolescent schoolgirls and to elucidate the role of vitamin A in contributing to Fe-deficiency anaemia (IDA). DESIGN Among 1269 schoolgirls who were previously screened for anaemia (Hb < 120 g/l), 391 anaemic girls were further assessed for Fe, vitamin A and subclinical inflammation status. Fe and vitamin A indicators were corrected for inflammation and were compared in the Fe-deficient and non-deficient groups as well as between those with and without inflammation. Logistic regression was done to determine whether vitamin A status and subclinical inflammation were risk factors for Fe deficiency. The differences in Fe status among tertiles of vitamin A concentrations were assessed using ANOVA. SETTING Myanmar. SUBJECTS Adolescent schoolgirls (n 391). RESULTS One-third of the anaemia (30·4%) was IDA. Prevalence of low vitamin A status (serum retinol <1·05 μmol/l) was 31·5%. Fe and vitamin A status were significantly different between the IDA and non-IDA groups and also based on their inflammation status. Logistic regression showed that low vitamin A status was a significant predictor for being Fe deficient (OR = 1·81; 95% CI 1·03, 3·19 and OR = 2·31; 1·31, 4·07 in the middle (1·056-1·298 μmol/l) and low (≤1·056 μmol/l) vitamin A tertiles, respectively). ANOVA showed that better Fe status was associated with a higher concentration of serum retinol but only in IDA. CONCLUSIONS Fe deficiency was not the main cause of anaemia in the present population. The role of vitamin A as well as other micronutrients should be taken into account in addressing the problem of anaemia.

Hepcidin Profile of Anemic Adolescent Schoolgirls in Indonesia at the End of 12 Weeks of Iron Supplementation

Background Iron deficiency is still the major nutritional problem in the developing world, and iron supplementation remains one of the most effective intervention strategies. Hepcidin, a newly discovered iron regulatory hormone, is an acute phase protein, and its role in iron supplementation has not been well explored. Objective To investigate the hepcidin profiles of anemic adolescent girls who had received weekly iron supplementation. Methods A cross-sectional study was conducted at the end of iron supplementation among adolescent schoolgirls (n = 83) in Pramuka Island, Indonesia. All the girls were anemic at the beginning and received 60 mg of elemental iron twice weekly for 12 weeks. Hemoglobin, hepcidin, serum ferritin, and red cell parameters were measured, together with inflammation markers. Results At the end of the 12-week supplementation, 65.1% (n=64) of the girls were no longer anemic, but 43.4% (n = 36) were still iron deficient. The rate of sub-clinical inflammation, measured by C-reactive protein (CRP) and α-1-acid glycoprotein (AGP), was 38.6% (n = 32). Hepcidin was not correlated with either ferritin or red cell parameters. There was no association between hepcidin and the inflammatory markers CRP and AGP. The mean hepcidin concentration was 42.9 ± 17.9 ng/mL and was not significantly different between anemic and nonanemic girls (44.2 ± 14.9 and 42.3 ± 19.2 ng/mL, respectively; p = .708). However, hepcidin concentration was slightly higher in the iron replete-group than in the iron-deficient group (45.2 ± 20.0 and 39.3 ± 13.5 ng/mL, respectively), a suggestive trend that did not reach statistical significance (p = .218). Conclusions Hepcidin concentrations tended to be higher among the subset of girls who responded poorly to iron supplementation as a consequence of increased subclinical inflammation. A longitudinal study should be conducted to explore the role of hepcidin in iron supplementation.

Supplementation strategies to alleviate iron deficiency: Experiences from Indonesia

Anemia, mainly caused by iron deficiency, is common in Indonesia, especially among pregnant women and infants. In pregnancy iron deficiency anemia is associated with undesirable birth outcome, and in infants with reduced mental and motor development. Iron status can be improved through dietary changes, food fortification, antehelminthic treatment, and supplementation. Supplementation offers the best chance for improvement on short term, although reported effectiveness of large scale programs is often limited. In Indonesia supplementation programs exist for pregnant women, female factory workers, and under-five children from poor families. Effectiveness of the programs is limited by tablet supply, program coverage, compliance and a possibly by a low vitamin A status, and the following changes should be considered to improve effectiveness. Tablets should also be distributed through channels other than the health sector, such as through traditional birth attendants. In order to decrease the iron deficiency prevalence during pregnancy young women/adolescent girls should be supplemented before they get pregnant. Infants should also be targeted by programs. Supplementation on a weekly in stead of daily basis should be considered especially under conditions where supplementation can be supervised such as in schools or factories. Since intake of vitamin A and zinc are also frequently deficient, a multi-supplementation should be strived for.