Correlates of Iron, Cobalamin, Folate, and Vitamin A Status among Stunted Children: A Cross-Sectional Study in Uganda
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design and Setting
2.2. Participants and Recruitment
2.3. Data Collection and Measurements
2.4. Statistical Analysis
2.5. Ethical Consideration
3. Results
3.1. Participant Characteristics
3.2. Correlates of Markers of Iron Status
3.3. Correlates of Markers of Cobalamin Status
3.4. Correlates of Marker for Folate Status
3.5. Correlates of Marker for Vitamin A Status
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Value | N |
---|---|---|
Age, months | 32 ±11.7 | 750 |
12–23 | 30% (222) | |
24–35 | 34% (259) | |
36–59 | 36% (269) | |
Sex, girls | 45% (338) | 750 |
Residence, urban | 55% (415) | 750 |
Household size | 5 [4; 7] | 750 |
Maternal education, primary and above | 54% (399) | 737 |
Own livestock | 51% (379) | 750 |
Breastfed, currently | 13% (95) | 746 |
Height-for-age, z-score | −3.02 ±0.74 | 750 |
<−3 | 42% (314) | |
Weight-for-height, z-score | −0.36 ±0.99 | 749 |
Mid-upper arm circumference, mm | 14.4 ±1.18 | 750 |
Serum C-reactive protein, mg/L | 1.57 [0.33; 8.25] | 741 |
<2 | 53% (396) | |
2–<5 | 13% (94) | |
5–<10 | 12% (88) | |
10–15 | 5% (35) | |
>15 | 17% (128) | |
Serum α1-acid glycoprotein, g/L | 1.29 ±0.52 | 741 |
<0.8 | 19% (139) | |
0.8–1.2 | 31% (232) | |
>1.2 | 50% (370) | |
Malaria rapid test positive | 40% (292) | 737 |
Micronutrient Biomarker | N | Uncorrected | Inflammation Corrected 2 |
---|---|---|---|
Serum ferritin, µg/L | 741 | 37.7 [16.9; 78.7] | 13.6 [7.6; 22.9] |
<12 | 16.6% (123) | 42.9% (318) | |
Serum soluble transferrin receptor, mg/L | 741 | 14.6 ±10.4 | - |
>8.3 | 61.7% (457) | - | |
Plasma cobalamin, pmol/L | 719 | 316 ±133 | - |
<148 | 3.5% (25) | - | |
148–221 | 20.0% (144) | - | |
Plasma methylmalonic acid, µmol/L | 733 | 0.32 [0.20; 0.55] | - |
>0.75 | 15.8% (116) | - | |
Plasma folate, nmol/L | 692 | 34.7 ±11.2 | - |
<14 | 1.2% (8) | - | |
Serum retinol binding protein, µmol/L | 741 | 0.76 ±0.29 | 0.89 ±0.27 |
<0.7 | 46.0% (341) | 21.3% (158) |
Serum Ferritin, % 2 (N = 741) | Serum Soluble Transferrin Receptor, mg/L (N = 741) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
n | Model 1 ‡ 10 β (95% CI) | p | Model 2 § 10 β (95% CI) | p | n | Model 1 ‡ β (95% CI) | p | Model 2 § β (95% CI) | p | |
Sex | ||||||||||
Boy | 407 | - | - | - | - | 407 | - | - | - | - |
Girls | 334 | 3 (−10; 19) | 0.65 | 11 (−1; 24) | 0.06 | 334 | −3.3 (−4.8; −1.8) | <0.001 | −3.1 (−4.5; −1.6) | <0.001 |
Age, months | ||||||||||
12–23 | 218 | - | - | - | - | 218 | - | - | - | - |
24–35 | 256 | 78 (50; 114) | <0.001 | 67 (45; 92) | <0.001 | 256 | −2.9 (−4.7; −1.1) | 0.002 | −3.0 (−4.8; −1.2) | 0.001 |
36–59 | 267 | 143 (103; 188) | <0.001 | 130 (100; 164) | <0.001 | 267 | −5.3 (−7.1; −3.5) | <0.001 | −5.3 (−7.1; −3.5) | <0.001 |
Stunting degree | ||||||||||
Moderate | 430 | - | - | - | - | 430 | - | - | - | - |
Severe | 311 | 18 (3; 37) | 0.02 | 2 (−9; 15) | 0.75 | 311 | 0.3 (−1.2; 1.8) | 0.70 | −0.2 (−1.7; 1.3) | 0.84 |
Breastfed currently | ||||||||||
No | 643 | - | - | - | - | 643 | - | - | - | - |
Yes | 94 | −24 (−41; −3.3) | 0.02 | −18 (−32; 0) | 0.05 | 94 | 5.1 (2.6; 7.5) | <0.001 | 5.3 (2.8; 7.7) | <0.001 |
Malaria rapid test | ||||||||||
Negative | 439 | - | - | - | - | 439 | - | - | - | - |
Positive | 291 | 167 (134; 204) | <0.001 | 75 (55; 98) | <0.001 | 291 | 2.8 (1.3; 4.3) | <0.001 | 1.9 (0.2; 3.5) | 0.02 |
Serum C-reactive protein, mg/L | ||||||||||
<2 | 396 | - | - | 396 | - | - | ||||
2–<5 | 94 | 73 (44; 108) | <0.001 | 94 | 3.9 (1.6; 6.1) | 0.001 | ||||
5–<10 | 88 | 124 (86; 171) | <0.001 | 88 | 2.4 (0.1; 4.7) | 0.04 | ||||
10–15 | 35 | 137 (79; 215) | <0.001 | 35 | 3.0 (−0.5; 6.4) | 0.09 | ||||
>15 | 128 | 322 (259; 397) | <0.001 | 128 | 3.0 (1.0; 5.0) | 0.003 | ||||
Serum α1-acid glycoprotein, g/L | ||||||||||
<0.8 | 139 | - | - | 139 | - | - | ||||
0.8–1.2 | 232 | 36 (14; 62) | 0.001 | 232 | 1.1 (−1.0; 3.2) | 0.31 | ||||
>1.2 | 370 | 224 (97: 282) | <0.001 | 370 | 3.3 (1.4; 5.3) | 0.001 |
Plasma Cobalamin, pmol/L (N = 719) | Plasma Methylmalonic Acid, % 2 (N = 733) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
n | Model 1 ‡ β (95% CI) | p | Model 2 § β (95% CI) | p | n | Model 1 ‡ 10 β (95% CI) | p | Model 2 § 10 β (95% CI) | p | |
Sex | ||||||||||
Boy | 392 | - | - | - | - | 400 | - | - | - | - |
Girls | 327 | 18 (−1; 38) | 0.06 | 17 (−2; 37) | 0.08 | 333 | −13 (−22; −4) | 0.008 | −12 (−21; −2) | 0.01 |
Age, months | ||||||||||
12–23 | 208 | - | - | - | - | 213 | - | - | - | - |
24–35 | 246 | −16 (−40; 9) | 0.21 | −14 (−38; 10) | 0.24 | 252 | −9 (−20; 4) | 0.18 | −9 (−20; 5) | 0.19 |
36–59 | 265 | −1 (−25; 23) | 0.94 | −1 (−25; 23) | 0.95 | 268 | −9 (−20; 4) | 0.18 | −7 (−18; 7) | 0.31 |
Stunting degree | ||||||||||
Moderate | 415 | - | - | - | - | - | - | - | - | - |
Severe | 304 | 6 (−14; 25) | 0.53 | 7 (−14; 27) | 0.51 | 306 | 5 (−6; 17) | 0.35 | 1 (−9; 13) | 0.80 |
Breastfed currently | ||||||||||
No | 626 | - | - | - | - | 640 | - | - | - | - |
Yes | 89 | −24 (−58; 10) | 0.17 | −29 (−63; 5) | 0.09 | 89 | 49 (24; 80) | <0.001 | 59 (31; 92) | <0.001 |
Malaria rapid test | ||||||||||
Negative | 430 | - | - | - | - | 438 | - | - | - | - |
Positive | 279 | −41 (−61; −21) | <0.001 | −34 (−57; −12) | 0.003 | 285 | 31 (17; 47) | <0.001 | 33 (18; 51) | <0.001 |
Serum C-reactive protein, mg/L | ||||||||||
<2 | 379 | - | - | 388 | - | - | ||||
2–<5 | 92 | 1 (−29; 31) | 0.94 | 94 | 5 (−11; 23) | 0.60 | ||||
5–<10 | 85 | −13 (−44; 18) | 0.40 | 86 | −1 (−17; 17) | 0.87 | ||||
10–15 | 32 | −7 (−55; 40) | 0.76 | 32 | −3 (−26; 26) | 0.80 | ||||
>15 | 125 | −44 (−71; −18) | 0.001 | 127 | 2 (−12; 18) | 0.79 | ||||
Serum α1-acid glycoprotein, g/L | ||||||||||
<0.8 | 135 | - | - | 137 | - | - | ||||
0.8–1.2 | 224 | 9 (−21; 35) | 0.63 | 229 | 16 (−1; 30) | 0.01 | ||||
>1.2 | 354 | −8 (−34; 18) | 0.56 | 361 | 24 (8; 44) | 0.003 | ||||
Serum folate, nmol/L | ||||||||||
>30 | 422 | - | - | - | - | 422 | - | - | - | - |
20–30 | 202 | −3 (−26; 19) | 0.77 | 0 (−23; 22) | 0.98 | 202 | −1 (−12; 12) | 0.87 | −4 (−15; 8) | 0.50 |
<20 | 62 | 29 (−6; 66) | 0.10 | 35 (0; 71) | 0.05 | 62 | −21 (−35; −4) | 0.01 | −24 (−37; −7) | 0.007 |
Plasma Folate, nmol/L (N = 692) | Serum Retinol Binding Protein, µmol/L (N = 741) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
n | Model 1 ‡ β (95% CI) | p | Model 2 § β (95% CI) | p | n | Model 1 ‡ β (95% CI) | p | Model 2 § β (95% CI) | p | |
Sex | ||||||||||
Boy | 383 | - | - | - | - | 407 | - | - | - | |
Girls | 309 | 2.2 (0.5; 3.9) | 0.01 | 1.9 (0.2; 3.6) | 0.02 | 334 | 0.02 (−0.02; 0.06) | 0.32 | 0.01 (−0.03; 0.05) | 0.657 |
Age, months | ||||||||||
12–23 | 199 | - | - | - | - | 218 | - | - | - | - |
24–35 | 231 | 1.9 (−0.2; 4.0) | 0.07 | 2.1 (0.0; 4.2) | 0.04 | 256 | −0.03 (−0.08; 0.03) | 0.32 | −0.02 (−0.07; 0.03) | 0.43 |
36–59 | 262 | 3.5 (1.5; 5.6) | 0.001 | 3.5 (1.5; 5.6) | 0.001 | 267 | −0.05 (−0.10; 0.01) | 0.08 | −0.04 (−0.08; 0.01) | 0.14 |
Stunting degree | ||||||||||
Moderate | 401 | - | - | - | - | 430 | - | - | - | - |
Severe | 291 | 0.0 (−1.7; 1.6) | 0.96 | 0.6 (−1.1; 2.4) | 0.47 | 311 | −0.01 (−0.06; 0.03) | 0.545 | 0.01 (−0.03; 0.05) | 0.775 |
Breastfed currently | ||||||||||
No | 605 | - | - | - | - | 643 | ||||
Yes | 83 | 4.7 (1.7; 7.6) | 0.002 | 4.5 (1.6; 7.5) | 0.003 | 94 | 0.13 (0.05; 0.20) | 0.001 | 0.12 (0.05; 0.19) | 0.001 |
Malaria rapid test | ||||||||||
Negative | 416 | - | - | - | - | 439 | - | - | - | - |
Positive | 266 | −2.2 (−3.9; −0.5) | 0.01 | −0.8 (−2.7; 1.1) | 0.41 | 291 | −0.05 (−0.09; 0.00) | 0.03 | 0.06 (0.02; 0.11) | 0.004 |
Serum C-reactive protein, mg/L | ||||||||||
<2 | 369 | - | - | 396 | - | - | ||||
2–<5 | 87 | −2.7 (−5.3; −0.1) | 0.04 | 94 | −0.10 (−0.16; −0.04) | 0.001 | ||||
5–<10 | 80 | −2.5 (−5.2; 0.2) | 0.06 | 88 | −0.07 (−0.13; −0.01) | 0.02 | ||||
10–15 | 32 | −1.8 (−5.8; 2.2) | 0.38 | 35 | −0.25 (−0.34; −0.16) | <0.001 | ||||
>15 | 119 | −3.67 (−6.0; −1.4) | 0.002 | 128 | −0.29 (−0.35; −0.24) | <0.001 | ||||
Serum α1-acid glycoprotein, g/L | ||||||||||
<0.8 | 136 | - | - | 139 | - | - | ||||
0.8–1.2 | 219 | −2.3 (−4.7; 0.0) | 0.05 | 232 | −0.02 (−0.07; 0.04) | 0.61 | ||||
>1.2 | 332 | −4.6 (−6.8; −2.4) | <0.001 | 370 | −0.16 (−0.22; −0.11) | <0.001 | ||||
Plasma cobalamin, pmol/L | ||||||||||
>221 | 530 | - | - | - | - | |||||
148–221 | 138 | 1.0 (−1.1, 3.1) | 0.35 | 1.2 (−0.9, 3.3) | 0.25 | |||||
<148 | 24 | 3.6 (−1.0, 8.2) | 0.12 | 3.3 (−1.2, 7.9) | 0.15 |
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Mutumba, R.; Pesu, H.; Mbabazi, J.; Greibe, E.; Olsen, M.F.; Briend, A.; Mølgaard, C.; Ritz, C.; Nabukeera-Barungi, N.; Mupere, E.; et al. Correlates of Iron, Cobalamin, Folate, and Vitamin A Status among Stunted Children: A Cross-Sectional Study in Uganda. Nutrients 2023, 15, 3429. https://doi.org/10.3390/nu15153429
Mutumba R, Pesu H, Mbabazi J, Greibe E, Olsen MF, Briend A, Mølgaard C, Ritz C, Nabukeera-Barungi N, Mupere E, et al. Correlates of Iron, Cobalamin, Folate, and Vitamin A Status among Stunted Children: A Cross-Sectional Study in Uganda. Nutrients. 2023; 15(15):3429. https://doi.org/10.3390/nu15153429
Chicago/Turabian StyleMutumba, Rolland, Hannah Pesu, Joseph Mbabazi, Eva Greibe, Mette F. Olsen, André Briend, Christian Mølgaard, Christian Ritz, Nicolette Nabukeera-Barungi, Ezekiel Mupere, and et al. 2023. "Correlates of Iron, Cobalamin, Folate, and Vitamin A Status among Stunted Children: A Cross-Sectional Study in Uganda" Nutrients 15, no. 15: 3429. https://doi.org/10.3390/nu15153429