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      Iron deficiency was not the major cause of anemia in rural women of reproductive age in Sidama zone, southern Ethiopia: A cross-sectional study

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      PLoS ONE
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          Abstract

          Background

          Anemia, which has many etiologies, is a moderate/severe public health problem in young children and women of reproductive age in many developing countries. The aim of this study was to investigate prevalence of iron deficiency, anemia, and iron deficiency anemia using multiple biomarkers and to evaluate their association with food insecurity and food consumption patterns in non-pregnant women from a rural area of southern Ethiopia.

          Methods

          A cross-sectional study was conducted in 202 rural women of reproductive age in southern Ethiopia. Anthropometrics and socio-demographic data were collected. A venipuncture blood sample was analyzed for hemoglobin (Hb) and for biomarkers of iron status. Biomarkers were skewed and were log transformed before analysis. Mean, median, Pearson’s correlations and ordinary least-squares regressions were calculated.

          Results

          Median (IQR) Hb was 138 (127, 151) g/L. Based on an altitude-adjusted (1708 m) cutoff of 125 g/L for Hb, 21.3% were anemic. Plasma ferritin was <15 μg/L in 18.6% of the women. Only one woman had α-1-acid glycoprotein (AGP) >1.0 g/L; four women (2%) had > 5 mg/L of C-reactive protein (CRP). Of the 43 women who were anemic, 23.3% (10 women) had depleted iron stores based on plasma ferritin. Three of these had elevated soluble transferrin receptors (sTfR). Hemoglobin (Hb) concentration was negatively correlated with sTfR (r = -0.24, p = 0.001), and positively correlated with ferritin (r = 0.17, p = 0.018), plasma iron (r = 0.15, p = 0.046), transferrin saturation (TfS) (r = 0.15, p = 0.04) and body iron (r = 0.14, p = 0.05). Overall prevalence of iron deficiency anemia was only 5%.

          Conclusion

          Iron deficiency anemia was not prevalent in the study population, despite the fact that anemia would be classified as a moderate public health problem.

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          Most cited references22

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          A review of phytate, iron, zinc, and calcium concentrations in plant-based complementary foods used in low-income countries and implications for bioavailability.

          Plant-based complementary foods often contain high levels of phytate, a potent inhibitor of iron, zinc, and calcium absorption. This review summarizes the concentrations of phytate (as hexa- and penta-inositol phosphate), iron, zinc, and calcium and the corresponding phytate:mineral molar ratios in 26 indigenous and 27 commercially processed plant-based complementary foods sold in low-income countries. Phytate concentrations were highest in complementary foods based on unrefined cereals and legumes (approximately 600 mg/100 g dry weight), followed by refined cereals (approximately 100 mg/100 g dry weight) and then starchy roots and tubers (< 20 mg/100 g dry weight); mineral concentrations followed the same trend. Sixty-two percent (16/26) of the indigenous and 37% (10/27) of the processed complementary foods had at least two phytate:mineral molar ratios (used to estimate relative mineral bioavailability) that exceeded suggested desirable levels for mineral absorption (i.e., phytate:iron < 1, phytate:zinc < 18, phytate:calcium < 0.17). Desirable molar ratios for phytate:iron, phytate:zinc, and phytate:calcium were achieved for 25%, 70%, and 57%, respectively, of the complementary foods presented, often through enrichment with animal-source foods and/or fortification with minerals. Dephytinization, either in the household or commercially, can potentially enhance mineral absorption in high-phytate complementary foods, although probably not enough to overcome the shortfalls in iron, zinc, and calcium content of plant-based complementary foods used in low-income countries. Instead, to ensure the World Health Organization estimated needs for these minerals from plant-based complementary foods for breastfed infants are met, dephytinization must be combined with enrichment with animal-source foods and/or fortification with appropriate levels and forms of mineral fortificants.
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            Phytate, zinc, iron and calcium content of selected raw and prepared foods consumed in rural Sidama, Southern Ethiopia, and implications for bioavailability

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              The role of vitamins in the prevention and control of anaemia.

              While iron deficiency is regarded as the major cause of nutritional anaemia, changes in vitamins A, B12, C and E, folic acid and riboflavin status have also been linked to its development and control. This paper provides a systematic review of vitamin supplementation trials relating to the control of nutritional anaemia. A MEDLINE search was used to find reports of vitamin supplementation trials that reported changes in anaemia or iron status. Vitamin A can improve haematological indicators and enhance the efficacy of iron supplementation. Both folate and vitamin B12 can cure and prevent megaloblastic anaemia. Riboflavin enhances the haematological response to iron, and its deficiency may account for a significant proportion of anaemia in many populations. Vitamin C enhances the absorption of dietary iron, although population-based data showing its efficacy in reducing anaemia or iron deficiency are lacking. Vitamin E supplementation given to preterm infants has not reduced the severity of the anaemia of prematurity. Vitamin B6 effectively treats sideroblastic anaemia. Multivitamin supplementation may raise haemoglobin (Hb) concentration, but few studies have isolated the effect of multivitamins from iron on haematological status. In general, the public health impact of vitamin supplementation in controlling anaemia is not clear. Neither are the complex interactions involving multiple vitamins in haematopoiesis sufficiently understood to explain the observed variability in haematological responses to vitamins by age, population, vitamin mixture and dosages. Further research is needed to understand the roles of individual and combined vitamin deficiencies on anaemia to design appropriate micronutrient interventions to prevent anaemia.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                12 September 2017
                2017
                : 12
                : 9
                : e0184742
                Affiliations
                [1 ] School of Nutrition, Food Science and Technology, Hawassa University, Hawassa, Ethiopia
                [2 ] Department of Health Sciences, Central Washington University, Ellensburg, Washington, United States of America
                [3 ] Department of Nutritional Sciences, Oklahoma State University, Stillwater, Oklahoma, United States of America
                Institut de recherche pour le developpement, FRANCE
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Article
                PONE-D-16-26505
                10.1371/journal.pone.0184742
                5595314
                28898272
                3024ace9-23fc-42ee-bbb5-6143ba314a68
                © 2017 Gebreegziabher, Stoecker

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 1 July 2016
                : 30 August 2017
                Page count
                Figures: 0, Tables: 5, Pages: 13
                Funding
                Funded by: Hawassa University
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100009496, Oklahoma Agricultural Experiment Station;
                Award ID: W3002
                Award Recipient :
                This work was supported by Hawassa University, Hawassa Ethiopia and W3002 Multistate Project - Oklahoma Agricultural Experiment Station. The funders had no role in study design, data collections and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Hematology
                Anemia
                Iron Deficiency Anemia
                Medicine and Health Sciences
                Hematology
                Anemia
                Biology and Life Sciences
                Biochemistry
                Proteins
                Protein Complexes
                Ferritin
                Biology and Life Sciences
                Nutrition
                Nutritional Deficiencies
                Iron Deficiency
                Medicine and Health Sciences
                Nutrition
                Nutritional Deficiencies
                Iron Deficiency
                Biology and Life Sciences
                Physiology
                Physiological Processes
                Food Consumption
                Medicine and Health Sciences
                Physiology
                Physiological Processes
                Food Consumption
                Biology and Life Sciences
                Biochemistry
                Biomarkers
                Research and Analysis Methods
                Experimental Organism Systems
                Model Organisms
                Maize
                Research and Analysis Methods
                Model Organisms
                Maize
                Biology and Life Sciences
                Organisms
                Plants
                Grasses
                Maize
                Research and Analysis Methods
                Experimental Organism Systems
                Plant and Algal Models
                Maize
                Biology and Life Sciences
                Biochemistry
                Proteins
                Hemoglobin
                Custom metadata
                All relevant data are within the paper.

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