Determinants of Anemia among School-Aged Children in Mexico, the United States and Colombia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population and Sample
2.2. Assessment of Nutrition and Health Status
2.3. Data Management and Statistical Methods
2.4. Multivariable Modeling Approach
2.5. Ethics Statement
3. Results
3.1. Demographic and Health Characteristics
3.2. Characteristics Associated with Anemia
4. Discussion
5. Conclusions
Supplementary Materials
Acknowledgments
Author Contributions
Conflicts of Interest
Abbreviations
SAC | School-Aged Children |
ID | Iron Deficiency |
OR | Odds Ratio |
CI | Confidence Interval |
YLD | Years Lived with Disability |
IDA | Iron Deficiency Anemia |
PSC | Pre-School Children |
CDC | Centers for Disease Control and Prevention |
WRA | women of reproductive age |
Hb | Hemoglobin |
CRP | C-reactive protein |
AGP | α-1-acid glycoprotein |
sTFR | soluble transferrin receptor |
ENSANUT | Mexican National Health and Nutrition Survey 2006 |
NHANES | The National Health and Nutrition Examination Surveys |
ENSIN | Encuesta Nacional de la Situaci ón Nutricional |
WHO | World Health Organization |
SES | socio-economic status |
PCA | Principal component analysis |
PIR | poverty income ratio |
SE | standard error |
IRB | institutional review board |
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Characteristics | Mexico/n = 3660 | USA/n = 733 | Colombia/n = 8573 | |||
---|---|---|---|---|---|---|
n * | % (SE of %) or Mean (SE) | n * | % (SE of %) or Mean (SE) | n * | % (SE of %) or Mean (SE) | |
Demographics | ||||||
Age in years | 3660 | 9.1 (0.1) | 733 | 13.6 (0.04) | 8573 | 9.9 (0.04) |
Age | ||||||
<12.0 years | 3083/3660 | 78.7% (1.2) | - | - | 6223/8573 | 72.5% (0.6) |
12.0–14.99 years | 577/3660 | 21.3% (1.2) | 733/733 | 100% (0.0) | 2350/8573 | 27.5% (0.6) |
Sex (Females) % | 2115/3660 | 59.5% (1.6) | 733 | 100% (0.0) | 4944/8573 | 57.4% (0.7) |
Race/Ethnicity | ||||||
Black | N/A | N/A | 244/733 | 15.6% (2.1) | 958/8573 | 11.6% (0.5) |
Non-Black | N/A | N/A | 489/733 | 84.4% (2.0) | 7615/8573 | 88.4% (0.5) |
Asset | ||||||
Poorest | 1191/3656 | 31.1% (1.8) | 160/717 | 14.3% (1.8) | 3299/8573 | 25.9% (0.8) |
All Other | 2465/3656 | 68.9% (1.8) | 557/717 | 85.7% (1.8) | 5274/8573 | 74.0% (0.8) |
Nutrition/Growth | ||||||
Stunting % (HAZ < −2) | 396/3658 | 10.2% (0.9) | 8/725 | 1.6% (0.7) | 963/8390 | 9.8% (0.5) |
Wasting % (BAZ < −2) | 54/3658 | 1.3% (0.3) | 8/725 | 2.4% (1.2) | 160/8390 | 2.0% (0.2) |
Overweight % (BAZ > 2) | 450/3658 | 13.3% (1.3) | 169/725 | 19.9% (2.9) | 339/8390 | 4.3% (0.3) |
Obese % (BAZ > 3) | 106/3658 | 3.9% (0.8) | 36/725 | 3.6% (0.8) | 40/8390 | 0.5% (0.1) |
Biochemical markers | ||||||
Hemoglobin (g/dL) | 3660 | 13.8 (0.6) | 733 | 13.7 (0.7) | 8573 | 14.5 (0.3) |
1 Hemoglobin (g/dL) adjusted for altitude and/or 2 smoking | 3660 | 13.3 (0.5) | N/A | N/A | 8573 | 14.1 (0.3) |
C-Reactive Protein (ng/mL) | 3660 | 2.2 (0.2) | 733 | 1.7 (0.4) | 8573 | 2.5 (0.1) |
2 Iron Deficiency % | 626/3302 | 18.1% (1.2) | ‡ 87/680 | 9.7% (1.3) | 736/7450 | 9.2% (0.4) |
3 Low Ferritin % | 663/3650 | 17.3% (1.2) | ‡ 92/733 | 9.3% (1.3) | 831/8573 | 9.2% (0.4) |
4 High sTFR % | 664/3645 | 19.6% (1.3) | ‡ 49/727 | 5.0% (1.0) | N/A | N/A |
5 Vitamin A Deficiency % | N/A | N/A | ‡ 2/720 | 0.1% (0.1) | N/A | N/A |
6 Elevated C-Reactive Protein (ng/mL) % | 353/3660 | 9.4% (0.8) | 53/733 | 6.9% (1.2) | 1123/8573 | 13.2% (0.6) |
7 Anemia % | 454/3660 | 11.6% (0.9) | 49/733 | 3.6% (0.8) | 452/8573 | 4.2% (0.3) |
8 Iron Deficiency Anemia using adjusted Hb % | 103/3302 | 2.6% (0.4) | ‡ 16/680 | 1.4% (0.5) | 77/7450 | 0.7% (0.1) |
9 Anemia associated with Iron Deficiency % | - | 22.4% | - | 38.9% | - | 16.7% |
Characteristics | Mexico | Colombia | ||||||
---|---|---|---|---|---|---|---|---|
Anemia (%) * | UnAdj (95% CI) | ** Adj OR (95% CI) | p-Value ‡ | Anemia (%) * | UnAdj (95% CI) | ** Adj OR (95% CI) | p-Value ‡ | |
Continuous | ||||||||
1 CRP (ng/mL) | - | - | 1.0 (0.9–1.0) | 0.16 | - | - | 1.0 (0.99–1.01) | 0.23 |
Categorical | ||||||||
2 Age (years) | ||||||||
<12.0 years | 12.0 | 4.4 | ||||||
12.0–14.99 years | 10.1 | 0.8 (0.5–1.3) | 0.7 (0.5–1.2) | 0.19 | 3.7 | 0.8 (0.6–1.1) | 0.8 (0.5–1.0) | 0.08 |
Sex | ||||||||
Male | 11.0 | 4.3 | ||||||
Female | 12.2 | 1.1 (0.8–1.6) | 1.2 (0.9–1.7) | 0.30 | 4.1 | 1.0 (0.8–1.3) | 1.0 (0.7–1.3) | 0.90 |
3 Race/Ethnicity | ||||||||
Non Black | 3.8 | |||||||
Black | N/A | N/A | N/A | N/A | 7.1 | 1.9 (0.4–2.7) | 1.6 (1.2–2.3) | 0.005 |
4 Asset | ||||||||
All Other | 11.1 | 3.3 | ||||||
Poorest | 13.0 | 1.2 (0.9–1.7) | 1.1 (0.8–1.6) | 0.55 | 6.7 | 2.1 (1.6–2.9) | 1.8 (1.3–2.5) | 0.0005 |
5 Low Ferritin % | ||||||||
No | 10.9 | 3.7 | ||||||
Yes | 14.8 | 1.4 (1.0–2.0) | 1.5 (1.1–2.0) | 0.02 | 9.3 | 2.7 (1.9–3.7) | 2.7 (2.0–3.8) | <0.0001 |
6 Overweight | ||||||||
No | 12.6 | 4.3 | ||||||
Yes | 5.5 | 0.4 (0.2–0.8) | 0.4 (0.2–0.8) | 0.007 | 1.7 | 0.4 (0.2–1.0) | 0.5 (0.2–1.2) | 0.11 |
7 Stunting | ||||||||
No | 11.7 | 3.9 | ||||||
Yes | 11.6 | 1.0 (0.6–1.5) | 0.9 (0.5–1.4) | 0.51 | 6.3 | 1.7 (1.1–2.4) | 1.6 (1.1–2.3) | 0.02 |
† Characteristics | USA | |||
---|---|---|---|---|
Anemia (%) * | UnAdj (95% CI) | ** Adj OR (95% CI) | p-Value ‡ | |
Continuous | ||||
1 CRP (ng/mL) | - | - | 1.0 (0.99–1.04) | 0.06 |
2 Age (years) | - | - | 0.9 (0.4–1.8) | 0.72 |
Categorical | ||||
3 Race/Ethnicity | ||||
Non Black | 1.2 | |||
Black | 16.7 | 16.5 (5.5–49.5) | 14.1 (4.7–42.1) | <0.0001 |
4 Asset | ||||
All Other | 3.0 | |||
Poorest | 7.9 | 2.8 (1.3–5.9) | 1.3 (0.8–2.2) | 0.33 |
5 Low Ferritin % | ||||
No | 2.2 | |||
Yes | 17.2 | 9.1 (4.5–18.4) | 8.0 (3.0–21.3) | <0.0001 |
6 Overweight | ||||
No | 3.6 | |||
Yes | 3.9 | 1.1 (0.4–3.2) | 0.8 (0.3–2.0) | 0.63 |
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Syed, S.; Addo, O.Y.; De la Cruz-Góngora, V.; Ashour, F.A.S.; Ziegler, T.R.; Suchdev, P.S. Determinants of Anemia among School-Aged Children in Mexico, the United States and Colombia. Nutrients 2016, 8, 387. https://doi.org/10.3390/nu8070387
Syed S, Addo OY, De la Cruz-Góngora V, Ashour FAS, Ziegler TR, Suchdev PS. Determinants of Anemia among School-Aged Children in Mexico, the United States and Colombia. Nutrients. 2016; 8(7):387. https://doi.org/10.3390/nu8070387
Chicago/Turabian StyleSyed, Sana, O. Yaw Addo, Vanessa De la Cruz-Góngora, Fayrouz A. Sakr Ashour, Thomas R. Ziegler, and Parminder S. Suchdev. 2016. "Determinants of Anemia among School-Aged Children in Mexico, the United States and Colombia" Nutrients 8, no. 7: 387. https://doi.org/10.3390/nu8070387
APA StyleSyed, S., Addo, O. Y., De la Cruz-Góngora, V., Ashour, F. A. S., Ziegler, T. R., & Suchdev, P. S. (2016). Determinants of Anemia among School-Aged Children in Mexico, the United States and Colombia. Nutrients, 8(7), 387. https://doi.org/10.3390/nu8070387